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peculiar mental restlessness." The disease is, as a general rule, easily distinguished, and is a very definite pathological entity both in its symptoms, causes, and course. It is a very curable disease at first, but as most commonly happens, when cured, the cause is soon at work again, and a relapse is the result. After a patient has had many attacks, there are certain mental, moral, motor, and sensory changes that take place, all running hand in hand, and abundantly proving the complete solidarity of the psychical and somatic functions of the nervous system. The intellectual power becomes weakened, they begin to exhibit many of the moral perversions and weaknesses, such as cowardice and untruthfulness, which I shall presently describe as characteristic of the dipsomaniac; the motor deficiency is shown by the muscular unsteadiness and trembling which become permanent, though aggravated during the acute outbursts, and there is a sensory paralysis of the limbs. All these things show degeneration of the nerve structure, from chronic poisoning, and excessive stimulation. Last of all a state of dementia is reached, the goal of all insanities, and that of alcoholism is in no way distinguishable psychologically from the profound dementia of other forms of mental disease. The motor and sensory complications alone mark its original form.*

Dipsomania.-This is a form of insanity that may conveniently be treated of at this point, though not nearly allied pathologically to alcoholism. Dr. Skae held very decided

views as to the existence and well-marked character of this disease, and his opinions were the result of very much practical experience in the treatment of such cases. While he had no doubt that many persons labour under a true neurotic disease, the chief symptom of which is an intense craving for alcoholic drinks which they cannot control, a disease which presents all the characters of other brain diseases in being frequently periodic, in its damaging and weakening effect on all the functions of the brain when of long duration, in its being very commonly a hereditary affection, some of

In the "Edin. Med. Journ.," for Dec., 1874, Mr. Hayes Newington, in one of "The Royal Edin. Asylum Papers," describes a kind of alcoholic mania of short duration, occurring as the result of alcoholic poisoning in a brain hereditarily predisposed to insanity, and very easily overset in its functions by a small quantity of the poison that would not be enough to cause delirium tremens. The brain gives way, in fact, from inherent weakness, before the latter disease has time to come on The brain weakness is shown by the small amount of self-control, and the early tendencies to vice always shown by such cases. this kind of brain disturbance he would limit the term "Mania à Potu."

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the ancestors and relations of the patients having the same disease, or suffering from other nervous affections, and lastly in its being frequently the result of physical causes that are also common causes of brain diseases, such as blows on the head-while he held this opinion strongly, yet he was by no means extreme or irrational in holding that all habitual drunkards are dipsomaniacs, or that it is always easy to distinguish between the two things. Last year Dr. Skae expressed his views in a very full and definite way before Mr. Dalrymple's Committee of the House of Commons, on his Habitual Drunkards' Bill. I think I cannot do better than give you an abstract of this evidence, the notes of which I drew up for him at his dictation the night before he went to London to be examined. He said, "I think there is a great variety among drunkards. First of all there is the regular drunkard who keeps sober during the day and gets drunk at night; attending to his business regularly. Such men may carry on for many years without injury to themselves or others. I have known one case where a gentleman was carried to bed drunk every night for 50 years, and yet he made a large fortune, and was in the market every morning attending to his business. I do not think that these are cases requiring any interference. The next class I would call the tipplers, who take small glasses of whisky or spirits of some sort, or ale or beer at intervals during the whole day." "Another class are what we call dipsomaniacs, or I would rather call it moral insanity, of which the drinking is one of the principal features. Those persons lose all control over themselves, and drink to any extent possible; in fact, they will drink anything they can get hold of, and if they cannot get spirits they will drink hair wash, or anything of a stimulating kind. Some of these cases are periodic, and come on at long intervals of time, perhaps two or three years; others come on at short intervals of time, perhaps every month or three months; those persons keep well for a few months, and then take ill again, when they lose all selfcontrol. These cases are mostly hereditary, though very often caused by disease, by blows on the head, sometimes by hæmorrhage and the loss of a large quantity of blood, sometimes by disease of the brain. All these cases I mention to show that this is really a disease, and not mere cases of drunkenness. I think that these persons ought certainly to be restrained for a considerable length of time, in the hope of curing them of this craving. Then there is another form of

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insanity brought on by drinking, namely delirium tremens: that is a form of delirium rather than insanity." "Then, besides these, there are forms of insanity (with a craving for drinking) characterised by delusions, for example, hallucinations of hearing and seeing. These, I think, are truly insane, and have distinct delusions; they are very often suspicious of their friends, and are dangerous to be at large. I think that these are the principal forms which I have noted." have known a lady (who laboured under true dipsomania) drink shoe black and turpentine. There are other symptoms of insanity besides the mere drinking. Such persons are entirely given to lying. You cannot believe a word they say when under the influence of the drink-craving, and they very often entertain a dislike to their friends which makes them dangerous. I have a gentleman under my care just now, who has been well for three years, but when he is ill he hates his wife and he hates his own life."

