Page images
PDF
EPUB

frequently beyond their strength, especially in hot weather, (circumstances which stimulate the vascular system,) are liable to this disorder-and contemplative habits, superstitious impressions, the effects of false representations of religion -all mental habits which render the impressions of reverei vivid, and withdraw the attention from objects of sensation and perception, tend to foster this disposition; yet all these might exist for many years, without producing a morbid effect, if the habitual resource, by which the constitution had relieved itself of a burthensome plethora, or of accumulating irritability, had not ceased to avail itself. We shall here abstract a case or two in illustration.

Case IV. Sarah A., ætat. 58. She is a fat short woman, of melancholic complexion, and strongly marked features. Her brother and sister had died maniacal, the former having committed suicide.

"She has, for several years, led a very solitary inactive life; kept a huckster's shop; used to read a great deal, and spend all her time alone. It seems that she was in the habit of indulging herself in eating and drinking.

"Pulse full. Bowels regular at the present time. Appetite good; rather voracious. She appears always cheeful, and struts about the ward.

[blocks in formation]

"Oct. 22. No material alteration. Seems to have been relieved by the shower bath, which she has used. Sleeps little; is garrulous. Pulse natural. Begs for a full diet."

210.

Full diet was accordingly allowed, with a cathartic twice a week, and the cold affusion. But the full diet aggravated the complaint, and rendered her more noisy and trouble. some. No medicine indeed produced any material alteration, but she was always worse after repletion.

After nearly two years' continuance of the disease, fever came on after taking a full meal of broth. She was bled and purged, and she seemed recovering. She was allowed porter and other stimulants, and four days afterwards expired.

Dissection. Calvaria heavy-vessels of the dura mater turgid-strong adhesions between the latter membrane and skull-a large piece of bony substance at the inner margin of the falx, near its origin, Vessels of the pia mater turgid -that membrane thickened and opake in patches-effusion of serous fluid beneath the pia mater-cerebral substance firm and hard-vessels of the medullary texture minutely Vol. III. No. 10.

2 P

injected-lateral ventricles distended with fluid-plexus choroides pale-vessels of the cerebellum loaded with blood.

What is usually termed religious madness, we have no doubt is generally a physical derangement acting on a mind disposed to religious contemplations, but perverting, of course, the emotions that would naturally rise in the mind of a sane and religious person. A case is related by Dr. Prichard at page 213 of his work, which strengthens this opinion.

Case V. Anne Howell, aged 53, of dark complexion, melancholic temperament, "an exquisite example of what is termed religious madness," lies in bed-has the most gloomy and dejected aspect-moans and complains in a tone of unvarying despair-sometimes utters the most frightful shricks and yells, so as to render confinement in the solitary apartment necessary-gives, on interrogation, the most pitiable account of her miseries, which she solemnly avers to be realities, and not the chimeras of the imagination.

"She believes that she is the object of the eternal wrath of an offended God, on account of her sins. At night she looks out of the window, and sees the gulf of hell yawning to receive her, and myriads of devils in the midst of fire and brimstone. Being 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 that her heart is hardened and dried up within her. She is as fully persuaded that she is eternally damned as she is of her existence.' 213.

On investigation it was found that the disease had made its first attack about the period when the catamenia cease; in consequence, it appeared, of hard labour, exposure, and over-exertion, while working in the open air carrying bark in a tanyard. After suddenly stooping to raise a heavy burden, she cried out that she was seized with a severe pain. in the back of her head and neck. When 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 much out of order, particularly the digestive organs-and pulse rather full. When first received into hospital, she underwent topical depletion and purging, in consequence of which, she was so much relieved that her husband had her removed home. She was re-admitted in

[ocr errors]

November, 1819; but from this time all remedial measures failed to afford any substantial relief. It was remarkable, however, that, at one time, dark-coloured patches appeared on her thighs, and subsequently on different parts of her body-she then became sane in mind. She is now (March 1821) much emaciated, with a strong pulsation in the lower part of the abdomen.

The sixth chapter is on the subject of metastasis to the brain, producing mania and epilepsy-the former disease being omitted in our first analytical article.* We touched on the subject of metastasis, however, in such a manner as will render it unnecessary to say much on that point in the present case. It may be remarked that, if mania be produced by metastasis to the head, it is also sometimes cured by the supervention of another diseased action in a part, or even in the whole of the system. Dr. Prichard relates three cases of mania cured by attacks of contagious fever during the late epidemics. In St. Peter's Hospital the lunatics are placed in the same wards with patients labouring under contagious fever-in consequence of which, our author had frequent opportunities of witnessing the effects of fever communicated to maniacs. The principles of treatment in these metastatic cases are detailed in our first analysis, page 138 et seq.

ENTERIC MANIA.

