KORSAKOFF'S PSYCHOSIS-REPORT OF CASES.'

BY ARTHUR W. HURD, A. M., M. D.,

Superintendent Buffalo State Hospital, Buffalo, N. Y.

Several articles have appeared within the last few years devoted to Korsakoff's "Psychosis" or Korsakoff's "Syndrome," but of these only a small proportion have appeared in English journals. The question as to whether it is a disease entity or a symptom complex common to several different conditions has been under discussion and seems not yet to be settled. Additions and contributions to our knowledge on these points are still much to be desired, and it is with the hope of adding, even though slightly, to our knowledge of this condition that I present these five cases.

In the bibliography following the excellent article on Korsakoff's "Psychosis," by Harry W. Miller, pathologist and assistant physician at the Taunton Insane Hospital, which appeared in the American Journal of Insanity for January, 1904, and to which I here acknowledge indebtedness, there are twenty-two articles referred to; of these there are but five in English. In the article in "Brain," published in the autumn of 1902, by Sidney John Cole, entitled "On Changes in the Central Nervous System in the Neurotic Disorders of Chronic Alcoholism," there are in the bibliography thirty-eight articles referred to, of which but fourteen are in English, and many of these are devoted to multiple neuritis. Korsakoff published his first article in 1887 and characterized the disease as a polyneuritic psychosis, and suggested the name "Cerebropathica psychica toxemica," as a more fitting designation in view of the fact that the neuritic phenomena might not be prominent. A number of observers took issue with him in his view that the disease was a clinical entity and insisted that it was a clinical picture which might accompany other diseases, and that it was not individual and characteristic.

'Read by Dr. A. W. Hurd, at the Annual Meeting of the American Medico-Psychological Association in San Antonio, Texas, April, 1905.

In the mental field the most prominent symptoms are memory weakness, persistent inability to retain impressions, loss of orientation, and falsifications of memory. That it is a toxic condition seems to be conceded; that it may be a toxic condition operating upon the central or peripheral nervous system, or both, also seems established. Whether the toxæmia is the result of direct poisoning, or is autotoxic, developed on the field prepared for it by other poisons, is open to consideration. That alcohol is by far the most frequent toxic agent is evident from a study of the recorded cases, but that other causes may be efficient would appear from a small number of cases in which it seemed to follow typhoid fever, lead poisoning, arsenic, tuberculosis, and leukæmia.

The clinical symptoms in the cases here presented, give, I think, a fairly definite mental picture of the condition, and it may recall to the minds of my hearers similar cases coming within their observation.

ONSET AND Course.

The symptoms may directly follow an acute intoxication, with delirium tremens, the symptoms of the latter persisting in a milder form with disorientation, fabrications of memory, occupation delirium, memory weakness with or without evidences of polyneuritis. In some the long-continued delirium with some febrile reaction may suggest an acute encephalitis. Other cases may present first symptoms of neuritis with mental confusion and memory weakness coming afterwards. Others again, without evidences of an acute toxæmia, may develop mental symptoms first, to be followed by neuritic symptoms later, and some even have been reported as having the disease ushered in by symptoms of a toxæmia with even epileptiform convulsions, or an apparent apoplectic attack. The disease runs a comparatively long course if the patient does not, as is possible, die from the violence of the toxæmia in the initial delirium. The neuritis may run a course of weeks and months with recovery both mental and physical, as in two of our cases. Others pass through a long course of mental enfeeblement, delirium, and confusion, with pain, paralysis, and trophic ulcers, gradually to improve and even recover from the neuritis, but leaving a degree of dementia, weakness of memory, and confusion, which becomes a chronic condition.

The abstracts of the histories of the following cases have been prepared for me by Dr. Henry P. Frost, first assistant physician, Buffalo State Hospital.

CASE NO. 1.-Man; aged 71; widower; occupation, brickmaker; nativity, England. Admitted January 5, 1905. Said to have had locomotor ataxia for ten or twelve years; pneumonia in 1901 and 1903, and chronic dysentery since the Civil War. Contracted syphilis in early life. Married in 1863; wife bore no living children but four were still-born. Has taken a wine-glass of whiskey before meals for years; became intoxicated occasionally. Drank more than usual last fall after the death of his wife, and his present mental symptoms date from that time.

In the commitment paper it is stated his mind seems to be a complete blank, is wandering and disconnected in conversation, easily confused; imagined that his nurse was his wife, also that his wife was in the next bed to him in the General Hospital. He looks for his revolver under his pillow, etc.

On admission and during his stay (three months), he was quiet, tractable, pleasant in his manner, able to understand his surroundings perfectly and to give a correct account of the remote past but with complete amnesia for everything recent. Constant fabulation; would give a detailed account of what he had done the day before, often relating adventures, such as street fights, in which he punished his assailants. He invariably stated that he "came here this morning" and that he walked all the way. Admitted that he did not feel very well and excused it on the ground that he had been on a "little spree" the night before. Aside from these symptoms his mind was clear and his intelligence unimpaired. No hallucinations at any time while under observation. Physical Examination.-Patient emaciated; in poor physical condition; weak, requiring assistance in walking; complaint of headache, dizziness, shooting pains in limbs, stomach, and chest ; numbness in all of the extremities; prickling feeling in hip and spine and running down the legs.

Eyes.-Pupils normal; no strabismus. Nystagmus in extreme lateral positions, and also when the eyes are turned upward. Vision poor.

Hearing, smell, and taste, all a little defective.