Such is the variety of insanity denominated dipsomania in the table. In regard to its frequency as compared with other forms of insanity, I find that in the first thousand cases admitted into the Carlisle Asylum, there were 50 of this disease, or about 5 per cent. Its curability is, I fear, very slight; or, at all events, it is most apt to relapse.

Before I leave those varieties of insanity that result from poisons introduced into the blood (the syphilitic forms, delirium tremens, and insanity of alcoholism), I may mention two other very curious and interesting forms, not mentioned in the table, that result in the same way. Happily neither the one nor the other is met with in this country. Griesinger describes the cases of young men in a malarious district who suffered from attacks of insanity coming on in the one case every other day, and in the other every fourth day, both being cured by quinine. This was clearly a Malarious Insanity; in the one case being tertian and in the other quartan. The symptoms were acute delirious excitement, with delusions, coming on suddenly and accompanied by quick strong pulse and heat of head."

Pellagrous Insanity.-In certain parts of France, and much more in certain parts of Italy, a disease known as Pellagra is common. It is caused by the use of diseased Indian corn as an article of diet. The mental phenomena, which are part of the complete evolution of this disease, "are very interesting in themselves, and still more important as contributing

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another instance to the comparison of insanity with other diseases which is such a promising branch of study." Prof. Lombroso has fully described the "Pellagrous Insanity" that is part of this disease in certain cases. He says it is characterised by "greater moral impressionability. A slight insult, the threatening of some trivial danger, completely carries them away, although they, perhaps, appeared before to be of sound mind. For example, a woman believes herself to be lost because she has missed mass; another person is in despair and goes mad because he has lent a pistol to a friend who will not return it. A woman hears her companions laughing at her dress, and becomes insane from grief; another, merely because her husband, a fisherman, is a few minutes late, breaks out into violent mania." "A real or apparent stupidity, an obstinate mutism "-called by Lambroso "a psychical catalepsy"—is common. A most curious symptom of pellagrous insanity, and one said to be the most characteristic of all, is what is called by the Italian physicians"Hydromania." "In one set of cases water is sought or desired on account of its coldness, in another set from its shining surface, the latter set being equally fond of the sight of fire, and will burn furniture to see the blaze. A third set of such patients have a profound dislike for the sight or touch of water on account of the vertigo it instantly produces in them. The symptoms are intermittent, being most common in the colder months. After death distinct pathological lesions are found in the brain. The most wonderful thing of all about pellagra and its insanity is that it is only curable by arsenic, and no other remedy, and that its recurrence is preventible by first steeping the diseased grain in lime, and then subjecting it to heat.

Post-Febrile Insanity.-The next form of insanity I shall refer to is that called by Dr. Skae post-febrile insanity. The exhaustion of the vital powers that is caused by zymotic diseases sometimes takes special effect on the higher functions of the brain, and we have an attack of insanity resulting. The nervous affections that often follow fevers in children are well known. These, no doubt, are precisely analagous to the post-febrile insanity of the adult. That insanity which sometimes followed fevers was known from the earliest times, and was evidently much more common two hundred years ago than now, but it was then ascribed not to the exhausting effects of the

* Dr. Gasquet, "Journ. Ment. Sci.," January, 1872.

fever, but to its not having been treated with "sufficient dilution and purges to carry off the entire materies morbi, thus leaving a dangerous element in the system that was liable to fly to the head, and cause insanity. Arnold thought that insanity was much less common in his time than in Sydenham's after fevers and agues, because they purged more than the older physicians, and used the Peruvian bark more freely. Post-febrile insanity is not specially confined to one kind of fever. I have gone over the records of over a thousand cases of insanity that were sent to the Carlisle Asylum, and I find that among those there have been ten cases of such post-febrile insanity, four of which followed scarlet fever, two small-pox, one typhus, one typhoid, one intermittent, and in the tenth case I could not ascertain the exact form. Those are small numbers to determine the statistics of a disease, but I am not aware of any fuller statistics on the subject. I think those numbers represent in a general way the comparative frequency of its occurrence after the different fevers. Scarlatina is unquestionably the most frequent cause, and smallpox the next. It is said to follow typhus more frequently than typhoid, and as intermittent fever is now unknown in this country, this is a very rare cause of the disease. Whether this represents the comparative exhausting powers of the poisons of those fevers on the brain, or whether scarlatina is at the head from its greater frequency, or from its more common occurrence in youth when the brain has not attained its maturity, I am unable to say with certainty. The form of insanity that results after scarlatina is almost always characterised by symptoms of dementia which is incurable. We might expect this from the well known occurrence of idiocy and epilepsy in children after this disease of sequelæ and complications. More frequently than after any other fever we hear the remark, "Such a person has

never been the same since he had scarlet fever." On the whole I think there is fair ground for the assumption that the poison of this disease is more apt to leave permanent brain disease than any of the others. When mental symptoms follow the disappearance of scarlatina they do so at once; the patient not having an attack of acute excitement so commonly as that he is left after the disease in a state of partial dementia. The weakness of mind is not complete, but more of a partial imbecility, a blunting of all the mental faculties and affections, with attacks of sub-acute excitement and irritability. In

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