Plain talk about insanity : its causes, forms, symptoms, and the treatment of mental diseases. With remarks on hospitals and asylums, and the medico-legal aspect of insanity / By T. W. Fisher.

  • Fisher, T. W. (Theodore Willis), 1837-
Date:
1872
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Licence: Public Domain Mark

Credit: Plain talk about insanity : its causes, forms, symptoms, and the treatment of mental diseases. With remarks on hospitals and asylums, and the medico-legal aspect of insanity / By T. W. Fisher. 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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    SYMPTOMS OF INSANITY. DR. SKAE'S classification of the forms of insanity given in my last paper, and based on special physical conditions, is by no means in general use. Most of these conditions are recognized, and many of the terms are employed, but mental disorder being the striking feature of each case, while its cause is often mere matter of conjecture, it must continue to form a basis of classification. In a large class of cases, insanity is purely idiopathic; we can assign no cause outside the brain. In these, the mental symptoms differ-; not only in the degree of underlying constitutional vigor or debility (sthenic and asthenic), but in various other ways, tolerably distinct and well recognized. Sympathetic insanity, too, always presup- poses disease of the superficial gray matter, secondary, it is true, to some distant source of irritation, but presenting similar phases of mental disturbance. To illustrate the principal modes of diseased mental action, let us take, or rather make, a few typical cases. A man thirty years old, whose maternal uncle was insane, whose father is intemperate, and his mother consumptive, for instance, inherits, in consequence, a sus- ceptible cerebral organization. He is in active business, and over- working himself. His wife dies after a few weeks' sickness, leaving him worn with watching and anxiety, and overwhelmed with grief. Here are all the elements for the development of insanity, viz., her- edity, over-work, loss of sleep, and the shock of intense grief. Take away either, and the crisis might pass safely; as it is the mind gives way. What is to determine whether this man shall become maniacal, melancholic, or demented? To the best of my knowledge and belief, it is a question of temperament and original mental constitu- tion, influenced, perhaps, by the comparative suddenness and sever- ity of the exciting causes. I think acute mania would oftenest occur in a person of excitable, sanguine temperament, in whose brain the normal rate of nervous action was rapid; while in a person of slower mould, with a constitutional tendency to depression, melancholia might arise. Dementia, as a primary affection, is more rare, but sometimes follows a sudden shock, or a fever, in a naturally weak brain. These hints are not to be taken as sure guides to the prediction of the special form of mental disease to be expected, as exceptions are very numerous, and it would hardly do to elevate them into rules. If mania is to occur, it may develop rapidly. The man who slept little before his wife's death, now sleeps none at all. He moves about silent and abstracted, or bustles about with over-officiousness, or goes calmly on the business of the day, according to his habits of self-control, but he does not sleep. His brain is congested, or the circulation is too rapid, and the physiological condition of sleep, which requires a diminution of blood, is an impossibility. Another question occurs: What is to determine whether the