The faculty of attention is variously affected in the subjects of insanity. In some the attention is entirely subjective, being occupied by sensations of misery, depression or sensory disturbances. In others the attention is objective, and attracted by every accidental sound or movement. In most of the early acute insanities the capacity of attention is wholly abolished, while in hebephrenia the stage of exhaustion which follows acute excitement, and the condition known as secondary dementia, loss of the power of attention is one of the most prominent symptoms. The memory for both recent and remote events is impaired or abolished in all acute insanities which are characterized by confusion and loss or impairment of consciousness. In the excited stage of manic-depressive insanity it is not uncommon to find that the memory is abnormally active. Loss of memory for recent but not remote events is characteristic of chronic alcoholism and senility and even the early stage of general paralysis. Entry: II
The disease occurs with equal frequency in men and women, and in the majority of cases commences during adolescence or early adult life. The universally accepted predisposing cause is hereditary predisposition. As to the exciting causes nothing is known beyond the fact that certain forms of disease, closely resembling delusional insanity, are apparently associated or caused by chronic alcoholism or occur as a sequel to syphilitic infection. In the vast majority of cases the onset is lost in obscurity, the patient only drawing attention to the diseased condition by insane conduct after the delusional state is definitely established. The friends of such persons frequently affirm that the patient has always been abnormal. However this may be, there is no doubt that in a few cases the onset is acute and closely resembles the onset of acute melancholia. The patient is depressed, confused, suffers from hallucinations of hearing and there are disturbances of the bodily health. There is generally mal-nutrition with dyspepsia and vague neuralgic pains, often referred to the heart and intestines. Even at this stage the patient may labour under delusions. These acute attacks are of short duration and the patient apparently recovers, but not uncommonly both hallucinations and delusions persist, although they may be concealed. Entry: DELUSIONAL
The commonest seat for atheroma of the cerebral vessels is the arteries at the base of the brain and their main branches, especially the middle cerebral. As a general rule the other arteries of the cerebrum are not implicated to the same extent, although in a not inconsiderable number of cases of the disease all the arteries of the brain may participate in the change. When this is so, we obtain those definite symptoms of slowly advancing dementia commencing in late middle life and ending in complete dementia before the usual period for the appearance of senile dementia. The same appearances are met with in certain patients who have attained the age in which senile changes in the arteries are not unexpected. As a rule atheroma in the cerebral vessels is but a part of a general atheroma of all the arteries of the body. Atheroma is common after middle life and increases in frequency with age. The chief causes are syphilis, alcoholism, the gouty and rheumatic diatheses and above all Bright's disease of the kidneys. Perhaps certain forms of Bright's disease, owing to the tendency to raise the blood pressure, are of all causes the most common. Entry: INSANITY
The exact pathology of writer's cramp has not been worked out, but it is now generally accepted that the disease is not a local one of muscles or nerves, but that it is an affection of the central nervous system. The complaint never occurs under thirty years of age, and is more frequent in males than females. Occasionally there is an inherited tendency to the disease, but more usually there is a history of alcoholism in the parents, or some neuropathic heredity. In its treatment the first requisite is absolute cessation from the employment which caused it. Usually, however, complete rest of the arm is undesirable, and recovery takes place more speedily if other actions of a different kind are regularly practised. If a return to the same work is a necessity, then Sir W. R. Gowers insists on some modification of method in performing the act, as writing from the shoulder instead of the wrist. Entry: CRAMP
_Morphinism._--The morphia habit is most commonly contracted by persons of a neurotic constitution. The mental symptoms associated with the disease may arise either as the result of an overdose, when the patient suffers from hallucinations, confusion and mild delirium, frequently associated with vomiting. On the other hand, mental symptoms very similar to those of delirium tremens may occur as the result of suddenly cutting off the supply of morphia in a patient addicted to the habit. Finally, chronic morphia intoxication produces mental symptoms very similar to those of chronic alcoholism. This latter condition, characterized by delusions of persecution, mental enfeeblement and loss of memory, is hopelessly incurable. The patient is always thin and anaemic on account of digestive disturbances. There is weakness or slight paralysis of the lower limbs, and the skeletal muscles are tremulous. Entry: INSANITY
