Colonel Bell Burr.

A handbook of psychology and mental disease, for use in training-schools for attendants and nurses and in medical classes, and as a ready reference for the practitioner online

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IRLF




PSYCHOLOGY

AND

NTAL_D[SAS
C.B.BURR.M.D.




THE LIBRARY

OF

THE UNIVERSITY
OF CALIFORNIA .

Biology Library

GIFT OF

Franklin P. Nutting



A HANDBOOK

OF



Psychology and Mental
Disease



FOR USE IN TRAINING-SCHOOLS FOR ATTENDANTS

AND NURSES AND IN MEDICAL CLASSES,

AND AS A READY REFERENCE FOR

THE PRACTITIONER



BY

C. B. BURR, M.D.

Medical Director of Oak Grove Hospital (Flint, Mich.) for Mental and Nervous Dis-
eases; Formerly Medical Superintendent of the Eastern Michigan Asylum;
Member of the American Medico-Psychological Association, of the
American Medical Association, of the American Neurological
Association, of the Detroit Society of Neurology and
Psychiatry; Corresponding Fellow of the Detroit
Academy of Medicine; Foreign Associate
Member of Societe Medico-Psy-
chologique of Paris, etc.



FOURTH EDITION REVISED AND ENLARGED
WITH ILLUSTRATIONS




PHILADELPHIA

F. A. DAVIS COMPANY, PUBLISHERS

ENGLISH DEPOT:

STANLEY PHILLIPS, LONDON

1916



COPYRIGHT, 1898, THE F..'A. DAVIS COMPANY
COPYRIGHT, 1906, F, A. DAVIS COMPANY
COPYRIGHT, 1914, F. A. DAVIS COMPANY



Copyright, Great Britain. All Rights Reserved



Philadelphia, Pa., U. S. A.

Press of F. A. Davis Company

1914-1916 Cherry Street



Add to. Lib

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Girt



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IT is a source of much gratification to the author that
the hope expressed in the preface to the third edition
has been realized : namely, that this book might become
increasingly useful to medical students as well as
nurses. The present revision concerns itself largely
with those portions of especial interest to medical men.

The book has been very materially enlarged. There
will be found a new section entitled "Symbolism in
Sanity and in Insanity." Studies have been made of
certain paranoid and hysterical states on the basis of
Freud's researches and a more detailed description of
symptoms and symptom groups incorporated. The
section on "Management of Cases of Insanity from
the Medical Standpoint" has been amplified and, it is
hoped, improved.

C. B. B.

Oak Grove Hospital,
Flint, Michigan



PREFACE TO FOURTH EDITION.



438



CONTENTS.



PART I. PSYCHOLOGY.

PAGE

Psychology 1

Life; the, Brain; the Mind; Faculties of Mind.
Thinking 12

Development of the Mind; the Senses; Sensa-
tion; Perception; Memory; Ideation, Reasoning;
Judgment.

The Localization of Function in the Brain 24

Feeling : Emotion 28

Volition 32

General Considerations 37

Sensation; Perception; Hallucinations; Illusions;
Delusions; Witchcraft; Ideation; Memory;
Higher Reflexes; Volition; Concept Associa-
tion; Inattentiveness ; Incoherence; Flight of
Ideas; Verbigeration ; Stereotypy; Pressure of
Activity; Retardation; Opposition; Negativism.



PART II.

Symbolism in Sanity and in Insanity 51

Word Association and Obsession.



PART III. INSANITY.

Insanity 62

Definition.

(v)



vi CONTENTS.

PAGE

Causes 63

Direct Physical; Indirect Physical and Emo-
tional; Vicious Habits; Constitutional and
Evolutional.

