The Home Medical Library Volume II Part 14

A man who presented a case of dementia pulled the hairs from his beard and planted them in rows in the garden, watering them daily, and showing much astonishment that they did not grow. He spent hours each day in spelling words backward and forward, and also by repeating their letters in the order in which they appear in the alphabet. When he wanted funds he signed yellow fallen leaves with a needle, and they turned into money.

A case of general paresis (commonly though improperly called "softening of the brain") pa.s.sed into the second stage as a delusion was uppermost to the effect that there was opium everywhere; opium in his hat, opium in his newspaper, opium in his bath sponge, opium in his food. He thereupon refused to eat, and was fed with a tube for two years, at the end of which time he resumed natural methods of nutrition and ate voraciously. Another general paretic promised to his physician such gifts as an ivory vest with diamond b.u.t.tons, boasted of his great strength while scarcely able to walk alone, and declared he was a celebrated vocalist, while his lips and tongue were so tremulous he could scarcely articulate.

_Fixed Delusions of Paranoia_

Paranoia is an infrequent variety of insanity in which the patient is dominated by certain fixed delusions, while for a long time his intellect is but slightly impaired. The delusions are usually persecutory, and the patient alleges a conspiracy. He is generally deluded with the belief that he is a prominent person in history, or an Old Testament worthy, and there is usually a religious tinge to his delusions. A patient of the writer believed himself to be the reincarnation of Christ, appearing as "the Christ of the Jews and the Christ of the Christians" in one. Over the head of his landlord, who requested overdue rent, the patient fired a revolver, "to show that the reign of peace had begun in the world." He wrote a new bible for his followers, and arranged for a triumphal procession headed by his brother and himself on horseback, wearing white stars.

_How the Physician Should Be Aided_

When there is a suspicion of irrationality in a person's conduct, and certain acts or speeches suggest insanity, the whole surroundings and the past life must be considered. Frequently when the eyes are once opened to the fact of insanity, a whole chapter of corroborating peculiarities can be recalled. It is wise to recall as many of these circ.u.mstances as possible and note them in order as they occurred, for the use of the physician. Strikingly eccentric letters should be saved. Odd arrangement of clothes, or the collecting of useless articles, should be noted in writing. Changes in character, alteration in ideas of propriety, changes in disposition, business or social habits, and great variation in the bodily health should be noted in writing. Delusions, hallucinations, and illusions should be reported in full. It conveys nothing to anyone's mind to say that the patient is queer; tell what he does or says that leads you to think he is queer, and let the physician draw his own inferences from the deeds or speeches. Write down, for example, that the patient talks as if answering voices that are imaginary; or that the patient brought an ax into the dining room and stood it against the table during the meal; or that he paraded up and down the lawn with a wreath of willow branches about his neck; in each case stating the actual fact. It is important to ascertain exactly what the patient's habits are, as to the use of alcoholic beverages, tobacco, and drugs (such as opium), and also as to s.e.xual matters. To secure such information is extremely difficult, and the help of a close friend or companion will be necessary. After the mind begins to waver many a patient plunges into dissipation, though formerly a model of propriety.

_The Causes of Insanity_

The two great causes of insanity are heredity and stress or strain.

Lunacy is not infrequent in children of epileptic, alcoholic, or insane parents, and those born of parents suffering from nervous disease frequently are in such condition that shock, intense emotion, dissipation, or exhausting diseases render them insane. Drinking alcoholic beverages is the most potent factor in the production of insanity. Mental strain, overwork, and worry come next. Adverse conditions, bereavement, business troubles, etc., rank third, equally with heredity. The arterial diseases of old age, epilepsy, childbirth (generally in the neurotic), change of life, fright and nervous shock, venereal diseases, s.e.xual excesses or irregularities follow in the order named.

