Degeneracy Part 18

An allied cla.s.s, belonging to a still blacker phase of biology, are the s.e.xual perverts. The congenital form a.s.sociated with the stigmata of degeneracy, as already shown, is an expression of the defective line whence the victim has sprung. The congenital types are, like the similar types of the prost.i.tute, victims of inherited defects. The s.e.xual pervert may be divided into precisely the same cla.s.ses as other criminals. The congenital type often links degenerate lunatics, epileptics, &c., with a born criminal cla.s.s.

Between the criminal and the insane is a debatable line occupied by moral imbeciles, reasoning maniacs, &c. There are many insane persons in whom the princ.i.p.al deviation from the normal consists in disorder of the moral faculties. In most closer inspection generally reveals signs of degeneracy. The seeming immorality is the striking factor of the case and superficially the mind otherwise appears clear and rational by contrast.

As Krafft-Ebing has shown in these cases, the most striking features are moral insensibility, lack of moral judgment and ethical ideas, the place of which is usurped by a narrow sense of loss or profit, logically apprehended only. Such persons may mechanically know the laws of morality, but if such laws enter their conscience these persons do not experience by any real appreciation, still less regard, for them. These laws to them are cold, lifeless statements. The morally defective know not how to draw from them motive for omission or commission. To this "moral colour-blindness"

the whole moral and governmental order appears as a mere hindrance to egotistic ambition and feeling, which necessarily leads to negation of the rights of others and to violation of the same.

These defective individuals are without interest for aught good or beautiful, albeit capable of a sentimentality which is shallow cant. Such persons are repellent by their lack of love for children or relatives, and of all social inclinations, and by cold-hearted indifference to the weal or woe of those nearest to them. They are without other than egotistic care for questions of social life or sensibility to either the respect or the scorn of others, without control of conscience and without sense or remorse for evil. Morality they do not understand. Law is nothing more than police regulation. The greatest crimes are regarded as mere transgressions of some arbitrary order. If such persons come in conflict with individuals, then, hatred, envy, and revenge take the place of coldness and negation, and their brutality and indifference to others know no bounds.

These ethically defective persons, when incapable of holding a place in society, are often converted into candidates for the workhouse or the insane hospital, one or the other of which places they reach after they have been, as children, the terror of parents and teachers, through their untruthfulness, laziness, and general meanness, and in youth the shame of the family and the torment of the community and the officers of the law, by thefts, vagabondage, profligacy, and excesses. Finally, they are the despair of the insane hospital, the "incorrigibles" of the prisons, and (Krafft-Ebing might have added) the veritable burdens of the poor-house.

