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2601 C64

1883

PREFACE.

ANOTHER book on Mental Disease almost needs an apology, the treatises on the subject of late years having been so numerous, and some of them so good. But the subject has never yet, in the opinion of many, been treated from so entirely clinical and practical a point of view as is desired by students of medicine, and by busy practitioners. The strong point of a clinical lecture should be that it appeals directly and on all occasions to the facts of disease as seen in actual cases, following the lines of the cases on which it is founded. It must have its foundation in the clinical experience of its author, this giving it vividness and interest. Its weak points are, that the diseases are not treated in a full, systematic, and generalised way, that the history of investigation into them cannot be entered into, and therefore great seeming injustice is done to previous authors and investigators. I have been much impressed in teaching students by the fact that you can manifestly interest every member of a large class when you are teaching mental diseases clinically, while you fail to reach some of them by systematic descriptions. Direct appeals to the facts of nature, however fragmentary, make more impression on them than any amount of elaborate description. These considerations led me to publish the following lectures as a text-book for my students in the University of Edinburgh; and I venture to indulge the hope that it will also

supply a want which I know many busy practitioners of medicine feel. The 260 cases of mental disease which I describe and embody in those lectures may, I hope, assist some of my brethren in the profession in their treatment of a very obscure and troublesome class of diseases. In the selection of those cases, I had in view rather their applicability as good ordinary types and guides than their rarity or their striking characters. The tendency in publishing mental cases has been to fix on wonderful rather than useful examples.

I have to acknowledge with gratitude the assistance I have received from the present or past staff of the Royal Edinburgh Asylum, Drs Turnbull, Carlyle Johnstone, Mitchell, Spence, Steedman, and Harrison Thomas, in getting up the statistics of many of the forms of insanity from the records of the institution, and especially I have to thank my friend Dr Ireland for advice and help in getting the work through the press.

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All men students of mind-Medical psychology-Necessity for medical men studying mental diseases-Frequency of insanity-Specialism-What mental disease implies-The standard of mental health differs-Temperaments and diatheses-Body and mindReproduction and its mental relationships-Clinical mode of studying mental symptoms-Nomenclature of mental diseasesClassification by symptoms-Skae's (clinical) classificationSome of the most important anatomical, physiological, psychological, and pathological considerations to be kept in mind in the clinical study of mental diseases-The method of clinically examining an insane patient, and the rules to be observedHome or asylum treatment,

LECTURE II.

STATES OF MENTAL DEPRESSION.

MELANCHOLIA (PSYCHALGIA).

Nearest mental health-Seen at beginning of nearly all kinds of insanity-Physiological capacity of feeling-Physiological depression-Melancholic phases of existence in all men-The melancholic variety of the nervous temperament and diathesisInfluence of heredity-Crises of life-The eight varieties of Melancholia.-Melancholy and melancholia defined. Simple Melancholia.—“Low spirits," want of affection, want of interest in and enjoyment of life-Fancies, whims, with impairment of reasoning power-Not much body wasting-Sometimes goes no further-Often is prelude to severe varieties, or to other forms of insanity-Condition comes and goes, and depends on slight causes-Curability-Great variety of symptoms-Cases A. B. to A. J. Hypochondriacal Melancholia.-Patient's depressed feelings centre round himself, and his delusions are about his bodily organs and functions-Fancies innumerable in kind and

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variety-Seldom very suicidal-Differences between the sane and
the insane hypochondriac-The one talks only, the other acts
and has lost his inhibitory power-Relations of symptoms to
peripheral disease-Cases from A. K. to A. M. Delusional
Melancholia.-Delusions from beginning the most prominent
symptom-Such delusions assigned by relatives as the " cause
-Visceral cases-Electrical and religious delusions-List of the
delusions of 100 cases-Cases A. N. to A. W.-Prognosis in
worst class of cases bad, as in all "fixed delusions,"

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LECTURE III.

MELANCHOLIA (PSYCHALGIA)—continued.

Excited (Motor) Melancholia.-Restlessness, noise, agitation, wring-
ing hands, moaning, shouting, tearing clothes, violence, insane
obstinacy-Difficulty of management, hallucinations-Delirium
Tremens a typical and exaggerated variety of this state-Mus-
cular expressions of mental state-Automatic misery-Cases
A. V. to B. A.-Trophic changes, boils, irritations of skin
causing scratchings, erosions of surface, pulling out hair, &c.
Resistive Melancholia. -Difficulty and danger of this-Mastur-
bation-Cases B. B. to B. E. Convulsive Melancholia.-Whole
of the functions of convolution affected in this-Cases B. F. and
B. H. Organic Melancholia.-Precedes or accompanies tumours or
softenings-Ends in dementia-Cases B. J. and B. H. Suicidal
and Homicidal Melancholia.—In every case of melancholia, how-
ever mild, look out for suicide, and guard against it. Meaning
of suicidal feeling-Infinite variety of motive and delusion, and
of modes of suicide-Concealment-Cunning-Act depends much
on natural courage of patient, and somewhat on his religious and
moral principles--Prevalent modes of suicide in individual cases,
in nations, and in sexes-Suicide by suggestion, from seeing means
at hand-Subtlety and liability to recurrence of the impulse-
Modes of forcible feeding-Frequency-Cases B. K. to B. R.-In-
ception of melancholia-Bodily symptoms-Causation—Termina-
tion-54 per cent. recover-Homicidal and suicidal impulses
and acts frequently combined-Period of life at which most
frequent. Treatment.-Diet-Tonics, nutritives, sedatives, use
and abuse-Stimulants: Quinine, iron, strychnia, phosphorus,
the bromides, mineral acids, laxatives, mineral waters, fresh
air, exercise, baths, change of air, scene, and association, rest,
occupation, amusement, music, avoidance of excitement or noise
or strain of any kind-Many attacks will "run their course," and

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