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TREATISE
ON
EAS
OF THE
N E R VM'^^^Y STEM.
COMPRISING
By
J.
C.
PRICHARD, M.
;
D.
SOCIETIES, &c.
PETER'S HOSPITAL
LONDON
PRINTED FOR THOMAS AND GEORGE UNDERWOOD, FLEET STREET.
1822.
PREFACE.
The
work I now lay before the public
owes
its
prin-
cipally
existence to
my
having held,
during the
appointment
my
treatise.
Here a
of phaenomena
have pre-
my
to
throw
light
to suggest
some
practical indication.
first
It is
now
several
to
occurred
me,
by publishing a
selection
from those
make some
addition
knowledge respecting
class of disorders
the interesting
and obscure
VI
PREFACE.
which they belong
in
;
to
and
in this
hope I have
as I
been
have
which continued
seemed
in
to
present them-
general
to coincide
with
certain
been led
It has
been
my
principal
object,
in the
his-
nervous system
to
improve the
into the
by an inquiry
rise
and disappear.
fallen
Some
notice,
facts,
which have
under
my
the
have induced
me
orders
symleast,
pathic
affections
symptoms of some
and
in
particular
temporary or permanent.
PREFACE.
Vll
If this
be allowed,
it
according to
his-
as
well
as the
ideas formed
respect-
more
complete.
similar
best expectation of
treatment
of such
for it
is
diseases,
in
as
thej'^
are
a relation
affection.
to
the
nature
of the
primary
Some
purpose
least
to treat, are
commonly
regarded, at
in
cases
human
art.
So
repeatedly
disappointed in the
of various remedies
Vlll
PREFACE.
this
kind
is
justly
some period
The
diseases
some
If medical prac-
the
method by which
these
natural
terminations are brought about, or to ascertain the process of those constitutional alterations, in
alluded to disappear,
might be enabled,
in
some
am
well
aware
many
known
though of
late,
some examples,
In other
in-
PREFACE.
stances I have been anticipated
IX
bj recent
authors
and, in
many
cases,
have pursued
my work
is
to
universally
known on
have
the
the subject of
it,
I should
it
not
the
presumption
to
offer
to
public.
flatter
But
am
not so
sanguine as to
exerting,
power of observation
during
many
ages.
To
in order to point
facts
basis
treatise.
The remainder
consists of
inquiries
and
reflections
on subjects which
consider,
to
by
their
X
intiaiate
PREFACE.
connexion
with
those
matters
in
some objections
to
my
work,
and unsystematic
I
in its arrangethis
have selected in
though
irregular, is not
founded
series
which
me to
on which
my
proceed to
it
each topic
in
that order in
which
will,
it,
by
intro-
in the
to
what
is
to follow,
and
considered in
connexion mutually
is
each other.
It
the
primary disease.
deviation
The motives
from
the
for
each
particular
most
will
be
PREFACE.
XI
at least,
become
so on a retrospective
view.
The
cases,
my
hospital
practice.
I'he
details
are
me-
of cases,
kept by
Infirmary, and in
cases kept
part
from
register
of
hospital*.
To
under
is
my
observation.
I
look
forward
the
publication,
at
some
several
future time,
of another volume on
late
apothecary,
ability
now
and
in
the navy
I
to
whose great
profession
have
much
satisfaction
XU
PRErACE.
on chorea,
hysteria,
and comatose
affections.
On some
cases,
lected a considerable
number of
illustrative
assemblage
my
to
me
to determine,
by an appeal
numerous
to
facts,
how
the
disorders comprised
in this
volume
may be
same
class.
CONTENTS.
CHAPTER
PHYSIOLOGICAL SURVEY OF
I.
PAGE
NERVOUS
Section
I.
Reason
1
why
the
less
Physical.
What
Section
II.
to their
System.
on the
or
Reasoning Faculty
Section
III.
Phenomena.
including
these
Propensities
and
Affections,
Pathemata Inquiry
sub-
how
25
Phsenomena are
related to the
Nervous System.
Section IV.
ceding Remarks.
Recapitulation.
Is the
Nervous Sys?
Note A.
NoteB.
39 45 50
CHAPTER
II.
Doctrine of
of the
the
56
Section
System.
with Mania.
lepsy.
Apoplexy with Paralysis with Epilepsy Mania with Epilepsy.Vertigo and EpiTremor. Somnambulism. Chorea. Hysteria,
58
II.
Connexion
of
Disorders
Nervous
tlV
CONTENTS.
PAGE
Application of the Inferences contained in
Section
general.
III.
In
66
SECTfoisr
IV.
Connexion
of
Note C.
75 32
CHAPTER
Section
Section
I.
III.
Epilepsy
II.
,
87
101
108
CHAPTER
Section
I.
IV.
113
Section
III.
117
Varieties
going Description.
Dementia,
or Incoherent Insanity.
132
Section IV.
On
139
CHAPTER
V.
of epileptical and maniacal cases, depending on THE state of the UTERINE FUNCTIONS.
Section
Section
I.
Remarks on
the Pathology of
Nervous Diseases,
141
148
151
Of
181
Of Maniacal
194
CONTENTS.
Section VI. Of Uterine Mania
Section VII. Section VIII.
the
XV
PAGE
201
Puerperal
On
Mania
Affections
203
occurring at the
Of Maniacal
208
CHAPTER
OF EPILEPTIC
VI.
AND MANIACAL CASES, ARISING FROM metastasis; or the translation of MORfilD ACTION FROM OTHER STRUCTURES TO THE BRAIN.
I.
Preliminary Remarks
Metastasis to the Brain on the healing of old
215
II.
Exanthemata
2\G
Of
Ma-
and Convulsive Diseases, in Cases of Gout and Rheumatism, and of the Inflammation of Serous Membranes
221
Section IV.
to
Of
the
Brain,
to Convulsive
-
or
Maniacal
Affections
225
Section V.
Section VI.
these Cases
Of
229 233
Other Facts
illustrative of the
Pathology of
Section VII.
On
the Treatment of
237
VII.
CHAPTER
OF EPILEPTIC
Section I. Introductory Remarks Section II. Description and Pathology of Enteric Mania* Section III. Description of Enteric Epilepsy Section IV. Treatment of Enteric Epilepsy Section V. Cases of Enteric Epilepsy Section VI. Of the Treatment of Enteric Mania
Section VII.
Cases of Enteric
Mania
XVI
CONTENTS.
CHAPTER
EPILEPTIC
VIII.
PAGE
EASE IN
AND MANIACAL CASES, CONNECTED WITH DISTHE LIVER, AND OTHER ABDOMINAL VISCERA.
Section I. Epilepsy connected with Hepatic Disease, &c.' 323 Section H. Maniacal Affections connected with Disease of
the Liver,
338
CHAPTER
IX.
CASES OF CEREBRAL DISEASE, GIVING RISE TO THE THMNOMENA OF MANIA OR EPILEPSY ; OCCASIONED BY THE
rise to
.
345
Section HI.
leptic, or
Epi-
Agents, which act directly on the Brain and Nervous System 353
Section IV.
Section
in the last
363
Section V.
tion of
Of Nervous
Mental Emotions.
Cases
of
>o
stitious Terror,
Section VI.
367 381
CHAPTER CHAPTER
OF CONVULSIVE
X. 385
TREMOR
SQS
CHAPTER
Section
Section Section
r
XII.
OF SOMNAMBULISM, OR ECSTASIS.
I.
walking
II.
OfEcstasis
399 407
of
III.
bulation,
and Ecstasis
Appendix*.
A TREATISE
M^tn^t^
OF
SECTION
I,
Reason zohi/ the AniPeculiar Difficulties of this Subject. are less understood than the Physical. mal Functions
What
REMARKABLE
its
every step that has been gained in explaining the structure of parts has been attended with a corresponding
But
be said
to
light
on the pro-
Anatomy
FUNCTIONS OF
seem to disclaim all alliance. The reason of this want of connexion between them, as we shall perceive
in the sequel,
is
not
difficult to explain.
quaintance
we
possess with
the
physiology
of the
improve
it is
requisite for
my
These data
will
They
mode
is
or ra-
which
work,
this
may
be
made
of
it
or, at least,
it.
we
body
all
vital,
natural,
and animal.
The
latter class
comprehends
those phasnomena
to be connected
all
The
functions,
or the physical
functions, as
we
shall
may be
* Bich^t has included the functions, termed natural and vital, under the denomination of " fonctions organiques." The term is
objectionable, since
all
it is
The
3
of organized
common
to
all
orders
Even
;
plants display,
under modifications,
;
these universal
phasnomena of
particles
fluids;
life
by generation
accretion of
new
by a circulation of by
a species of secretion,
But when a nervous system begins to appear, a new series of properties is displayed, remarkably different
in kind
the properties
for,
DISTINGUISH
MEDIUM
therefore,
CONSCIOUSNESS.
not
only
all
This
the
Category,
includes
intellect,
operations
of
thought,
passion,
volition,
but
even the
appetite
lower
and
more common
properties
of
and sensation.
worms and
the molluscas
* Some persons will probably object to the including such phcenomena as those of sensation and appetite among the properties or
operations of mind
FUNCTIONS OF
man
more
from
it is
as well as
and on
though
this in
term
may
:
be con-
Are the
to be
same sense
in
vital functions
are
There
is
the
it is
In the
functions,
result or
latter instance,
accomplishment.
;
The
organs are
;
pieces of mechanism
their action
is
mechanical
the
upon each
other,
Thus,
the phasnomena
On
iand shall
con-
See
Note A.
at the conclusion of
this
chapter.
fluids
by mechanical movwhich
is
respiration
nutrition,
mode
though
With
respect
these
functions
it
may be
observed. First;
That the
Secondly the means by which it is brought about. That both the means and the end fall under the
cognisance of observation by the senses
can, by the
;
so that
we
same faculty, grasp the whole. There indeed, some steps in several of these processes are, some intervals in our view of the not explained still, in a collective surchain of causes and effects vey, we are enabled to compare the product with the
; ;
it,
and to
Now,
it
is fully
The means
at
may
the
some
what
it
is
for
can only be
(a chemical change
component substance, or
of contained fluids
FUNCTIONS OF
;)
since these
it
capable.
But
if
we
if,
for example,
are,
as
Sir
Isaac
or,
Newton
;
conjectured,
of
chords;
them, vibrations
and vibratiuncules
logists
or,
Darwin
;
fancied, contractions
and elongations of
as
fibres
or,
as the
older physio-
some modern
theorists
movement
still
is
any
just
be thought capable;
as far as
we should probably be
we now
in
What
is
relation,
example, or
common
fibre,
property,
movement of a
There
is
no imais
In
this case
we must
we have not
nomena in one connected point of view, or through the medium of the same faculty the whole train is
:
the
con-
The
result
which
this
change
is
destined to be instrumental,
known
to us through another,
;
and altogether
distinct
channel of knowledge
mean
that of consciousness.
The
result
is
which we always
on
this subject,
a ph(Lnome7ion of mind.
The
large *,
modern
times, to regard
or immaterial principle.
this conclusion is
As
the arguments
on which
founded appear to
me
irresistible
upon any ground of logic, or philosophical reasoning, I shall adopt the phraseology which it imports. According to this, all the phaenomena of which we
are conscious, such as sensation,
thought,
volition,
is
acted
endowment of animal
philosophers
life,
and not
* In note
limited,
as
Christian
have
a
B. at the end of
which appear
to
me
to enforce this
inference.
p
generally thought
to the
FUNCTIONS OF
it
limit
it,
regarding
all
mental
phsenomena as
remains to be inquired,
is
Whether
this
connexion
universal?
Are
there
or
some
affections
This
is
an inquiry which
its
is
of
important in
and
it
is
one,
the prosecution of
which
will
When
have no reference
to the theo-
logical doctrine
structible.
of a principle
If there
English language
expressive of
my
meaning,
should prefer
its
ferent kind.
and B,
SECTION
Survey of the Intellectual Faculties
nexion with the
II.
in respect to their
Con-
Operations of the Nervous System. and Perception. Memory. Remarks on the Sensation
Association of Ideas.
ing Faculty.
That
sensation
a phaenomenon to which
is
an
instrumental, will
is
who
not ignorant
of physiology.
The
on sur-
we
its
appearance, affords in
is
itself
when we
The same
any part
conclusion
accom-
that a total
obliteration of this
power
communication
and the
perception upon
10
PERCEPTION DEPENDENT ON
powers, which results from a
It
is
well
known, that
for
severe concussion of
brain
skill,
human
some-
powers*.
The
all
among
it
but of late
many
instances, to
injuries
we should be
it is
ment of perception.
Some
*
An interesting
in his
is
Aberuethy
whom
in
this
depressed
portion of the skull having been removed by the trephine, and the
dura mater
cut, five
upon which
up
Examples of a
I
11
life,
we
give full
is
the whole of
it
there
must be some
and a part
way of
with the tenour of ordinary observations of the evidence they offer may, until
it is
presented in
in
on
dissection, to
have
compressed by contained
to
and
some instances
substance by
the sentient
have
lost
a considerable portion of
its
life,
faculties in general
appeared to
have sustained no material injury. But these facts admit of an explanation, without contradicting an inference which seems necessarily to result from other
facts equally well established.
In relation to those
volume of the Edinburgh Review. The reviewer infers from the examples of compressed and injured brain, which have been reported, that the whole encephalon is entirely unconcerned in the changes which precede sensation.
12
PERCEPTION DEPENDENT ON
much
of their substance by
absorpskull,
tion, as to
it
life,
and
to the
is
so framed as
to
when gradually
its
applied,
functions.
That
power
its
in the brain, of
accommodation, or of
modifying
much
less
With
and Spurzheim.
this
I allude
organs, and
purpose to which
structure
is
is
probably
subservient.
We
know
that one
eye
fellow.
similar
Hence
disorJournal
* See Dr.
of the
Royal
13
is
ever,
presume, venture to
is
This conclusion
but
may
proof,
classes of mental
phaenomena.
In
a suspension of
all
the faculties
and
even a
total obliteration,
sciousness.
But
we
is
shall hereafter
Some
further proof
must be
adduced before we
tion, are carried
on
in the
we
shall
but,
on
we
shall
not, unless I
is
am
mistaken,
applicable to
late writers
the
phasnomena of mind,
first
as
many
on
We shall
it
relates to
14
MEMORY DEPENDENT ON
faculty by
memory, or the
The
on
this
relation
and perIf
it
be
mo-
sensation and perception, it becomes probable that the same organic operations are repeated, under certain We know modifications, in the exercise of memory.
that there
is
phaenomena; that
a
lively
when
recalled
by memory
in
and
forcible
were
first
may
be adduced,
satisfactory
on more
Some
which tend
to display
on
in the nervous
In the
first
place
it
brain
is
may
complete
state.
There
is
more or
first
less,
It
is,
indeed, the
mental
15
apo-
as in consequence of paralytic
affections,
plexies,
epilepsy,
disease.
and frequently renewed attacks of lethargy, or indeed any other form of cerebral
severe
head
will
effects,
This
last
interesting
more
case
is
reported by
Van
Swieten,
of a boy of
who met
with a blow,
suture.
No
severe
symptoms taking
it:
the
depressed
portion
without any
attempt to remove
gradually
so
to
fail,
instruction,
and continued
striking, although,
memory may
;
be occasioned by dis-
when
the
brain
is
restored,
certain
of ideas are
recovered
We
may
facts,
which
which had
may
which
exists in certain
morbid
I
slates.
A
in
gentleman with
I
whom
full
am
acquainted,
and
whose accuracy
have
me
IG
MEMORY DEPENDENT ON
own
played
themselves
head,
in
his
case,
after
fall
a severe
occasioned
to his
by a
from
his
He
was confined
On
all
his recovery
from that
recollection,
which had
entirely
for
had vanished
from
his
The
memory,
of surrounding objects gradually recalling the evanescent trains of ideas with which they had been connected, to his recollection.
the whole transaction.
It has often
He now
remembers nearly
who had
learnt to speak
some
head.
per-
only
answer
old.
in
ing, vi'hich
Hospital:
"
St.
Thomas's
a
man was
brought
in,
who had
received
When
he became convalescent
However, a Welsh milkwoman came one day into the ward, and immediately understood what he said. It appeared that the patient was a Welshman, and had been absent from his native
thirty
country about
years.
when he recovered
from
his accident
and lost*."
Two
trine,
vi'ere
instances,
but,
perhaps,
in
the course
Medicine f
is
anarchy had left her country, and resided in England. " She had a severe attack of
late
in the course of
delirious.
At
this
talk
in
was
and seemed
to con-
However, there
domestic,
happened
be in the
house a Welsh
* I have extracted this curious account from Dr. Tupper's " Inquiry into Gall's System of Craniology." f
I
I
am
who was
a pupil and
friend of Dr.
Rush,
for
my
Dr. Rush
18
MEMORY DEPENDENT ON
declared that she understood the countess, and
who
Welsh
lan-
guage.
When
no small
the
surprise
and
curiosity.
Britanny, by a nurse
Armorican language, or the dialect of Lower who was a native of that country,
it
many
years before
the
manner revived
In these instances
it
of inflam-
produced
by
fever,
certain
actions
were
many
The
following fact,
with
and
to
show
that
no other
is
admissible.
who, as
may
observe,
is
now one
of the most
possessed
respectable
when
In
to
the con-
him
*
entirely of his
of
former acquisitions.
is
fact,
he
The language
Lower Britanny
well
known
be a dialect
of Welsh.
19
When
:
he had regained
his bodily
again the
to
rudiments
new
him
in his
when,
effort to recollect
his illness.
case
the
brain,
or
perhaps
some part
of that organ,
when roused by a
it
had
formerly performed.
I have heard lately of a case, in which the
cir-
some
fit
respects reversed*.
inconsciousness
to
three
or four
days,
was found
have her
faculties in
some
respects impaired.
The
who
after-
wards attended the lady who was the subject of the observation.
The
to
him
in so circumstantial
a way as to
20
MEMORY DEPENDENT ON
remarkable circumstance was, that she had lost the power or aptitude to speak in her native language, which was English. This continued a month, and
her nurses and servants were obliged to employ a person to interpret for them.
to
The
of
them
in
French*.
loss
Instances of partial
memory
it
are
by no
only
to
means
words
;
infrequent.
Sometimes
M'ho had
extends
at others, includes
this
city,
A
all
lady in
attack
of apoplexy, has
recovered
She cannot
recall
the
name
of any body,
but
is
is
speaking of by describing
with
person.
Another
lady,
whom
am
ac-
quainted,
lection
of
many
things
that had
happened to her
Not
no
traces
parallel case
in
to this is related
Dr. Abercrombie,
his
as follow
An
old gentleman
was
:
seized with
side,
the
On
day he recovered
After
then began
from the
state
of stupor,
but his
faculties
were gone.
;
know
remember words,
and
to read
a few
language,^
off
by a
stroke of apoplexy.
SI
some other
We often
hear of precocity in
it is
generally
There was
lately living
in
Bristol a child,
whose head
exhibited,
from
cephalus.
never closed.
;
The
quantity
is
of
fluid
is
subject to variation
is
when
the vertex
;
when
dis-
she
is
disordered
but
to
produce convulsions.
When
and exhibited an
uncommon
In
acuteness of perception.
this case I
hence
perhaps a premature
;
that
the
action of
memory,
particularly of speech,
was
its
is
These
us,
if I
facts,
am
operations of the
memory,
like those
of sensation, are
As
mind which we
call sensation is
22
MEMORY DEPENDENT ON
;
so the operation
and passes
to the
same
extent,
some concomitant, or rather previous operation of the nervous system or some change in the momentary condition of the nervous fabrick.
;
The
site
the recalling an idea into the mind, as the the string of a harpsichord
is
movement of
to the
These considerations
least they
serve,
in^some measure,
to
connect
this last
pha3nomenon with a
class
the
of
life
could not,
as far as
we can apprehend, be
as
nomy
it
must be considered
But
in the
We
are tempted
is
to
resolvable into
23
Now
ciation of ideas,
to
the
We
system
by
is
called
up
in
the mind.
These
the
same combination
all
this
is
exactly
body
the
actions
of the
brain
manner,
which
has
is
is
tions,
its
It
not
show, that
all
the observations
we have made
nation.
this
memory, may
The most
;
conclusion
is
as those of dreams, in
which
this
faculty
alive.
How
phsenomena
in
the head,
will
The
same
observation,
and
sufficient
On
we
subject
we
24
REASON INDEPENDENT ON
madness.
There
is
we have adduced
or that power
allude to
the Judgment, or
:
we
distinguish true
and
false
philosophy,
is
morals.
This
name of
on
science depends.
exercises,
independently of
corporeal
concurrence on the
part of the
scarcely
organs
possessed of the
satisfactory conclusion
on
I
it
am
probable
the action
is
is
termed judgment,
connected
or
dependent
may
be said, that
of this faculty
this
since
believe
to
be
the
with
respect
to.
to
the
But
there
in
reality
;
bering
faculty
and judging
which only
external objects,
abstract relations,*
.'^
25
from any other class of intellectual phaetestimony of pathological facts seems adverse
supposition.
I
nornena.
The
to
this
know of no
It
is,
disease
of the
perverted.
indeed, a
common
remark respecting
from
tions
false
premises.
Owing
ment of
but
the
to exert this
faculty,
when
the brain
is in
functions
seems
is
to afford
its
exercise
the mind.
SECTION
III.
to other Classes
of Mental Phenomena. Pathemata subdivided into Passions or Emotions, and active Principles ; including
Propensities
and
Affections.
Inquiry
how far
Phenomena
Lastly;
these
respecting Volition.
Besides
the understanding,
we
26
PATHEMATA, OR PASSIONS
our minds
or which, to speak
more
philosophically,
I allude
to
and
fears,
which
life:
ira, voliiptas,
As
the
all
known
to us
through
same medium
of the
By
writers
all
on the
included
philosophy of the
human mind,
they are
moral powers.
only
These
one department
necessary, in
on
It
is
make
the
is
use of
some general
I
denomination
and
as
English
applicable,
hope I
shall
term Pathemata
in
which
I include the
whole class
two orders.
The
:
first
of these
may
part,
they consist of
for the
most
to
any
fear,
sorrow,
regret,
remorse,
AND ACTIVE
like.
PRINCIPLES.
27
The second
desires,
appetites,
and aversions;
Tliey
or
those innate
principles
voluntary action.
may
strictly,
and properly,
not,
We
do
however,
among them
though
:
Will
ciple
itself;
this is, in
it
of action
respects,
but
is
clearly, distinguished,
many
considered separately.
We
those mental
phenomena termed
are produced
intellectual, at least
several of them,
and movements
of that system.
the
By some
it
On
this
question
we
shall
now
endeavour
to arrive at
some
first
conclusion.
place, that these
We
may
observe, in the
viz.
two
classes of
phaenomena,
or become
known
to
us
In
all
other particulars
the intellectual
about to consider.
I.
Of the
;
Passions.
The
it
necessary
28
with
head.
sions
in
the
Some modern
and
affections
to
the
head.
Perhaps
in
so
made
who
In
common
and
not
difficult
to
and
which gave
rise to
them
to
their cause.
They have
all
vehement emotions.
total
Many
persons
have experienced a
in
loss of appetite,
and even
Anger,
in the
force
in
others
it
appears
to
Anxiety, especially
in the intestines,
if
or syncope,
*
is
Hence
P%^'
yap iv^vq
/} Eo'-i?
osdoixoTa.
all the bod}-, rejoicest in
O
evils
our
for
it is
29
their seat
in the part
felt
to
be so powerfully affected
by their operation.
These
sions,
and undefined.
Physiologists
have attempted to render them more accurate, without losing sight of the same principle.
jectured,
Bichat con-
among
the
It is
even in
proposed as a solution.
its
will
display
principal effect
on
ferent individuals.
effect is
heart;
but
the
particular
if
effect
ought to be
the mental
emotion were
connected
vvith
some
sympathetic.
this
The
is
subject
sufficient
of
men
The Greeks
and reins
;
most
;
liver,
Hebrews
to the bov^els
we
refer
them
vary
The
diversity
of these phsenomena,
which
according to the peculiarities of constitutions, indicates that they are effects which the mental operations
induce secondarily,
of the viscera
j
or
by
sympathy, on the
organs
being most
functions
those
so
him
to
be
There
is
no
the
opera-
This
a mere
hypothesis.
It
thought
it
necessary to
it
upon some
locality,
as
Descartes thought
seat
of the soul
am
no
fact, either in
which
whatever.
It
seems
soul,
to
me
or immaterial principle,
The phaenomena
:
they
are at any
rate
conse-
As
and per-
mary operations of
the
mind
react
They
the
upon
influence of terror in
to
51
Of the
includes
Active Principles.
several
This term
they
phaenomena,
distin-
may
The common
that they excite
characteristic of the
whole order
is,
two departments,
according
to
Propensities
and Affections,
they
are
the
objects
towards which
dencies
to
action
whom
him
they are
to seek the
good or
ill
The
he
agent,
who
is
entirely selfish
under the
latter,
is
in
a great
measure
disinterested.
Yet
the
is
nature of man, as
so constituted, that, in
aiming at
self-gratification,
the
is
individual
is
led to
some mode of
action which
;
creatures or to society
as, for
which
left to
is
be neglected
of
dut}^,
:
if it
were
good of one's
affections
country
promote the
;
indi-
vidual
as anger or resentment,
have
32
But
The
to
inquiry I
am now
interested in
is this
Are they
be viewed as
phenomena
there
exclusively, without
structure?
or
is
in
the
forth or excited
In
other words,
Have
is
these
phaenomena any
intricate
in
local seat in
?
This question
than
I
much more
of
and obscure
conclusion
;
that
which we considered
despair
almost
coming
to
any
yet
could
but,
unfortunately,
is
from
pathology
alone that
we
upon
it.
we
still
possess,
we must subdivide
and
the
;
pro-
desires
the
the latter,
all
those
whose aim
objects
;
to
fight
and,
in
common
incen-
to activity
and exertion.
The whole
of these
33
human
principles of animals.
Perhaps
desire
it
would be
strictly philosophical to
genethe
and
to
reduce them
all to
or
appetite
for
pleasure,
and
the
aversion
to pain.
With
liable to
;
organs
by the
state of the
stomach
But these
is,
facts scarcely
conscious,
is
and which
ceded
nerves,
therefore a mental
affection,
pre-
by
as
any organic
operation
to
is.
of the
brain
or
we have reason
of sensation or perception
Now,
we
is
a certain state
shall get rid of
of uneasiness,
;
pleasure, by eating
this intimation.
All that
subject to variation
;
in
and aversion
to pain,
in
is
We
have,
this appetite
system;
applies
petites.
the
other
ap-
There
is,
34
tites,
OK"
mind
mean
the inordinate
gourmand or debauchee.
But
On
the whole,
vi^e
may
become
active
it
called for,
:
or
is
likely to
formed
desire
all
but, with
this exception,
;
And
appetites,
more
to those desires
have
said,
may
pain
and
so ingenious as to
human
nature,
liable
to
be affected
by no changes
They
upon the
objects
human
versally
being,
and necessary
so
constituted
with respect to
the
at
sources
which
35
The conclusion
is
to
which
considerations,
which Drs.
:
they
well
is
Although
on account of
moral qualities as
his talents,
I
and
the services
he has rendered
to cranioscopy.
Dr. Gall,
in his
on the brain,
organization
and condition.
sities.
I
Some
is
adduced
stated to
with
this
is
The accident happened to a boy in Copenhagen, who until 14th and 15th years gave but very little promise
At
this
of future abilities.
epoch, however, he
fell
over a stairfall
he
dis-
Nor was
this the
only change.
Nobody was
position, but
That an individual
If
at the
nothing extraordinary.
may
and we
shall
proceed
now
the halter
36
The
instincts of animals
seem
to stand in a near
relation to
the propensities
observations
may
be
made way of
them.
We
explanation by referring
NOW
ciples,
termed the
opportunities
which
prompt us
or
ill
to
seek
of conferring good
upon
Of this kind are the and upon ourselves. benevolent affection, and its modifications, as gratiothers,*
tude, friendship,
(a principle
as
strong in
;
the
the
human
species)
malice, revenge.
It
with some
are liable
appearance of truth,
to
the
affections
morbid changes, or perversions, in consequence of Lunatics, for example, not only lose bodily disease.
all
particular
regard
to
to
their
relations,
or towards
those persons
whom
they
most
affectionately
attached,
In other
morbid
and nervous system, that persons, formerly of the most happy and cheerful disposition, have become Of this fact 1 have habitually sullen and morose.
seen more than one distressing instance.
Some
per-
S7
and
easily
'
have
become
extremely irascible,
Are
these
in
the active
by morbid
it
system
on
when
the latter
be disturbed.
''^
when
strictly
examined, of a
instances
explanation.
The apparent
if
of
not always,
The
insane mother,
aversion for
to
who
little
neglects
her offspring,
only feels
have
been substituted
cruelly torn
from
her.
madman
to
is
the victim of
or mortification,
temper,
is
added the
ing sleep,
feelings of internal
1 have scarcely seen any instance of alteration in the temper and affections, which did not bear
a.
pretty
nected with
it,
instances
38
perverted,
will
follow
that
we have no decided
which
has
and
the
argument
organic
it
been
drawn
mental
in
processes
the
of phaenomena, be abandoned.
We
facts
shall
fully the
bearing on this
when we
enter
upon
the description
of madnesSo
Of
There
is
Volition.
mind, which,
though connected in
is yet,
from
all
of them.
mean
Volition,
or that
movement or
There
is
no reason
any
It is
exercise
is
preceded
by, or effected by
system,
we know, has no
same
relation
Volition
may be
to the passions
Memory and
on which
arbiter
its
;
powers are
surveys the
exerciscd
It stands as
supreme
39
compares, discerns,
judges what
is
true
and what
false
what
right
and what
wrong
in morals;
what
is
human
In like manner,
which are
presented to
tites,
it
affections,
its
and makes
is
own
choice from
among them.
It
ing
ones,
in
faculties,
are,
as far as
we can
one
is
exercised,
its
produces
organs.
effects,
by the corporeal
act of the
Volition, as
we
well
know; even an
;
may
but
it
mandate.
SECTION
IV.
Solution of an Objection to some of th^ preceding Remarks. Recapitulation. Is the Nervous System the Organ of any
Notwithstanding what
going sections,
fabrick
is,
it
in
40
since
all
REPLY TO AN OBJECTION.
when
the brain
is
compressed, as in apoplexy,
are suspended.
the phasnomena
of mind
This
may be
nervous system
performance of
ception.
all
No
in
its
performed by
these faculties
but when
ing or intellectual
because
it
power must needs be quiescent, can only exert itself on materials furnished
faculties.
by the above-mentioned
similar
all
remark
may
the active
which
call
them
present themselves.
from
this
when they
They may
when the
train
of mental actions
with the body, and ends with the body, though the
more remote
links are
withdrawn from
this
intimate
EECAPITULATION.
I shall
41
which
now
the mind
conscious,
as
although
an
or
commence
of the
an operation
;
in
the
organic
structure
nervous system
ment or the
rational faculty,
the phas-
nomena of
love or
passion
are
hatred,
mental
processes
it
or affections
must be concluded,
this conclusion
we have no proof of
And
may
The
economy,
is
am
only concerned
mind and
the body.
am
arrive
ascertain
the
nature of the
nervous functions,
and
carried
on
in this part of
our bodily
At
present,
however,
we must
confess that
42
we
to
possession
We
assured
may
that
indeed,
all
as
suppose,
be
pretty
well
the
operations
carried
on
in
the
nervous fabrick
itself are
its
structure renders
it
capable.
The
may
be capable of
tiuncules
;
or vibrations, or
structure
vibra-
though
by
their
they
do not
seem
mode
of mechanical
contractions
operation
or they
may
be subject to
less
;
nomena of muscular
secretion
fabrick,
action
may
the
be
and
All
circulation
of fluids in
nervous
influences.
are
mechanical or chemical
I believe, safely conclude,
in
operations;
and we may,
the
condition
of the
nervous
structure,
chemical
or
mechanical
changes.
But
we cannot hope
perfect
the
nervous
fabrick
be
much more
than
we
elucidating the
theory
we
shall
subservient
PHYSICAL FUNCTIONS.
to the consequent
43
;
pheenomena of mind
since
we
are,
and are
likely to remain,
While we are
it
entirely
ignorant of the
nature
or essential
properties
of mind,
we cannot
understand how
Hence
it
would seem probable, that there must ever continue to be a wide chasm in the chain of our observations
respecting the theory of the mental operations.
I have
now
what I
Here
must make
some remarks on
who
who
regard
it,
for
example, as a chief
muscular
It
must be allowed
be instru-
There
it
is
probable
are
inde^
perves or brains.
The
nervous system
is
co-extensiye
44
with
the
:
PHYSICAL FUNCTIONS.
manifestations of
mind
in
the
organized
world
mental faculties
perform secretion
endowed with
irritability,
though
But
all
this question
seems
to
me
to
be settled beyond
imperfect specimens of
human
organization
mean
irritable muscles.
There are
we
learn
human
foetus
rudiments of
which has
lately-
who
has placed, in
and
irritability are
I refer the
Theory which
of the Nerves.
Animal Heat
D.," &c.
to the
Agency
By W.
P. Alison,
M.
On
the subject of
animal heat
It
medium
which
of the nerves.
is
examples of
this fact,
familiar to
every pbysiologer.
subsists
It is
PHYSICAL FUNCTIONS.
45
OTE
Some
of
A.
my
and
be
resolved into chemical and mechanical operations. The expressions in which this proposition is announced will
therefore require
I
some explanation.
inhere
in
it
peculiar
as
lonw as
This
the above
Muscular irritability is the principal property, the possession of which distinguishes the living solid, say the But, whatever the cause of living fibre, from the dead.
irritability
may
be, whether
it
results
from a peculiarity
in the chemical composition of a fibre maintained by the circumstances of the living state, or by the presence of
a peculiar principle, such as the vital principle is fancied or whatever the to be, analogous to the electric iiuid
;
nature of
in
this
property
may
a
be,
it
only displays
itself
the
living
body
as
Let us take the theory of the mechanical operations. Though there are some circulation for an instance.
circumstances relating to the state of the vessels and
other less important particulars, as yet not fully explained,
yet
is
we know enough
carried on
it
by contrivances which act on the ordinary The heart is the great agent. principles of mechanism.
of
its
It acts in virtue
property of
irritability,
but
it
acts
46
PHYSICAL FUNCTIONS
for
their
end to maintain
reason to con-
we
shall find
At
made by Harvey,
in It
was involved
as great
of secretion
now
is.
was just
apparently
titled to
was
all
and
to
this
is
all
that
respect
secretion.
in
We
mechanical
operates in
structure
the glandular
sufficiently
understand
a
it
know how
in the
producing
chemical change
through
it.
composition of the
fluids transmitted
There
is
whom
who
are reckoned
many
highly distinguished
writers,)
by the
difficulty
of explaining
affinity*
supposed to be an extremely
attenuated
fluid,
fluid,
and possessed,
affinities
power
to
chemical
results diff'erent
in the
shall
47
sufficient
much
discussion.
It
[
is
my
have made
in the text, to which this note refers, is equally secure, whether we adopter reject the doctrine of the Vital Prin-
ciple.
to
;
To
we refuse to allow this hypothesis, we must imagine the new product secreted from the blood to result from the mechanical operation of an organized structure, by which the component particles of the blood are, in some unknown way, brought into such a state as to form new combinations. Here the effect is the joint result of mechanical and chemical agencies. Now, if we suppose
if
in the gland,
and by virtue of
mical
affinities,
its
controlling
assist the
to
component particles of the in compounds, different from those which their ordinary tendencies dispose them to form, we only add one more chemical agent to those already known to be in action: the effect is still the joint
structure,
and
to dispose
the
result of chemical
What
Thus
far
may be
applied
respiration
is
complicated function.
It is
is
performed by
the
aid
so
connected with animal life. The muscles, however, only bring into operation a piece of mechanism very analogous to a pair of bellows. This part of the operation
is
strictly
mechanical
is
che-
change effected
composition of the
blood.
The production of animal heat is so nearly connected, at least in several of the circumstances of this function, with the chemical changes produced in the
blood during respiration, that we may safely refer it to the category of chemical operations. As I am not going
48
to enter into a
PHYSICAL FUNCTIONS.
minute disquisition on tbe
tlieory of
animal
the
the
in the respiratory
function of the
consumed by any animal, and the degree of heat produced in any given time. Thirdly; I refer to the facts
developed
in
the experiments
DrfDavy.
what they mean by
chemical
Those who
vital
refer tbe
this
expression
but
it
can,
of producing
or other exist
power of creating the matter of heat, or where it did not before in some form
it
compound by
:
a particular
in other words, it on the chemical affinities In no manner, therefore, operates as a chemical agent.
The phsenomena of
They seem
in part
to be,
and developed
by chemical
agencies
of another kind. by considering the various relations which present themselves, on a comparison of animal generation with the The production of processes of reproduction in plants.
the unfecundated ova in
tion.
We
some animals
is
strictly a secre-
The germination
in the
eggs
49
such as heat and moisture: peculiar actions are set up in contain; but the capability
set in operation
parts.
is
by
its
component
On
the whole, I cannot imagine that any person the subject, and lays aside
all
who
pre-
carefully CQusiders
there
is
sufficient
reason to
vital
and
be resolvable into chemical and mechanical agencies, variously modified, or operating under a great diversity of circumstances, to which they are subor, if we jected by the infinite artifices of Nature speak in the language of philosophy, and divest ourselves
:
by the
infinite skill,
who gave and move, and who so arranged the parts of which they are composed, as to render them self-preserving, and endov*'ed with perpetual movement, and with the property of producing other systems of similar structure.
the Artificer
origin to the
we
live
50
NOTE
'ascribing
that
elass of
B.
medium
of consciousness,
them
as affections of
is
an immaso
principle, I
am
much
some explanation.
first
would, in the
place, wish
it
to be understood, that I
make no
The
soul,
of which
is
suppose
phaenomena
to be affections,
to
be recognised
flatter
on very
different principles.
On
briefly express
my
ideas, although
do not
myself
impossible.
Nothing can be more unphilosophical than to ascribe attributes to a thing or being, the existence of which
is
in
This censure I hope not to to be previously proved. but, lest any person should impute it to have incurred
;
me,
1.
I shall
:
enter
my
siderations
It has often
who
ness,
are
challenged
distinct
from
all
the
body,
and
the properties of
mind
at all.
The
existence of mind,
per
prima facie, upon quite as strong evidence as the existence of body or matter, and the one stands not more in need of proof than the other. Two classes of phaenomena are revealed to our minds by the faculties
se,
rests,
OR IMMATERIAL PRINCIPLE.
implanted
is
51
in
our constitution.
the other.
The
faculty of perception
class,
the
medium which
displays to us one
that of
consciousness
The
objects set
before us by
phaenomena of mind.
of some
first
AW
properties
must be
qualities
substance or
essence.
The
is,
to
soul, spirit,
mind.
totally
and
utterly
body
means nothing at substance to which certain known properties belong; and the word soul means nothing at all but the unknown substance to which another set of known properties belong: and algebraical symbols, such as x and ?/, would be just as
or matter
The nature of both unknown the word all except the unknown
:
if
body should
I
me
to
can only
only
the very
demand
is
frivolous
and absurd
it
who
puts
it
principles of logic.
if
But
tical
;
a;
and
are iden-
or that
of mind
are
qualities
of
same substance of which the properties of body are qualities; I have no objection to agree with him if he will only afford some proof of his assertion; but most certainly the onus probandi rests on him. There is nothing in the mode under which we become acquainted with these two classes of phaenomena that leads the mind to adopt such a
the
conclusion.
On
the
contrary,
we cannot contemplate
them through the medium of the same faculty, nor can we imagine any possible connexion between them*. There
* This argument for, or rather observation on, the existence of mind or soul, has been placed in the strongest point of view by Professor Dugald Steward.
52
results, indeed,
a notion which
results
we
cannot think of matter without fancying it to be infinitely divisible, and we cannot think of mind without feeling it to
be absolutely
indivisible.
