A textbook of mental diseases.

  • Lewis, W. Bevan.
Date:
1899
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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)

    683/749 (page 597)
    PATHOLOGY—CHRONIC ENDARTERITIS. we do not doubt, although the percentage of insane females subject to chronic alcoholism is small; but we must be prepared to regard cases of chronic alcoholic insanity as presenting predispositions which more or less modify tlie tendency to peripheral implication of the nervous- system. Whatever be the explanation of this paucity of cases of multiple alcoholic neuritis amongst the insane community, certain it is that alcohol in tliese predisposed subjects does tend to concentrate its operations chiefly upon the vascular membranes, first, of the brain and, next, of the spinal cord. Pathology.—The pathology of alcoholic insanity is but one chapter, though not tlie least important, in a long history of retrogressive changes to which the whole organism is subjected through the prolonged operation of this agent. Through the medium of the blood- vascular system, alcohol, by its ready absorption and permeability, is rapidly conveyed to the most distant parts of the organism, establishing wide-spread constitutional disturbances; whilst through the peculiar selective capacity of the nervous centres for this poison, it thereupon expends its primary and most potent influence. Although in all cases the nervous centres bear the chief brunt of its attack, it by no means follows that the subjects of chronic alcoholism sufi'er in the same way. In one, the gastric; in a second, the hepatic • in a third, the renal and cardiac symptoms may come to the front; whilst in others, the nervous centres express the special virulence of the agent in their direction. Undoubtedly a neUPOtic heritage plays a 'foremost part in thus predisposing to more exclusive determination of the morbid agency upon the higher nervous centres, just as those subjects predisposed to renal degeneration will, on the establishment of alcoholism, display the usual cardio-vascular changes of chronic Bright's disease. Beyond the limits of simple functional hyper-activity of the nervous centres induced by frequent indulgence in alcoholic drinks, its persistent use leads to organic change, first expressed in the vessel's wall by the direct irritating eflect of the spirit on its tissue elements. A chronic inflammatory state leading to extensive atheromatous and fatty degeneration of the intima is the first apparent eff^ect, associated with which we find parallel changes undergone by the adventitial sheath in the increase and fatty degeneration of its elements. Fat-emboli are frequently established in the smaller cortical vessels during the procuress of these changes, and the extensive dilatation and aneurismal states described above are probably direct results of the diminished resist- ance of the vessel, and paralysis of its muscular coat. An extensive uhtTT \ ^^^'^^^^ effects the ultimate terminal radicals of the cortex, and, with the pre-existin^r change in the composition of the blood, leads to the devitallsILn of the nervous tissues, undermining the nutritional stability of the nerve-