The Home Medical Library Volume II Part 13

=Treatment.=--The failure of the kidneys to perform their usual function of eliminating waste matter from the blood makes it necessary for the skin and bowels to do double duty. The patient should remain in bed and be kept very warm with flannel night clothes and blankets next the body. The diet should consist wholly of milk, a gla.s.s every two hours, in those with whom it agrees, and in others gruels may be subst.i.tuted to some extent. The addition to milk of mineral waters, limewater, small amounts of tea, coffee, or salt often makes it more palatable to those otherwise disliking it. As the patient improves, bread and b.u.t.ter, green and juicy vegetables, and fruits may be permitted. An abundance of pure water is always desirable. The bowels should be kept loose from the outset by salts given in as little water as possible and immediately followed by a gla.s.s of pure water. A teaspoonful may be given hourly till the bowels move. Epsom or Glauber's salts are efficient, but the compound jalap powder is the best purgative. Children, or those to whom these remedies are repugnant, may take the solution of citrate of magnesia, of which the dose is one-half to a whole bottle for adults. The skin is stimulated by the patient's lying in a hot bath for twenty minutes each day or, if this is not possible, by wrapping the patient in a blanket wrung out of hot water and covered by a dry blanket, and then by a rubber or waterproof sheet, and he is allowed to remain in it for an hour with a cold cloth to the head. If the patient takes the hot bath he should be immediately wrapped in warmed blankets on leaving it, and receive a hot drink of lemonade to stimulate sweating.

For treatment of convulsions, see Vol. I, p. 188.

Vomiting is allayed by swallowing cracked ice, single doses of bis.m.u.th subnitrate (one-quarter teaspoonful) once in three hours, and by heat applied externally over the stomach. Recovery is hastened by avoiding cold and damp, and persisting with a liquid diet for a considerable period. A course of iron is usually desirable after a few weeks have elapsed to improve the quality of the blood; ten drops of the tincture of the chloride of iron taken in water through a gla.s.s tube by adults; for children five to ten drops of the syrup of the iodide of iron. In either case the medicine should be taken three times daily after meals.

=CHRONIC BRIGHT'S DISEASE.=--This includes several forms of kidney disease. The symptoms are often very obscure, and the condition may not be discovered or suspected by the physician until an examination of the urine is made, which should always be done in any case of serious or obscure disorder. Accidental discovery of Bright's disease during examination for life insurance is not rare. The disease may exist for years without serious impairment resulting.

=Causes.=--Chronic Bright's disease often follows and is the result of fevers and acute inflammation of the kidneys. It is more common in adults. Overeating, more especially of meat, and overdrinking of alcohol are frequent causes. Gout is a frequent factor in its causation. The disease has in the past been regarded as a local disease of the kidneys, but recent research makes it probable that there is a general disorder of the system due to some faulty a.s.similation of food--especially when the diet itself is faulty--with the production of chemical products which damage various organs in the body as well as the kidneys, notably the heart and blood vessels.

=Symptoms.=--The symptoms are most diverse and varied and it is not possible to be sure of the existence of the disease without a careful physical examination, together with a complete examination of the urine, both made by a competent physician. Patients may be afflicted with the disease for long periods without any symptoms until some sudden complication calls attention to the underlying trouble.

Symptoms suggesting chronic Bright's disease are among the following: indigestion, diarrhea and vomiting, frequent headache, shortness of breath, weakness, paleness, puffiness of the eyelids, swelling of the feet in the morning, dropsy, failure of eyesight, and nosebleed, and sometimes apoplexy. As the disease comes on slowly the patient has usually time to apply for medical aid, and attention is called to the foregoing symptoms merely to emphasize the importance of attending to such in due season.

=Outcome.=--While the outlook as to complete recovery is very discouraging, yet persons may live and be able to work for years in comparative comfort in many cases. When a physician p.r.o.nounces the verdict of chronic Bright's disease, it is not by any means equivalent to a death warrant, but the condition is often compatible with many years of usefulness and freedom from serious suffering.

=Treatment.=--Medicines will no more cure Bright's disease than old age. Out-of-door life in a dry, warm, and equable climate has the most favorable influence upon the cause of chronic Bright's disease, and should always be recommended as a remedial agent when available.

