The study of mental disease : being the introductory lecture delivered in the University of Edinburgh on the institution of the Lectureship on Mental Diseases, May 1879 / by T.S. Clouston.

Date:
1879
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Licence: Public Domain Mark

Credit: The study of mental disease : being the introductory lecture delivered in the University of Edinburgh on the institution of the Lectureship on Mental Diseases, May 1879 / by T.S. Clouston. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    weeks. Out of the 180 qases, 118, or 66 per cent., had such inter- missions of sanity with subsequent relapses. This tendency to short, sharp attacks with intermissions of more perfect sanity than occurs in almost any other kind of mental disease, with relapses occurring one, two, three, four, and five times before complete recovery or dementia finally takes place, may be taken to be very characteristic of this Insanity of Adolescence, as it may be called, for you see it was not an insanity of puberty, except in a very few cases indeed. In many of them, as the maniacal attacks passed off, there was a slight tendency to melancholia, a sort of reaction of the brain in fact. This was present in 62 cases. Another rather well-marke^ characteristic was this, that a hereditary predisposition to mental disease, or at least to some of the neuroses, was present in 77 of the JfcO, or in 45 per cent, of the whole number. It is very difficult to gef.family histories of insanity in most cases, and you may multiply/fry two those you get if you want the truth. This is best shown by the fact, that of the 1580 cases admitted to the Asylum during the five years 1873—77, only 308 were put down as hereditary. This is only 20 per cent, as compared with the 45 per cent, among the adolescents, in whose cases no special pains had been taken to ascertain family history. A still more striking fact I discovered in regard to the heredity of the insanity of adolescents. I happened to have a personal know- ledge of the history of the cases and of the families in 15 of the cases, and in 12 of these there was a hereditary predisposition to the neurosis. The insanity of adolescents is therefore predisposed to in most cases by a nervous heredity. Another marked character of the mania was that the ideas, emotions, speech, and conduct, were all very strongly tinctured by the mental characteristics of adolescence in an exaggerated or morbid way. That perversion of the reproductive nisus, the habit of masturbation, was very common, probably existing in over 50 per cent, of the cases, aggravating the symptoms, and diminishing the chances of recovery. In the females hysterical symptoms were very common, such as mock modesty, simulated pains, and a desire to attract attention. In the males heroic notions, an imitation of manly airs and manners, an obtrusive pugnaciousness and some- limes a morbid sentimentality were present. In almost all the cases the physical appearance of the males was boyish when the attack commenced, and most of the young women were girlish rather than womanly in contour. As regards the results of treatment in those cases, 93 were discharged recovered, or 51 per cent., but then 40 were removed home or to other institutions relieved, many of whom, I know, would have been likely to recover ultimately. I only know of 26 of the 180 who became incurable. Insanity occurring at the •adolescent period is therefore a very curable disorder, as compared with many other forms, though not so curable as some others, e.g.,