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DIAGNOSIS OF IKSA3STITY                                                 381

Epileptic idiots are, as a rule, very impulsive and irritable, and are apt to
injure their playmates, if not carefully watched.


Sometimes, it is very difficult to form a correct diagnosis as to whether
an individual is sane or not, especially when he has no permanent delusion,
and when he is just on the border line between sanity and insanity. Under
such circumstances it is always advisable to note carefully the following
points before a definite opinion is given: —

1.    Family History.—Insanity being mostly hereditary, it is very impor-
tant to enquire into the mental condition of the patient's parents, uncles,
grandparents, brothers, sisters and other relatives as to whether any of them
ever  showed  mental   excitement  or   depression,   or  mental  weakness  or
suffered from nervous diseases, such as chorea, epilepsy, etc.   It is also neces-
sary to find out if any of them committed suicide, or were attacked by cere-
bral affections, gout, rheumatism or syphilis.

2.    Personal History.—While listening to the history of the patient, the
medical man should always try to be sympathetic, so as to win his confidence.
The history should be as thorough and complete as possible, noting all the
characteristic details from childhood likely to give a clue to the disease.
Questions should be asked about his personal habits with reference to the
excessive use  of any intoxicating drug, such as  cannabis indica, alcohol,
cocaine or opium, sexual excess, masturbation, any morbid propensity at the
time of puberty, occupation, mental strain or shock, injury to the head or
any brain disease, and chorea, epilepsy, convulsions, or any other nervous
affections.   It should be ascertained from his relatives and friends, if they
noticed of late any change in his conduct and behaviour towards them, if
he was cleanly in his habits or filthy and disgusting, and if he was restless
and passed sleepless nights, or if he looked excitable or depressed at times.
Lastly, it should be found out if this was the first attack, or there has been
any attack previous to it.

3.    Physical Examination.—The patient's manner of dressing and walk-
ing as well as his bearing and gesture?, should be carefully noted, when he
comes to the physician.   The presence of deformities and malformations in
the head or body, as also the power of speech and articulation, should be
observed.   The  pulse  and  temperature  should  be  taken,  as  both  might
increase in insanity.   The tongue should be examined to find out if it is foul
or furred due to constipation.   All the organs should be carefully examined.
The skin would be dry, mottled and wrinkled, and the hands and feet would
be moist with sweat.

4.    Mental Condition.—The mental capacity should be found out by first
testing his memory, and then the power of his reasoning and sound judgment.

While testing the memory the patient should be asked to give the dates
of common incidents, that occurred in his family, or to recite the names of
his relatives, or the- days of the week, or to answer such other simple ques-
tions. The questions put to him should not be too complex or difficult to be
easily answered by an average man of his culture and education.

The power of his reasoning and sound judgment should be detected by
discussing with him on various subjects. During discussion an attempt
should be made to find out a delusion. An insane person tries to conceal his
delusion; hence it may be necessary to watch him for days before his condi-
tion can be certified.

Lastly, handwriting will show the mental confusion, the misspelling? ^e
omission of letters or phrases and the muscular tremor, if an educated insane
person is asked to write.                                                                 '-^