PROGNOSIS. — This is unfavorable. The duration of the disease is for life. Dementia does not occur except in ad vanced stages. The exhaustion of the maniacal stage may shorten life.
TREATMENT.—The treatment is un satisfactory. Chloral fails to quiet the exaltation and restlessness in the mani acal stage unless given in such doses as to be dangerous. In like manner, opium is usually of little benefit during the stage of depression. When possible, rest in bed should be enforced, especially in the stage of excitement.
Dipsomania.— DEFINITION. — A mor bid irresistible desire for intoxicating liquors.
Ordinary indulgence in alcoholic liquors must not be considered as dipso mania; neither are the various forms of drug-habit to be grouped with it. These habits are formed by repeated indul gence, which in the early stages can be avoided by the exercise of a little re straint. In dipsomania, on the other hand, the impulse that drives the sub ject to drink is due to an inherited pathic tendency which is too strong to be resisted when the opportunity to indul gence offers.
In a case known to me, a prominent public man of fine domestic attributes, intelligent, strong-willed, a man known to the public as a leader or "boss," the desire would arise suddenly. He would attend political gatherings and banquets, would work out with his confreres the problems of carrying a district, or in fluencing a legislative body, and all the time refuse to take a drink. On the way home, in a car or carriage, he would pass a drinking-saloon; if a low or dis reputable one it appeared more attrac tive; he would stop, enter and take a drink, which generally resulted in a pro longed debauch ending with an attack of mania a potu. In all this there was
no pleasure in the indulgence. He was fully conscious of the degradation to which he subjected himself and his family. He had been repeatedly warned, both by his physicians and by his polit ical friends who were interested in his supremacy, that continued indulgence would be dangerous, not only to his temporal prospects, but to his life. To all remonstrances he turned a deaf ear, and finally died in one of his debauches. GEORGE H. Rolm.] —The prognosis of these cases is unfavorable. While drunkards may reform and opium and cocaine habitues relinquish their stimulus, the dipsomaniac is never cured of his morbid appetite.
—This can only be symp tomatic. Seclusion, withdrawal of hol, and in the event of delirium tremens, hypnotics, bed-rest, and food comprise the resources at command. (See ALCO HOLISM, volume i.) Psychoneuroses.—It is probable that the brain-organization in hereditary hys teria, hystero-epilepsy, and epilepsy is also primarily defective. The ultimate mental weakness in these states is, how ever, a form of secondary dementia, prob ably due to the repeated physical shocks to which the brain is subjected in the nervous explosions characterizing hys teria and epilepsy.