Proper diet is of great importance. Cereals, vegetables, an abundance of fat in the form of b.u.t.ter and cream--to the amount of a pint or so a day of the latter, and the avoidance of alcohol and meat, fish and eggs const.i.tute the ideal regimen when this can be carried out. Tea and coffee in much moderation are usually allowable and water in abundance. The underclothing should be of wool the year round, and especial care is essential to avoid chilling of the surface. Medicines have their usefulness to relieve special conditions, but should only be taken at the advice of a physician, whose services should always be secured when available.

Part IV

DISEASE AND DISORDER OF THE MIND

BY

ALBERT WARREN FERRIS

CHAPTER I

=Insanity=

Insanity is the name given to a collection of symptoms of disease of the brain or disorder of brain nutrition or circulation. The princ.i.p.al test of insanity lies in the adjustment of the patient to his surroundings, as evidenced in conduct and speech. Yet one must not include within the field of insanity the improper conduct and speech of the vicious, nor of the mentally defective. Crime is not insanity, though there are undoubtedly some insane people confined in prisons who have been arrested because of the commission of crime.

Then, too, while mental defect may exist in the insane, there is a certain cla.s.s of mental defectives whose condition is due not to disease of the brain, but to arrest of development of the brain during childhood or youth, and these we call idiots or imbeciles; but they are not cla.s.sed with the insane.

_Mental Disorder Not Insanity_

We frequently hear repeated the a.s.sertion, "Everybody is a little insane," and the quotation is reported as coming from an expert in insanity. This quotation is untrue. The fact is that anyone is liable to mental disorder; but mental disorder is not insanity. To ill.u.s.trate: a green glove is shown to a certain man and he a.s.serts that its color is brown, and you cannot prove to him that he is wrong, because he is color-blind. Green and brown appear alike to him. This is mental disorder, but not insanity. Again, a friend will explain to you how he can make a large profit by investing his money in a certain way. He does so invest it and loses it, because he has overlooked certain factors, has not given proper weight to certain influences, and has ignored probable occurrences, all of which were apparent to you. He was a victim of his mental disorder, his judgment, reason, and conception being faulty; yet he was not insane. Again, you answer a letter from a correspondent, copying on the envelope the address you read at the head of his letter. A few days later your answer is returned to you undelivered. In astonishment, you refer to his letter and find that you have misread the address he gave, mistaking the number of his house. This was an instance of mental disorder in your not reading the figure aright; but it was not insanity.

_What Autopsies of the Brain Reveal_

The changes in the brain accompanying or resulting from disease, as found in some chronic cases of insanity in which autopsies are made, consist largely in alteration of the nerve cells of the brain. The cells are smaller and fewer than they should be, they are altered in shape, and their threads of communication with other cells are broken. Nerve cells and often large areas of gray matter are replaced by connective tissue (resembling scar tissue), which grows and increases in what would otherwise be vacant s.p.a.ces. All areas which contain this connective tissue, this filling which has no function, of course, cease to join with other parts of the brain in concerted action, and so the power of the brain is diminished, and certain of its activities are restricted or abolished.

_Curious Illusions of the Insane_

In the normal brain certain impressions are received from the special senses: impressions of sight or of hearing, for example. These impressions are called conscious perceptions, and the healthy brain groups them together and forms concepts. For instance, you see something which is flat and shiny with square-cut edges. You touch it, and learn that it is cold, smooth, and hard. Lift it and you find it heavy. Grouping together your sense perceptions you form the concept, and decide that the object is a piece of marble. Again, you enter a dimly lighted room and see a figure in a corner the height of a woman, with a gown like a woman's. You approach it, speak to it and get no reply, and you find you can walk directly through it, for it is a shadow. Perhaps you were frightened. Perhaps you imagined she was a thief. Your first judgment was wrong and you correct it. The insane person, however, has defective mental processes. He cannot group together his perceptions and form proper conceptions. His imagination runs riot. His emotions of fear or anger are not easily limited. He has to some extent lost the control over his mental actions that you and other people possess if your brains are normal. The insane man will insist that there is a woman there, and not a shadow, and to his mind it is not absurd to walk directly through this person. He cannot correct the wrong idea. Such a wrongly interpreted sense perception is called an illusion. Another example of illusion is the mistaking the whistle of a locomotive for the shriek of a pursuing a.s.sa.s.sin.

_What Hallucinations Are_

The insane man may also suffer from hallucinations. A hallucination is a false perception arising without external sensory experience. In a hallucination of sight, the disease in the brain causes irritation to be carried to the sight-centers of the brain, with a result that is similar to the impression carried to the same centers by the optic nerves when light is reflected into the eyes from some object. An insane man may be deluded with the belief that he sees a face against the wall where there is nothing at all. When the air is pure and sweet and no odor is discoverable, he may smell feathers burning, and thus reveal his hallucination of smell.