This
is
which
the qualities of the one essence can enter into any sort of
relation to those of the other
;
Some
X and y
writers,
a philosopher
ment
are the
same
They
in conjunction with matter; the one class is never found ergo, they belong in a state of separation from the other
same substance or essence. If it is meant to call upon us to produce a proof of the existence of mind where there is no matter existing,
to the
it is
we cannot
escape
out of the material universe; we have no faculties capable of being employed in such a pursuit; therefore we cannot
detect
But
apprehend that
of
;
it
is
meant
to in
assert
that
the
properties
connexion with
from matter,
in a
organization
state of organization,
to
in a state of separation
organized matter*.
The whole
of the
most
striking
proofs
* This
is
"
The power of
sensation, or
we
power necessarily
it
exists in,
and
unless
OR IMMATERIAL PRINCIPLE.
Intellect, or
53
mind, in a state separate from organization, under conditions which preclude all reference to There is therefore, at least, one being organization.
and
we
call
mind, separate
The second
that
observation
to
which
I advert,
is
an
prove
the
way
comit
modified.
It
is
In
all
or aggregate of the
powers
or properties of
the parts.
motion,
(in
par-
nothing has ever been known to result but some modification of figure, magnitude, and motion.
is
therefore
to
in
a
If
of organization,
to bestow."
pleased
him
This
* This consideration is more clearly and distinctly stated by Mr. W. Belsham than by any other writer. See Essays Philosophical, Historical, and Literary, vol. ii. Essay 25.
54
properties
mean nothing
it
else
it
On
tinct
the whole,
from the nervous system, but, by the constitution of things, capable at present of coming into relations with
the external world only through the instrumentality of the
nervous system,
that
is
whatever affections of mind do not appear to be subject to changes from the various states and conditions of the nervous fabrick, or its parts, may safely be concluded to be affections of the immaterial prhiciple
itself.
But it may be questioned, How far does the sphere of mind or soul extend ? What creatures are possessed of
what are destitute? Where is the limitation between mind and mere matter? The possession of mind certainly extends as far as its phseaomena whatever beings have conscious feeling, have minds or souls distinct from the substance of which they If all animals feel, all appear to us to be composed. animals have souls *. But some of the lower orders of
it;
;
and
to be possessed
of mere
irritability;
-f.
a principle comas
it
mon
Irritability,
is
upon by
external sub-
stances in
such a way as
to
occasion
certain
motions,
revolting to
However quaint and singular this expression may be, and however some persons the conclusion it presents, it cannot be
is
it is
:
probably capable of
at
On
this supposition
apathiques."
OR IMMATERIAL PRINCIPLE.
without feeling or consciousness,
matter;
a
is
65
a property of mere
depending on cliemical affinities, though of such a kind that it has only been discovered in the matter of a living body, or in the same matter
property
within a short period after the death of the individual.
It either results
which
is
Vital Principle,) or
results
from a peculiar
parts
state of
com-
position
or organization
in the
doctrine of those
who do
is
and
this
supposition
result,
(viz.
supposed
peculiar
mode
of mobility,
termed
irritability,) is
On
as
phaenomena of
irritability,
well
as all
those of the
its
properties.
56
PATHOLOGICAL SURVEY
CHAPTER
IL
SECTION
tomy.
Observations on
i.
Morbid Ana^
Connexio7is, the
Doctrine of
the History ^
"While we remain
parts
entirely unacquainted
with the
offices
allotted to them,
in Avhat
we
shall
distinct
conception
changes or variations
state,
System.
An
artist,
who
is
unac-
fully
ment
is
to
which
its
mechanism may be
disorders, or those
It
morbid con-
which the
train of
symptoms
are the outward signs, and from which they result by a necessary connexion. All that we can do may
be compared
to the
which an artisan
mend a
mechanism.
OF NERVOUS DISEASES.
57
We
to a careful collection of
compare them
symptoms and
results of
Our
pro-
ceeding
must, in short,
upon empirical*
principles.
The
I.
resources
we
may
Perhaps
the
most
important
is
Dissection.
Although we cannot expect to obtain from morbid anatomy a knowledge of the precise nature of those derangements of structure which are the proximate
cause of disease,
this
we are made acquainted, through medium, with many circumstances in the morbid
II.
living,
We
to
many
interesting
phaenomena
on
their
relating
to the
some
The
not,
con-
a subject
till
much
directed
but
it is
a resource
which
affords the
means of extending
the science of
assistance
pathology in
The very
modern
to
it
is
often
58
to be derived
INTIMATE CONNEXION
from
this
investigation
is
not more
in the difficult
An
all
and Laedentia,
another
channel
of knowledge.
To
this
head
belong
From
a variety of
we
some
modes of
to
practice,
and even
to
SECTION
II.
Connexion of Disorders of the Nervous System. Apoplexy with Paralysis zeith Epilepsy with Mania. Mania
other
with Epilepsy. Vertigo and Epilepsy. Tremor. Somnambulism. Chorea. Hysteria, with Nervous
Diseases.
In pursuing
is
which
system.
in
which
they consist,
classed
than
together
This
remark
will
be
illustrated
by
observing
the
OF NERVOUS DISEASES.
59
mutual relations of some of these disorders, their successions, and their conversions into each other. In some instances the
of disease sphere of
is
affinity
so apparent,
common
and
observation, that
it.
superfluous to notice
to
This
apoplexy
paralysis,
same morbid
The connexion
it
of
and
his
commentator Martianus*,
observations,
disorders,
former.
illustrate
Many
the
facts
and
tending
to
relation of these
have been
collected by
Morgagnif.
is
Epilepsy
palsy,
and yet
and
they
all
Persons
who have
fits
an attack of
hemiplegia
II.
On
1.
who
fall
* Annot. in
Hippoc. de Gland,
lib. 1.
103.
'
In his brain
in the ventricles.
Dr.
Med.
Hist,
Reflect, vol.
ii.
p. 11.
fever,
60
INTIMATE CONNEXION"
fits
;
victims to repeated
all
the
symptoms of apoplexy
a severe
fit,
of epilepsy,
modifications of palsy.
and
in their
phasnomena
lepsy, that
is
difficult to
Of
this
are
those
fits,
re-
peated,
and
generally
same
state as before
the attack
of epilepsy.
suddenly
previous
The
patient in
this
disease
is
seized
with
vertigo,
or
is
falls
symptom, and
like a person in
sleep, with
The
stertorous breathing,
in true apoplexy, is
;
wanting
circum-
of this description
is
much
more analogous
this
and paroxysms of
sort
are
The
*
(Essays Medical
and Experimental,
p. 148.)
Many
detailed in
following pages.
OF NERVOUS DISEASES.
6l
cases,
though of
less
frequent
those just
mentioned,
which are
like affinity to
depends,
is
nearly allied to
same
:
fabrick,
which gives
find palsy
former complaints
at
for
we
and
mania concurring
to
one time,
and
in other cases
is
related
by Dr. Ferriar.
hand
The
numbness
in the
thumb and
the pain
extending along the arm and shoulder, darted into the right side
of the mouth, and the articulation was impeded until the
over,
fit
was
which was
in
It
returned periodically.
Dr.
Mead
fol-
seized
folly, with
for
had
63
INTIMATE CONNEXION
found to have
side.
lost the
power of voluntary
on the other hand, a degree of
motion on one
Paralytics,
is
fatuity,
or imbecility, vi^hich
attacks of the disease
is
by no
means a
epilepsy.
Insanity
epilepsy, the
paroxysms of
which are
fits
These
of
in other instances,
is
of longer continuance,
is
sometimes a
distinct disease;
that
is,
though, like
it
many
is
distempers
of the class
we
are considering,
usually
com-
Very
is
is
frequently, however,
it
the harbinger of
It like-
were
as
who
considered vertigo
Vertigo
Comment.
i;i.
17-
OF NERVOUS DISEASES.
occurs also in chorea
;
63
and attacks of
some
of consciousness.
identified
In these
we
are considering.
of their
occurrence,
and we sometimes
is
them,
at
length,
this disease.
Chorea
there are
yet
indicate a con-
and epilepsy.
In chorea
and,
it
on
are
some
to
instances,
the disordered
actions
confined
line.
I have
same
individuals have
by chorea,
is
plegia*.
sometimes
The
limbs,
Among
64
violent chorea,
INTIMATE CONNEXION
fall
much resembling
a genuine paralysis.
Conversions of chorea, epilepsy, and paralysis, are
is
well
inducing,
after
paralysis.
who had
Somnambulism is an affection which has excited more attention, as a matter of curiosity, on account
of
its
logical inquiry
It
seems
to combine, in a surprising
some of
Dr.
the
Darwin
first
who advanced
* I have this
symptoms
of coughing
Thesie
symptoms
from which
now
though
in
OF NERVOUS DISEASES.
idea that
it is
65
;
more nearly
su2;crestion
related to epilepsy
to
and
little
although
this
seems
to
have been
its
more than a
conjecture,
and
have owed
existence
of epilepsy, yet
state of the case.
it
This
is
evident from
some
facts
and
pages.
Hysteria
is
" Sometimes," as
Sydenham has
observed, "
which proves
sons."
"
per-
Sometimes
much
"
Sometimes
it
seizes the
vital parts,
may
an
rise occasionally to
first
all
the appear-
The
is,
however,
much
my
section, I
must add
* Various
am
sufficient to establish
my
conclusions.
66
said,
PATHOLOGICAL INFERENCES
that the morbid appearances discovered
on
dis-
section are
very analogous in
above mentioned.
to point out
In
fact, it is
much more
difficult
some minor
differences,
by which they
may
their
are,
is
a subject that
SECTION
III.
Application of the Inferences contained in the last Section, to the Pathology of Nervous Disorders in general.
State of the
Diseases of this Class.
in
General Conclusion.
The
system leads us to one conclusion, which is important with respect to the pathology of these complaints.
Diseases which are so nearly allied as to be liable
frequently to supersede or pass into each other, and
at
other
times to
it
co-exist in
the
same
individual,
must, as
in
the
same
The
pre-
disorder
* See
M.
same complaint; and in cases which, though they do not come under the same nosological definition, are
yet connected by their frequent transitions and combinations,
it
may
differ
We
tions
are then authorized, by the foregoing observadiseases, to conclude, that the proximate cause * of the morbid
this class,
on the history of
whatever
may be
in
phaenomena
in
one disorder of
a condition
forms; and
it is
well
known,
the
head
As
it is
well
known
that
this expression,
which so
writers have
made,
discard
it.
what logicians
however,
if
real essence of
It is,
we
use words in their strict sense, not the cause of the disease, but the
effects
known
to us.
t Some observations on the theory of local determinations, or accumulations of blood, will be found in Note C, at the conclusion of this chapter.
68
PATHOLOGICAL INFERENCES
we
well
down be
is
founded,
actually
same
class,
although
This
conclusion
to be
is,
deserves
more
particularly examined.
it is
In apoplexy
sists in
well
known
arteries
belonging
to the encephalon
tion
or,
at least, in
vessels
;
an unusual repleis
or in what
;
termed
an increased determination
ducing
skull.
to the head
often pro-
effusions of blood,
or
we
have from
which by
their frequent
apoplexy,
consists
in
and modified by a
variety of circum-
now
the
first
or
its
in serous effusion.
The inflammatory
*
When
which
commonly
logical theory
is
founded.
vei^tigo, convulsion,
and delirium.
that announces
The
;
disease
sometimes commences
is
at least this
the
first
thing
existence.
In other instances a
of the disease
first
to effusion.
mation
on
depend,
is
con-
This
us
cannot
fail
to
afford
an
more doubtful
character,
matory
state,
or altogether elude
detection.
and
in this instance
they
may be
traced to
if
inflammation.
Fits of
vvith this
symp-
70
especially
CONFIRMED BY
as
DISSECTIOiJ'
dissection.
displayed
by
When we
discovered in
who have
part,
themselves, for
the effects
;
of
such
and
in
which have
fallen victims to
encephalon,
in
such as
;
some-
though more
a preternatural
softness, ossifications,
These varied
appearances are probably the causes, or more generally the consequences, of disordered vascular action
;
perhaps of inflammation.
When tumours
phalus,
I
epilepsy,
and sometimes
and
in
hydroce-
to the ultimate
by inducing inflammation.
may
eff"usions,
and other
I
indications,
which almost
once
who
at length died of
hydro-
cephalus.
well as a large quantity of serum in the ventricles. of this boy's illness, the
sions, so
OF REMEDIES.
71
We
shall
and Lgedentia
points,
the same
result.
Disorders of the
them
in treating
them
still, if
we were
called
upon
to point
which
is
it
to consist
but
I'eturned.
In this
the
cause was
permanent,
length
true that in
vestiges of disease
memthat
the
branes,
and distended
but
is
it
is
highly probable
life in
capable of destroying
impossible to say
secondary
effects that it
evidence.
We
"various
shall,
in
many
made
is
chiefly
the near
alliance of these
and
in order to obviate
an objection
that might be
made
appearances on dissection.
73
in the
EFFECTS OF REMEDIES.
means adapted
to restraining the determination
is
rally or locally, is
to all states
many
not
occasions
not only
:
fails to
still
I believe
that
there are
many
degree, at
the disease.
But the
head
disease,
fails to
is
afford relief in
many
cases of nervous
affection, in this
depend
upon, or
fulness in
is
the
since
we
often experience a
we know
1 have
which
had
proceeded
;
when,
abstraction of blood,
:
the disease
seemed
which
and
I
in cases
most decided
benefit to accrue
assertion
respecting
several
of the
73
But such
cases
are
exceptions,
to the reader.
How
?
rise to
such a
variety
of effects
do not pretend
rise to different
to
understand
explain
how
it
can give
morbid
states;
is
momentarily so modified as
to
become the
learn
in
more advanced, we are not likely what way these operations are so disis
turbed by an undue congestion of blood, or by irregular vascular action, as to give rise to one train of
morbid phacnomena
train, often
in
new
is
substituted
The
infer,
only modifications
we can
distinctly trace, or
find a patient, in
When we
and
infer
that a
may
be,
and
is,
more predisposed
than another
;
to exhibit
this,
and
74
brain.
may be some
difference in the
It is probable that
a change
or simple
may
take
which consti-
different conditions
are connected
with particular
modifications of the
morbid phaenomena.
it
We know
a part
is,
of sensibility.
state
accompanied by
and the
When
ear,
parts,
the eye
is
inflamed
it is
extremely sensible of
light
Even
insensible
inflamed.
An
we have an
when
cold.
But
there
is
accumulated
in a part,
without
this
state is
commonly termed
in
that of simple
it
accumulation of blood
the
veins;
position
in
this
is
state
venous blood.
PATHOLOGICAL REMARKS.
75
SECTION
IV.
Connexion of Disorders of the Nervous System ivith several Distribution of Cases Diseases of the Natural Functions.
founded on
this Observation.
By
attending
to
the
successions and
relations
of
to another train of
we have made
I
on the near
affinity
and now
fully
Tt
may
an increased
proaches
this
to,
or
is
of the character
inflammatory action
of
class
which
constitutes
what
it it
is
commonly termed
increased arterial
action; or,
when
At
must be confessed
is
a subject involved in
no small
degree of obscurity.
76
common
some of
which are
still
Modern
more
intent in endeavouring to
much
:
two or three
path
to,
distin-
guished writers has contributed to lead the attention of medical practitioners into
this neglected
:
and
is
no
have sought
state of viscera
They
and
seem disposed
by anatomy.
On
the other
hand,
it
is
that in those
symptoms of
disease
OF NERVOUS DISEASES.
ill
77
any morbid change of the encephalon itself, but resulting, in an indescribable way, from a sympathy
between the nervous system and the functions of other
organs.
It
occur, the
to afford coun-
and sometimes
brains,
whose
mists,
no
have been
discovered
am
fully
is
diseases
It is difficult to
how
all
arise
from
but
itself:
it
equally
unknown
to
us
how
In conall
necessary to discard
pre-
from
I
facts.
am however
fallen
which have
under
my own
or
observation,
that
among
cerebral
disease,
two
fatal
trifling
There was no
indi-
78
disease,
some other
first
becomes
in the sequel
a morbid cause of no
less difficult
less
real existence,
of cure, than
itself.
am
is
we must adopt
to,
in
and those instances before alluded which the functions of the nervous system are
itself is free
from disease,
to
From what
that I lay
it
will
The
doc-
blished
trine
tions,
will
my
endeavour
will
be to
and to make
if
it
example, that
epilepsies, of
we can
a disordered
the
same
disease,
which originates
a disturbed and
in
medical treatment.
first
The
.cases
class
require
latter
to
be treated, in
some
respects,
new
acces-
be more and
more
rare.
On
tions I
have
to offer will
be distributed*.
be
placed which originate in a suppression, tardy appearance, or other deficiency of the periodical functions of
second class
some
cases in
fourth class
functions,
may
which
may
and tech-
to force
what
is
Equally mistaken
is
the censure,
commonly
if
the only
mode
advantage; and
we have
to consult.
80
To
belong,
for
example,
arise
those
cases
of
terror,
and the
like.
Another
ture.
class of nervous disorders appear to depend on diseases of the heart, whether of function or struc-
fallen
under
my own
observation,
but I
to
am
afraid
establish
the
manner
satisfactory to all
distinct
my
from
readers.
all
Another
division
of diseases,
metastasis
These cases
to the order in
will
to
which they
originate.
For the
same reasons
mode
of
my
ma-
niacal
connexion,
after
premising general
some remarks on
This
mode
of proceeding, though
is
me
to
throw some
light
on the relation of
and
relation
and mania as specimens, because they exhibit this more distinctly than other affections of the
same system.
My
81
volume
them.
In a suc-
and
to
diseases of the
same system
are equally
these
affections
referrible to
82
THEORY OF LOCAL
NOTE
Some
writers
C.
the circulation.
lation
is
it which are founded on the theory of But the processes by which the circu^ maintained and modified according to the exi-
attending
what appears
to
be
We
often
find
patient
labouring
heated
stricted.
arteries,
in the face,
we
find in
under these circumstances we examine the the carotid and temporal arteries a
bounding pulse, with an evident increase of the ordinary At the same time we percalibre or capacity of the tube.
ceive in the arteries of the extremities a feeble, small, contracted pulse, attended with paleness of the skin, and every
appearance of a constricted state of the vessels. If the plunged into hot water and rubbed, while
is
blood
is
covered
soon produced.
to that
The
becomes
is
in
due proportion
in the carotid,
description
we have
person
who doubts
in
sponding alteration
may be
convinced of
into a vessel
DETERMINATIONS OF BLOOD.
On
83
and
branches stronger^
and of greater volume than in the arm which has been immersed in cold water*. It must be allowed that, according to the prevailing ideas, which make the circulation depend in a great measure on an alternate systole and diastole of the arteries,
it
is
difficult to
conceive
how
When
conveyed to a given
or
in
having
become
therefore
contractions and consequence of the conveying tube more capacious than usual. But the
is
number of
number
body
must
;
of pulsations
the
same
in
an
increased
is,
if
But the
diastole, accord-
* It
is
true that
is
we have
of capacity; and
we have
The
result
system, with those which take place in an inflamed part, as in the arm,
when
affected
by
erysipelas or phlegmon.
84
con-
and
its
extent
is
determined by the
to
elasticity
to
of the tube.
me
demon-
arteries are
endowed with some other property besides muscularity, formerly and com-
monly
reality
ascribed to them.
The
appear to be endowed
a capability of variation
that of
becoming
this
at
at
another; and
property must be a
internal
altogether inde-
supposing such a
:
mode
which
a subject
attempt
to discuss
it is
permanent
in
dilatation,
the constitution,
is
alteration
really a
is
change
actually
larger
the
time being,
convinced, by comparing
carotid, or other artery,
my
when
and
full
experienced on exa-
which occurs on
is
precisely that
which
CHAPTER
III.
SECTION
Definition
I.
Few
sympis
yet,
in
this
instance,
it
there
phaenomena
in
as renders
difficult
to contrive a definition
may
comprehend every form of the complaint. Sauvages has defined it, " Spasmus clonicus, periodicus, chronicus
nition
artuum,
cum sensuum
obscuratione;" a defilittle
alteration
by
Cullen.
is,
as usual,
somewhat
more
precise
he terms
this
disease,
" Universalis
vehemens
agitatio,
cum sensuum,
tarn
internorum,
but pre-
quam
sendy after offering this definition, the author makes a remark which excludes from certain forms of the epileptic paroxysms most of the phaenomena just enu-
merated as characteristic of
it.
He
quam
specie;
nam
interdum, loco
liceat;
baud secus
velit."
86
It
is
DISTINCTION OF EPILEPSY
impossible to include these different forms
and
it
two species
by
may
in
"A
sudden
sense and consciousness, and a general convulsive agitation of the voluntary muscles."
2.
The less
fits
is
distinguished
by sudden
ness,
spasm of the system of voluntary muscles the whole fit rigid and inflexible. To these may be added a third species of 3. paroxysms, which consist in sudden attacks of coma,
vertigo, but in other instances
sometimes preceded by
In
relaxed state
and
lies
for
an uncertain tim in a
state of insen-
sibility,
resembling a profound
sleep.
Paroxysms
of this description must be considered as a modification of epilepsy, because they often occur in individuals
who
attacks.
similar
whole
history.
87
way*.
relaxed,
sleep,
Those
which consist
in a
sudden
loss
of
in a state
resembling
circulation
which
is
peculiar
to
syncope,
may be
termed
leptic
fits
somewhat
which
fall
under the
description of apoplexy f.
SECTION
11.
PERSON who
is
subject to epileptic
fits,
often, withis
aware,
him
total
and
if
he
happens
to be in
an erect posture,
of leipothymia
falls
to the ground,
* Sauvages'
definition
is,
superstite."
to the
paroxysm
it
distinguish
aflixed to
in the
nosology of Sauvages
belong to epilepsy.
shall
produce
many
which were
88
GENERAL ACCOUNT
Hence
this disorder
In other instances
him
his
malady, so that he
who were
firmly per-
Those
patients
who
the paroxysm,
The most
fit
frequent
symptoms
which
is
noise.
Sometimes there
and
fulness
is
in other instances
no disagreeable senin
sation
fit,
commence
;
some extreme
part, as in
a foot or hand
rigid
a convulsive tremor, or
sometimes a
place,
first
and gradually
In
when
it
coma and
convulsion ensues*.
This
epileptica,
symptom
and
it
is
is
vapour
alluded
I
affecting
but
it
my
inquiries.
generally reprc-
SQ
in
many
are
is
cases
the
the
fit
more
like those
respiration,
palpitation
frequent mictu-
As
the patient
;
is
seized, he often
screams out as
if
in a fright
most agitated
the
eyes are open and generally reverted, so that the white part only can be seen
;
the tongue
is is
often protruded
firmly closed
and
bitten
by
jaw
by
it.
The
manner
at the mouth.
These violent
few
commencing
in
a limb.
Some-
times there
is
of the limb, as in a
which the
*
coma.
to the
These symptoms
:
may
nature of hysteria
epilepsy.
90
minutes,
DESCRIPTION OF EPILEPSY.
either
cease
altogether,
is
or undergo
some
followed by an exacerbation.
is
The
duration of the
fit
very various
it is
finished
or continues two or
is
three hours
five
from
When
from
vulsion,
takes place
way to a revival of sensibility and consciousness when this happens the patient complains generally of
aching pain, and a sense of severe oppression in the
head.
rarely,
the patient
is
subsides.
The paroxysm
some
patient
is
of tetanoid epilepsy
is
similar,
in
now
described.
The
seized suddenly;
and the whole trunk extended and fixed by a rigid spasm the eyes are widely open ; not reverted, but
;
staring frightfully
" Eri-
quoque penis in infantibus; in adolescentibus semen ejicitur, et seepius urina ad magnam distantiam
prorumpit*."
The
convulsive
epilepsy,
symptom.
it.
VARIETIES OF SYMPTOMS.
allied in
91 some-
pathology.
a few hours.
Variations in Symptoms.
varieties in the
symptoms of
epi-
We
are
of epileptic
without convulsion
seize
some which
their
the
patient
warning of
approach.
symptoms
the
fit
The symptom
in the
is
In a very great
coma
totally
is
but I have
examination,
it
the patient
knew and
distinguished
the by-standers
Sauvages lays
;
this
is
down
lepsy
I
inclined to follow
their opinion.
him
in this distinction.
am
by no means of
92
VARIETIES OF SYMPTOMS
fits
character of the
in
some
individuals, but
it
more
the disease.
Hence
it
may
be considered as depend-
all
a perceptible diminution of
it,
vages defines
power.''
sensibility or, as Sauan " Obscuration of the sensitive Sometimes this amounts to nothing more
sight,
than a dimness of
combined with a
feeling
Most of
Epileptic
There aro
experience
part,
many
during
persons
sleep
who
others
most
soon
my
care, a
fit
and
it
this
number
of cases,
has
appeared
to
me
that there
is
and
have
had reason
during the
to
fit,
was retained
As
the case
have alluded
to
it
is
:
a brief account of
somewhat remarkable,
till
in
the night
by a spasmodic
AND CIRCUMSTANCES.
of a few moments during the day-time. a child subject to
fits,
QS
have seen
who was
repeatedly
position
seized
Avith
manner
recurred
the
dis-
and
this
through a
the
fit
whole night,
while
to
seemed not
waking
It
state.
some
which
peculiarity in the
is
highly favourfit.
with
the
left
shoulder, which
the
fit
lasted four
left
him
in a tremor,
a perspiration.
time.
assign for
it is,
that about
and
;
on his
it
but
soon
in
is
The above account I received from a very intelligent gentleman Somersetshire, who put this man under my care. His letter This man soon afterwards came dated January 2, I8I6.
where a variety of methods were put
in
practice, with
benefit.
At
going to sleep
if
fiew
He
I
in the
same
state,
much
cure
him; and
94
VARIETIES OF SYMPTOMS
been said
to
;
be more
but this
remark
is,
There
have:
is
no temperament which
its
is in
a very decided
I
and
this
remark particularly
proofs of a
distinguished,
and
in
which the
At no
period of
this
life is
the
malady, but
occasions at which
at others.
it
its
commenceIt occurs in
ment
from
is
in
which case
generally arises
as soon
as
removed.
Again,
during the
dentition,
is
many
all,
by
the
it
and there
often in
many
fits,
children of
same
family, a predisposition to
when under
the
first
thus
dentition
completed.
the
first
time,
about
;
eighth,
or from
that
to
and
* See
AND
that the
greatest
disease.
CIItCUMSTANCESi
its
95
becoming an
its
danger exists of
habitual
There
is
still
a prospect of
subsiding in males
at the
age of puberty,
and
;
in
but
these
subsist
through
stitution
danger of
its
continuing through
But
if
catamenia sometimes
of this disorder,
to
it
;
it
much more
or,
rather,
the laws
of the animal
economy
up
in the
require a
new
system at
of which,
when they
this class
ensue
is
none
is
fact there
no time of
its
life,
in females, at
which
it
so frequently
makes
appearance.
life
but as the
now
superior even
we
contradicting
him
in this instance.
There
is,
however,
thus
far,
appearance of
after
by Hippocrates,
much more
life.
preceding periods of
We
must
not,
however,
often
become subject
lie
to
fits
of sudden
vertigo,
which they
fall to
96
The
all
VARIETIES OF SYMPTOMS
predisposition to epilepsy, like the liability to
is
often
I
hereditary,
had once a
five,
who
from the
effect
of another disorder.
He had
fits
laboured under
this disease
them
as he
became
adult.
men-
seized
with severe
when
its
existence.
In
this instance
ceeding generation.
I
nervous system.
that
One
observation,
I
bears
subject.
mean
the fact,
some
individuals of
same
class
as palsy, or connate
all
others,
to be
most nearly
allied, is
mania.
I believe
these diseases
have a
relative,
old,
who has
for
He
generally rises
some imme-
Another
fits.
PREDISPOSITION HEREDITARY.
and, what
is
97
fre-
more
than
to
each other by
considered
same
disease.
is
There
predisposition, which
to
mention
The
in
itself,
We
or
all
same
or
parents,
arrive
eighteenth year.
more advanced
age.
know a
family, formerly a
numerous one, of which several members died of phthisis between the ages of twenty-five and thirty two individuals, who still survive, after having passed
over the critical time with difficulty seemed to lose
all
I could
adduce
tion
easily
many
that
predispositions
temporary,
and
the disease
am now
:
who was
this
attacked by epilepsy
an elder
sister
of
individual
before,
and
98
hysteria and
sister.
same them got rid of the disease the two former have been, during some years, healthy;
three attacked about the
They were
life.
period of
All of
and the
third,
who
is
in
These circumstances
in
when we attempt
the con-
Terminatiotis,
\.
Epileptic
;
fits
children
often
is
terminate
in
sudden death
dissection.
the cause
of which
obscure, and
and especially
there
is little
after the
become
habitual,
danger of
is
paroxysms
very frequent.
takes
place,
fits
In this
great
;
instantaneously fatal
Severe
epileptic
fits
give
occasion
to
fact,
almost
every
every
*
modification
of paralysis*.
In
have
this
in
which
epileptic
fits
in
a child,
is
The
child
of a
first
third
left
OF EPILEPSY.
species
lesion
this
99
to
of disease
which
is
is
known
depend on
and
the
of the brain,
cause;
among
the
these a partial
Whether
is
fits
the recur-
rence
This
is
first
:
memory
there
is
impaired
a complete
fatuity, or
a state
much
4. Another concomitant of epilepsy is that affection which has been termed " mania epileptica." It is,
in fact, a
fit
a similar
author
condition
of the
brain.
The
first
who
all,
Mead*.
it,
It has
writers,
been
little, if
at
observed
by subsequent
until
the late
in his valuable
monograph
on Mania.
it
Yet
it is
This
affection,
which
shall
distinguish
by the
* Dr. Mead, however, had a very erroneous idea respecting the He remarks, " that the raving fits of nature of this affection.
mad
people,
which keep lunar periods, are generally accompanied " which, he adds, " was attested to me
Bethlehem Hospital, who upon that account usually
physician
to
100
CONSEQUENCES OF EPILEPSY.
consequent on a severe
it
appears
without any
previous
The
is
face
is
flushed,
like that
of a
man under
he attempts to
start
and endeavours
to
overcome
resistance.
commonly
continues
patient
during which
the
this
affection,
that
it
has given
rise to
a suspension in
fits.
This fact
may
be
in the history of
epilepsy
somnam-
bulism, or of a kind
patient
is
of ecstasis,
reverie,
in
an undisturbed
amusements or avocations.
This singular affection
subsequent chapter.
considered fully in a
Chapter V. below.
PATHOLOGY OF EPILEPSY.
10]
SECTION
III.
HOPE
to be enabled
to
throw some
light
on the
be
distributed
according
to
What
to
on
therefore, be
more than the anticipation of results established ; and the chief reason for be afterwards
offering
it,
now
is
the sequel.
The immediate
is
the vessels
of the encephalon, or an unusual fulness in some part of the vascular system of that organ.
The
First,
may
be
frequent mutual
or conversions,
of dis-
with
the certain
102
PATHOLOGY OF EPILEPSY.
On
this subject I
give rise to
attacks
of epilepsy.
They
to occasion a
Thus
of indolent habits,
who
live luxuriously
the quantity
who
when
the flow
is
scanty and
difficult.
chiefly subject
when
it
well
known
sometimes
some-
when
the consequence
is
a profuse epistaxis
all
these
When
epileptic
fits
The appearance
is
same
inference. After
up of
gout, rheumatism, or
PROXIMATE CAUSE.
branes,
it
103
is
well
known
And
epileptic
fits,
as
we
shall in
the
sequel
observe,
occur under
is
all
these circum-
stances.
The
inference
obvious.
Under
are well
known
to occasion
fits,
encephalon, epileptic
or
pheenomena very
similar,
The
fits
of con-
examples
of this description
the
we may add
the paroxysms of
in the acute
same
kind,
in
which
irritation
occasioned by
hydrocephalus.
Epileptic
fits
is
obvious
speaking.
They
brought on by
in hot
sudden
or
a paroxysm of rage.
in the
But
I think there
is
no instance
than
we can more
effect,
and
when we
find epileptic
paroxysms
to be the
immediate
104
PATHOLOGY OF EPILEPSY.
fit
result of a violent
find at the
of coughing.
The
reader will
end of
this
in one, if
both
of these instances, a
it
is
evident
injury
;
that
brain
sustained
the
considerable
appaforced
rently
from
violent
impetus
of blood
paroxysm of the
cough *.
must be confessed that the circumstances I have now enumerated do not include all the examples of epilepsy, and that the disease sometimes appears
It
under circumstances which do not decidedly indicate the presence of that condition of the brain which I
consider as the immediate cause of the disease
as
:
but
we have reason to believe that epilepsy, in the majority of cases, we may say in general, depends on the cause assigned, we may presume, or consider
it
as
most probable,
that
the
same condition
is
is
some reason
and
this
can scarcely be
pretended.
The
instances which
to
seem most
likely
to furnish
an exception worms, or
the pathological
I believe I
satisfactory
proof, that in
*
many
Chapter.
The
to
same
subject,
me by my
Guy's Hospital.
PROXIMATE CAUSE.
tion,
05
is
actually
present.
Thirdlv,
The phasnomena
of the paroxysm
itself
are
face,
as
it,
and the
Fourthly,
The consequences
life,
we regard
is
not an
uncommon
occur-
much
injury, during a
paroxysm
some part of the muscular system, or of some organ of sense. In this way an hemiplegia, an
incurable deafness, at other times, an amaurotic blindness, has often been occasioned.
The appearances
into
ever,
displayed
is
by dissection of the
In general, how-
inflammatory action.
The
common,
are
turgid
state
of the
vessels
which
itself;
cavities or
on the surface of
the encephalon.
106
PATHOLOGY OF EPILEPSY.
;
brains of epileptics
a case mentioned
repeated
hydrocephalus.
in which,
a victim to epilepsy,
no
kind
this
my own
observation.
In these cases
is
the
paroxysm
sudden
either in
and
at
others,
to
has
arisen
from some
or in
impediment
or
the
process
of respiration,
glottis,
the disturbed
or,
perhaps, in
to
some
heart
is
instances,
itself.
the
some accident of
most of those
patients
who
perish during
some
violent
paroxysm
the
cases
irrita-
itself
some
just
tion
disease
of function merely,
to,
now
alluded
or
of tubercles or exostoses.
In other instances,
long sub-
we may presume
PROXIMATE CAUSE.
become so much changed
and
the
in its structure, that
its
it
107
has
requisite functions,
ensued
in
consequence.
Patients
agitation of
but
108
CASES ILLUSTRATIVE OF
NOTE
Sarah Ponchard, aged
About
D.
brought on
fits
fits
of tetanic epilepsy.
stiff, and her She laboured under
When
these
seized
with these
she became
four months.
She continued
in
a bad state of
health after she got rid of the cough, and about two years
ago was
afflicted
This symptom came on suddenly, and after a short time she began to get the better of it. About three or four months ago she began to be troubled with
the right side.
R
Feb. 23.
Aq. Cinnam.
cum
ter in die.
She
is
much
better, but
sometimes attacked
liable to fall
to
by
fits
is
the
ground.
Repeat the medicine.
March
9-
She
is
Continue.
23.
stronger:
for a time,
Her
her temples.
109
;
She has
a troublesome
cough
in
other
T.
Scill.
April 13.
She
has
now no
disorder at
all.
Discharged cured.
Elizabeth Howell, aged eleven,
out-patieut at the Infirmary.
When
labouring under this disease she was one night seized with
a spasmodic
stiffness
From
fits,
;
have occurred
if
the right arm. any body catches hold of the arm and rubs
otherwise she
fit.
is
She
convulsed
mouth; sometimes
severe headache.
What
is
remarkable
is,
At
least her
what
severe vertigo.
l>latural functions.
She
is
Her
bowels were,
till
She
men
feverish.
110
CASES ILLUSTRATIVE OF
September 3. She has taken only two powders in all, and a small quantity of the cath. mixture every day. The no appearance of worms has bowels have been open been discovered. She complains of pain when pressure is made at the lower part of the beliy on the left side. Pulse natural, slow; tongue white; headache relieved.
;
fits
;
The
girl
the
fits,
but
Pil.
Cath.
3. o. n.
j.
t.
Appetite better;
fits
less
troublesome: she
she has not
now
seized,
about twice
in
fit,
viz. affecting
her head.
Repeat.
13.
One
fits
slight
fit
three slight
Appetite natural.
Is
Emuls. Tereb.
20.
Spasms nearly
fit.
as before; occur
more than
tongue
once
in a
Once
Soon
She had
The
shall here
to
insert in the
words
in
and of rather
habit of body.
He became,
1 1 1
which recurred in paroxysms, and was at its commencement unattended by febrile excitement, approaching in its
character to hooping-cough, which was at that period very
which there was no certaintj^ of his having As the paroxysms increased in severity and frequency, they were accompanied by much flushing of the countenance, and upon several occasions with entire
prevalent, and
previously had.
the expectoration of
viscid
mucus.
During the
The
difficuliies
life
seemed
in this
from
in the first
instance
have been
mischief,
brain."
since
neither
more of the
than
;
body, the lungs were found so gorged with blood, and the
bronchial cells, with even the larger ramifications, so
of effused
fluid,
that it
surgeon
of acknowledged
skill in anatomical researches, whether any further investigation was requisite to account for the fatal event. On opening the head, the real cause was determined to be a considerable extravasation of blood
at the
112
ILLUSTRATIVE CASES,
&C.
We
DESCRIPTION OF
lyiADNESS.
}\3
CHAPTER
IV.
SECTION
I.
There
is
no other disorder so
difficult to
describe as
madness,
and there
.
is
common
and
on some
kind
is
striking
often
peculiar
case.
Of
this
the remark,
some
and gradually
In a great
its first
extends
itself to
onset,
involve
every succession
It
is
of images
chiefly
that
passes
distinguished
by
the attention
to
passes in a hurried
another.
approach gradually
a certain waywardness, or
is
by
his
friends
as
a lunatic.
all
But
in
general
at once: the
manners of the
114
ried, his
GENERAL DESCRIPTION
mind
full
restless
activity.
He
by announcing some false and When his absurd impression, or by acting upon it. when by accident he explains attempt is resisted, or
ment of
his intellect
the motive of
it,
his condition
is
at
and
becomes obvious.
is
At
the
first
considerable
febrile
excitement
the bowels
is
an
entire
;
disinclination
to
food;
the sleep
is
dis-
turbed
is
The
pulse
accelerated;
pupils contracted.
more incoherent at the commencement of madness than at a more advanced period. In this state of things, the mind
The
can with
difficulty
be traced
it is
often impossible to
a short question
re-
As
pressions
still
maniacal or insane
in trains
applied
the
ideas are
association.
habits of
willing to
OF MADNESS.
115
and,
when under
becomes
the influence of
some
vivid
hallucination,
violent
and
intractable.
The
are sometimes
relapses
into
incoherence
settled
and connected;
morbid impresis
insensibly restored
or they
become more
firmly, and,
The
instances,
from what
description.
may
It
ordinary
The
body as
his
enemy,
and
most clamorous
invectives.
This form of madness is generally accompanied with a high degree of constitutional irrita'
tion
;
considerable
;
excitement of the
sanguiferous
system
to the head
It
is
in fact
common form
kind.
of
On
more chronic
In
patient
is
his imagination
is
It is
rise to
the
common
16
GENERAL DESCRIPTION,
of religious
or
&C.
is
epithet
madness.
It
in
cases
of
sorrowful
melancholy madness
are
that
particular
;
hallucinations
most
frequently
observed
or
instances
some
mind retaining its sanity and coherence of thought on topics foreign to the
particular trains of ideas, the
subject of
its
delusion.
The
constitutional disorders,
combined with
are also by no
in
affections
means
frantic
;
action
exists
often dull
in the
head
a greater or
less degree.