If intellectual insanity or crime do not claim them, pauperism or criminality is likely to be their destiny. The moral imbecile may, however, keep within the law, and as in the instance of the "Napoleon of Finance," cited elsewhere from Kiernan, may achieve business success. His descendants often, however, evince degeneracy in an aggravated form. Many of the supposed reformers of various alleged social evils are often of this cla.s.s. Their morbid egotism takes the direction of cant and sentimentality, so common at certain states in evolution, as points of least resistance. Like Guiteau, the a.s.sa.s.sin of President Garfield, they aim at doing a "big thing for humanity and myself," the humanity being concentrated in "my" ideas. The moral lunatic needs but a slight twist intellectually to become the paranoiac in whom there is, as Spitzka has pointed out,[256] a permanent undercurrent of perverted mental action peculiar to the individual, running like an unbroken thread through his whole mental life, obscured, it may be, for these patients are often able to correct and conceal their insane symptoms, but it nevertheless exists, and only requires friction to bring it to the surface. The general intellectual status of these patients, though rarely of a very high order, is moderately fair, and often the mental powers are sufficient to keep the delusion under check for practical purposes of life. While many are what is termed crochety, irritable, and depressed, yet the sole symptoms of the typical cases of this disorder consist of the fixed delusions. Since the subject matter of the delusion is of such a character that these patients consider themselves either the victim of a plot or as unjustly deprived of certain rights and position, or as narrowly observed by others, delusions of persecution are added to the fixed ideas, and the patient becomes sad, thoughtful, or depressed in consequence. The patient is depressed logically, as far as his train of idea is concerned and his sadness and thoughtfulness have causes, which he can explain, and which are intimately allied with that peculiar, faulty grouping of ideas which const.i.tutes the rendezvous, as it were, of all the mental conceptions of the patient. Nay, the process may be reversed, and the patient, beginning with a hypochondriac or hysteric state, imagines himself watched with no favourable eye. Because he is watched and made the subject of audible comments (hallucinatory or delusional), he concludes that he must be a person of some importance. Some great political movement takes place; he throws himself into it, either in a fixed character that he has already constructed for himself, or with the vague idea that he is an influential personage. He seeks interviews, holds actual conversation with the big men of the day, accepts the common courtesy shown him by those in office as a tribute to his value, is rejected, however, and then judges himself to be the victim of jealousy or of rival cabals, makes intemperate and querulous complaints to higher officials, perhaps makes violent attacks upon them, and being incarcerated in jail or asylum, looks upon this as the end of a long series of persecutions which have broken the power of a skilled diplomatist, a capable military commander, a prince of the blood, an agent of a camarilla, a paramour of some exalted personage, or finally the Messiah Himself. All through this train of ideas there runs a chain of logic and inference in which there is no gap. If the inferences of the patient were based on correctly observed facts and properly correlated with his actual surroundings, his conclusions would be perfectly correct.

For years and years many such patients exhibit a single delusive idea as the only prominent symptom. There is hereditary taint in most of these subjects, who are strange in disposition from infancy. As children they frequently shun society and indulge in day-dreams. Their bodily growth is normal, but even trifling disease takes on a cerebral tinge. They may show talent in special directions, but their intelligence rarely pa.s.ses out of the puerile stage. They often brood over a feminine ideal, a girl who has never encouraged them, and whom they persecute with absurd plans of marriage.

Connecting the paranoiac with the moral imbecile are the so-called "reasoning maniacs." Here the intellectual power is less than either that of the moral imbecile or of the paranoiac, twisted though the intellect of the latter be. Loquacious or unusually taciturn, heedless or morbidly cautious, dreamers, wearisome to all brought in contact with them, capricious and unmitigated liars, their qualities are often, in a certain manner, brilliant, but are entirely without solidity or depth. Sharpness and cunning are not often wanting, especially for little things and insignificant intrigues. Ever armed with a lively imagination and quick comprehension, they readily appropriate the ideas of others, developing or transforming them and giving them the stamp of their own individuality.

But the creative force is not there, and they rarely possess enough mental vigour to get their own living. Pa.s.sing without the slightest transition from one extreme to the other, they felicitate themselves to-day on an event which they sneered at the night before. In the course of a single second they change their opinions of persons and things, novelty captivates and wearies them almost in the same instant. They sell for insignificant sums things they have just bought, in order to buy others which, in their turn, will be subjected to like treatment; and, strange to say, before possessing these objects, they covet them with a degree of ardour only equalled by the eagerness they exhibit to get rid of them as soon as they become their own. To see, to desire, and to become indifferent are three stages which follow each other with astonis.h.i.+ng rapidity.

The intense egotism of these persons makes them, as W. A. Hammond remarks, utterly regardless of the feelings and rights of others. Everybody and everything must give way to them. Their comfort and convenience are to be secured though every one else is made uncomfortable or unhappy; and sometimes they display positive cruelty in their treatment of persons who come in contact with them. This tendency is especially seen in their relations with the lower animals.

Another manifestation of their intense egotism is their entire lack of appreciation of kindness done them or benefits of which they have been the recipients. They look upon these as so many rights to which they are justly ent.i.tled, and which in the bestowal are more serviceable to the giver than to the receiver. They are hence ungrateful and abusive to those who have served them, insolent, arrogant, and shamelessly hardened in their conduct toward them. At the same time, if advantages are yet to be gained, they are sycophantic to nauseousness in their deportment towards those from whom the favours are to come.

