Clinical Lectures on Mental Diseases

Physiological alternations and periodicity-The law of "action and
reaction "-Reproductive and sexual periodicity, with their
mental changes, elevations, perversions, irritabilities—The perio-
dicity of neuralgia, epilepsy, sleeplessness, &c.-Folie Circu-
laire a distinct disease—First described by Falret and Baillarger
-Three conditions in the circuit: depression, exaltation, and
sanity-Duration of these vary in different cases-A very incur-
able disease-Psychological interest of this disease-The same
braini n different states-Bodily symptoms periodic too, e.g.,
cephalalgia, vomiting, &c.-A few relapses in mania or melan-
cholia do not constitute this disease-Frequency-Commence-
ment and termination. Treatment.-Complete the cure of all
insanity in youth and adolescent insanity-Prevent a "brain
habit" being formed, or a "vicious circle" being got into-The
bromides Non-stimulating diet-Marriage, exercise, regimen—
Heredity the strongest predisposing cause. Pathology.--Cases D.
A. to D. G.,

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211

LECTURE VI.

STATES OF FIXED AND LIMITED DELUSION.

MONOMANIA (MONOPSYCHOSIS).

"Delusion," popular and medical use of-Delusion from want of
judgment in idiots and imbeciles-Delusions from ignorance and

superstition False sense-impressions transmitted to brain

Sleep and dreaming and nightmare-Definition of "Insane

Delusion" - Fixity or not of delusion important - No pure

monomania. Types most common. -Monomania of Grandeur or

Pride.-Different forms-Has a basis in normal brain condition-

Day dreams, &c.-Cases D. L. to D. O. D. Monomania of Unscen

Agency.-Connection of delusions with bodily feelings and diseases

-Nocturnal aggravations-Cases D. O. V. to D. T. Monomania

of Suspicion.-Frequency of morbid suspicions in insanity-In-

sane jealousy-Fear-Concealment of delusions-Cases D. T. A.

to D. T. H.--Proportion of cases-
ses-Diagnosis-Infinite variety

of delusions and subjects of delusion. Monomania usually in-

curable. How it arises: 1. Out of temperament and disposition;

2. After acute mania; 3. From brain poisoning by alcohol, or

after traumatic injury; 4. From perverted sensations-Legal im-

portance of delusion-Importance for diagnosis and signing

certificates of insanity-" Harmless" and " dangerous" delu-

sions. Treatment.-Change-Distract mind by new ideas, new

pleasures, new work-Correction of any bodily disorder, or any

cause of irritation-Electricity-An asylum. Prevention.

Counteract temperament and morbid disposition by reason and

good principles and habits-Suitable choice of occupation-Tem-

perance in all things-Cheerful family life-Work body rather

than brain,

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242

LECTURE VII.

STATES OF MENTAL ENFEEBLEMENT

(DEMENTIA,

AMENTIA, PSYCHOPARESIS, CONGENITAL IMBE-

CILITY, IDIOCY).

Physiological weakness of mind-Childhood and dotage-Weakness
of mind in ordinary bodily diseases from starvation, exhaustion,
extreme mental effort and tension, or emotional shocks-Defini-
tion of true dementia - Symptoms negative - Enfeeblement
general, but not uniform, of all the faculties and mental powers-
Originating mental power first and most markedly affected-No
line of demarcation between sane and insane weakness of mind-
A typical case of dementia. E. A.-Five varieties. (a) Secondary
(Ordinary) Dementia-The most common, important, and charac-
teristic dementia of all-The natural termination of all insanities,
if recovery or death do not occur-Acute insanities tend most
towards it, especially acutely maniacal states-Dementia patho-
logically considered an exhausted trophic and functional state
in a delicate organ originally unstable, from morbid over-

action- A typical case

PAGE

Clinical features - Heredity - Acute

mania-Non-recovery-Changes in expression of face, of tastes,

habits, volition, judgment-Affective nature-Memory-Silliness

-A mental death before the rest of the body dies-Re-education

of brain-Limits-Bodily health often good-Long life. Things

tending to Dementia.-1. Long duration of attack; 2. Acute-

ness; 3. Many previous attacks; 4. Heredity very strong; 5.