Melancholy
and gradual.
madness
is
permanent
disease, especially
when
its
The
The
is
perma-
nent
in others
liability to
subject to
occasional relapses.
which ought
to be
a term evidently
improper, since
it
is
returns.
17
SECTION
Remaiks on
the
II.
It seeais
few or
inquiries
to
no
within
the
range of medical
difficulties
encumbered
distinction
with
greater
than
a correct
of the
characteristic
circum-
stances of madness.
Numerous
offered,
proved to be incomplete.
Of
late it
seems to have
might be determined.
The confessed obscurity of this subject, and the many abortive attempts which have been made to
elucidate
it,
would
enter
afford
altogether
to
upon
Since,
however,
the
lie
it
ought not
up
in despair.
I shall therefore
make an
and
disit is
its
peculiar
tinguishing phaenomena.
If this endeavour, as
fail,
my
predecessors.
The
as consisting in
some
ing faculty.
whole
no observation more
118
made, as I
madmen
more deliberate and systematical way into this subject, and after discussing the nosological ideas of his predecessors, he has given the following definition of Delirium the term applied by him, and other writers of the same class, to the morbid state of the mind
;
most frequently
in
life,
and
particularly
when
the judgment
is
very different
from what
formed."
the
person
himself had
before usually
This
definition,
like
many
this
offered, is defective in
includes
number of persons
to be regarded
whose
sense
peculiarities are
more properly
as examples of caprice.
it
In a certain paradoxical
But
this
comprehensive species
of insanity
is
by a nosological
of which
racter,
folly.
is
we
something
for
one, involving
some
" Deli^
OF MADNESS.
rium," he says, "
119
may be more
shortly defined
in
a person awake, a false judgment, arising from perceptions of imagination, or from false recollections,
is
any
in
this definition.
The emotions
and are
often vehement,
forcibly expressed;
but
it
may
arise,
more
which
many
circumstances
with which
the
imagination of the
will often
lunatic environs
him.
A madman
fancy
all
the
him
is
many an
autocrat
is
fated to experience.
Give
and he
will
be
infinitely gracious
and conde-
scending.
I believe define or
it
will
more nearly
approach
in
is
nowise
l*^
iftg
constitutes
Men
from
same
data, that
to
it
rule or criterion,
which
*
in
A very
is
recorded
the Gentleman's
Magazine
for
plifies
the observation
that the
reasoning power
retained by
lunatics,
the case
Simon Browne, a dissenting teacher, of great intellectual powers, who became convinced, to use his own expressions, that he
had
fallen
common
with brutes
that
it
him
to
In
his
when
all the
powers of
mind
to say grace
many
still
company kept
and, after some
"
and
hesitation,
thy
Spirit,
which moved upon the face of the waters when there was
descend upon me, that from this darkness there
to praise thee
!
no
rise
light,
may
up a man
"
"
Defence of the
Answer
to
Tindal
"
cination discovers
Cases analogous to
this
are
though
it
is
The
work on
case of
OF MADNESS.
the imputation
121
the difficulties
of insanity.
Hence
cumbered.
It
at,
that
we may
mad-
ness
any primary derangement of the emotions or These, although they appear to us under a passions.
distorted
aspect,
are
still
in
due proportion
their rise.
to
the
We
field
shall cursorily
intellectual faculties*,
and endeavour
in
to
reduce the
which sensation
is
erroneous
mad-
no
The
false
impres-
immediately corrected
depraved, so
objects
the
I
;
no actual sensation.
In the
may
in the
latter,
purposely omit to
make any
it
active principles,
disease in
madness:
be the case,
it
it
is
a comparatively
its
ordinary form.
122
tion
:
perception,
distinctly
considered;
since lunatics
in
surround them.
It
and
indistinct perception
may
be observed to take
arise
place in
some
also,
states
of disease which
occa-
The
ravings of a
maniac are
it
is
difficult
to distinguish in
his
still it
canis
this
faculty
;
a general or characteristic
lunatics, in general,
trait
all
of the disease
since
amidst
their hallucinations,
then,
we determine
viz.
to exclude
classes
we
at least reduce
remains?
What
are
we
circumstances of madness?
It will be found, if I
faculties of the
am
are
memory and
that of
OF MyVDNKSS.
123
and
mistaking
the
ideas
impressions of
memory and
reflection.
it is
We
may
not
in
one of two
respects,
states, or habitudes,
which
It
are, in
is
some
opposed
to
each other.
during the
waking hours never absolutely vacant, but is ever occupied by a succession of ideas, which may be said
to pass over
it
But
although
the
mind
is,
is
never altogether
vacant of
thoughts, there
exertion
and a
state of repose.
is
it
In the former of
alive
the
mind
is
in
a state of
a parti-
energetic reflection
recalls impressions in
that
it
is
attended with
;
the consciousness of a
;
voluntary
exertion
it
compares ideas
it
actively
trains of thought to
false.
the
it
This
condition of the
active reflection.
indisposed
exertion
to
of the faculties,
is
mind
sinks
one of
inactivity
The
own
which
This
latter
habitude
It
is
may
that
mind
;
naturally returns
when
to
when approximating
124
the slate of sleep, or when it suffers itself to be idly amused by the current of floating images. Like other mental states, it is described by figurative terras, borrowed from sensible objects, and other obvious
analogies
:
more or
mind
is
less interested
much
roused into
its
is
attended
and
unreal
assemblages
of
combined by
and
;
reflection,
mind
as such
attended with
Now,
these
if
we suppose
to
power of discriminating
or
if
phsenomena
be
the impressions of
become so modified and altered that the mind is unable to distinguish them from those of reflection, let us consider what will be the result.
reverie should
The power
may
still
exist
to
it
but
the
mind
will, nevertheless,
be a complete chaos
OF MADNESS.
individual
distinguish
125
to
thus affected,
truth,
will
no longer be able
most
desires, as great,
in real belief:
opulent, or renowned, he
if his
becomes so
temper
is
vindictive,
if
of a timid and
in the habit of
brooding over
and
fears,
in imagination
phantasm
and he
is
his predicament,
as clearly as
ties
;
he
is
Such appears
his reveries,
even
madman
upon
most
idle
and
fantastical of
effect,
and
same impression,
as in a sane person
The
hallucinations of the
maniac generally
refer to
a class
him
upon such
would be conceived in a different way, and would present themselves to the mind as unreal phantasms whereas now they appear, some of them at least, as truths. Mr. Haslam has mentioned the case of an usher to a school, who
fancied himself a kinsman of Anacreon.
126
To sum up
this
circumstance that the impressions of reverie are so modified by the disease as to be no longer distin-
There
to differ
is
may be
it;
thought
from
In
this instance it
may appear
that there
is
an erro-
neous perception.
even cases
considera-
When
as actually present
some
the
mind
effect to
the patient in
to place
other respects
or
but he
is
so intent upon
totally
most part he
neglects
them
becomes so intense
in its operation
OF MADNESS.
as to carry
127
him away from the influence of his external perceptions, and to environ him with visions of unreal
scenes*.
I have seen a lunatic under this form of disease,
to avoid falling in
the
way of
horses
and
intent
his reverie, as to
general,
left,
and
All this he
To
this
modification
hallucinations,
of madness
belong
those
maniacal
by
some authors
with
is
idolo-mania, or dasmonomania
fancies
in
that
he sees and
holds
imaginary beings.
The
of which, never-
theless, there is
inability to
form a correct
perception
* This
Horace,
is
whom
his
countrymen.
Fuit haud ignobilis Argis,
Qui
Csetera qui
128
really present.
under
my
notice,
person
to
who was
liable
to
this
affection
would reply
him,
and
tion
at the next
really
who were
mena
if it
moment speak rationally to persons present, and who called off his attenPerhaps a similar phaenooccasionally on an affection
:
may depend
which
the
false
impression
is
connected
with
reverie.
would be easy to fill a volume with cases of this description, but it would answer no useful purpose.
It
It
is
sufficient to
form
This
from others.
scene,
and represents
if
as actually present,
may be
It
is
a rare ph-cenomenon,
in
we compare
it
The
affection,
which
* Dr. Cullen
is
some-
not
but this
is
the disease.
The
judgment
is
up
in the
memory."
This observation
OF MADNESS.
mania, has a near relation to
tlie
129
nambulism, or
sion to observe.
These
affections
depend
under
But
its
it
usual aspect,
consists in
to
conclude that
such a modification in
the impressions
reflection.
How
are
we continue
so ignorant as
we now
know not by what mind are pro^ termed impressions of memory, and
state,
We
are
nor do we know
differ
what
which
are
these
operations
to
from
those
are
peculiar
we
how the former can be changed into the latter. The difficulty, however, of conceiving that such a change may happen
therefore
not prepared
explain
will
We
momentary change
in the physical
or
is
at least intimately
This operation
in
in the
brain
is
a thing
totally
;
distinct
kind
from the
consequent perception
but
it
is
130
every perception.
As
it is
subservient to perception,
meaning aWays by this expression to designate, not the mental phaenomenon of perception, but that
;
change
sical
phy-
condition
of the organ,
which
is
its
uniform
antecedent.
But perception
which
is
is
a particular change in
ori-
again suggested
to extend this
recol-
We
conclusion
lection,
not
only
the
ph^enomena of
It
is
memory,
as
phantasm which
is
presented to the
imagination.
An
to
impression of
memory
the
corresponding perception,
which renders
it
it
is
preceded
is,
to the
mind.
We
may
regard
fabrick,
organic
operation,
which re-suggests an
idea,
is
OF MADNESS.
repetition,
131
operation, which
impressed
it
it.
If this be granted,
will scarcely
be disputed that
connected
with the
phsenomena of
of the
brain,
re-
and memory,
that the
tion
or
operations
belong to the
latter class,
We
a
that in
is
diseased
:
of
the
brain
this
distinction
abolished
now
shall
we
hallucinations
it may happen that become so analogous to those of memory and reflection, that the phaenomena of one class can no longer be distinguished from
Whether
this transition
of the
consists,
brain,
or in
what other
diseased change
to
we
explain,
unless
we
What
the
of the brain
reader
is
liberty
to
adopt or
reject,
as
he
prefers.
respect-
ing
it
will not, in
132
VARIETIES OF MADNESS.
in
which
madness or lunacv
consists.
SECTION
III.
Conlinuation of the same Subject. Varieties of Madness, distinguished by Authors, reduced to theforegoiitg Description.
Dementia,
or
Incoherent
Insanity.
Supposed
draw an
I
Derangement of
Delirium.
Disorder
Madness without
Temper.
In
now proceed
to consider
whether
it
may
serve as
madness.
Nosological writers
have divided
a variety of
affections.
species,
must
it
most elaborate
classification
in the
of the different
two prhicipal
varieties,
Notional Insanity.
The
In the
other species,
or
disordered,
andforms erroneous
INCOHERENT INSANITY.
133
of
things
as zvhen
is
ruler
show
that halluci-
exercise
when he
will, in
him.
so intent
upon
his day-
dreams that
withdrawn from
of ideal insanity.
In
this
is
There
which
is
is
common
The
patient
is
perpetually
incoherent
manner, and
is
sometimes impossible
to
trace any connexion or association in his thoughts. If this were a distinct and
permanent character of
134
disease,
it
INCOHERENT INSANITY.
would seem
to afford countenance to the
But
it
is
only a casual
frequently
gives
way
to
a different
state.
have
space
of twenty-four
;
hours,
to
the
ordinary
maniacal reverie
connected
in
which the
ideas,
though turning
in
their
transitions to be traced.
may
observe that,
in
order to be enabled
to
unravel the
uew
com-
mencement of
his disorder.
a lunatic speedily
we must endeavour
to
arrive at
is
some
a species
135
without
intellectual faculties.
Such
is
common
persuasion
It
is
among
even described, by
M.
Pinel,
who
has adduced
racter.
is
termed, by
is,
M.
Pinel,
" that
madness without
The
victims
of
to violent
paroxysms of
way.
Avhich
exerts itself
to
upon every
in their
person indiscriminately
who happens
come
of
such a writer as
M.
ence of this
disease
rests.
That a human
being,
in the possession
of his
own
interest,
to others,
paroxysm of
to
what seems
be
universally
ments of anger,
at variance with
mean an apprehension of
the
real
or
known
law^s of
human
in
nature.
niind,
passion
or emotion
taking
place
the
136
is
implies an impression
forth.
adequate to
call
it
An
sion
on the understanding,
a volition without a
may
is
well founded,
in so
far as
relates
to
madness
It
manner from that of the healthy state. Still, however, the same laws govern these operations, though their action is disturbed and thrown out of its" usual course. But such a phasnomenon as that of a man rushing with eagerness to commit the most atrocious
murders,
calculated
offence
against
his
unfortunate
victim,
cannot be
literally
possessed by
being,
a daemon
of a human
however insane.
Yet M. Pinel
in the
common
full
sense of
possession
am
convinced
this representation.
hundred
celebrated
instances
\a ill
of
occur to
Such
on
all
hands to
137
of an incorrect report.
I believe the true explanation of these
phsenomena
to
be
the following.
The
individuals
who
are the
but they
fall
at certain periods
to
Perhaps
this
some-
amounts
inflicted
to
nothing
of
undefined
affront,
impression
whom
cealed
rise,
;
their
malice
directed.
often happens
studiously conits
that
of rage
has
arisen
inde-
may
observe, that in
all
those instances of
to
mad-
ness,
me
as
examples
without
of disorder affecting
lesion
principles,
of the understanding,
have discovered, on
in reality other-
After
traced
minutely interrogating
such
patients,
have
some
latent
impression,
which has
It must have been observed by every medical person, who has the care of lunatics, that they sometimes acquire the habit of cou-
ceahng
their
impressions, particularly
that
it
if
frequently questioned
art and address to bring them to the subject wilhout putting ihem on iheir guard.
requires
some
138
sufficiently
CIKCUMSTANCES WHICH
accounted for the change observed in the
feelings
or affections*.
It has often
which
verify this
standing, or
some
the
arise
the peculiar
tendency.
The
of
habits
are
also
very
sensa-
much under
tions
tions,
spirits.
influence
the
internal
which
temper and
When
and
the stomach
all
is
oppressed by imperfect
digestion,
difficulty,
a constant irritation
low
spirits,
in a person
moody and
discontented
the
number
of maniacal patients,
an accurate examination,
of
the
bias
understanding,
strongly
to
ph?enoinena.
sional
tolerably
sane, and,
when
comes on,
he
is
found
to be
It
paroxysms
combined with
by no means
in
accord uith
139
same causes acting on an insane person determine Thus we find the complexion of his hallucinations.
melancholic patients, for the most part, dyspeptic
;
had
its
origin.
On
when
all
the
internal
functions
go on
and prosperously, a
arises,
by which
is
a cheerful flow of
liable
spirits is
promoted.
This state
to interruption
it
in
but, as far as
exists, it
general habits.
SECTION
On
the
IV.
With
might be repeated.
On
the
appearances
further
make some
where they
will
common
complaint
among morbid
The fact is, that they have looked for some peculiar phenomenon distinctive of this particular malady
whereas,
if
am
right in
the
obaervalious
have
140
IN BIADNESS,
all
made on
that can
common
vestiges of
as
it
is
commonly, and,
difference
in
imagine,
states.
correctly
thought, any
these
To
in
vascular
action
I suppose
we may
phasnomena usually
;
found
without excepting
so often mentioned
by
or
even
the
depositions
of bony
matter,
M.
Pinel.
He
says,
" I
have attended at
who have
is
in
a manner so
light
calculated
to
throw much
view
in
upon the
which I
*
am now
contemplating
M.
Pinel on Insanity.
Translation, p. 183.
141
CHAPTER
V.
OF EPILEPTIC AND MANIACAL CASES, DEPENDING ON THE STATE OF THE UTERINE FUNCTIONS.
SECTION
Remarks on
the
I.
Before we
necessary to premise
which take
from the
known
attention to the
to every person who has paid any phaenomena of the animal economy^
is
that the
constitution
and
in
relation
to
particular
states of the
system.
is
The
utility
very evident.
site for
out
it.
grow and
142
THEORY OF
much
it
what
At
new determination
is
required,
and actually
blood
to
place.
The
vessels
conveying
the
mammary
infant.
The
phaenomenon
allude to,
;
but
is
kind
to
the require-
To
to
when
its
secretion
is
be increased,
is
probable
it
We
it is
the last
step
in
the process
which gives
part
rise to the
is
a particular organ,
;
peculiar
agencies,
and
pass,
arrangement of physical
that a particular set of
comes
to
vessels dilate,
than
it
was
when a
greater
PAIITICULAR DETF.UMINATIOXS.
flow of blood
143
than usual
or
is
required in
the organ
which
brought
they
is
supply,
over,
how,
when
the
temporary
is
exigency
tlie
distribution
state,
of that fluid
ac^ain to its
former
we
are, at present,
unable to discover.
effect is
We
;
this
or conservatrix Naturae
but this
is
no explanation.
But we are not here considering this subject in a physiological point of view the foregoing remarks have been made in order to prepare the way for some observations, which may tend to illustrate the patho:
We observe
1.
That
economy.
system
in the
to take place,
consequence of which
and
in
Among
the circumstances
connected
is
with
these
and
in
a certain way succeed each other and that, after one determination has subsisted for some time, so that the
energy of the system has been exerted during a period
in
it
ceases,
a neces-
sity for
some supplementary or
a new
owing
to
any im-
peding circumstance,
healthy determination
is
144
THEORY OF
constitution
is
The
We
most
striking
illustrations,
ceptionable
ones,
It
of these remarks
is
among morbid
example, that
phasnomena.
after
well
known,
for
an old sore or
artificial
drain,
which has
dis-
charged
much
it
for
particularly if
the head
is
known,
that
after
some
cutaneous
eruptions
and
On
times
healthy determinations
somewell
of the same
Thus pregnancy
pulmonary
is
known
phthisis,
and even
new
illus-
physiology serves to
theory of menstruation
it
so
far,
The
if it
female
is
subthis
would
extreme dangers.
fluid,
So great a
the energy of
so
much of
directed
in a particular
channel'
PARTICULAR DETERMINATIONS.
]45
these
exertions
to
would be subject
dies,
a formidable
of mala-
Such a resource
is
As
is
designed to undergo
and supplement
to this
temporary exertion,
the
periodical determination to
when
the growth
is
is
no longer required
The
if
time
when
it
comes
its
to' hold
an important place
;
or
if,
after
has
performed
office,
all
this
function
becomes
suspended or suppressed,
Morbid determinations take place in conseThese are various in kind. The pulmonary
it
system, as
is
well
known, often
suffers
not unfre-
is
then the
chief seat of morbid symptoms we have gastrodynia and hasmatemesis but no other part of the con:
146
stitution is
THEORY OF
assailed
the nervous
epi-
fabrick,
lepsy,
hysteria,
and a variety of
other diseases.
These considerations may be applied, perhaps, still more directly and obviously to explain the origin of
various diseases which occur soon after delivery.
system
character of healthy
processes, as
when a
free
is
and
fol-
lowed in due time by a restoration of the catamenia. In other instances the determination gives
disturbance
in
risq
to
the
economy, or
to
morbid phae-
nomena
disease,
as
when
or
dolens occur,
some pulmonary or other chronic which gestation had suspended, becomes now
If the brain is the part that sustains the
renewed.
the
same cause
peral mania.
On
that
a similar principle we
to
is
may
suckle
children
when
liable to
hysterical complaints,
to maniacal paroxysms.
The
mammary
is
system,
re-
from
yet too
sparing to
affiard relief
by
its
own
effect.
remarks to observe,
PARTICULAR DETERMINATIONS.
that pregnancy,
147
when
it
This
effect,
indeed,
apt to ensue
it
whether
when any new determination is set up, Under the former be morbid or natural.
fall,
in
in women of the latter, I believe the instances would be much more frequent if the circumstances, under
which the
took place.
result
may
be looked
for,
more commonly
it
Before
we
will
be proper
medium
of the catamenia, in
may be main-
What would
another.
On
this
account
told
we must
that
not always
flow of the
conclude,
when we
is
are
the
catamenia
the
may
not
lie
in
148
SECTION
II.
This
disorder
chiefly affects
sanguine temperament; I
mean
light
who have
fair
sandy or reddish
hair,
with a
full
constitution.
its
It
makes
when
commence, or
at
no long
There
are,
it
has
to
exposure
the
damp
feet, at
at
some
particular
much more
and
over,
scanty
than usual,
and of an
commencehas
affected
epileptic
ment,
passed
with
sometimes
the
head
becomes suddenly
vertigo,
pain,
strong
pulsation,
and
OF UTERINE EPILEPSY.
fits
149
ensue.
fail
gether
age,
make
their
disorders
fits,
which continue
system displays
during
life.
the
function
of the
uterine
less severely
There
the
fits
is
which belong
tinguishes
arising
of epilepsy
mence with
tids,
epileptica
at
others,
are
preceded by pain
and vertigo
The
more
character which
particularly to
is
has appeared to
me
to belong
the
form I
have
have
termed
Leipothymia.
Some
authors
denominated
The
* Sauvages
hysterical epilepsy,
which he uses
1.
as
synonymous expressions:
Sexu
;
aegrotantis; 2. Praegressis
3. Insultus
sequuntur tempus
4.
Aut a
mate excitantur; b*^. Obscurissimae sunt in paroxysmo scnsaSauvag. Nosolog. Method. tiones, non omnino suppressae."
torn.
i.
p. 582.
The 3d
facts
:
of these remarks
is
is
founded on
no
:
to
other forms
of epilepsy
secondly, hysterical
paroxysms as
with uterine
with enteric
as
examples of
remark
is
the fourth
by no means peculiar
form of the
150
term
with
is
an
erroneous
opinion.
There
are,
indeed,
accompanied
by
the
by
many of
the
phaenomena of hysteria;
hystericus,
rising
of the globus
by sobbing, con-
striction
of the prsecordia,
or by that sensation of
stricture in
women com-
plain of; sometimes by crying and laughing. Indeed there are fits which it is extremely difficult to dis-
criminate,
really
am now
considering.
symptoms
Some
remark.
Before I proceed to lay
down any
indications or
me
must request
will,
his attention to
my
remarks on treatment
have afterwards
afford
an exemplification of the
I
practical rules
to offer.
the
fifth
observation
is,
as I
have observed
following section.
OF UTERINE EPILEPSY.
I here beg the reader to take notice, once for
that I have not
}5'1
all,
adduced the methods of treatment followed in each particular case as examples of the practice most to be approved or recommended, but
only as a part of the medical history; or as contributing towards the stock of facts, the comparison of
which
will
serve
for
comment
or
inference.
The
in
to practice,
which I venture
particular section,
to offer, will be
summed up
work.
In
this,
made
to
whether favourable or
;
or affords
SECTION
III.
CASE
Anne
plexion,
state,
I.
Davis, aged seventeen years, of sanguine comwas brought into the Infirmary in a comatose
on the 18th of January, 1820. The following account of her case was obtained on sub:
sequent inquiry
About
a
return.
five
months ago,
in
Two months
after
period she
became
On
these
the day when she was brought into symptoms had come on with unusual
the Infirmary
violence, and
152
CASES OF
increased until she became quite insensible, and had the appearance of a person in an apoplexy. Twenty ounces of blood were immediately taken from her arm; after which she began to recover her senses. She took
a cathartic powder, and the next day lost sixteen
blood.
Mist. Cath. ter indies.
ounces of
On
faculties,
but
still
The blood
last
did
the catamenia had began to flow soon after the last bleeding
31.
and
thirst.
Vena
Sectio,
Feb. 3.
Complains of headache.
Cathartic
pills
and mixture
were
prescribed, and
to
be applied to
her head.
8.
an out-
Observations.
This
is
well
marked case of
leipo-
The
attack probably arose from an ill-directed effort of the constitution to restore the function.
The
marked.
CASE
Mary Laning,
January 18, 1821.
II.
UTERINE EPILEPSY.
eyes, aged eighteen years.
153
About
six
right arm,
and
which continued all the evening to increase, she had an epileptic fit. The same symptoms have recurred twice since that time. The last fit was on Monday night last. (This day is Thursday). She has a severe headache, which has continued from the first fit. Her pulse is rapid, and beats violently in the carotid. Natural functions. tongue white. Bowels regular Catamenia first appeared two years ago, but never came
at night
regularly
The
last
time
she had
scanty
months.
et fluant sang. Jxvj.
Head
relieved.
Pulse
full
and
strong.
Bowels only
twice moved.
Repet. Venae Sectio.
Mist. Cathart. ter indies.
22.
complains of
pain in her
arm.
o. n.
Pil.
Cath.
25.
On
warm
thigh,
bath,
comstili
which
in her
arm.
Other-
Feh. 3.
Pulse
full
and strong
and
Mist. Aper.
154
13.
CASES OF
Has
lately fallen
:
down two
or three limes, as
if seized
with syncope
yet appeared.
immediately recovers
herself.
No
catamenia have
Bain. Calid,
:
alt.
noct.
Cath. o. n.
Emuls. Tereb.
she
is,
17'
however, better.
Can-
March
6.
No
catamenia.
Omit
Ferri Carb.
Bain. Calid.
o. n.
r.
n.
Repet. Tinct.
Melamp.
5i. o. n.
22.
for
two days.
Complains of
April l6.
had no catamenia.
Mist. Myrrhas
cum
Ferro.
28.
for
two
in
days.
the Infirmary.
symptoms of determination
is
to
the
clearly marked.
In
women who
often
It
is
commence, as in this instance, after a scanty flow. when the system is making an effort that the danger
effect also of the plan
is
The
the system,
decisively
UTERINE EPILEPSY.
Ii5
CASE
Sarah Boon*,
1820.
ast.
III.
15,
20.
girl
who
but
About
every day, which sometimes She sometimes knows when they are coming on by a pain in her head, but more frequently they attack her without any premonitory symptom. Formerly she used to struggle, while under the fit now she lies quite still. Bowels generally regular.
continue an hour or more.
;
Pulv. Cath, o. n.
Mist. Aper.
ter indies.
y4<,
16.
The blood
is
not inflamed.
Pulse
and
full.
Bowels
confined.
17.
buffy.
She was
;
now
lying quite
if
breathing easily
with a
asleep
Repet. V. S. ad Jxvj.
Epispast. inter Scapulas.
19.
but the
fits
are
as
frequent as ever.
ad 3XVJ.
fits,
20.
accom-
better.
V.
21.
S.
Only half the quantity of blood ordered was taken, because she had a fit at the time, and more could not be obtained. She says she is better.
V.
* This
firmary.
S.
ad Jxvj.
to the In-
was a patient of Dr. Carrick's, the senior physician I had no part in the management of the case.
156
22.
lasted
CASES Of
Not
yet bled.
fit
yesterday, vvhicli
the only
She
feels
herself
much
better; has
Her
feels
pulse
is
23.
all the
day
she
her head
much
relieved.
full.
25.
No
fit
yesterday.
fit
Some
26.
No
appearance of the
catamenia.
dolens.
is
to-day better.
fits.
28.
Her arm
S.
affected.
July
No
No
catamenia.
It is to
be poulticed.
still
12.
swelled.
Pil.
She
Cath,
is
to
bandage
25.
lotion.
Takes
o. n.,
No
catamenia.
Leg
up
to the knee.
Pulse quick,
and rather
full.
V.
28.
S.
ad ^xvj.
Her
legs
now
both swelled;
little.
Bowels open.
She
except her
legs.
Sept. 7.
Her
legs
and
blisters,
29.
Made an
her legs
still
troubled her
Observations.
The
effect of
seems as if the determination to the head was removed ; but the necessary discharge by the catamenia not succeeding, a
new morbid
an occurrence by no
means unusual.
UTERIl^E EPILEPSY.
l57
CASE
Elizabeth Downton,
set.
IV.
15.
A girl
hair.
of sanguine temperament,
complexion, brown
More than
became
chiefly
beset with
which
occupy the legs and thighs. Her belly is tumid. She complains of pain on a moderate pressure being made below the umbilicus, and in the left hypochondre, at the
region of the spleen.
About twelve
to
or fourteen
the
epilepsy.
The
fits
much
convulsed in them.
At
menstruated.
The catamenia
;
first
made
their
to
appearance
and previously
this
change
The abdomen
appetite
is
Her
deficient,
is
are regular.
Her pulse
Pil.
Hyd.
14.
22.
better.
Her
appetite good.
pressure.
Repet. Pil.
Mist. Sal. Antim.
26.
she
is
The
better.
The catamenia
and
to
warm
She went into the warm bath by mistake, while the cata28. menia were beginning to flow. The effect was an immediate
suppression, followed
yesterday.
by an attack of epilepsy, which occurred To-day she has had a second fit.
158
CASES OF
Piead.
^ther.
Spir.
Ammon.
fits
Foet. n|.
j.
subinde.
May
had one
1.
last night.
S, et fluant sang. ^xvj.
Enema
Statim
ex
.01.
Terebinth,
^j.
injic. et
omni nocte
repet.
Tinct. Asafoet.
Tinct. Valerian. Volat. 6.
Is
aa. 3ss.
pretty well.
No
fit
used,
and
the bleeding.
10,
Has been
fit
:
is
now
threatened
with a
attacks.
viz.
by an appearance of
Foet. 3j.
Spir.
Ammon.
when
the agitation
comes on.
Emuls. Terebinth,
ter indies.
Enema omni
12.
l6.
nocte.
fit
She had a
slight
last report.
V.S.
no buffy coat.
20.
Had
yesterday a violent
fit.
V.
27.
S.
ad
^'^^j-
June
She says
is
and
come
on.
To-day she
full.
She
was ordered
to be bled.
relief.
however, afforded
V.
Episp. ad
Pil.
Nucham.
2. o. n.
Cath.
Mist. Aper.
epigast.
The head
relieved
quantity flowed.
system.
No
fits
UTERINE EPILEPSY.
15.
time.
'159
No symptom
girl
She has no
ail-
Discharged.
fits
went out
well,
much
dis-
the catamenia.
CASE
Sarah Harris,
Sept. 25, 1820.
V.
girl
of short stature,
comthe
About
five
to
and were
last
occa-
The
when more
she suffered
scanty,
more pain, and the menstruation v/as and of paler colour than usual. A few days
felt a stiff-
contracted.
at that time,
without
any further ailment; but about three days afterwards it recurred, and on that occasion was speedily followed by a trembling or quivering sensation, which went up the arm towards the head when it had reached the head, she fell down senseless, and was convulsed for some minutes. She has had two fits of the same kind since that time, viz. in the course of the present week. She suffers from pain in the head, particularly towards the back part. Her sleep is disturbed. Pulse frequent, rather
;
Appe-
omni nocte.
c.
Mist. Cath.
Mist. Menth.
Rheo.
160
27.
CASES OF
Her head was immediately
fits
relieved
;
by the bleeding.
She
has had no
white.
same hand, and in the leg of the same Her sleep is more undisturbed. Pulse as before. Tongue Her bowels have only been moderately opened. Says
pills,
little
of the mixture.
Hydr. Submur.
Scammonii,
;
30.
fits
the Infirmary, she was seized with the contraction of the hand,
and
the
which used
to precede
fallen
down
in
fit,
but
escaped.
strong and
full in
the carotids.
Has
Jxvj.
mane
quotidie.
On
the
catamenia appeared,
No symptom
a very
Bowels
freely opened.
retain
the emulsion.
Pulv. Cathart. ut antea
o. n.
Mist. Cathart.
11.
manb
quotidie.
Fingers
is
still
In other
respects she
well.
18.
discharged.
Nov.
over.
1.
;
Saturday
She remained perfectly well until and are not yet quite
;
On Sunday some
but,
UTERINE EPILEPSY.
to lose
I5l
2xij
of blood, by
way of
and frequent.
She was
and
relieved,
;
and remained
free
from
fits
during several
months afterwards
dies,
in the following
May came
to the Infirmary,
having suf-
fered a relapse.
CASE
Elizabeth Sutton.
VI.
girl
About two
which
first
troubled
When
ceased.
the
catamenia
made
their
in
appearance the
fits
The catamenia
due periods, but were more scanty than six months ago she had again an epiand since that period a similar attack has leptic fit occurred three times. The last fit happened eleven days ago ; it took place two days after the catamenia had
returned
natural.
About
stopped. This fit continued three hours, and was followed by a severe pain in the occiput, which still continues, and prevents her from sleeping by night. The bowels are constipated, and the right hypochondre is Pulse frequent and strong. Tongue white, tender.
VencB Sec.
et fluant sang. ^xvj.
Nov. 27'
The pain
Pil.
in her
Dec.
1.
She
a pain in her
head
Her head
partially relieved
it still
pains her.
Two
days
162
CASES OF
ago she was troubled with the globus hystericus, but had no
epileptic
symptoms.
V.
Pulse frequent.
S, et fluatit Jxvj.
Mist. Cath.
Menth.
the
c.
Rheo.
left side, for
On
though
which
On
15th
the catamenia
returned,
a scanty degree.
From
this
complain of pains
in her head,
On
made an
made
their
March
scanty.
She attended afterwards as out-patient. Catamenia returned a few days ago 22.
they were
in the temples
and
vertigo.
jjpril 5.
is
much
lessened since the discharge has been free from the seton,
26.
scantily
complains of pain in
her head.
On
bled.
The
now
taking were,
Hydrarg. laxant.
2. ter indies. aa Jj.
is
t,
Mist. Aperient.
Aq. Menth.
she
d.
21.
Catamenia
flow naturally:
now
well, with
the
Discharged.
On
fits.
her symptoms
viz.
She was, at
first,
amount of
much
benefit.
Soon
dis-
much improved
state of health.
Observations.
This was a
UTERINE EPILEPSY.
mination of blood
deficient flow
to the
163
of the
catamenia.
fits
:
At
it
first
this
disease
was restrained by
and prevented from reaching so severe a degree; but as an increase of pain and giddiness was generally perceived
the cause continued, the complaint was not removed
:
by the menstrual discharge. may be remarked that the flow of the catamenia was several times promoted by bleeding, and was generally more free when it occurred after a considerable abstraction
It
of blood.
The connexion
of the
fits,
in this case,
The
patient
was subject to epilepsy before the catamenia first appeared they were late in their appearance when they occurred In most of these features the fits ceased to trouble her. that of Elizabeth Downton. her case resembled
:
CASE
Dinah Gay,
VII.
1,
1819.
hair, aged about twenty years, who has been subject four years to
girl
epileptic
fits.
They
return
very frequently,
and she
seldom passes a week without an attack. Sometimes she has three or four violent fits in a day. She menstruates,
as
she
says,
freely,
but always
has the
fits
about the
period.
No
much from
She
is
Present
state.
Pulse
Cath.
full.
several violent
fits.
Veil. Sect,
Pil.
fl,
sang. 5*vj.
164
Dec. 4.
CASES OF
fit
convulsed.
Pulse
still full.
Van
Pil.
Sect.
o.
Cath.
fits
n. Mist.
Cath. m. quotid.
Dec. 11.
affected
No
bleeding;
but she
is
now
most violent
down the right leg, from the hip, but The knee also is in pain. The pain ankle.
In other respects she
is
well,
fl.
Jxij.
Pulv. Febrifug. o. n.
Jan.
1,
1820.
Her
leg
is still
very painful.
Liniment. Terebinth.
4.
No
relief to the
symptom commenced,
the
of the
Soon afterwards she menstruated naturally, without any return fits, which she never remembers to have done before.
Pain in the leg abated.
disorder in the leg abated from this time, and for a short
31.
The
interval she
was
free
The
epileptic
fits
then
returned, and she had several before the ^nd of February, when
the following
as an out-patient.
The
fits
catamenia.
She continued
to attend
during the
summer
of 1820.
after
She
Whit-
now
fits,
suntide, (23th of
May).
Soon afterwards her abdomen became lately been married, and supposed
last
September 30.
report.
No
fits
Abdomen tumid
child,
the motion of
UTERINE EPILEPSY.
has no other ailment.
\65
and stomach in
et
regular,
cum Rheo
Mag-
Dinah Gay has come to return thanks, and be dismissed. She has a child several weeks old. Is quite well: has never had any return of her fits since
April 11, 1821.
she became pregnant.
CASE
1819.
VIII.
out-patient,
Aug.30,
domestic servant, aged twenty-one years, of middle and stature, who, about three years ago, was seized with an epileptic fit, which she attributed to a fright. A similar attack occurred about six months afterwards, and
size
At
wanting.
The
is
returns of
Her
attack.
pulse
frequent and
Her bowels
bled
since
consti-
pated habitually.
V.
She
has
been
the
last
S. et fluant Sxvj.
Pil.
Cath.
o. n.
fits
14.
Head
relieved
by the bleeding.
No
menia.
She has
25.
Much
relieved.
:
they are
Repet. Medic.
She left off taking her medicines for a week. The catamenia returned after an interval of three weeks. A sudden
Oct. g.
166
giddiness sometimes seizes
respects she has
CASES OF
her for a few
to
left
moments.
In
other
no complaint
make
this
off her
purgative
Four days ago the catamenia began and on that day She complains of vertigo and headache. Pulse she had two fits.
20.
;
Med.
22.
The
30.
strong.
Pulse quick
living
on a
full diet.
Spare Diet.
Repet. Med.
Nov.
10.
Complains
Repet. V.
-
S. et
Med.
Bowels opened
thrice or
l6.
Head
relieved
by the bleeding.
Pulse 100, and
softer.
Pil,
23.
Pulse
120.
Tongue
furred.
Has pain
head
Hirud. temporib.
Dec.
8.
feels her-
ailment.
Thinks herself
and wishes
cease attending.
Discharged.
Observations.
It
may be concluded
at the
mencomtheir
is
when
made
a time of
life
when
UTERINE EPIIEPSY.
as yet scarcely established
;
l67
when
is
turbed,
and
its
suppression
As the panied by disorders of the nervous system. catamenia were wanting when the disorder made its first attacks, it may be inferred that they arose from the suppression of this function, and from abortive struggles of
the system to restore
it
or set
it
up.
still
of
only ineffectual
efforts
efforts
system.
These
2.
were
still
accompanied by
fits.
The
was obvious in this case. It was evidently pointed out by the symptoms, and was followed by a relief, and, at least, a temporary removal of the disease. A return of vascular plethora, with constipated bowels and a stimulating diet, would probably again excite the predisposition to epilepsy into action but it seems likely that a recurrence would be avoided by an opposite regimen. As I have not heard any thing of this patient since her discharge, I infer that she has had no relapse.
:
CASE
Elizabeth Millard,
1820.
IX.
admitted Aug. SO,
in-patient;
years.
of fair sanguine complexion, aged seventeen She has been subject to the catamenia about three years, and they were regular in their returns. Two months ago, when the period was just over, she had an epileptic fit her head had ached for a fortnight before. The fit came on in the day-time. One month ago she had another fit, under similar circumstances and to-day, when she
girl
; ;
expected the catamenia to return, a third attack of epilepsy came in their stead. It attacked her suddenly,
witliout
headache.
She
fell
down
168
CASES OF
Infirmary.
bled, to the
gij,
amount
which
in
Com-
V.
S. et fluant^xvj.
Epispast. ad Sternum.
Sept. 4.
5.
better yesterday
and to-day.
fits,
On
this
and one
she was
again
She
had
lost
no warning
her senses, she
of their attack,
felt as if
The
fits
lasted
in them.
S.
fit
since.
9.
Is
fits
to-day
the
first
No
fit
On
the
same day
way.
the cata-
menia began
23.
to flow,
and continued
after the
in the usual
She has
had no headache
on the 24th.
since.
fits
vomit.
Now takes
25.
Her head
She was
26. 27.
was bled.
She was
to
relieved.
An
issue
was ordered
be
made
in
her arm.
UTERINE EPILEPSY.
30.
Oct.
l69
Leeches
I.
to her head.
the leeches.
Issue begins
to discharge freely. 5.
11.
Is apparently well,
Yester-
day
the catamenia
made
their appearance.
l6.
usual
time,
and were
natural.
17*
worse
after
the
bleeding.
to the temples.
21.
Head aches:
The
Epispast. ad Nucham.
A
again
few days
ailment.
if
She
Note.
Juli/,
IS21.