The egotism of these people is unmarked by the least trace of modesty in obtruding themselves and their a.s.sumed good qualities upon the public at every opportunity. They boast of their genius, their righteousness, their goodness of heart, their high sense of honour, their learning and other qualities and acquirements, and this, when they are perfectly aware that they are commonplace, irreligious, cruel, and vindictive, utterly devoid of every chivalrous feeling, and saturated with ignorance. They know that in their ratings they are attempting to impose upon those whom they address and will even subsequently brag of their success.

It is no uncommon thing for the reasoning maniac, still influenced by his supreme egotism and desire for notoriety, to attempt the part of reformer.

Generally he selects a practice or custom in which there really is no abuse. His energy and the logical manner in which he presents his views, based as they often are on cases and statistics, impose on many people, who eagerly adopt him as a genuine overthrower of a vicious or degrading measure. Even when his hypocrisy and falsehood are exposed he continues his attempts at imposition, and when the strong arm of the law is laid upon him, he prates of the ingrat.i.tude of those he has been endeavouring to a.s.sist, and of the distinctiveness and purity of his own motives.

Closely akin to that instability of inter-a.s.sociation resulting in loss of proper checks on action in the types just described, is the sentimentalism which often covers real hardness, but which charms and allures the ma.s.s.

This has essentially the same psychological basis as the suspicional tendencies and pessimism with which it is so often a.s.sociated. Suspicional tendencies arise from states of anxiety resultant on instability of a.s.sociation, dependent on lack of a.s.sociating fibres. Pessimism (so frequently present in the otherwise healthy degenerate) is often, as Magalhaes has shown, nervous instability with alternations of irritability and prostration. The subject is supersensitive; impressions call forth intense and prolonged reactions followed by exhaustion. The state is characterised by a general hyperaesthesia, which naturally results in an excess of suffering. From instability and hyperaesthesia results discord between the feelings themselves, between the feelings and the intelligence, between the feelings, the ideas and volitions. Discord between the feelings shows itself in a great variety of paradoxes, contradictions, and inconsistencies. To the pessimist possession of a desired object does not atone for former privation. Pain or unsatisfied desire is replaced by the pain of _ennui_. With inability to enjoy what he has are coupled extravagant expectations regarding that which he does not have. He is extremely susceptible both to kindness and to contempt. He pa.s.ses suddenly from violent irritability to languor, from self-confidence and vanity to extreme self abas.e.m.e.nt. His intense sensitiveness results in intellectual disorders. For this involves a great vivacity of the intuitive imagination, which favours the setting up of extravagant ideals, lacking in solid representative elements. Hence a gap opens between his ideal and the actual. He can never realise the ideal he pursues and so his feelings are of a sombre hue. From this excessive realism results a state of doubt, a certain distrust of all this rational objective knowledge. It a.s.sumes another form in extreme subjectivism. The pessimist is haunted by images of the tiniest religious scruples, suspicions, fears, and anxieties, resulting in alienation from friends, seclusion, misanthropy.

The pessimist is further characterised by an incapacity for prolonged attention, a refractory attention and a feeble will. These result in inaction, quietism, reverie, self-abnegation, abolition of the personality, annihilation of the will, amounting sometimes even to poetic or religious ecstasy. Pessimism is frequently a.s.sociated with a morbid fear of death. The tramp is one phase of the degenerate in whom the restless wandering tendencies of the neurasthenic and paranoiac are added to the parasitic tendencies of the pauper, and the suspicional egotism of the "reasoning maniac."