_Delusions Common to Insanity_

The insane man may have wrong ideas without logical reason for them.

Thus, an insane man may declare that a beautiful actress is in love with him, when there is absolutely no foundation for such an idea. Or, he may believe that he can lift 500 pounds and run faster than a locomotive can go, while in reality he is so feeble as scarcely to be able to walk, and unable to dress himself. Such ideas are delusions.

Sane people may be mistaken; they may have hallucinations, illusions and delusions; but they abandon their mistaken notions and correct their judgment at once, on being shown their errors. Sane people see the force of logical argument, and act upon it, abandoning all irrational ideas. The insane person, on the other hand, cannot see the force of logical argument; cannot realize the absurdity or impossibility of error. He clings to his own beliefs, for the evidence of his perverted senses or the deductions from his disease-irritation are very real to him. When we find this to be the fact we know he is insane.

Yet we must not confound delirium of fever with insanity. A patient suffering from typhoid fever may have a delusion that there is a pail by his bed into which he persists in throwing articles. Or he may have the hallucination that he is being called into the next room, and try to obey the supposed voice.

Certain delusions are commonly found in certain types of insanity.

Depressed patients frequently manifest the delusion that they have committed a great sin, and are unfit to a.s.sociate with anyone.

Excited and maniacal patients often believe they are important personages--kings or queens, old historical celebrities, etc.

Paranoiacs commonly have delusions of persecution and of a conspiracy among their relatives or their a.s.sociates or rivals. Victims of alcoholic insanity have delusions regarding s.e.xual matters, and generally charge with infidelity those to whom they are married.

General paretics in most cases have delusions of grandeur; that is, false ideas of great strength, wealth, political power, beauty, etc.

The emotion which accompanies mental activity is generally exaggerated in all insane people except the demented. One sees extreme depression, or undue elation and exaltation, or silly glee and absurd joy.

Intensity of emotion is frequent.

_Crimes Impulsively Committed by the Insane_

An interesting mental feature of many insane patients is the imperative conception, or imperative impulse. This is a strong urging felt by the patient to commit a certain act. He may know the act is wrong and dread the punishment which he expects will follow its commission. But so constantly and strongly is he impelled that he finally yields and commits the act. Crimes are thus perpetrated by the insane, with a full knowledge of their enormity. The fact that such impulses undoubtedly exist should modify the common test, as to an insane person's responsibility before the law. The statute in many countries regards an insane criminal as responsible for his act, if he knows the difference between right and wrong. This decision is unjust and the basis is wrong; for an impulse may be overwhelming, and the patient utterly helpless during its continuance. However, a patient who has committed a crime under stress of such an irresistible impulse should be put under permanent custodial care.

_Physical Signs of Insanity_

The physician who is skilled in psychiatry finds in very many insane patients marked physical signs. There are pains, insensitive areas, hypersensitive areas, changes in the pupils of the eyes, unrestrained reflex action, and partial loss of muscular control, as shown in talking, walking, and writing. Constipation and insomnia are very early symptoms of disease in a very large proportion of the insane.

It is productive of no good result for a layman to try to cla.s.sify the insane. The matter of cla.s.sification will be for several years in a condition of developmental change. It is enough to speak of the patient as depressed or excited, agitated or stupid, talkative or mute, homicidal, suicidal, neglectful, uncleanly in personal habits, etc.

_Ill.u.s.trations of Various Types_

There are very interesting features connected with typical instances of several varieties of insanity, as they were noted in certain cases under the writer's care. A depressed patient with suicidal tendencies cherished the delusion that war with Great Britain was imminent, and that in such an event British troops would be landed on Long Island between New York City and the spot where he conceived the cattle to be kept. This, he argued, would cut off the beef and milk supply from the city. He therefore decided to do his part toward husbanding the present supply of food by refusing to eat; an act which necessitated feeding him through a rubber tube for many weeks. He also attempted suicide by drowning, throwing himself face downward in a shallow swamp, whence he was rescued. This young man was an expert chess player even during his attack.

A maniacal patient wore on her head a tent of newspaper to keep the devil from coming through the ceiling and attacking her. She frequently heard her husband running about the upper floor with the devil on his back. As a further precaution she stained her gray hair red with pickled beet juice, and would occasionally hurl loose furniture at the walls and ceilings of her rooms and a.s.sault all who approached her.