ALCOHOLIC BRAIN-DISORDERS. 



431 



prone to reverie, finds for itself a new and insane 

 sphere of existence. Intellectual helplessness 

 and physical changes advance. One limb may 

 become weak, one pupil may dilate, and, if exces- 

 sive or even moderate drinking is still indulged 

 in, the victim has no other prospect than to end 

 his days in a state of degraded dementia and 

 muscular paralysis from progressive brain-soften- 

 ing. 



There is another well-pronounced class of 

 cases which owe their origin to excess in alcohol- 

 ic drinks, and which possess some interesting 

 features. In this class the patients are generally 

 advanced in life, are not unfrequently women at 

 the menopause, and generally bring with them a 

 history of excessive drinking suddenly abandoned. 

 The feature of such cases which is sufficiently 

 striking to give character to them is, the almost 

 absolute loss of memory for recent events. The 

 patients are cheerful, attentive, understand what 

 is said to them, and show little dementia as far as 

 simple processes of reasoning are concerned, but 

 are absolutely destitute of memory for passing 

 events. When the medical officer makes his vis- 

 it (perhaps the third in the course of the day), 

 and asks, " Have you seen me before ? " the pa- 

 tient asserts that he or she has not ; and the con- 

 stant ineffectual repetition of this question at 

 short intervals shows that the capability of re- 

 taining new impressions' has completely disap- 

 peared. I do not mean to assert, however, that all 

 such cases are necessarily of alcoholic causation, 

 but only that they are a frequent result of alcoholic 

 excess. In fact, I think that in cases where or- 

 ganic change has been produced in the brain, the 

 nature of the symptoms will be determined, not 

 so much by the character of the exciting cause 

 as by the physiological functions of the regions 

 diseased. The same complete failure of memory, 

 for instance, as I have just now commented on, 

 is frequently present in specific disease of the 

 brain; and Dr. Major has drawn my attention to 

 a case in which the exciting cause was the shock 

 produced on the patient by the death of her hus- 

 band. Though the mention of the circumstances 

 of her husband's death always produced in her 

 the most painful emotions, it was on each occa- 

 sion accepted by her as a novelty. Each time 

 that the lamentable event was mentioned she 

 regarded the information as something she had 

 never heard before, and the grief she manifested 

 was consistent with this remarkable forgetfulness. 

 Still, in other respects, she was comparatively ra- 

 tional. 



In such cases there are not, as a rule, the 



other ordinary symptoms of dementia. The pa- 

 tients are not dirty in their habits, sometimes 

 employ themselves, are interested in immediate 

 impressions, but retain no recollection of recent 

 experiences. Such cases seem to begin with com- 

 parative suddenness, and may terminate — after a 

 considerable interval, in which loss of memory 

 has been the leading symptom — in apoplexy, 

 epilepsy, hemiplegia (from clot or progressive 

 softening), or in simple brain-wasting. In such 

 cases there are no paroxysms of excitement, but 

 there is a tendency to general weakness of the 

 muscular system, and a cheerful expression and 

 insane laugh, which, however, cannot be con- 

 founded with the look of fatuous rapture which 

 adorns the face of the general paralytic. 



The last class of cases of alcoholic etiology to 

 which I shall refer are those which are frequent- 

 ly difficult to diagnose as distinct from general 

 paralysis. They simulate that disease strongly, 

 and may even merge into it. They occur princi- 

 pally in men somewhat beyond the age commonly 

 assigned as the period at which general paralysis 

 manifests itself. In one respect, also, they are 

 peculiar, inasmuch as the history of the cases 

 generally begins with an attack of what would 

 have been formerly described as brain fever. An 

 attack of cerebritis in a man of forty-eight or 

 fifty, who has been much addicted to alcohol, may 

 leave him in a state of almost absolute dementia 

 and partial paralysis. When he attempts to 

 stand, his knees bend under him. He is de- 

 graded in his habits, and eats ravenously. He 

 rarely speaks ; but, when he does, it is usually to 

 express exalted ideas. His manner may be ha- 

 bitually sullen, or constantly cheerful and fatuous. 

 For a few months his symptoms may show no 

 modification, when suddenly he may burst out 

 into an attack of aggressive excitement. He 

 shows symptoms of a new attack of encephalitis, 

 and, though completely helpless, manifests by his 

 conduct the presence in his mind of delusions and 

 hallucinations. His attempts at violence toward 

 those of whom he knows nothing, and whose mo- 

 tives are humane, show the existence of the for- 

 mer, and his rushing or striking at imaginary ob- 

 jects is sufficient evidence that he is actuated by 

 the influence of the latter. Self-mutilation re- 

 veals the existence of some important mental ab- 

 erration, and I have known one instance in which 

 a patient, strongly alcoholic in his history, and 

 whose case presented such features as I have 

 sketched, lacerated his body with his teeth in a 

 most serious manner. In such cases, counter-ir- 

 ritation of the shaven scalp and the internal ad- 