The one-sided genius is a link between the neurotic, the epileptic, the paranoiac, the hysteric, and the imbecile. Cases crop up in which all these elements are so mingled as to create a puzzle where they shall be placed. In some cases, in accordance with the general law that physiologic atrophy is accompanied by hypertrophy in other directions, the intellectual powers other than along certain lines may be remarkably deficient. Moreover, the intellectual power due to healthy atavism is increased by the degeneracy in certain directions. Without going into the question, raised by Lombroso,[257] as to genius being an epileptoid neurosis, sufficient evidence exists to show that ill-balanced genius often coexists with defects in a large number of directions. The coexistence of genius with imbecility and even idiocy has been well ill.u.s.trated by Langdon Down, who cites numerous instances thereof.[258]

Defect in genius, whether of the imbecile stamp or otherwise, accompanied by deficiency, is not expressed in the genius, but in its deficient accompaniment. Even the mental instability of the highest type of defective genius is closely akin to that of the neurotic.

The hysterics, as has been shown by Des Champs,[259] are neurotic women in whom an aggravated sensibility exists. Neurotic women are divisible into three categories according to the predominance of one of three centres--cerebral, genital, and neuropathic. These types may be pure or intermixed. The general characteristics are an absolute want of equilibrium in sensibility and will power. There exists mobility of humour in direct relation with facile impressionability to external influences or to internal states. The nerves vibrate to all sentiments coming from within or without, and all are registered without proper relation. One fact chased by another is forgotten. Another produces a momentary hyperexcitation, which takes place of the truth, whence it is that falsehood is instinctive, but the patient protests her good faith if accused of the same. This lack of equilibrium leads to a decided modification of the mental faculties. Intellectual activity is over excited, but in diverse degrees and variable ways, according to the particular tendencies adopted. Absorbed by a preoccupation or controlled by an idea, they become indifferent to all else. Their ideas are abundant, and they rapidly pa.s.s from the idea to the act. Their vivid imagination, coupled with a bright intelligence, gives them a seducing aspect, but their judgment is singularly limited, attenuated, or false. They judge from a non-personal standpoint excellently. They are quick at discovering the faults of even their own relatives, but faults rightly attributed to themselves are repudiated. Their memory is capricious. They forget their faults and their acts under impulse, albeit these may be consciously done.

The cerebral type is led by the intelligence. She has little or no coquetry; what coquetry there may be is the result of intention and temporary. There is an ethical sense, frankness and n.o.bility in her ideas, disinterestedness and tact in her acts, and she is capable of friends.h.i.+p.

Her tastes carry her to male pursuit, in which she succeeds. She becomes often what is called a "superior woman," and too often what is called an "incomprehensible woman." She has but little guile. To the sensual type voluptuousness is the aim of life and the centre of her acts and thoughts.

She is well endowed with guile and extremely diplomatic. She is full of finesse, but not very delicate. Her lack of scruple often spoils her tact.

She is ruseful, dissimulating, and unconsciously mendacious. She despises friends.h.i.+p and needs watching. If circ.u.mstances permit she loses all delicacy, reserve and modesty. She is dest.i.tute of scruples. Her crimes are coolly remorseless. The neuropathic type is one to which the gra.s.shopper is a burden. Her nerves are always on edge. She is a heroic invalid who displays the air of a martyr about trivialities.

The character of the neurotic, as Kiernan remarks, recalls the observation of Milne-Edwards concerning the monkey character. Levity is one of its salient features, and its mobility is extreme. One can get it to s.h.i.+ft in an instant from one mood or train of ideas to another. It is now plunged into black melancholy and in a moment may be vastly amused at some object presented to its attention.

Neuroticism in man differs in no respect from that in woman except that anaesthesia, paralysis of emotional origin, and conscious convulsions are less common. The male neurotic could be subdivided precisely as Des Champs has the hysteric. Neurotics are often long-lived, peculiarly resistant to certain acute and fatal disease, and are frequently retentive of their youthful appearance, which is to a certain extent an evidence of their resistance to the wear and tear of life and advancing old age, and due to emotional anaesthesia. Recognition of the neurotic tendency often induces the individual to take better care of himself. The youthful appearance may be due largely to arrest of facial development at an early age, the face thus retaining the child character throughout life. Considering, therefore, this cla.s.s of neurotics, which does not include those afflicted with the more serious nervous disorders such as epilepsy, they may be looked upon as the victims of evolutionary processes that are constantly going on in the race and under civilised conditions.