Forms of Insanity 67

Infection Psychoses 70

Fever Delirium 70

Infection Delirium 71

Postf ebrile Conditions 72

Simple Neuritis 73

Treatment 73

Exhaustion Psychoses 74

Collapse Delirium 74

' Acute Confusional Insanity 76

Chronic Nervous Exhaustion (Neurasthenia) . . 78

Intoxication Psychoses 82

Lead Poisoning 82

Alcoholic Intoxication 82

Delirium Tremens 82

Dipsomania < 86

Chronic Alcoholism 87

Alcoholic Delusional Insanity 87

Alcoholic Pseudoparesis : 88

Alcoholic Paranoia 91

Alcoholic Epilepsy 92

Morphine and Opium Addiction 92

Cocaine Habituation 98

Insanities from Disturbance of Function of the Thy-
roid Gland , 99

Myxedema 99

Cretinism 99

Hypo- and Hyper- thyroidism 99

Dementia Prsecox 100

Hebephrenic Form 102

Katatonic Form 108

Paranoid Form 109

Paralytic Dementia 116

Elated Type; Depressed Type; Differential
Diagnosis.



CONTENTS. vii

PAGE

Juvenile Paresis 129

Dementia with Paralysis 130

Insanity from Syphilis 131

Manic-depressive Insanity 132

Excited Phase 132

Depressed Phase 136

Alternating Type 142

The Presenile and Senile (Involutional) Insanities.. 147

Epileptic Insanity 151

The Hysterical Insanities 152

States of Obsession 156

Dual Personality 160

Fugues 161

Idiocy and Imbecility 165

Paranoia . 165



PART IV.

Management of Cases of Insanity from the Medical
Standpoint 173

Medical Examiners ; Diagnosis ; Nursing Atten-
tion; Medicinal Treatment; Bed Treatment;
Enemata; Hydrotherapy ; Mechanical Feeding;
Othematoma; Travel; Hospital Care.



PART V.

Management of Cases of Insanity from the Nursing
Standpoint 199

Qualifications of Nurse ; Administration of
Food; Administration of Medicine; Nursing;
Correction of Pernicious Habits and Checking
Morbid Impulses; Mechanical Restraint; Ethics.



ILLUSTRATIONS.



PAGE

The Brain as Seen from the Right Side 5

Physiological Lobes of the Cerebrum 9

Neurone 11

Sensation 14

Perception 15

Concept 21

Zones and Centers of Cerebrum 25

Volition 35

Stereotypy 47

Handwriting in Paralytic Dementia 121



(viii)



PART I.



PSYCHOLOGY.

PSYCHOLOGY : the Science of Mind.

The word Psychology is derived from two Greek
words: Psyche, Soul, Mind; and Logos, Discourse.

The problems of the mind involve those of BIOLOGY :
the Science of Life (Bios, Life; Logos, Discourse);
and PHYSIOLOGY : the Science of properties and func-
tions of Living Beings (Physis, Nature; and Logos).

LIFE is defined as "a relation or combination of mat-
ter and force in which peculiar phenomena (ap-
pearances) take place, which are: (1) motion from
inherent power, (2) a capacity for appropriating nour-
ishing material (assimilation), and (3) the capability
of multiplication or reproduction for the preservation
of species. In the higher forms differentiation 1 of
structure and development occurs ; and, in the highest,
sensibility (feeling), intellection (thought), and will
(volition)." 2

That which distinguishes the living from the not
living is the possession of the three qualities or attri-
butes: Motion, Nutrition, and Reproduction as
above mentioned.

The locomotive moves from the force exerted by ex-
pansion of water ; the automobile, from that occasioned



1 A production of diversity of parts by a process of evolu-
tion or development.

2 The late Dr. A. B. Palmer.

CD



2 PSYCHOLOGY.

by the sudden explosion of gases by means of an elec-
tric spark. Inorganic substances change their positions
from force exerted upon them (as the rolling of a stone
from an earthquake upheaval). Heat and electricity
are so-called modes of motion. The acid and the alkali,
coming together in solution, make disturbance in the
glass (motion from chemical action). All these are
illustrations of motion, but not motion from inherent
power.