CASE
X.
1
Mary Hodge, admitted out-patient, May 1, 1818. A girl of fat and plethoric habit, twenty-two years old, who
has been five years subject to epileptic
fits.
They always
accompany
conclusion.
She says she has never missed having the fits never has more than one at a time.
:
They
attack
her
without
any
premonitory symptom.
,^xvj.
Bowels
regular.
Pulse natural.
Cath.
o. n.
June
3.
pain on
pressure.
Mist. Menth.
Rheo.
ter d.
170
30.
Feels herself well.
CASES OF
Continue.
July 3.
10.
now two
17.
the
fits.
fits. The catamenia have been expected Formerly they were always regular to a day. The catamenia have taken place without any return of
Continue.
25.
fits
is
quite well.
Observations.
It is very
measures adopted
in this case
were so soon
etfectual in
fits,
which
in
so unvarying a manner,
CASE
XI.
June
10, I8I9.
Mary A few
Ford, admitted
weeks ago,
first
fits
out-patient,
at the
make
in
She was
time
her
Similar
V.
Pil.
Cath.
o. n.
Mist. Aperiens.
I
have no notes of her case (except that she was again bled on
16) until
June
June 26.
Abiad.
The
fits
every day.
Erapl. Lyttffi
Nuch.
Pulv. Cath.
o. n.
30.
fits
prescribed.
Pulse
120,
and
full.
UTERINE EPILEPSY.
July 8.
171
last:
fits
since she
was here
coughs
and
spits blood.
Pulv. Cath. o. n.
M.
Lax. Ant.
cum
T.
Scill. 4.
qq. h.
Had one
Her head
time.
relieved.
The catameuia
Pulse
took
place soou
has had no
symptom of
and
still full
and frequent.
were
On
The
this
to lose twelve
ounces of blood.
Scil.,
cathartic pills
ordered to be repeated.
to the Infirmary;
and
conclude that no
This
is
by a suppression of
the catamenla;
remove such a disease. No impression seems to have been produced on the disorder, until the severe measures, ordered on June 26, which immediately arrested its course
but the function of the uterus not being restored, the
recurred.
fits
Soon afterwards haemoptysis took place, probably from a new effort of the system, which occasioned a second morbid determination. The artificial evacuation was again repeated, and the fifth bleeding was followed almost immediately by the healthy return of the catamenia the absence of which had been the exciting cause
;
of the disease.
CASE
Mary Mitchell,
XII.
girl
Tea days
when
172
CASES OF
fit.
She has
had
fifteen
fits
The
27.
night,
free
from
fits
when
8.
July
Since she was here she has had three attacks, which
fits.
resembled fainting
Ven. Sec.
Pulv. Cath. o. n.
15.
fits
Hyd.
22.
It is
now
is
troubled
with
fits
again.
Nuch.
o. n.
Cath. 3.
4ta.
qu&que
horS..
No
fits
since she
was
last
V. Sect.
Pil.
Cath.
o. n.
Aug.
5.
fits
for several
when she had one : the catamenia are not affecting her at present. The fit begins with a coldness in the feet; the sense of coldness rises towards the head, when she is seized. Has pain in her
back
:
neither
pain in
her head
nor
vertigo.
Pulse natural.
Bowels open.
Emplast. Cantharid. ad lumbos.
Pil.
Cath. 3. o. n.
Pil.
12.
side.
fit
Empl.
Lyttae;
Nuchce.
Ven. Sect.
Pulv. Feb. p.
X.
6ta.
quRque hora.
UTERINE EPILEPSY.
19.
173
fits
She was
The
are frequent,
but slight, and of shorter duration. Ven. Sect, fluant sang. ^xij. Keep open the blister with Ung. Sabin,
Repet. Pulv. Feb.
Mist. Cath. manfe quotidie,
25.
Two
slight
fits.
die.
Has had no
fits
since she
was here.
Complains only
She has
lately
had a
fit.
She has
several times
had
fits
Vertigo.
Was much
V.
relieved
slight
last night.
S. fluant sang. ^\i}.
Had two
fits
yesterday evening:
has headache.
-With
these exceptions
report.
Art.
Pil.
Temp.
Cath.
3. o. n.
Oct. 7-
She
is
much
better:
has had no
fits.
Her
pulse
is
fit
during the
last three
weeks.
Vertigo
Bowels constipated. Ex Arter. Temp. extr. sang. ^xij. Repet. Med. Cathart.
Setae, in Wuch^.
31.
She had a
violent
fit
when
the seton
is
was
inserted.
Has
.since
free
Mist.
A per.
174
Nov. 21.
CASES OF
On
the day preceding that on
fits.
The catamenia occurred. The fits have happened almost every day until to-day, when she has been free from them. The catamenia have ceased.
were expected, she had several
Sect. Art.
Temp.
Pulv. Cath. o. n.
Mist. Cath. ter indies.
25.
Had
lately
fit,
vomiting.
Zinc. Sulphat. 9j. alt. dieb,
mane.
Pil.Cath.
o. n.
Rheo.
fits;
et
Magnes.
Dec. 5.
vertigo
has pain in the region of the navel when she dilates the chest
p.
has
lost
her voice.
Pulv. Feb. o. n.
Eniplast. Lytt. Sterno.
l6.
fit
has
now
26.
fit
for three
weeks.
Thinks
She was discharged, under the condition of attending again any recurrence of her fits took place.
Observations.
if
The
vi'ith
in
The
epileptic attacks
2.
The uniform
experienced
at
by evacuations,
intervals^
particularly
by bleeding.
such distant
UTERINE EPILEPSY.
175
and so interrupted, that an opportunity was not afforded of following up the advantage obtained for the time
fainting
fits,
were
CASE
1817.
XIII.
out-patient,
March
17,
who
menia.
fits, which attack her at the periods of the cataShe has two or three fits with almost every return
of menstruation.
fits
The catamenia
She
The
which took place a year ago, to a fright. Her general health has gradually become bad. Her pulse is full she complains of pain in her left side, and shortness of breath when she walks up hill. Urine scanty. Much troubled
:
Cath. 3.
o. n.
Scill. 3j.
4ta.
qu&que hor&.
:
22,
Is better.
Sleep undisturbed
Pulv. Cath. o. n.
Mist. Cath. ter indies.
29.
gums
Ven. Sect.
Mist. Cath.
c.
Antim. Tart.
fit. She had left off her medicines some time before, and her bowels had become con-
Jpril 23.
stipated.
Cath. o.
n.
}76
27.
four
CASES OF
Symptoms
continue.
Pulse
full.
Has had
three or
fits.
Ven. Sect.
epigast.
Feb.
gr. x. o. n.
Pil.
Hyd.
bleeding.
Pulse 72,
still full.
entirely
removed.
her head, or
last prescription,
is
blister.
Says she
now
in perfect health.
to return if
any more
fits.
Observations.
In
scanty menstruation.
The
was conjoined, and, perhaps, connected with the weak and disordered condition of the system, which resulted from the state of the alimentary canal. The general health of this patient was restored by the remedies employed, chiefly by bleeding and mercurial purgatives; andjfrom the improvement produced in other respects,
there seemed to be a
epileptic attacks.
rid of the
Her attendance
at the Infirmary
was
CASE XIV.
Elizabeth Cole,
complexion, brown
a girl of slender habit, fair sanguine
hair,
been about two years subject to epileptic fits, was admitted an out-patient at the Infirmary on the 10th of
June, 18
19.
The
fits
were
at
more troublesome about the period of the catamenia; which flow, as she
are
UTERINE EPILEPSY.
says, sparingly, and are
177
aspect
is
imbecile.
Fiat Ven. Sec. et fluant sang. 3xvj.
Pil.
Mist. Aperiens.
l6.
Several
fits
Warm
Bath, or Pediluvium.
Pills at night.
R
30.
Several
fits
in
a day.
No
headache.
V.S.
Fiat Setae, in
Nuch^.
Jvly
8.
No
relief.
Pulse
full
and quick.
No
fits
Nausea.
On
fits
was admitted an
The
now occurred
Ammonias
Feet.
On
and
29-
fits
to-day
her pulse
is
in general
effect
frequent and
resolved
now
to try the
of
The
fits
disease sometimes
continued to recur
seemed
to
safe
and expedient.
seemed
derive
some temporary
of Valerian
Blisters
Ammoniated Tincture
from time to time.
topical bleeding
to
was ordered
were of service
her in so far
As
blisters
It!;-:
i'lS
effectual drains,
to be
CASES OF
and ordered a part of the scalp, over the vertex,
be a
relieved since the discharge from
Feb. 3.
Seems
to
little
Apply cupping
16.
severe
fit
last night.
24
fits
delirious,
29.
Under
the full
effect
of digitalis.
Fits as before.
Pulse intermitting
It
is
stomach
evident that
Dry up
the issue.
Omit
No
material
until
the 7th
of March,
On the
side,
left side
of
membranes of
same
the encephalon, a
was observed.
In
a number of
beads
blood-vessels.
In the ventricles of the brain about 3J of fluid was discovered, and a considerable quantity between the medulla oblongata
and
to
its
coverings.
that
An
eifusion,
which
to the
appeared
The
cineritious
that
is
respect to
the
pathology of
through
case,
is
the fol-
io wing: ^-
The
filled
left lateral
sinus,
its
up by
utrin epilepsy.
179*
It
appeared so
completely to occupy the calibre of the sinus as to have entirely impeded the transit of blood through it.
In the thorax were found, in each cavity, about four
ounces of fluid
In the
abdomen, the
between
its
mid-way
giving
it
internally the
shape of an hour-glass.
On
number
of small red patches, of various hues, apparently occasioned by exudations of blood from the
coat.
villi
of the internal
The
liver
was rather
pallid,
diseased appearance.
Remarks.
sinus,
in the lateral
seems
be adequate to account for a great part of poor woman had suffered in her head, and
serum on
the surface
of the brain.
The history of the case leads to the same conclusion. Although a variety of measures were adopted in the long
course of this case, the patient never experienced any,
even temporary
relief,
blisters
drains of various
means of
When we
it
became
of the constitution in
of the san-
establishing
function,
or the irritation
its first
appearance,
gave
rise to the
this conjecture is
fits
were more
fre-
180
Cases, &c.
CASE XV.
Mrsi
some time
in
Engin
the
memory
impaired.
By
warm
was rendered more copious, and the fits relieved so far that she sometimes passed two or three months without any attack. During the warm weather of summer the disorder was generally less troublesome.^ About four or five years after the period above alluded to, she was doomed to experience a sudden stroke of She did affliction, which she was unable to sustain.
secretion
Hot,
however,
give
way
immediately,
but
for
some
weeks appeared less depressed than she was expected to be. However, after passing some days in a state of mind, which appeared unnaturally cheerful, she was suddenly seized with a very severe and long continutid epileptic fit;
On
her
characters
state,
of melancholy
I last
despondency, which has assumed all the derangement; and from this
when
P. S.
come
under
my
observation
all
my ideas
respect-
nected with a very rare, or with a very scanty flow of the cata-
menia.
181
SECTION
Of the
In
IV.
the observations I
now propose
to offer
on the
I shall
occasionally
make
in
my
observations,
principle
;
and
actual
experience.
If,
indeed,
my
most of the
down.
The measures
to
On
this
account
my
observations will
be arranged
instance,
the
in cases
of total
when
epilepsy
has
supervened on a
sudden disappearance of the catamenia, the consequence of exposure to cold, or of other noxious causes,
applied during the period of the orgasm
;
or when the
to epileptic
fits
at
uncertam
or, lastly,
when
and
at
the usual
age,
182
PRINCIPAL 1NDICATI9N$.
this disease
is
paroxysms of
short,
appear in
its
stead
in
whenever epilepsy
In
all
rhoea.
any founda-
down,
All
up the uterine
function.
these cases
ticulars
effort
;
aife
they
tion;
its
gives rise to
morbid congestion
in the brain,
and
to
The
practical
A
sists
second division of cases of uterine epilepsy conof those which are connected with dysmenor-
rhcea.
are, for
The catamenia
productive of epileptic
1 shall
fits.
Of
this
proceed to
treat,
methods
to be pursued in cases
The
first,
results
to practice.
to relieve the
The
first,
;
morbid determination
thirdly, if that
head
secondly, to restore
:
or,
effects of
ame-
norrhcea are
felt in
EFFECT OF BLEEDING.
One
we
possess for
fulfilling
indications
effect
is
The immediate
and oppression
in the
and temporal
lancet
is
arteries.
speedily followed
catamenia.
Of the
to
quantities of blood
in cases of this
which
it
may be
3,
requisite
draw
description,
some opinio^
4, in the;
may
upon
relief
last section.
some
light
may be thrown
this subject
principle
inflammatory disease,
is
freely bled,
so that either absolute syncope, or a degree of relaxation approaching to syncope, be induced, one of the
commonly ensue
to the
First,
The
morbid determination
consisted,
entirely
inflamed part,
or the
be
found to be removed
quently
this event ensues most frewhen venesection has been employed within a few hours after the commencement of an inflammatory
disease:
or,
local inflammation,
remove them or, thirdly, when the patient recovers from his fainting state, and
and require other
efforts to
its
force;
or sometimes,
after
an
184
EFFECT OF BLEEDING
have entirely subsided,
but a
new morbid
is
of the system
a greater
this
degree
than
the
original
affection
and
new
It
is
nomena.
joints
frequently in
cases
of
rheumatic
but
by
pleurisy,
is
which
confined
to
thorax,
After inflammation of
often attacked.
tendency of
many inflammatory
it
trait
is
equally well
is
known
very often an
effect,
bution
system.
tions,
of blood
various
parts
of the
vascular
which
IN CASES OF SUPPRESSION.
after the collapse,
85
Now
the
sometimes
In-
going cases.
Either event
was
In order more
be conducted
in
by means of
way
in
which
it
may
be most
It should be performed
is
sitting
If
it
to be repeated,
its
effect
should be promoted by
With
respect to
may
be required,
at each operation,
is
impossible to lay
down any
general rule.
The
practitioner
As
commenced upon by
expectation
the disapfirst
pointment of
instances.
his
of relief in the
is
Of
in
this
remark a proof
to be found in
in
several
particularly
the
second case,
18^
TREATMENT OF EPILEPSY
beneficial effect of bleeding
is
The
it,
much promoted
thus
or, at least,
warm
bath.
The
influence of heat,
96
or
medium of 98 of Fabr.
blood
into
the
cutaneous
and
superficial
arteries.
When
and
in
debili-
tated body,
is
is
par-
may
the capillaries,
exhalant vessels on
the surfaces
is
and no function
subject to
its
more
Among
moting
warm bath
in pro-
this function*.
While the patient is in the warm bath, friction should be employed with flannels, to the back, loins, and abdomen. The patient should remain in the bath until she begins to be fatigued and exhausted
and
after she is taken out
effect
of the bath
* There
tiously,
is
maintained
by
gave
to
a suppression.
at the
comThis
mencement of
the flow,
OF AMENORRHCEA
EMMENAGOGUES.
187
abdomen, and by encouraging a circulation through the extreme vessels by the means of moderate warmth,
and by frequent draughts of warm diluent fluids. The same indication will be promoted by stimulating clysters; which at the same time relieve the
system, by evacuating the bowels, and by powerfully
exciting the vessels in the vicinity of the uterus, tend
to determine blood into the right channel.
An
ounce
of
Oleum
Oleum
Ricini,
makes an enema
I have
had no experience of
The
these
is
The most
is
powerful of
In
has-
a variety of
maturia, and
instances this
it is
not,
it
so
but, in
upon
it.
In cases of maniacal
of the catamenia,
it
affection,
number of
experi-
it
The form
is
in
in which it can best be given, in this view, an emulsion, each draught containing from half a to
dram
oil,
188
in
;
EMMENAGOGUES.
a day or the oil may be given in the dose of two drams every night. The Tincture of Melampodium, and the Pulvis Sabinae, possess emmenagogue powers, but are not so
effectual as Turpentine.
fits
cease,
But
if
they
fail
of exciting
the
system,
they
generally relieve,
and
often
remove the
epileptic
to
restore the
uterine
to
prove
is
abortive,
all
that
remains
be
is,
attempted
which
into a state in
which the
defect
injury,
fits.
of this function
and particularly
First;
With
after
this
view
is
important, in the
first
system,
it
by the
is
This purpose
to be
The
be
1.
a view to
this indication.
The
SUPPLEMENTARY DISCHARGES.
2.
189
Some
be used regu-
state
is
natural in health.
Secondly
The
effect
of
artificial drains,
is
by issues
;
considerable
but
going cases
it
may be
epilepsy
removed
in
cases
in
which no other
as
after
remedies succeeded.
In
some
instances,
in
some rheumatic
In
all
new
disease
is
vicarious, to
of
in
epilepsy,
according
a principle
known
pathology.
which,
some
the
degree,
will
This
may
:
be done by
perhaps more
an
issue in
in
one or
in
each arm
will
have a similar
effect,
a certain degree.
tutional disorders
sions,
Of
this
nature
EFFECT OF PREGNANCY.
are cutaneous diseases, discharges from the legs, and other local maladies*.
Thirdly;
observe, that
relieving this,
in reserve for
disease,
which
These disorders
Pregnancy
women.
of the catamenia.
take place, I
But even
very
if
am
much
marriage,
and
that
On
I shall
enter
more
on a form of
this disease, in
t Hoffmann has related a well marked case of uterine epilepsy, brought on by a suppression of the catamenia ; the consequence of
violent mental agitation,
and continuing
way
alluded to above.
own
statement.
sensibilis, affectibus
animi, praesertim iracundise dedita, h parentibus morbo melancholico affectis progenita, hactenus
sterilis,
ex inopinato mariti
tempore, cum
ipsi
morbo
mcerore.
Quo
menses Jluerent ,
et sub eojiuore
;
deret tristissimus
ilia
mensium
Hinc anxia,
;
faciei tortur^,
quam cynicam
;
vocant
quibus
ferre volebant.
Tandem purpura
rubra
malum quidem
mitigavit;
illud
autem
EPILEPSY OF DYSMENORRHCEA.
II.
19!
In cases of epilepsy of dysmenorrhoea, the pracbe pursued must be somewhat different from
in the foregoing pages.
tice to
that
recommended
is
Where
there
a scanty and
and eleventh
to
cases,
the practice
to
be pursued
is
adopt the
of dys-
in cases
menorrhcea
tiiose
in
general.
means
w-hich
recrudult,
cum
tanta
mentis perturbatione,
in
ut
a multis furori
vicina haberetur.
Hinc
usum
coelum sa^pius mutavit, multorumque medicorum consilia imploravit; sed rediit nihilo minus malum licet niinori atrocia. Verum CUM DENIQUE SECUNDAS SUBIRET NUPTIAS, AB AFFECTU SUO
He
says,
case, the facts of which are very some good pathological observations. " Nostra quidem ajgrotans ab erumpente purpura
sui
si
omnino mali
aliquale
percepit levamen.
Htec enim
et
puerperis etiam,
lochia
haud
rite
ita quoque eadem ad corporis superficiem prorumpente, pabulum malo epileptico subtrahitur. Optimum autem auxilium ex matrimonio redundavit; quippe quo libido extinguitur, menses snppressi
toti
cor-
of the same volume, which had a similar termination, described " Tandem subiit a?gra conjugii leges, et tum melius as follows :
habere caepit
ritnt ac
cibum
paroxysmi
Frib.
See Case VII.,
Hoffmann.
21.
192
TREATMENT OF
to be relied upon.
vein should
be immediately
be determined by circumstances.
flow,
If there
it is
is
any
desirable
to avoid syncope,
total
which
is
sometimes followed by a
In
this
cessation of the
discharge.
case the
and
if this
it
should be
is
repeated.
The immediate
effect
of this measure
and temporal
vessels
is
arteries.
The
often
removed
at the
in
free
and
natural.
At
the
promoting a
occur
fits
same
practice
must be pursued.
In such
orgasm
is
probably insufficient
the determination to
is
observed in other
the
place
ought.
Whether
this
notion
is
UTERINE EPILEPSY.
193
mended.
eighth,
and ninth
just described.
If the scanty and laborious production of the catamenia should continue, and the fits should obstinately
must
A
warm
purgatives
other diaphoretics,
often
give rise to
a more
The
of the
drams
in a draught,
contribute powerfully
much
on
arti-
may be done
ficial
to
obviate
its
injurious
effects
and
in the case of
194
OBSERVATIONS ON
SECTION
Of
Maniacal
V.
of the
Uterine Function.
Maniacal
is
Ttiere
may
by exposure
In
is
more permanent
than the exciting cause, and will even remain obstinately fixed in the system,
but
When
miti-
arising
much
gated, by
its
removal.
afFections in
Maniacal
in the
variety of disorders
arise
UTERINE MANIA.
In such cases we also obtain much
relief
19^5
with respect
catamenia
experience no interruption to
irritation in the
:
system
chiefly
the
period
of menstruation
;
these
are
a condition of body
The
happens
in cases
of the catamenia
slow, scanty,
is
and
difficult.
is
In
often
much of what
termed
spirits
often
hysteria,
and
attended with
fits
ing:
in
and expression
is
vivid impressions
on the fancy
is
torpor
disposition,
These symptoms often disappear with the temporary circumstances which had given
rise
to
them,
The
They
196
CASES OF
CASE
Rebecca James,
I.
A
talks
plethoric
aged about
thirty.
was
in
this
now
labours under.
boisterous
;
She
ex-
is
sometimes
very
When
sullen
mood, or
cries
Her bowels
Cata-
a time, and
always
ex Nuch^
Mist. Cathart.
;
June
6.
She
is
noisy.
furred.
July 21.
very
noisy;
sent
to
the
pens.
No
is
febrile
symptoms.
27'
In the state of collapse; cries and laughs, or
sullen.
Bowels open.
Pil.
Confect. Hydr.
cum
Aloe.
Aug.
^S-
rently well.
She applied
Bowels rather
in
March, 1821,
as an out-patient
in her
in great fear
Pain
menia now
UTERINE MANIA.
She was ordered
opening
pills.
197
to lose sixteen
menia flowed
and
in
as good
came again
CASE
Anne Marsh, aged
An
unmarried
II.
thirty-five,
admitted
May 25,
1816.
woman, of middle
comShe comsays she has been plains of being extremely nervous subject to giddiness from her infancy. She has been for some years a cook, and fancies that her present complaints were brought on by standing near the fire. Her complaint is not hereditary; it has been gradually coming on for some months. She would frequently start from bed and walk about the room. But it is within the last nine days that the disorder has assumed its present
habit, short neck; face generally flushed; sanguine
brown
:
hair.
form.
At
present
her
countenance
is
extremely wild
the
She
is
-Bowels costive
is,
breath
they are
in
when they
is
fail
to
:
appear
at the
due
head
latterly, if
her, her
head
affected.
She
says, that
if
much
198
distressed.
is
CASES OF
When
at the best,
She
very
irritable,
Treatment.
blister.
Shave
head,
27.
Although the
blister
is
not relieved.
4th hour.
June
5.
Febrile
symptoms abated
skin moist
bowels and
urine natural.
in her
head
is
most excruciating
Twenty ounces
15.
Is considerably
Is
calmer
sits
much
better;
up
incoherently.
July 2.
Nov.
15.
much
better,
and
is
employed
as a servant in the
house; but
the evening.
is
troublesome, particularly in
Dec. 12.
Had
a slight relapse.
the head.
A blister to
Jan. 12, I8I7.
Has
recovered.
Employed
as a servant in
In March, 1819, she had another attack. She was suddenly seized with darting pain across her forehead ; her
her skin
is
hot; pulse in the arm quick and feeble; the carotid and temporal arteries beat with considerable force; the bowels
are open, and the tongue clean.
Capilli abrad.
Lowf
diet.
re-
UTEllINE MANIA.
Aug. 20.
disorder.
199
She was
the
Nov.
and
takes
if
19, 18 19-
She
lives
now
as
a servant
in the city,
is still
and
not
She
irritable;
:
spoken to
with,
hastily, will
become
if
interfered
She
is
talkative.
If she
any
head becomes
affected.
to
have an
issue, but
to
its
application.
CASE
Susan Lewis,
aged
thirty-five,
III.
full habit, fair
woman
of
conipiexion,
The mother of
About
she complained that she was unwell, and said she was sure
she should be deranged at
some time
or another.
:
About
November
head.
last
during gestation
From
regular
:
the catamenia have been, for the most part, wanting; and when at long intervals they have appeared, have been very scanty. Since that time she has been in displays general dejection of mind, a state of melancholy
:
indolence, and
is
disposed to suicide.
Her bowels
are
She has had a scrofulous affection of the hip for eighteen years when it heals she is troubled with increase of her headache, and is more
irregular; appetite good.
:
uneasy.
Some mercurial
J
5.
30.
alteratives and bitter infusion were ordered. To-day she has the catamenia. She is much improved in her condition.
Soon
after this
out-patient, with
com-
200
CASE
Mrs.
,
IV.
mental excitement.
She talked in a loud voice, and in a more vehement manner than was natural to her she was highly excited by every trifling circumstance, and even by
;
difficulty
restrained
without
These symptoms
in
which times she displayed symptoms of mental alienaThese disorders appeared with increased violence a tion. days after the birth of her last child, when she became few very unmanageable. At the same time she laboured under intolerance of light, pain, and strong pulsation in the head and flushing of the face. After undergoing some depletion by bleeding and purging, she was gradually restored nearly to her usual degree of tranquillity, though
still
Some months afterwards, in consequence of a sudden alarm, she became suddenly frantic, and fell into a In this state stale of raving and incoherent insanity.
catamenia.
she refused
luntarily,
all
and, in spite of
eflbrts,
to
coma.
'
201
SECTION
Of the
VI.
I SUPPOSE
will
connected with
struation,
is
dysmenorrhoea
to
analogous
from the analogy of the circumstances under which the two diseases appear, there is an additional one in the
fact before alluded to,
marked sanguine
in the functions of
phaenomena of the
eifect of remedies,
disease,
what course
ought
mania.
to
be pursued
in
the
treatment of uterine
One
made
the
respecting the
following.
In
of
stimulating
instances of epilepsy
former disease as
in the latter.
Yet
202
TREATMENT OF
warm
marked *.
The most
this
efficacious
emmenagogues
in
cases
of
class
are
the
Tincture of
medicine in cases of
amenorrhoea
am
persuaded of
its
pos-
this discharge.
But
generally
more
efficacious.
This medicine
lant;
it
is
diffiisible
stimu-
acts
on several of the
secretions, particularly
on that of the kidney, and often occasions even There is no other substance more likely, haematuria. from its known properties, to exert an influence on
the secretive action of the uterus.
I
With
this
view
have prescribed
it
in
the
form of an emulsion,
to
Sometimes
the
oil
have preferred
two drams of
Clysters of
at night,
or a double
some
brisk purgative.
bringing
the
same
result.
The
use of the
warm
* Sec Cases
I.
and
II.
UTERINE MANIA.
time.
20S
powers
upon them
cacy.
enable
I
me
Chalybeates
Exercise by walking,
if
it, is
of great assistance in
struation.
all
of defective men-
as that of uterine
and
on the regimen
to be
ment of the
intestinal
I have
viaa
which the
cause*
;
state
of the catamenia
is
the principal
miti-
state of the
SECTION
On
I
VII.
Puerperal Mania.
HAVE
me
to
Anne Marbh.
204
same
TREATMENT OF
principle in pathology, to
those of maniacal affections connected with dysmenorrhoea, or the suppression of the uterine function*.
a circumstance in which
it
In
disease
the
following
case
of puerperal
mania,
the
unexpectedly gave
Martha Cook,
admitted Feb.
]81f3.
who
has
of sanguine tempera-
ment, light brown hair, blue eyes, fresh complexion, disposition gentle, habits temperate and domestic. She has
had
six children.
last
she was
said to have
been puer-
became maniacal.
on
* Since
same
light in
which
have considered
it.
"
am
conversion.
During
gestation,
and
after delivery,
is
turbed as to be liable to
much
If, therefore,
want of
sleep,
regu-
larly
to the
its
head,
force,
and produce
Ferriar's Medical
ii.
On
the
UTERINE MANIA.
205
During the first fortnight after the last delivery she At that period the maniacal appeared to be doing well. symptoms showed themselves.
Feb. 2.
Head
to be
shaved
the temples.
01. RIcini, ss.
8.
manb
quotidie.
is
suddenly hurt.
No
Bowels
open.
Thirst considerable.
Bain. Calid. hac vespere.
16.
ing.
The use of the hot bath has occasioned a profuse Her head is relieved, and she talks more rationally.
flood-
Large pads, wetted with vinegar and water, applied over the
pubes.
18.
The discharge
is
continues, but
relieved.
is
less
in quantity.
The
mental derangement
22.
Is able to sit
up
in
bed
is
extremely languid.
Pulse 64,
and small.
Appetite better.
She
talks rationally.
if
March 2. Able to walk about the ward without any Has meat and a pint of porter daily.
Continue the Mixture.
24.
assistance.
Observations.
In
tinued undiminished
catamenia was
it
This
way
to
attempt a cure
endeavour to restore the natural determination to the uterus, by which the whole system obtains
is
to
its
and
if this
cannot be
206
TREATMENT OF
other instances,
it.
we have
ascer-
The
following case
may be
it
considered as an instance of
before
Anne Bryant, admitted March 8, 1816. A married woman, aged twenty-six years, of low
stature,
meagre habit, pale complexion, smooth skin, light blue eyes, brown hair, low forehead, high occiput. She is pregnant with her sixth History of her case.
child
in
:
the seventh
is
month
months
melancholy
Present
state.
Skin
;
continually crying.
full
and strong;
a state
She
was ordered
and
to take half
June 12. She was delivered last night: her mental derangement has continued without alteration. No secretion of milk ; takes no notice of the child child 28.
;
weak.
July 3.
the child
is
Her health
dead.
is
improved
it
is
with the
to take food.
Her bowels
pale.
are regular, but the stools are deficient in the quantity of bile
abdomen tumid.
Her
skin
is
Pulse
120,
small.
the house.
Warm
She was
lowed.
still
and no amendment
effect of the
fol-.
When
mercury, a
fainted.
UTERINE MANIA.
A
207
No amendment
Hyd.
bis indies.
30.
Warm
bath of 110 F.
affected; appetite
Feb. 9.
Mouth
April 23.
benefit.
Seldom speaks.
if
She has been reduced by mercurials, without much Skin always cold: sits in a fixed
disturbed.
Laxatives occasionally.
Omit
May
indies.
1.
Dec. Cinchonse
^ij.
cum
July 14.
day.
for the first
Aug. 30.
time since she
came
Preparations of iron were prescribed for her, and continued for some time with occasional laxatives, with some benefit. May 11, I8I9. She has become dropsical. Various diuretics were given, among which were Calomel and Squill, but in vain. June 18. A vein was opened, but syncope followed. Incessant vomiting
sible
came
on,
it
was impos-
to ascertain
Effervescing draughts
were prescribed.
Aug. 16.
Dissection,
Skull very
thin.
A considerable
quantity
sternum
liver
soft,
bile.
Considerable adhesions of the pleura small quantity of serum each thoracic Abdomen. Effusion the cavity: adhesions of the
Chest.
to the
;
of the brain.
in
cavity.
into
to
the parietes.
The substance of
that organ
was
of
The
gall
bladder was
full
The ileum
gangrenous spots.
Observations.
Spleen
It
soft, like
grumous blood.
that
has
been
observed
puerperal
208
TREATMENT OP
mania sometimes makes its appearance before delivery. This would seem to have been an instance of that description.
From
the
puny stamina of
the
the
offspring,
to
it
may be
uterine
;
conjectured that
due determination
the
system had
the time
It
of gestation
viz. at
when
the disease
commenced.
may be remarked,
natural
restored.
The appearances
effects
It is not
my
ment of this form of disease, which depends on the same principles before laid down, modified by the
peculiar circumstances of the puerperal state.
The
all
the information
SECTION
Of
VIII.
Maniacal Jffections occurring at the Period of Life zchen the Catamenia cease.
already remarked
is
HAVE
is
that the
period
of
life
when
tution
particularly obnoxious to
morbid affections
It depending on irregular distributions of blood. would be a needless repetition to account for this fact
on the principles
to
which
UTERINE MANIA.
209
it
woman
in
England
will
vouch
at least I hear
class.
Women who
become
tutional tendency to
fathers, or springing
either derived
from
his fore-
up anew
in his original
conform-
ation*,) are
period
when
or rather soon
is
after they
have ceased.
in females
life,
This predisposition
greatly
promoted
sedentary
who
similar
opposite
women
who
liable to this
Solitary
and contemplative
habits,
super-
tions of religion
all
many
a morbid
if
effect
and
of
would continue
source, by
harmless,
my
210
CASES OF
irritability,
to avail
it.
cases,
which I look
of uterine mania.
religious
had
ciently manifest.
Sarah A
aet.
fifty-eight.
Jan. 4, 1819.
strongly
woman, of melancholic complexion, marked features. Her brother and sister died
:
maniacal
She has,
life
;
and spend
Pulse
tite
in
good
Bowels regular at the present time. Apperather voracious. She appears always cheerful,
Pil.
and
struts
Low
diet.
Oct. 22.
No
material alteration.
Seems
to
Sleeps
is
gar-
Pulse natural.
Let a
Begs for a
full diet
full diet.
be
tried.
AfFus. Frigida.
Dec. 28.
The
full
trouble-
some.
Pil.
Cath.
o. n.
Magnes. Sulphat.
Capt. cochl.
vj.
Jj-
M.
raanb quot.
UTERINE MANIA.
No
but
211
she
on
full
diet,
and
kept low.
October 14, 1820.
After taking a very
was attacked by symptoms of fever. Her tongue became brown and She was bled and purged. dry her head affected with stupor. These symptoms were reduced, and she seemed recovering. She
;
was allowed
18.
porter,
She expired.
in the
symptoms which
head.
in
her perceptions.
Dissection.
Calvaria heavy
mater
turgid
skull.
large piece of
its
bony substance
at the inner
margin of
origin.
that
membrane was
in
between the convolutions. Substance of the cerebrum Vessels of the medullary texture minutely firm and hard.
injected.
Lateral
ventricles
considerably
jij
distended
with
fluid
of serous fluid.
Great
parietes.
not diseased.
'In the case
Observations.
disposition, which
was encreased subsequently to the cessation of the catamenia. The circumstances which chiefly excited the disease were a plethoric state, induced by her
life,
habits of
tinal
and a
full
diet, in
In addition
212
to
CASES OF
her disposition
to
these circumstances,
reverie
and
her disease.
Sarah Ringstone, admitted July 22, 1820. A woman of melancholic temperament, who has
ceased
to have the catamenia for two years. About a year ago she began to be desponding; fancied that her soul was
lost.
Present
state.
Scalp hot;
feels a great
weight
in the
course of the great longitudinal sinus, and across the forehead. Carotids beat with considerable force. Pulse in
the
wrist small
and feeble ; skin cold and shrivelled bowels constipated; sleepless She answers questions very rationally ; is con-
cloths.
Calomel,
statim sumend.
25.
pulse quickened
tongue clean
bowels purged.
tongue a
;
Aug.
purged
2.
giddiness
little
furred
bowels
stools watry,
five.
pulse
full, intermitting
about one in
with carbonate of
scribed.
confection,
was
pre-
September 4.
She
in
an improving
state.
Allowed
change of
to
go
friends, for
air.
Anne Howell,
aged about
plexion, melancholic
UTERINE MANIA.
of what
is
2l3
viz.
melancholy,
:
yet the
origin
had
its
She
aspect:
lies
in
bed:
apartment.
When
most
She believes
that she
God, on account of her sins. At night she looks out of the window, and sees the gulf of hell yawning to receive
and myriads of devils in the midst of fire and brimBeing told that God is merciful to those who repent of their sins, she replies, that his clemency extends only to those who have a broken and contrite spirit, and
her, stone.
is
She
is
as fully
eternally
damned
as she
of her existence.
The
disease
made
;
its first
when
and
in
consequence, as
it
appears, of
in
the
open
air,
carrying bark, in
to
raise
After
suddenly
stooping,
heavy burden, she cried out that she was seized with When severe pain in the back of her head and neck. taken home, and confined to her bed, her senses were confused, and she complained of undefined feelings of distress. Her apprehensions were directed at first to the state of her body ; but being desired to pray and read the bible, on opening it she immediately felt that the wrath of God was denounced against her. Her health was in many respects out of order; digestive Pulse rather function deranged ; bowels, &c. irregular.
214
full.
CASES, &c.
When
she
first
came
went topical depletion and purging; and became so mucli relieved that her husband thought it unnecessary to leave her longer in the house, and removed her. She was readmitted
in
November, 18 19.
time every method of practice that could be thought
From
this
been
tried,
with
little
success.
She
alka-
warm
bathing, slight
;
body
At another
period she
experienced
catamenia;
such as the Dec. Aloes, and antispasmodics, agree best with her. March, 1821. Her bowels are kept regular by the medicines
above mentioned.
tion
is
She
is
greatly emaciated
abdomen;
this
descending aorta.
is
PRELIMINARY REMARKS.
215
CHAPTER
VI.
OF EPILEPTIC AND MANIACAL CASES, ARISING FROM metastasis; or the TRANSLATION OF MORBID ACTION FROM OTHER STRUCTURES TO
THE
J3RAIN.
SECTION
I.
Preliminary Remarks.
Morbid
affections
arising
bear an analogy in
in
many
particulars to
that
class of disorders
which
On
that account
it
seems proper
to proceed,
phaenomena
The
cases
depends,
all ages.
has been
recognised by
medical authors in
among which he
men-
epilepsy*.
He
remarked the
that these
Hippocrates supposed
this
disorder to be occasioned by a
cold
phlegm.
If the
peccant
humour expend
effect;
itself in
ulcera-
tions behind
external parts,
produces no injurious
it
flow
upon
216
great
in this supposition;
cases,
which
have a reference to
their works.
occur in consequence of
differ
accord-
ing
to
of the
preceding
disease.
SECTION
II.
One
on
Accordingly, this
is
one of the
Hoffmann has
rhoeas; or,
epilepsy.
'ihKio.
If
collected
a number of facts of
by any natural
[ji.\v
this
if it
cannot pass
:
off
*'
I?
Oxoroi<7
Hi(pa'Kny
xa*
ovchtx x.a)
iXiKirii'
hruvQx y^ u(pUi
(x)9'
tccci
x6ap6T to ^^Ey/xa'
toiffi
hytoaa, ^\
KciGafa
iarl aa)
i'Xxoj
fjt.v)dlv.
x. t. X,
iXi^xsaGai
inro
rccvTni;
t?{' vovaou'
x. r.
HiPPOCRATES
dc
Morbo
Sacro, cap.
iv.
217
and
among
the forms of
which he denominates metastatic f. The votaries of the humoral pathology were led by their theory to be more observant of phaenomena of this description
than recent authors have been, but similar instances
in
suppression of
artificial
drains.
remarkable
me
in the instance
had
me
for relief.
At
of
length happening to
skilful in
fall
into the
who was
all
When
saw
to
and anorexia.
t Sauvages, Opera, torn. i. p. 585. torn. ii. p. 267. I See, for example, Dr. Ferriar's valuable essay on the Conversion of Diseases.
218
have an
died*.
drain
formed
in
tier
leg,
which
undergo,
and
in
short time
The
eruptive
in
relation
diseases,
between
is
convulsive
affections
and
well
the
acute exanthemata.
fits,
allude
to
the con-
vulsion
in children
and some-
by no means rare as consequences of the disappearance of the chronic or non-febrile disorders of the
skin.
in conse-
by reproduction of the
itch.
made
v\ith
its
neous complaint.
known
often fol-
lowed by convulsive
* Dr.
fits.
to
this.
An
old
accompanied by oedema.
lime
tlie
first
in
his
life,
seized
with violent
See
219
become
tion
is
affected
in a
different
way
viz.