_A Temperate, Virtuous Life the Best Preventive_

To avoid insanity, therefore, one should lead a righteous, industrious, sensible life, preserve as much equanimity as possible, and be content with moderate pleasure and moderate success. In many cases, people who are neurotic from early youth are so placed that unusual demands are made upon them. Adversity brings necessity for overwork, duties are manifold, and responsibilities are heavy. In ignorance of the fact that they are on dangerous ground and driven by circ.u.mstances, they overwork, cut short their sleep, and, conscientiously pressing on, finally lose their mental balance and insanity is the result, a great calamity which is really no fault of theirs. Undoubtedly such is frequently the sad history; and for this reason, as well as for the general reason that the insane are simply ill, all insane should be cared for sympathetically. To consider the insane as constantly malevolent is a relic of the old-time, absurd belief that insane people were "possessed of the devil." It is no disgrace to be insane, and the feeling of chagrin at discovering disease of the brain in a relative is another absurdity. Avoidance of insanity should be studied with as much devotion as avoidance of tuberculosis. Yet there should be no detraction from the fact that the heredity is strong. No one should be allowed to marry who has been insane, for the offspring of the insane are defective.

The tendency of the times is toward nervous and mental disorder. In the large cities the strain is too constant, the struggle is too keen, the pace is too swift. Haste to be rich, desire to appear rich, or ambition for social distinction has wrecked many a bright, strong intellect. This is the age of the greatest luxury the world has ever seen, and a large proportion of people in cities are living beyond their means, in the gratification of luxurious desires or the effort to appear as well as others. Stress and strain are voluntarily invited. Children are pushed in their studies and overloaded with too many subjects. Genius and insanity, worry and dementia, proceed among us hand in hand; the overwrought brain finally totters.

_False Ideas Regarding Insanity_

Curious ideas regarding insanity are common, and are apparently fostered by the reportorial writers of the daily papers. We read of people who are "insane on a subject." This is an impossibility. Many people can be drawn out and led into a betrayal of their mental condition only when a certain topic or idea is discussed. But although exhibiting their insane condition only when this topic is broached, they are in no respect sane. Not every act of an insane man is an insane act, we must remember. Forgetfulness of this fact leads to errors in the superficial. You will hear people say that a certain person must be sane, because during a half day's companionship nothing astray was noticed. True, there may be a long period of self-control, or of absence of test; but occasional conduct will establish the fact of constant insanity. Again, we hear the expression: "He cannot be insane; there is too much method in such madness." The answer to this silly remark is that there is method in all madness except some epileptic insanity and terminal dementia. Insane people prepare careful plans, with all the details thoroughly considered, and perfect methods to escape from hospitals with the greatest cunning. One must never take it for granted that the insane person is so demented mentally as to be unable to appreciate what is said and done. One should never talk about the insane man in his presence, but should include him in the conversation as if sane, as a general rule, allaying his suspicions and avoiding antagonism. Do not agree with the delusions of an insane person, except so far as may be necessary to draw them out. Yet avoid argument over them. Simply do not agree, and do not strengthen them by appearing to share them. His food should be prepared for him, and his medicines administered to him as to any other sick person. His baths should be regularly taken.

A depressed patient should be very carefully watched. If the slightest suspicion of a suicidal impulse be present, the patient should never be left alone. Many a valuable life has been saved through the moral support of constant companionship; while we read very frequently of the death of an insane patient who sprang from a window during a brief period of relaxation of watchful care. Some people think it a protection to one insane to elicit from him a promise not to be depressed, and not to do anything wrong. One might as well secure a promise not to have a rise of temperature. The gloom of despondency and the suicidal impulse are as powerful as they are unwelcome and unsought; and the wretchedly unhappy patient cannot alone meet the issue and resist.

It is unreasonable to be offended by acts or speeches of an insane patient, to bear a grudge or expect an apology. Very frequently such a patient will turn savagely upon the nearest and dearest, and make cutting remarks and accusations or exhibit baseless contempt. All this conduct must be ignored and forgotten; for the unkind words of an unaccountable and really ill person should not be taken at all seriously.

