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- In Many Cases a Transformation from a State of Depression to one
of Confidence and Partial Excitement Occurs—Persons Become the
Owners of Vast Estates-Kings, Queens, Illustrative Cases—Peculiar
Writing, with Translation-Cases in which the Delusions have been from
the First of an Exalted Nature-Case- Prognosis—Recovery Sometimes
Occurs in Acute Cases-Remissions of Considerable Duration–Treatment.
LECTURE XII.-FOLIE CIRCULAIRE.
Cases of Folie Circulaire Not Numerous—Impossibility of Deciding Before.
hand whether a Case of Mania will Eventuate in Folie CirculaireTwo
Stages of the Disease - Etiology-Heredity-Climatic Influences-
More Frequent in France than in England-Symptoms – Those of
Mania-Mental and Physical Faculties Become Excited – Period during
which the Patient is Relieved-He Passes into the Stage of Depression-
During the Excited Period Confusion of Ideas Rarely Exists—The
Meniory Good-A Moral Defect Present-Dress and General Ap-
pearance-Craving for Stimulants-Painful Emotions-Forebodings-
Desire to Remain Indoors and Frequently in Bed— The Length of a
Full Period of Excitement and Depression-Case-Patients May at
Times Exhibit Very Little Mental Impairment-Importance of Recog-
nizing the Character of the Disease-Case-Prognosis-Recoveries.
Dementia and Idiocy– Distinction-Definition of Dementia— Importance of
Averting an Issue of Dementia in Cases of Mania-It Rarely Occurs as a
Sequel of Delusional In-anity-Symptoms—The Degree of Dementia
Varies Very Much in Different Cases - Prevalence Among Chronic Cases-
Periods of Excitement— The Transition to a State of Dementia is Generally
Gradual – Third Class of Dements-Symptoms—Delusions-Sequential to
Attacks of Mania and Melancholia – Three Forms of Dementia-Ten-
dency to Merge into Each Other-Lines of Clinical Distinction Cannot
be Definitely Drawn—Cases i and 2—Prognosis in Primary Dementia-
In Secondary Delusional Insanity – Treatment - Importance of State Pro-
vision for Proper Care--Two Methods-Boarding Out of Such Patients
Among Farmers- Public Institutions—Advantages of the Latter Method.
LECTURE XIV.-ADOLESCENT INSANITY.
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 Disease-
Symptoms—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 Ten-
dency to Recurrence,
LECTURE XV.-ADOLESCENT INSANITY. (CONCLUDED.)
Case 2—As Age Advances the Tendency to a More Protracted Period
Excitement Increases—The Catamenia—Cases 3 and 4—Absence of
Acute, Prolonged Excitement or Great Depression, also of Fixed De-
lusions and Hallucinations-Condition one of Partial Dementia-Cases
Occurring at a More Advanced Age-Symptoms More Pronounced-
In Females Absence or Irregularity of the Catamenia— Probability of
Relapses—Importance of Avoiding a Too Early Removal from Asylum
Life-Danger of Masturbation -- Treatment — Importance of Restraints
and Regularity of Lise-Medication- Educational Influences-Occupa-
LECTURE XVI.-SENILE INSANITY.
Old Age--Characteristics of Evolution No Longer Keeps Pace with Involu-
tion-Ætiology-Physiological and Pathological Changes in Brain and
Nervous System-Diminution of Functional Activity-Vascular Changes
-Nerve-cells—Mental Symptoms—Impairment of Perception-Excite-
ment-Loss of Memory-Illusions—Depression - Physical Symptoms-
Three Varieties-Senile Dementia-Senile Mania-Senile Melancholia-
Cases Illustrative-Suicidal Tendencies— Treatment-Should Such Cases
be Removed to an Asylum ?—Testamentary Capacity, · · · PP. 302–321
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-Pro-
found Change in the Female System-Change in the Channels of Mental
Activities and Sympathies—Changes in the Processes of Elimination-
The Cessation of the Catamenia-Heredity-Symptoms-Melancholia--
Case 1-Conditions of Depression-Abnormal Sensations--Loss of Flesh
-Recovery-Case 2–Mother Insane-Very Suicidal-Convalescence-
Recovery After Four Years-Delusions—Hallucinations—Physical Symp.
toms Present-Cases 3 and 4-Differentiated from Melancholia at After
Periods of Lise-Prognosis—Sixty Per Cent. of Cases in the Retreat Re-
cover-Length of Time – Permanency of Recovery will Depend Largely
upon the Antecedents of the Case— Treatment, .
LECTURE XVIII.INSANITY OF THE PUERPERAL
INSANITY OF PREGNANCY.
Importance of —Insanity of Pregnancy—Ætiology-Intimate Relation between
the Brain, the Stomach, and Sexual Organs—Craving for Particular Anti-
cles of Food while in the Pregnant State-Heredity—Tables of Cases
in the Connecticut Hospital and the Retreat -- First Pregnancies--Symp-
toms—Puerperal Insanity Proper— More Frequent in First Labors
between Thirty and Forty Years of Age-Frequency of in Scotland
Character of Blood in Puerperal Insanity-Symptoms, Primary and
Secondary-Hallucinations-Homicidal and Suicidal Tendencies-Con-
valescence-Age--Table of Thirty-nine Cases in Reference to Recoveries,
Ages, and Time under Treatment-Cases, . .
LECTURE XIX.-INSANITY OF THE PUERPERAL PERIOD.