Old age-Milder forms of mental weakness, mental "twists,"

and changes, often follow attacks of insanity and apparent reco-

very-Temporary states of dementia that are recovered from after

acute attacks of mania-Case of E. B.. (b) Primary Dementia.—

Imbecility and idiocy defined-Classification of idiocy, genetous,

eclampsic, epileptic, paralytic, inflammatory, traumatic, micro-

cephalic, hydrocephalic, by deprivation, cretinism-Cases E. C.

to E. I. (c) Senile Dementia.-Kinship of this to secondary de-

mentia. Special Characteristics.—Irritability-Loss of memory.

(d) Organic Dementia.-Results from softenings, apoplexies,

tumours, and such gross brain lesions. (e) Alcoholic Dementia, 267

LECTURE VIII.

STATES OF MENTAL STUPOR.

(PSYCHOCOMA.)

A distinct variety of mental disease. Definition.-Lethargy-Stupor

-Impressions on senses produce no effect-Attention gone-

Desire and emotion absent-Stupor from the physiological point

of view-Connection with reproductive instinct-Receptivity

and irritability of brain gone-Higher reflex functions suspended

—Even reflex functions of cord lessened-Hunger and thirst not

felt-Condition of muscles. Melancholic Stupor (Melancholia

Atonita).-An intense melancholia with delusions that para-

lyse" the mind-Memory not gone-Sensibility not gone-Prog-

nosis-Cases F. M. to F. T. Anergic Stupor ("Acute Dementia ").

-A real stupor-Sensibility, memory, attention, resistance gone

- Feeble circulation - Vaso-motor paralysis. Treatment.

Vaso-motor stimulants-Continued current-Strychnine-Iron

-Ergot-Warmth-Rubbing. Moral treatment unavailing-

Causation-Prognosis-Cases F. P. to F. S. Secondary Stupor. —

Transitory-Sequential, usually following sharp attacks of acute

mania Curable. General Paralytic and Epileptic Stupor.-

Causation of Stupor-Prognosis-Treatment,

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PAGE

LECTURE IX.

STATES OF DEFECTIVE MENTAL INHIBITION (IMPUL-
SIVE INSANITY, VOLITIONAL INSANITY, UN-
CONTROLLABLE IMPULSE, PSYCHOKINESIA, HY-
PERKINESIA, INHIBITORY INSANITY, INSANITY
WITHOUT DELUSION, EXALTATION, 'OR EN-
FEEBLEMENT, AFFECTIVE INSANITY). THE IN-

SANE DIATHESIS.

Self-control in the popular sense-Sane self-control need not be perfect
-Variation in amount of in different persons, ages, and conditions
of society-Laws, natural and human, should teach it-Physio-
logical view of inhibition in a child-Its absence at first-Its'
gradual growth with brain development-Degrees of inhibition
and of accountability-Conscience as a physiological brain quality
Children of criminals and of the insane-Organic lawlessness-
Self-control affected in all insanities-Want of inhibitory power
and morbid impulse as an insanity, without other morbid mental
symptoms-Uncontrollable motor impulses-Coughing-Sudden
acts of defence and offence -Exhaustion lessens controlling power
-Meaning of irritability-Doctrine of inhibitory centres of
motion, nutrition, and mental action-Laycock's doctrine of
reflex function of brain-Illustrated by maternal instinct in cats
-Illustrations and cases of impulsive but reasoning insanity-
Epileptiform character in some cases-Hereditary connection
with epilepsy-Impulsive acts by suggestion-Brain acting
automatically, just as muscles do during sleep in coughing,
speaking, &c.- Action from impulse either by loss of controlling
power, or by an excessive production of energy that must find an
outlet somewhere-Conscious and unconscious impulsive action
-Medico-legal importance and difficulty of uncontrollable action
from impulse-Defective inhibition may affect every kind of
action, every kind of affective state, and every propensity and
instinct-Degree of strength-May result in no action, but merely
a desire to act. Etiology. Heredity-Sunstroke-Effects of
alcohol on brain and offspring-Injuries to brain-Congenital
defects-Want of or bad early training-"Moral Idiocy "-
"Instinctive Juvenile Mania"-Visceral derangement and re-
flex irritation First symptoms of Mania or other insanity.
Prognosis.-Depends on causes-Some of the worst and most
hopeless cases of insanity as well as most dangerous and trouble-
some of this class, and some of the slightest. Treatment.-Pro-
tective to self and others-Change of scene, and removal from
association of morbid ideas-Medical, by improving health,

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