Neurotics are not met with to any extent among barbarous races, but are numerous in civilised communities, where the weak are preserved from early death and then subjected to the struggle for existence. Neurotics are individuals naturally imperfect in some directions, but by the law of economy of growth they are often superior in others. Their disordered nervous functions and hyperaesthesia are not, necessarily, indicative of inferiority of general organisation compared to their ancestry. They may simply imply a more rapid advance in some one direction in the development of the nervous system than can be kept up with by the remainder. These defects may in some cases be the advance guards in the progress of the development of the race.

As the nervous system controls nutrition in all departments of the organism, anomalies occur with erratic nervous functions in such individuals. In these neurotics are often found defective development involving the bony and other structures. They have fine and delicate features, small jaws and defective teeth. These are the results of general systemic modifications connected with the neurotic state. The arthritic diathesis occurs also; it is one of the underlying conditions of many neurotic manifestations, often responsible for acquired bony deformities, not infrequently involving the jaws to some extent.

Neurotic degenerate symptoms from a mental standpoint are noticeable long before deformities of the osseous system are developed. They show themselves in mental weakness, extreme stupidity, and precocity. Under the first cla.s.s the child is obstinate, quarrelsome, malignant, even immorally inclined, and is often spoken of as being wicked or vicious. Harriet C. B.

Alexander[260] says the ruling instinct in the child of three or four is self-gratification. It destroys what it dislikes. Among the earliest manifestations of morbid mental activity in childhood are hallucinations, which depend on already registered perceptions.

In many instances even moral agencies produce sudden explosions of mental disorders. The inherited tendencies of childhood predispose to these attacks. As Clouston has shown, neuroses and psychoses not requiring hospital treatment are by no means uncommon in the too sensitive child with hereditary taint. Children of this cla.s.s have crying fits and miserable periods on slight or no provocation. As Clouston has also shown, precocity, over-sensitiveness, unhealthy strictness in morals and religion for a child, or too vivid imagination, want of courage, thinness and craving for animal food, are common characters. These children are over-sensitive, over-imaginative, are too fearful to be physiologic, and tend, as a general thing, to be unhealthily religious, precociously intellectual, and at first hyperaesthetically conscientious.

The other cla.s.s of children, as a rule, are very handsome babies and children. The brightness is noted by parents at a very early age, and they extol their many clever qualities and sayings. The tendency is for the parents to cultivate these precocious qualities and believe it to be the proper thing to encourage them; while in early life this cla.s.s may possess the peculiarities of the other cla.s.s and also show those of degeneracy.

These children are the best scholars in the schoolroom and learn their lessons with apparently little or no study. They are usually thin, frail children, and very nervous. Very little food is taken and much of that is not a.s.similated. Especially is this true of the lime salts, which form bone and tooth structure. These lime salts are excreted through the kidneys and salivary glands. This is easily demonstrated by an examination of urine, mouth, and teeth. Large collections of tartar are always found in these cases. Children of both cla.s.ses are sure to show stigmata of degeneracy. This period of degeneracy commences at the sixth year, or at about the time the first period of brain development ceases. The bulk of the brain has obtained its growth. In some the child commences to improve mentally very fast. In others mental development is slow. In still others it ceases altogether. From the time the second set of teeth begins to develop until the twelfth year, neuroses of development and stigmata of degeneracy are stamped upon the head, face, nose, jaws and teeth, and later any of the conditions mentioned under the heads of nutritive degeneracy and local perversion tendencies may appear.

Closely akin to these states are expressions of degeneracy manifesting themselves with some approach to regularity in periods, as in epilepsy and the periodical insanities. The periodical insanities may be simply emotional states of exaltation (as in mania), of extreme depression (as in melancholia), of stupor, or of mental confusion. They may show themselves in periodical acts, as in dipsomania. This condition differs from the condition called inebriety in the fact that it is a periodical expression of degeneracy whose form has been accidently determined, but which would exist even were its form changed. The differences are excellently outlined by Dana,[261] who divides intemperate drinkers into four cla.s.ses: Periodical inebriates or dipsomaniacs, pseudo-inebriates, common drunkards and victims of delirium inebriosum. The disease in the first cla.s.s is a periodical insanity. In the pseudo-inebriates the desire for drink is only one of many manifestations of a weakened const.i.tution or inherently unstable nervous system. The third type are those which approximate the occasional criminals. Another periodical insanity is kleptomania, in which insane stealing occurs at intervals of greater or lesser regularity.

