ALCOHOLIC BRAIN-DISORDERS. 



427 



embrace those of which the prominent character- 

 istic is that they show a temporary interference 

 with, and morbid intensification of, brain-func- 

 tion. This class will include delirium tremens 

 and mania a potu, and the classification is, I 

 think, more accurate than would be the case if I 

 were to speak of these disorders as being simply 

 acute ; for, though they may be acute in the sense 

 of being severe, they are not acute according to 

 the meaning which the ferm is generally employed 

 to convey — as running a short and definite course. 

 The presence in the blood and tissues of a poison 

 which it is necessary to eliminate, and the exist- 

 ence of a delirium which multiplies itself as long 

 as the deterioration of nutrition and the instabil- 

 ity of the nerve-centres combine to maintain it, 

 constitute a condition which renders precise lim- 

 itation of the symptoms and course of the dis- 

 order impossible. Without any apparent differ- 

 ence in the constitution of a patient, or in the 

 means by which the mania has been induced, the 

 intense furor which sometimes accompanies alco- 

 holic brain-disorder may disappear under treat- 

 ment during the course of a single night, while 

 under precisely the same appreciable conditions 

 the excitement may in another case continue for 

 weeks. In both cases the etiology, the treatment, 

 and the issue, may be the same ; but the mania is 

 a factor of so versatile and mobile a character 

 that, though the general and ultimate effect of 

 sedative and nutritive treatment may be safely an- 

 ticipated, the time which will be required for the 

 production of a good result can never be even 

 approximately determined. 



Under the second head I shall speak of cases 

 which are characterized anatomically by an es- 

 sential variation from the normal structure of 

 the contents of the cranial cavity. This group 

 will embrace cases of chronic alcoholic mania 

 not passing into dementia ; cases of dementia of 

 which the principal feature is almost absolute 

 loss of memory for recent events ; and cases 

 which either verge upon or merge into general 

 paralysis of the insane. 



Under the first head I shall at present refer 

 only to the state which bears the most charac- 

 teristic name — mania a potu — inasmuch as sim- 

 ple alcoholic delirium is a disease with which 

 general practitioners are more familiar than spe- 

 cialists in lunacy. When admitted to asylums, 

 patients suffering from mania a potu closely re- 

 semble each other even in the details of their 

 history, the nature of their excitement, and in 

 the circumstances of their admission. They have 

 generally undergone an initiatory experience in 



the police court and the strong cell ; are not un- 

 frequently brought to the asylum at night, as if 

 a sudden resolution had been arrived at as to the 

 advisability of regarding the patients as the vic- 

 tims of a disease essentially different from an or- 

 dinary attack of delirium tremens. At times the 

 maniac is firmly secured and accompanied by a 

 body of policemen. His suppressed excitement 

 manifests itself in his expression, which varies in 

 the same individual from abject timidity to sud- 

 den and violent emotion and aggressive impul- 

 siveness. The infliction of restraint intensifies 

 the mania in more ways than one. By the em- 

 ployment of force the patient is confirmed in his 

 belief that evil is in store for him, and is driven 

 to bay by the feeling of utter helplessness which, 

 as an external reality, combines with the insane 

 timidity alternating with his outbursts of aggres- 

 sive excitement. His inability to look upon things 

 in a rational manner places him in a position 

 which corresponds with the experience of an 

 animal inhaling an anaesthetic. In him the hu- 

 mane motive has the appearance of a purely hos- 

 tile design, and he experiences all the agony 

 which results from the entertainment of vague 

 notions of coming evil. When relieved from re- 

 straint the patient's excitement is almost inva- 

 riably alleviated, and the administration, forcible 

 if necessary, of liquid nourishment and antacid 

 effervescents, with bismuth and opium, is fre- 

 quently followed, with comparative speed, by re- 

 freshing repose. Sometimes, as I have already 

 said, the effect of concentrated liquid nourish- 

 ment and sedatives is so marked that one ad- 

 ministration is sufficient to produce a compara- 

 tive removal of the excitement, and the patient 

 begins to be skeptical about the hallucinations 

 which he so recently acted upon with avidity 

 and energy. By a continuation of treatment, and 

 by freedom from restraint, he resumes his former 

 calmness of demeanor, and cannot unfrequently 

 fix the exact time of his own recovery by being 

 able to employ his memory in going back, step 

 by step, to a particular hour when reminiscence, 

 first becoming difficult, gradually becomes impos- 

 sible. He cannot remember the incidents of his 

 excitement, and has only a dim recollection of 

 the nature of his delusions and hallucinations. 

 Unfortunately, however, cases so gratifying in 

 their issue are not often met with. The primary 

 effect of sedation is almost always good, but 

 probably in the middle of the night the pa- 

 tient's sleep becomes less sound, peripheral irri- 

 tations of a somatic or emotional nature thrust 

 themselves upon the consciousness, and the 