In the first volume of our quarterly series, No. 2, for October 1818, we gave an account of Dr. Edward Percival's excellent report on the connexion between maniacal affections and disordered states of the abdominal viscera. Dr. Prichard characterises Dr. Percival's paper as a truly graphical description of enteric mania. Dr. Prichard, however, differs in one point from Dr. Percival-he does not consider a depraved state of the intestinal canal as so very general a feature in maniacal affections as Dr. Percival, seems to view it. Still Dr. Prichard admits that "this is one of the most frequent forms under which maniacal disorders present themselves to our notice." There is nothing peculiar in the mental phenomena occurring in enteric mania. It most frequently takes place between the periods of 25 and 40 years of age-is often periodical-the first attack being generally after irregularities in the functions of the stomach and bowels. Our author has notes of many cases where the disease occurred immediately after a long voyage, during which the patient had been fed upon salt provisions, and suffered his

* See page 138 of this volume.

bowels to become constipated. Irregular diet and the habitual use of ardent spirits are among the most frequent of the previous circumstances.

"Great anxiety of mind, unusual exertions in business, and especially an effort to grasp at a greater variety of objects, or to engage in a greater diversity of pursuits than the mental powers of the individual qualify him for, will often be found to precede the attacks of this disease; the patient having neglected the state of the natural functions, which an unusual excitement of the nervous system had contributed to throw into disorder. A trifling degree of incoherence, a hurry and confusion of thought; sometimes an absurd degree of energy, manifested in the pursuit of some trifling object, is the first symptom which betrays the actual condition of the patient, In an attempt to reason with him, or resist him, he commonly becomes violent: he has often very early a lurking suspicion of his deranged state: at least this would appear to be the case from the frequent and positive assurances he makes to the contrary, even at times when no suspicion has been hinted.*" 247.

The diseased state of the alimentary canal is generally very strongly marked-the gastric, biliary, and intestinal secretions being depraved. The phenomena would lead to the supposition that chronic inflammatory action was seated in the mucous membrane of great part of the alimentary canal.+ In this form of the disease constipation seems to be, as it were, the natural character of the complaint. On enquiry we will be told that the patient has passed six or seven days without a motion-and, when cathartics are administered, a large quantity of excrements is discharged, of an unnaturaĺ appearance, the fæces being sometimes dark as coffee grounds, or of a dirty green colour, and very fetid. A long-continued torpor occasionally gives place to a diarrhoea, which usually augments the evil-the abdomen becoming more distended than before-flatulence being added to the load of solid contents, which are only partially discharged. The evacuations are generally thin and watery; or contain mucus mixed with vitiated bile, and recent aliment undigested -sharp and transient pains are experienced in various parts of the abdomen-a quantity of wind is discharged, or rattles

« I have sometimes observed a maniac, after saying something extremely absurd, (although I have taken care that nothing in my countenance or manner of conversing betrayed my impression of his insanity,) as if suddenly struck himself with the apparent incongruity of what he had been saying, break off and protest that he was in his right senses."

+ We cannot agree with our author on this point. Constipation of the bowels is a phenomenon quite inconsistent with inflammation of the mucous membrane.

about in the bowels-at length dysentery supervenes, and often carries off the patient, or reduces him to a state of extreme emaciation.

"The mouth and fauces, if examined, generally present a diseased aspect. The fauces and velum pendulum are red, the vessels injected, covered in patches with mucus. The tongue is often red; sometimes red with white streaks: more generally, especially when there is diarrhoea, covered partially with a brownish fur. The mouth is viscid, and the patient generally spits out a frothy slime in all directions. There is an ardent thirst, and a peculiar fetor of the breath, which indeed extends to the whole person, and would induce a suspicion that the secretions are loaded with absorbed excrementitious matter." 249.

The appetite is irregular-sometimes there is an aversion to all food, so that the patient cannot be induced to take sufficient nourishment for the support of life-in other instances, there is a voracious desire for food, which is greedily devoured, without selection.

The skin is clammy and cold, with often a remarkable coldness of the extremities, resulting from want of energy in the extreme vessels. In some protracted cases there are papular or scaly eruptions-or furunculi appear in various parts of the body, which are disposed to slough, especially in debilitated subjects.

The complexion is often flushed-the eyes wild, glossy, and lachrymal—the tunica conjunctiva frequently injectedthe eye intolerant of light-the pupils more or less contracted the urine is scanty and high coloured, containing matter that should pass by the alimentary canal. The pulse is quick and irritable, the carotids beating with more than proportional force. The patient is sleepless, often for many nights in succession-irritable and tremulous.

The progress of this form of insanity is various. Sometimes a diarrhoea affords relief, the disease either continuing in a mitigated form, or recovery takes place—in other instances, the diarrhoea carries off the patient.

"In more protracted cases, the diseased state of the mucous membrane of the intestinal canal gives rise to glandular obstructions in the mesentery: at least it is a fact that disorganizations of this description are often discovered after death. Hectic fever, with great emaciation, follows, and the patient sinks under a general cachexia, or effusion takes place into the abdomen, and he dies dropsical." P. 250.

Such is a sketch of enteric mania, on the ratio symptomatum of which, our author has not much to say.That the affection of the brain producing mania, is connected with the

« PreviousContinue »