376 MEDICAL JURISPRUDENCE
under restraint, for he is often a source of danger to himself as well as to
others. There is no motive or forethought for criminal offences, but some-
times premeditation and elaborate arrangement precede a criminal assault.
Exhaustion Psychoses.—These disorders result from fatigue and exhaus-
tion of the nervous system at the late adult or senile period of life in men,
but at an earlier age in women owing to prolonged lactation, especially in
Symptoms.—Physical.—The onset is, as a rule, slow and insidious.
Insomnia is the first symptom which is generally a disturbing factor in nerve
exhaustion or neurasthenia. Sleep is either absent or is unrefreshing,
disturbed and accompanied by nightmare. Hearing becomes so acute that
the slightest noise in a room, even the tickling of a clock or palpitation of the
heart is enough to startle the patient from sleep and to cause much annoy-
ance. The other symptoms are loss of physical ^ activity and vigor,
dyspepsia, constipation, malnutrition, headache, giddiness, irritability,
nervousness and anaemia. The pupils are widely dilated, but the visual field
is not diminished and there is no abnormality of optical conditions. Circu-
lation is feeble; the extremities are, therefore, cold and cedematous.
Palpitation is a common symptom. The skin perspires readily. The tem-
perature is generally sub-normal. The superficial and deep reflexes are
well-marked, and the muscles are in an irritable condition and react readily
to the slightest external stimulus. The urine is normal.
Mental.—Irritability and loss of self-control are prominent mental symp-
toms. The power of attention is weakened, and memory either wanders or,
is incoherent in its associations. The power of thinking is lost. Any
attempt of thought fags the brain. However, if persevered in it leads to
mental confusion and depression. The speech is hesitating but not inco-
herent. Sometimes, the patient passes into a semi-stuporous condition, when
he has a sad vacant look and sits listlessly in one position for a long time.
He cannot be roused to answer questions.
Visual hallucinations very often occur, and the patient is at times
troubled by painful obsessions of fear. For instance, the patient is afraid of
an empty space (agoraphobia) and cannot cross a street, especially if it is
open and unoccupied. Similarly, some patients have a dread of being shut
up in a closed space or apartment (claustrophobia), Some of these
obsessions are apt to be associated with visceral sensations of a more or less
oppressive nature. Thus, the patient may complain of an oppression at the
chest, constriction of the heart, or may have a disposition to pass water or,
motion.7 These obsessions may also lead to impulsive actions, which the
patient is unable to control, though he is conscious of their evil effects. He
may later on develop delusions of persecution or poisoning and consequently;
may develop suicidal tendencies.
Katatonia (Catatonia).—This is a disease which is associated with adoles-
cence ^ and occurs among Europeans, Anglo-Indians and Indians. The
conditions which tend to impair the vitality and lower the resistance to
infective ^diseases render the person liable to this disease. Heredity also
plays an important part. For convenience of description the disease may be
divided into four stages :
1. The prodromatous stage. 3. The stage of stupor.
2. The acute 'stage of onset. 4. The stage of excitement.,
1. The Prodromatous Stage.—The onset is, as a rule, slow with gradual
loss of energy and thinning of the body from malnutrition. The first mental
7. Albutt, System of Med., Vol. VIII, p. 749.