Chapter 40

1. Prodromal or forerunning; the stage of pain.--This consists of lightning-like pains in the lower extremities, numbness, formication (feeling of ants, etc., crawling), sensation of dead extremities; pins and needles in the soles of the feet and fingers, coldness, itching of arms and scrotum or other parts, a sensation of constriction around the chest, headache, pain in the small of the back and loins of an aching character may occur. These symptoms may constitute the only evidence of locomotor ataxia and last for years; but sooner or later there are added absence of knee cap bone reflex (knee jerk), and immobility of the pupil. The loss of the knee jerk is always observed in time. The pupil fails to respond to light while it still accommodates for distance, called Argyll Roberston pupil. There may be imperfect control of the bladder with slow, dripping or hasty urination. Later the control is not imperfect, but it may be painful. Inflammation of the bladder may occur which is dangerous. There is usually obstinate constipation and loss of sexual power. These symptoms may last for several months and years, and then the second stage symptoms appear.

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2. Stage of Ataxia (Disturbance of motion).--The disturbance of motion (ataxia) is very marked, especially in the lower extremities; the walking becomes difficult and uncertain; there is difficulty in rising or rapid turning; the legs are wide apart; feet lifted too high and come down too forcibly; the length of the steps is irregular, and the body is imperfectly balanced. If the patient stands with his feet together and eyes closed he begins to sway, (Romberg's symptom), which is due to a defect in controlling the muscles from impairment of sensation. There may be imperfect use of the hands in dressing, writing, etc.; lancinating pains are marked in all cases and come on in paroxysms. The pains are mostly in the legs, but also occur in the arms, head, loins, back, and trunk. Then the sense of touch is partially lost. The prick of a pin may not be felt until a few seconds after being applied. This stage may last for years and remain at a "standstill;" but it is usually progressive, and advances to the third stage.

3. The stage of paralysis is marked by a gradual change to the worse, and the patient must remain in bed, because he cannot get out. The lower and sometimes the upper extremities have lost a great deal of their power of sensation: The joints, mostly the knee and hip joints show on both sides of the body a painless swelling, owing to the great quantities of watery liquid there. Dislocations and fractures occur simultaneously. Bed-sores and peculiar ulcers on the sole of the foot also occur. The urine dribbles away constantly, for all control of the bladder is lost. Death occurs from exhaustion; bedsores, inflammation of the bladder, or pneumonia coming on as a complication.

Treatment;--The only thing to do when the patient has this disease is to make him comfortable and arrest the progress of it, if possible. It is incurable, but treatment sometimes arrests the progress and at least lessens the suffering and prolongs life as long as it is worth living to them. I have given a longer description than was necessary, for I wanted men who live such fast lives to understand what it brings them for most cases are caused by syphilis. The description could have been made longer and other symptoms and complications put in. I think enough has been given and perhaps this description may deter some one from going the same road.

The Diagnosis is made at first by the fatigue, peculiar pains, loss of the knee jerk, the peculiar pupil and history of syphilis. Later it is made from the ataxia; the peculiar walk, etc., and the bladder disturbances.

HEREDITARY ATAXIA. Friedrich's Disease.--This peculiar disease is due to a degenerative disease of the posterior and lateral columns (parts) of the spinal cord, occurring in childhood, and often in several children of the same family.

Causes.--More in boys than in girls and oftener in the country districts. Heredity is frequently a cause and it is traced to syphilis, epilepsy, alcoholism, and insanity in the ancestors. Several children of the same family may have it.

Symptoms.--In very young children it is noticed that they are slow in learning to walk; the child staggers in trying to stand or to walk; it uses its hands clumsily, and has difficulty in speaking. The movements of the hands are peculiar, the hands move like in chorea, the speech is slow and drawling.

Recovery.--Very doubtful, but they may last for years.

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INFANTILE PARALYSIS. (Acute Anterior Polio Myelitis).--This is an acute disease occurring almost exclusively in young children with paralysis, followed by rapid dwindling of the muscles of the parts affected by the paralysis.

Causes.--Found in children under three years old. It is more common in summer than in winter. It often follows scarlet fever, measles, and diphtheria.

Symptoms.--The onset is usually sudden; often the child is put to bed at night seemingly well and in the morning is found paralyzed in one or more limbs. High fever or chills, general feeling of illness, pain all over the body, decided brain symptoms, like delirium or convulsions and intermittent contractions of the muscles may usher in the disease. These forerunning symptoms may last a short time or for several weeks, after which the paralysis is noticed, being extensive as a rule, and affecting one, two, or all of the extremities and sometimes the muscles of the trunk. This general paralysis soon disappears being left permanently in only one extremity, chiefly in one leg. The other symptoms disappear. The paralyzed part atrophies (wastes) rapidly. The disease is very rare in adults. If the paralysis does not show a decided change within the first few months, full recovery is doubtful.