DRUNKENNESS, a term signifying generally a state resulting from excessive drinking, and usually associated with alcoholic intoxication, or alcohol poisoning. It may represent either an _act_ or a _habit_, the latter consisting in frequent repetitions of the former. As an act it may be an accident, most usually arising from the incautious use of one or other of the commonly employed intoxicating agents; as a habit (as in the form of chronic alcoholism) it is one of the most degrading forms of vice which can result from the enfeeblement of the moral principle by persistent self-indulgence. Entry: DRUNKENNESS
Fusel oil and its chief constituent, amyl alcohol, are direct nerve poisons. In small doses it causes only thirst and headache, with furred tongue and some excitement. In large doses it is a convulsent poison. Impure beverages induce all the graver neurotic and visceral disorders in alcoholism; and, like fusel oil, furfurol and the essence of absinthe, are convulsent poisons. Pure ethyl alcohol intoxication, indeed, is rarely seen, being modified in the case of spirits by the higher alcohols contained in fusel oil. According to Rabuteau the toxic properties of the higher alcohols increase with their molecular weight and boiling point. Richet considers that the fusel oil contained in spirits constitutes the chief danger in the consumption of alcoholic beverages. The expert can immediately detect the peculiarly virulent characters of the mixed intoxication due to the consumption of spirits containing a large percentage of fusel oil. Entry: FUSEL
_Tachycardia_ is the name applied to a more or less permanent increase in the rate of the heart-beat. It is usually a prominent feature in the affection known as Graves' disease or exophthalmic goitre. It may also result from chronic alcoholism. In the condition known as paroxysmal tachycardia there appears to be no adequate explanation for its onset. Entry: 2
_Chronic Alcoholic Insanity._--Almost any mental disorder may be associated with chronic alcoholism, but the most characteristic mental symptoms are delusions of suspicion and persecution which resemble very closely those of the persecution stage of systematized delusional insanity. The appearance of the patient is bloated and heavy; the tongue is furred and tremulous, and symptoms of gastric and intestinal disorder are usually present. The gait is awkward and dragging, owing to the partial paralysis of the extensor muscles of the lower limbs. All the skeletal muscles are tremulous, particularly those of the tongue, lips and hands. The common sensibility of the skin is disordered so that the patient complains of sensory disturbances, such as tinglings and prickings of the skin, which may be interpreted as electric shocks. In some cases the mental symptoms may be concealed, but delusions and hallucinations, particularly hallucinations of sight and hearing, are very commonly present. The delusions are often directly the outcome of the physical state; the disordered stomach suggesting poisoning, and the disturbances of the special senses being interpreted as various forms of persecution. The patient hears voices shouting foul abuse at him; all his thoughts are read and repeated aloud; electric shocks are sent through him at night; gases are pumped into his room. Sexual delusions are very common and frequently affect marital relations by arousing suspicions regarding the fidelity of wife or husband; or the delusions may be more gross and take the form of belief in actual attempts at sexual mutilations. The memory is always impaired. Entry: INSANITY
CAPSICUM, a genus of plants, the fruits of which are used as peppers (see CAYENNE PEPPER for botany, &c.). As used in medicine, the ripe fruit of the _capsicum mimum_ (or _frutescans_), containing the active principle capsaicin (capsacutin), first isolated by Thresh in 1876, has remarkable physiological properties. Applied locally to the skin or mucous membrane, it causes redness and later vesication. Internally in small doses it stimulates gastric secretions and causes dilatation of the vessels; but if used internally in excess for a long period it will cause subacute gastritis. In single doses in excess it causes renal irritation and inflammation and strangury. The administration of capsicum is valuable in atony of the stomach due to chronic alcoholism, its hot stimulating effect not only increasing the appetite but to a certain degree satisfying the craving for alcohol. It is also useful in the flatulency of the aged, where it prevents the development of gas, and has a marked effect on anorexia. It has been used in functional torpidity of the kidney. Externally capsicum plaster placed over the affected muscles is useful in rheumatism and lumbago. Capsicum wool, known as calorific wool, made by dissolving the oleoresin of capsicum in ether and pouring it on to absorbent cotton-wool, is useful in rheumatic affections. Entry: CAPSICUM
