heart-State of the pulse in incipient insanity-Sympathy between the lungs and brain-Post-mortem examination of the lungs of the insane-Exaltation Obscurity of the pathology of the brain-Cases illustrating the difficulties attend- ing the investigation of cerebral pathology-Opinions of celebrated authorities as to the proximate cause of insanity-Capillary congestion a cause of insanity -Apparently normal condition of the brain often observed after death from acute insanity-Disordered condition of the psychical co-ordinating principle a cause of insanity-Pathological phenomena of general paralysis-Softening of the brain and hemiplegia-Idiopathic ramollissement of the brain-Influence of deposits in the arteries upon the circulation-Diseased arteries a cause of apoplexy-Diagnosis of insanity-Affections with which insanity is liable to be confounded-Distinction between insanity and delirium-Diagnosis of cere- bral congestion-Distinction between insanity and cerebritis-Diagnosis be- tween meningitis and inflammation of the substance of the brain-Anæsthesia preceding cerebro-spinal disease-Incipient symptoms of general paralysis- Diagnosis between general paralysis and wasting palsy-Diagnosis of softening of the brain-Premonitory symptoms of acute and chronic softening-Cerebral abscesses and tumors-Importance of knowing the antecedents of patients— Diagnosis of cerebral cephalalgia-Importance of cephalalgia in a diagnostic point of view-Neuralgic and rheumatic cephalalgia-Nervous headache, and the cephalalgia symptomatic of tumors of the brain-Diagnosis between cere- bral and idiopathic sickness of the stomach-Treatment of incipient insanity- Duties of the physician-Depletion in insanity, its use and abuse-Caution to be exercised in the exhibition of purgatives-Use of hellebore by the ancients for the cure of insanity-Value of opium in the treatment of incipient insanity -Use of chloroform in cases of insanity-Isolation of the patient from his friends-Mr. Spurgeon's method of subduing evil thoughts-Necessity of self- control-Importance of early treatment of organic disease of the brain-Value of tonic treatment in incipient apoplexy and paralysis-Treatment of softening of the brain-Disease of the brain caused by mechanical injuries to the head- Injurious effects of blows upon the head-Importance of watching the state of the brain after injuries to the head-Various diseases of the brain preventable if treated in the early stage-Abscesses from blows upon the head-Course of treatment to be adopted after severe blows upon the head-Importance of the early detection of head symptoms-Treatment of cases of impaired in- telligence-Importance of a cultivation of the faculty of attention-Treatment of impairment and loss of memory-Treatment of the mind after an attack of insanity Susceptibility of the memory to improvement-Mental remedies for the improvement of memory-On the cultivation of the memory-Montaigne's loss of memory-On the advantages and disadvantages of a commonplace book-Impairment of memory the result of undue straining in early life-Im- portance of the careful cultivation of the memory-Excessive straining of the memory in schools-When does the intellect begin to decline?—The vital, not the intellectual, principle affected in old age-Celebrated men who have re- tained their intellectual powers to a great age, as exhibited in the lives of Che- rubini, Corneille, M. des Quensounnières, M. Leroy, Fontenelle, Voltaire, Richelieu, Mr. Waller, John Mapletoft, Titian, Benjamin West, R. Cumberland, Handel, Ben Jonson, Sir Isaac Newton, Locke, Dr. Johnson, Bacon, Chaucer, Sir E. Coke, Lord Eldon, Lord Kenyon, Lord Hardwicke, Lord Stowell, Boling- broke, and Lord Mansfield-Is great vigor of memory allied to defect of judg ment?-Great strength of memory combined with intellectual vigor, illustrated in the lives of Dr. Johnson, Edmund Burke, Clarendon, Gibbon, Locke, Arch- bishop Tillotson, Grotius, Pascal, Leibnitz, Euler, Muratori, Ben Jonson, The- mistocles, Cyrus, Hortensius, Niebuhr, Sir James Mackintosh, Dugald Stewart, Dr. Gregory, and Seneca-Kind treatment of the insane-Duties of the psycho- ON OBSCURE DISEASES OF THE BRAIN AND MIND. CHAPTER I. INTRODUCTION. THERE is not in the whole range of medical literature, ancient or modern, a passage that transcends in grandeur of conception, majesty of diction, and sublimity of truth, the exordium with which Hippocrates introduces to the reader his celebrated aphorisms: 1. Ο βίος βραχὺς (Life is short); 2. 'Η δὲ τέχνη μακρὴ (Art long); 3.0 de xatpòs ¿òs (The occasion fleeting); 4. 'H òè nɛípa σφαλερή (Experience fallacious); 5. Ἡ δὲ κρίσις χαλεπή (Judgment difficult). “'0 dè xaipò; dĘds." How important it is, to fully appreciate, when considering the treatment of the diseases of all vital structures, the practical significance of this great medical apophthegm. "The occasion fleeting!" Let this profoundly wise axiom ever be present to the mind, and engraven in imperishable materials, and in indestructible characters, upon the memory. If these "fleeting" moments of inestimable, incalculable, and precious value, are neglected or trifled with; if serious morbid states of brain are overlooked, or, if recognized, not immediately subjected to proper treatment, chronic, irreparable, and incurable organic alterations in its structure may be the result, succeeded, when it is too late to remedy the mischief, by the bitterness of self-accusation, or the unceasing lamentations and regrets of those who ought to have been the first to observe and attack the fatal disease! How often is the physician called upon to witness the melancholy consequences, to health of body and mind, life and reason, of a neglect of well-marked premonitory symptoms of cerebral disease! It is frequently his painful duty to hear both relatives and friends reproach themselves, when the time for action has, alas! passed away, for their criminal negligence in wilfully closing their eyes to the long-existing evidence of positive disease of the brain. The late Dr. Marshall Hall, when addressing himself to the consideration of head affections, remarks: "A useful work might be written on the subject of insidious and impending diseases, with the view of making their first or antecedent symptoms known to the public, and of thus suggesting the care and means necessary for their prevention." 