A practical manual of mental medicine / by E. Régis ; with a preface by M. Benjamin Ball ; authorised translation by H.M. Bannister.

Date:
1895
    fever, characterized by disorders of the sensibility, of the inteiligeiice, and of tlie will." This definition, considered as the best of all those so far offered, an<] they are numerous, is ne\ ertlieless very imperfect, inasmuch as it may l)e applied in- differently to all clu-onic cei'ebral affections in which there is any psychic disorder, and in that it does not especially include the distinction we have noted between mental alienation and insanity. In order to be more precise and yet without pre- tendinu,- to u'ive an accurate dehnition of insanitv, wjiich is in the present state of oui- knowledge almost an imjtossibility, we may say that iusaiiity is <( !ijje<dal (Useai<e, i.s a form of allenatiou churacterizi'd by the orcidt'/ital, v'/icoNi^rioiff!, (on/ mon nr l<-ss pcr- iii finerit distarhunce of tIlk reaxon. Synonym v. Tkkminology.—Mental alienation has as synonyms, mental diseases ovphrcuDpntliio^; insanity, psyrhosl.^ or jisi/r/iojKifJn/; mental medi- cine, pHyi-liliitry or freniairy. As to the words dementia, monomania, hallucina- tion, delusion, which are often improp(!i-h- used by the public as synonyms of insanity, they ha\ e each a particular and very dirt'erent signitication. 'i'lius dementia is a form of alienation, and it can scai'cely be made the ecpiivalent of insanity anywhere exce)it in judicial language wliere tliis usage has ])revailed. The same is the case with monomania or systematized insanity, which is only a special form of insanitv, and should not therefore be confounded with it.
    Finally, as to delusion and hallucination, they are merely the names of two primary or symptomatic elements of insanity. There remains' a term, habitually misapplied, whose signification as established in scientific lan- guage it is important to state correctly: it is the term vesania. We give the name vesania to the pure insanities in order to distinguish them from those connected with other morbid conditions, into which they enter only as symptoms or complications. For example, the insanity of persecution is a type of vesania, as it is idiopathic and forms by itself alone the existing morbid condition; paralytic insanity, or the insanity that so frequently accompanies general paralysis, on tlie other hand, is not a vesania since it is connected with a cerebral disease, an organic affection of the nervous centimes. It is need- less to add that the insane termed vesanics are in consequence those affected with pure insanity or vesania. II. ETIOLOGY. One of the most important parts of the study of mental alienation is that of its etiologj'^, and this is what many authors, notably Morel, liave made the basis of their classification. The same as with most diseases, there are, for mental alienation, predisposing and occasional causes. The more important of these have been
    brought together by optical table : Predi.sposiiiK causes. General. Individual. Moral. Occasional causes. Physical. ■ Marce in the following syn- Civilization. Keliffious ideas. Political events. Heredity. Ape. Sex. Climate. Civil condition. Profession: Education. Emotions, passions, ohaffrin. Imitation. Cellular imprisonment. A<!tin)^ directly on tlie brain. Acting at a distance and sympathetically. Aii<'emia,cachcxia, sem- inal losses, onanism. Diathesis, darlreii, rheu- matism, typhoid and intermittent fevers. Menstruation, pregnan- cy, confinement, lac- tation. Intoxications: lead, mercury, opium, bel- ladonna, iioisonous folcmacide haschich. Local causes. Cteneral causes. Physiolog- ical causes. Specific causes. A word on each of these causes in particular. Predisposinc! Causes. Civilization. Race.—It is generally recognized that civilization, by the needs it creates, the habits of luxury and pleasure it excites, and linally by the struggle for existence that it necessitates, favors the development of mental alienation. Nevertheless, it is impossible to say with certainty whether the number of the insane actually increases progressively, and, if so, in what proportion. The census figures have shown how it has been in France: in 1835 there Ment. Med.—3.
    were 16,538 insane or 4.96 to each 10,000 inhab- itants; in 1841, 18,367 or 5.37 to each 10,000; 1861, 46,357 or 12.95; in 1866, 90,709 or 23.82; in 1876, 83,012 or 22.50 to the 10,000. Judging only from these results it would appear that the number of the insane among us has quintupled dur- ing the past thirty-five years, but there is in this evidently an exaggeration due to the greater accuracy of the recent censuses. If we take the insane, not as enumerated in the census, but the number admit- ted to the hospitals, we find that the increase of ad- missions which was annually 12.5 per cent, forty years ago, is to-day only 1.70 percent. The num- ber of admissions has therefore a tendency to be- come stationary. This proves, as Lunier states, that the increase in the number of the insane, admitting that it exists, is, in any event, less con- siderable than is generally believed. Another interesting series of statistics is that of the insane of the Department of the Seine from 1801 to 1883. It is seen from these figures, that there Avere on January 1, 1801, 945 insane maintained at public expense, while on the 31st of December, 1883, the number was 8,907, or more than six times greater, while in the same space of time the general population of Paris has hardly more than tri])led itself, having been 600,000 at the beginning of the century and 2,237,928 by the census of 1881. The statistics^of other countries seem likewise to afford contradictory results.
    There is, nevertheless, an interesting fact to be noted rehxtive to the progress of insanity in the black race. Solbrig had already observed that in America the free negroes of tlie Northern States had l)roj)ortioiially, as it ai)[)eared, live times as much insanity among tlu-m as existed among their colored brethren of the South. According to the more re- cent researches of Buchanan, the development of insanity has increased rapidly in the colored race since emaiicii)ation. In 1850 there were enumerated Bl 8 insane amongst the black population of the United States, in 18G0 their number was 7GG, or one Foi' every 5,790. In 1870 there were 2,695 colored lunatics; in 1880 the proportion was 1 to 1,096, so that, admitting a regular increase, this proportion, says the author, will rise to 1 to 500 in 1890, thus ccpialing the frc- (piency of mental alienation among the Americans of the white race. If it is imj)ossibIe, according to these data, to establish in any positive manner the influence of civilization upon the frequency of insanity, its influence on the type of alienation, on the other hand, is much more certain. We may say, in- deed, that the pure insanities, or vesanias, have existed from all time and probably with- out increasing to any considerable extent. An)ong them the generalized insanities, mania and melancholia, have continued absolutely identical with their type in ancient times, as anyone may con-