Nymphomania or satyrasis is a periodical insanity in which there is an insane impulse for s.e.xual intercourse. Pyromania is a periodical tendency to commit arson. All of these periodical conditions may occur alone or in combination with other degeneracies.

Closely related to the periodical insanities are the epileptic states which play so large a part in many of the phenomena presented by the degenerates. In the epileptic the mental rather than the gross nervous expression merits attention. From what has already been said about epilepsy, it and the periodical insanities are in no small degree the effect of mal-development of the fore brain as compared with the centres of organic life. The great convulsive centre is, according to Spitzka,[262] the reticular grey matter of the brain isthmus, particularly of the pons and medulla. All characteristic features of the full epileptic onset can be produced in animals deprived of the related cerebral cortex.

It needs but a slight puncture with a thin needle to produce typical convulsions in the rabbit, and some of the convulsive movements reported by Nothnagel have not only shown the true epileptic character but also that peculiar automatism noted in aberrant attacks. It is in this segment of the nervous system that all the great nerve strands conveying motor impulses, both of a voluntary and automatic and some of a reflex character, are found united in a relatively small area, and just here a relatively slight irritation might produce functional disturbances involving the entire bodily periphery.

The experiments of physiologists have shown that if a sensory irritation of a given spinal nucleus be kept up, after having produced a reflex movement in the same segment, any reaction beyond the plain of that segment is not in the next or succeeding planes but in the medulla oblongata. The motor reaction then manifests itself in laughing, crying, or deglut.i.tory spasms, and, if the irritation be of the severest kind, epileptic or tetanic spasms in addition. Now the occurrence of laughing, crying, or deglut.i.tory spasms could be easily understood if the molecular oscillation induced by the irritation were to travel along the a.s.sociating tracts from the given spinal segment to the nuclei of the medulla oblongata. For in the medulla are found the nerve nuclei which preside over the facial, laryngeal and pharyngeal muscles. It is not easy at first to understand how teta.n.u.s and epilepsy, that is, spasms consisting in movements whose direct projection is not in the medulla oblongata but in the cord, can be produced by irritation of the former.

There are scattered groups of nerve cells in the medulla oblongata which have either no demonstrable connection with the nerve nuclei, or are positively known to be connected with the longitudinal a.s.sociating strands. These cells hence can safely be regarded as representing a presiding centre over the entire spinal system. No spinal centre exerts any influence even remotely as p.r.o.nounced as that of the entire cord.

This applies to man and other mammals. That the elaboration of the medullary centre was as gradual a process as that of other higher differentiations is ill.u.s.trated by the case of the frog, whose medulla has acquired the faculty of reproducing general spasms while the spinal cord itself retains this property also; hence here the predominance of the medulla is not so marked as in mammals.

The reticular ganglion of the oblongata is not in the adult a part of the central tubular grey matter, but has, through originally developing from it in the embryo, become ultimately isolated from its mother bed. It const.i.tutes a second ganglionic category, and the a.s.sociation fibres bringing it in functional union with the spinal grey (first category) in lower animals and shown to have a.s.sumed the position of projection fibres in the higher, const.i.tute a second projection tract; both together are a second projection system. The scattered grey matter of the medulla has great importance. Anatomically it is (though its cells be scattered diffusely as a rule) a large ganglion with numerous multipolar cells of all sizes, many of them gigantic, sometimes exceeding the so-called motor cells (which they simulate in shape) of the lumbar enlargement in size.

Scattered in the "reticular substance" of the medulla from the upper end of the fourth ventricle to the pyramidal decussation, they merit the collective designation of reticular ganglia.