Treatment.--During the acute stage there must be absolute quiet and rest with a diet that is not stimulating, one that is easily digested; ice to the head or cold cloths, counter-irritation to the spine; electricity should be used after a few weeks. There is quite a good deal of this paralysis, and the case should receive careful attention from the start.

TASTE.--Taste-Buds.--There are three kinds of papillae or eminences on the human tongue,--the circumvallate, the fungiform and the filiform. The circumvallate are from seven to twelve in number and lie near the root of the tongue, arranged in the form of a V, with its open angle turned forward. Each one is an elevation of the mucous membrane, covered by epithelium and surrounded by a trench. On the sides of the papillae, embedded in the epithelium, are small oval bodies called taste-buds. These taste-buds consist of a sheath of flattened, fusiform cells, enclosing a number of spindle-like cells whose tapering ends are prolonged into a hair-like process. As the filaments of the gustatory nerves terminate between these rod-like cells, it is probable that they are the true sensory cells of taste.

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In the human tongue taste-buds are also found in the fungiform papillae, often seem as red dots scattered over its surface; and to an area just in front of the anterior pillar of the fauces. It is also possible that single taste-cells are scattered over the tongue, as the sense of taste exists where no taste-buds can be found.

Many so-called tastes are really smells. This is easily proved by compressing the nostrils and attempting to distinguish by taste different articles of food.

The taste sensation is greatest when the exciting substance is at the temperature of the body. There is no perceptible sweetness to sugar when the tongue has been dipped for a half-minute in water either at the freezing temperature or warmed to 50 degrees C. Neither is there any sense of taste until the substance is dissolved by the natural fluids of the mouth, as will be seen by wiping the tongue dry and placing sugar upon it.

The four primary taste-sensations are bitter, sweet, sour and salt. These probably have separate centers and nerve fibers. Sweet and sour tastes are chiefly recognized at the front and bitter and alkaline tastes at the back of the tongue. The same substance will often excite a different sensation, according as it is placed at the front or back of the tongue.

There are also laws of contrast in taste sensations. Certain substances will enhance the flavor of another and others will destroy it. Again, certain tastes may disguise others without destroying them, as when an acid is covered with a sweet.

INSANITY. History.--The earliest reference to insanity is found in the book of Deuteronomy. Another reference is in Samuel where it speaks concerning David's cunning and successful feigning of insanity. "And he changed his behavior before them and feigned himself mad in their hands, and scrabbled on the door-posts of the gate, and let his spittle fall down upon his beard," Feigning insanity under distressing circumstances has been one of man's achievements throughout the centuries. It is spoken of in Ecclesiastes. Jeremiah says in regard to the wine cup: "And they shall drink and be moved and be mad." Nations also were poisoned by the wine cup, for Jeremiah says, "Babylon has been a golden cup in the Lord's hands, that made all the earth drunken. The nations have drunken of her wine, therefore the nations are mad." Greek writers speak of cases of mental unsoundness as occurring with some frequency in Greece. The inhabitants of the Roman Empire were afflicted with mental unsoundness and Nero was considered crazy. In ancient Egypt there were temples and priests for the care of the insane.

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Hippocrates, who lived four hundred years before Christ, was the first physician who seemed to have any true conception of the real nature of insanity. For many centuries later the masses believed that madness was simply a visitation of the devil. The insane, in the time of Christ, were permitted to wander at large among the woods and caves of Palestine. The monks built the first hospital or asylum for the insane six centuries after Christ.

A hospital for the insane was established at Valencia in Spain in 1409. In 1547 the hospital of St. Mary of Bethlehem was established near London and was known as "Bedlam" for a long time.

The first asylum to be run upon reform principles was St. Luke's of London, founded in 1751. About 1791 Samuel Hahnemann established an asylum for the insane at Georgenthal, near Gotha, and the law of kindness was the unvarying rule in the institution. Hahnemann says in his Lesser Writings: "I never allow any insane persons to be punished by blows or other corporeal inflictions." Pineli struck the chains from the incarcerated insane at the Bicetre, near Paris in 1792 or 1793.

There has been a gradual tendency during the last century toward better things in the behalf of the insane. A hundred years ago they were treated with prison surroundings and prison fare. Then asylum treatment began to prevail. This means close confinement, good food, sufficient clothing and comfortable beds. Asylum care means the humane custody of dangerous prisoners. "From the asylum we move on to the hospital system of caring for the insane and this system recognizes the fact that the lunatic is a sick man and needs nursing and medical treatment in order to be cured. Hospital treatment has been gradually introduced during the past thirty years or more," and in time it will eventually supercede asylum treatment and prison or workhouse methods in the management of the insane everywhere.

