Mental medicine and nursing : for use in training-schools for nurses and in medical classes and a ready reference for the general practitioner . f spirits and health,and his affairs most prosperous. He is often in AUTO-INTOXICATION PSYCHOSES 117 an irritable mood and at times roused to violence,but he can easily be turned and calmed intogood-natured complacence. In this stage thereare usually repeated exacerbations of the symp-toms, leaving the mind each time more clouded. Physical symptoms: The general health ofthe patient is usu-ally very good. Ina cheerful frame ofmind, free from careand an
Mental medicine and nursing : for use in training-schools for nurses and in medical classes and a ready reference for the general practitioner . f spirits and health,and his affairs most prosperous. He is often in AUTO-INTOXICATION PSYCHOSES 117 an irritable mood and at times roused to violence,but he can easily be turned and calmed intogood-natured complacence. In this stage thereare usually repeated exacerbations of the symp-toms, leaving the mind each time more clouded. Physical symptoms: The general health ofthe patient is usu-ally very good. Ina cheerful frame ofmind, free from careand anxiety, all ofhis bodily functionsare performed nor-mally; his appetiteis good and he sleepswell at night. The diagnosticphysical symptomsare chiefly defectsof speech, pupillaryanomalies, andtremor. The speech defectconsists in the slow,slightly laboredenunciation, asthough the patient were speaking with unusualprecision; sometimes he shows a labored effort toenunciate a word. In time this is followed by ablurring of consonants and a slight thickeningof the speech. These defects are augmentedwhen the patient is fatigued. In the latter part. Fig. 45.—First stage of paresis, show-ing exaltation and self-importance ( Paresis—P. Blakistons Son & Co.). u8 MENTAL MEDICINE AND NURSING of this stage the difficulty of speech becomesmore noticeable. The pupils are often unequal, or the inequalitymay not be constant. In other cases they arefound contracted; often more or less sluggish tolight. One or both may be irregular in at this stage is not so common. The facial expression undergoes a change. Theeyebrows are raised and when the patient isabout to speak the occipitofrontalis is broughttogether with a tremor. The features are gen-erally florid, and the lines which give characterto the face disappear. The tremor is seen in the muscles involvedin speech, as those of the face, lips, and tongue,gradually extending to those of the hands andlimbs. The control of t
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