arriving at a right solution of the character of the case. He lost no time in delicately mentioning the matter to the relative who accompanied the young lady to the ball, and she was immediately taken home. On the following day she became acutely insane, all her delusions and conversations having reference to a morbidly exalted state of uterine functions. "A woman, aged forty-two, for a year and a half gradually fell into a state denoting general softening of the brain, manifesting almost entire blindness, inability to walk, and semi-imbecility of intellect. Two years ago she felt severe and almost constant pain in the head; her general health was in other respects perfectly good, and her intellect clear. Three years previously, this woman, though possessed of an ample competency, committed a petty theft at a fair. This was the first symptom of her approaching cerebral disease."* * Related by Dr. Brierre de Boismont. CHAPTER XI. Impairment of Mind. I PROPOSE to consider this subject in the following order : 1. General Weakness of Mind. 2. Morbid Phenomena of Attention. The intellect often GENERAL WEAKNESS OF MIND. presents evidences of general prostration and debility, long anteriorly to any serious disorder of the brain being diagnosed, or even suspected. This condition of cerebral lassitude, mental sluggishness, psychical weakness and impairment, is, in many of its features, analogous to the torpor of mind that so frequently supervenes upon certain acute forms of bodily disease, particularly those of a febrile character implicating the nervous functions. In this state of mental ill-health, the patient is conscious of a want of brain tone, sluggish action of mind, and of a deviation from his normal condition of intellectual acuteness, activity, and vigour. He is painfully sensible of feeling mentally below par, and recognises his inability to use efficiently his powers of mind. He suffers from a torpid state of the intellect, a psychical malaise unfitting him for any kind or degree of cerebral work. The effort to think is irksome and painful, caus ing, if persevered in, vertigo, headache, painful confusion of thought, and acute mental depression. In this condition of nervous exhaustion, the patient is incapable of exercising, for any lengthened period, continuity of thought, and is at times quite unable to think at all. This mental listlessness, prostration, and apathy, disqualify him for any occupation requiring the active operation of the intellectual powers. He throws aside his favourite books, and even the newspapers, formerly the source of so much pleasure, become devoid of interest, and even distasteful to him. He then neglects his ordinary vocation, feeling in mind blasé, and only able to sit quietly in a state of gloomy abstraction in his room, or saunter about the house or streets in a condition of dreamy reverie. I have often witnessed these symptoms consequent upon an overtaxed and unduly exercised mind. Men, naturally of the most active understandings, of a high order of intelligence, and capable, when in health, of a considerable degree of sustained and vigorous intellectual labour, have been reduced to this sad state of psychical impairment, and "precocious senility," as the result of anxiety, or as the effect of an excessive and severe cerebral and mental strain. Under these circumstances the mind is easily fatigued. This condition of failing intellect is recognised by the difficulty which the person experiences in preserving intact the sequence of ideas and chain of thought. The memory either wanders, or is vague and incoherent in its associations. All power of healthy psychical combination is either lost, or greatly impaired. The mind has no fixed hold upon its conceptions, and in consequence of an enfeeblement of the will, and weakened power of attention, the ideas are influenced by the most casual and accidental circumstances. In general terms, all balancing or co-ordinating psychical power appears to be gone. This morbid condition of intellect is generally associated with, and, in a great measure, dependent upon, a depressed, debilitated, and exhausted state of the vital and nerve force. The blood is impoverished in consequence of being deprived of some of its important organic elements, and the whole system suffers from anæmia. The countenance assumes a pallid, haggard, lifeless, and exsanguine aspect. The assimilative functions are disordered, and the patient sometimes becomes seriously emaciated. Such is often the physical state of those whose minds have been prematurely exhausted. This phase of mental and bodily ill-health, in the majority of cases, speedily yields to the judicious administration of stimulants and blood tonics associated with appropriate moral treatment, provided no serious structural mischief has commenced in the brain. Among the incipient symptoms of softening of the brain, and apoplexy, are occasionally observed a torpor, and prostration of intellect, exhibited in an inability to undertake any kind, and degree of mental work. The patient complains of a deficiency of psychical power, an exhausted state of the nervous energy, and of a want of vis, the brain appearing to have lost its healthy tone, and stamina. M. Gendrin says, " Apoplectic attacks are often preceded for some days by a difficulty in executing intellectual work, by an incapacity for unusual attention, by an extraordinary irascibility, by a morbid weakness which exaggerates impressions, and produces terrors without a cause, or by unreasonable anxiety concerning ourselves or those related to us."1 These premonitory symptoms are not demonstrable in every case of cerebral hemorrhage, for many patients appear capable of severe brain or mind work up to the moment immediately preceding the apoplectic or paralytic fit, but in many cases this conscious diminution of vigour of brain and impairment of mind are important premonitory signs of approaching acute paralytic and apoplectic seizures. The symptom, however, is present in other states of disease of the brain. Should this condition of mind be associated with giddiness, headache, depressed spirits, aberration or impairment of vision, or a slight sensation of numbness (even if circumscribed) in any part of the body, the patient may well be anxious as to the state of his cerebral health. 1 "Traité Philos. de Méd. Prac." Tom I. p. 487. The symptoms, however, previously detailed, are, occasionally, precursory of formidable attacks of organic disease of the brain, and are to be viewed, in some cases, as pathognomonic of the existence of cerebral tumours, softening, abscess, induration, and other formidable types of encephalic disorganization. A gentleman, aged fifty-four, who died of softening of the brain, associated with hemiplegia, had for nearly twelve months previously to his loss of motor power, complained of no other symptom than painful prostration of mind. He had the greater portion of his life been actively engaged as principal of a large academy, having under his scholastic supervision nearly sixty boys. Being a strictly conscientious man, and of an anxious temperament, he was always in a state of feverish excitement and painful apprehension lest he should fail in the discharge of the serious and responsible duties devolving upon him. His mind was thus kept in an unceasing condition of mental inquietude and perturbation. Under this severe amount of cerebral pressure and mental anxiety, he was conscious, as he admitted at the time to his medical attendant, of his mind gradually fading away from him. He eventually became quite incapable of personally superintending his establishment. On one occasion, fancying that his intellect had in a great measure recovered its original strength, he entered the school, and occupied himself with his usual duties. He, however, soon found that he was quite incapable of directing his attention for five minutes continuously to any one subject connected with the business of tuition, and he immediately retired to his own private room, and seating himself in a chair, burst into a flood of tears, exclaiming, in wild despair, "my mind is gone! altogether gone!" In this case no symptom of physical disease of the brain was detected until twelve months anteriorly to death! |