congestion of drum, with loss of power of the hearing nerves, and consequent noises in the ear. The central nervous system is affected. In high schools, non-smokers get on better than smokers. Children from 9 to 15 years of age exhibit less intelligence, laziness, or other degenerative tendencies. Adults have head-pressure, sleeplessness, or drowsy stupor, depression, apathy, and dizziness. There may also be ataxic symptoms, paretic weakness of bowel and bladder, trembling and spasms. Tobacco insanities are comparatively rare in smokers, but are common in snuffers and still oftener in chewers.[157] In the precursory stage, which lasts about three months, there is general uneasiness, restlessness, anxiety, sleeplessness, and mental depression, often of a religious type. After this occurs precordial anxiety, and finally the psychosis proper consisting of three stages: 1. Hallucinations of all senses, suicidal tendency, depression of spirits, attacks of fright with tendency to violence and sleeplessness. 2. Exhilaration, slight emotional exaltation, agreeable hallucinations after from two to four weeks' relaxation, again followed by excitement. 3. The intervals between exaltation and depression diminish, the patient becomes irritable, but otherwise not alive to his surroundings, and perception and attention are lessened. The patient may be cured in five or six months if he stop tobacco during the first stage. In a year or so he may recover during the second stage. After the third stage the disease is frequently incurable. As the patient often becomes (especially by the use of the cigarette) an _habitué_ ere puberty, the proper development and balance of the sexual and intellectual system is checked. These patients break down mentally and physically between 14 and 25. The moral delinquencies, other than sexual, are often an especial tendency to forgery and deceit of parents. Frequently the insanity of puberty (hebephrenia) is precipitated by tobacco. The cigarette, if used moderately, may be a sedative, but as used is a stimulant, and is often made of spoiled tobacco, resembling in reaction morphine, and on animals acting in a somewhat similar manner. As tobacco turns the salivary glands (which are concerned in digestion of starch) into excretory glands, it leads to imperfect digestion of starch, to consequent irregular fermentation in the bowel, thus at once furnishing a culture medium for microbes, to form more violent toxins from, and also creating leucomaines, to interfere especially with a nervous system overstimulated by nicotine. This is one great reason why those who snuff and chew tobacco more frequently become insane from tobacco than smokers, albeit these last are not exempt.