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Page 55
Although insanity is determined by the social relations of man, that
part of the social organization which is termed _Society_, and
which has been developed by the idle as a diverting game, is a fertile
source of nervous disease and even of insanity, affecting particularly
females. The strenuosity of the life, the nervous excitement
alternating with ennui, the lack and improper times of sleep, the lack
of rest and particularly of restful occupation, the not infrequent use
of alcohol in injurious amounts, are all factors calculated to make a
defect operative. The so-called "coming out" of young girls is an
important element in the game, and their headlong plunge into such a
life at a period under any conditions full of danger to the nervous
system is especially to be reprobated. If we consider the influence of
the game in other respects as conducing to lack of moral sense, to
alcoholic abuse (for without the seeming stimulation, but which is
really the blunting of impressions which alcohol brings, the game
would not be possible), to discontent, to mental enfeeblement, it is
all bad. Curiously enough the game is one which in all periods has
been played by the idle, but its evil influence is greater now than
before when it was the game of royalty chiefly, because there are now
more people living from the work of others.
The unusual mental action of the insane not infrequently expresses
itself by suicide. The analysis of three hundred deaths from suicide
showed pathological changes in the brain in forty-three per cent, and
when we think that mental disturbances are very often without
recognizable anatomical changes after death, the percentage is very
large. In another analysis of one hundred and twenty-four suicides
forty-four of these were mentally affected to various degrees. Five of
the men and seven women were epileptics, in ten of the families there
was hysteria, twenty-four of the men and four of the women were
chronic alcoholics.
It is extremely difficult at the present time to say whether insanity
is increasing. Statistics in all lands giving the numbers committed to
insane hospitals show on their face a great increase, but so many
factors enter into these statistics that their value is uncertain.
There is now an ever-increasing provision for the care of the insane.
Owing to the recognition of insanity as a part of nervous disease and
its separation from criminality there is no longer the same attempt to
conceal it as was formerly the case, and hospitals for the insane are
no longer associated with ideas of Bedlam. It is generally believed
that modern conditions in the hurry and excitement of life, and the
extreme social differences, the greater urban life, the greater
extension of factory life, all tend to an increase in insanity, but
there is no absolute proof that this is true. We know very little
about insanity in the Middle Ages, but the conditions then were not
conducive to a quiet life. There prevailed then as now excess and
want, luxury and poverty, enjoyment and deprivations, balls and dinner
parties and other features of the social game. There were factions in
the cities, public executions, not infrequent sieges, scenes of
horror, epidemics, famines, and all these combined with religious
superstition and the often unjust and cruel laws should have been
factors for insanity. There were actual epidemics of insanity
affecting masses of the population, as shown in the children's
crusade, the Jewish massacres and the dancing mania in the Rhine
provinces. Where civilization seems to be the highest, statistics show
the most insane, but this most probably depends upon better
recognition of the condition and better provision for asylum care.
The so-called functional diseases have a close relation with diseases
of the nervous system, for they chiefly concern the reactions of nerve
tissue. Disease expressing itself in disturbance of function only,
does not seem to fit in with the conceptions of disease which have
been expressed, nor can we imagine a disturbance of function which
does not depend upon a change of material. Living matter does not
differ intrinsically from any other sort of matter; like other matter
its reactions depend upon its composition structure[1] and the
character of the action exerted upon it. By functional disease there
is expressed merely that no anatomical or chemical change is
discoverable in the material which gives the unusual reaction. The
further our researches into the nature of disease extend, particularly
the researches into the physiology and chemistry of disease, the
smaller is the area of functional disease. In functional disease there
may be either vague discomfort or actual pain under conditions when
usually such would not be experienced, and on examination no condition
is found which in the vast majority of cases would alone give rise to
that impression on the nervous system which is interpreted as pain. In
the production of the sensations of disease there can be change at any
place along the line, in the sense organs, in the conducting paths or
in the central organ. Thus there may be false visual impressions which
may be due to changes in the retina or in the optic nerve or in the
brain matter to which the nerve is distributed. It is perfectly
possible that substances of an unusual character or an excess or
deficiency of usual substances in the fluids around brain cells may so
change them that such unusual reactions appear. There may be, of
course, very marked individual susceptibility, which may be congenital
or acquired. The perception of every stimulus involves activity of the
nerve cells, and it is possible that the constant repetition of
stimuli of an ordinary character may produce sufficient change to give
rise to unusual reactions, and this particularly when there is lack of
the restoration which repose and sleep bring. We know into what a
condition one's nervous system may be thrown by the incessant noise
attending the erection of a building in the vicinity of one's house or
the pounding of a plumber working within the house, this being
accentuated in the latter case by the thought of impending financial
disaster. Even the confused and disagreeable sound due to the clatter
of high-pitched women's voices at teas and receptions may, when
frequently repeated, be productive of changes in the nerve cells
sufficiently marked to give rise to the unusual reactions which are
evidence of disease.
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