SOME DIAGNOSTIC POINTS OF MENTAL DISEASES

AND WHY THE COMMITMENT PROCEEDINGS

OF THE INSANE OF GEORGIA SHOULD

BE ENTIRELY REVISED.

J. Cheston King, M.D., Atlanta, Ga.

Before bringing out any of the cardinal points of my subject, I wish to impress upon this medical body that mental disease is the result of disease of the brain, and is not a mere immaterial disorder of the intellect the brain is an organ through which mental phenomena is manifested, and therefore, it is impossible to conceive of an insane mind in a healthy brain.

Twenty-three centuries ago the learned physicians of Greece and Rome had emancipated themselves by scientific induction from brutal superstitions, and they clearly and boldly taught that insanity was brain disease with prominent psychical symptoms ;that there are mental and bodily causes; that medical and diatetic means of cure should be employed

It was Hypocrates, 460 B. C., who propounded certain truths which formed the basis of the science of psychiatry. He demonstrated that the brain was the organ of the mind, and that it was subject to physical laws and diseases like other organs, and that insanity followed abnormal conditions of the brain.

Before this time the civil and social status of the insane and their treatment were determined by religious and superstitious hypotheses; they were regarded as afflicted by the gods or possessed by demons. Do you know that even to this day and time, there is among the laity some remnants of the middle ages. They absolutely act

towards and speak of the mentally unbalanced with hushed breath and mortification.

But the middle ages at last gave way to the philosophic phase of medical science of the seventeenth and eighteenth century after the appearance of Kepler and Gallileo, after Descartes had founded modern philosophy, after Bacon had aroused the thinking world by his inductive method in the study of nature, and after Harvey had published his researches on the circulation of the blood.

It was in the eighteenth century through the labors of Jacobi, Vering, and Fredrich, all of Germany, that there was a systematic study of the Somatic symptoms and to the doctrine that physical disease was the cause of insanity.

The Somatic School established a belief in the sure of insanity, a point of great importance with reference to the general amelioration of the condition of the insane, who had ordinarily been dealt with as beyond hope of

cure.

So from these rapid advances of the human mind, we can but truly feel as the author, who said: "That knowledge is not a couch whereon to rest a searching and restless spirit, or a terrace for a wandering and variable mind to walk up and down, with a fair prospect, or a tower of the state for a proud mind to raise itself upon, or a fort, or commanding ground for strife and contention, or a shop for profit and sale; but a rich storehouse for the glory of the Creator and the relief of man's estate."

Before giving out some diagnostic points of mental diseases, a classification is necessary. Each part of the brain has its special functions, and to a certain extent is independent of each other.

One part is essential to vital processes, hence its destruction causes death; another part presides over the various movements of the body, hence paralysis of motion is the result of destruction of any portion of this area;

a third part enables the mind to appreciate touch, temperature and pain; a fourth presides over sight; and in the same way smell, hearing, and taste are governed by distinct portions of the brain.

In our contact with mental diseases, four leading classes stand out prominently before us: viz.: Amentia, Dementia, Mania, and Melancholia.

Amentia: Under this heading there are two forms: (1.) Idiocy and (2.) Imbecility.

By describing idocy we mean a congenital malady, and the idiot is one, who by reason of his perpetual infirmity, is non compos mentis. The vitality of the general system is less than normal, the palate is vaulted and narrow, the teeth misshapen, wrongly placed and prone to decay, the patient is dwarfish, the head unsymmetrical, and some times the commissures are atrophied.

Inbecility: This term is distinguished from Idiotism in that the mental defect is manifested in the first years of childhood, and does not reveal itself as early as idiotism. True the fainter shades of imbecility pass into the lighter tints of idiocy. But the possession by the imbecile of the faculty of speech as distinguished from the parrot-like utterance of the few words which the idiot can learn, is one of the best lines of demarcation.

This class of children as a rule are unruly, vicious and cruel. They are intellectually as well as morally deficient, and cannot control their emotions or passions.

There is a class of imbeciles who exhibit intellectual deficiency without offending against morality, and still another class, who combine the highest intellectual endowment with utter incapacity in the conduct of lifeso we have the intellectual, moral, and general imbecile.

The form of imbelicity which is most common and most important in a medico-legal point of view is that which affects the intellect, the morals and the conduct of life.

Persons who exhibit this threefold deficiency, profit by education so as to form and express ideas to read, write,

and count to become musicians, draughtsmen or mechanies. They may even attain proficiency in some branch of knowledge; but they do not profit by opportunities afforded them. They present great varieties of character. Some are fickle and changeable and incapable of fixing their attention others methodical and persevering. Some are fit for the coarsest labors, while others duly assisted and guided are equal to the conduct of business and management of business, but are unequal in emergencies and unable to sustain close conversation or argument. They have a very imperfect idea of the laws of society, morality, courts and trials; and though they may have an idea of property, they have no conception of the consequences of theft.

Some writer has said: "These beings of limited capacity furnish to the courts of justice, to prisons, and scaffolds, more subjects than is generally supposed."

The moral imbecile remains at large, because the intellect being unaffected, they have no distinct delusion; and as weakness of intellect is a necessary ingredient in the legal idea of imbecility, the attempt to prove such persons of insane mind in a court of law necessarily fails.

That absence of moral sense and corresponding want of self-control, which is the essence of their mental malady, can be proved only by the history of their daily life; a history often hard to explain and generally studiously withheld. There is one class of imbeciles that should not be overlooked. They are very apt and really precocious in the first few years at school, but at puberty their mental capacities retrograde, and what they have accomplished in the past vanishes, and mental development closes. Now this occurs suddenly.

The question of responsibility for such acts as arson and murder can only be answered by weighing well all the circumstances of the act, and the whole life and character of the accused, and ascertaining the motive by which the act was instigated. It is in imbeciles more than in other persons of insane minds that the test of the

knowledge of right and wrong utterly breaks down. So from what I have said on idiotism and imbecility, the boundary line between the two is evanescent. The imbecile patient is capable of pursuing some calling, and the idiot simply occupies space and has no voice in the body politic.

Dementia: Is a functional psychosis, manifested by paralysis of the mental facuties.

It is distinguished from the two forms of amentia just described in that it supervenes slowly or suddenly in the mind already fully developed, and in childhood, manhood, or old age. It differs from mania, for it consists in exhaustion and torpor of the faculties not in violent and sustained excitement.

We recognize an acute and chronic form of it. The first is rare and consists of a profound melancholy; the second is common and characterized by incoherence, but said incoherence is different from the incoherence, of mania, for it is void of excitement. There is also a Senile dementia. Dementia has its stages of forgetfulness, irrationality, incomprehension and inappetency. We find in this class of patient a want of memory, then loss of reasoning, lack of ability to comprehend, the pulse is retarded, and the temperature is subnormal, the later there. is an abolition of the common instructor of volition.

In acute dementia, caused from sudden mental shocks, the mind seems fixed and arrested in sad abstraction on the event which occasioned it.

The chronic form of dementia is often brought on by some slow acting cause, such as prolonged grief or anxiety, sometimes it follows fever, appoplexy or paralysis.

It has been ascertained that the inhalation of a poisonous vapor like mercuric methide can induce in a perfectly healthy man a state of brain passing gradually into the most hopeless dementia.

Senile Dementia arises from causes acting slowly and gradually. The first symptom is impaired memory of re