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Full text of "Medical Jurisprudence And Toxicology"

ACUTE INSANITIES                                                  375

Ordinarily, "there is no recovery from the chronic form, but Stoddart has
seen cases of recovery. One of his female patients recovered after eighteen
years' duration, a male patient of his recovered from a previous attack of
thirty-five years, and another male patient recovered from a previous attack
of seven years.6

Delusional Insanity (Paranoia).—This is a form of insanity, which is
characterized by fixed and systematized delusions, as also by hallucinations
of various characters. It is called partial insanity by lawyers, and appeals
to their legal mind, inasmuch as they believe that a delusion must be present
to constitute insanity. The medical man, however, thinks that a delusion is
merely a symptom, but not an essential element, of insanity.

Delusional insanity is mostly a disease of adults, affecting both the sexes
equally. It exists in two stages : acute and chronic.

Acute Stage.—In the acute stage the disease commences with digestive
disturbances and a rise of temperature, accompanied by melancholic depres-
sion and confusion of ideas. These are followed by hallucinations of hearing
and delusions of persecution. The patient imagines voices dinning into his
ears through the walls of a room. He becomes forgetful, loses the power of
self-control and is apt to commit some crime under a sudden uncontrollable
impulse. Insomnia is a constant symptom throughout the disease. The
patient may appear to have recovered, when a relapse may occur, or the
acute condition may pass into the chronic stage.

Chronic Sta,qe.—Suspiciousness is the characteristic symptom of this
stage, in which the physical symptoms are also more prominent. The chief
physical symptoms are a furred tongue, foul breath, irregular temperature,
disordered nutrition and anaemia. Sleeplessness is a general complaint,
which results from sensory disturbances producing impressions of electric
shocks.

Auditory hallucinations, which occur very early in this condition, are
first supposed to be sounds or noises in the ears, but are afterwards changed
into abuses and insults. At first the patient is able to dismiss them by
reasoning faculty. When the judging power fails, these hallucinations give
rise to systematized delusions, which he is at times able to defend with
logical arguments. These delusions are at first indefinite, but gradually
they become fixed and definite so as to lead the patient to believe that he is
persecuted by some unknown person or some superhuman agency. The
patient then develops hallucinations of taste and smell, so that he believes
that his food is poisoned, or that some noxious gases are blown into his room.
Disturbances of general sensation give rise to hallucinations, which are
attributed to the effects of hypnotism, magnetism, electricity, wireless tele-
graphy, etc. The patient gets very irritated and excited owing to these
painful and disagreeable hallucinations and delusions.

In almost all cases the delusions of an exalted type referring to
grandeur, power and wealth are seen, and the patient generally conducts
himself in a haughty and overbearing manner. With the lapse of time the
hallucinations of a grandiose character become less marked, and the patient
becomes listless, apathetic and passes into a condition of melancholic
depression. At this stage the patient requires to be carefully watched, lest
he commit suicide.

During the chronic stage the patient usually retains his memory and
self-control. He talks sensibly, and does not show any sign of insanity,
until the conversation is directed to the particular type of delusion from
which he is suffering. It is, however, always safe to keep such a patient

6.   Mind and its Disorder, Ed. V, p. 276.