Dec 30, 1881.] 



♦ KNOWLEDGE 



175 



BRAIN TROUBLES. 



Part III.— Distracted Attention. 



THE next of these signs — one, indeed, which many 

 mental physiologists set first — is an inability to fix 

 the attention on any subject till the mind has done 

 \\ ith it We have taken the failure of memory lirst, 

 dimply because we believe that this symptom can ordi- 

 narily be recognised earlier than inability to fix tlie 

 ttfiition. The fact would seem to be that, since in 



I i nary processes of thought, we first recognise or 

 trtaiu particular facts, and then commit them 



the keeping of the memory, tht; latter process is 

 -turally the one which first fails us. That it should be 

 taken first is indicated, too, by the circumstance that 

 although many cases can be cited of persons who, although 

 able to direct their attention to a subject, are unable to 

 ritain in their memory what has been suggested to their 

 thoughts while thus directed, no case is on record in which 

 this state of things has been reversed, and a person has 

 been al)lo to remember recent facts distinctly after he has 

 lost the power of an-iving at fresh ideas by efforts of 

 attention. To mention only one case of the fonner kind, 

 Iir. Winslow tells of one patient whose memory as to 

 ricent events was seriously damaged, while yet his per- 

 ci ptive faculties and reasoning powers were not at all 

 ' •'• cted. "He conversed with great sagacity, fluency, and 

 iteness on every subject, but if I permitted a second to 

 Ipse in the conversation, he entirely forgot what he had 



II previously talking oi" From the time when his 

 mory thus failed him, he retained his former power of 



1' asoning. " He could discuss at short intervals the most 

 subtle and abstruse political, professional, and literary 

 matters with apparently unimpaired mental vigour ; but 

 his memory never recovered its healthy tenacity." It may 

 hence be inferred that temporary loss of the power of 

 fixing the attention (which must be carefully distinguished 

 from mere forgetfulness, that is the habit of being in- 

 attentive), is more likely to be a sign of serious mental 

 mischief, than faOure of the power of memory. Yet the 

 fiinnor, like the latter symptom, indicates in the great 

 majority of cases no serious mischief, though it would be 

 ' A cedingly unwise to overlook it. 



The failure of the power of directing the attention to a 

 subject may show itself in several ways. Thus the mind 

 may be unable even to begin the study of a subject ; or it 

 may begin the study and presently wander off to other 

 subjects, despite the most anxious efforts to restrain it from 

 so doing; or suddenly it will seem to cease its action, re 

 maining for a short time confused and, as it were, lost, and 

 then resuming the consideration of the same subject at the 

 point where it had left it, and apparently as acutely and 

 attentively as before. These three forms of distraction are 

 of difl'ercnt significance as symptoms of mental trouble. 

 The first, though undoubtedly it would be very serious in 

 this respect, if persistent, nearly always indicates only that 

 the mind wants rest, and no one who is wise will neglect 

 the warning. The second equally implies that the mind 

 wants rest, though not in equal degree. But the third is 

 usually a sign of serious mischief. We consider it here, 

 not as belonging to those indications of mental disturbance 

 which, without being alarming, should be attended to by 

 aU who wish to keep their brains in good working order, 

 but because the nature of the cerebral mischief indicated 

 by such symptoms has been ascertained, and we may hence 

 infer the general nature of the mischief indicated when the 

 less serious symptoms of distraction are recognised, and 

 may so judge what is the appropriate remedy. For, unfor- 



tunately, several of the cases in which the mind has been 

 observed suddenly to become confused or lost, resuming its 

 activity and clearness after a short interval, have been 

 followed by severe illness, which has proved eventually 

 fatal. 



Among the most remarkable and carefully-observed 

 cases of this kind is that of King Oscar of Sweden, the 

 circumstances of which were minutely detailed by Dn 

 P. O. Liljcwalch, the king's first physician. King Oscar 

 had enjoyed fairly good health during the greater part of 

 his life ; but before his last illness it had been noticed 

 that occasionally the heart's action was irregular, oftener 

 in spring than in other parts of the year. In 1851 the 

 heart became vei-y irregul.ar in its movements, and the 

 digestive functions were impaired. Althougli he soon 

 after recovered to some degree, an attack of typhus fever, 

 following the loss of a beloved son, severely tried his con- 

 stitution, when, slowly recovering strength after this, he 

 unwisely omitted his usual autumn rest and excursion, 

 and devoted his mind to political matters requiring close 

 and anxious attention. In 18.57 his health again gave 

 way, and it was at this time that the nervous mischief was 

 first noticed which subsequently proved the characteristic 

 feature of the king's illness, and, in Dr. Liljewalch's 

 opinion, " brought him to his death." The first trace of 

 this nervous disease, says Liljewalch, " manifested itself 

 long since, although it was not until the last six or eight 

 years of his life that, as we have seen, it occurred with 

 more definite and at last with such threatening symptoms. 

 No one who had an opportunity of observing him during 

 a long period in his daily intercourse, could avoid being 

 amazed at the very extraordinary power the king always 

 e.xhibited of retaining in his memory the most varied 

 details, or could cease admiring " (really one could imagine 

 that some few could achieve this, however impossible it 

 might seem to the courtly Liljewalch) "the rapid appre- 

 hension, the unerring judgment, and the singular clearness 

 of statement which were exhibited whenever he spoke. 

 But at the same time he could not fail to recollect 

 how the king sometimes, in the middle of a con- 

 versation to which he was directing all his attention, would 

 of a sudden appear to be abstracted, and would actually 

 transfer liis thoughts to some other subject on which 

 unless he might be disturbed, he would allow them to rest, 

 usually only for a few moments, but sometimes for many 

 minutes, after which the conversation would be resumed 

 as if it had not been interrupted. The peculiar expression 

 of the king's features — particularly his look, assumed on 

 such occasions, and the spasmodic state, or the involuntary 

 movements which at the same time took place in one or 

 other part of liis muscular system — render it probable that 

 this distraction, which at times was of frequent recurrence, 

 was due to an incipient affection of the central organ of 

 thought. This symptom, referable to the most important 

 organ of the nervous system " (the care and ingenuity with 

 which the court physician avoids any direct statement that 

 the king's brain was affect«;d is worthy of all praise) " was 

 of late years accompanied, as has been already mentioned, 

 with increasing weakness in the muscles of the lower 

 extremities, and with uncertainty in the combination of 

 movement, probably depending on a commencing organic 

 change, either in the organ alone on which the power of 

 motion depends or else in that by ^\hich the co-ordination 

 of movements is eflected." The king himself was not misled 

 by the phraseology in which the court physicians endea- 

 voured to cloak the fact that his brain was disordered. 

 " Incapacity to discharge his royal functions now brought 

 on a deep melancholy, and the king, even in the commence- 

 ment of his illness, expressed his conviction of its incura- 