1 No one was better qualified, by habits of thought, educational attainments, practical sagacity, and enlarged experience, to form a right estimate of the importance of an accurate acquaintance with the incipient symptoms of the diseases of the brain and nervous system, than this justly distinguished and accomplished physician. It was his painful province, in the course of a long and brilliant career, to witness the sad consequences of the non-recognition of the precursory or premonitory symptoms of those organic affections of the brain, for the relief of which his great skill and extensive knowledge was so often called into requisition. This able physiologist fully appreciated, that many of the fatal cases of brain disease with which he had to grapple formed so many sad illustrations of the neglect of premonitory symptoms. Upon investigating the history of the diseases of the encephalon, how frequently does the medical man discover that positive and unequivocal symptoms of brain affection have existed, and perhaps, during the early stage, been observed for months, and in some cases for years, without exciting any apprehension on the part of the patient, his family, or his friends! 1 "On Diagnosis," sect. iv. "Diseases of the Head." By Marshall Hall, M.D., NEGLECT OF INCIPIENT SYMPTOMS. 19 In the majority of these instances, clearly manifested head symptoms were entirely overlooked, and, if noticed, no right estimation was made of their value. My attention has been called to cases, in which serious mischief to the delicate structure of the brain and its investing membranes, has been thus allowed by the patient's friends to proceed uninterruptedly for years, no treatment being adopted to arrest the progress of the fatal disorganization! The brain, the most important, and exquisitely organized, of all the structures of the human body, "The Dome of Thought; the Palace of the Soul," the material instrument of the intelligence, the centre of sensation, the source of volition, is permitted to be in a state of positive disorder, in fact disease, without exciting any attention, until some frightfully urgent, alarming, and dangerous symptoms have been manifested, and then, and not till then, has the actual extent of the mischief been appreciated, the condition of the patient recognized, and advice obtained for his relief! Other deviations from organic conditions do not, as a general rule, meet with similar systematic neglect. In affections of the stomach, liver, bowels, lungs, and skin, &c., the first symptoms of approaching disease, or departure from a healthy condition of those organs, are observed, and the patient, without loss of time, seeks the aid of his physician. Under such circumstances, he does not hesitate to place himself under curative treatment; he feels no delicacy in describing his physical sensations; is not ashamed at being thought ill, and readily adopts the treatment suggested for his recovery. But when the brain is affected, and the patient is troubled with persistent headache, associated with some slight derangement of the intelligence, disorder of the sensibility, illusions of the senses, depression of spirits, loss of mental power, or modification of motility, his condition is, in many cases, entirely overlooked, or studiously ignored, as if such abnormal symptoms were signs of robust health, instead of being, as they undoubtedly are, indications of cerebral disorder, requiring the most grave and serious attention, prompt, energetic, and skilful treatment! It will be well to consider, briefly, the cause of the neglect to which the brain is subjected when under the influence of disease. It is a notion too commonly entertained, that many fatal cerebral diseases are suddenly developed affections, presenting no evidence of any antecedent encephalic organic change, and unaccompanied by a premonitory stage, or incipient symptoms. It is indeed natural that such an idea should be entertained, even by educated professional men, whose attention has not been specially directed to a study of this class of disease, or whose opportunities of watching the progress of such affections have been limited and circumscribed. A man, apparently in vigorous health, mixing daily with his family, going to his counting-house, engaging in the active pursuits of commerce, or occupying his attention in professional or literary duties, whilst stepping into his carriage, or when entertaining his friends at the festive board, falls down either at his door in a state of unconsciousness, or quietly bows his head on his plate at the dinner table and dies, surrounded by his family, in a fit of cerebral hemorrhage! A midwife, whilst sitting by the bed of a patient whom she is attending, suddenly exclaims, "I am gone," and immediately falls down in a state of apoplectic coma! A gentleman, during dinner, complains suddenly of giddiness and sickness. He retires to another room, where he is found a minute afterwards supporting himself by a bed-post, confused and pale. Being put to bed, he soon becomes comatose, and dies. A person in good health, after using rather violent exercise in the forenoon, returns home to dinner, and whilst sitting near the fire, without any warning starts up, pushes his chair backwards with violence, exclaiming, "Oh, my head!" Immediately afterwards he falls on the floor in a state of apoplectic insensibility. A literary man, whilst speaking at a public meeting, is suddenly seized with an uneasy sensation in his head. He says it feels "as if it would burst," "as if the brain was too big for the skull." He returns home, becomes apoplectic, and dies on the evening of that day. A clergyman, whilst preaching, is observed to stop, and put his hand to his head. He then attempts to proceed with his sermon, but talks indistinctly, and has evidently lost his recollection. He keeps himself from falling by grasping the side of the pulpit. He is immediately removed from the church, and is found cold, pale, |