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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.


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.