PATHOLOGY
544
PATHOLOGY
less in all sorts of positions. Set forms of speech,
eertaiii sonRS anil motions are repeated in a stereo-
typed manner. .\11 of these states can change with
ureal rapidity. \ ery often a remarkably sudden im-
provement sets in, leading one to expect a recovery.
Little by little a state of incurable dementia becomes
established.
(.5) Senile Dementia. — On a basis of a general breakdown due to okl age, there develops incicasiiig dementia, cliieHy cliaracterized by a disturbaiicr of memory. In the mild eases the patients remember the occurrences, jiersons, and names from their early years, but cannot retain in their memory anything recent. In the severe cases the patients live entirely in the past, speak of their parents as still living, think themselves from twenty to thirty years old, do not know where they are, nor what is going on about them. As a result such patients are easily led, are suggesti- hle; they do not know, for instance, what they have done in the morning, but declare, on being questioned, that they have been to school. Married women recall only the names of their parents and forget that they have had children. As a result of forgetting many words, their speech also is often very character- istic. Many nouns having escaped them, they help themselves out by frequent repetitions of stop-gap expressions, such as "what-d'ye-call-it", etc., or they use tiresome circumlocutions (e. g. instead of key, they say, "a thing that one opens things with"). The patients are irritable, hypochondriacal, sus- picious, believe that their pockets have been picked, or that they have been poisoned. As in general paresis and dementia prcecox, it is especially important to remember that marked loss of the moral sense may for some time precede the loss of intelligence. Sexual desire especially mounts up again in unhealthy fashion in these old people, and leads with special frequency to immoral attacks upon small children. Very fre- quently, in the early stages of senile dementia, there maybe observed silly, intense ideas of jealousy, whose object is often the aged wife with whom the patient has lived for many decades in the happiest of wedlock. By reason of the disturbance of memory and the above-mentioned suggestibility, these patients often fall victims to unprincipled scoundrels, who swindle them out of their entire fortunes, induce them to make foolish wills, etc.
(6) Chronic Delusion (Paranoia). — Certain pa- tients develop ever-increasing fixed delusions with clear consciousness and without any weakening of the intellect. The individual stages of this disorder may usually be distinguished. At first, these patients believe themselves to be under observation, to be pursued by enemies. Everything that is done has a deliberate reference to themselves; people slander them, spy upon them, or watch them. Hallucinations of hearing develop (e. g. mocking, abusive voices). The circle of their persecutors gradually enlarges; it is no longer a definite person (an enemy, a rival, a business competitor, etc.) who is the originator of this persecution and slander, but entire classes or bodies (Freemasons, Jesuits, political parties, the entire Civil Service, the members of the royal house- hold, etc.). As their grandiose ideas develop, the patients believe themselves the victims of widespread intrigues and persecutions, because others are envious of them, or because of their importance. The con- crete content of the delusions varies greatly in different cases, but remains fixed in the same indi- vidual. One believes himself to be an important inventor; another, a reformer; a third, a legitimate successor to the throne; a fourth, the Messias. In addition to the hallucinations of hearing, different bodily hallucinations develop. The patients feel them- selves electrified, penetrated with the rontgen rays, etc. In the initial stages the patients are very often well able to hide their delusional ideas in case of
necessity, and to pretend that they no longer believe iu
them (dissinmlation). By reivson of the obstinacy of
the ideas of penseculion, and especially because of
their clearness of thought in other respcds, 1he.se
patients may become very dangerous, attacking those
about them with violence, taking their revenge by
killing, or by well-planned murders of their supposed
persectutors.
In many cases the apinirent sanity of these patients, and the fanaticism with which they inomulgute their ideas, deceive an uncritical following, so that healthy but undiscriminating people share in their tlelusions (induced insanity). Many cases of so-called psychic epidemics, of perversely abstruse religious sects, be- long to this category. In some cases the ideas of perse- cution are based on real or imaginary legal injustice suffered by the patient, who then beUeves that all advocates, judges, and administrative authorities are in league against him {Paranoia qiiervlans, litigious paranoia). Traces of this are seen in the cases of ob- stinate litigants, who spend large amounts of money on lawyers to recover absurdly insignificant sums. When their complaints are dismissed everywhere, they commit a crime merely in order to come before a jury and be thus enabled to renew their old suit.
(7) Alcoholic Mental Disease. — In addition to what has already been said of alcoholism, it may be added that in chronic drinkers there often arise character- istic, motiveless delusions of jealousy (alcoholic para- noia), which, by reason of the habitual brutality of the drinker, lead to continuous cruelty, and at times to assault and murder of the wife.
Pathological intoxication is another important dis- ease, in which the symptoms of ordinary drunken- ness do not appear, but which constitutes a true psy- chosis. This is usually of short duration ; the patients are for the most part unusually violent, are entirely confused, and on recovery have no memory whatever of their mental disturbance. In delirium tremens, in addition to the marked tremor, sweating, and absolute sleeplessness, one finds vivid hallucinations of sight (of numberless small animals, mice, vermin, men, fiery devils, etc.), confusion, and feverish activity, dur- ing which the patients go about restlessly, working with imaginary tools. In other cases active hallucina- tions of hearing take place. They hear threatening and abusive voices, which may make the patient so anxious as to lead him to impulsive suicide.
(8) Epileptic Psychosis.- — Mild but permanent psy- chical anomalies are observed in very many epileptics. These patients are for the most part extremely sensi- tive and irritable, and, in contrast with this, may often simultaneously showan exaggeratedly tender and pathetic pietism. Not infrequently one observes char- acteristic periodic variations in the mood. P'rom time to time the patients themselves feel an incomprehen- sible internal unrest, anxiety, or sadness; some seek to mitigate this condition by taking strong nerve poisons, at times in excessive doses (many eases of dipsomania belong to this class) ; others have recourse to debauch- ery; a thinl cla.ss go off like tramps for days; while a fourth attempt suicide. In other cases we meet with moodini'.ss, which is not sad but irritable and angry, and consequently differs from the regiilur irrital)ility of the epileptic; it frequently leads to most violent attacks upon those about them. Such conditions may often be traced even to earliest childhood.
In connexion with eclampsia, or even in its place, there often take place characteristic mental disturb- ances which begin very suddenly (dream or twilight states), last but a short time and pass, usually leaving no trace in the memory. These attacks show them- selves outwardly in characteristic impulsive acts — as for instance in aimless wanderings (many cases of niil- itary desertion are due to such attacks), or in delirious confused conditions, mostly of a horrifying nature (fire, blood, ghosts, etc.). Such patients are often very