;
by the
dis-
and
this affec-
duce, in general,
when
and delirium
degrees of mania.
is
of erysipelas
often finishes
tion
it
its
the inflamma-
internal parts, in
disease,
more prone
Mary Hamlet,
1818,
in the
evening.
woman
ago by measles.
rium followed.
The
under
a phrenzy warrant.
The
dened
hot
; ;
vessels
the scalp
;
She
is
very unmanageable.
to
was
to
22d, morning.
Slept a
:
little
in the
her countenance
now
She continues
220
is
pressed.
Bowels
freely purged.
Secretion of
milk suppressed.
a powder, consisting
and
to be
put into a
warm
bath.
Six ounces of blood were taken from her arm in the course of
the day, which formed a firm crassament, covered with a buffy
coat.
the skin
was warm
and moist
tended.
is
the secretion of milk restored, and the breasts disrespiration: weight in the head.
Cough; hurried
V,
She
quite rational.
S. in brachio
vj.
fluant Jxxiv.
Hirud.
ad pectus et
Emp.
Lyttae.
Breasts drawn.
:
Very
red
pulse quick
easily compressed.
Tongue
and glossy.
V.
carotid
arteries
I)ulsate strongly.
S. fluant ^viij-
P.
M.
:
Much
relieved
Emp.
24.
Lyttae
ad caput.
restless night.
;
Is noisy.
have been
the tongue
evacuated
somewhat
furred.
She
is
teeth.
;
Pulse 130,
Bowels relaxed
stools
dark-coloiued
and
Urine scanty.
The
tracts occasionally.
cathartic
and
affected.
bled.
221
ptyalism
came
on.
From
tinually improved,
May
following.
delivery
this is well
known
;
to
predispose strongly
to
of the intestinal canal, as evinced by the discharge of worms, and by the appearance of the evacuations. This woman was bled to a considerable extent; but this was not done until reaction had taken place, and had
ushered in symptoms of oppression in the chest.
this state
Until
in
which was shaved, a warm bath, with antimonial doses determining to the skin, and evacuating the bowels, were the means which were resorted to ; and which so far relieved the head that she was, as it was observed, rational
the
constitution
mercury.
SECTION
Of
vulsive Diseases, in Cases
III.
and Con-
It
is
well
known
222
peritoneum*.
The consequences
fits
;
of this
in other in-
nates in a slate of coma, the harbinger of death f. Among the cases of epilepsy detailed in the fore-
vention of an
my
knowledge, in
to
and
to
alleviate,
time,
is
brain.
The
following
seemed
to be
The
fits
never recurred
the
but,
rheuniatic pain,
the patient.
disease of the
destroyed
The encephalon
of inflammatory affection.
Mary
pital.
Jenkins, an
Hos-
1811.
years
last
The first note I have of Jier case is dated Aug. 15, A woman of short stature, spare habit, about fifty old, who has long been an epileptic. During the
months she has experienced no attack of her
has witnessed, in a variety of
four
"
of epilepsy wholly
SfC.
by those
of gout."
Elements
of Pathology,
376.
t Apoplexy
lation,
is
223
She labours under rheumatic pains in her limbs, with a cough and diarrhoea, and still complains of vertigo. She took medicines some time ago, to which she attributes,
without reason, as
I
paroxysms.
small dose of rhubarb and calomel was ordered for her every
Aug. 20.
She
is
troubled with
gr. xxv.
Her
Calomel
Pulv. Antim.
Pulv. Opii,
aa gr.
ij.
o. n.
gr. j. o. n.
The rheumatic
disorder
the affection of
the head increased, and she gradually sunk into a comatose state;
The
vessels
Observations.
In
morbid appear-
many
years
but
which,
being
subsequently
aggravated,
is
put a
period to existence.
the
the
first
When
the brain
affected for
time,
in
vestiges
of inflammation
paratively slight.
About
six years
slight
inflammatory affection
have before
The circumstances
of
224
cation of leeches
apparently in
a convalescent
vessels
The somewhat more than twelve hours. of the membranes surrounding the brain were
found injected with blood, and the whole encephalon appeared somewhat redder than usual, but there was
no
effusion of
any kind
nor, unless
my
recollection
fails,
any
species of disorganization.
Mr. Abernethy
yet,
on
dissection,
The
I
comunless
am
which
of the
has attacked
flammation,
encephalon,
is
the brain
is
but
that
acute
inflammation
capable of destroying
during
its
first
stage,
and before any of those changes of structure have supervened which are often so strongly marked in cases of cerebral affection, and while the disease is
of that kind which leaves but comparatively slight
vestiges
;
in cases
on any
disease,
but
chiefly
on experience of the
state
effect
of
remedies,
and the
225
of
own
The me
result
my
on
to venture
Unless the
I should
is
excessive,
by cold applications
to
the
and covering
it
with a
blister,
same
oil.
With
into
this
department of cases
may be
connected
mania; a
fact
SECTION
Of the
IV.
THIRD example
in
occurs
dropsical
of
*.
essay above
alluded
to,
has given an
account of a case of
this description,
from Lieutaud.
226
Mania
stances
also
occurred
under similar
circum-
On
some
cases of this
fluid
description,
and from this fact, compared with the circumstances under which the disorder has occurred, it has been supposed that these affections depend simply on an absorption of the fluid effused into the cellular membrane,
in the brain.
translation
know,
been suspected.
is,
at least in
some
think, be proved
George Coles,
Sept. 20,
was admitted an
disease
six
1820.
He
had been
ill
of that
months.
He was
to
and
seemed
28th,
bowels.
On
vulsive
morning of the SQth he was seized with which lasted about half an hour.
after the
fit
con-
About an hour
* Dr.
Mead
patient, a
young lady, who was in the last stage of dropsy, was attacked by mania. The case terminated in recovery. Dr. Rlcad attributed
the cure of the dropsy to
IN CASES OF DROPSY.
very restless, turning constantly about.
227
Pulse about 95,
and
full.
Pupils natural.
V.
S. etfl. 3xvj.
Epispast. ad
Nucham,
Gapillis Abrasis.
He had
several
fits
In one of these,
which
much
convulsed, foamed at
and
to the
nucha, the
gr.
blister
30.
He
has taken
five
of the powders.
He
when
left
undisturbed,
lies
strong.
He
is
Sinapism, ad pedes.
R Calomel,
gr. vj.
ij.
Elater. gr.
Pulv. Digital,
4t^.
gr. j.
qu&que
horfi.
Oct.
Much
purged
all
last night.
Took
five or six
of the
powders
he had no more
and seemed
to be
He was
appearance
to
fits.
;
On
the
the
day of
their
head
seemed swelled
dropsical
effusion
it.
Six
great quantity
;
and when
into the
5
made
which, after standing some time, coagulated. The veins of the brain were rather turgid, and would, doubtless, have
been more so
if
first*
228
There was a
the ventricles.
At
an ounce.
texture
was unusually firm, and a considerable quantity of serum was found at the basis.
The pericardium Nvas full of fluid. The left ventricle of the heart much thickened. The cavity of the thorax
contained
fluid,
and
the lungs
were anasarcous.
The
foregoing case
is
but I have
now a
Hospital
is
who
under
ascites,
and
The remarkable
circumstance in
her
case
is,
that
When
in
this
which
is
evidently
case
an
effect
of
diminished.
When
is,
saline purgatives
and
diuretics.
IN CASES OF Diiopsy.
229
fall
With
under
this
scarcely possible to
;
draw
any conclusion from a few instances yet, I confess that I feel a persuasion, from the facts which have
fallen
under
my
notice,
that in
the metastasis of
much more
Should
in the
this
it
was
two cases
We
phaenomena of particular
cases,
rather than by
SECTION
Of Metastatic
V.
Removal of Tumours.
This,
place in conrise,
by
its
with which
becomes so connected,
drain.
that,
on the
from the
suffers
want of an accustomed
person
who
has
is
in
230
a situation
delivered.
of a
woman
recently
The consequence
The
result.
effects
someis
times epileptic
ensue;
at others,
mania
the
The
A
bone.
healthy looking
girl,
perament.
left
parietal
On
tumour was removed when she was that period she has been more She used to have them or less subject to epileptic fits. at uncertain periods, once in a month or two, and somefive years of age.
on a spot whence
From
in
a day.
About
:
three or four
About the latter end December she scalded herself, and the fits then she has now been for some time troubled with returned
of last
:
ad caput admoveatur.
entirely
The
blister
removed
fits
the pain.
She now
her head.
Has had no
Lax. Ant.
since
31.
ailment.
the
Mist.
Has no
Feb. 3.
flowing.
7.
Catamenia now
Pulse slow,
soft, natural.
Tongue
white.
diet.
House
12.
Tongue
V.
S.
furred.
An
much
^xvj.
M.
Aper.
Haust.
231
Vomited,
after
the emetic,
Head
o. n.
relieved
by the bleeding.
Cath.
Mist. Aper.
Is
25.
now
well.
The
The
In consequence of an
irritation in
new
the system,
in the
the
fits
head,
Maey-Anne
March
Q,
Humphries,
aged
forty,
admitted
1818.
A woman of sanguine temperament, who has lately undergone an operation for the removal of a large tumour from the neck of the uterus. Previously to the operation
some slight aberrations of mind had been noticed, in consequence of her receiving information that her husband
had
suffered shipwreck.
The removal
and
the
Hora 8. P. M. She has undergone large evacuations, is much exhausted her countenance pale skin cool
;
; ;
it
was counted
in
Her
tongue
dry
there
is
She
is
ad tempera.
Head ordered
to be
March
7.
well.
232
sit.
gr.
iij.
cum
Milk
diet,
easily
compressed.
Temporal
well
last
arteries
considerable
force.
She
slept
night, but
bowels purged
stools offensive
Empl. Lyttse
capiti.
less frequent.
purged
night.
is
Magnes.
M.
iij.
4ta qq. h.
Calomel,
gr.
M,
Pulse small and
11.
Sleep disturbed.
Aberration of mind.
quick.
Repet. Haust.
lax. et habt.
in
to the knee.
perfectly
rational:
bowels
open:
appetite
sleeps well.
natural.
Pulse
She
Knee
continues inflamed.
Anodyne Draught
25.
at night.
Again
slight aberration
of mind.
130.
ad Temp.
Emp.
Lyttse Nuchae.
233
symptom
From
this
of maniacal disease.
came
to
on,
not suffered
be examined.
Observations.
The
origin
and
termination
of this
its
pathology.
The
disorder
came on
after the
removal of a
and thereby
The
means applied
in the
head
itself,
until a
in
new cause of
local determination
As soon
as
the
suppurative inflammation
took
If the
if
it,
the
it is
woman's
probable
to health
and
sanity.
SECTION
VI.
Other
in
But
I believe
they
may
.
all
would be useless
to
more
234
which lead
or practice.
FACTS ILLUSTRATIVE OF
to
no important conclusions
in
pathology
In order to render
my
to
account of
this subject as
now
insert
some notes of
viz.
in
which maniacal
diseased action.
John Lewis,
eight.
and
eyes dark,
He has been deranged weeks. No cause can be assigned except disappointment but not Present Talks very
History.
five
in love.
state.
incoherently,
is
violent.
Countenance wild
pupils contracted
head hot
tongue white.
Treatment.
blistered.
manfe quotidie.
July 6.
In the
same
state.
Cupping
18.
Head much
1,
cooler.
Appetite improved.
Bowels regular.
June
1817.
decided benefit.
He
has
last fortnight.
fluant 3xij.
In the nionth of
tagious fever*,
*
August this man was attacked with conwhich was then prevalent. When he
that
J I
must be observed,
is
the
arrangement of
in the
St.
Peter's
Hospital
same ward
235
He
is
his insanity left him, and he has (Note of Mr. Kift's, dated Nov. 29, now employed as a wood-cutter in the
is
by the supervention of
to the following case
:
fever.
applies
Mary Guest, Aug. 9, J818. A married woman, aged thirty-six, of sanguineo-melancholic temperament. No account can be obtained of her
case.
She
if
is
emaciated
is
Mutters to herself:
hensions
:
roused, she
Warm
Full diet.
Purgatives as occasion
may
require.
May
Considerably improved.
Continue as before.
July 28.
Has a
Aug. 4. She was attacked by pains in the limbs, and symptoms of fever her head became considerably affected. It was shaved she was bled and purged. The symptoms of fever have subsided. Her mouth 12.
other
:
is
much
affected by calomel,
R
From
ment.
Infus.
this time she had no return of mental derangeShe was employed about the house for some time,
left Bristol for
and then
Ireland.
We
have thus an
of fever
commu-
9,36
FACTS ILLUSTUATIVE OF
admitted June 17, 1817. married woman, aged twenty-eight
She is of tall and mother of three children. brown hair, dark grey eyes, a low fore-
She
Her
natural disposition
is
irascible.
before affected
with
brought on by intemperance. Her husband is insane, and is confined in this house: his disorder is attributed to
vexation, in consequence of the loss of property.
Present
state.
^\\e
is
extremely irritable
talks inces-
Frowns and
intolerant of light.
Treatment.
Shave
diet.
the head.
et nocte.
House
July 20.
The purging
has l>een
continued.
Little
or
no
amendment.
Cold shower bath.
Continue the purgatives,
Aug.
drowsy.
17"
No
Pulse
the
;
full,
:
not
is
quickened.
head
neither of
them appeared
V.
Syncope followed
I'lie
From
pain
this time
she continued to be
attended
with
troubled increased
occasionally
pulsation
with
in
her
head,
About
the 2d of January,
of contagious fever,
which subsided
about a week.
From
that
was
dis-
Full
237
was evidently a case of inflamhead. It was excited by dram drinking, and relieved by local depletion but not cured until a new disease took place, which altered the determatory congestion
in the
;
This
mination
of
the
vascular
system,
and
overcame the
similar
is
SECTION
On
the Treatment
VII.
from
Metastasis.
Although,
on metastasis,
all to
have no
be treated
the
same manner
down,
will
be best
illustrated
by
arrangement.
disorders
is
similar,
in
some
respects,
to
that
of
uterine cases.
We
In the
first
place, venesection
is
not so generally
if
occurring
vigorous
and
plethoric
persons,
the
abstraction of blood
may
has been
recommended
The same
observation
may
be made when
ulcers
it
discharge.
The same
rule,
am
deceived,
the sequel to
haemorrhages.
probably
differs
considerably
from
menof
tioned
arterial
The
theory
these cases
but, as far as I
can venture
1
am
in
venesection
action in
in
the
arm
the
strength
of vascular
239
measures.
When
may
The
be applied.
On
is
In the metait
stasis
It
is
only
when
the
is
strong,
promises advantage.
may
blood
instances of
remedy which
may
;
safely
it
be
and
often
any general
;
should be
in cases
variable.
employed vigorously
3.
but with
some caution
is
feeble
is
and
to
indication
produce a
that
new
or,
if possible,
to
restore
to
the metastasis.
hot
exanthemata.
In some
be
pre-
cases
a pediluvium,
or
fomentations,
may
ferable.
by
friction
Heat of the surface should be maintained and warm clothing, or wrapping in flannels.
applied to any previously
affected
in
Blisters
may be
part;
or,
Irritating ointments
ammoniae and
oil,
may
many
cases*.
all
regimen,
may
be adopted.
Among
relief
in
and
this
confirms
body.
delay.
to
be derived from
drains
express
when I
arising from causes which primarily act upon the brain and nervous system. 4. Another remedy which I have found efficacious
in
this class of disorders is
mercury
so administered
benefit accruing
from
this
its
measure
rise
in
appeared
tive
to
have taken
disorder.
The
patient,
all
several
months
under
the
He
tating perspirations,
On
discovering that
freely,
ordered him
tarized
to
antimony.
this
application
the
From
and
his suffering
in his chest.
241
on ptyalism.
the
In the
first
case reported in
chapter,
constitution
became
I
by
this
remedy
effect
and
in
other
am
by no means disposed
less
to
approve
of the frequent,
much
system
but in cases
of the description I
am now
it
referring to, I
am
We
febrile
have
seen,
in
that a
new
It
disease
the effect of
is
effica-
who
and
it
in those cases of
seems most likely to afford benefit mania which arise from metastasis.
it
In
metastatic
epilepsy
be
so decidedly useful.
242
CHAPTER
VII.
TINAL CANAL.
SECTION
I.
Introductory Remarks.
Medical
morbid
aware that a
canal.
intestinal
or
what
is
termed sympathy,
of the
brain than
disease
what
is
implied
by the
irritated
is
portion of
the
not
commonly
is
set
up
an intermediate
the abdomen,
in
ON ENTERIC IRRITATION.
and the subsequent manifestation of
state of the animal functions..
its effects
243
in the
am
where morbid
are followed
nervous fabric
itself.
The
they will
cases,
of dis-
sections,
comprised in
The
disease
which I
degree of inflammatory
to
affection,
or
I
sometimes
amounts only
simple congestion.
have indeed
know
in
what
consists
By what
train
It
in that instance
disorder of a
new
;
which subsides
in the case
we
are
now
considering,
on the
morbid
structure,
without
affection
in
any degree
previously
diminishing
existed
in
the the
which
intestinal canal.
Q44f
ISIEllVOUS
DISORDERS DEPENDING
much more
it
frequently of an
to
costiveness,
with
diarrhoea,
and
of the skin,
viscid
mouth, white
whole
train of
symptoms
often depend
upon a low
mem-
and
this
is,
perhaps, a
by Dr.
The symptoms of this diseased state are admirably described Ferriar, who experienced them in his own person. He says, " Another symptom of dyspepsia frequently deceives even
this
is
experienced practitioners:
region of the liver;
side, in the
commonly
With
this
fixed, but
there
is
perma-
frequent distention
The
the
tongue and
lips
former
is
slightly in
The
is
sometimes very
severe,
and
shoulder.
not to be wondered
observation,
suffered this
all
however,
particularly
in
these
symptoms may
and a spasmodic
affection of
ON ENTERIC IRRITATION.
frequent,
if
245
cases where
not
an ordinary
state,
in
ordered parts.
In
this
first
some
the
nervous
of the
intestinal functions*.
The
little
distinction
is,
may
be
felt to
change
likewise
its is
place a
soft,
The
pulse
The
secretion of
mucus
interrupted,
and sometimes
and
He
is
slight
this
disorder, returning
p. 27-
many
words,
shall
distinguish
the
this
department by the
246
SECTION
II.
This
is
There
is
in constitutions
approach-
It
is
in
many
cases
attack
often
makes
its
patient
and
intestines.
which
occurred
during which
provisions,
the patient
and
has
suffered
his
bowels to become
constipated.
For a complete
and
truly
graphical
description
of this
disease
we
Edward
is
Percival.
I
{See
The only
point in which
the following.
am
He.
seems
to
common
opinions
and gives
it
prominent place
I
The
me
to consider this as
a parti-
an universal character.
OF ENTERIC MANIA.
ardent
spirits,
24?
are
among
previous
circumstances.
Great
anxiety
of mind,
engage
mental
be
the
than the
precede the
attacks
of this disease
A
the
of thought;
symptom which
him, he
the patient.
resist
commonly becomes
would appear
violent
he has
at least this
to be the case
from
makes
to the
when
i.o
hinted*.
The
general,
is,
in
The whole
it
of the
more or
less disturbed
are in a depraved
state:
something
in
my
my
impression of
the apparent
insanity,)
incongruity of what he had been saying, break off and protest that
248
DESCRIPTION
AND PATHOLOGY
having
its
seat in the
many
I
enumerate the
alvine
State of the
is, if
Obstinate
a great
without an
constipation
may
and we are
six,
told,
has
passed
seven,
excrement
unnatural
:
is
is
brown
colour,
most
they
We
On
further
most
part,
augments the
evil instead
The abdomen, which was previously distended by the indurated fgeces, is now more swelled than before,
flatulence being superadded to the load of solid contents,
which are
in
The
or
contain mucus,
mixed with
vitiated
bile,
and the
recent aliment in
an undigested
state.
Sharp and
OF ENTERIC MANIA.
249
is
discharged, from
about in the
bowels
at
fre-
or reduces
him
to
extreme emaciation.
2.
The
fauces
and velum
covered in
;
pendulum are
The tongue
:
is
often red
some-
more
viscid,
generally, espe-
when
there
fur.
is
diarrhoea,
is
a brownish
The mouth
thirst,
directions.
fetor
There
is
an ardent
and a peculiar
of
The
appetite
is
in
an unhealthy
state.
all
In
many
and
cases
food,
way.
4.
The
skin
is
clammy and
cold
there
is
often a
damp
in
and
debilitated subjects,
furunculi
in various
much
disposed to become
sloughy.
250
5.
DESCRIPTION
AND PATHOLOGY
often flushed
;
The complexion
with
is
glossy,
with blood
the patient
is
The
urine
matters
which should
naturally
pass
by the
general
alvine evacuation.
7.
The
full
pulse
is
rapid and
irritable:
in
neither
nor strong.
The
The
many
sleepless nights
in succession
is irritable,
tremulous.
the
In these, and
state
other
particulars
connected with
there
is
of the
animal functions,
this species
little
or no peculiarity in
of mania.
The
Sometimes a diarrhoea
in
mitigated form,
in the latter
frequently recurrent.
In other
to glandular obstructions in
the mesentery
at
least it
this descrip-
Hectic fever,
abdomen, and he
dies dropsical.
OF ENTERIC MANIA.
S51-
Remarks on
On
the ratio
symptomatum
I shall
add
little
to
manner
is
in
which
excited
by
That
symptoms
its
is
connected with
on morbid
fact, that in
down any
to
general indi-
some
other
topics
which belong
the
subject
of this
chapter.
SECTION
III.
The
appearance of epileptic
fits
is
sometimes con-
unknown
to medical prac-
titioners.
Accordingly
this
modification of epilepsy
252
DESCRIPTION OF
it
ments.
But
epileptic
fits,
from
irritation
in
and
transient
phaenomena
in
and
it
has
whether
this
disease
is,
the
majority
the
of
instances,
functions,
symptomatic
of disorder in
natural
or of ailments in
in
participates
a secondary way.
When
it
epilepsy
and too
if
attention
This circumstance,
am
not mistaken,
I
has often led to a very erroneous practice. convinced that I have seen
epilepsy
am
is
its
many
cases of inveterate
which
were
The
disease
had
some
other
by the exhibition of a
this
set of
medicines supposed to be
:
yet
it is
to
mode of treatment
comes a permanent malady when it is impossible to a circumstance which remove the exciting cause occasionally happens; or when the disease induced in
;
the brain,
or in
first
though at
ENTERIC EPILEPSY.
tion,
253
occasioned
action.
In
may be
it.
cured by a plan
The
longer
the
is
still, if
the disorder in
is
alto-
gether desperate.
after a patient has
Nature sometimes
been
a cure mani-
many
recurrence of
fits,
and even
injury.
festly sustained
much
state
spontaneously,
may be
:
be adduced in
is
may
be
much
overcome.
connexion with the
Epileptic
often occur
in
presence of
intestinal canal.
in
This
is
more subject
in
to
worms
of be
irri-
of
the
this
kind
have
In
occurred
either
patients
it
latter
description.
fits
case
may
from
254
certain
this
DESCRIPTION
that
OB^
cause,
when
there are no
worms
or,
at least,
From
this
I have reason to which applies to the tape worm. the irritation arising from the existence of believe that this
is
in itself
a sole
many
by
other disorders.
it,
is
disturbed
is
and a con-
often produced.
in
The
is
worm
is
a nidus of
life.
The
viae.
convulsive attacks, to
liable,
when
the confall
into
and
this
circumstance
is
some-
In such
fits
ing to
coma
frequent startings
strong,
full,
and rapid
The abdomen
on
is,
at the
same time,
flatus.
It is discovered,
an irregular
On
ENTERIC EPILEPSY.
cuations,
off in
is
it
255
is
an undigested
In
many
is
instances there
a deficiency of
bile,
but this
:
not a constant or
matter discharged
is
natural to
the
The
breath
is
oftensive;
tongue white
his nose.
In short,
the
though
it
that
none
exist.
These disorders quickly subside under a proper regimen, but they are liable to recur when the primae
viae
fall
Like other
this
infantile ailments,
after a period.
The
makes its first appearance in children between the eighth and fourteenth year, it is frequently much more obstinate. The first attack is
in these cases often attributed to a fright;
When
but subse-
In these
as in others, there
is
real,
and requires
and
it
is
liable,
at every period, to
become a
young.
If there
any predisposition to
this
malady
256
in the system,
life.
DESCRIPTION OF
it is
There
of the
is
fits
which occur
in this
accompanied with severe conhave the characters of leipoSometimes they commence with
at others they
thymic paroxysms.
the aura epileptica
;
at others without
any premonitory
symptom, or with only a previous complaint of vertigo and headache: they happen sometimes during sleep;
at others in the
waking hours.
of disorder in the functions of the
canal,
intestinal
The symptoms
stomach and
are not
so
:
strongly
there
is,
marked
health.
mania
The bowels
permanent
are constipated.
Sometimes
this is
state,
in frequent
constipation
The
an unhealthy appearance,
and
display
and of the
times there
liver,
digestive structure.
is
The
appetite
at
is
variable
some-
anorexia;
others,
a craving and
morbid inclination
stances which
is
for
various
unwholesome sub-
worms
in
acrimony
the
ENTERIC EPILEPSY.
9,57
may be
the
The tongue
is,
at
is
same
time,
furred
beset with I
is
eruptions*.
this disease
mania.
is
The
the
dis-
same
ex-
same
one person to a
disease
sions
;
which manifests
itself
in
maniacal impresdif-
same
organs, the
attacks of epilepsy.
SECTION
IV.
The
principal indications
which
disorder
of the intestinal
a healthy and natural determination; in another, to restore a morbid determination to some less important
* See
Case
S
I.
below.
258
TREATMENT OF
new
direction to
In the instance
will
evidently be to
canal,
in
which
brain,
is
the
of the nervous
structure.
But besides this principal indication, on the fulfilment of which all hope of ultimately curing the disease rests, a more immediate one often occurs, which is to
relieve the secondary,
the brain.
If the patient
is
subject to frequent
and severe
paroxysms,
relief
it
will
more evident that we ought to pursue this when there is a constant stupor, drowsiness, when the headache, dilatation of the pupils, vertigo
course
;
patient
is
subject
to
starting in
his sleep,
or to be
disturbed
by
agitating
dreams.
is
it
rather
will
full,
and such
be proper, under
In
be
it
some
instances
this
operation
will
require
;
to
if,
but
as
happen, a
relief
will
be
may be
ENTERIC EPILEPSY.
If there strong
is
259
much
action
of the
temporal
arteries,
redness
of
down
to thirty-two degrees.
instance,
more
effectual
means of
By
measures of
this description,
varied according
symptoms
will
be
commonly reduced
in a
marks of determination to the head will be lessened, and the frequent return of the epileptic paroxysms put
off^for the present.
still
more
The whole
of the plan
description
In cases, the symptoms of which render the foregoing measures necessary, the state of the intestinal
canal must not be neglected
cases, our sole attention
this object.
:
but, in a great
many
may be
directed at once to
stomach and bowels are loaded with undigested substances, or retained feculent matter, which
If the
by the presence of
immediate
relief
be sought
by
260
TREATMENT OF
There are some cases
in the in
head
may
render
merous.
by prescribing
often
of Tartarized
excite
Antimony.
This mixture
will
If
necessary,
may
fails
to
on the bowels, a
cathartic pills
may be
by cathartic
used.
have succeeded in
much
The
use of a
warm
it
other respects
may
After
the
intestinal
canal
has
been
thoroughly
what remains
to
be done
falls
under the
The combination
easily
Antimony
acts
more
alone.
ENTERIC EPILEPSr.
second division of practice.
I
26l
the
mean
more con-
we
often find
to
long
many
instances, exhausted
canal of
its
more
solid contents.
At
the
same time a
a
unwholesome substances.
this
Under
these circumstances
its
it
is still
better to eva-
couraged by means of
warm
fluids.
The compound
:
decoction of Aloes
day, with half a
this
may be
may
take at night
pills
com-
Compound
Aloetic Pills
262
or
if
TREATMENT OF
the bowels are loose, a scruple of Hydrargyrus
Creta, with
cum
agree better
with
the state of
Pil.
Hydrarg.
Asafoetidas,
Gunim.
Extr. Coloc.
Comp.
5a gr. v.
This
lowing:
medicine
may be
alternated
with
the fol-
Infus. Sennas,
Infus. CalumbEe,
AquEE Piment.
aa 3v.
M.
sumend.
The
of
this class is
very
much promoted by
stomach occasionally by means of emetics of Ipecacuanha, and the bowels by strong purgatives.
Of
all
am now
considering, I have
The
first
efficacy of this
medicine
is
exempli-
was
induced to
make a
trial
its
efficacy
by the
late
Dr. E.
candour, that it made a strong impression upon me, and I immediately began to adopt the practice recommended by the author. The trials 1 made were followed by
results
which exceeded
the
my
is
expectations.
in a great
prescribed
same medicine
it
number
5ij,
and
in pretty
three times in a
Even
by the
ENTERIC EPILEPSY.
fied in
Q63
cularly
No.
;
I.
II.
III.
and v.
The
precise
manner
explain
is,
according to
in a great
am my experience,
unable to
its
it
number, probably
many hundreds
effects,) that it
At
the
power on the nervous system. It lessens irritability, the disposition to starting and convulsive
quillizing
fibres,
and promotes
sleep.
The
best
way of administering
If
it
tine is in
to be given
occasions a troublesome
in the day,
when taken
a double In can
may
be given at bed-time.
oil
some
The
best vehicle
milk.
an
ounce* of
it
day
in
a tea-
cup-ful of milk.
stomach
in
many
oil,
instances,
when given
in the
form of an emul-
a dram of the
may
The emulsion
by means of honey, or
Aqua Carui
oil.
Cinnamomi.
264
TREATMENT OF
a continued and persevering employment of
this
By
some
I
auxiliary measures to
be afterwards mentioned,
disorders of the class
now under
seemed
at
first likely
which Drs.
Latham,
Percival,
and
others,
Turpentine so
useful,
to
be nearly useless.
I
silver
has
salts,
iron,
have a certain
efficacy,
in
many
in
disorders of the
the
to
pains
led
head.
My
own
experience
has
not
me
some
less
more
useful,
and the
have
made
It
is
that class
ENTERIC EPILEPSY.
lence
are
;
Q65
:
such cases
more
hysteria,
spirits,
than
any
other.
Patients
who
distempers
often
now
as
it
ought to be, as
I
it
was
am
much
neglected.
in
which there
is
may be combined with absorbents, or Hydrargyrus cum Creta may be given at night with Aromatic
powder, and
pills
some
instances,
and that
this
stimulant
is
parti-
cularly useful,
but I
either.
of
will
do much towards
given, are
The
best forms in
the Spiritus
foetida,
Ammonise
Camphor Julep
Pills of
Asa-
with
Oxyd
Ammoniatcd
Tincture of Valerian,
Camphor made into Pills, with Extract of Henbane; Compound Galbanum Pill. In whatever form such
Sometimes
effect.
have a good
266
TREATMENT OF
But whatever
class of alteratives
we may
canal.
brisk pur-
followed by a cathartic
draught,
will contribute
much
advantage.
Occasional emetics
purpose
I
For
this
generally
alterative
in a day, with a
Aloetic powder,
some other
purgative, in
small doses.
of these medicines
is
promoted
warm
abdomen.
time, should
The
diet,
in
the
mean
be carefully
restricted.
generally be proscribed.
in small quantities
:
indeed
whole quantity of
run
into
easy
of epileptic
There are some cases of enteric disease, productive fits, which differ from the instances
to.
already alluded
The
cathartic
medicine
ENTERIC EPILEPSY.
porary
effect.
Q67
are never fully evacuated, and the scanty relief which the natural degree of action in the canal allows, takes
This
is
permanent, and
The
without
doses,
practical indication
is,
encreasing
their
insensibility
by excessive
cathartics.
One
we have under
these circumstances
or
viz.
every
Many
persons prefer
it
warm
sufficient relief.
man
who
experienced for
many
years.
injects
His remedy
is
an enema
of water,
which he
it
always as cold as he
can procure
bag.
excite
He
his
first
bowels
to
contents,
and
among
Many
268
an ounce of
morning.
should
TREATMENT OF
Epsom
this
When
regimen
is
rise early,
Some persons find a more easy relief from the use of Oleum Ricinij of which they take a dose every
nighttIt
to
is
may
be laid
down
as
a general
that
the
stronger, or
more
be
used when a
milder class.
torpor,
sufficient effect
If the
disorder
merely intestinal
should
the
be
avoided.
When
moting a flow of
doses of neutral
*
they should
be followed by
salt,
or
some
active purgative.
The
The
late
me
a case of
epilepsy occurring in a
woman
Epsom
bed-time.
t Some persons
sufficiently
find
a dose of olive
oil,
purgative.
is
One
habitual use
ad
giv.
3ij.
Aquse Menth. P.
Magnes. Sulphat. ^.
Capiat cochl.
iij.
M.
manfe quotidie.
ENTERIC EPILEPSY.
26*9
medicines,
we can prevent
and the necessity of constantly encreasing the doses, is by frequent changes, or by giving a variety of
medicines in succession.
enteric epilepsy, in
which the
means
some-
may be adopted
canal, a
renewed determination
head
will
times occur.
Number
vii.,
among
In such cases,
the head,
with vertigo,
strong
pulsation
of the
the
jfits,
stances
becomes
The
may be
but the
way from an
adult,
it is
may
it
be repeated as often as
required.
it
is
better to
In children
the best
severity
of the
method of relievsymptoms
270
CASES OF
SECTION
V.
The
four following
cases
characteristic
symptoms of
enteric
depending
of
on morbid secretion
much
fourth
to
emaciation.
The
was not long enough under medical treatment admit of any satisfactory conclusion, and the dis-
CASE
Henry Parker,
An
idiot,
aet.
r.
Hosp. Jan.
1,
1818.
has sometimes three or four attacks in a day at other times they occur once in a day occasionally he escapes them He is insensible of their approach. for a week.
: :
subject to epileptic
from infancy.
He
He
labours
now under
;
an undigested state his appetite is voracious he goes about the house and yard, picking up any thing that can be eaten, and devouring it he has been seen eating a cabbage leaf from the ash-pit. He is emaciated, and his
:
He
was sent
is
:
to the
medical ward.
diet,
A warm
for
bath twice
a week,
and a nutritious
it
were ordered
in
him.
There
psoriasis
an eruption on
occasionally
his skin,
of the character of
the
subsides
course of a
when
is
relieved.
Jan. 8.
ENTERIC KPILEPSy.
9.
271
ter indies.
R Pulv.
Rhei.
Hydrarg.
cum Creta
gr.
ij.
Sing. gr. v.
Pulv. Aromat.
ft.
M.
April 10.
He
The
allowed
turpentine
full diet.
has
been given
regularly,
The
fits
return
now once
and
in
violent as formerly,
state of his
last
The voracious
is
appetite continues.
The
much
im-
little
furred.
He
improved
and grateful
?]
to his attendants.
Magnes. Carbonat.
Pulv. Rhei,
3ij.
^.
iv. ter die.
Aquas
ft.
Purffi, ^vj.
M.
Mist.
this
Sumat. cochl.
for
He
took
mixture
improvement
June 13.
return of the
in the state
He
complains of headache
the pain
is
con-
to be applied to the
to be kept shaved,
September.
The
fits
The paroxysms
but a few
have been
latterly
much more
still
they lasted
and headache.
Jan.
1,
18 19.
He is He
in
a state of idiotism.
fits:
he
relieved
by a purga-
He
Vv-as
272
the
CASES OF
diet of the house.
common
3,
Nov.
the
I8I9.
He
is
continues in a
much improved
state,
no medical care
common
fits.
He
has had no
Sept. I, 1821.
He
epilepsy.
CASE
William HiGGS.
II.
pupils,
He became
consequence,
uncertain
epileptic
fits
during infancy, in
is
said, of a fright.
The
part,
fits
return at
periods,
in the
but,
for
the
most
trouble
him
about twice
aspect,
course of a week.
He
He
and
the forehead.
is
emaciated,
seems
almost starved
has
voracious appetite.
Pulse feeble.
Magnes. Sulphat.
3ij.
fuerit.
R
ft.
Pulv. Ipecac,
Sodae Borat.
gr. viij.
M.
10,
Bowels completely
01. Tereb. 3SS.
relieved.
Not
so drowsy;
in
R
Aug.
13.
manh
bis in Tana.
Improved,
01. Terebinth.
R R
Magnes. Calcinat.
Pulv. Calumbas, Pulv. Rhei,
^a g. v.
5ss.
M.
ft.
Let him have half a pound of mutton daily, and a pint of milk.
ENTERIC EPILEPSY.
Sept. 3.
11^
Sumat
binth, ut antehfic.
Nov.
11.
Spirit of Turpentine.
fits
for
many months.
appetite.
Is
apparently in
Has a natural
CASE
William Williams.
III.
who
has served
From
his
subject to epileptic
continued to trouble him he had no when they ceased about four 3'^ears ago, when they again
fits,
v.'hich
and continued to trouble him at uncertain interSometimes he has had them every week at others
;
He
attributes
the
which he received when at Gibraltar the immediate effect He has no premonitory symptom, except of it was a fit.
:
an attack of giddiness.
Present
state.
The
He
fits
much
Mai/ 11.
He
has had a
to-day, the
first
Continue.
June 20.
Aug.
5.
:
The fits return about once in a fortnight. The voracious appetite continues, and is a troublesome
he complains of headache. TheTurpentine discontinued.
Pulv. Emet.
Pil.
alt.
symptom
R
The
dieb. raanfe.
scalp
was ordered
to
Has had
three
fits
was inserted
the
274
Oct. 28.
CASES OF
Of
late the
fits
used
It
to be.
is
Silver.
die in haustu
fit
Nov. 13.
pentine.
He
Tur-
18.
Attacked by a
fits
Since the
have become
first
Ammoniae Carbonat.
Confect. Aromat. 9j.
Mistur. Camphor,
^ij-
M.
sumend.
be withdrawn.
;
ft.
rigores
The
Jan.
1,
little
let it
1819-
He
has had no
fits
December.
Nov.
3, 1S19-
This
man
is still
it
in the
house as a paupqr; he
slight that
had a
think
fit
was so
it:
he did not
it
recollect
when he had a
fit
before.
He
he
Dec. 4, 1820.
some
Jan.
He had
18 19.
is defective in some parsymptoms which accompanied the attack of the disease during his youth, no statement could be obtained. The man's memory was so defective, that it was only through the accident of his father's being a patient in the ward at the same time that he was known to have been subject to fits in his childhood. The voracious appetite mentioned among his symptoms I consider as
Observations.
This account
ticulars.
Of
the
ENTERIC EPILEPSY.
characteristic
Q75
of enteric
epilepsy
which tend to
disease.
was the
CASE
Sarah Treganny,
aet.
IV.
Sept. 27, 1818.
24.
A
by
girl
of sanguine temperament,
healthy
first
the
lepsy.
now
She
and dimness of sight her bowels are always costive sometimes she has passed a week without any evacuation, and requires repeated purgatives to produce any. She has
never menstruated regularly.
Some
years
week.
She was
Bristol Infirmary,
where she received some relief from a During the last two years she has been subjected to no medical treatment, except
seton and purgative medicines.
She
is
now
;
idiotic
Her
appetite
voracious
is
emaciated
tenance.
violently
if
at times
she squints.
Screams
moved.
have animal
3ij.
Ordered
to
diet.
ter die in
01. Terebinth.
Aq. Menthse.
S76
Oct. 4.
CASES OF
No
fits
The
R
ft.
Pulv.
Sumend. manfe
alternis dieb.
7.
Has
fits
of rigor*.
Mist. Camphorat. ^vij.
.Either. Sulph.,
Sp.
ft.
Ammon. Aromat.
Capt. Cochl.
iij.
aa. 3ij.
M.
r.
Mist.
statim et repet. p.
n.
9.
Bowels
costive.
13.
fit;
headache.
LyttEB
Nuchs admoVv
the Turpentine.
26.
Bowels
costive.
Omit
gr.
iij.
ij.
