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.