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This part of the subject is involved in great difficulties; we are ignorant of the quo modo of the functions, moral and physical, of the organization affected. Treatment is consequently indirect and aimed at a particular lesion wholly dissimilar to any other morbid actions. Indications are therefore guided by symptomatic effects, purely physical, as morbid determinations, &c. Much is promised hereafter from the portfolio of M. Esquirol, and the Dictionnaire des Sciences Med. The author does not profess to have adyanced science in this respect.
“ Diffident of the experience of others, I shall limit myself to that which I have seen. I shall offer no miracles; they are not made for rational people."
Individual remedies are all of very limited use. At la Salpétrière M. Fouquier's nux vomica has failed to cure in any case of paralysis ! The use of violent reinedies is less successful than attention to the prevention of untoward circumstances, and conducting the Jisease, by well-timed interferences, to a fortunate issue. Attention to the due regulation of the mental and bodily functions forms the grand outline. Any active symptoms which concur or supervene, as cerebral congestions or organic inflammations, will demand the most active practice.
Hygiene.. The general laws apply to this as to other diseases. Diet and exercise should be voluntary, thereby avoiding irritation. Nudity, if desired by the patient, mag be granted-with care to decency, and in winter to the protection of the extremities. Extreme cleanliness. Beds o oaten straw are used for the unmanageable. Narcotics have a variable effect, but are generally less active than with others. Emetics, epispastics, and purgatives, produce the ordinary influence, except that their local action does not seem to exert the same general influence on the brain, and excites less sensation. In the period of incubation, removal of moral causes, as reparation of injury, or re-union of lovers, avails infinitely more than tormenting the organic system with stimuli addressed to functions impeded or suppressed merely as effects.
Period of Excitement. Sequestration, restraint, diminution of irritation spasm and convulsive actions. Privation of light and heat, cropping the hair, and exposure of the head, (if wished,) acidulous beverages, with fruit, but no wine. Tepid bath daily, if strength permits, staying in as long as possible, from half an hour to two or more. apoplectic tendency obtains, it is interdicted.
“ The use of baths tends especially to diminish excitement, to calm the nervous system, to dissipate tension, agitation, and encreased muscular action; to relax and refresh the dry skin of melancholics. It is of use, and often essential in point of cleanliness.” 316.
This stage does not require violent treatment. Blood-letting has been much abused in it, and has produced the worst effects-confirming the derangment of mind, and dangerously enfeebling the system, except in supervening acute affections. In congestions, local determinations, and inflammations of structures, e. g. serous membranes, &c. local blood-letting is advised. Pervigilium, which is increased by opiates, requires blood-letting. Dyspepsia, suppressed menstruation, will only Le abated by diminishing cerebral irritation, and by the suco cessful progress of the general plan. The author's objections to external irritants and cold affusion, are absurd. " Nine hours' cataract with the shower bath" is certainly extravagant enough. Baths of surprise and empirical means need no observation. General plethora, common at pubertal periods, require repeated small blood- lettings.* Bleeding from the foot, and cupping the thighs, after suppressed catamenia. Baths in plethora are manifestly improper—disposing to internal congestions and apoplexy. Debility with the usual symptoms, and delirium or loquacity, may follow refusal of nourishment, masturbation, or subterranean confinement, or improper depleting treatment. Masturbation in both sexes is generally excessive, and requires restraint and cold applications to the genital system. 'If the parotids are pressed, pain compels them to open their mouths, and the introduction of a tube will ensure deglutition. Active cerebral congestion, premonitory of apoplesy, and common to all varieties, demands derivative treatment, by new irritations, nauscating remedies, irritative or mustard pediluvia, (ceplieluvia being used simultaneously,) and foot-bleeding. Small blisters to the arms or thighs, and neck (occasionally.) Sub-inflammation of the brain, denoted by encephalic tension, bead-ache, and the phrenitic physiognomy with vibrating carotids, requires the same treatinent.
The author has well described pubertal plethora, and likewise that at the turn of life ; fulness with a sense of sinking and lassitude is present, and oft mistaken for general debility, and most injuriously treated as such. We have found no remedy equal to the sulph. ferri (one grain dose) with the aloetic and sagapenum pill of Dr. G. Fordyce, in these cases. It produces free purging, occasional alvine hæmorrhage, and thus lessens congestions of the spleen, and abdominal viscera.
For the stupor, insensibility, and cerebral inactivity of aliénées stupides ; setons, moxa, &c. to the neck, frequently repeated and kept up; they cause a general shock, but require time for constitutional influence. These, and repeated vomits, rouse the animal energies in the “ most desperate cases.'
Nerdous Irritat ility. This is accompanied by leanness, despondency, morbid susceptibility, mental or bodily impressions, despair, constipation, fidgets, dyspepsia, and watchfulness. The treatment which is here indicated, is purging, tranquillizing, obviating local actions, diminishing cerebral irritation. But, above all, the hellebore and "Naviget Anticyram" of Horace, viz. mental and bodily transitions by travel.* Jalap, hellebore, aloes, and colocynth, (daily if not too effective,) produce serous evacuationis abundantly, and relieve the cerebral action. At night the systern should be calıned by conium, &c. Orange flower ptisans excellent in great quantity. Irritants to the skin and batlıs improper.
In cases which are entirely hopeless under the foregoing modes of treatment, the empirical methods may be had recourse to, in as far as they do not endanger life.
Tendency to la demence. This state combined with paralysis (acute or chronic) is incurable; without il-very doubtful. As it implies collapse of the mental powers, tepid baths, tonics, stimulants, derivatives, and counter-irritants, are indicated.