Calomel,
v.
M.
Pulv.
Sumend.
o. n.
Haust. Cath.
o.
m.
after
27.
One
fit;
very
violent:
opened.
28.
Repet. Terebinth.
5.
Warm
bath.
Nov.
7.
Two
fit
fits,
One
She has
14.
hitherto been
fits
on
full diet.
This
is
now
omitted.
Has
daily.
R
19.
Argent. Nitrat.
fit.
ter indies.
One
slight
20.
Is
Another
fit.
She
is
considerably better in
the ward with help.
Pills of Nit.
many
respects.
down
Warm
bath,
and continue
Argent.
ENTERIC EPILEPSY.
Dec. 4.
voracious.
Jarj, 1,
27?
Appetite not so
No
ISI9.
fit
November.
Bowels regular.
Fits frequent.
gr. x. gr. vj.
Omit
M.
R
ft.
Tereb. Chize.
Oxyd, Zinci,
Pil
Sumend.
ter indies.
S.
Fits
more frequent.
Head
aches.
19.
of the house.
much
The two
different
some
respects,
with them.
other
symptoms of disorder of the alimentary canal besides constipation of the bowels. In both of them benefit was obtained by remedies similar to those
which were administered
in the foregoing cases,
CASE
Margaret Becheb,
Oct. 28, I8I9.
V.
into
admitted
the
Infirmary
A
fits,
girl
seized
by
in
which
still
They occur
;
morning
and generally
ten
happen
Her mother
says that
the disorder
fits;
but
that
character of leipothymia.
Her
is
natural
rather full.
Abdomen somewhat
278
tumid
;
CASES OF
functions of the bowels irregular.
fortnight ago
;
she then
Ol. Terebinth.
Rect.
sj.
every night.
the
fits,
These remedies immediately put a stop to and she went out, supposing herself cured but
;
Cath.
2. o. n.
29'
fits
continue
in
to-day she
state of insen-
and looked as
she
is
Nov.
3.
fit
Med. antea
R 01. Terebinth.
Sumat
ter indies in
Rect. 3ss.
Emulsione,
P.
From this period the fits immediately ceased, and The 01. Tereb. disagreed with her stomach, and
which she continued
to take until nearly the
was
end of November,
She
again constipated
her
she had
hypochondre
the last
symptom
and
her
a cathartic powder
in
effects
cold
for
which
to
She
ENTERIC EPILEPSY.
Q79
has had no symptoms of her complaint since November, 18 19, but attends at the Infirmary to carry medicines for another
patient.
no comment: the
oil
of turpentine has
some
were
fits
of
fits
depending on enteric
that
irritation.
may
be
observed
other
purgatives
tried
nearly a
week
before
turpentine
commenced.
VI.
A young
leptic fits
:
woman
of sanguineo-melancholic temperament,
mind brings
through the
them on
her
life is
a source of misery
Habit full; bowels constipated; Natural functions. abdomen tumid ; appetite good ; rather voracious ; tongue clean ; extremities cedematous ; urine scanty, high coEarly in the morning she is loured ; sometimes pale. troubled with vomiting of clear fluid, followed by spas-
at night
her rest
is
dis-
by
dreams,
which
fit.
no
expectoration.
Catamenia somewhat
:
Remedies ordered
Argent. Nitrat.
Opiates at night.
280
April 15.
of the
fits:
CASES OF
No
alteration of
any consequence
the
in the
frequency
vomiting
regular.
of
water in
mornings troublesome.
Slight pain
Bowels more
in
Abdomen
swelled as before.
R
ft.
Calomel,
gr. 5.
Pulv. Ipecac.
Comp.
gr. x.
M.
Pulv.
o.
nocte sumend.
g'ij-
Tinct. Cinchonse,
Acid. Nitr.
dilut. 5iv.
M,
Mai/
6.
Somewhat improved
fluid, yet
hardly any
Head-
ache
is
the
Fits as usual.
Terebinth,
15.
firm.
Fits
not severe;
Pulse
120,
Blood-crassament firm
Continue
Pil.
Continue the
June 10.
Nausea
pills.
The
pill until
the
less
The
fits
became
It
was novy
3ij.
changed
her
three
and had
blisters applied.
The
fits
left
her:
they
fort-
became
to pass
a week or
ENTERIC EPILEPSY.
22.
281
Has pain
;
in
her
left
;
skin moist
tongue clean
Omitt.
Pil.
bowels regular
is
weak.
Terebinth.
ii.
R Pulv.
25.
Digital, p. gr.
Scillse, gr. j.
M.
bis indies
sumend.
Hydrarg.
Oct. 7.
Mercurials injurious.
Cough
increased.
i6.
Pulse 130.
Pain
in
very irritable
V.
Repet. Pil.
cum
Pulv. Antira.
gr.
iij.
in sing.
Repet. Emulsio.
27-
Complains of pain
in
the
left
side,
near the
heart
head
rises in
the morning.
Catamenia regular.
Pulse QO,
Tongue
and
full.
white.
gutt. 30.
n.
;
serum milky.
by the bleeding and other
Nov.
4.
Considerably relieved
Pulse 100,
full.
remedies.
Continue.
25.
in the
Dec. 4.
Jan.
1,
is
per-
fectly well.
Discharged cured.
282
Observations.
CASES OF
This
is
a well
marked case of
enteric
This
latter
The
tine.
The
tur[)entine
in
pills
would appear from the combined with turpenappear to have had a conit
siderable
share
restoring
thq
healthy
state
of the
intestinal canal.
The
disorder
in
tlie
sanguiferous
functions,
to
though
secondary,
was yet
so
considerable as
effect of this
require the
abstraction of blood.
called for
in
this
The
measure, though
by the symptoms, does not appear to contribute, form of the disease, towards the removal of the
morbific cause.
The
five
following
cases
are
of the description
illustrate
They
fits
tolerably
CASE
Frances Elliot.
VII.
May
27, 1820.
aged nineteen years, of robust square make, corpulent, of dark sallow complexion, black eyes and hair. She has been subject occasionally to what she terms
girl,
hypo-
chondrium.
time past.
afterwards.
regular for
some
On
vomiting of bilious matter, followed which was accompanied with severe pain by These symptoms distressed her until two in her bowels. o'clock in the morning, when they were followed by
vertigo, nausea, and
diarrhoea,
an epileptic
lit;
the
first
An
apothecary.
ENTERIC EPILEPSY.
who saw
her, bled her to the
283
sixteen ounces,
amount of
On
May
27,
Mr.
to,
Kift, apothecary to
and found her labouring under severe epileptic paroxysms. He obtained with diflaculty twelve ounces of blood ; the abstraction of which
St. Peter's Hospital,
was applied
fits.
She complained
pulse
her
abdomen was
tense
tongue clean
and irregular.
The
for her:
Emplast. Lytt. ad Nucham.
R Calomel, gr. v. Aloes, gr. in Pilulis R Haust. Cathart, 3ti^. qu&que hor^.
iij.
statim.
8 P.
M.
fits
have been
incessant
during the
and the consequent state of stupor, she has a permanent strabismus. Bowels once moved ; stools dark coloured,
and very offensive
force.
:
head hot
Hirud. 10 ad tempera.
Antim. Tartar.,
Calomel,
aa gr.
iij.
statim. et
Repet. Antimon.
et Haust. Catliart.
12
P.M.
fits
Bowels
continued
freely
purged
The
15.
to
15,
She was
this
7th she has been taking the 01. Terebinth, with Fetid Spirit, and
the
Enema
of
Opium, &c.
The
latter
times.
16.
A
17.
blister to the
Enemn
foetid,
T. Opu.
584
19.
CASES OF
Aqua Carai
fort.
Enema
July
4.
Pilul. Cathart. o. n.
28.
Purgatives contin\ied.
\6.
Avg,
charged.
21.
fits
now
for three
weeks.
Dis-
Attends as an out-patient.
Sept. 11.
These symp-
in
fits
came
on.
severe
:
frequent and
;
the
;
cathartic
;
medicines
abdomen
tense
flatulent
nausea, and
full;
menstru-
27.
The
fits
In the place of
paroxysms she now has hysterical fits every three or four days ; sometimes several in a day. She is seized with vertigo, headache, the globus hystericus ; she is held up in the bed, and
epileptic
seems
senses.
to
abdomen
soft,
though tumid
no pain on pressure;
11.
stools
still
dark-coloured.
fit:
Nov.
the hyste-
rical attacks
n. repet.
Teh. 19.
April 6.
repeated.
She has
have quite
had no
epileptic 18.
since
it
was ordered.
to
May
Is quite free
recovered.
ENTERIC EPILEPSY.
and
topical
if
285
and
will
bleeding.
Wishes
to be discharged,
apply
again
CASE
William Sherborne, A man of shoft stature,
VIII..
He
has
At
first
he was troubled
when these complaints were most urgent he had vertigo. Three months ago he had, for the first time, an epileptic
fit.
fits
vals,
Present
He has
Pulse
Postea
Hydrarg.
21. 22.
25.
He
feels
Complains of pain
Bowels not
Pil.
stomach.
at all affected
sufficiently
open
mouth not
by the
Hydrarg.
Omit
it.
R
29.
Calomel,
He
has
to
now
the trembling
fit.
and shaking of
his
limbs,
which used
precede a
Ven. Sec.
fl.
Jxvj.
Complains of
his
stomach.
much
The
well purged
blister.
;
He makes no complaint
Medicines given according
is
to the effect.
diet.
286
16.
CASES OF
Bowels constipated,
01. Ricini, 3j- statim.
Calomel,
19.
gr. v.
Again
his
Hydrarg.
2.
manfe et meridie.
pills,
21.
he
is
still
costive:
Tempo ris
^.
01. Ric.
statim.
27.
Head
aches.
Hirud. 10 temp.
extremely
is
difficult to
when
costive he
now
ordered him a
cathartic
powder every
to this,
and
Magnes. Sulph.
his
3ss. o. 4. h.,
to be inserted in
neck
10.
May
6.
Is better,
Pulse
full.
3xvj.
He was
relieved
by
the
last
prescription
remainder of the month took the Cathartic regularly, with alterations of the dose, according to circumstances,
as to affect his
gums
slightly.
30.
Complains of spectra
Pil.
Jai
5.
1.
Is considerably better.
is
Says he
quite well.
He was
ENTERIC EPILEPSY.
Observations.
287
The history of
CASE
John Bullock,
IX.
at St. Peter's Hospital,
out-patient
aged
who has been three which happen in the day as well as the night, and attack him once or twice in the space of two or three months. His bowels are habitually very torpid he seldom has an evacuation more frequently than once in three or four days. He is subject to excruciating pains in his bowels, resembling cholic, which suddenly seize him. Abdomen rather swelled and hard. Tongue somewhat white. Pulse natural.
thirty years,
by trade a
tailor,
fits,
Pulv. Cath. o. n.
13.
He
had a
fit
on the evening
after
he was here,
(viz.
on the
9th,) but
He was seized last night with pain in He has palpitation and rapid circubreathes.
when he
Bowels relaxed
in
He
complains of pain
sight.
omni nocte.
c.
Mist. Aper.
T.
Scill. et
T. Digitalis.
full
23.
strong.
No
fits
and
Headache
Pil.
otherwise he
better.
Hirud. temper.
Cath. frequenter.
Feb.
6,
1821.
He
the Hospital.
tolerably
well,
He
had no
for three
months.
Finding himself
bowels open.
fits
288
lately.
CASES OF
Complains of headache and drowsiness.
;
Bowels very
costive
Pulse quick.
nape of the neck.
Cupping
and a
Cathartic
I
pills
and mixture.
Observations.
it
This case
is
the
brain
with
more
three
The
CASE
Richard Durham,
X.
May
3,
1819.
tailor;
meagre slender man, aged forty years, by trade a accustomed to a very sedentary life, to which he was led by his occupation used to of irregular habits
: ;
sit
occupation
He
During
leptic
fits.
to epi-
He
is
seized with a
:
hand
sometimes
up towards his head, as he expresses himself: he used to fall down, sometimes, in the street. Says he does not
always lose his senses
use of his right
in
the
fits.
fits,
he has
is
lost the
arm and
leg
his
speech
also affected.
He has been in the Bristol Infirmary, and was there bled and purged, had a seton in his neck, and used the warm
bath.
By
these
means he obtained no
is
relief,
and was
dis-
charged
stipated.
as incurable.
His appetite
generally good
his
Present symptoms.
has
fits
occasionally
during them,
ENTERIC EPILEPSY.
but
is
289
is
unable
to speak to them.
The
Aug.
pentine.
ter indies.
He
R
M.
13.
Fits
Pil.
iij.
has
little
or no appetite:
hemi-
plegia unrelieved.
R
ft.
iij.
Habeat
19.
Colocynth.
c.
Calomelane, p.
r.
n.
Continues the
Nux Vomica:
feels relieved.
Electricity
was ordered.
He
It
was
dis-
is
proved.
first
He
report;
and consequently
epilepsy.
lives regularly,
very simple.
lost all
He
has long
symptoms of
The
last
fits
six
slight.
His palsy
lessened,
and he
has
him
CASE
Daniel Boyle,
1821.
XI.
March
15,
A
fit.
man
time, an epileptic
to trouble
From
fits
have continued
him every fortnight, or every month at furthest. The fit comes on with dizziness, and a sensation of something
290
rising
CASES OF
up to his temples: he then falls down backwards. His bowels are habitually constipated.
Pil.
Cath.
0. n.
Emuls. Terebinth.
April
larly.
7.
He
a day,
and the
Ma^
Similar
He
:
has
His appetite
is
he
23.
No
fits;
Cath.
o. n.
30.
No
fits;
cougli well.
Take the
pills
now
twice a day,
if
Emuls. Terebinth.
Jan. 6.
He
is
now very
Cath.
do without the
pills,
Solut.
Magnes. Sulph.
;
q. &.
mane
quotidie.
Aug.
Is quite well
Has had no
fits
September,
He
fits,
CASE
John Harris,
1820.
XII.
He
had three
ing day.
fits,
On
ENTERIC EPILEPSY.
291
months ago he voided a worm, (a lumbricus,) at v\>hich time he was troubled by pain in his stomach but since then he has enjoyed good health. Belly hard when pressed, and tender Present state. about the right hypochondrium he is flatulent, and feels
;
when he draws
:
a full
Ven. Sec.
3xvj.
0. n.
Pulv. Cath.
Mist, Catli.
cum Emuls.
28.
stools dark-
no worms; pain when pressed on chondre, at the angle of the ribs; the same part
coloured
in the
the
feels
right
hypo-
tumid; pain
same
situation
when he
inspires deeply.
is
pain which he
had
at the shoulders
and neck
without uneasiness.
Pulse natural.
T.
c.
Scill.
Nov.l.
Still
very unwell:
flatu-
He
has had no
Cath. 3.
o. n.
Much carotid. No
4.
full
in
the
Art.
Temp.
sec.
Ep. Nnchse.
Continue Cathartics, with Emuls. Tereb., as before.
8.
suppression
to take
of
it.
though he continued
Pulse
full
Urine
still
turbid
head pained.
fl.
and
strong.
Ven. Sec.
Pil.
3xvj.
Cath.
o. n.
R Infusi
Spir.
Sennae,
^ther. Nitros.,
aa ^ss.
M.
iij.
ter indies.
292
CASES OF
few days after
this date
On
account of
this
out,
about the
soft
abdomen
no
recurrence
of his
epilepsy.
Observations.
This
worms.
case would
I
be termed by some
epilepsy
from
am
inclined,
on comparing
it
with
the morbid
worms.
The
in
a morbid
intestinal irritation,
CASE
Jemima Davis.
August
XIII.
13, 1819.
girl,
ment, red
to epileptic fits;
how
She She
during the
on by
is
emaciated, as
appears,
nourishment.
Her
;
appetite
is
to diarrhcea
her tongue
She
is
free
Complains
chiefly of headache.
ENTERIC EPILEPSY.
R Pulv. Stanni, gr. R Calomel, gr.iij.
Pulv. Jalap,
ft.
293
xij. ter
indies.
gr. xij.
M.
Light diet.
30.
Is
after the
powders.
now
Nov.
Discharged, cured,
11.
Has had no
I have
fits
observed
repeated
instances
of epileptic
occurring in individuals
who had
formerly been
was reason
;
to
that
the
worm had
its
been destroyed
or,
at
when no proof of
this
The two
following cases
exemplify
some other
respects, remarkable.
CASE XIV.
George Hulbert.
Sept.
1,
1817.
man, of melancholic temperament, dejected aspect, aged thirty-two years, a schoolmaster by profession. He has, through life, been subject to flatulence and other dyspeptic symptoms. His bowels are habitually constipated he has frequently had recourse to laxative
stout
:
many
years.
Of
this
com-
odd description. He says it used to sei^e him in the back of his head. It was not so much pain as a sense of vertigo ; during the continuance of which he was confused, and scarcely conscious. Whenever this sensation came on he was apprehensive of being
seized with a
fit
:
he
is full
of apprehensions
subject to
294
CASES OF
He
says that he
was troubled
by taking two ounces of oil of turpentine he has never had any symptom of
;
them.
morn-
cines.
He was He
at
the
distance
his
much engaged by
:
On He
fits
now
fits
Is
subject to palpitations
down
at night.
The
is
come on
;
sonorous
if
He
lence,
is
hypochondriacal;
is
his
bowels loose;
subject to
flatu-
which
fits;
his appetite is
voracious.
Pulse quick.
attended
This
man
and
after
some time
from
c.
desisted entirely
from attending.
Some
were ordered
containing
et
for
him
he obtained temporary
Rheo
Turpentine
emulsion.
in the Infirmary,
on
He
is still
subject to
He
CASE XV.
Samuel Tillet,
January 15, 1821.
admitted out-patient
at the Infirmary,
A man
who, about twelve months ago, was ill of a complaint, which he terms a fever. He had then pain at
thirty-three years,
ENTERIC EPILEPSY.
^OS
the bottom of the sternum, and a cough, and lay in a state of delirium, and, as he says, at the point of death several
weeks.
He
in
had of
lale
home
Some
which
Since
but
is
still
troubled with
He
has also
feels
Abdomen
and tense
this has
He
20.
that he
His morbid
feelings
He
fancies
but very
much by
the blister.
He
Cough
relieved.
Mist. Cath.
mane
quotidie.
indies.
of a black colour.
worm
now
moving and
01. Terebinth.
^.
eras
mane.
Mist. Cath.
27.
oil.
Puhe
full.
Pain
in the
eye.
Exsugantur Jxvj.
Cath. o. n.
,
Feb. 3.
Discharged cured.
2^6
CASES OF
CASE XVI.
Hannah Vowles.
April 17, 1817.
aged eighteen years. About five months ago she was seized with a violent pain in her head and back, attended
with other febrile symptoms.
The
the
whole body. While these symptoms were present she was attacked by a convulsive fit. She was bled, and soon
afterwards recovered.
right
her.
very troublesome to
On
fits
were the
The
down
approach.
pain
:
flies
is
senseless
she
without any warning of their up into her head, and she falls convulsed, foams at the mouth,
are regular
headache.
is
appetite
bad
She now
Cath. 3.
o. n.
fit
daily,
and yesterday
had two.
Antim. Tartar,
gr. j.
M.
r.
May
6.
fits
medicine.
Continue, and take
Pil.
27.
ENTERIC EPILEPSY.
another on the following morning.
297
much
troubled by
vertigo.
Pulv. Cath.
gr. 25. o. n.
M. M.
c.
Rheo.
ter indies.
June
4.
The
is
belter.
full.
Ven. Sect,
Repet. Med.
this
attend
at
the
accidentally
met
fits,
and had
Observatmis.
This
case
is
;
not so
circumstantially
reported as might be wished and ultimate cure, which arose from the use of cathartic
medicines, pretty plainly indicate that the primary seat
of disease was in the alimentary canal.
CASE
William Vowles.
the Infirmary.
XVII.
1817.
Feb. 17,
Out-patient at
age.
Three months ago he was seized with epileptic fits, in consequence, as his mother thinks, of a fright. For some time several fits occurred in one day they were preceded by giddiness and drowsiness: they always happened in
:
the daytime.
week.
stale.
Of late they have occurred about once in a Appetite and bowels reported to be in a natural
Pulv. Cath. 9j.
omni
noct.
after a
it
in the
morning.
298
March
12.
CASES OF
He
has not had one
fit
April 30.
He
he has had no
fits,
and
is
now
15,
discharged as cured.
to the
Infirmary again on
May
The
fits
have recurred
noct.
manfe quot.
;
24.
Had two
five
fits
the day
minutes.
S. et fluant Jx.
Pulv. Cath. o. n.
27.
well
;
He now
seems quite
31.
His stomach
No
fits.
Calomel,
omni nocte.
June
7.
Seems
well.
in a day.
Continue.
14.
Feverish symptoms.
The
too
much.
Pulse
full
and quick.
V.
S. et fluant ^x.
a week,
epileptic
fit.
noct.
Oct. 1.
Had
fit
V.
S. 3x.
25.
Had
two
fits
ENTERIC EPILEPSY.
Nov.
1.
299
Had one
Pil.
fit
in the present
o. n.
week.
Cath.
8.
Two
fits
yesterday.
Keep
He was
Dec. 31.
No
fits
last.
Calomel,
M. Menth.
Jan. 17.
fit
c.
Rheo.
He
takes the
Continue.
Feb. 4.
sent
He
to
has
left
him
school
to
learn arithmetic,
fits.
of his complaint.
Let him
He had two
c.
Calomel every
night,
and the
Mist. Menth.
Rheo
in the morning.
To
(1
open
14.
is
air,
Mouth
24.
doubt whether
it
regularly given).
March
his
He
fits.
last report;
and
He
Discharged.
his complaint.
or cathartic mixture.
gr. iv. o. n.
Calomel,
May
9-
2.
Had
fit
yesterday.
V.
S, fluant 3xij.
fits
Has had no
full
since he
was
bled.
sore.
Pulse
and
strong.
V.
S. fluant ^vj.
300
16.
Cath. 3.
o. n.
r.
Mist. Cath. p.
n,
20.
Quite well.
Continue
Pills,
June
6.
Quite well.
Continue the purgative medicines.
^ttg. 8.
As
before.
Pills
is
Continue.
He
Dec, 30.
He
has had no
fits
Observations.
epilepsy.
This was
which appears very unpromising. The doses which he took were so powerful, and long
continued,
as
to
occasion
system.
attacks
complaint by
maintaining an
must be considered.
J
SECTION
Of the
VI.
The
connected
with
301
.1
we have considered
in
fifth section.
The
must be
which
it
The same
epilepsy.
We
must endeavour
to relieve the
secondary
in
The
however,
it
cumstances.
When
the
disease
commences
particularly
in
with
symptoms approaching
rium,
a rapid
bounding
the
carotids,
eyes, heated
would be wrong to
It
much
method than by emetics to which recourse has often been made, as if they were the The quantity specific remedy for violent delirium.
system in
of blood taken should be moderate
;
it
should not
many
the purpose,
applications,
local
same
result.
These
as were
menat
tioned in the
and covering
with
cloths
welled with
water,
302
TREATMENT OF
:
in other instances
on
some
in other
instances blisters
additional irritation.
When
the head
is
hot,
and the
:
may be
expected
produce a beneficial
effect.
General bleeding
will scarcely
be required in two
and,
when
it
is
will, in
the majority
some
of cupping glasses.
benefit
Some
patients experience so
much
by occa-
come,
it
may
be done.
The uneasy
In the treatment of the alimentary canal, we must be directed by the same rules as
epilepsy.
in cases
of enteric
is
no strongly
marked
fulness
in the carotids
ENTERIC MANIA.
and temporal
arteries,
303
mony, as mentioned in page 60, will be sufficient. Sometimes a larger dose of the latter salt, with Ipecacuanha,
is
necessary.
I have
known a
dose, con-
to
be completely purged
by
takes place.
some time
found to
intestinal canal
in the
to
foregoing section.
The
system
is
in enteric epilepsy,
There
is
and requires the same treatment. no other medicine, on the whole, so valuable
irritation
it
same time
that
restores
intestinal canal.
When
there
mucous
304
TREATMENT OF
in the
mentioned
containing half a
dram or a dram,
will
is
to
If this medicine
given in
doses
in
it
Even
is,
smaller quantities
sometimes gives
rise to
The
less offensive
oil in
generally retained
when taken
to
The warm
relieve
bath, by
its
the system
when under
the influence of
intestinal irritation.
spontaneously, or follow
cines, they
may be
relieved
The
mania.
The
disease
to,
is
or gives rise
Except
in
it is
better
stomach seems
is
emaciation, diar-
In
very
some much
ENTERIC MAJflA.
305
When
evacuated,
the
intestinal
its
and
secretions
a more
recommended
in this
and
is
much promoted by
often produced
and the
The
latter
remedy has
a much greater
effect
cipated from
it.
to
intestinal irritation,
become
idiopathic.
The
SECTION
VII.
The
treat-
ment of
enteric mania.
S06
CASES OF
CASE
I.
James Nott, a strong muscular man, of sanguine temperament, aged forty-six, labouring under mania, admitted at the Infirmary, in a frantic state, November 13, 1820. His tongue much furred ; mouth and fauces beset with
frothy mucus
:
pupils contracted
:
eyes
not par-
pressed,
in
He
can give no
account of himself.
lected from his
The following
:
wife
She
;
observed that he
;
was not
w-as costive
complained of occalittle
sleep.
These symptoms continued four or five suddenly got out of bed one night, talked very incoThis herently, and began to break the chairs and tables. happened about a fortnight before he was brought to the
Infirmary. His trade was that of a tiler and plasterer: he had formerly been in the habit of drinking freely, but His for the last two or three years was very sober. and when they bowels were at first much constipated became freely open, his wife says, the evacuations were
;
days; when he
History subsequent
to his Admission.
;
glistening
his eyes wild and he was talking with great energy ; chiefly asserting himself to be a man of great fortune, and declaring that he was not mad. He was bled from the arm and the temporal artery his
;
:
When
head was shaved he had leeches applied to the head, and was purged all without a blister to the nape of the neck
:
:
ENTERIC MANIA.
Three grains of Emetic Tartar produced no
his
307
occasionally.
his
When he did vomit, he brought off from stomach a great quantity of thick viscid mucus. He was continually restless, and was kept in a straight
For
five or six days after his
waistcoat.
little
admission he took
or no food.
fits.
raving
He
His sleep was very much disturbed by constantly passed his evacuations under
him
in the bed.
From
that time
he gradually sunk
December. was a peculiar and During the whole of his illness there strongly fetid smell emanating from him; which was very
Dissection Twelve
Hours
after Death.
Abdomen.
were, in
The
they
more vascular than usual. There was no perceptible mark of inflammation in the external surface of the stomach; but, when slit open, its inner membrane was found to be considerably reddened this appearance was more strongly marked about the cardiac portion the inner coat of the duodenum was also more
places,
:
:
many
and
stomach, contained
to the coats,
much
wiped
off.
The remainder
was
firm, but
The
liver
appeared healthy
tained but
little bile.
In the thorax
to the
diaphragm, and the same part contained abscesses ; one of which had formed an opening into the right thoracic cavity. This cavity was quite full of purulent matter,
The luug op
the
same
side
was quite
308
CASES OF
and pleura pulmonalis,
The
left
lung
Head.
Much
The
side,
fliiid
:
dinal sinus
was cut
the arachnoid
there was
all
under
it.
at the basis
of the brain.
The
state
stomach and intestines, and the morbid appearances discerned in the brain, are circumstances worthy of attention
in this case.
CASE
John Eaton,
out-patient
II.
at
St.
Peter's
Hospital,
Oct. 17,1820. youth in the seventeenth year of his age, of meagre short stature, melancholic temperament, who habit,
A few days ago he labours under maniacal impressions. rose early to go out, and said he was going to meet
the
Queen
in
Lord de
Clifford's park.
This
is
the third
attack of insanity he has experienced, and both the former occurred about the same season of the year.
At
under the following symptoms, which are now present. Abdomen distended ; pains in the abdomen and in the
chest
voracious appetite
titillation
of the
nostrils
rest-
lessness at night.
At
Omni
the
same
R Pil. Hydrarg.
Submuriat.
nocte sumend.
5x1].
24.
Remains nearly
Pil.
in the
same
state.
ENTERIC MANIA.
31.
309
He
the
reduced:
have
lost
all
in his
head:
carotid
Nov. 10.
Dec. 5.
complaints.
Discharged cured.
He
Observations.
This was
irritation
The
sioned
considerable
symptoms
and were
of increased determination,
which required,
Similar changes
probably
we
cannot so trace
CASE
Stephen Mansell.
III.
13, 1818.
October
old, of brown hair and eyes; a sailor, just arrived from North America, of which country he is a native. His elder brother has been insane several years. He became mad on the voyage. The captain bled him twice, and he was relieved for the time but during the latter part of the voyage he has
;
refused food
constantly raving,
310
drinking hard.
CASES OF
Mouth
parched.
Tongue
furred.
Pulse
Skin cold.
and keep
it
Warm
Calomel,
Haust. Cath.
qq. h.
donee alvus
solut. fuerit.
Low
14.
risen in frequency
diet.
;
bowels purged.
Pulse has
and
Cath.
fulness.
Jxij.
Haust. Cath.
15.
o. 4. h.
offensive stools;
in
is little
drawn
to the
the crassament
is
lax,
and great
serum.
Continue Purgative Draught.
Slept well
Symptoms
as before.
Hirud.
ad
sing.
temp.
Postea
01. Terebinth.
ter indies.
He
24.
for
breakfast.
Pil.
Cath.
iij.
si
opus
fuerit.
Haust. EfFerves.
4. qq. h.
Omit Turpentine,
On
the 27th
to the head.
2.
Noisy as
before.
ij.
Opii, gr.
statim.
:
3,
No
sleep procured
;
stools
:
dark and
fetid
head continues
hot
tongue foul
face
flushed
exceedingly rapid.
Sectio. Art.
Temp.
ENTERIC MANIA.
Partial collapse occurred after the bleeding:
relieved.
31
he was much
7.
8.
Shower bath ;
gr.
iij.,
cold.
Noisy.
He was
ordered
Calomel,
fourth hour.
On
is
mouth became
affected
by the mercury; he
more
stools bilious
he
extremely feeble.
the Calomel and other medicines.
Omit
19.
arteries
Temp;
Haust. Cath.
20.
He
he seems
to be sinking.
^ther and
Spirit of
Ammonia.
Tinct. ejusdem.
Haust. Cretac.
0. 4. h.
c.
Decoct. Cinchon.
Night sweats. Diarrhoea continues. Stools dark coloured. 24. Is tranquil and rational. Sleeps well.
Opiate Draught at night.
occasionally,
Dec. Cinchon,
28.
manb sumend.
as
Dec. 24.
Symptoms continue
Is
intervals,
of long duration.
Jan.
6.
much
improved.
n.
diet.
4
01. Tereb.
3iij. o.
Continues nourishing
He
this time.
As
soon as he gained
to
sufficient strength,
walk daily
convalescence.
He grew remarkably fat, and was who had left him on August 3, I8I9.
312
Observations.
CASES OF
In
this case
by
CASE
Gard Luke,
Oct.
4, 1818.
IV.
in-patient
at
admitted
the Hospital
A man
states that
he was in the Tagus frigate, Capt. Dundas, at Malta. An order came from England to discharge all foreigners, and he was sent on shore at Malta. The account of what ensued is stated in his own broken words, which are the most expressive. He had no where to go to. Massa, no
friend in the world.
sitting
'*
*'
me
tinking on God Almighty at once me heard a voice me not know him denn me never massa look up. Saw God Almighty me do great you. Denn me took courage and
way,
me
my
This
me
staid
some time
all
said,
fear,
tings for
symptoms.
it.
If he could not
for,
he used to
is
would
tell his
Father of
If asked,
Who
your
God
Almighty.
was allowed
have
ENTERIC MANIA.
deatli,
313
he.
dyspnoea,
hurried
circulation.
Tension of
Languor and
tongue more
the
effusion in
lowness of
;
spirits
no appetite;
;
abdomen
diarrhoea.
During
of the case
He
to
These were partially by remedies employed. On April 6, 1819, he was seized with enteritis, and died on the morning of the 8th.
Morbid Appearances
discovered on Dissection.
removing the skull the dura mater presented many bleeding points: cranium thick and heavy. Brain firm:
vessels running into
usual.
its
On
tained no
so united
Abdomen. The whole of the abdominal viscera were by adhesions, apparently the effect of chronic
When
cut into,
looked
The
was covered with numerous small cartilaginous bodies. The mesenteric glands were enlarged, and as hard as
cartilage.
The
was
The
pericardium contained
flabby,
The
The
left ventricle
Observations.
In
this case,
314
CASES OF
abdominal viscera.
This
pearance and return of the hallucination, according to the opposite conditions of the abdominal functions. During
the
period
of excitement
in
these
organs
the
mental
disease appeared.
When
this condition
way
to relaxation,
in the
proved, in
dissection.
CASE
Elizabeth Jones,
V.
6,
admitted Jan.
1816.
An
twenty-one years,
who
making dresses. Of middle stature, dark complexion, dark brown hair, light grey eyes, cheerful and mild temper. She has been slightly affected
gains her livelihood by
with
insanity
about
until
three
her
become worse,
ordered
thought
it
necessary
One
way.
Present symptoms.
ing, or crying.
She
is
Bowels
generally in a
pupils
more
ENTERIC MANIA.
Treatment.
315
it.
Head shaved
R Pulv. Jalap.
manb
ft.
a blister applied to
5ss.
sumend.
Jan. 20.
talks less.
Bowels open.
Urine natural.
Tongue
n.
clean.
She
r.
state.
She has a
fluant ^xvj.
;
March
6.
Cough
Empl.
better
Repet. Mist.
April 5.
Pectoral
far
Mental
derangement so
any attendance.
May
17, lSl6.
Discharged cured.
Observations.
There
is
nothing
else
remarkable in
this
gradual
CASE VL
Elizabeth Eden, admitted March
20, 1815.
An
stout
make,
under an
31^
CASES OF
shower bath.
Present symptoms.
while speaking.
She
and
is
way of
vital functions.
Bowels
constift^r;
Head shaved.
the Temporal arteries.
cum Antim.
manb
April 12.
quotidie.
Appears
to
made
CASE
John Laundry,
VII.
temperament; highly
last
He
nine
months
in
a state of insanity.
This disease
contracted
is
hereditary
in his family.
Present symptoms.
breath offensive
is
:
Pupils
tongue furred
talks incessantly,
:
extremely weak
Treatment.
Head shaved.
:
Aug.
20.
I.
Derangement as before
Continue.
strength improved.
No
alteration,
is
improved.
ENTERIC MANIA.
Oci.
6.
317
other respects im-
in
proved.
deranged
strength improved.
Nov. 14.
regular.
He
less noisy.
Dec. 12.
respects
health
in
other
few days
Bowels constipated.
Capiti.
Capilli.
Empl. Lyttae
Magnes. Sulphat.
19.
5j.
post horam.
Pulse 86,
full
and strong.
fit
29.
About
eight P.
M. he was
attacked by a
of apoplexy.
of the attack.
Extravasation
of the brain.
serum.
CASE
Alice Lowe.
Aug.
VIII.
9, 1816.
sta-
An
ture,
sanguine complexion, thin ; has been for several years slightly deranged, particularly in the spring ; but never so troublesome as to require con-
She
318
finement
until
CASES OF
now.
No
cause
is
assigned
none of her
relatives affected.
Present symptoms.
able
;
Bowels
confined;
thirst consider:
tongue
foul,
complains
rational,
Appears tolerably
Head
shaved.
,
Blister applied.
Antim. Tart.
ft.
gr.
ij.
Sept.
2.
Is
;
more tranquil
appetite good.
bowels open
urine natural
tongue clean
in the
;
week.
;
Complains of pain
full,
breathing oppressed
pulse 108,
Empl. Lytt. ad
14.
collected.
R
ft.
Pulv. Jalap,
gr. xij.
M.
Pulv.
manb
to
quotidie sumend.
22.
Continues
improve daily.
sionally.
Oct. 5.
Discharged cured.
CASE
Anne James,
IX.
married
;
woman, aged
who,
occupied as a
niantua-maker
which
it
was
She
is
dark brown
ENTERIC MANIA.
hair
;
319
dark complexion ; small blue eyes small head ; low forehead short and meagre person. She is very feverish; pulse quick Present symptoms. and small head extremely hot countenance wild pupils
;
contracted.
offensive language,
and makes
Cathartic
Blister to the
morning.
head; to be kept open.
Blister healed.
A%ig. 1.
Uses the
Sept. 27.
much
better,
and
is
last
resides.
is
letter
much
better,
and
enabled to gain
own maintenance.
CASE
Jane Young.
January
8,
X.
1816.
;
of sanguine tem-
Bowels
constipated;
tongue
white;
pulse quick;
:
com-
plains
forehead
talks rationally at
limes.
Treatment.
Ftb. 12.
same
state.
Takes the
powders prescribed.
Shower bath every second morning.
*
320
March
19.
CASES OF
She
is
;
considerably better.
bowels open.
Calomel. 9ss.
ft.
M.
Capt. 2. omni nocte.
pills
Massa
j^pril 28.
Continues the
:
appetite good
she
is
free
rational.
June 15.
Discharged as cured.
CASE
XI.
29, 1816.
market woman, aged forty-three years, the mother of a family ; of melancholic temperament, tall and stout ; of industrious habits, but rather addicted to intemperance.
this time,
remained sane three years. Her present attack have been occasioned by domestic troubles.
Present state.
is
said to
Natural functions.
tremely offensive
Treatment.
;
much
contracted.
Head
R
Calomel,
back
part.
Pulv. Jalap,
gr.
xxv.
gr. v.
gr.
ij.
Tart. Antimon.
ft.
M.
Sept. 12.
No
Arter.
Temp,
Ibj.
24.
Countenance assumes a
milder aspect.
Not
so talkative.
Bowels regular.
Continue.
ENTERIC MANIA.
Oct. 12.
Is Is
321
maniacnl symptoms.
apparently convalescent.
No
is
Nov.
Dec.
4.
employed as a nurse
Discharged cured.
May
2,
1819.
ceded by intemperance.
Present
feeble
:
Her pulse is noisy and incoherent. no increased heat on the scalp. Tongue white.
state.
She
Eyes suffused.
gr.
ij.
M.
gr. v.
Pulv.
4,
Pulv. Antiraon.
Extr. Hyoscyam.
g. x. o. n.
More
tranquil
answers questions.
fetid.
13.
Stools dark
and
Magnes. Carbon.
Pulv. Rhei, 3ss.
Aq. Menth. P.
Capt. cochl.
15.
ij.
^viij.
M.
all
tertia
qu&que hor&.
her medicines, and have an
to
omit
Pulse feeble.
restless nights.
Omit
Hirud.
viij.
ad Caput.
c.
Postea
*
R Haust. Cath.
in the
Antim. Tart.
AflPusio frigida.
21.
Much
same
state.
way
3xij. of blood.
322
25.
Relieved.
ENTERIC MANIA.
Ordered to have
bitter infusion 3ij. ter indies,
woman.
Observations.
In
head was
evidently connected with a disordered state of the intestinal canal; evinced not only
by
mucous membrane.
HEPATIC EPILEPSY.
323
CHAPTER
VIII.
EPILEPTIC AND MANIACAL CASES, CONNECTED WITH DISEASE IN THE LIVER, AND OTHER ABDOMINAL VISCERA.
SECTION
I.
S^c.
That
epileptic
fits
stomach and
intestinal
The dependance
a subject
fact is
The former
train
common
we
find
of our observaadmitit
no
difficulty in
ting
it
the
latter
is
no
dis-
we should not be
happened
in
to
me
epilepsy,
which,
liver,
were discernible:
and
disorder of the
viscera, if they
same
32;4
nervous system.
commenced a
abdominal
viscera,
had
also
been
It has likewise
happened that
first
epileptic
fits
time,
in
From
there
is
these observations
it
which
of the
and a diseased
and other large viscera of the abdomen*. I shall now add the details of a case which
first
drew
my
CASE
Sarah Avery,
fair
r.
girl of slender
make, middle
stature,
my
extensive disease
pancreas,
spleen,
stomach, and
mesentery,
is
Edinburgh Medical
which
have
do not remember
to
seen this
attended
symptom mentioned by any medical author, but I once a patient, who laboured several months under symp-
On
and
in the
HEPATIC DISEASE.