Stones enlarge by additions to their surfaces (accre-
tion), but cannot appropriate (assimilate) substances
with which to grow.

Two or more stones may be produced from one by
a process of breaking or disintegration. They have no
ability, however, to reproduce their kind.

Certain plants, on the .contrary, demonstrably have
motion from inherent power: as witness the sensitive
plant, which closes when its leaves are touched; the
morning-glory, which opens and closes its petals; the
ivy, which climbs the conductor-pipe or the tree; the
insect-eating plant, which closes about and absorbs the
prey which alights upon it. Plants also have ability
to appropriate nourishing material. This is absorbed
from the soil, .or from the atmosphere, or, as in the
case of the insect-eating plant, as above shown. Plants
reproduce their kind by contact of the male and fe-
male elements. Conclusion (JUDGMENT) : Plants pos-
sess life.

The lowest form of animal life is that of the amoeba.
This consists of a simple mass of albuminoid matter,
possessing irritability (rudimentary sensation), con-
tractility (enabling motion from inherent power), and
the power of segmentation or division, through which



PSYCHOLOGY. 6

it reproduces itself. From this low form of life up to
man, showing the highest organization, differentiation
of structure occurs.

The lowest form of animal life in which a nervous
apparatus (and this very rudimentary) appears is the
jelly-fish. This animal possesses a muscular, digestive,
and circulatory system sufficient for its needs. The
oyster has imperfect nervous, muscular, circulatory,
respiratory, and reproductive apparatus. The oyster
has a bony system, its skeleton being upon the outside
and constituting its shell. In the reptile and fish there
is 'a higher development of the bony, muscular, diges-
tive, circulatory, respiratory, nervous, and reproductive
systems, with special adaptation of structure to the
conditions in which the animal exists.

Special senses are not developed in the lowest animal
organisms. In the very lowest form, as the amoeba,
there is irritability; in higher, common sensation (im-
pressions of pain). As the scale is ascended, the tactile
sense, and from this on, other senses, as vision, hearing,
etc., develop.

That portion of the nervous system contained within
the skull and called the encephalon, or brain, has the
following principal divisions : the cerebrum, the largest
mass, consisting of two lobes or hemispheres connected
by a bridge of white substance ; the ' cerebellum, a
smaller mass situated behind and below the cerebrum ;
the pons Varolii, a bridge which partially surrounds
the legs or crura of the cerebrum and assists in binding
the lobes of the cerebellum together, and the medulla
oblongata, which in its lower portion is continuous with
the spinal cord. Three membranes, the dura mater,
arachnoid, and pia mater, envelop the brain, the pia



4 PSYCHOLOGY.

lying closely to it and the dura directly beneath the
skull. The other principal divisions of the central ner-
vous system outside the skull are the spinal cord and
the great sympathetic, the latter consisting of a chain
of so-called ganglia, 1 situated on either side of the
spinal column and hereafter alluded to under the head
of Emotion.

In the higher animals, accompanying certain nervous
manifestations, there appears what is called conscious-
ness (mind). Fishes can be taught to come at the ring-
ing of a bell ; perroquets and canaries to live in (stage)
harmony with their hereditary enemy, the cat, to per-
form acrobatic feats, propel carriages, fire miniature
guns, engage in mimic battle and simulate death ; lions
and leopards to perform tricks and subordinate savage
instincts to the will of man; horses and pigs to indi-
cate numbers; dogs to present an entire play, taking
the parts of policeman, fireman, sentimental lover, busy
housewife, and nurse for baby. Dogs often display a
high type of reasoning and judgment. The word "in-
stinct" employed as indicating the conduct-governing
force in lower animals, formerly much in use, is now
nearly discarded. Habit associations and inherited
tendencies (instinctive) are numerous and obvious in
these, but the psychologist no longer denies even to
those low in the scale of intelligence a certain degree
of ability to group concepts (reason) and to form judg-
ments through which action is determined.