The cells of the reticular formation are known to be connected with the nerve nuclei, on the one hand, and with longitudinal fasciculi, which, since they run into the cord, terminate either in the grey matter or the nerve roots directly, for nerve fibres do not terminate with, as it were, blind ends. Now in the mammalian brain the reticular ganglion lies scattered among fibres which come from the higher centres, and the interpellation might be made whether, after all, the reticular ganglion be not a mere intercalar station for fibres derived from a higher source.

Originally the ganglion was an independent station. In reptiles this body of cells is too considerable to account for a termination in them of the few cerebral fibres possessed by these animals. And, on the other hand, the vertical strands are notably increased in their pa.s.sage through the field of the medulla oblongata.

The medulla oblongata with its reticular ganglion seems to be the great rhythmic centre. In fish the movements of the operculum and mouth, in sharks those of the spiraculum, in perenni-branchiate amphibians the branchial tree, in the infant the suctorial muscles, in all vertebrates the movements of deglut.i.tion, of the heart and respiratory muscles, all movements presenting a more or less regular rhythm, are under the control of the medulla oblongata. The early differentiation of this part of the cerebro-spinal axis is related to the manifestations of rhythmic movements in the embryo and their predominant importance in lower animals. The possibility should not be excluded that a rhythmic movement may be spinal, nay even controlled by peripheral ganglia (heart of embryo). A higher development, however, implies the concentration of rhythmic innervations at some point where that anatomical a.s.sociation may be effected which is the expression of the mutual influence these movements exercise among themselves.

Two sets of phenomena must be borne in mind in studying the physiological pathology of the epileptic attack. First, the condition of the epileptic in the interval. Second, the explosion itself. Too much attention is paid to the last, too little attention to the first. The const.i.tutional epileptic is characterised by a general deficiency of tone a.s.sociated with exaggerated reaction and irritability. Thus the pupils are at once widely dilated and unusually mobile. The muscular system, though generally relaxed, manifests exaggerated reflex excitability. The mental state is characterised at once by great indifference and undue irascibility. In the same way the vascular system is depressed in tone in the interval with rapid marked changes under excitation. The state of the nervous system as a whole Spitzka forcibly compares to that of an elastic band which, being on the stretch continually, is apt to rebound violently when one end is let go. Under normal circ.u.mstances the band is less stretched and hence not as liable to fly so far when the check is removed.

An irritation which, in health, produces restlessness of the muscular system, accelerated respiration and pulsation and various mental phenomena within the normal limits, in the epileptic results in more intense phenomena in the same direction. The nervous irritability of the epileptic manifests itself in one direction especially. An important vaso-motor centre for the brain vessels exists, possibly diffused through an area somewhere between the thalamus and subthalamic region above the pyramidal decussation below. The irritability of this centre results in sudden arterial spasm in the carotid distribution (so characteristic a feature of the fit onset); simultaneously with the contraction of the vessel the pupil undergoes an initial contraction, and relaxation instantly results in both cases. The sudden interference with the brain circulation produces unconsciousness, and destroys the checking influence of the higher centres on the reflexes in a manner a.n.a.logous to any shock affecting the nerve centres. In the meantime, while there has been a sudden deprivation of arterial blood and a sinking of intracranial pressure so far as the great cerebral ma.s.ses are concerned, there has been as sudden an influx of blood to the unaffected district of the vertebral arteries whose irrigation territory is now the seat of an arterial hyperaemia. The result of this is that the great convulsion centre, the medulla, being over-nourished, functional excess, that is, convulsion, occurs unchecked by the cerebral hemispheres, which are disabled by their nutritive shock. The unconsciousness and coma of epilepsy more resemble shock than they do cerebral anaemia or syncope. The impeded return circulation of venous blood now comes into play. The contraction of the neck muscles explains this obstruction and especially the acc.u.mulation of venous blood in the cerebral capillaries of the medulla.