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Causes of Insanity.--There are many and various causes. One author states: "Mental abnormality is always due to either imperfect or eccentric physical development, or to the effects of inborn or acquired physical disease, or to injurious impressions, either ante-natal or post natal, upon the delicate and intricate physical structure known as the human brain." Some physical imperfections, more than others, give rise to mental derangements, and some persons, more than others, when affected by any bodily ailment, tend to aberrated conditions of the mind. Some impressions more than others, are peculiarly unfortunate by reason of their crowding effects upon the brain tablets of a sensitive mind. To these natural defects and unnatural tendencies, we apply, in the general way, the term "Insane Diathesis." This diathesis may be inherited or acquired. Those who are born to become insane do not necessarily spring from insane parents or from an ancestry having any apparent taint of lunacy in the blood. But they do receive from their progenitors oftentimes certain impressions upon their mental and moral, as well as upon their physical being, which impressions, like iron molds, fix and shape their subsequent destinies."

The insane diathesis in the child may come from hysteria in the mother. A drunken father may impel epilepsy, madness or idiocy in the child. Ungoverned passions, from love to hate, from hope to fear, when indulged in overmuch by the parents, may unloose the furies of unrestrained madness in the minds of the children. "The insane may often trace their sad humiliation and utter unfitness for life's duties back through a tedious line of unrestrained passion, of prejudice, bigotry, and superstition unbridled, of lust unchecked, of intemperance uncontrolled, of avarice unmastered, and of nerve resources wasted, exhausted, and made bankrupt before its time. Timely warnings by the physician and appeals to his clients of today, may save them for his own treatment, instead of consigning them to an asylum where his fees cease from doubling, and the crazed ones are at rest." The causes of the insane diathesis (constitution) are frequently traceable to the methods of life of those who produce children under such circumstances and conditions that the offspring bear the indelible birthmark of mental weakness. Early dissipations of the father produce an exhausted and enfeebled body; and a demoralized mind and an unholy and unhealthy existence in the mother, are causes. Fast living of parents in society is a fruitful cause of mental imperfections in their children. "The sons of royalty and the sons of the rich, are often weak in brain force because of the high living of their ancestry."

The fast high livers of today are developing rapidly and surely, strong tendencies to both mental and physical disorders. Elbert Hubbard says of those who live at a certain hotel and waste their substance there, that they are apt "to have gout at one end, general paresis at the other, and Bright's disease in the middle."

Drunkenness, lust, rage, fear, mental anxiety or incompatibility, "if admitted to participation in the act of impregnation will each, in turn or in combination, often set the seal of their presence in the shape of idiocy, imbecility, eccentricity, or absolute insanity."

Diogenes reproached a half-witted, cracked-brained unfortunate with this remark, "Surely, young man, thy father begat thee when he was drunk."

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Burton in his anatomy of melancholy states that: "If a drunken man begets a child it will never likely have a good brain," Michelet predicts: "Woe unto the children of darkness, the sons of drunkenness who were, nine months before their birth, an outrage on their mothers."

Children of drunkards are often "sad and hideous burlesques upon normal humanity." Business worry may cause unsoundness in the offspring generated under such conditions.

One father had two sons grow up strong and vigorous, mentally and physically, while a third son was weak, irresolute, fretful, suspicious and half demented. The father confessed to his physician that on account of business troubles he was half crazy and during this time the wife became pregnant and this half-crazy son was born and the father states that "he inherits just the state of mind I was then in." Many such cases could be mentioned. "A sound body and a cheerful mind can only be produced from healthy stock." Mental peculiarities are produced by unpleasant influences brought to bear upon the pregnant mother. The story is told of King James the Sixth of Scotland, that he was constitutionally timid and showed great terror at a drawn sword. His father was murdered in his mother's presence while she was pregnant. Children born under the influence of fear may be troubled with apprehensions of impending calamity, so intense that they may become insane at last. An instance is given of "an insane man who always manifested the greatest fear of being killed and constantly implored those around him not to hurt him." His mother lived with her drunken husband who often threatened to kill her with a knife.

Other Causes of Insanity. Imperfect Nutrition.--Whatever tends to weaken the brain or exhaust the central forces of life must favor the growth of insanity. The brain is not properly nourished.

Blows and Falls upon the Head.--Sometimes such injuries are forgotten, but they result infrequently in stealthily developed, but none the less dangerous, conditions, which may result in the derangement of all mental faculties. A child should not be struck on the head. Teachers or parents should not box a child's ears. One author says such a person "is guilty of slow murder of innocents."

Fright is Another Cause.--Punishing a child by locking it in a dark room or by "stories of greedy bears or grinning ghosts produces, oftentimes, a mental shock that makes a child wretched in early life, and drives him into insanity at a later date." Overtaxing the undeveloped physical powers is another cause.