Should a patient escape from home, it is the duty of the one in charge without hesitation to overtake him, and then accompany him or at least follow at a short distance. The nurse should go with and stay with the patient, telephoning or telegraphing home when opportunity offers, and finally securing aid; he should know where the patient is at all times, foregoing sleep if necessary to protect his charge, and should avoid as long as prudence permits the publicity of an arrest; though the latter may finally be essential to safety, and to the prevention of embarking on a voyage, or taking a train to a distance, or purchasing weapons.

=Diversions.=--Music favorably affects many patients, so the pleasure of listening to it should be afforded at frequent intervals. Patients should be encouraged to absorb themselves in it. It is often possible to take insane people to opera, musical comedy, or concert. Vocal and instrumental practice at suitable intervals is of great value in fixing the attention, filling the mind with desirable thoughts and memories, and allaying irritability. Drawing and painting are of service when within the number of the patient's accomplishments.

Intellectual pastimes, as authors, anagrams, billiards, chess, and many games with playing cards, are generally helpful. Gardening, croquet, and tennis are very desirable. Golf, rowing, swimming, and skating are excellent, but are within the reach of very few insane patients. All regular occupation that necessitates attention and concentration is of supreme value; in fact, insane patients not infrequently ask for occupation and find relief in the accomplishment of something useful, as well as in the healthful sleep and increased appet.i.te that attend judicious physical fatigue.

_The Beneficial Atmosphere of Sanitariums_

After caring for an insane patient for a time at home, the question arises as to the desirability of sending him away to a sanitarium.

Generally this is a wise course to pursue. The constant a.s.sociation with an insane person is undermining; the responsibility is often too heavy; children, often inheriting the same neurotic tendency and always impressionable, should not be exposed to the perverting influence; it may not be safe to keep a patient with suicidal or homicidal impulses in his home; the surroundings amid which the insane ideas first started may tend to continue a suggestion of these ideas.

Removal to strange locality and new scenes, the influence of strangers, the abandonment of all responsibilities and duties, and the atmosphere of obedience, routine, and discipline are all beneficial.

An insane person will generally make a greater effort for a stranger than for a familiar relative. Discipline, in the form of orders of the physicians, and exact obedience is very often very salutary. There is a feeling with some that all discipline is cruel. This is not so, for the conduct of an insane person is not all insane, but frequently needs correction. Many cases of mental alienation improve promptly under custodial care, many need it all their lives. A great many cases of insanity are never obliged to go away from home, and there is a considerable number who carry on a business while still insane, rear a family, and take care of themselves. In general, a depressed patient should be kept at home as long as there is absolute safety in so doing. Most other forms of mental disease progress more rapidly toward recovery in sanitariums or hospitals equipped for such patients.

Prospects of recovery are never jeopardized by confinement in a proper inst.i.tution. Mental and physical rest, quiet, regularity of eating, exercising, and sleeping are the essentials which underlie all successful treatment of these cases. Dietetics, diversion by means of games, music, etc., regular occupation of any practicable sort, together with the a.s.sociation with the hopeful, tactful, and reasoning minds of physicians and nurses trained for this purpose are of great value. It must be remembered that in wholly civilized localities madhouses have been replaced by hospitals, keepers have been replaced by nurses and attendants, and the old methods of punishment and coercion have been long since abandoned, in the light of modern compa.s.sionate custody.

Certain forms of insanity are hopeless from the start. Few recover after two years of mental aberration. Omitting the hopeless cases, over forty per cent of the cases of insanity recover. About sixty per cent recover of the cases cla.s.sed as melancholia and mania. Most recoveries occur during the first year of the disease; but depressed patients may emerge and recover after several years' treatment.

FOOTNOTES:

[10] Caution. Dangerous. Use only on physician's order.

APPENDIX

=Patent Medicines=[11]

The term "patent medicine" is loosely used to designate all remedies of a secret, non-secret, or proprietary character, which are widely advertised to the public. This use of the name is erroneous, and it is better first to understand the exact difference between the different cla.s.ses of medicines generally comprised under this heading. Only in this way can one comprehend their right and wrong use.

