33STDICATIONS OP INSAOTTY 365 Toxic Causes.—The toxic causes may be grouped under the following heads : — 1. Toxic substances resulting from excessive formation or deficient elimination of morbid waste products owing to disordered metabolism. 2. Toxins generated in the system by microbic infection. 3. Toxaemia produced by the excessive use of certain drugs, such as cannabis indica, opium, morphine, cocaine, alcohol, etc. Psychic Causes.—Intense emotional disturbances, such as love, hatred, passion, disappointment, etc. are the psychic causes, which are liable to cause mental derangements, especially among those who are already predis- posed to it. INDICATIONS OF INSANITY The onset of insanity is usually gradual, but it may be sudden in some cases. When the onset is gradual, the early physical symptoms of insanity are loss of appetite, constipation, dyspepsia and other digestive disturbances. Insomnia is almost a common symptom and in some cases there is a rise of temperature; these are then followed by mental disturbances. The rela- tives and friends of the patients notice a change in his conduct and behaviour. He is not the same man as he used to be. He is quite eccentric in his dress, manners, habits and in his dealings with other people. Speech becomes involved and the face bears a blank or vacant expression. He is gloomy, morose, listless, apathetic and does not care for the social conventionalities. At times he is very excitable and irritable even by trifling worries, which he will not otherwise mind. These are followed by an alteration in his emotions. His affections for his wife and near relatives are changed into dislike and hatred. So far the intellect may not be impaired, and the patient may be quite capable of looking after himself and managing his business affairs. Later, his memory, however, fails him and the power of self- „ control is lost. The power of reasoning is interfered with, and the judg- ment becomes weak and faulty. At this stage the errors of perception of the special senses are evident in the form of hallucinations and delusions, which may lead the patient to perpetrate some crime or outrage. In addition to these personal changes, the surroundings of the patient, are often very characteristic. The house or room, in which he lives, is untidy and filthy, and the furniture is not unoften arranged in some fantastic fashion. Stigmata of Degeneration.—In addition to the above symptoms, an insane person may exhibit physical peculiarities known as stigmata of degeneration. These are— 1. Changes in the SkuU.—The skull may be much smaller or larger in all its dimensions than that of the average healthy sane individual, or it may show inequality in the shape of both the sides. Hie frontal or occipital bone may also appear to be flattened and the vault may, therefore, look extended backwards and upwards in a very prominent manner. 2. Changes in the Face.—The face shows an irregular contour so that the nose appears to project on one side and the mouth to be tilted at one corner. In some cases the nose may be distorted, and stunted at the root. The ears are unusually large or small, and very often present a hsematoma, which is known as the asylum or insane ear. The teeth are also set irregularly, and separated widely. The canine teeth are sometimes UBcfuly prominent. The palate is highly arched, narrow, and unequal oa 1x»i||^Jfc& sides. The pupils are irregular, and there is very often a high cjeg^sei of myopia, or the presence of pteryghim in one or both the eyes.