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Insanity is most Prevalent among the Working Classes.--Our factories, shops and stores frequently employ the young of both sexes and they are overtaxed by day and night and they become feeders of our hospitals for the insane. Another cause is forced education in the young. Our present school system tends to break down the body. The work may not be too hard, but the amount of anxiety and worry, which this work causes in the minds of sensitive children, tends to enfeeble them. Many children are sensitive, with nervous temperaments, and they are easily affected by the strain of mental toil. Delicate children should be kept in the open air and their physical condition should be considered more than their mental. Girls, especially, at the age of puberty, should be built up instead of rushed through a heavy routine of study. Herbert Spencer says: "On old and young the pressure of modern life puts a still increasing strain. Go where you will, and before long there comes under your notice cases of children, or youths of either sex, more or less injured by undue study." Here, to recover from a state of debility thus produced, a year's vacation has been found necessary. There you will find a chronic congestion of the brain that has already lasted many months and threatens to last much longer. Now you hear of a fever that has resulted from the over excitement, in some way, brought on at school. And, again, the instance is that of a youth who has already had to desist from his studies, and who, since he has returned to them is frequently taken out of his class in a fainting fit.

Social pleasure also tends to weaken the system of parents who produce nervous and weakened children. Another great cause of insanity is the unnatural, improper and excessive use of the sexual organs, and diseases that often come from indiscriminate sexual relations. General paresis is very often caused by specific disease. I might go on and enlarge upon these causes, but enough has been written to give warning to those who are breaking nature's laws.

Classification.--There are many classifications. I will mention only the leading names, such as Melancholia, Mania. Dementia, General Paresis.

MELANCHOLIA (Sad Mania).--Melancholia is a disease characterized by great mental depression.

Causes--Predisposition, physical disease, dissipation, work and worry, shock, brooding. In simple melancholia the mildest attack may be called the "blues."

ACUTE MELANCHOLIA.--Is generally the result of some mental shock.

CHRONIC MELANCHOLIA is the end of all other forms of mental depression. All these have their own peculiar manifestations and need a special line of treatment.

MANIA.--This type of insanity means a raving and furious madness. There are many cases of this kind. The causes are many and may be the same as those which produce melancholia. In melancholia the shock, etc., causes depression, while in the mania the causes of mental injury tend to produce irritation and excitement. In dementia, the causes of insanity tend to exhaust the body and to mental failure, while in general Paresis "the shock of disease comes after long and unwise contact with worry, wine and women." Insufficient sleep often causes mania. It often follows after exhausting and irritating fevers. Long continued ill health, together with worry, etc., may cause it.

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To sum up, "mania" may result from any unusual shock or strain upon the nervous system; or it may come after any unusual mental excitement in business, politics or in religion. Such are the exciting or stimulating causes, but we must go back of the presence of worldly misfortune and trace the tendency to mental disorder through channels of hereditary influence. "Infants are born every day whose inevitable goal is that of insanity." What is said in the Bible about sins of the parents is true.

DEMENTIA.--This term literally means "from mind," out of mind, and such a person is in a state of the most deplorable mental poverty. We all have seen such cases and some cases are not only very sad but disgusting.

PRIMARY DEMENTIA comes on independently of any other form of insanity.

SECONDARY DEMENTIA follows after some other form of insanity,--chiefly melancholia or mania. Dementia may be acute or chronic.

SENILE (OLD AGE) DEMENTIA may be Primary.--Acute dementia attacks both sexes, but it occurs most often in females, though in a milder degree. It is a disease of youth, being rarely seen beyond thirty years of age. It seems to depend often upon exhausting influences operating at a period of rapid growth. Monotony of thought and feeling or want of mental food can also induce it. Children who are sent at an early age into factories often pass into the condition of acute dementia. Prison life also tends to produce such a condition. Acute diseases such as typhoid and other fevers are sometimes followed by acute dementia. Persons frequently go "out of their mind" suddenly in this age, and upon recovering from acute dementia, the patient finds a great "vacancy of memory."

Chronic Dementia.--Shakespeare says, "Last scene of all, that ends this strange, eventful history, is second childishness and mere oblivion; sans teeth, sans eyes, sans taste, sans everything."

"The Sans Everything."--Is the sad and hopeless obscuration by time or disease of the once bright, vigorous, scintillating mental powers of exhuperant and lusty youth. Everyone has seen such people who are partially or hopelessly demented. It may come from diseases, such as epilepsy and syphilis; alcohol produces it.

Senile dementia is the result of old age and of acquired brain disease. It is different from simple old age or dotage. In old age the mind is weakened, but the patient is conscious of it, such a person forgets a name or date and gropes about in his memory to find it.

The demented person is not conscious of loss of memory, but applies wrong names to persons, and serenely thinks he is right.

The senile demented person does not realize his condition, and if there is any mental power left he cherishes delusions or false beliefs.

The victim of old age is unconscious of his weakness.