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Softening of Brain

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BRAIN, SOFTENING OF. --This designation. as it is used by the laity, does not correspond with the scientific name of a distinct affection, techni cally known as general paresis or dementia paralytics. It is true there is a genuine softening of the brain-substance (for instance, after a haemorrhage of the brain), but this is not identical with the disease to which the laity refers. This affection consists in a wasting and destruction of the nerve elements in the cortex of the brain ; and it manifests itself, briefly stated, in a gradual decay of the mental faculties, combined with a weakness of the muscles of the body, which may he increased to loss of their function.

The disease is of great importance for various reasons. primarily because of its frequency. It occurs three to four times as often in men as in women ; and about ten per cent. of all demented patients admitted into asylums are paretics. Further, it is prone to affect patients in the prime of life, thirty to fifty years of age. It is almost invariably fatal within a few years, although occasionally temporary improvements simulate a cure for weeks or months. It is particularly important to recognise this disease in its early stages, as the afflicted person often commits foolish or criminal acts.

The following example may serve as an illustration of this : A business man who has always been moderate and capable becomes " nervous " ; he does not sleep well, grows irritable and restless, neglects his business, drinks, associates with women, becomes conspicuous by absence of mind, forget fulness, and " inconceivable " social offences, and he will not listen to well meant counsel. He is looked upon as overworked and neurasthenic, and lie is made to go into a hydropathic institution. There, however, the true nature of his affection soon becomes manifest—his mind deteriorates very rapidly, and he may some day frighten the institute by an attack of mania.

The further course of the disease develops in various manners, but its main feature is always a gradual collapse of the mental faculties. The

memory fails, the capacity of judgment is lost, the mentality is dulled, and gradually the patient becomes completely idiotic. It often happens that " delirium with exaltation " develops, which may alternate with hypochon driacal depression. The deterioration of the mind goes hand in hand with that of the body : the faculties of the muscles relax, the gait becomes clumsy, the speech stuttering and babbling, and the writing indistinct and trembling (see Fig. loo). Slight paralytic attacks resembling epilepsy occur occa sionally, but the patient usually recovers from them ; finally, the condition is intensified by the supervention of paralysis of the muscles involved in swallowing, and failure of the muscles of the rectum and of the bladder. The patient, now helpless as an infant, dies with the symptoms of the most complete exhaustion, provided pneumonia or another affection has not previously terminated his unfortunate life.

The principal cause of paresis is syphilis, which has been either neglected or insufficiently treated. In .some cases the paretic condition does not appear until ten years or more after the syphilitic infection, and generally when other injuries of the nerves (caused, for instance, by the abuse of alcohol) are added. There can be no doubt that also non-syphilitic persons arc affected by the disease, although far more rarely. Heredity also plays a part, but less so than in most of the other mental diseases. Paretic patients are always best taken care of in an institution, private or public.

BRAN-BATH.—This is prepared by adding a decoction of 2 to 6 pounds of wheat-bran to a full bath of a temperature of 95° F. The decoction is obtained by boiling the bran in a linen bag, and the extraction as well as the boiled bran are thrown into the bath. The bran-bath acts soothingly, and is therefore of service in conditions accompanied by itching of the skin.

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