Among the somatic symptoms are otInematoma, often anaesthesia, localized oedemas and other disturbances of nutri tion. Loss of control over the sphincters is usually present. According to Kahl baum, pulmonary phthisis is nearly al ways associated with the later stages.
Pathognomonic, in addition to some or all of the symptoms above mentioned, is a peculiar aberration of speech termed by Kahlbaum "verbigeration," and a rhythmical or stereotypic movement of certain groups of muscles. A spastic pouting or "Schnauzkrampf" is described as especially frequent. Other move ments are the constant twisting, fraying, or buttoning and unbuttoning of the clothes, or the patient walks in definite limited lines or areas, not diverging from his regular path.
Verbigeration consists in the rhyth mical reproduction of sounds, words, or sentences, often without logical connec tion, which are repeated in a declamatory or pathetic style. This verbal repetition is easily differentiated from the jabbering talkativeness or senseless rhyming mania of acute confusional insanity, or the drivel of advanced dementia.
In advanced cases consecutive de mentia comes on, during which the stereotypic movements, verbigeration, and cataleptoid states may persist in a more or less modified form.
Causation.—While direct insane an cestry does not seem especially influ ential in the causation of catatonia, a neuropathic constitution, hereditary or acquired, is a usual precedent condition. Among other causes, masturbation is mentioned by authors as a frequent fac tor. While not denying the influence of this practice, the writer is not inclined to attribute to it much weight in the eti ology of the affection.
Diagnosis.— Stereotypic movements, muscular tension, and stupor are not in frequent in other mental disorders, espe cially in so-called acute dementia, para noia, general paresis, acute hallucinatory delirium, grave hysterical conditions, and the insanities of pregnancy, the puerperal period, and of lactation. For a time these symptoms may simulate catatonia, but prolonged observation will show that they are merely incidents in the development of the particular psychosis in question, which is easily recognized in its further course. Most of the cases reported by American writers as catatonia are probably of this nature.
Prognosis.—This is unfavorable. Re covery rarely occurs. Most of the cases
die of intercurrent Pathology.—This has not been suffi ciently studied. The macroscopical ap pearances in the brain resemble those of general paresis.
Treatment.—This is essentially symp tomatic.
Consecutive Dementia.
Definition.—Consecutive dementia is a state of permanent and incurable weak mindedness following an acute psychosis.
Symptoms and Course.—In one hun dred cases of acute mania or melancholia, from 50 to 75 per cent. will, under ap propriate treatment, end in mental res toration; 10 to 12 per cent. will die of exhaustion or intercurrent somatic dis eases; and the remainder will run into chronic mania or melancholia or into de mentia. By this term is meant an alter ation in the mental functions character-. ized primarily by enfeeblement of the psychical processes. The subject may recover sufficiently from the acute psy chosis to properly perform mechanical labor of various sorts, particularly if he is prompted by some one, but consecu tive thought, especially upon a complex subject, is impossible. Such persons are sometimes spoken of as having recovered with defective action of the brain, and many of the cases of mania discharged from hospitals as recovered are examples of such partial destruction of brain power. He can continue doing his usual work, especially if it is mechanical and does not involve complex mental proc esses; but he is easily confused, is often irritable, may retain delusions or have hallucinations, and is altered in disposi tion in various ways. His friends will often remark that he is not the same since as before his illness, but it is often not easy to define exactly in what this alteration consists. In a more pro nounced form of dementia there is great confusion of thought. Consecutive ac tion as well as consecutive thinking be comes impossible. The dement of this stage may wheel a barrow, dig a trench, shovel sand, break stone, or chop wood with a good deal of energy, but every little while he stops, looks vacantly around, until his attendant calls to him, or until the repetition of some associative sight or sound calls up the remembrance of what he is doing, and of the necessity for "moving on." It is often extremely interesting to watch these mental para lytics at their occupation, and to note the breaks in the continuity of their mental processes.