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children and neighbors, to that of entire strangers. It is certainly not too much to urge that great patience and forbearance on the part of relatives be used toward this class of persons, and that every available resource be tried before removal. This was done in the case of F. H., referred to above, and a man was placed in charge of him for several months prior to his coming to the Retreat; but he finally became so obstinate, and so much disposed to resist and strike every one who in any way opposed him, that his family became fearful lest he should actually do injury to those having the care of him. The course to be followed in such cases becomes evident.

Again, there are many cases in which the friends have not the requisite means to provide for necessary attention at home, however much they may desire to do so. Under such circumstances the well-being and interests of the other members of the family must be consulted as well as those of the individual, and no greater kindness or good for the greater number can be done than by a removal to a public institution. But whether at home or in an asylum, the principal desideratum is skillful management and care. Medicine may be of temporary use in allaying excitement, if it exists, as in other forms of insanity, but a sunny, warm room in winter, with a bath-room attached or near at hand, together with a simple, and abundant dietary, comprise the requisites for proper care.

Testamentary Capacity.-In one respect, senile insanity is the most important of any of the genera which we have to study; that is its relation to the disposition of estates. More wills, which have been executed after persons have exhibited indications of a diminution of mental capacity, have been contested for this reason than for any other. In some lay minds, any mental impairment means insanity, and when individual interests are at stake, it is remarkable how large, or how small, according as these interests may become affected, these early indications of impairment may become.

It is important in this connection to bear in mind the distinction already made evident between the normality of old age and the different forms of senile insanity. It will not be safe to assume that because one has become infirm in body, and has given indications of diminished vigor of mind, or because he has exhibited senile eccentricities, and is quite determined to have his own way in spite of the desires of his friends and family, has periods of more or less irritability, and has not as good ability in business transactions as when younger; nor, again, because he has become retrospective in his mental tendencies, and thinks that the former times were better than the present, repeats the incidents and stories of his experience in other days, while he forgets more recent ones, ---therefore he is incompetent to intelligently and properly dispose of his own property.

On the other hand, only when the mind has become so far impaired, that the person is unable to properly understand the relation he sustains toward his heirs at law, or is influenced in his feelings toward them, or others, by delusions, or unjust suspicions and insistent ideas; or when he becomes incapacitated to understand the immediate effects of his will upon the members of his family, or their respective claims upon him, or his own duties and responsibilities toward them; or, again, has been subject to undue or improper influences to such an extent as to will away his property from his legal heirs to others whose claims are not valid, or otherwise make wrong disposition of it, -will the Court be likely to decide that the person has not sufficient testamentary capacity.

LECTURE XVII.

CLIMACTERIC INSANITY.

Ætiology—The Epochs of Life-Relation to the Period of Involution-De

pendent Upon Physical Changes in the System-Diminution of Nerve Energy-- Indifference-Loss of Appetite-Absence of Good Feeling-Profound Change in the Female System-Change in the Channels of Mental Activities and Sympathies-Changes in the Processes of EliminationThe Cessation of the Catamenia-Heredity - Symptoms-Melancholia-Case 1-Conditions of Depression-Abnormal Sensations-Loss of Flesh -Recovery-Case 2- Mother Insane-Very Suicidal-ConvalescenceRecovery After Four Years— Delusions-Hallucinations—Physical Symptoms Present-Cases 3 and 4-Differentiated from Melancholia at After Periods of Life-Prognosis-Sixty Per Cent. of Cases in the Retreat Recover-Length of Time - Permanency of Recovery will Depend Largely upon the Antecedents of the Case— Treatment.

now

Ætiology.-Having studied

those insanities which are connected with the two great epochs of lifepubescence and senility—we next proceed to the study of that connected with another epoch of life, which is of scarcely less importance, viz., -the Climacteric. These three forms have been grouped together, because they alike arise in connection with the great physiological epochs of life; the genus now to be studied has been arranged as the final one, for the purpose of more clearly and definitely differentiating the main characters and symptoms of those already examined, and also for showing in what distinctive manner they resemble and differ from one another. One of these insanities has been shown to be connected with, and in some measure to arise from, the processes of physical and mental functions, and the other from those changes which occur in connection with the processes of involution, or decay. The one now under consideration is proximately caused by changes in physiological activities which occur only during that epoch which is termed the grand climacteric, and therefore differs in some degree, in its character and symptoms, from each of the other forms. While it is far removed from the period of evolution, and is in no degree connected with it, it does have a close relation to that of involution ; that is, it, so far as it depends upon predisposing causes aside from heredity, arises from those physiological changes which occur in a portion of the nervous system at the period which immediately precedes or coincides with the commencement of physical involution. It, therefore, becomes necessary for us to enquire in what those changes consist.

One of the more important, indeed, perhaps the most important of all, because the others arise indirectly from it, is the diminution of nerve energy in the system. Nearly or quite all persons pass through a period at some time between the ages of forty-five and sixty-five during which they are sensible of a decided change in their feelings, as well as in their bodily health. The condition is one attended not so much with indications of actual disease, though it may be so, as it is with a feeling of weariness, indifference, or malaise. Persons do not experience the same pleasure in the business pursuits of life which they formerly had. They are unable to endure physical or mental exertion as well as formerly; business cares annoy more easily, and change or periods of rest are more often required if they are able to have them, and especially desired whether they can have them or not. The appetite is not so keen, and food is not relished as before, and in consequence some diminution of weight in the body occurs; there is less strength and fullness of pulse, and the blood passes to the brain with less force, which doubtless accounts for the diminution of good feelings and a slight tendency to look upon the dark side, if there exists any such to look upon. The period during which an increase of either physical or mental activity takes place has long since passed, and now the period during which it has held its own and exercised its largest capacity in the sphere of its activity has also passed. It has arrived upon the border-land of descent, and can no longer pass through the same amount of exertion; or if it does, more marked and longer continued periods of exhaustion supervene, while a reaction comes more slowly. These and similar experiences occur to most persons between the ages of forty-five and sixty-five, especially those who have been engaged in such occupations and avocations as require an excessive expenditure of nerve energy. Not unfrequently these abnormal experiences and changes in the system pass over into something of more grave import, and the individual may have an attack of physical disease, a pneumonia, a fever, an attack of rheumatism, or a disease of the kidneys, some of the more general effects of which may remain for a long time after the more acute symptoms have passed away.

In the female, in addition to these changes in sensations and capacity for physical effort, the catamenia cease, and the tendencies as well as the capacity of the system to reproduce itself by conception and gestation and to nourish its offspring, which has for thirty or thirty-five years exercised so profound an influence, also ceases. The expenditure of nerve energy which hitherto has been

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