Treatment of Puerperal Insanity, Local and General-Insanity of Lactation-
Ætiology-Period of Lactation—Influence of Prolonged Lactation-
Modes of Living-Accidents and Complications at Time of Labor-
Effects Upon the Blood and Nervous System-Symptoms—Suspicion-
Depression- Morbid Impulses—Sexual Excitement-Hallucinations-
Physical Condition--Tables of Cases at the Retreat and the Connecticut
Hospital - Illustrative Case-Prognosis Generally Favorable-Of Fifty-
four Cases, Thirty-nine Recovered— Treatment,
LECTURE XX.--INSANITY OF MASTURBATION.
Ætiology-Effects of Sexual Derangement upon the Mind—Anxiety-Seminal
Emissions—Neurotic and Sanguine Temperaments-Heredity-In Cases
of Adolescent Insanity Masturbation is often a Consequence Rather than
a Cause-Symptoms--Debility— The Circulation-Appetite-Seclusion-
Depression-Irritability-Cases-Diagnosis-Religiosity-Dislike of the
Opposite Sex-Tendency to Seek Isolation-Short Periods of Self-
importance-Prognosis— Treatment--Importance of Labor in the Open
LECTURE XXI.- EPILEPTIC INSANITY.
Epilepsy and Insanity-Characteristics of Epileptics— Tendencies to Mental
Derangement-Responsibility of Epileptics—Epileptic Neurosis-Charac-
teristics of-Symptoms of Epilepsy– The Aura Epileptiia-Phenomena
Attending Il-Hallucination of Any of the Special Organs of Sense-A
Case-Swedenborg–The Aura May Affect both Sight and learing -
A Case—“ Petit Mal”-Symptoms of-Age—“ Grand Mal”—Symptoms
of--Derangement of Mind—“ Epileptic Fury," .
LECTURE XXII.-EPILEPTIC INSANITY. (CONCLUDED.)
Tendency Toward Dementia—Loss of Memory and Judgment-Case of
Napoleon--Religious Emotions in Epileptics—Amorous Propensities-
Religious Excitement-Dancing Mania-Acts of Great Violence May or
May not be Connected with Convulsions - Two Cases-Homicidal Vio.
lence--Cases- Prognosis— Pathology-Treatment,
· PP. 407-420
LECTURE XXIII.-ALCOHOLIC INSANITY.
Physiological Effects of Alcohol — Modification of-Per Cent. of Alcoholic
Insanity-Statistics-- Acute Alcoholic Insanity-Symptoms-Illusions-
Hallucinations — Attention - Temperature — Termination-Examples-
Treatment - Chronic Alcoholic Insanity – Symptoms—Irritability-In-
somnia-Loss of Memory-Paresis of Muscular System-Suspicion-
Hallucinations-Cramps— Hyperästhesia-Gastritis-Epileptiform Seiz-
ures—Delusions-Examples—Pathological Anatomy, · · Pp. 421-438
LECTURE XXIV.-ALCOHOLIC INSANITY. (CONCLUDED.)
Alcoholic Paresis— Diagnosis of_Character of Mental and Physical Symptoms
Contrasted -- Peripheral Neuritis-Hyperæsthesia — Treatment, Morphin-
ism—" The Opium Habit”—Increase of — Mode of Invasion-Dose-
Idiosyncrasies—Hypodermic Use of Morphine-Symptoms--Feelings of
Exaltation Followed by Those of Depression-Increase of Dose Neces-
sary-Loss of Memory and Moral Tone- Ellects Upon Nerve Cells and
the Sensory System of Nerves-Prognosis— Treatment, .
LECTURE XXV.-GENERAL PARESIS.
Synonyms — Importance-Definition- Ætiology-Sex-Age-Heredity-So.
cial Position-Locality-Statistics : 1. In New England Institutions; 2.
New York Institutions, Michigan Institutions--Comparison of the Different
Sections, Different Nationalities, and Races-Sexual Indulgence- Table
of Causes from Reports of the Commissioners of Lunacy in England -
Syphilis— Intemperance in the Use of Alcohol-Acquired or Inherited
Tendency-Symptoms : 1. During the Initial Period— May be Those of
Elation or Depression--Peculiarities of Mental and Physical Symptoms
in Both These States—Duration of Initial Period, .
LECTURE XXVI.-GENERAL PARESIS. (CONTINUED).
Symptoms Become More Pronounced in Character—Increase of Irritability and
Excitability – Egotism-Self-confidence – Extravagance of Projects-
Sexual Excitement-Change in Moral Character-Failure in Memory-
Mental Obtuseness-Insomnia - Depression not Unfrequently Present
- Physical Symptoms – Vertigo - Incoördination of Gait—Tongue-
Articulation-Spinal Symptoms—Disturbances of Circulation-Importance
of Recognizing Early Symptoms-Symptoms of Pronounced Period
-Excitement-Impairment of Judgment-Dementia—Memory-Atten-
tion-Inability to Combine Concepts-Delusions of Great Wealth and
LECTURE XXVII.-GENERAL PARESIS. (CONTINUED.)
Depression - Much Less Common During the Pronounced Period than Exalta-
tion and Elation-Melancholic Symptoms May be Present—Periods of
· Excitement- Illustration--In Some Cases Neither Excitement nor Depres-
sion Exist-States of Elation May become Changed by Suggestions-Ex-
travagance of Delusions—Physical Symptoms of the Pronounced Period-
Tongue— Lips-Muscles of the Face—Handwriting--Epileptiform Seiz-
ures_Corpulence-Gait-Eye Symptoms--Period of Boasting - Increase
of Dementia--Paralysis-Sphincters--Convulsive Seizures-Bed-sores--
LECTURE XXVIII.--GENERAL PARESIS. (CONCLUDED.)
Remissions—Duration of—Relapses—A Case—Duration of Disease; Average
from three to four years-Diagnosis-Characteristic Symptoms--Im-
portance of Physical Symptoms in Determining Doubtful Cases—These
May Precede or Follow Mental Symptoms— Maniacal State of Alcoholism