378 MEDICAL JURISPRUDENCE lasting for two to three years and then there is a relapse. _ Attacks of excite- ment generaly come on in paroxysms. During the periods of quiescence the patient appears to be sane. The patient takes his food freely. The general health improves and he gains in weight. Rhythmical stereotyped movements of the hands and verbigeration may be present. Confusion of thought is less marked, though memory and attentiveness are weakened. The patient becomes definitely weak-minded and passes steadily into a state of dementia. Hallucinations and delusions are present and generally affect the conduct of the patient, who should always be carefully watched. Hebephrenia.—This is a disease, which occurs usually in the early adolescent period of life, and affects females more than males. Owing to marked leiicocytosis, Dr. Bruce8 thinks that the disease is due to toxaemia brought on by some bacterial infection. Symptoms.—The onset is so slow and insidious, that the changes in character and temperament of the patient are not noticed for a very long time. The characteristic feature of this disease is an arrest of physical development. The patient is inactive, lethargic, and sits idle the whole day. He shuns society, avoids friends and sometimes wanders about aimlessly in streets. He is untidy and careless of his dress. He is very often cruel, mischievous and addicted to self-abuse. Obscene language and indecent actions are marked features of this disease. The patient is full of emotions, changing from time to time. Once he may be mute and depressive; at another time he may become verbose, irritable and excited. This condition passes on steadily to dementia. The power of concentration^ and attention is lost. Memory is impaired. Visual and auditory hallucinations may be present and may lead to obsessions, impulsive acts and general restlessness. INSANITY ASSOCIATED WITH NERVOUS DISEASES There are certain forms of insanity, which are associated with nervous diseases. The chief of these are general paralysis of the insane and epileptic insanity, which will be described here. General Paralysis of the Insane (Dementia Paralytica).—This is a chronic progressive disease, which is characterized by physical and mental symptoms terminating in paralysis and dementia due to degeneration of the brain and central nervous system. It affects men more than women, and occurs in the prime of life between thirty and forty-five years of age, but it may occur in childhood or old age. Heredity plays a very minor part in the causation of this disease. Acquired or congenital syphilis is the chief factor causing this disease. Symptoms.—In this disease there is always a prodromal stage lasting for months or years. During this period forgetfulness, irritability, restlessness, over-friendliness, intemperance in drinks and deterioration of the moral senses are usually the first symptoms, which attract the attention of the friends and relatives of the individual. At this stage the feelings of self- satisfaction and expansiveness are the characteristic features of the disease. These are followed by ideas of grandeur which assume the nature of delusions of an exalted kind. The patient believes that he is the most powerful, and possesses enormous wealth. He squanders his money, under- takes business of a speculative nature, or orders the purchase of a large number of useless articles. At times, he steals articles which are of no use to him, or, owing to perversion of the moral sense, he may commit an indecent assault on a woman in public. . 8. Overbeck-Wright, Lunacy in India, p. 262.