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370 MEDICAL JURISPRUDENCE
Senile Dementia.—This condition results from the gradual decay of the
body as well as the brain during old age, and depends upon the degenerative
changes of the arteries. It affects those people, who have a hereditary taint
of mental aberration, and who have led a strenuous life.
In this form the patient is forgetful, unable to fix attention on any
subject, is dirty in his habits, and erotic in his tendencies. He begins to
suspect his own near and dear relatives, and is often affected by hallucina-
tions of sight and hearing and delusions of persecution. He imagines that
he has become poor and destitute. He becomes melancholic and lastly
becomes a perfect dement. Suicide is also common in such a condition.
Maniacal excitement is very rare, though garrulity and continuous and
aimless movements are sometimes seen.
Organic Dementia.—This condition is a result of some organic lesion of
the brain. The lesion may be a localized one as a new growth, embolism,
cerebral abscess or haemorrhage, or it may be diffused as chronic meningo-
The symptoms vary according to the site and extent of the lesion. In
a localized lesion the patient slowly becomes lethargic and somnolent. He
speaks and thinks slowly and with great difficulty. His movements are
slow and awkward. He does not seem to take interest in life, and has
very few wants and desires. In acute cases the patient suddenly becomes
restless and delirious, and suffers from visual and auditory hallucinations.
In the case of a diffuse lesion of the brain, the mental faculty is
gradually diminished or abolished, accompanied by loss of memory and
difficult speech. The patient is irritable, and is apt to get violent attacks of
mania. Sometimes, convulsions occur, and exhaustion or syncope ends the
In all cases of organic lesions of the brain if death does not occur soon,
the patient becomes forgetful, loses perceptive faculties, and is incapable
of fixing attention on present impressions. He is hopelessly indecent in his
behaviour. He is unable to look after himself or manage his own business.
Finally the patient becomes bed-ridden and passes into a state of complete
3. ACUTE INSANITIES
These are generally associated with some kind of toxaemia. Mania,
melancholia, delusional insanity, exhaustion, psychoses, katatonia and
hebephrenia may be described under this heading. The first two disorders
have been grouped together by Kraepelin under the term, manic-depressive
insanity, but it is more convenient to describe them separately.
Mania.—This is a condition of exaltation affecting the emotions and the
intellect and manifesting itself in increased mental and physical activity.
For the convenience of description mania is sub-divided into three
forms, simple mania or hypomania, acute mania and chronic mania, although
these forms merely represent the different stages of the same disease, vary-
ing in degrees of intensity and duration.
Simple Mania or Hypomania.—This is the mildest form of mania, in
which there is an exaggerated sense of self-importance. The symptoms
manifested in this form result from the decreased inhibitions to the motor
impulses. The general demeanour and conduct of the patient are greatly
altered, although there is no real change in personality. He'is quick-witted
and ^ntertaininsr in conversation, but owing to lack of unity in the course
of ideas he rapidly wanders from one subject to another. He is full of
schemes and ideas which are never thoroughly worked out. Later, the