7
Insane people are not likely to take care of themselves, and therefore we have no
right to expect many admissions among people over 40.
Statement No. 6.—Appears always to attract much comment in reference to
differences in the diagnosis of the several forms of insanity : a few words by way
of explanation of why this is so may not be out of place.
The " acute mania'' as described by European experts in lunacy is a disease
very rarely met with in India. A. violent raving lunatic dangerous to himself
and to others, given to destroying things, tearing his clothes to shreds and
beating his head against the wall, requiring straight jackets, padded rooms, &c.
to restrain him, is seldom to be seen in India. Consequently I very rarely
classify a case under this head.
" Chronic" mania is a misnomer, it, in reality, implies a milder form of
mania than the above, which would be more aptly designated "sub-acute." When
acute mania becomes " chronic" it is not to be distinguished from chronic demen-
tia when the patient has become fatuous, his bodily powers worn out, drifting
fast into paralysis or acquired idiotcy :—acute or sub-acute mania and dementia
very soon assume this form in the generality of instances, therefore the majority
of cases of insanity come to be classed under these heads.
A young man possessed with much bodily vigour may suffer for a " long
time " from acute mania with intervals of mitigation or a complete lucid interval,
and yet the latest attack may betray as much active severity and sharpness as
the first, in fact be as "acute" as ever; it would be misleading to call such a case
" chronic" because it lasted a long time.
It is often not easy to distinguish between acute dementia and sub-acute
mania, and first attacks generally assume one or the other of these forms.
A man suffering from chronic dementia of some standing is very little
removed from a helpless idiot, although in the first years of his madness his
P hysical powers and perverted mental faculties were very active and he would
be described as having a "mind" such as it was. In idiotcy (amentia) there is
" no mind", no mental process. Thus it happens that a man suffering at first
from sub-acute mania generally, if he lives long enough, passes from one form to
another, through dementia and paralysis until he comes to be aptly described as
an idiot. This is "acquired" idiotcy: the history of the case readily distinguishes
it from that which is "congenital." But as most insanes arrive at this final
stage, as I have just stated, if they live long enough, it is not difficult to conceive
how there should be a good proportion classified under this head also.
The foregoing description, rough though it be, maps out clearly to my mind
the more common varieties of insanity : doubtless some cases are met with occa-
sionally in the border land between two classes, where it is not easy at first to
specify under which it should be placed. In the simply cultured minds of Indian
people, such cases are rare, and when they do occur a longer observation than
usual solves the difficulty. There ought not therefore to be so much diversity
in classification, some there always must be: most divisions of medical science
are proverbially " inexact," insanity perhaps most of all; and as long as this
is so, Doctors will differ.
Happily these differences do not affect the well-being of the patients. The
treatment and management of lunatics are not determined by refinement of diag-
nosis.
Statement No.7.—The determination of causes of insanity is of considerably
greater difficulty than the classification of the variety. Only too often it is impos-
sible to procure any previous history of the patient. Native relatives (even if any
exist and are willing to do so) are not skilful at depicting those traits of
character previous to his seizure which might tend to show what led to his becoming
insane: but too often the man has no known relatives, and " shots" are made by the
neighbours as to the cause of his madness. I think it is of doubtful value to set
down every thing told in this way as if it were reasonably true :—if these returns
are ever to be made use of it would be better to assign only such alleged causes as
have some pretensions to being correct. Omitting altogether those which are
nothing more than mere conjectures, even if a great number go unclassified, it
is better so than that doubtful causes should be assigned. I have been informed
that certain lunatics have gone mad from " fear". 1 do not think British law and