In the highest form of life (mankind) the develop-
ment of the brain and nervous system reaches its



1 A ganglion (plural, ganglia) is a nodular mass consisting
of an aggregation of nerve cells.



PSYCHOLOGY. D

greatest perfection, and manifestations of mind are of
the most complex character.

The BRAIN is the organ of the mind.

The cerebrum, with which in this connection we are
chiefly concerned, is composed of white and gray
matter. The white matter is fibrous, and makes up its
bulk. The gray matter contains the cell elements, and




The brain as seen from the right side. (Mills, "Nervous
Diseases," J. B. L. Co.)

is for the most part found upon its surface, although
there are islands of this substance in the interior. The
cortex, or covering of gray matter, dips down into
grooves upon the surface of the brain, increasing its
superficial area very considerably. The raised or
prominent portions of the brain found between these
grooves are called convolutions, and upon their depth



6 PSYCHOLOGY.

and perfection of development mental strength largely
depends. In lower forms of life and in primitive
peoples they are smaller and less definitely outlined
than in the higher orders of mankind.

Simplicity in the structure of the brain indicates low
mental development, as shown in idiots and imbeciles.
As complexity in structure increases, convolutions grow
deeper, and gray matter becomes more abundant, men-
tal operations are correspondingly higher. The size of
the head, unless it exceeds or falls far below certain
limits, is not indicative of the degree of mental develop-
ment. 1

"No mental modification," says James, "ever occurs
which is not accompanied or followed by a bodily
change," and experiments upon the lower animals and
observations in disease in man show that the brain is
the organ of thought. Disturbance of its structure or
function interferes with the play of emotion and the
faculty of ideation. Serious and long-continued im-
pairment of its nutrition displays itself in settled per-
versions of thought and feeling. Injury resulting in
cerebral concussion may cause temporary or permanent
suspension of intellection, and defects in cerebral devel-
opment are accompanied by partial or complete absence
of the higher psychical processes. A child is born into
the world the structure of whose brain is anatomically
deficient, or the growth of which is impeded by me-
chanical compression. The result is idiocy or imbecil-
ity ; the development of the higher intelligence, of judg-
ment and reasoning, is impossible. "The pursuance of



1 There are both microcephalic (small-brained) and mac-
rocephalic (large-brained or at least large-headed) idiots.



PSYCHOLOGY. 7

future ends and the choice of means for their attain-
ment," which, according to James, are "the mark and
criterion of the presence of mentality," are absent.

The gray matter is the originating and emissive por-
tion of the brain, the white matter the conducting por-
tion. Nervous force originates in the gray matter. The
nervous system is comparable roughly to an electric cir-
cuit, with its battery of cells, in which force originates ;
with its white matter of insulated wires, by which the
current is conveyed ; and with relay stations or substa-
tions, the gray islands at the base, in which messages
from the central station are grouped and co-ordinated,
and in which, under certain conditions, messages from
without, carried by the nerves of sensation and special
sense, are responded to without the intervention of the
main office.

That the Brain is the organ of the mind, and that in
the Cerebrum (the large brain) reside the higher men-
tal faculties, is shown :

1. By experiments on the lower animals. The pigeon
deprived of the cerebrum remains apathetic and droop-
ing. If thrown into the air, contact with this element
produces, through what is known as reflex action, the
muscular movements of flying, but these gradually be-
come feebler until the bird sinks to the ground. If
food is placed within its reach it is not voluntarily ap-
propriated. If inserted far back in the mouth, food is
swallowed through reflex action. The frog deprived of
its cerebrum rights itself if an attempt is made to turn
it over. If pricked or prodded, it jumps, but is quiet
and motionless unless disturbed by contact with some-
thing. It initiates nothing. The behavior of animals
thus deprived of the cerebrum is akin to that of human



8 PSYCHOLOGY.

beings suffering from profound dementia (acquired
mental impairment).

