INSANITY 163 INSANITY young people of both sexes, and is very- curable, 50 per cent, recovering. Impulsive insanity, or states of de- fective control, is the most interesting of all the divisions of the mental classi- fications, inasmuch as will is the highest of all the mental faculties, and volitional disturbances have a close relationship to morals, law, social life, and conduct. The childi'en of insane or drunken par- ents are lacking in the normal power of control, and in their perception of the sense of right and wrong, their conduct being apt to be impulsive and not guided by reasonable motives. All forms of in- sanity are more or less distinguished by lessened control, but there are persons without general depression or excitement, insane delusions, or enfeeblenient of mind, who will suddenly smash furni- ture, tear clothing, steal, set things on fire, obey gross animal impulses, or kill themselves or others. The function of mental inhibition residing in the highest regions of the brain, controls mental ac- tion in other portions of the brain con- volutions. In this form of insanity it is supposed that the inhibitory controlling portions or "centers of mental inhibition" have lost their power. Clinical Varieties. — Chief among these types of insanity is general paralysis, a specific disease of those portions of the brain that subserve mind and motion. It is always incurable, getting progres- sively worse, gTadually impairing and at length destroying speech, motion, mind, and, usually in about three years' time, life itself. In this form of insanity pa- tients commonly have extravagant delu- sions of wealth and power. Paralytic insanity is that connected with apoplex- ies, softenings and tumors of the brain, which cause ordinary paralysis first, and one form of dementia afterward. Epi- leptic insanity may accompany epilepsy. It is often attended by great violence and irritability, and by danger to those around the patient. Many murders are committed by insane epileptics. Syphi- litic insanity is the result of brain poi- soning by this terrible scourge of hu- manity. Alcoholic insanity is a very frequent form. It may be very short in duration or very long continued, or in- curable. Rheumatic and gouty insani- ties are very rare. Phthisical insanity, or that connected with consumption, is a very interesting variety. The patients are suspicious and unsocial, and often have no cough or spit or outward sign of consumption, which may not be discovered till the chest is examined. In some cases it is curable. There are various forms of in- sanity connected with derangement of the reproductive functions. Uterine, amenorrhoeal, ovarian, hysterical, and masturbational insanities; while preg- nancy, childbirth, and nursing are the causes of the insanity of pregnancy, pu- erperal insanity, and lactational insan- ity. These form 10 per cent, of mental disease in the female sex. They are the most curable of all forms, recovering in over 80 per cent, of the cases. Puer- peral insanity occurs commonly within a fortnight of childbirth, and is the most acute and one of the most dangerous to life of all insanities, while the most cur- able, and is attended by the highest temperatures, sometimes reaching lOS"". The diff"erent periods of life have each their own form of insanity. Pubescent and adolescent insanity is always heredi- tary, commonly acute and maniacal, usually has remissions and exacerbations and recovers in over 60 per cent, of the cases, those not recovering commonly passing into the most typical form of secondary dementia. It is one of nu- merous diseases to which the period of development is subject. Climacteric in- sanity occurs at the period of the meno- pause or the "change of life." It is usually melancholic in character and re- covers in 53 per cent, of the cases under proper treatment and conditions of life. Senile insanity is typically seen in the senile dementia of extreme old age, when the memory and all the faculties have faded away. A number of rarer and less important clinical varieties of insanity have been described. Traumatic insanity, from in- juries to the head; anaemic insanity, from thinness of blood; diabetic insanity; in- sanity from Bright's disease ; post-feljrile insanity, following all kinds of fevers, especially scarlatina; the insanity of lead-poisoning; and myxcedematous in- sanity. Causes of Insanity. — Hereditary tend- ency is the chief predisposing cause of insanity. All sorts of disturbing influ- ences to the brain bring out this predis- position into actual disease. No doubt 70 per cent, of all cases have an insane or neurotic heredity. Epilepsy, drunk- enness, all nervous diseases, consumption, too exciting or depressing or exhausting employment, or unfavorable conditions of life in ancestry may cause insanity in the offspring. Marriage of near rela- tives causes it if the stock is bad; not if it is good. The physical causes of in- sanity affecting the body, such as alco- hol in excess, produce insanity in four times the proportion which mental and moral causes, such as affliction, losses, love-affairs, and religious excitement, do. Nature of Insanity. — No one now
