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the most irregular manner. The temperature is generally lower than normal.
The condition of chronic gastritis from which many patients suffer not infrequently leads them to think that they are being poisoned. The movement of gas in the stomach sometimes gives rise to the belief that there is a snake or some animal there. The character of the hallucinations, suspicions, and delusions generally renders the person sad and melancholic, and he may become so much depressed that he endeavors to commit suicide. When the element of suspicion is most prominent, he may become excited, and determine to resist and overcome his enemies, and for this purpose resorts to violence.
In some cases epileptoid attacks accompanied with trembling or twitching of the hands, faintness, difficulty in breathing, and sometimes with vertigo and vomiting, followed by great prostration, attend the course of the disorder with more or less frequent regularity; and again he may pass into a condition of hebetude, remaining day after day with a dull, stolid appearance of countenance, saying little or nothing to those about him, or if he replies at all it is only in monosyllables, or words imperfectly articulated. These mental states are subsequent to those of excitement referred to above, and generally are attended with local anaesthesias affecting the extremities and portions of the body.
When the delusions and suspicions have become partially allayed, as is not unfrequently the case, the person will spend months or years in some form of daily occupation, under the supervision of others. He may not voluntarily refer to the delusions concerning his family or friends, but on being questioned admits that he still believes his wife has been faithless, and that his present condition is due to
the plot of some former friend. Even when these delusions have entirely passed away, and the mind appears to be clear and active, it is rarely the case that it regains its normal tone. It remains permanently on a lower plane, and the patient becomes indifferent to the opinions of friends and society; the natural affection for children and wife, and desire for their welfare and interests, do not resume their former ascendancy, and he refers to them only when questioned.
EXAMPLE 1.-J. M., age fifty, a farmer. His father died of phthisis. Has used alcohol, and smoked and chewed to excess for years. Two years ago he became morose, and at times subject to fits of violent anger; was restless and irritable, did not sleep well, had loss of appetite, suffered from indigestion and lost flesh. On several occasions he attacked his wife and threatened to kill her, and also some of his neighbors, because, as he claimed, they were trying to get his property from him. He carried a revolver with him, and for some time before admission was under the charge of a sheriff. On admission had many ill-defined delusions, and was not sure of anything, but thought some one was plotting against him; attributed his troubles largely to his second marriage, and said his enemies in town had concocted vile stories about him and the chastity of his wife, and he had left her and gone to a neighboring town to live. Thought he had been poisoned by wearing a pair of shoes which had been given him, as he had a strange sensation in his feet when using them. After some months he began to work in the garden, but persisted in his belief as to the chastity of his wife, and though she often wrote to him, said the letters were not from her. The delusions continued active, and he made no requests to be allowed to go home.
EXAMPLE 2.-W. A. R., a farmer, age fifty-eight; has been intemperate for more than twenty years; his father was also intemperate. Had rheumatism several years ago, and has been sensitive to the effects of heat. Had partial paralysis of the right side seven weeks prior to admission, attended with loss of memory, incoherence, and delusions ; thought that he was not in his own house, and when in bed that he was walking about the neighborhood. On admission he appeared to be weak and illy-nourished; action of the heart feeble; bowels costive; had hemorrhoids; loss of appetite ; trembling of the hands, and unsteady gait. Had hallucinations of sight; did not sleep; thought that the walls of his room were closing in on him; was very noisy at times in the night from terror, at other times thought he was at work in the woods all night drawing wood; or that he was shut up in a tomb; complained that persons came into his room at night, and threw him out of bed on the floor; that they went to the rooms above him and shouted at him to prevent his sleeping; that they were plotting to kill him; thought he could see writing on the carpet of his room. He often complained of prickling and smarting sensations on his body and limbs; also that rheumatic pains were present about the region of the sciatic nerves. These prickling pains seemed to alternate with shooting and electric-like flashes along his spine and the tracks of the spinal nerves.
After three months the hallucinations became less vivid; he slept better and was less depressed. Has, at the time of this writing, partial anesthesia of his right side from his shoulder to his knee, and complains much of cold when the thermometer is at seventy degrees, and sits for hours with his hat and overcoat on, near the steam radiator, when not required to exercise in the grounds, where he walks daily in a feeble manner.
Diagnosis.—This is not difficult, and may be verified by the history and general appearance of the person, the trembling of the hands, the difficulty of coördinated movements of hands and feet, the character of the hallucinations and suspicions, the hebetude of mind, and the change of character. Other points of diagnosis will be referred to in the next lecture.
Treatment.—Effort should first be made to restore the stomach to such a condition that it will crave and digest food. For this purpose the vegetable tonics, preceded by gentle laxatives, may be advantageously used. Strychnine, electricity, and the acid phosphates are all of some value in restoring tone to the demoralized nervous system, and should be given in connection with abundance of food, gentle exercise in the open air, and, as soon as the patient is sufficiently strong, occupation in the garden and field. When indisposed to take exercise, or too weak to do so, passive exercise or massage may be employed, or the patient aided in exercising by attendants. Improvement may be expected, especially in first attacks, but relapses are very certain to occur, and persons rarely make good recoveries from chronic alcoholic insanity.
Pathological Anatomy.—The membranes are thickened, and there are often observed slight extravasations of blood in the pia mater, and adhesions to the eminences of the convolutions, which resemble those existing in cases of general paresis. The volume of the brain is lessened, the fibrous tissues increased and the arteries atheromatous; these vascular changes lead to partial congestions, softening and breaking down of the substance of the brain, attended with slight hemorrhages, or exudation of serum. The pathological changes existing in the liver, stomach, and other portions of the body will be found described in treatises on general practice.
ALCOHOLIC INSANITY. (CONCLUDED.) Alcoholic Paresis—Diagnosis of—Character of Mental and Physical Symptoms
Contrasted -- Peripheral Neuritis—Hyperästhesia— Treatment- Morpbin ism—“ The Opium Habit "-Increase of-Mode of Invasion-DoseIdiosyncrasies—Hypodermic Use of Morphine-Symptoms-Feelings of Exaltation Followed by Those of Depression-Increase of Dose Necessary-Loss of Memory and Moral Tone- Effects Upon Nerve Cells and the Sensory System of Nerves-Prognosis— Treatment.
ALCOHOLIC PARESIS. (Alcoholic Degeneration.) Other cases pass into a still larger degree of alcoholic degeneration, and develop symptoms which closely resemble those existing in general paresis. It is important to observe and become somewhat familiar with any differences which may be found to exist in the symptomatology of these two forms of disease.
1. Ideas of grandeur, an optimistic feeling, and a facile state of mind are often found in both these diseases. In the general paretic, however, they are more frequently among the primary mental symptoms, and, though they may be associated with, yet are very rarely secondary to the sensorial and motor disturbances. On the other hand, when existing in alcoholic paresis they are always associated with motor and sensorial disorders, and are secondary to them in the order of their development.
In general paretics the ideas of importance and grandeur are often changing from day to day, without order or con