2. By disease of the brain, which is so often asso-
ciated with disturbance of the mental operations.

3. By the mental deficiencies which exist in connec-
tion with lack of cerebral development, as in idiots and
imbeciles.

A definition of mind is impossible. It is known only
through its operations. I am conscious of my mind
from evidence within (subjective). I am conscious of
mind in others because they act in obedience to out-
ward, or apparent, circumstances as I do myself under
similar conditions (objective evidence). Their so-
called "reaction to their environment" is similar to my
own.

As to the relation between mind and brain, this much,
and only this much, is definitely known, that upon the
relative integrity of the latter, the natural operations
of the former more or less closely depend. As to what
consciousness is that subtle something through which
we are made aware of ourselves, of our environment,
of ouf relations to society, by means of which we act
and think and feel intelligently we are on no better
ground of knowledge than were the philosophers of
long ago who knew not the use of the scalpel, the mi-
croscope, and the staining agent.

The prefrontal lobes of the brain have been desig-
nated the "higher psychical." This is perhaps objec-
tionable, inasmuch as the brain in its entirety is the
great psychical organ, and all portions of it in some
way participate in the thinking processes; but it has
been shown by investigations upon the brains of lower
animals that, as a result of destruction of portions of



PSYCHOLOGY. m 9

these lobes, inhibitory control and capacity for close at-
tention and intelligent observation are impaired. If
they are destroyed completely there arise alterations in
the personality and incapacity to form serially groups
of images or re-presentations.

The cortex, or gray covering of the brain, is largely
composed of layers of nerve cells of different shape and
size and of infinite number. Those of the so-called




Physiological lobes of the cerebrum, lateral aspect :
S, Sylvian fissure; C, central fissure or fissure of
Rolando; Po, parieto-occipital fissure. (Mills, "Nerv-
ous Diseases," J. B. L. Co.)

pyramidal cell layer are thought to be chiefly concerned
with the psychical functions because of the peculiarities
of their distribution and their numerical diminution
and imperfection in the brains of those of low order of
mental development, as idiots. The so-called psychical
neurone is of tree-like form, the body, with the thicker
portion of the process extending from it, representing
the trunk, and the tuft-like expansion, the foliage. The



10 PSYCHOLOGY.

neurone also has a body with nucleus 1 and nucleolus 2
and a system of fibers passing through it which unite
at the basal end into the axis cylinder or axone, through
which impulses generated within the cell-body are con-
veyed outward.

The prolongation from the cell, called the axone, is
insulated by a sheath throughout its entire extent.
This insulation is for the apparent purpose of prevent-
ing dissemination of impulses along the fiber. Berkley
says that the researches of Flechsig have shown that
at the time of birth .the human infant possesses only a
narrow region bordering on a fissure, called the Rolan-
dic, which contains fibers having these sheaths. In the
first month two other small areas in the cortex show
beginning insulation, and from this time on, as intel-
lectual activities increase, further and further insula-
tion of fibers shows itself in other areas. He also says
that in the earliest stages of brain growth when the
nerve cells have reached nearly their adult proportions,
Flechsig finds only four centers that show signs of a
tendency toward individual insulation of the nerve
fibers of the cortex. The principal fibrous prolongation
after leaving the cell body throws off collateral
branches. Through these collaterals association con-
tacts in the brain are established, and upon the perfec-
tion of their development and the multiplicity of their
connections with other cells the faculties of discriminat-
ing judgment and of comparison of impressions with
other impressions are supposed by some to depend.

Association paths between the different areas of the



1 A center of growth a kernel.

2 A body within the nucleus.



PSYCHOLOGY.



11




Illustration of the neurone. A, axone with col-
laterals; B, apical dendrite, showing gemmules; C,
lateral dendrites; D, cell-body. (With grateful
acknowledgment to J. F. Burkholder, M.D., Chicago.)