325
been labouring four months under severe epileptic fits; which of late have attacked her very frequently she has sometimes ten or twelve fits in a day. She seldom passes
:
or, if she
escapes by day,
the
fit is
is
While
violently convulsed
afterwards affected
and stupor. She was troubled with dyspeptic symptoms; a great degree of flatulence and on examining I found that she suffered great pain when a slight pressure was made on Her pulse was frequent. the right hypochondre. She had lately been taking doses of Cinchona and
in the head,
:
Flores Zinci
creased.
me
a suspicion
perhaps of the
Her
and
down by
syphilis^
which she had been subjected for the cure of it. She had been released about two months She had not enjoyed good before from a salivation.
by the treatment
to
health,
At
which
this
for which,
I
time (June 1812) she laboured under jaundice ; and for the symptoms accompanying it, (of
On
this
in the
325
was subject to
I
now
She complained of great pain, on hypochondre but as the fits were very severe, and scarcely gave her any respite, the head seemed to be the part to which it was requisite, in the first
attack, July 4, 1816.
Six Jeeches were directed to be applied to the temples. A blister to the nape of the neck. R Pil. Cath, 2. omni nocte.
Mist. Salin. 4ta. quaque hoi-a.
She
artery.
feeble.
lost
She remained
for
faint.
Pulse extremely
of blood.
18.
The
fits
since the
Let her omit the wine, and take occasionally Peppermint water, and two Cathartic Pills every night.
Leeches to be applied occasionally to the temples, and a kept open on the nape of the neck.
24.
sure.
blister
Her head
She
is
is
much
on pres-
much
hypoch. dextro.
R Pulv.
Syrup
Repet.
Rhei,
aa gr. x.
Magnes. Carbon,
Tinct.Zingib.aa3J.
at
ft.
Aq. Menth.
haust.
cum
flatus argeat
sumend.
25.
Bowels
relieved.
R Pilul. Hydrarg.
Aug. 12.
Side
still
painful.
slight
fits
of
HEPATIC DISEASE.
327
stupor and headache. Venae Sect, fluant Jxvj. Hirud. 12. postea ad hypoch. dext.
Hirud. postea ad terapora.
R Pil.
From
this
Hyd.
et Extr. Coloc.
Co.
2. bis indies.
of her disorder.
Sept. 30.
She has
lately
It is
now
Appears
Discharged cured.
Observations.
this case,
combination of symptoms during both the periods when she was under my care, and the
after its termination, the
I felt little
or
no doubt that the primary affection was a disease of the liver ; and that the disordered state of the brain, of which the epileptic fits were symptoms, was consequent and dependent upon the former. It may, however, be remarked
here,
as
in
it
disorder.
cases,
nervous fabrick.
not in
my
power
but the
328
CASE
Anne Hulse.
II.
May
18, 1818.
Of meagre unhealthy aspect, aged sixty-four years. She has been twenty years afflicted with epileptic fits.
She has
often several
fits
in a
day.
in the left
She took
some time
pills,
Oxyd
and
these were laid aside for an emulsion, containing the RecUnder the use of the latter her tified Oil of Turpentine.
fits
became
less
frequent.
She passed an
fit.
interval
of
fit
of epilepsy, she
chilliness,
commencing
at
The
The fits of genuine epilepsy its symptoms. were nearly removed, and in their place was substituted a kind of rigor, with stupor ; which was soon dispelled by rousing her, and making her walk up and down the ward. The turpentine was discontinued in consequence of her
disease, or of
becoming
stituted.
subtried,
The
from the idea of her labouring under some disease of the liver, or larger abdominal organs. On the 8th of October she was attacked by diarrhoea;
under which, in spite of all efforts to relieve her, she sunk, and expired on the 9th of November, 1818. The dissection of her
interesting
appearances.
Dissection of
Skull thin
;
Ai^^E HvLSE,
in several places.
No
bleeding points.
HEPATIC DISEASE.
329
Between
observed.
The
vessels
of these
membranes were,
in
firm.
The substance of the cerebrum and cerebellum was The internal carotid arteries were ossified, where
vessels running on
The
down
the me-
This appearance extended downwards along nearly the whole course of the
dulla spinalis, were minutely injected.
dorsal channel. On the surface of the medulla was observed about half an ounce of a red glary gell^Mike substance. The pleura pulmonalis was completely adThorax.
itself
The heart was healthy. Effusion into the cavity. Abdomen, Liver. The substance, on cutting
into
it,
appeared
diseased.
Some
small
its
texture.
Observatio?is.
disease,
In this case the traces of inflammatory and the consequent disorganization, were plainly disin various parts
covered
of the encephalon.
It is
remarkable
circum-
and
this
sympthe
fits in this
case, (I
mean
may
lead, in other
some
The
little
330
examined
aflfections
of the
but some observations have of late been recorded, which render it very probable that the source of
nervous system
disease
of
may often be traced in this quarter. The instance Anne Hulse coincides with, and tends to confirm, the remarks of Dr. Esquirol, who has described eight cases of
epilepsy, in which disease was discovered in the medullary substance of the spinal marrow. In three of these cases the
medullary substance was of a brownish colour, and softened about the tenth, eleventh, and twelfth dorsal vertebrae.
In other instances there was a similar change of structure lumbar extremity, and the vessels of the meninges were highly injected in various parts of the spinal sheath.
at the
The
view to establish a
in
new
Ten
epileptics
had died
the
Salpetriere
between the
1st of February and the 1st of June. Nine of the bodies were opened ; and in seven of these diseased
spinal
marrow, or
its
In the case of
Anne Hulse,
The
As
had no
* In one of these cases the meninges were injected: in two, the arachnoid coat of the spinal marrow was greyish; and in one studded
with osseous points
:
in one, hydatids
were fount!
in the sac
formed by
the spinal sheath, from the bulb of the brain to the lumbar extremity of
the rachis.
translation
is
to be
The paper contains several interesting remarks some observations, tending to confirm the conjecture, which I offered in a foregoing chapter, that when death takes place during an epileptic paroxysm, it is frequently caused by asphyxia.
Repository, p. 432.
are
among which
HEPATIC DISEASE.
^31
was
the cause,
its
CASE
John Bennet, upwards
III.
He was then in a raving state, and was confined in a pen. In a short time the maniacal symptoms subsided, and he recovered his usual degree of tranquillity. He is of moderate stature, rather slender, of uncommonly dark and brown skin, for an European ; very black He has been subject to eyes, and black straight hair. epileptic fits, which return sometimes every two or three days ; at others he is free from them for a longer interval. Several fits generally follow each other in succession ; and
when
they are very severe, leave
before the
fits
him
he
in a
is
maniacal
state.
Often,
violent.
come
pills,
on,
He was
ordered to take
keep the
to
He
began with
d.
May, he caught a
severe
and was attacked by inflammation of his lungs; which was subdued by moderate bleeding, blistering, and common remedies.
purgative
pills
The
after these
symptoms
1813, his
bled
fits
and maniacal
symptoms were
artery,
violent.
in
He was
and once
He
of these
state.
His
still
recurred
339,
The
appli-
and of the
blue
pill,
When
they
In June, 1817j his disease was very severe, and his general
health greatly impaired.
all the
functions
He was
Cath. 3.
alt.
noct. and
to
his
No
perceptible
I
benefit
was derived.
the
chopped straw.
directed
purgatives to
seton
was
July 7.
He
felt
himself better.
fits.
24.
Is
Aug. 20.
containing
Sept. 2.
bile.
Little, if
any, amendment.
four days
his
30.
agitated
For the
last
by epileptic attacks.
relief.
without
On
the 30th
he expired.
It
the
more severe
they were.
his
Previous to the
fit
countenance appeared
it
bloated,
cast.
sallow;
assumed a yellowish
The
tendinous expansion of
pericranium.
The cranium adhered firmly to the dura The dura mater was much thickened
the effect of disease.
It
mater.
evidently from
HEPATIC DISEASE.
333
When the dura mater was cut away, the cerebrum appeared partially covered with flakes of an opaque white substance, which appeared to be coagulable lymph, effused
from the
vessels of the tunica arachnoides.
The
vessels
on the surface of the cerebrum were injected with blood ; and the substance of that organ seemed of a harder consistence than natural.
The
ventricles of the
fluid
than natural.
soft,
it.
and adhered firmly and extensively to the pleura. A great part of it was covered with a very dense membrane, About four ounces as hard and as thick as the cutis vera. of fluid were found in the right cavity. Cavity of the abdomen The liver was enlarged, and
the right lobe diseased.
The
blood.
spleen
diseased;
appeared
filled
with grumous
The
empty.
hepatitis, con-
CASE
Elizabeth Button.
IV,
girl,
plexion.
Her abdomen
much
enlarged
she
is
been able
She had
worms
She
in her evacuations.
fell
down suddenly
insensible,
334
and lay as
Similar
She is somewhat convulsed in her fits, foams at the mouth, and is afterwards troubled with severe pain of the head. She has also complained of severe pain and tenderness in the right hypochondre.
R Calomel, gr. v. h^c nocte sumend. R Emuls. Terebinth, ^ss. ter indies.
Low
5.
diet.
freely,
when
made on
there seems to be
Ten
afterwards a blister-
Calomel,
9.
gr.
iij.
ter indies.
She has
it.
been
considerably
purged
by
the
Calomel.
Omit
10.
now
relieved.
She makes no
complaint.
tumid.
o. n.
manb
quotidie.
this
14.
after-
An
appearance of
clear fluid.
V. S. statim ad Jxij. Let her hair be cut short, and her head sponged, when hot,
with cold water.
Antimon. Tart.
Postea
Pil.
gr.
ij.
statim.
Cath.
3. et
HEPATIC DISEASE.
17.
335
after the bleeding.
Head somewhat
fits
;
relieved,
immediately
I
to
No
by the purging which followed one dose of mixture, and she took no more of them.
and
Has
light.
still
vertigo.
Pulse of the
Dislikes the
water.
19.
Head
vertigo ceased,
and she has now no complaint of her head. She sleeps well in Tongue general, but is sometimes annoyed by agitating dreams.
clean.
Bowels moved
20.
Sept.
Has continued
the
mixture regularly.
Is
now
Made an
27.
out-patient.
flatulence,
and tumid
state
of a cold taken.
She
is
going
Observations.
In
this case I
not absolutely
beyond
doubt.
It
ushered in the
fits, which did not recur after the measures adopted for removing it.
336
CASE
Anne Holvey,
Of
florid
jst.
V.
October 28, iS19.
twenty-six.
complexion.
fits.
When
she
came
first
mention of any
such.
made no symptoms of
could
Had
Menstruation regular
Fiat
Veiiffi
in general
Nov.
6.
Much
benefited
re-
side;
mouth
sore.
Has
foot
It
went
off
rose along the thigh to the trunk, and, reaching her head, she
fell
down
in a state of insensibility
and convulsion.
The
left
leg
had no pain
The same
She stopped
a third time.
from
rising to her
On
before,
fits
had two; but was never similarly affected before or since that
time.
Nov. 13.
Is
quite
is
much
troubled
and
bowels.
No symptoms
what-
Cath.
o. n.
and
She made no further application for relief at the Infirmary, it is to be presumed that she had no occasion for it.
HEPATIC DISEASE.
The
following
is
337
I insert on account of
CASE
Sarah Reynolds,
aet.
VI.
July 31, 180.
twenty-seven.
woman
complains of severe
it. Rather more than a week ago she began to be troubled with fits, which seize her only when she is walking her sight suddenly becomes obscured, and she falls to the ground, with
:
but
immediately recovers
rather
full.
is
:
herself.
Her pulse
is
regular, and
She
bilious
viz.
with headache.
appetite, and
Has
She has
lost
her
Cannot
lie
hepatic region.
Episp. Nuchffi.
Pulv. Feb.
o. 6. h.
August 26.
afford blood.
Six leeches
were applied
of her
to the temples,
Bowels open.
Cath.
Cath.
3. bis die.
c.
M.
M. M.
Rheo.
aa.
bis die.
Has been
is
was here
lately
last,
of
She has
caught
and
now
headache, the
to lose sixteen
of catarrh,
ounces of blood.
SECTION
II.
the Liver,
The
liver,
on the
in the
abdomen, pre-
of maniacal disorders.
spirits
upon
insanity.
But I
apprehend that
all
on
this subject
may
fail
could scarcely
to
were
conjoined
with
the
desponding condition of
to.
mind I have
indeed,
just
adverted
These symptoms,
when
there
is,
in fact, nothing
more
HEPATIC DISEASE.
$39,
and a disposition
to
constipation or a
mucous diarrhoea. I believe that I have been more than once deceived by similar appearances, and have imagined hepatic disease to exist when there has been no such thing. There is, however, a much more firmly established malady
sometimes existing in the viscera of the abdomen, in persons labouring under maniacal disorders. On this
subject very
little
was known
late,
anatomists were of
it.
in
attempting
establish
a similar
In his valuable
cited,
work on comatose
the authority of
the
diseases,
on
to
House of
is
correct,
fully
lects
to establish
than either
my own
whose works I
" Mr. Todd, an accurate anatomist," says Dr. Cheyne, states, " that
am
acquainted.
made
after idiotism,
and
mental derangement, {aiid he has made upwards of four hundred,) he has found the liver more or less
diseased.
He
generally
is
no more bulky,
340
Liatural adhesions,
peritoneum."
no other anatomist has ever been so successful as Mr. Todd in discovering mirforrnhj the cause of madness in the hypochondria though many,
I
believe
been diligent
in searching for
it
in the
same
quarter.
1 have, however, no design, by this remark, to discredit the assertion of Mr. Todd, or of Dr. Cheyne
and
in
the liver
existed, in
many of the
;
gentleman
am somewhat
it
number of
instances in which
out
of the four
hundred
not,
dissections,
the
morbid
slight,
unequivocal
my own
observation
and
numerous
with
liver,
or other large
viscera,
been
discovered
I must,
in
conjunction
maniacal disorders.
some peculiar disadvantages, which it on this occasion to detail. I subjoin some abridged notes of
lunatic,
is
unnecessary
the case of a
who was
several years
under
my
:
care
in
He
mental
HEPATIC DISEASE.
341
seemed
troubles.
Dissection, as
it
will
be noticed, displayed
liver,
and
form
his
own judgment on
George Batt,
bruary 26, 1815.
A
light
tall
fair
two.
his
He
a married
man, by
trade a hatter.
Some of
with madness.
He
good tempered and moderate in his habits : Bears great enmity at intervals talks quite rationally. towards his family, particularly his wife and children. (In
in general
it
the sequel
woman
of loose
Present sijmptoms.
upon
his mind).
pupils contracted
tongue white
:
bowels costive
very restless.
Treattnent.
he
is
Head
Not
to
be shaved.
blister to
be applied to
it.
March
1.
sufficiently
purged:
still
irritable
and
violent.
R Puiv.
Head
14.
Jalap. 3ss.
gr. v.
gr.
iij.
Calomel,
Antim. Tart.
M.
Statira suraend.
again to be shaved.
April
4:.
Mane
342
May
31.
sang. Jxvj.
Nuch.
June 12.
Under
to
be discharged.
while living in
violently
if
Happening, however,
separation from him,
had
summary vengeance,
some
He was
detained in the
August
but
viscera:
12.
The symptoms
belly
is
swelled,
scanty:
thirst
troublesome:
his
and
and stands
He
which
symptoms
improved
He
gradually acquired an
Dec. 12.
He
often
his
intellects.
symptoms
Squills.
When
way
symptoms, typhus
attack
house.
the
7th,
The
commenced on
near the
the 5th,
while
sitting
fire,
he suddenly expired, no
Dissection.
Head. On the removal of the skull bleeding points were observed over the surface of the dura mater; which
HEPATIC
DISJEAS-E.
343
mation had existed^at different periods. The skull was not so deeply furrowed by the marks of
the vessels as
it is
Dura
mater.
The
the
mem-
Between
serous
disease.
fluid,
and
the
latter
Both on
lymph.
The
vessels of the
its
sub-
The
The
ventricles
:
serous fluid
substance of the
its
In general
all
Thorax.
Lungs
healthy, but
extensively and
firmly
at the
heart appeared to have been inflamed it adhered apex to the pericardium. Liver was generally enlarged, and its right Abdomen.
The
Spleen diseased
its
The
tines,
omentum, displayed no
ap-
pearance.
344
Observations.
HEPATIC MANIA.
This
man
larger
severe
malady of the
during his
abdominal viscera
as
it
was
evident,
life,
and, after and other symptoms of dropsy more manifest by dissection particularly There by the diseased state of the liver and spleen. were also unequivocal marks of chronic inflammation in
his
belly,
death,
still
the encephalon.
Which
secondarily?
The
history of this
this
particular case
;
would
inquiry
we
to
is
by no means
blished, that
we must conclude
in this instance.
Vexation and
distress of
mind seem
to
be
by hereditary conformation,
345
CHAPTER
IX.
CASES OF CEREBRAL DISEASE, GIVING RISE TO THE PH.ENOMENA OF MANIA OR EPILEPSY; OCCASIONED BY THE DIRECT OPERATION OF
SECTION
I.
Preliminary/ Reinarks.
Having
epilepsy,
we come now
to
mention
by the
which
arise
The noxious
In the
first
this depart-
ment mechanical
both to epileptic
injuries
have given
rise
to maniacal attacks.
Secondly
disease
A
their
variety
of physical
effect
agents
induce
by
immediate
on the nervous
:
system.
the habit of
dram-
346
drinking
All these
Thirdly;
Violent emotions,
passions,
long con-
therefore,
necessary
:
to
divide
the present
the
first
of which compre-
hends what
arising
is
and the
SECTION
IL
to
the
The
encephalon
is
skull,
which
is
one
of the most obvious consequences of severe injuries, are so diversified, that it would be nothing more than
we have reason
to expect, if
it
Many
TRAUMATIC
CASES.
is
347
one of the
this class.
Dr. Bateman
I
fall.
have notes of
some by a
is
no
not occasionally
so produced.
As
there
is
in
few examples.
fell
The
St.
following case
under
my
1
observation in
Thomas's Hospital,
in
November
I.
804.
CASE
Trusty Halsted, a negro sailor^ aged twenty years. He is a slave; and about four years ago his owner, or
his
some other white man, in a fit of anger, struck a blow on head with a hammer. The extent of the mischief
became
subject to epileptic
fits,
He
was admitted
into
the
Hospital as a patient of
blister,
and per-
mixture.
The head being examined, it appeared probable that some injury of the skull had been the consequence of the
blow received; and accordingly the operation of trepanning was performed. A piece of the cranium being removed, a fragment of the interior table was found to
348
TRAUMATIC EPILEPSY.
An
as
epileptic
fit
took
place
same
disorder assailed
long as he remained
in the Hospital,
He
owner, and obliged to go to sea before the wound was healed. It is probable that some considerable disorganiz;ition
in
the
encephalon, bj
perhaps, by the
compression, and,
in
may be
ascribed
it
In the following
can-^
CASE
Rees Williams,
11.
who was
in
good
health
he received a blow on From that his head by a ship mast, which fell upon him. time he has been subject to epileptic fits, which seize him
a
\'ear
ago, when
sometimes
a well
he has
several in
the
course of a day.
From
grounded suspicion of some depression of the skull, the scalp has been divided, and the cranium carefully examined, when no lesion of the bone could be discovered.
^Vhile the
but
it
returned
wound was open the disorder was relieved, when the incision had become cicatrized.
made
in
I saw him not again until the latter end of October, 1820, when he was brought into a medical ward in the Infirmary, after having been for some time in the house in consequence of aj^
TRAUMATIC MANIA.
accident.
349
preceding
He was
just in
the
same
stale as in the
year.
According
to his
own account
his disorder
was
were given.
After these measures the intervals between his
fits
much
prolonged.
as long as
possible, without
endangering his
effect
life;
and,
if this
attempt
failed, to
have
tried the
ward, his
my
CASE
William Harris.
III.
1,
J
May
818.
A man
lie
of intemperate habits
he fell from a scaffold and injured his head since that time he has complained of giddiness and headache his bowels During the last eighteen months are generally costive.
his disease has gained ground.
He is now
quite maniacal
He
be
is
at the wrist
He
can hardly His countenance expresses wildness and anxiety. His bowels h: e been confined for very abusive.
arteries
The temporal
seven days.
Warm
baih immediately.
gr.
viij.
R
R
R
Submur. H_yd.
in a bolus,
to
be taken
immediately.
in the evening.)
Calomel,
gr.
ij.
Antim. Tartar,
gr. j.
M.
350
4.
CASES OF
He
has been freely purged
:
he was
much more
quiet after
Is
now
V.
AfFusio tepida.
Hyoscyami,
5. 6.
Is tranquil since his
7.
8.
Tranquil.
Bowels not open since the evening of the 6th. Repeat the Powder of Calomel and Tartarized Antimony every 3d hour, until it purges him.
Constipated.
Is
p.
more
tranquil.
Pulse reduced in
fre-
quency.
Scalp hot.
Capill.
Abrad.
Enema
n.
R
In
Calomel,
Cambogis,
Pil.
gr.
ij.
statim sumenda.
Bain. Calid.
10.
fetid stools.
In a sinking
state.
and dry.
He
is
insensible.
He was
11.
and a
Slept
wine.
after
some hours
Skin
;
Is
tranquil.
more
natural.
moist.
He
in
is
conscious
Complains of pain
on pressure.
the right
hypochondrium, which
increased
Tongue
dry, dark,
and tremulous.
aa gr.
iij,
Cordial Mixture
Animon.
ppt. 9ij.
TRAUMATIC MANIA.
Repeat warm bath. Empl. Lytta; hypoch.
dextro.
351
Wine
3ii.
twice to-day.
left side
of the
13.
Pulse feeble.
He
is
sensible
and
tranquil.
His mouth
Blister
affected
by the mercury.
on the
Aromati
Wine, &c.
He
Hours
after Death.
to adhere strongly
On
removing the
;
skull,
it
was found
longitudinal sinus.
blood.
brum
firm.
liver
The
was of natural
full
size
much
indurated.
Gall bladder
of
bile.
with
effused blood.
CASE
Peter Wessel,
Sept. 20, 1816.
IV.
at
admitted
St.
Peter*s
Hospital,
tall
temperament, who has been twenty years in the British About eight months ago he received a violent service.
taken to an hospital
which fractured his skull. He was in Jamaica, where he was cured of his wounds, but it was observed that he talked at times He complained of a dull obtuse pain of the incoherently. head, particularly during a hot sunny day, when he whole
blow on
his
head,
3S^
was obliged
to
TRAUMATIC MANIA.
go below deck and keep himself quiet.
At
except ascending the mast, which he could not attempt without great danger of falling. He behaved tolerably
well during the
in
to
He
:
is
in the
habit of drink-
Tongue white
:
bowels confined
pupils
and contracted head tender, when pressed, particularly about the forehead. (The injury received was on Extremely noisy and violent; it the side and back part.)
difficulty that eight or nine
was with
men
could bring
him
forehead with
pain.
gives
him much
Treatment.
Head
Blood
shaved.
Temporal artery
divided,
and
Sept. 25.
much
inflamed.
Still
very noisy.
this
case.
The
relief;
and maniacal
symptoms recurred, and in May, 1817> he sunk under an attack The body was carried out of the Hospital without of diarrhoea*.
being examined.
Observations.
We
much
regret that
Respecting the treatment of cases of epilepsy, or of mania, proceeding from injuries, little need be said.
used,
if
In other respects I
will
fall
may
what
SECTION
III.
Cases of Cerebral Disease giving rise to Epileptic, or Maniacal Phenomena, occasioned by physical Agents, which
act directly on the
These
in
cases
to
may
relation
them.
1.
Disease in
the
brain,
its
whether consisting in
effects,
in tumours, or
rise to
changes of structure, which are not manifestly connected with a scrofulous constitution.
3.
the aliment;
as
poisons,
occasionally as
One
A A
of these
is
mercury ; a
354!
some
by
it.
and dangerous
disease.
Maniacal
affections
But a very frequent exciting cause of mania, which comes under this department, is the use of wine and Dram-drinking is a very common preardent spirits.
cursor of madness
4.
is
among people
Where the
articles,
but
full diet,
they become
affections are
some
disease.
Maniacal
External
;
heat
is
often
disease
effect
frequently hot
rooms
in
the
We
find
many
it is
persons
subject
to
mania,
who
themselves
from
the
stimulating
effect
of
returning warmth.
The
some of
355
CASE
Thomas Weston,
I.
out-patient,
man
who
he
is
constitutionally
and inclined to sleep. He has lately become of Within the last three months
he has been three times attacked by epileptic fits, which came on during his sleep, and continued about an hour at
each time.
inflamed.
Pulse
full,
Eyes
to
He
been
head.
I
afflicted
with
symptoms of determination
this
the
to
it,
he gained
his subsistence
shoulders.
He was
issue
in
each arm
pills
Nov.
4.
Head
relieved
by the bleeding
No
fits.
Pulse natural.
Continue Cathartics.
10.
Much
He
one arm.
Empl.
Lytt.
ad Nucham.
much from
Repeat
hagmorrhoids.
tlie Pills.
24.
He
1.
says he
is
Dec.
He
is
often
leg,
is
In other respects he
better.
Ven. Sec.
3S6
8.
sense of coldness
and numbness
is
in the thigh
pain
less
and moves
his
Pulse small.
29.
The
him
3j.
he
Mist. Cath. p.
r.
n.
Jan. 19.
He
is
drowsy and
lethargic.
Ven. Sec. fl. Jxvj. Empl. Lytt. ad femur. Continue Pulv. Feb. and Mist. Cath.
Feb. 8.
The pain
removed.
June 15.
good health.
still
affect the
posterior
He
is,
however,
when he
Bowels
rather constipated.
He
still
Emp.
Lytt.
ad Nucham.
Pills
and Mixture.
He came
cation.
3d of Jan. 1821,
feelings,
after
He was now
numbness
free
from
all
;
morbid
except some
relics of the
in his thigh
he applied.
He had no
Observations.
This
came
on.
The speedy
all
357
by the use of evacuants and drains, proves more may be done by the steady application of such means, even in inveterate cases, than is commonly
imagined.
CASE
Mary Grant.
II.
Jan. 3, 1814.
living in service.
:
A girl,
History/.
Shape
complexion
:
fair,
dark hair
high forehead
lively
and affectionate
other children.
disposition.
Her mother
She has been troubled with scrofulous affections. Her complaint began by a feverish disorder, under which she laboured about nine weeks it was followed by She was observed to a melancholy and pensive habit. spend much of her time in reading religious books, and attended a meeting of Calvinistic dissenters. Countenance very wild she is Present appearance. very mischievous, and fond of destroying her clothes.
'
Functions.
in the
Appetite
natural.
Tongue
clean,
except
morning.
Bowels open.
c.
Treaiment.
Feb. 12.
Mist. Cath.
quotidie.
March
18.
Is permitted to
go
out occasionally to
her friends.
May
place.
19, 1814.
Discharged cured.
Returned
to her
former
This patient was again admitted into the Hospital on June 21, 1817; where she remained till her death, which happened on the 30th of August, 1820.
On
this
fulous affections
showed
itself in
358
The
inflamed
she
was
symptoms.
When
these disorders
by pneumonic became a little relieved, was aggravated. She generally sat and her eyes fixed downwards.
18'20 she suffered much from and disorder of the stomach.
the neck,
in spite of all
General debility and exhaustion followed ; and increased, attempts to relieve her by tonic medicines
irritable,
thick.
Dura mater
pia mater.
The membrane
itself
thickened.
The
sinuses.
longitudinal
sinus
contained
firm
coagulum,
lateral
The
Abdomen.
There was
no mark of disease
The
vessels of
Cerebral inflammation,
of the
life.
alternating with
:
scrofulous inflammation
absorbent glands
the
The unwholsome
unfavourable to
359
CASE
William Rogers,
III.
4,
admitted Aug.
1818.
A
pale,
man, aged forty years, of melancholic temperament, swarthy, of diseased countenance: he has worked at
a floor-cloth manufactory.
Some time
ago, in consequence
of domestic
labourers
length,
to
affairs
addicted to dram-drinking.
he became He was observed by his fellowbe for some days very dejected, and, at
of an untoward nature,
to
made an attempt
Present symptoms.
In the evening.
cum Antim.
Pulse 120.
Scalp
hot
is
He
imagines that he
to
Haust. Purgans.
5.
soft.
Tongue
furred.
Pulse 80,
He
Slept well.
clean.
Bowels relaxed.
130,
full.
Tongue
Pulse
V.
Headache
forehead.
S. et fl. sang, ad Syncopen. Empl. Lytt. Nuchae admov.
From
this
On
discharged as an out-patient.
This
man was
He was
the
by mercurials, which produced ptyalism. He was discharged on the 19th of August following.
^60
Observations.
In
This
this case
is
inflammatory.
indicated
CASE
IV.
9, I819.
A woman
the
first
This
is
appearance of insanity.
She has enjoyed pretty good health until about two She has sufyears ago, when she had an epileptic fit. spirits. fered much from distress; and latterly drank About a fortnight ago she complained of headache, and soon after she was observed to talk incoherently. Her
bowels have been constipated.
At
and the
sixty in
Her tongue
is
clean
number.
Treatment.
Capilli abrad.
Calomel,
gr. v.
Aloes, gr. v.
Sapon.
ft.
gr.
iij.
Pil.
iij.
statim sumend.
vj.
Vespere.
Hirud.
relaxed.
is
She
slept
a httle:
lation unequal.
Hyd.
laxant. gr. x. 0. n.
Jss.
Magnes. Sulphat.
mane
quotidie.
Middle
11.
Irritable
diet.
and
talkative.
Pills
Continue the
Pulv. Ipecac.
361
Improved.
Continue.
19.
Countenance
and
cold.
distressed.
Eyes
suffused.
Pain
in
her
Tongue
clean.
Bowels open.
Skin
Pulse
rapid,
small,
and
hardly per-
Warm
in the
dose of
23. Hor. 4 P.
M.
After a
visit
;
much
affected
she
ab opus
sit.
8P.M.
blood
was taken
sunk on the
friends
and a
She appeared a
little
relieved, but
could be examined.
Observations.
epilepsy,
This
in the
the
symptoms described
It
at the
woman's
doubted
and subsequently.
days of her
by deplehave been the fact, though it was not ascertained by dissection. These facts tend to illustrate the nature of that morbid state of the brain which gives rise to mania.
pretty clearly indicate this to
CASE
V.
years, of
Betsy Bishop, admitted March 7, 1814. A short and stout woman, aged twenty-nine
swarthy complexion, dark eyes, black hair;
position.
lively dis-
a prostitute,
362
Present
She
is
very noisy
uses the
most ob-
scene language.
Treatment.
VeiiEe Sect.
fluant jxvj.
blister.
April
1.
unconfined.
May
12.
is
oppressed.
June l6.
Discharged cured.
of this patient affirms that her complaint has been
The mother
slight as to be
on by dram-drinking: sometimes
it
is
so
CASE
Samuel Riche,
VI.
4,
admitted July
1814.
tall
his
he has been
in
three
months.
and
It
Two
of
his relatives,
on
were affected
Present symptoms.
fur;
in a similar
manner.
a dark
brown
countenance
Twenty
He
unable
to
363
gruel,
as
it
was
bosvels
freely
purged
takes
thin
panada, &cc.
to the temples.
Frequent spong-
and water.
pupils dilated
]S.
He
his stools
unperceived.
little
are
more
increased
since
yesterday.
21.
Is able to sit
up
in
Complains of
Aug. 12.
better;
talks
the ward
appetite considerably
Infus. Gent.
Takes a mixture of
Comp., and
Sept. 3.
Nov. 24.
Oct. 4,
I816.
by
SECTION
IV.
last Section.
The
arising
from
the effect of morbid causes, which act immediately on the brain and nervous system, is much more
simple, and founded on
that which
is
364;
now
the head
constitution in general.
In a great majority of
action in the head
state
is
of the
is
constitution
general.
in
is
The
arterial
action
vessels
somewhat stronger
;
proportion
in
the
of the head
but
it
every where.
Heat,
thirst,
costiveness,
and other
symptoms of
Such
are the effects which ensue from over stimulation, by the use of ardent spirits or other exciting causes.
the other hand,
as
On
morbid determinations
to the head,
the
habit
the
latter case
same
Thus,
in
cases
resembling that of
Mary Grant,
would be preposterous
curative indications
or antiphlogistic treatment.
The
here are,
first,
The
first
fulfilled
by
frequent change of
diet,
are
among
the
means
At
the
same time great care must be taken to promote on this account the
:
may
In the
employment of leeches, blisters, cupping-glasses, may and particularly the more permanent be requisite method of obtaining relief by a seton in the neck, or by issues in the arms. The latter, though not a topical remedy, is frequently efficacious on another
:
principle.
But where,
as
it
much more
frequently happens,
is
in
harmony with
where there
is
full
it
is
necessary to
Bleeding from
the
glasses
and
the
quantity
be
taken
must be governed by circumstances, and the repetition of the measure by the effect produced by
the
first
attempt.
mel.
sions,
Blistering the
may be
cumstances.
Most
by
these measures.
means must be adopted, with greater caution, and in a way that admits of their use being continued for
a longer time.
The
Thomas Weston,
;
and
work
I shall
equally decisive*.
* Numberless cases are recorded by medical writers of the
benefit accruing from the use of issues
and setons
in diseases of
I shall call to
the
remembrance of
my
which appear
by
setons.
to afford
One was
who was
in
affected
by chorea,
fall
he was subject
right side, and
to irregular to
chiefly
on the
three weeks,"
;
says Dr. B. " the boy has been unable to leave his bed
peevish and irritable
as if from
blisters,
;
has been
and
sudden pain.
purgatives,
Bleeding from
afforded
the
temporal artery,
relief;
and
no material
but
he
recovered
gradual
"
girl,
was reduced
a
:
state
bordering upon
by frequent
attacks of epilepsy
little
The measures
her intellects
the drivelling
367
SECTION
Of
V.
Nertous Diseases, resulting from the Operation of Mental Emotions. Cases of Madness from Superstitious Terror, and other Passions.
Strong
it
is
efFect,
:
as
is
well
this
The same
her countenance,
free
and the
from epilepsy,
and
remedy,
related
by Dr. Mead.
and decisive as to the efficacy of this " A girl of five years old, of
violent
plethoric habit,
difficulty saved
Mead
says,
"
at
the full
moon
seized with
a violent
fit:
after
which the
She
disease kept
its
always lay speechless during the whole time offood, and recovered
!!
The
father,
river,
who
lived
by the Thames'
side,
and
business
upon the
it,
with
which
illness,) broke,
returning no more,
an
issue to the
neck
in the
arm.
The
patient,
woman's
estate,
Mead's
Works,
p.
180.
368
sometimes give
in a
From
these,
and other
common
observations,
we might be
occasionally excite
much
nervous system.
Such
is,
Every
vehe-
of hysteria, or of
The
ment ravings of
commonly
in this
species
their efforts on the passions of their audience. Such phaenomena have, on many occasions, been multiplied by the influence of sympathy, as the history of a
But the phaenomena of convulsive diseases arising from mental emotions, are more interesting in pathology
than
with
respect
to
practice.
sudden
paroxysm of
habitual,
immediate cause of
of this kind become
an epileptic attack
but
when
fits
we have reason
occasional causes
tion
and
it is
to
must be
at the
BY MENTAL EMOTIONS.
The moral
history of
369
in
madness
is
more important
make on
mental
causes,
The
that
this
species of agency.
The
the
fact
is,
than
the
causes
of his
malady.
Every insane
and
sion,
person has
some
false
impressions,
less
his hallucinations
engender more or
to be
of pas-
morbid emotion.
lunatic,
its
life,
bowels or
if
liver
had performed
talk wildly
their
proper actions, or
he had not
will
He
day-dream
this
supposed by those
370
MANIA PRODUCED
will
This consideration
much
the
number of maniacal
Still
to
moral causes.
passion
may
We
brain
somewhat
the phy-
is
of reverie
action
to
modes of
The
same
influence of a strong
the
presented
the
If the brain
is
into those
modes of
this
cerebral,
In
conversion that
abdominal
viscera*.
Yet
this
Gard Luke.
BY MENTAL EMOTIONS.
of blood to the brain, which
is
371
a concomitant circum-
mind
who who
by circumstances are withdrawn from the active pursuits of life, little acted upon by external impressions,
to the influence of
mental
Of
is
none
This
When
and
in
its
most violent and sudden, it is termed this form it is, of all passions, the most
powerful in
When
it
in its operation,
:
is
its
effects
on the
many
instances,
The
is
seems to be so necessary
common
to
many, perhaps
animated creatures.
birds,
* "
Haud
ignara et non
incauta futuri."
Common
notions
deny
and represent
the
them
to
end
which
moved by
the
mind and
to
They
are
now
still
generally allowed
be possessed
of sensibility;
but we
37^
THEORY OF MADNESS
especially observe
we
But
the
effects
of this principle.
there
is
this peculiarity in
human
species,
bounded by no
Even
death, which
the experience of our senses presents to every one as the " ultima linea rerum," has never been with the
senerality of men, in
of their
anxious
expectations.
endeavoured in vain to
respect.
make them
is
The
propensity
it
by circumstances; and
may hence be
concluded,
man.
by the
after
The dread
experience of
the
barrier
is
of future
is
evils,
which
in
the present
scene of existence
held in
some
restraint
realities,
passed.
hang over the path which the human imagination has marked out to its view through the regions of futurity. Hence death becomes the king of terrors not by the
;
rise to in
human
creatures.
in
their habits
to
and modes of
the
phsenomena arising
short, as Descartes
a celebrated
passage,
the
terrible.
373
of the
human mind.
:
The
this life
cheerful
sist
may
tions
rall}?^
which
remark
is
well
we need only
refer, in
to the superstitious
by surveying the
mankind
displays,
principles
of
human
fol-
and,
among
bias
and expatiating at
large,
we
are enabled
The
passage
" To die to sleep " To sleep perchance to dream. Ay, there's the rub; " For in that sleep of death what dreams may come, " When we have shuffled off this mortal coil, " Must give us pause. There 's the respect " That makes calamity of so long life.
:
" Who would fardels bear, " To grunt and sweat under a weary life, " But that the dread of something after death, " The undiscover'd country, from whose bourn " No traveller returns, puzzles the will; " And makes us rather bear those ills we have, " Than fly to others that we know not of.'' " Thus conscience does make cowards of us all."
374
to discover
affections.
THEORY OF MADNESS
what are
its
It
is
a very striking
fact,
all
the forms of
mythology the representations which prevailed respecting the fate of the dead were
full
apprehension of
fictions
evil.
Even among
whose
by the graces of
was a theme of
of the dead was a
sorrowful expectation.
The abode
Its
scene of horror
cheerless
or,
and
prospect.
situation
in
subterranean
caverns,
could
fix
The
very
names of
And among
we
are,
their
some instances, but imperfectly acquainted with modes of thinking, we discover proofs enough
and external practices of
to convince us
similar feelings
expiation,
and
ideas.
the
slaughtering
of
and
yells,
to
have
what
of
is
the
evils
ence
in
There seems
to
it
no
375
why
The
solution of
problem appears
men
in all ages.
With
this is intimately
connected
whose
tribunal
will,
be arraigned*.
necessarily called in to
Here conjure up
whose
office it is to inflict
punishment
in the invisible
life.
of the present
Hence
As
and
these
in the history of
actions,
we may
it
principles
human
their
nature
but
moral philo-
them
to
source
am
If
it
fear, rather
than
It
wit-
M.
dc Voltaire, who, in
376
to hope,
THEORY OF MADNESS
respecting the future state, and to indulge
and
ness.
is
human mind, we
gain
one step
mad-
It will
sentations
from which
it
originates.