Derangement consequent to Parturition—is generally more curable than any other, especially if taken carly after the event.
Treatment. Excite the secretions of the intestines and skin; give daily lacemens of milk and sugar, which cause abondant stools without irritation—tepid bath. The general Treatment of Excitement.-Renewed blisters to the arms. Breasts hard, painful, and slow in advancing to resolution, require friction and ammoniacal liniments: opiate cerate for dressing. Under this treatment hysteritis or peritonitis rarely follows. Those who become insane after every parturition should abstain to prevent the effect.
* A gentleman at Bath, in whom retrocedent rheumatism, torpid liver, and melancholy of this description concurred, recovered by removal to Cheltenham, where his rheumatism was restored-under desperate des. pondency. In this state he was forced from Bath by our adınonitions, in direct innovation on his local advice, which in watering-places seldom tends to prompt removal, however necessary, from feelings of jealousy towards other rival situations.-R.
Periodical Derangement. Rarely curable. Tonics sometimes prevent the accession. Syncope, convulsions, fever, vomiting, are generally fugitive, and merely require tranquillizing treatment.-Convalescence. Atony is usual at this period, with ædema; embarrassment of speech, itching of parts, and painful digestion, often forerun paralysis, as, also, much sleep. Some who recover become phthisical.–Vigilance, also, occurs in convalescence. Tepid baths, active exercise, orange-flower water, blisters to the arms.- Plethora is characterized by palpitations, weight in the head, disturbed sleep, &c. Low diet, active exercise, cautious blood-letting. - Cephalalgia. Very general in convalescence. Tranquil. lity mostly suffices. External head-aches, if obstinate, require pediluvia and leeches to the part affected. If internal, and indicating congestion, active constitutional treatment. Suppressed menstruation, with such symptoms, as cephalalgia and plethora, requires emenagogues, mustard pediluvia, footbleerling, hip baths or fomentations, leeches to the pudenda.
Relapses. To prevent all the preceding symptoms, remove causes, and regulate the functions. Marriage has been proposed for love-madness. It entails three evils, its own chagrins, the hazards of accouchement, and of hereditary transmission. Guard the brain especially, and, also, the regular action of the uterus and bowels. Baths, partial and general, crural and pudendal leeching, purges, and setons in the arms.
Pathological Researches. Our analysis of this section must, necessarily, be very brief, especially as the author's opinions entirely refer the origin of mental alienation to organic derangement, not sensible or demonstrable. For his speculations on this point, we, therefore, refer the reader to the work, briefly noticing such pathological particulars as are interesting to all.
The infrequency of manifest organic affections of the brain, and its occurrence in those not affected, leads the author to deem such phenomena as effects, or, at least, merely the causes of such secondary nervous affections, as concur with derangement.
Though mental derangement is not in itself mortal, it necessarily involves exposure to the causes which abridge life. Out of 100 received in the Salpétrière25 die....
Out of 95,
20 to 30 years.
30 to 40
10th to 15th
20 18 14 14 7 2
40 to 50
50 to 60 9
60 to 70 3
Acute maladies very rarely supervene compared with chro. nic. Diagnosis is very difficult, sensibility being diminished, symptoms may not be well marked; some fcign symptoms and diseases ; morbid alterations of functions, debility, want of appetite, and dejection, afford the best indications of chronic maladies. "Phthisis destroys more than half the patients admitted into the Salpétrière. It is never acule, and often so latent that it is not discovered till examination after death.” Not the least mark of pulmonary irritation exists, the patient neither conghs, expectorates, nor complains; he attenuates, loses strength, and dies with constipation or diarrhæa; the progress is very slow. All who die in bed, die with the last symptom. The first constipation) is the effect of atony, and is often wonderfully protracted. It is often incurable, the intestines, becoming enormously distended and paralyzed. Mechanical efforts alone avail.
Crania of Idiots.-Almost always mal-conformed. Volume either preternaturally small or large. Out of 100 crania of aliénies, 50 may be natural, and the rest irregular, thickened, &c. These changes are probably effects of cerebral development, rickets, &c. In the encephalon, the rachidian column, and meninges, except in aged démences, and in paralytics, no organic alterations at all are generally observed, unless fevers, or other acute diseases, supervene.
Dura Mater.-Occasionally thickened and ossified. Tu. nica Arachnoides and Pia Maler.—Chronic inflammation, or serous effusion. Cerebrum, sometimes hard, sometimes soft. Ventricles. Adhesions, especially at the prolongation of the cornu ammonis, serous effusion, especially in idiots. Plexus Choroides-Bloodless. Full of hydatids.--The lobes changed in color, and putridly soft, especially in paralytics. Partial atrophy of the substance of the brain, is almost peculiar to paralytic idiots,* the portion affected being reduced to one Third of natural bulk, and the centre hard or cartilaginous. Erosion. Cancerous-like tumors.-Cerebellum soft. -- Spinal Column. Rarely affected.- Pleura and Lungs. Adhesions and tubercles frequent.-Intestinal Canal. Mucous coat almost always more injected than naturally.-Colon. Transverse arch occasionally oblique or perpendicular.--Liter. Preternaturally large or small-sometimes congested, tuberculous, scirrhous, hydatidous.-Gall Bladder. Distended with bile; gall-stones. -Spleen. Enlarged, soft.—Ulerus, Oraries. Tuberculated, enlarged. The author sums up :
“ This, which is congenital, is probably the immediate cause of defective understanding, as well as of paralysis.”