^* Tuke Dr., Op. cit., 1865, p. 1021.Google Scholar

^* It is important practically, and interesting physiologically, that perfect mental recovery almost never takes place until the menstrual function is restored and regular, and the sooner it takes place the better is the prognosis. If any further proof were needed than have been given of the soundness of the principle that the various forms of insanity are intimately connected with the state of other bodily functions, taking their origin and shape and departure in this way, this fact would confirm it strongly.—T. S. C.Google Scholar

^* Those physical symptoms of an ill–nourished and exhausted brain are more constant in this form of insanity than in any other, and should certainly never be neglected in any case.—T. S. C.Google Scholar

^† Op. cit.Google Scholar

^* “Ed. Med. Journal,” 1865.Google Scholar

^* “The connection between Tuberculosis and Insanity.” By Clouston T. S. M.D., “Journ. of Ment. Science,” 1863.Google Scholar

^* In 1854 I pointed out that the specific gravity of the gray matter of the brain was below the average in all patients who died of phthisis.—An. Rep. for 1854.Google Scholar

^† When we consider that it was not so much insanity occurring in the course of consumption as the two diseases appearing simultaneously, and that very few indeed of my cases had well developed insanity on admission, we see that the cases would not be so apt to go to the Hospital for Consumption as be sent to the lunatic asylum. Even if all the cases of phthisical insanity had first been in the hospital, and supposing that it is twice as common among the phthisical as ordinary insanity among the general population, then Dr. Cotton would only have met with one insane person in 170 patients.—T. S. C.Google Scholar

^‡ Blandford Dr., Op. cit., p. 86.Google Scholar

^* Op. cit.Google Scholar

^† My experience since the foregoing was written, ten years ago, has led me to believe that there is a phthisical insanity that occurs in persons of this diathesis with no local symptoms of tuberculisation at all, and that under proper treatment and hygienic conditions it is by no means an incurable disease. I have also observed that the coming on of phthisis in a patient, who has been for many years insane, will often affect the character of the insanity, and affect them in the direction of the special symptoms of true phthisical insanity. I also believe now that this form of insanity is not so incurable as I stated in 1863, even if there are local deposits of tubercule in the lungs.Google Scholar

It has also been urged that phthisis is really no more prevalent in lunatic asylums than among the population, if as much so. This is a fallacy resulting from the mode of calculating the comparative prevalence of the disease, as was well shown in the last report of the Scotch Commissioners in Lunacy. Counting the proportion of deaths from phthisis to the average population of an asylum, and comparing it with the same proportion in the case of the general population, we find it to be quite three times as much. During the last ten years ten patients to the thousand of the average population have died of consumption in the Carlisle Asylum (and in it the disease had been rare compared with many similar institutions), while in the general population above three years of age the proportion is not more than three, or at most four, to the thousand, as shown by the registrar's returns.Google Scholar

The proportion of cases of phthisical insanity to the whole number of insane has been 5 per cent. in the Carlisle Asylum for the last ten years. —T. S. C.Google Scholar