Proceedings of the Boston Society for Medical Improvement

F. B. Greenough
1877 Boston Medical and Surgical Journal  
tor incoordination generally are coincident with the emotional excitement. All the functions seem at first stimulated under loss of the inhibitory or restraint power, but are soon abolished by complete narcotism. Disorder purely intellectual from the first is rare, but I have recently had a patient whose affection was of this nature.1 A gentleman, with full frontal development, by the way, had complained of frontal headache for some time, induced by too close attention to accounts during a hot
more » ... ounts during a hot season. After exposure to heat and fatigue in the middle of the day, he took a ride in the afternoon, appearing as well as usual, but speaking of his recent disagreeable experience. The next morning he left his hotel without eating or speaking to any one, and started on a tramp of one hundred and thirty miles, under the delusion that he was to meet a dead burglar who was to inform him where a great amount of money was buried. This delusion disappeared at the end of a week, as suddenly as it came. The patient could not remember how he acquired this delusion, as the first few hours after leaving the hotel were a blank. He looks back upon the whole experience as a nightmare or waking dream. He showed during the tramp, and in the letters he wrote quietly relating his new prospects, but little excitement, and conversed sensibly and appeared naturally to those with whom he came in contact. His most persistent physical symptom was a tight feeling in the frontal region, which indeed lasted for weeks after his mental recovery, and which was increased by letter-writing or attention to accounts. I think this case very significant of the localization of the functions affected. The motor centres were stimulated apparently from the intellectual side, and a delusion of very narrow range, due to hyperaemia of the anterior lobes, was carried out in action, with the least possible disturbance of the emotional centres. These hints of localization drawn from a cursory view of a few forms of mental disease I am aware have been stated with too much confidence, from a desire to economize space as far as possible. The subject is new, and the questions involved can be determined only by patient study of symptoms in their bearing upon the results of continued experiment.
doi:10.1056/nejm187703290961305 fatcat:h5gmst2g5rg2bmjfmsdm2izfva