=A Patent Medicine= is a remedy which is patented. In order to secure this patent, an exact statement of the ingredients and the mode of manufacture must be filed with the government. These true "patent medicines" are generally artificial products of chemical manufacture, such as phenacetin. The very fact of their being patented makes them non-secret, and if an intelligent idea is held of their nature and mode of action, they may be properly used. Physicians with a full knowledge of their uses, limitations, and dangers often, and legitimately, prescribe them, and thus used they are the safest and most useful of all drugs and compounds of this cla.s.s.

=A Nostrum.=--The Century Dictionary defines a nostrum as "a medicine the ingredients of which, and the methods of compounding them, are kept secret for the purpose of restricting the profits of sale to the inventor or proprietor." Some nostrums have stated, on their label, the names of their ingredients, but not the amount. There has been no restriction upon their manufacture or sale in this country, therefore the user has only the manufacturer's statement as to the nature of the medicine and its uses, and these statements, in many instances, have been proved utterly false and unreliable.

=A Proprietary Medicine= is a non-secret compound which is marketed under the maker's name. This is usually done because the manufacturer claims some particular merit in his product and its mode of preparation, and as these drugs are perfectly ethical and largely used by physicians, it is to the maker's interest to maintain his reputation for the purity and accuracy of the drug. Familiar instances of this cla.s.s are: Squibb's Ether and Chloroform, and Powers & Weightman's Quinine.

From the above definition it may be seen that the only unreliable medicines are those which are, in reality, nostrums. In regard to all of these medicines the following rules should be observed:

_First._--Don't use any remedy that does not show its formula on the label.

_Second._--No matter what your confidence in the medicine, or how highly recommended it is, consult a physician before using very much of it.

_Third._--Take no medicine internally without a physician's advice.

Throughout this chapter the word "patent medicine" will be used in its widely accepted form, in the everyday sense, without regard to its legal definition, and will be held to include any of the above-mentioned cla.s.ses, unless a direct statement is made to the contrary.

In Germany the contents of patent medicines are commonly published, and in this country, notably in Ma.s.sachusetts, the State Boards of Health are a.n.a.lyzing these preparations, and making public their findings. In North Dakota a law has been pa.s.sed which requires that a proprietary medicine containing over five per cent of alcohol, or any one of a number of specified drugs, be labeled accordingly.

=PURE FOOD BILL.=--A far-reaching and important step, in the movement for reform of patent medicines and for the protection of the public, has now been taken by the United States Government. On June 30, 1906, an act was approved forbidding the manufacture, sale, or transportation of adulterated, misbranded, or poisonous or deleterious foods, drugs, medicines, or liquors. This act regulates interstate commerce in these articles, and went into effect January 1, 1907.

Section 7 of this act states:

"That for the purposes of this Act an article shall be deemed to be adulterated: in case of drugs:

"_First._ If, when a drug is sold under or by a name recognized in the United States Pharmacopoeia or National Formulary, it differs from the standard of strength, quality, or purity, as determined by the test laid down in the United States Pharmacopoeia or National Formulary official at the time of investigation; _Provided_, that no drug defined in the United States Pharmacopoeia or National Formulary shall be deemed to be adulterated under this provision if the standard of strength, quality, or purity be plainly stated upon the bottle, box or other container thereof although the standard may differ from that determined by the test laid down in the United States Pharmacopoeia or National Formulary.

"_Second._ If its strength or purity fall below the professed standard or quality under which it is sold."

Section 8 states that a drug shall be deemed misbranded:

"_First._ If it be an imitation of or offered for sale under the name of another article.

"_Second._ If it (the package, bottle or box) fails to bear a statement on the label of the quant.i.ty or proportion of any alcohol, morphine, opium, cocaine, heroin, alpha or beta eucaine, chloroform, cannabis indica, chloral hydrate, or acetanilid, or any derivative or preparation of any such substances contained therein."