12 PSYCHOLOGY.

same hemisphere and between the two hemispheres by
the bridge called corpus callosum are more numerous
and intricate as mental development increases. Micro-
scopical anatomy demonstrates that up to maturity
there is a steady increase in means of association be-
tween cells of the cortex. Each cell with its processes
is separate and distinct from its fellows. It exists as
an individual unit anatomically, and is independent of
the myriads of others in the nervous system. Contact
is not made directly between the prolongations of one
cell and the tufts of others, but an interval exists, and
upon the theory of failure of contact or delayed con-
tact has been built up the retraction theory of psychical
cell association. It has been assumed that in the rapid
flow of ideation, this contact is continuous and exact,
discontinuance or break resulting when the particular
association in thought is no longer required or when
the flow of ideation is arrested by fatigue or changed
conditions. Thus the inability to recall a name or an
incident may be* due to the failure of contact between
the different nerve-cell elements concerned in the asso-
ciation which would in normal conditions arouse the
memory.

The faculties of mind are three :

1. THINKING (intellection, thought).

2. FEELING (sensibility, emotion).

3. ACTING (will, volition).

Thinking.

Development of the Mind. Knowledge is derived
through the medium of the SPECIAL SENSES and mental
development depends upon the reception of impressions



PSYCHOLOGY. 13

from without and their comparison with those already
stored in memory. These SPECIAL SENSES are six in
number : .

1. Hearing: mental impressions through the audi-
tory apparatus.

2. Seeing: mental impressions through the visual ap-
paratus.

3. Smelling: mental impressions through nerves sup-
plied to the nasal mucous membrane.

4. Tasting: mental impressions through nerves sup-
plied to the tongue.

5. Touch: mental impressions through sensory
nerves supplied to external parts of the body, skin, and
mucous membranes.

6. Muscular: mental impressions as to force and re-
sistance derived from contracting muscles. 1

There are necessary to the mental upbuilding :

1. SENSATION.

2. PERCEPTION.

3. MEMORY.

4. IDEATION.

5. REASONING.

6. JUDGMENT.

A SENSATION is an impression made upon an organ
of sense, which organ must be composed of three
parts :

1. A nervous mechanism to receive the impression.

2. A sensory nerve, or nerve of special sense, to con-
vey the impression to the brain.



1 Compare the impression received from compressing a
rubber ball with that from a similar attempt upon a piece of
steel. The essential difference between the touch and the
muscular sense is plainly apparent.



14 PSYCHOLOGY.

3. A nerve cell, or group of cells, to receive the im-
pression.

Take the eye for illustration. A ray of light from
some object falls upon the retina. An impression is
conveyed through the optic nerve to the center of sight
in the brain and there received. This is a simple sen-
sation. SIGHT, or SEEING, is a different thing, how-
ever, and involves, just as hearing, smelling, touch,
taste, and the muscular senses do, something else, which
is called



^Hk-r- ~

Illustration of simple sensation of touch. Arrow
represents impression conveyed by sensory nerve to
nerve-center in brain.

PERCEPTION. This is at the very foundation of
thought and is the conscious recognition of the external
causes of sensation.

To illustrate: nothing is so helpless as the human
infant at birth. Unlike the chick, which as soon as it
emerges from the shell helps itself to food placed in
the incubator, the child is utterly dependent and with-
out means for self-preservation or protection. It is an
unorganized bundle of tissues and passes during the



PSYCHOLOGY. 15

early weeks of life a purely vegetative existence." At
three months of age or thereabouts the child is said to
"notice" that is to say, it takes cognizance of what
comes before it. It follows with the eyes a candle or a
ball of bright yarn, watches for them and associates
pleasant sensations with them. It perceives that the


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Online LibraryColonel Bell BurrA handbook of psychology and mental disease, for use in training-schools for attendants and nurses and in medical classes, and as a ready reference for the practitioner → online text (page 1 of 17)