A textbook of mental diseases.

  • Lewis, W. Bevan.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: A textbook of mental diseases. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    262/749 (page 204)
    odour. The pulse is small, somewhat frequent, and the heart's sounds are often muffled. Griesinger* speaks of the heart's sounds as being indistinct during the paroxysm of excitement, and becoming clear during moments of calm ; during the maniacal paroxysm also we learn from Dr. Clifford Allbuttf that the optiC diSC iS anaemle, becoming, in a few days subsequent to the attack, suffused and obscure. The spasm of the retinal vessels, presumably present in these cases, appears to us of great importance in revealing the true nature of the maniacal process as distinguished from states of mental depression. The tongue is often coated and foul; the bowels are torpid; whilst the appetite, sometimes indifferent, is more frequently exalted and often insatiable. It matters not how well the patient takes his food— incessant activity and continued insomnia are sure to result in loss of body-weight; in most instances great emaciation prevails—the face assuming a pinched appearance, the features are sharpened, a dark areola surrounds the eyes, the eyeballs are sunken, yet restlessly active and mobile. The re-instatement of a well-nourished frame is a rapid process cet. par. upon cessation of the maniacal symptoms. There is frequent interference with the menstrual function, during the course of mania. Despite the incessant motor agitation and excite- ment, the body temperature is apyrexial and normal. Periodicity. During the course of maniacal excitement, a remark- able periodicity is often noted in the exacerbations and remissions which occur. We have already alluded to the nocturnal crises which are very prevalent, and we may now draw attention to diurnal varia- tions of excitement and calm occurring upon alternate days, and to which the attention of the nurse is often attracted-an observant nurse will often speak of such a patient's quiet day'' or his had day, referring to this strange alternation. We quite as frequently find the subject alternate between mental exaltation and depression from day to day, and this ready transition from one form to the other appears to us of the highest importance for a proper comprehension of the pathogenesis of these mental states. The menstrual molimen is especially prone to arouse in these subjects an exacerbation of excitement, so that a monthly periodicity m these maniacal outbursts (with more or less complete remissions intervening) is by no means infrequent. Frequent relapses occur in certain sub- jects, apparently attributable to the vicious habit of masturba lon- maniacal reductions and stuporose states being often readily in- curred. West Riding Asylum.