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hope. They are the ones for whom the selectmen and taxpayers of towns and cities never cease, day nor night, to offer prayers, that they may become translated, and clothed upon with glorified bodies.
While the prognosis in secondary delusional insanity and dementia is also unfavorable, yet the prospect is not so profoundly dark and hopeless. Some occasionally recover, and many improve. They retain some degree of mental capacity, which varies greatly in different cases, and a considerable per cent, may, in time, become capable again of accomplishing some kind of simple work, and also of a greater or less degree of enjoyment.
Treatment.-In view of the unfavorable prognosis of dementia it may be regarded as unnecessary to occupy attention in considering the subject of treatment. This, however, would be a mistake. Dementia comprises those classes of the insane which constitue one of the great problems of psychiatry at the present time. The manner in which they shall be cared for, the methods to be adopted for their supervision and humane management, certainly forms one of the most serious questions with which modern society has to deal. One point has been pretty definitely settled in regard to them, and that is that they shall be regarded as wards of the State unless they have sufficient property for their comfortable support. Not many years ago it was considered as feasible to care for them all in large asylums which would serve alike for the acute and chronic insane. But as the number increases and the hopelessness of recoveries from among the ever-increasing numbers of them becomes more apparent, the question of economy thrusts itself into the field, and the inquiry is made whether they may not be properly and humanely cared for in some less expensive manner, and also be made to contribute
toward their own support. In former times they were left to roam from place to place, and subsisted on such scanty supplies as they could gather from those who were disposed to feed the hungry. The conditions of civilization have now changed and society is beginning to realize in some measure its duty to interest itself in, and care for, these helpless ones who can no longer care for themselves.
Two methods of accomplishing this have been advocated, and to some extent adopted. The first consists in providing homes for them, or for some classes of them, among the rural population of the State, where they may become members of the families in which they live, and also, to some extent, be employed in such work as they are capable of doing. They are to be under the general supervision of a Board of Lunacy Commissioners, who shall visit them from time to time, and may also be under the professional care of some country physician. It is thought that such a disposition of them would be preferable to life in a public institution, which necessitates a considerable restriction of personal liberty. The objections to this plan consist mainly in the impossibility of any efficient system of supervision, and the consequent liability to abuse and ill-treat ment.
The other plan is to place them in public institutions especially adapted to the care and use of such patients, and where they would be under the special observation of a physician and attendants educated for the purpose.
The liability of abuse or unkind treatment would be reduced to a minimum by this method. They could be employed in some kind of labor, according to the judgment of the physician. They can always be sure of an abundance of properly prepared food, occasional means of amusement, and some degree of education in some form. This plan also secures the possibility of ministering to disordered minds in all known methods, for the purpose of restoration or improvement; and if recoveries are ever to occur among this class, they must come mainly through agencies devised for re-educating the brain in the line of former duties and activities,
Two Epochs of Life-Adolescence and Senility—Ætiology-Heredity-Char
acteristics of Pubescence and Adolescence- Motor Activity – Evolution of Sexual Functions—Development of Brain Capacity– Reasons Why there Occur so Few Cases of Insanity at these Periods of Life-Causes Ordinarily Potent Not Operative — Physiological Reasons · Heredity Comes into Forceful Activity Later in Life in Most Forms of DiseaseSymptoms-Exaltation or Depression, Both in a Modified Form-Little of Maniacal Excitement or of Mental Pain-Both of Short Duration, and Succeeded by a State of Hebetude or Apathy-Case Illustrating Tendency to Recurrence.
Adolescent insanity is that form of mental disorder which is connected more especially with the period of development, and is in this respect the antithesis of that connected with old age. The one occurs in connection with the evolution of both physical and mental capacities; the other with the period of involution.
Mental processes are more or less affected by even the daily modifications which occur in the brain, and more especially are they influenced by the more profound ones which occur at the two great epochs of life. These epochs, therefore, become more or less critical in the history of every individual. In old age the process of organization no longer keeps pace with that of involution, in consequence of a diminution of the vital energy of the system; but in the period of youth the ratio of progress in these 2.4
processes is reversed-evolution and organization more than keep pace with that of involution, and the system increases both physically and mentally. In all cases of normally organized and healthy persons these processes proceed in harmony the one with the other, and the system is developed in accordance with the law of its being; but if from any cause or causes the consonance of this mutual growth is disturbed, there result manifestations of derangement in all degrees, sometimes in the mental, and at others in the physical system, and not infrequently in both. Illustrations of the grosser forms of all these are observed in cases of scrofulous or tubercular disease occurring in childhood and youth, and in the different degrees of imbecility and idiocy. And when we consider the number of factors which enter into and influence this development of the system, how delicate is the adjustment and play of these upon one another, and upon the whole force of the system itself, it is by no means remarkable that these dependencies sometimes become deranged, thus producing disorder. Indeed, it is remarkable that they no oftener become so, especially during the pubescent period, when all the elements of the structure are in so unstable and changeful conditions; and were it not for the force of healthful inheritance and surrounding influences it would be far otherwise.
Ætiology.-On this point it may be stated that heredity is a more important factor and apparently exercises a more direct influence in the production of this form of insanity, than any other. Indeed, so generally is it developed in connection with or from this influence, that Dr. Clouston writes that he has never known a case in his large experience, in the history of which there could not be traced a hereditary taint or neurosis. The degree in which this