INSANITY 162 INSANITY of control by the will. A man sees a large plate glass window and he impul- sively hurls a stone through it. Another cannot resist the impulse to tear his clothes, a third cannot resist the impulse to set a haystack on fire. Uncontrollable impulse naturally goes with diminished volition in insanity. One of the most common and most painful symptoms of insanity is a change of natural affection toward relatives. This is not universal, but in nearly half the cases of insanity the affective condi- tion is thus perverted or reversed. The memory is not necessarily affected in in- sanity. In many patients it is exagger- ated; things come back Avith unnatural vividness. One of the chief bodily symptoms in insanity is sleeplessness. Almost every kind of insanity is sleeplessness in its early stages. Another is morbidness of speech; it may be incoherent or par- tially coherent; it may be over-rapid, slow, or entirely absent. Often the con- ventionalities of speech are lost or dropped in insanity. The articulation of words may be changed. Next in im- portance to speech is the expression of the face and eyes. This is given by the most delicate combined muscular and nervous apparatus that exists in nature, being in the most intimate connection with the mental part of the brain, and acting as its chief expositor and inter- preter. In the depressed and demented cases the eye loses its luster and bril- liancy; in maniacal cases it has abnormal feverish brilliancy; the pupil enlarging and the eye-lids being drawn too far apart pi'oduce staring, by exposing not only the cornea, but much of the sclerotic as well. Irregularity of the pupil is sug- gestive of organic brain distui'bance. The natural expression of the face is greatly changed, and little beauty of fea- ture survives during acute attacks. The conventional control over the outward expression of the emotions is lost, and the face accurately shows the state of the melancholic, the maniacal, or the de- mented patient. Clouston has thus classified the forms and varieties of insanity: Melancholia, comprising all states of depression, and having emotional depres- sion or mental pain and sense of ill-be- ing as its leading and dominant symp- tom. There may in addition be loss of self-control, insane delusions, which are usually suggested by the depression or impulses toward suicide, as well as in- capacity to follow ordinary avocations in melancholia. These distinguish it from sane melancholy. Suicide is the great '■ risk in such cases; four-fifths of melan- cholic cases being suicidal. The recov- eries from melancholia are the most com- plete of all forms of insanity. It would seem to be caused by a more entirely functional and dynamical brain disturb- ance than any other form of insanity that may leave no trace whatever behind it after recovery. Mania, comprising all states of mental exaltation, such as joyousness and rage, and commonly accompanied by muscular excitement, restlessness, sleeplessness, the speech tending to become incoherent, the conduct violent or uncontrolled. The symptoms range from a joyous elevation with talkativeness and merely want of common sense and foolish conduct up to complete incoherence, delirium, and rav- ing madness, or "acute mania." Folie ciiculaire, or states of regular alterna- tion between melancholia and mania, forms a small but distinct variety of in- sanity. Monomania, or delusional insanity, is that form where insane delusions are the chief signs of the mental aberration. In such cases the intellect is chiefly affected rather than the affective nature. The delusions are morbid in a particular di- rection, the chief forms being monomania of grandeur or pride, of unseen agencies, and of unfounded suspicions. Electric- ity, mesmerism, telephones, gases, noises made by imaginary persecutors are the common subjects of the second form; while utterly perverse interpretations of the conduct of friends or strangers is the common form of the latter. The two together are sometimes classed as mono- mania of persecution. Hallucinations of the senses — i. e., imaginary sights, sounds, smells, and tastes — -are very com- mon in this form of insanity. It is not very curable when the delusions get fixed. Dementia, or conditions of general mental enfeeblement, is the state of mind where the memory is impaired, the rea- soning weakened, the feelings diminished, the will especially lacking, the attention and curiosity far below normal, these changes having occurred in a person who had at one time been normally consti- tuted. It is in fact silliness, want of mental force, imbecility not congenital, but acquired. Stupor, embraces those cases where there is mental torpor, in which impres- sions on the senses produce no effect, the patient neither speaking nor taking no- tice of anything, and having no volition except to resist, but being able to stand, walk, and to eat. Trance and catalepsy are forms of stupor, the heart's action is low and the body is cold, and the muscles are flabby. Stupor commonly occurs in