INSANITY ASSOCIATED WITH OR CAUSED BY ALCOHOLIC AND DRUG INTOXICATION.--The true rôle of alcoholic indulgence in the production of insanity is at present very imperfectly understood. In many cases the alcoholism is merely a symptom of the mental disease--a result, not a cause. In others, alcohol seems to act purely as a predisposing factor, breaking down the resistance of the patient and disordering the metabolism to such an extent that bodily disorders are engendered which produce well-marked and easily recognized mental symptoms. In others, again, alcohol itself may possibly act as a direct toxin, disordering the functions of the brain. In the latter class may be included the nervous phenomena of drunkenness, which commence with excitement and confusion of ideas, and terminate in stupor with partial paralysis of all the muscles. Certain brains which, either through innate weakness or as the result of direct injury, have become peculiarly liable to toxic influences, under the influence of even moderate quantities of alcohol pass into a state closely resembling delirious mania, a state commonly spoken of as _mania a potu_. Entry: INSANITY
Considerable diversity of opinion exists at present regarding the causation of general paralysis. Hereditary predisposition admittedly plays a very small part in its causation. There is, however, an almost universal agreement that the disease is essentially the result of toxaemia or poisoning, and that acquired or inherited syphilitic infection is an important predisposing factor. A history of syphilitic infection occurs in from 70 to 90% of the patients affected. At first it was held that general paralysis was a late syphilitic manifestation, but as it was found that no benefit followed the use of anti-syphilitic remedies the theory was advanced that general paralysis was a secondary auto-intoxication following upon syphilitic infection. The latest view is that the disease is a bacterial invasion, to which syphilis, alcoholism, excessive mental and physical strain, and a too exclusively nitrogenous diet, only act as predisposing causes. This latter theory has been recently advanced and elaborated by Ford Robertson and McRae of Edinburgh. Entry: GENERAL
_Bright's disease_ is the term applied to certain varieties of acute and chronic inflammation of the kidney. Three forms are usually recognized--acute, chronic and the granular or cirrhotic kidney. In the more common form of granular kidney the renal lesion is only part of a widespread affection involving the whole arterial system, and is not actually related to Bright's disease. _Chronic Bright's disease_ is sometimes the sequel to acute Bright's disease, but in a great number of cases the malady is chronic from the beginning. The lesions of the kidney are probably produced by irritation of the kidney-structures owing to the excretion of toxic substances either ingested or formed in the body; it is thought by some that the malady may arise as a result of exposure to cold. The principal causes of Bright's disease are alcoholism, gout, pregnancy and the action of such poisons as lead; it may also occur as a sequel to acute diseases, such as scarlet fever. Persons following certain occupations are peculiarly liable to Bright's disease, e.g. engineers who work in hot shops and pass out into the cold air scantily clothed; and painters, in whom the malady is dependent on the action of lead on the kidney. In the case of alcohol and lead the poison is ingested; in the case of scarlet fever, pneumonia, and perhaps pregnancy, the toxic agent causing the renal affection is formed in the body. In Bright's disease all the elements of the kidney, the glomeruli, the tubular epithelium, and the interstitial tissue, are affected. When the disease follows scarlet fever, the glomerular structures are mostly affected, the capsules being thickened by fibrous tissue, and the glomerular tuft compressed and atrophied. The epithelium of the convoluted tubules undergoes degeneration; considerable quantities of it are shed, and form the well-known casts in the urine. The tubules become blocked by the epithelium, and distended with the pent-up urine; this is one cause of the increase in size that the kidneys undergo in certain forms of Bright's disease. The lesions in the tubules and in the glomeruli are not generally uniform. The interstitial tissue is always affected, and exudation, proliferation and formation of fibrous tissue occur. In the granular and contracted kidney the lesion in the interstitial tissue reaches a high degree of development, little renal secreting tissue being left. Such tubules as remain are dilated, and the epithelium lining them is altered, the cells becoming hyaline and losing their structure. The vessels are narrowed owing to thickening of the subendothelial layer, and the muscular coat undergoes hypertrophic