Still it
cannot be questioned
madness must be
more or
less influenced
future state,
We
are
not sufficiendy acquainted with the domestic history of the ancients to determine,
by any authentic
evi-
among them
but
we need not
hesitate
tions,
jaws of a crocodile, or
with
frequent instances
furnace,
emotion,
Even
Agamemnon, who
many a
if
religious lunatic
and yet
it
human
nature
is
heathens
of antiquity
have
from
377
reli-
And,
accompanied, as
we know from
It must,
Whether
to decide. to
enter,
this arises
On
themes of
are
more favourable
the
to the
In
the
Romish church
facility
of
obtaining absolution,
are well fitted
to
alarmed conscience.
On
is
dogma
eternal damnation,
to
excite terror
and
dismay
in the
such a persuasion.
am
convinced, by
my own
must be allowed
style
in
that
much
less
or
professed
tenets,
on the
or
modes
of representation
any par-
there
is
vehemence
378
THEORY OF MADNESS
:
of declamation
that
and
it
facts
we
madness
is
now com-
paratively rare
among
this
those
who adhere
to the catholic
ordinances.
But
among them
harangues, a
terrific
and impassioned
During
this kind
have occurred in
catholic countries.
description,
have before
me
which happened
in the
kingdom of Naples
in
I
1812.
The circumstances
omit
'
cannot
to insert
it.
In order to
animate the
powerful an
faith of believers,
on weak minds.
Thus they hold their hands whip themselves with scourges, garnished
until the
with iron points, &c.: and, where these means are not sufficient,
&c.
The
"
One
am
about to
describe.
The
subject was
HELL:
and
it,
'
If
thou
art
in
thou art in
hell, curse,
&c. &c.'
the lady
He
then cast
it
system of
who was
The case which follows may be read in the London Medical Repository. It was reported
I\Iedicale d'Emulation, of Paris,
the
Soci^te
to
by M. Berthollet, Physician
the Forces.
379
of excitement, hand, in
On
the
other
Reformed church has been long Scotland and the Dutch provinces,
for
mode
of preaching,
re-
markable.
And
a similar observation
may
be applied
to those sects
which approximate
this
in doctrine to the
reformed
striking
wfe
remark some particular and exceptions must be made and it is here that
:
but to
find
religious
insanity
which occur
country*
church
is
has never abounded in that species of oratory which graced with trophies of
After
all,
this description.
neous,
if
we do not bear
the
mind
state
disposition in
physical
of the brain
the above
is
necessary condition, in
order
that
men-
may
a
only
Superstition
is
indeed
:
itself
is
is
it
when its influence is exerted on a nervous system, weak by organization, that the disorder in the corporeal
organs, which constitutes insanity,
is
produced.
We
fearful
may
exist,
its
victim
through
life,
without giving
Many
curious
facts,
relating
to
the
subject
of religious
by Dr. Burrows,
to Insanity,"
in his recent
I
work,
to
&c. to which
beg
380
CONCOMITANT CIRCUMSTANCES
in
have often
with
the
circumstances
connected
sensations
When
spirits,
this habit
amounts
to nothing
apprehension
of terrible
diseases
and dejection of
termed
hypochondriasis.
itself,
When
who have
under the
Other groundless
individuals
to
fears are
sometimes observed
:
in
a singular degree
as
when men of
Such a habit
great
opulence
imbecility of
mind
or
it
some
notion
Next
cially
and apprehension,
in the pursuit
grief,
and espe-
disappointment
of wealth, in this
hazardous
pursuits,
are
most
rors
frecjuent
of the revolution
partly,
grief,
as
it
should
seem,
occasioned by domestic
and partly
in
381
effect of emotions,
is
will often
con-
This may,
effect
of the distemper of
much more
it
to be regarde<^l
as a contributing cause
is
on
all
accounts, however,
which seemed
SECTION VL
Treatment and Examples.
Respecting
whose disease
tions,
emo-
in treatises
practitioner.
which are
in the
is
Nothing that
litde
new can be
said
on
this
subject.
Indeed
properly said
common
sense
and discretion
stances.
in
to
every individual,
in particular in-
The
cruel
some establishments, to the disgrace of our nation, must have owed their origin to carelessness and indif-
382
CASES OF MADNESS
any mistaken ideas
;
since
it is
from
At
least, if
set
ment of
lunatics,
practitioners, has
origin in motives
which are
easily
traced, and
common
in their operation.
The medical
class
down
at
25, 1816.
woman, aged
forty-two years, of
About
whom she lived two years, and had one child. Her husband went abroad, and three years afterwards she was informed that he died in America. Some time afterwards she married an elderly man, by whom she had six children.
About
a fortnight ago, to her great astonishment, her
first
husband made his appearance. From that time she has been in a state of derangement. Slie was never before
so
affected,
in
tendency
Present
state.
She
is
she cannot
383
it
Eyes inflamed.
high coloured.
Treatment.
Tongue
furred.
blistered.
30.
that
it
Is less noisy,
is
slightly
morning.
natural.
Continue.
Dec.
faculties.
14.
Continues
gradually
improving
in
her
mental
Continue.
Jan.
1,
1817.
Appears
to be quite rational.
June 14.
Discharged cured.
Observations.
In
this instance
the
exciting
circum-
Thomas Wintle,
no hereditary tendency
mania
in his family.
religion
entertains violent
Pulse
100
in
much
contracted.
Pain
in the
forehead.
Bowels constipated.
384
Treatment.
Back
to
be dressed
Oct. 12.
Discharged cured.
still
Some
complained occasionally of
lowness of
PARTIAL CONVULSION.
385
CHAPTER
X.
Cases
of the head,
more or
less
severe,
sometimes occur,
;
affinity to epilepsy
or
coming up
to the description of
it.
It is
not
The
partial nature of
the disorder
plaint I
is
The com-
now
it
refer to,
may
be regarded as an imperfect
or partial epilepsy.
epilepsy,
not
one half of the muscular system, and scarcely passing over the median line and the affection of the per:
ceptive
attacks,
faculty,
and of consciousness,
in
epileptic
;
was observed
indeed,
to be in various degrees
combut
monly,
amounting
to
absolute
coma,
sometimes only
There
vulsion,
is
which I suppose,
be
allied,
in
a certain
manner, to epilepsy;
which
It consists in a
sudden
vertigo,
which comes on
c c
at uncertain
and
386
This disorder
is
produced, as I beUeve,
to epileptic
and
this
But of
The
am now
considering
is
characterised by
convulsion, of a
more
in epilepsy.
The
cases.
best
way of setting
adduce one, on the authority of Dr. Pitcairne, and his contemporary, Dr. Mead, and then relate two or three similar cases which have
I shall first
fallen
under
my own
observation.
thirty years old,
haemorrhage from the nose, " complained," says Dr. Mead, " of some humour suddenly arising from his
right
hand
felt
and then
fell
senseless
fit,
on the ground.
stir his fingers,
Upon
and
his recovery
from the
he
could not
arm was
vio-
his will,
which time he
author informs
twice in a year
had
altered
its
character
viz.
OR PARTIAL EPILEPSY.
from the
first
;
387
him
;
of his senses
that
is,
for
The
the left
arm
he could
still
but
when
it
had got up
motion
afterwards,
upon
its
arm began,
Sometimes the
numbness occurred without the convulsive agitation following the memory was remarkably affected about
:
first
commenced
\vith
was confined
one arm.
The
convulsion I
am now
attempting to distinguish.
The
among
the out-
Hugh Bray,
admitted
Dec
23, 1816.
who
has
been of
of his
much
left
arm.
comes on by
is,
fits
:
his
it
arm
is
violently
a minute or two
afterwards feels
benumbed, and he
ing
it.
mov-
The
disorder
388
Pulv. Cathart.
says he
is
28.
He
much
better: he has
the
fit.
The complaint
in
his
arm
is
quite gone; he
omni nocte.
c.
T.
Scillse.
Oxymel.
15.
Scill.
Syrup. Opii,
part. eq. p.
r.
n.
Cough continues:
chest oppressed.
Ven. Sec. fl. Jxvj. Empl. Lytt. ad Stern. Repet. csetera med.
Feb. 1.
Discharged cured.
He
From
disorder,
may be presumed
was
the
had
its
seat in the
intestinal canal.
The
some
following case
respects.
It
is
is
remarkable as affording an
example of those
which
thirty-two years,
who
Two
ago he was suddenly seized with a jerking, or tossing which continued about an hour, and
;
About
OR PARTIAL EPILEPSY.
lysis seized
389
same arm, and continued about half an hour; during which time he was completely blind in the These symptoms, like those of the former right eye.
the
attack, were but temporary.
to
occasional
of vertigo,
own
account, so that he
He was
of existence.
the
and remained, during four days, scarcely conscious If he attempts to walk or move quickly,
and giddiness
is
sense of faintness
almost insupwhite.
portable.
Tongue
Throat
Jooks reddened.
Cupping glasses to the nape of the neck and shoulders. Empl. Lytt. ad nucham postea.
Pil.
Cath.
o. n.
Emuls. Tereb.
Sept. 1.
ter indies.
Much
if
relieved.
Repeat medicines.
8.
Vertigo,
he walks
fast.
otherwise well.
15.
Nearly as before.
V.S.
Pil.
fl.Jxvj.
o. n.
Catb.
Emuls. Terebinth.
29.
Cupping
to
be repeated.
aa. jj.
3j. ter indies.
R Infus. Calumb.,
Aq. Menth.
Sp.
Pil.
Ammon. Co.
Cath.
o. n,
Oct.Z.
scarified
Much
part,
relieved;
is
the
which
twice as
much
as before.
He
can now
390
The
seat
essential
of convulsive action.
twelve.
;
Mabell Hookings,
sBt.
A
The
girl
of pale complexion
subject to
fits
of violent hiccup.
fit generally comes on three or four times in the day and night, and continues from ten minutes to an hour. She knows when it is coming on by a pain in the epigastric region, and a sensation of nausea: sometimes the globus hystericus accompanies the attack. After it has lasted some time, it occasionally excites sneezing and gaping. After these symptoms have ceased, a headache commonly follows. These fits occur during sleep as well as by day.
The
first
during
She now complains of soreness when the epigastrium is Tongue clean. Appetite, &c. natural. Abdopressed.
men
tumid.
R
9.
Emuls.
fe
which have
minutes, but have not been so violent since she has taken the
medicine.
11.
epigastrium tender.
Two
each.
12.
ing,
fit
No
fit
On
Ifc
fit;
likewise
entirely
on the l6th.
The bowels
The
OR PARTIAL EPILEPSY.
tumour of
23.
the
391
fits
The
feels
have of late
for a
week, and
much
better.
Continue emulsion.
29.
No
fit
for
two weeks.
Continue.
Full diet.
Juli/ 3.
No
return.
Discharged cured.
The symptoms
duced by
that any
patients
:
in the
a resemblance to those which are occasionally prointestinal worms but I could not discover worms were evacuated by either of these and I believe that all the symptoms which
;
from the
irritation
of long
retained
feculent
canal which
is
produced by constipation.
to epilepsy, that
The
I think
as imperfect attempts
from genuine
modifications.
Whether
all
occasionally, under
somewhat
different circumstances,
modes of
have
not
it
left
arm, and
arisen
left side
In
392
Stupor,
of power in
the
lower extremities
a severe headache.
The
patient has
issue in
every morning.
OF CONVULSIVE TREMOR.
393
CHAPTER
XI.
OF CONVULSIVE TREMOR.
In
which
fits
of rigor, or
of the
usual
epileptic
paroxysm.
This was
eftect
of remedies,
severity.
It
is
of tremor
my
who
laboured under a
attacks of this
disease,
occasional
description,
was so
and accom-
These
and
and smoke with a profuse transpiration the head is sometimes affected with vertigo and stupor,
hot,
violent pain.
it
subsides spontaneously,
and
is
noticed by medical
S94
authors.
CASES OF
Tulpius.
plexion,
recorded by
of pale com-
was
;
afflicted,
which did
accompanied by a hoarseness and suppression of voice. And Sauvages has copied from Bonetus an account
of a disease, to which he gives the term of tremor
vertiginosus.
The symptoms
:
what
and
I have described
which came on
in
paroxysms.
;
But
this
and a circumstance
M'as
It
said
in
that,
found
with a sharp
mouth and
The
fell
under
my
observa-
affords a characteristic
John Pugh,
set. fort3'-five.
March
1,
1820.
meagre habit, low stature, dark hair. About a month ago he complained of cynanche tonsillaris soon after be was affected in his chest: his symptoniis were considered as asthmatical his bowels were consticarpenter, of
:
pated.
He
some
time, of headache,
On
by a violent tremor, which continued two or three hours, and then went off, after he had taken an emetic. It
recurred again on the following day at the
CONVULSIVE TREMOR.
on every succeeding day about the same hour.
labouring under a paroxysm.
395
He
is
now
looking at this man I should have supposed be under a severe rigor of intermittent fever ; but, on a closer inspection, his affection appeared very different. The whole muscles of the upper extremities, including
On
first
him
to
ribs, clavicle
The
lower
The man
perfectly con-
to answer any question distinctly. His and appears to be irregular; but it is very difficult to feel it on account of the constant agitation of the tendons. The skin is warm, and he does not appear to have any sensation of chilliness. The upper part of the body is in a state of profuse perspiration, and smokes. He complains of vertigo and headache. I ordered him to be bled, and a large orifice was made in the arm, from whence the blood flowed in a full stream. Thirty-eight ounces, avoirdupoise, had flowed, before syncope came on. When about half the quantity had flowed, the tremor became more general, and the convulsive jerking motion now occupied the glutei, which threw him up from his seat, with the action of a man sitting on a trotting horse. As soon as he became sick and fainting, the arm was tied up, and he was laid upon a bed the tremor immediately ceased, except some slight and partial qui-
and able
quick,
pulse
is
vering.
He
was ordered,
Pulv. Cath. 3ss. statim. Mist. Cath. 4. qq. h.
Pil.
5.
11 A.
M. Return
Cold
of the tremor.
affusion.
The
He became
afterwards hot.
396
9.
CASES OF
No
Subm.
gr. v. o. n.
Magnes. Sulphat.
o. in.
H.
11.
Salin. 4. hor.
six
twenty minutes.
He
fell into
a state of
debility.
April \\.
Appetite
fails.
c.
Coughs and
Acido Sulph.
spits
much.
Dec. Cinchon.
Pil.
ter indies.
Cath.
o. n.
o.
Mist. Aper.
m.
Has, however, a
he
May
12.
came on
after
bleeding.
On
account of
this
is
now
ill
the
surgery ward.
The
were
combined
with
stupor
and dehrium.
to febrile rigor,
The
and
disorder had
more resemblance
he has
been
in the
About
was seized with rigors, attended with by heats, headache, and wandering pain in his limbs. These symptoms ushered in a state of stupor and delirium during which his countenance became distorted, the eyes rolled, the muscles of the face were slightly convulsed, and the body generally agitated. After a time all these appearances subsided, and he became
coldness, and followed
;
seemed
a lillle stupid,
as
if
roused
CONVUJ^SIVE TKEMOIl.
from a sleep.
307
The
He
has
to the Hospital
He
body
is is
rolls his
head about,
arteries beat
and
his
generally agitated.
the
The temporal
is
rapidly
flushed
;
and forcibly:
tongue a
little
scalp
hot;
the
feet
cold
face
furred.
Let
his
his feet
immersed
Calomel.
Pulv. Antim.
cum
aa gr.
iij.
soluta fuerit.
12.
freely:
Mane.
Is
and
Head aches
V.
:
at times, but
is
Syncope followed
blood slightly
buft'y
crassamentum lax.
Twelve leeches and a blister to the right hypochondre. Calomel gr. v. cum Haust. Cath. 6ta. qu^. hor&.
Low
diet.
to
Cold water
Has had two returns of the rigor, followed by the Vesp. symptoms before described, but of shorter duration. Paroxysms shorter and more frequent: if he is roused 14.
from his stupor, they
are, in
off.
After this time he was freely purged, occasionally bled from the
to the
head.
The
the
fits.
The
On
for eight
days
he
then began to take two grains of Argent. Nitrat. three times in the
On
state,
liver.
398
I
cASESj kc.
or rigor, like
with
spasm, occurring
of paralysis.
who had
suffered
tendency
to stupor,
With
it
must be conducted on the same principles as that of epileptic, and other convulsive disorders. The measures to be pursued in particular cases
must depend
on the disordered function from which the morbid phsenomena arise in most instances, I believe, it will
:
is
symptomatic of
intestinal
and
gastric
functions.
I attended a lady
some time
ago, in
whose case
this disorder
appeared
of the catamenia.
years,
to
it
several
when
the
paroxysm seized
her,
as
to
occasion
apprehension of imminent
danger.
In cases
of this description,
be
no reason
is
which
found to be most
cases, perhaps
uterine epilepsy.
Those
from
means recommended in the chapter on enteric epilepsy; particularly by stimulating cathartics, joined or with the use of bitters, aromatics, and alkalines
;
and other remedies of a similar description; care being taken, at the same
to relieve congestion in the head.
&C.
399
CHAPTER
XII.
OF SOMNAMBULISM, OR ECSTASIS.
SECTION
I.
Sleep-walking.
The
stories
of sleep-walkers
related as matters of
mere
curiosity,
and as displaying
sleep, rather
them
as
interesting facts
in
physiology;
far as I
know, the
first
have had any clear insight into the nature of somnambulism. He was not possessed
to
who appears
in illustration
of
it,
Darwin was
led,
by
on the nature of
for
reverie
and
have
This conjecture,
else,
it
appears
to
been
nothing
by recent
observations, which
seem
to prove that
somnambulism
400
in
many
I
is
But before
it
necessary to make some phaenomena of ordinary sleep-walking. remarks on the Somnambulism appears to be a morbid modifition
of this subject,
cation
of ordinary dreaming.
We
have before
re-
But a
fit
of somnambulism
its
is
pre-
in fact, a
dream so modified,
is
somnambulism
fact,
to that of ordinary
dreaming,
after they
is
proved by the
that sleep-walkers,
ushered in the
remembered
lated
their adventures,
re-
them
not,
somnambulism It is, has been noticed by Sylvius and Hoffmann. however, by no means an uniform occurrence, and it will therefore be proper to adduce some particular
This circumstance
in the history of
hominibus som-
nambulorum affectum
tium
se soniniasse loco citato.
Sylvii, Prax.
Med,
OF ORDINARY SLEEP-WALKING.
example.
401
The
stius, aftbrds
a striking instance
who were
his
bed
in the
He
took a cloak,
movements. After some time he lighted on a nest of magpies, which he tore in pieces; and having wrapped up the young birds in his cloak, went down again into his chamber by the same way through which he had gone out of it. Then, after walking about for some time, he returned to his bed, and placed his cloak by his side, with the young birds in it. In the morning he awoke, in his usual way, and began to talk to his brothers, and observed, after a time, that he had had a singular dream. He then related to them circumstantially his adventure on the roof of the castle; upon which they laughed at him, and, opening his cloak, showed him, to his great surprise, They told him what the young birds wrapped up in it.
had occurred, but he could not be
believe them, until they led
persuaded fully to
him up
An
incident occurred
affords a curious
some years ago in this city, which example of somnambulation leaving an impresas in the instance recorded by Horstius.
sion on the
memory,
maid-servant,
who
some years since deceased, had risen early on a winter's morning, and was employed in washing, by candle-light, the entry of the
house,
who
D D
402
Incubus
which
of an
seems
bulism.
to be,
some
respects, similar
is
to
somnam-
In
incubus a person
conscious
which accompanies
is
awakens him.
As
the person
he generally remembers it: the somnambulist often returns to his bed and sleeps soundly, and the impression
is
obliterated.
is
Sometimes, however,
disturbed
in
if
a sleep-
walker
suddenly
the
midst of his
exertion,
he
is
a precarious
state of health,
coming down
stairs
let
The
;
her mistress pass, which the latter did with a hasty step, and
street
appearing, to the
terrified
imagination of
it.
without opening
The
came down
mother, and
stairs,
who
desired her to
conceal
it
from
their
anxiously
waited
for
her
appearance.
The
complained of having been disturbed by an alarming dream. She had dreamed that a dog had pursued her from her chamber
dovvn the staircase, and along the entry, and that she was obliged
to take refuge in the streets.
This
it,
recital
impression on those
who
heard
and
it
had appeared.
setting
this
apprehend that
as
no hesitation
in
down
I
an example
the
memory
I
awoke.
is
may
intimately
known
to
can vouch
OF ORDINARY SLEEP-WALKING.
403
somnambulism and incubus are similar affections. A young lady, who was some time under my care, was
formerly very subject to walk during her sleep
the succeeding
:
during
She had
and of very
her sleep.
She has been free from the tendency to somnambulism several years, but has since been
subject to incubus.
Her
feelings, after
fit
of incubus,
are precisely similar to those which she formerly experienced after somnambulation.
When we
bulism to
somnamit
the state
of sleep,
and
to
it
:
dreaming,
should attack
during
their
waking
hours
but
of this
and
we
shall
nambulation.
Sylvius supposes
somnambulism
intent,
to arise
from the
that all
its
is
near
to
the
account
ecstatic
lunatic,
street,
in.
head of an army of
soldiers, to
But
appre-
one circumstance
in the state
of
404
the sleep-walker,
differs
which
his
temporary condition
lunatic.
The
exercise of per-
ception
much
madman. The
but the sleep:
while he
is
intent
upon
his
phantasm
windows
if
he treads
it is
the consequence of
and of
Hoffmann
affection.
of a somnambulator, which
this
man who
on a journey, rose and put on his clothes, his shoes, and spurs; and then striding across the sill of an open window, began to kick his heels, and
to set out
if to excite his
horse to speed.
terrified
When
at
An
authentic instance
rose in his sleep,
to
me
of a
man who
saddled a horse,
but this
and actually proceeded on a journey; was what he was accustomed to do reguweek, in order to attend a market: here
larly every
Hoffmann likewise mentions the case of a sleep-walker, who got out of a window, and of anpressions.
other
who threw
which
is
aroused when a
OF ORDINARY SLEEP-WALKING.
particular voluntary
effort is
405
directed
to
it.
Many
during a paroxysm of
is
affection
on
some
sat
verses
which he
great
and opening
to
his
desk,
down with
and,
earnestness
renew
his
attempt;
at length,
seems
all
to
that
as usual in
somnambulism.
The
is
and
The
perceptive faculty
is
some;
so
no
possibility of
awakening or arousing
come
to
a close, he
lies
down
yet,
slumber f.
*
And
when
the
chain of internal
Hemic, ab Heer
I
in Observat.
Med.
p. 32. in
Hoffm.
1.
c.
somnambulism.
boy,
about
twelve years of age, used to rise in his bed during the early part
and
sit
with
his
No
effort to
awaken him was ever successful, lie down and become composed.
he would
406
movements prompts him to make the effort, he can exert this faculty upon any of the objects towards
which he may be
led to direct
it.
Among
for, like
the
causes
first
of
somnambulism
must be
reckoned, in the
another to
families*.
this
affection,
is
transmitted to certain
more frequently subject to it than females; and young persons, than those of middle
are
or advanced age.
Men
The
exciting cause
is
of the mind to
some object which it pursues with the same train of ideas recurs and is accompanied with the same ardour of In short, the same causes excite to som:
dreaming.
This analogy
is still
further extended
by
in
some
som-
nambulation.
The
is
history of
interesting,
number of curious
and incidents
but
it is
chiefly
some
consti-
subject
and
it
is
* I
have learned
this
fact
by personal inquiry.
know 3 The
same
assertion
is
made by Hoffmann.
OF ORDINARY SLEEP-WALKING.
these
particular
407
this
circumstances.
shall close
on which some
cases,
occurred in
in his
fit
my own
to
practice,
in
which a person,
during
of insensibility
impressions;
which
resembled that
of the sleep-walker.
the person
is
These
fits
suddenly terminate;
little
As
this
affection
parti-
cularly,
Where
seem
they
do not
to stand
in the place of
and
to
SECTION
II.
Of Ecstasis.
It
is
so near a relation
affections,
as
their
conversions
into
each
other,
and the
originate
similarity of circumstances
under which
they
seem
to
point out,
nomena of
little
40S
resemblance.
CASES
AND DESCRIPTION
affection
I
The
am now
about
to
them.
its
paroxysms resemble epileptic attacks at the same time the phcenomena, which display themselves during
the
fit,
my meaning
in this
remark,
T.
R
eyes,
and
delicate
constitution,
possessed
to be, for
some
in
and
in
One day
February,
1821, on going
out,,
soon after breakfast, with his school-mates, he suddenly exclaimed that somebody was beating him on
his
head
he staggered and
fell
his
companions led
him
The most
fol-
fits
were the
They
him nearly
free
from any appearance of disease. He was aware of the approach of the paroxysm, and used to say that
he perceived a mist, or darkness, before
his eyes,
fell
and
into
off.
He
then immediately
less uncoii-
OF ECSTASIS.
scious of external impressions.
409
During
this
fit
he
sometimes repeated
that
his
lessons,
evidently
fancying
On
those
gone through
fingers,
in
Sometimes he fancied
his
in his
himself playing on a
was
then
observed
the
movements of
if
fingers
he supposed himself
into
his
to
be playing
it.
hands
he would use
Occasionally he
would
call to
other boys,
whom
he fancied he heard
tell
Sometimes he seemed
after the ball.
When
;
he
came
and, though
his
arms and
was
arrested.
Once
or twice
he repeated a long^
him much.
it
His
father,
it,
heard
had
really
these conversations he
He
when
the
objects.
Yet he
when
by a voluntary exertion,
Thus,
flute, several
play to him, by
way of experi-
410
ment, and
it
CASES
AND DESCRIPTION
listened to
them.
If
break in upon
movement of
the
He
the paroxysm,
he was situated
its
commencement.
Once
or twice
he expressed wonder
not
During the
a strong
light.
intervals of the
fits
he was impatient of
He
to
He was
his
thought
was taken by
country
;
his
I
father
to
and
who
asi
has since
attended
him considered
his disorder
He
symptoms of a
maniacal description*.
*
I
Happening
to
be
summoned
to
the school,
heard of
it,
an accurate
OF ECSTASIS.
41
The symptoms with which this singular aflectioii commenced, in the first instance, and the mode in which the paroxysms recurred, the premonitory sensations which ushered them in, are all like the circumstances of epileptic
attacks.
The subsequent
fit itself,
oblifit,
is
a phae-
nomenon which
am now
considering with
many instances, been combined in the same individual, or may be said to have passed into each other. The fits of delirium
the fact that they have, in
to
subject,
may,
we
but
am now
is
adverting to
a kind
of paroxysm
which
of a more decided
character.
The
in
remarks.
was an instance of
with
epilepsy
:
ecstasis
occurring
conjunction
the
exciting
cause
appeared to be intestinal
irritation,
Robert Summers,
St. Peter's Hospital,
aged
11,
forty-six.
An
out-patient at
Feb.
1820.
A man
temperate
but sometimes
intoxicated
with beer.
412
he
fell
CyVSES
AND DESCRIPTION
down in an epileptic fit, and remained insensible some hours. About three months afterwards he had another fit. These attacks have, of late, recurred frefor
quently.
Present
state.
Countenance
;
head
is
at present cool,
:
feet generally
He
is
began
in the
down
He
it
appeared
he fancied himself to be working in his usual occupation. In this state he remained all the ensuing night,
da}'.
in
During
a natural
that time he
manner: he sometimes caught hold of a piece of bread, and having bitten it hastily, threw it down, and drank in the same way, immediately continuing his work. If he was spoken
to,
would reply
question,
person does
who
is
disturbed by a
when
in a reverie.
He
ness
:
this
long
slightest
four hours.
When
his
him speaking of
alluded
to.
OF ECSTASIS.
Me was
'
413
Epsom
still
salts in the
morning.
Bowels
and
feels
freely
purged;
Says he
is
lighter: has
forehead.
Twelve leeches
to the head.
A
15.
blister to the
Well purged;
says he
is
still
He
though not
state
of stupor
and
that
before
He
He
is
now
gives
it.
On
Saturday
last (this is
Monday) he had
time,
one
slight
fit.
Aug. 29-
This
man was
relieved,
for
the
from the
but he
is
still
fits.
An
attempt
has been
made
to
get
him
into
order to try
more advantageously
relieve
his
disorder,
but
Two
curious
and interesting
cases,
which also
the
ecstasis or
somnambulism
in
is
by Dr. Martinet,
following
The
an abstract
CASE
Massy,
I.
when
414
cumstance.
insensibility,
which continued three quarters of an hour. Soon afterwards a second attack occurred, and the paroxysms then returned every day for some weeks, and were brought on by any mental irritation; the duration of
the
fit
continually increasing.
was good.
He
and
in
the third
They ceased entirely until the nineteenth year of his age, when he became a somnambulist, working during the night
at his trade as a saddler, getting
to
Soon
fits
of epi-
commencing from
insensi-
He
much
astonished to find
:
himself,
one night, on the roof of the house, wet with rain the impression which he thence conceived, produced some time afterwards an attack of epilepsy, followed by contraction of his fingers
and
toes.
CASE
J.
11.
Beatrix, twenty-two
who
have never manifested any particular cerebral disorder, experienced, for the first time, after a fit of terror, complete loss of sensibility.
When
fourteen
watch-maker, he sought for a shoe-pbrush one day to clean His master, surprised, gave him a blow, a walch with it.
which occasioned,
second time, a
fit
of insensibility.
OF ECSTASIS.
415
Three months afterwards he became subject to fits of somnambulism, which recurred about every fifteen days. They commenced with a sense of heat, extending from
the
epigastrium
to
the
head,
followed by confusion of
During the
fits
his
in all the
which formed the subject of his usual occupation. On awakening he was much surprised to find his work ill a different state from that in which it had been before Sometimes, howthe commencement of the paroxysm. ever, he recalled the impressions which had presented themselves most forcibly. Between the age of twentyone and twenty-two he became subject to paroxysms of genuine epilepsy and since that time the fits of epilepsy and somnambulism have happened very frequently*.
;
or somnambulation,
siderably
resembles
;
the
case
above described
it
occurred
in
The
first
symptom was a
legs, like
sort of convulsive
movement
swimming
a reverie ensued,
during which the boy sang, and fancied himself hunting or jumping: the
fit
The
a
This account
is
somewhat abridged.
it
The reader
will find
complete translation of
in
the
forty-second
volume of ihe
I
416
CASES OF F.CSTASIS.
of sanguine temperament
it
was combined
came on soon after the period of The paroxysms began with vehement
gave place to a
fit
of
during
this
was proper
paroxysm
was accompanied
by the appearance of
inexpressible surprise.
SECTION
O/' the Pathology
III.
It appears
I
to
me sufficiently
con-
nected with epilepsy, and depend on a slight modification of the proximate cause of that disease.
state
The
of
the
brain,
which
gives
rise
to
epileptic
of walking reverie.
is
Whether
this last
more or
less
peculiar to epilepsy,
The
fits
PATHOLOGY OF
to be a
ECSTASIS.
417
of epilepsy themselves.
We
may
venture to lay
it
down
as
probable,
may
We
have, in
the case of
Summers, an instance
irritation.
The
state of the
by Darwin,
have been of
this description
but
it
seems very probable from the symptoms that accompanied the attack.
2.
When
this
disease
we have
it
to be connected with
The
liability to
variety
and
excite
pseudo-maniacal
dis-
orders,
which
be
known
to
to
would
enough
yet there
suspicion
and
although of cases,
we have
number
enough to confirm it. The female, mentioned by Darwin, was of the sanguine temperament; she was seized by her disease just
after the flow of the
catamenia
case,
my
Infirmary,
fits
of ecstasis arose
function
from a
uterus.
defect
the
periodical
of the
E E
418
PATHOLOGY OF
A
age,
girl
who
been subject to
fits
of a
She rises from her bed and walks about, and often sleep. makes violent efforts to go out of the house which she would do if not prevented by her friends. At these times
;
she
is
in a state
of great agitation
and
weep, nor
;
she distinctly
affected
she sometimes
her throat.
all
and She then gets up and walks about, without knowing whither she is going ; and after the fit ceases, she has no recollection of what has occurred during She is troubled with stupor, and a sense of oppression it.
similar affection sometimes occurs in the day,
is
while she
awake.
The catamenia have State of natural functions, S^c. been wanting during three or four months. When they appear they are very scanty this happened about a month
:
ago.
She has of
late suffered
much from
a violent pain,
in
in the
sacrum.
Pulse natural
number,
tumid.
fuller
than natural.
Abdomen
I
should have
As she was an
out-patient
it
to circumstances.
Mist. Cath.
Spir.
M. M.
c.
Rheo.
r.
Amraon.
Feet. 3j. p.
n.
ECSTASIS
Second Report.
AND SOMNAMBULATION.
3.
419
Sept.
Somewhat
relieved
Still
by the bleeding
and purging.
rather
gets
up and walks
Pulse 100,
better.
Tongue
rather white.
Appetite
much
Bowels opened
a day.
She
is
better.
Tongue
4tS,
clean.
Pilul. Cath. o. n.
Emuls. Terebinth.
p.
Is
quaque hori.
Tongue
clean.
Had
yesterday headache.
fits
by day.
fl.
sang. ^xvj.
l6.
Bowels not
sufficiently open.
Tongue
clean.
Strength increased.
Repet. Emuls.
Spir.
Ammon.
Foet. 3j.
when
the
symptoms of her
disorder appear.
30.
she has
Has
and
better since
lost blood.
of her disorder
are
still
wanting.
The
fits
When
the
fit
Empl.
Lyttae Nuchas.
Oct. 1.
Two
Vertigo relieved.
Sleeps better.
21.
Fits of
night;
and quick.
Seemed
420
PATHOLOGY OF
would not attend agan, which proved
to
be the case.
I
saw no more of
her.
A case of very
by Lorry,
vages.
who was
it
As
repeatedly into
which were unaccompanied by any during these paroxysms she would severe convulsion talk, and was accustomed to address herself to some one
whom
she conversed, at
first,
in
an obscure voice, but afterwards in a distinct and audible manner. She evidently perceived him, and observed all
his gestures, but all she said to
idea,
one appeared not to see or hear any other person, even if he exerted his voice to the utmost to make himself heard.
This fact," says Lorry, " I witnessed with the greatest astonishment ; but many other persons are living who can The mother of this female died unexpectedly ; attest it. after which the daughter used to hold conversations with her, as if she were present ; she would answer questions, as if interrogated by her mother; would entreat her to take care of her health, and recommend some physician, as more able to restore her than others: moreover
she would talk to her mother of her destined marriage, although it had already been some time completed, in
intent.
objections to
it,
replying to others,
ECSTASIS
AND SOMNAMBULATION.
:
421
and appeared to be revealing all her secret wishes in a word, she seemed perfectly collected and rational, excepting
the error respecting time,and the supposed presence of her
This woman had, in other respects, good health, but was afraid of the smallest noise, and was easily affected by any thing she saw or heard. At length she fell into a
mother.
first
all
left her."
The same
the foregoing,
except that
catalepsy.
it
M'as
complicated with
the
symptoms of
subject of
it, fell
during
which
If her finwrs o
until
extended,
their
or placed in a certain
position,
it
they
in
retained
was
changed
of the limb.
she lost
all
recollection
I think
that
affections,
;
may
but
I
also
am
not
in possession
With
plaint
com-
little
need be said.
It
is
made on
the ana-
422
TREATMENT OF
ECSTASIS.
When
the dis-
irritation,
or affection
it
down
in the sections
The
indications
and
the
to
cular
plethora,
with which
this
brain has
is
it
become
affected.
When
complaint
connected with
down
in the sectior
must be treated on
423
NOTE ON CHAPTER
XII.
The
my remark on the analogy between somnambulism, and certain forms of mania. I mean those cases in which the intensity of reverie is so great as to withdraw the attention of the lunatic from external objects, and employ him exclusively in those acts to which the course of his phantasy directs him. And this consideration throws an additional light on the nature of that deviation from the healthy state of the intellectual operations in which madness consists. The analogy I have alluded to is very curiously illustrated by some interesting facts, related in the first volume of the American Journal of Science, which has just come
ficiently
explained
ecstasis, or
to
my
As
this
work
1
may
not be in
some of
my
I
readers,
allude to.
CASE
Some
years ago a farmer, of
in an interior
I.
fair
character,
who
resided
England, sold his farm, with an intention of purchasing another in a different town. His mind was naturally of a melancholy cast. Shortly
in
town
New
he was induced to believe that he had sold it for less than its value. This persuasion brought on dissatisfaction, and eventually a considerable
degree of melancholy.
bours engaged him
to
and
rail fence,
which he was
commence making
went
the
next day.
At
424
and begun, with a beetle and wedges, to split the timber, out of which the posts and rails were to be prepared. On finishing this day's work, he put his beetle and wedges
and went home. Two of his sons had work through the day in a distant part of the same field. On his return, he directed them to get up early the next morning, to assist him in making the fence. In the
into a hollow tree,
been
at
when
his
mental powers
The
first
the return of his reason, was, whether his sons had brought
the beetle
and wedges?
He
appeared to be wholly
mencement of his delirium. His sons, apprehensive that any explanation might induce a return of his disease, simply replied, that they had been unable to find them. He immediately arose from his bed, went into the field, where he had been at work a number of years before, and found the wedges, and the rings of the beetle, where the beetle itself having mouldered he had left them away. During his dehrium his mind had not been occupied with those subjects with which it was conversant in
;
health.
CASE n.
Mrs. S
,
New
fine needle-work.
she
became suddenly
In
this
state,
years,
first
abatement of her disease, she continued for about seven when her reason was suddenly restored. One of the
questions which she asked, after her reason returned^
It is
of her delirium
425
as usually
occupied her
when
in health.
CASE
A
rium.
lady in
III.
New
paroxysms of deliThese paroxysms came on instantaneously, and (after continuing an indefinite time, went off as suddenly, It often happened leaving her mind perfectly rational. that when she was engaged in rational and interesting conversation, she would stop short in the midst of it, becQJme in a moment entirely delirious, and coramence'^ar'"
for a considerable period, subject to
conversation on
some other
the
re-
When
she
became
rational
would pursue the same conversation in which she had been engaged during the lucid interval, beginning where she had left off. To such a degree was this carried that she would complete an unfinished story, When her next or sentence, or even an unfinished word. delirious paroxysm came on she would continue the conversation which she had been pursuing in her preceding paroxysm; so that she appeared as a person might be supposed to do who had two souls, each occasionally
again,
she
doing:.
FIRST.
F F
APPENDIX.
For
the sake of brevity, I have generally used, in the foreIt
is
I shall by
The
doses
is
those
understood to be given in
grains
;
where no dose
specified.
draughts of Jiss.]
Pilulce Catharticce.
aa X.
Aloes Soc.
Pilul.
Fil.
aa. X.
Extr. Coloc. Simpl.-^Hydrarg. Submur. Scammon. 2 Dos. 3 omisso submuriate. Aperient. Quas Hydrarg. Extr. Coloc. Simplic. Hydrarg.
aa
x.
Pil.
suprk.,
Pil.
laxant.
Dos. 3
Pil.
Pulv. Cath.
Emulsio Terebinth.
Pulv. Febrif.
Pulv.
gr.
Jalap. 4 Hyd. Sub. Dos. before described. Dos. Pulv. Antim. Hyd. Subm. Laxans. Pulv. Rhei. Magnes. C^rb.
x.
x.
gr.
xxv.
5ss.
f^y
Dos.
aa.
^
gr. x.
aa. x.
x.
Dos.
XX.
Mist. Salina.
Tart. gr. |.
4,li
quaq, hora.
Mist. Salin. Ant.
Mist. Sal.
Mist.
T.
Potass, mutato.
Mist. Cathart.
Jalap.
5j.
Infus. Sennae c.
Magn. Sulph.
3ij.
et Tiuct.
Dos,
PRINTED BY
J.