Insanity : its classification, diagnosis, and treatment : a manual for students and practitioners of medicine / by E.C. Spitzka.

  • Spitzka, E. C. (Edward Charles), 1852-1914.
Date:
1889, ©1887
Catalogue details

Licence: Public Domain Mark

Credit: Insanity : its classification, diagnosis, and treatment : a manual for students and practitioners of medicine / by E.C. Spitzka. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    tion are necessary additional elements in periodical insanity. Inasmuch as these latter features determine the grave prognosis of periodical insanity, they are of greater prac- tical import, as they are certainly of higher significance, from an abstract pathological point of view, than the symptomatic direction in which the disorder manifests itself. Consequently the neurotic predisposition and peri- odical recurrence of the malady must as criteria determin- ing classification rank higher than the symptoms per se. It may also be urged that heredity and the neurotic constitution, while they do not play as important a part in the simple as in the constitutional forms of insanity, yet they occasionally and in some forms, as in melancholia, quite frequently accompany the simple forms. But it is exceedingly rare for the patients suffering from a simple insanity to exhibit a.continuous neurotic condition, and where they do manifest it, then simple insanity attacks them, as an acute disease may attack a previously healthy individ- ual and evenly with one suffering from chronic disease or a constitutional vice but without any tangible connection with such chronic disorder or constitutional vice. An individual may inherit syphilis and become attacked by an acute pneumonia, but we do not speak of such a pneumonia as a syphilitic pneumonia; or another may have the tuberculous predisposition and die with a surgical affection, and while —this is said merely for the sake of offering an analogy —the statistics might show that more tuberculous subjects die of surgical affections of a given kind than non-tuber- culous subjects, yet until a more intimate relation could be shown between the vitiated constitution and the local disease, we would hesitate to speak of surgical affections in these cases as of the tuberculous variety. It is the same with insanity: certain varieties like monomania and imbecility are almost invariably associated with an ac- quired or transmitted neurotic vice, and on comparing a large number of cases exhibiting these forms of derange- ment it is found that there is on the whole a sameness in the origin and nature of the symptoms. On the other hand, simple mania, stuporous insanity, and other of the simple forms are not as a rule associated with such taint, may attack persons previously healthy and free from hereditary taint, and are noted for an absence of those characters found with the constitutional forms. Syphilis and the tuberculous diathesis are undoubtedly transmitted,