True epilepsy presents an enormous number of sub-groups, exhibiting every variety of deviation from the ideal convulsive form, and the existence of these forms tends to demonstrate the views just expressed. In ordinary pet.i.t mal the initial arterial spasm has but to be confined to the surface of the hemispheres, leaving the thalamus ganglia undisturbed, and it can readily be understood how the momentary unconsciousness or abolition of cortical function can occur without the patient falling, his automatic ganglia still carrying on their functions. At the same time with the lesser spasm there would be a less extensive sinking of intracranial pressure with less consecutive collateral hyperaemia of the lower centres and therefore no convulsion.

In certain cases the arterial spasm fails to affect the entire cortical surface simultaneously; some one trunk may be more pervious, and as afflux of blood may occur in its special field where certain impressions and motor innervations are stored, the result will then be that the function of the relatively well-nourished territory will be exalted. If it be a visual perception territory, sights, colours or luminous spectra will be seen; if it be an olfactory territory, odours will be smelt; if a tactile centre, crawling, tingling and cold sensation are felt; if a speech centre, cries, phrases, and songs may be observed. This explains the manifold epileptic aura, which is simply an isolated, exaggerated, and limited cortical function. The recurrence of the aura is readily explicable on the ground of the well-known physiological law that any nervous process, morbid or normal, having run through certain paths, those paths will be the paths of least resistance for that process to follow in the future.

These conditions will be greatly exaggerated in proportion to the deficiencies in the a.s.sociating tracts and will often, in turn, pervert these. The s.e.xo-religious and other mental states of epilepsy often closely mimic normal mentation and serve to disguise the intense depth of degeneracy which epilepsy implies.

In their explosive, unchecked character the morbid restlessness of the neurotic, hysteric, and criminal depend upon like brain disorder to that of the epileptic, except that consciousness is not involved, and with conscious acts are intermingled those preceding from the lower automatic processes described. Consciousness, however, is sometimes lost in part, whence frequently the defects so often noticed in the thoughts of the degenerates.

The two following cases which have come to my notice ill.u.s.trate the obliteration of the function of limited areas of the brain. A young lady, aged 22, of refinement and highly accomplished, was engaged to be married.

One evening her _fiance_ called; she failed to recognise him and he remained ever after a stranger to her. In every other respect her mind was seemingly normal. She died of tuberculosis. In another case a young lady, an expert stenographer, while riding her wheel, fell striking her head against a stone. She remained unconscious for some days, and was quite ill for three or four months. After her recovery she was much surprised to find that she knew nothing about her former employment, although her brain was perfectly normal in other respects.

CHAPTER XVIII

CONCLUSIONS

Since, as Weismann[263] admits, interference with the nutrition of the germ plasm will result in the production of variations, the fact is evident that even according to the Weismannian principle the nutrition of the parents will determine the power of the embryo to pa.s.s through the various embryonic stages up to the developed child. Impairment of nutrition may check this development at any standpoint, and may thus produce any or all of the defects due to degeneracy. Weismann has no doubt about the inheritance of a "tuberculous habit whose peculiarities are certainly transmissible." Practically, therefore, even according to Weismann, that most emphatic critic of the transmission of hereditary defect, a condition of nervous exhaustion is produced in the parents which may be transmitted as a whole to the offspring, or may simply so affect the ovum as to produce various arrests in development with hypertrophies elsewhere. The influence of nervous prostration in the father may be overcome by conditions in the mother tending to help development. As her share in the germ plasm is most emphatic, not only at the time of the formation, but also during the entire development of the embryo, production of degeneracy will largely depend on her nutrition. The influence of healthy atavism is much more emphatically exerted through the female, albeit even in the male it may overcome the nervous exhaustion of the ancestor so far as reproduction of it is concerned.

While many are called, few, owing to healthy atavism, are therefore chosen for complete degeneracy. Although heredity plays a large part in the degeneracy of the individual, still environment in many cases exerts a greater influence in determining, according as it strengthens or weakens healthy atavism, the depth of degeneracy. Treatment, therefore, both of the individual and of the family is largely a question of prophylaxis or prevention.