The author prefixes to his cases an interesting summary of the somewhat conflicting modern opinions on tobacco as a factor in the causation of insanity. He thinks the tendency is to assign to tobacco a less serious part than formerly, greater care being taken to distinguish between the post hoc and the propter hoc. ætiology is so complex that it is difficult to assign a precise place to nicotine. The abuse of tobacco can only in very rare cases be alone a sufficient causation of a psychosis. Näcke believes, however, that very exceptionally the chronic abuse of tobacco may produce a condition clinically corresponding to general paralysis (for he is not one of those who consider syphilis as an absolutely essential factor of this disease), and he accepts the case brought forward by Krafft-Ebing. He also agrees with Arndt and Schüle that, as in other cases of chronic poisoning, tobacco may enfeeble the nervous system, act as an intellectual and moral depressant, and even by affecting the germ-cells influence offspring. But, even as a merely co-operating cause, the misuse of nicotine in the production of psychosis is very rarely seen. In thirty years' psychiatric activity among a vast number of cases, Näcke has seen very few cases in which tobacco, to his knowledge, played any part at all, and never any case of pseudo-paralysis thus caused. He brings forward two cases he has recently met with in which tobacco was influential. The first was that of a cigar sorter (from age of sixteen) in a tobacco factory, and himself a great smoker. There was some insane heredity on paternal side but otherwise his record was good; no alcohol, syphilis, or trauma. He was, however, rachitic. At the age of twenty he became nervous, displayed fears and anxieties (at first in regard to diet), then highly irritable, and later violent and destructive, finally presenting “a classic picture of amentia,” with confusion, hallucinations, and corresponding delirium. Two years after outbreak he left the asylum cured. On the physical side tobacco had at the outset produced definite neurasthenic symptoms as well as some amblyopia. The chief cause of the psychosis, Näcke concludes, was the abuse of tobacco. The second case was somewhat similar, though here the heredity was fairly sound, and smoking only began at nineteen, from which age cigarettes were consumed in great excess. At twenty he fell on a staircase and struck parietal region, being rendered unconscious, and later had another somewhat similar injury to head. There were neurasthenic symptoms, later culminating at age of twenty-five in a sudden outbreak of amentia, and for four days he was completely amnesic. Recovery took place four or five weeks later. In this case, Näcke holds that abuse of tobacco was one of several depressing conditions influential in bringing on the attack.
Email your librarian or administrator to recommend adding this journal to your organisation's collection.