ALCOHOLIC BRAIN-DISORDERS. 



429 



alcohol, and to the tendency which one series of 

 delusions has to cause the formation of another 

 up to the time when the alcohol has been elimi- 

 nated, and the excitement subdued by proper 

 nourishment and sedatives. The second point is, 

 that an hereditary and collateral tendency to in- 

 sanity appears to be more than usually common 

 among the victims of mania a poiu. 



In proceeding to speak of the forms of alco- 

 holic insanity in which the presence of some or- 

 ganic change in the cerebral vessels, or the brain- 

 substance, is supposed to exist, I have first to 

 mention a form of chronic mania produced by 

 alcoholism which Dr. Magnan seems to have 

 omitted from his classification. In our English 

 asylums there are numerous cases in which the 

 alcoholic disease manifests itself in the form of 

 recurrent ' attacks of excitement, generally based 

 upon some delusion of suspicion, or some hallu- 

 cination of the special senses. Such cases may 

 be of very long duration, and may undergo no 

 change during the greater part of their course. 

 They may commence as uncured cases of mania a 

 potu, or they may be the result of a gradually- 

 developing mania arising from the constant abuse 

 of alcoholic stimulants for prolonged periods. 

 That they are characterized by a decided predis- 

 position to insanity is shown by the fact that 

 they sometimes occur in very young patients, in 

 whom the constitutional condition must have 

 favored the development of the mania. One of 

 the most typical instances I have ever seen was 

 that of a youth, who was about twenty-one years 

 of age, and in whom delusions of suspicion and 

 hallucinations of sight and hearing were developed 

 with great fertility. A leading feature of these 

 cases is that sometimes the patient may be qui- 

 escent, tractable, and industrious, for a consider- 

 able time, unless his delusions are voluntarily or 

 accidentally aroused ; but, when they are touched 

 upon, his excitement is extreme. He threatens 

 violence, and seems frequently to be on the point 

 of employing it, but rarely does so. His speech 

 is voluble and vituperative, and his movements 

 agitated and rapid ; but he is comparatively co- 

 herent, shows no defect of memory, and no other 

 sign of dementia. In rare cases the patient is 

 sullen and intractable, and given to instantaneous 

 outbursts of violence, of which he offers no ex- 

 planation, and which assume a homicidal or a 

 destructive character. Such a patient is one of 

 the most dangerous of asylum inmates. Cases 

 which manifest the symptoms of chronic alcohol- 

 ism of the variety under consideration present a 

 wonderful uniformity in the nature of their delu- 



sions. They are essentially delusions of suspi- 

 cion. The patients imagine that they have been 

 forced to sleep upon damp beds ; that poison has 

 been placed in their food ; that electricity has 

 been brought to play upon them ; that they have 

 been drugged with morphia, dosed with chloro- 

 form, or stifled with sulphurous fumes. They 

 are tortured with voices using the most obscene 

 and threatening language, and regard themselves 

 as victims operated upon by hidden agencies, 

 which act with a subtilty greater than that of 

 magnetism or electricity ; and though, when their 

 hallucinations are excessively harassing, they are 

 sometimes driven to attempt suicide, yet their 

 mental agitation has little effect upon their bodily 

 nutrition, and they invariably eat well and main- 

 tain excellent health. 



What is the physiology, so to speak, of these 

 delusions of suspicion ? Some consideration of 

 the subject has suggested to me a principle which 

 I think will hold good, and which will suggest 

 the explanation of such delusions in chronic 

 mania from alcoholism. The principle is that, in 

 all cases where the brain-tissues, while retaining 

 to a considerable extent their integrity of function, 

 do not receive their proper and sufficient supply 

 of nourishment, delusions of suspicion are apt to 

 occur. Take as a typical case the condition of 

 the mental functions in old age. The advanced 

 senile dement has no delusions of suspicion, but 

 the patient in whom brain-wasting has made less 

 progress, and in whom the physiological ten- 

 dency to decay is supplemented by privation, 

 shows marked delusional suspicions. He thinks 

 that his friends are " against him ; " that they 

 drug his food, lay plots for the subversion of his 

 interests, or long to be free from the responsi- 

 bility of his maintenance. The pathological con- 

 dition in such a case is one which is the result 

 of a physiological diminution of cerebral nutri- 

 tion. The heart's action fails, the vessels lose 

 their elasticity, the cerebral tissues participate 

 in the general diminution of functional activity, 

 and the diminished a fronte combines with the 

 diminished a tergo force in reducing the supply 

 of blood. To a certain extent the same patho- 

 logical condition exists in chronic mania from 

 alcohol. The heart's action is often weak, the 

 abdominal organs often fatty, and the cerebral 

 vessels, especially the smaller branches, are athe- 

 romatous, tough, and unyielding. A general ten- 

 dency to connective-tissue degeneration not un- 

 frequently leads to increase of the neuroglia, to 

 the detriment of the proper nerve-elements. Simi- 

 larly, where degraded habits have led to anaemia 