and fibroid changes, so that the vessels are abnormally rigid. When the overgrowth of fibrous tissue is considerable, the surface of the organ becomes uneven, and it is for this reason that the term _granular kidney_ has been applied to the condition. In acute Bright's disease the kidney is increased in size and engorged with blood, the changes described above being in active progress. In the chronic form the kidney may be large or small, and is usually white or mottled. If large, the cortex is thickened, pale and waxy, and the pyramids are congested; if small, the fibrous change has advanced and the cortex is diminished. Bright's disease, both acute and chronic, is essentially a disease of the cortical secreting portion of the kidney. The true granular kidney, classified by some as a third variety, is usually part of a general arterial degeneration, the overgrowth of fibrous tissue in the kidney and the lesions in the arteries being well marked. Entry: KIDNEY
Whatever may be the causes of these and other false perceptions,--most curious when the impression is shared by several witnesses,--they may best be considered under the head of hallucination (q.v.). Hallucinations may be pathological, i.e. the result of morbid conditions of brain or nerve, of disease, of fever, of insanity, of alcoholism, of the abuse of drugs. Again, they may be the result of dissociation, or may occur in the borderland of sleep or waking, and in this case they partake of the hallucinatory nature of dreams (q.v.). Again, hallucinations may, once or twice in a lifetime, come into the experience of the sane, the healthy, and, as far as any tests can be applied, of the wide-awake. In such instances the apparition (whether it take the form of a visual phantasm, of a recognized voice, of a touch, or what not) may be coincidental or non-coincidental. The phantasm is called coincidental if it represents a known and distant person who is later found to have been dying or in some other crisis at the moment of the percipient's experience. When the false perception coincides with nothing of the sort, it is styled non-coincidental. Coincidental apparitions have been explained by the theory of telepathy (q.v.), one mind or brain impressing another in some unknown way so as to beget an hallucinatory apparition or phantasm. On the evidence, so far as it has been collected and analysed, it seems that the mind which, on the hypothesis, begets the hallucinations, usually does so without _conscious_ effort (see SUBLIMINAL SELF). There are, however, a few cases in which the experiment of begetting, in another, an hallucination from a distance, is said to have been experimentally and consciously made, with success. Entry: APPARITIONS
_Cirrhosis of the Liver._--As the result of chronic irritation of the liver increased supplies of blood pass to it, and if the irritation is unduly prolonged inflammation is the result. The commonest causes of this chronic hepatitis are alcoholism and syphilis. The new fibrous tissue which is developed throughout the liver, as the result of the chronic inflammation, causes general enlargement of the liver with, perhaps, nausea, vomiting and jaundice. Later the new fibrous tissue undergoes contraction and the liver becomes smaller than natural. Blood then finds difficulty in passing through it, and, as a result, dropsy occurs in the belly (ascites). This may be relieved by tapping the cavity with a small hollow needle (Southey's trocar), or by passing into it a large sharp-pointed tube. This relieves the dropsy, but it does not cure the condition on which the dropsy depends. A surgical operation is sometimes undertaken with success for enabling the engorged veins to empty themselves into the blood-stream in a manner so as to avoid the liver-route. Entry: SURGERY
_Chronic Poisoning._--A dose of a little more than a drachm (a teaspoonful) will produce a condition of inebriation lasting for one-half to one hour, but the dose must soon be greatly increased. The after-effects are, if anything, rather pleasant, and the habit of ether drinking is certainly not so injurious as alcoholism. The principal symptoms symptons of chronic ether-drinking are a weakening of the activity of the special senses, and notably sight and hearing, a lowering of the intelligence and a degree of general paresis (partial paralysis) of motion. Entry: ETHER
Delirium tremens is one of a train of symptoms of what is termed in medical nomenclature acute alcoholism, or excessive indulgence in alcohol. It must, however, be observed that this disorder, although arising in this manner, rarely comes on as the result of a single debauch in a person unaccustomed to the abuse of stimulants, but generally occurs in cases where the nervous system has been already subjected for a length of time to the poisonous action of alcohol, so that the complaint might be more properly regarded as acute supervening on chronic alcoholism. It is equally to be borne in mind that many habitual drunkards never suffer from delirium tremens. Entry: DELIRIUM