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MOVES, GREVILLE STREET.

TREATISE
ON

EAS
OF THE

N E R VM'^^^Y STEM.

COMPRISING

CONVULSIVE AND MANIACAL

By

J.

C.

PRICHARD, M.
;

D.

LATE OF TRINITY COLLEGE, OXFORD

FELLOW OF THE LINNEAN AND WERNERIAN


PHYSICIAN TO
ST.

SOCIETIES, &c.

PETER'S HOSPITAL

AND THE BRISTOL INFIRMARY.

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

last ten years, the

appointment

of physician to a hospital, where a great


proportion of the cases brought under

my

observation have belonged to that class of


diseases

which are the subject of this


variety

treatise.

Here a

of phaenomena

have pre-

sented themselves, from time to time, to


notice,

my

which have appeared

to

throw

light

on some pathological inquiry, or

to suggest

some

practical indication.
first

It is

now

several
to

years since the idea


that

occurred

me,

by publishing a

selection

from those

cases which have seemed worthy of record,


I might be enabled to
to the general stock of

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

some measure confirmed,

have

proceeded, by observing that the examples of


disease,
selves,

which continued
seemed
in

to

present them-

general

to coincide

with

certain

pathological distinctions which I had


to adopt.

been led
It has

been

my

principal

object,

in the
his-

composition of this work, to render the


tories of the diseases of the

nervous system
to

somewhat more accurate, and


treatment of them,

improve the
into the

by an inquiry

circumstances of the constitution under which

they take their

rise

and disappear.
fallen

Some
notice,

facts,

which have

under

my
the

have induced

me

to suspect that disin

orders

of the nervous system are,

majority of examples, secondary and

symleast,

pathic

affections

they are often, at

symptoms of some

latent disease in another


;

part of the constitution


in the state, either

and

in

particular

temporary or permanent.

PREFACE.

Vll

of those organs which are subservient to the


natural
functions.

If this

be allowed,

it

becomes evident that by discriminating these


affections into certain
classes,

according to

the nature of the primary diseases, of which

they are symptoms and indications, their


tory,

his-

as

well

as the

ideas formed

respect-

ing their pathology, will be rendered

more

complete.

similar

method likewise holds out the


improvement
in practical

best expectation of

treatment
of such

for it

is

obvious that the cure


so
far

diseases,

in

as

thej'^

are

sympathetic, must be founded on, and bear

a relation
affection.

to

the

nature

of the

primary

Some

of the diseases, of which I

purpose
least

to treat, are

commonly

regarded, at

in

cases

of long duration, as almost

incurable by any efforts of

human

art.

So

repeatedly

have medical practitioners been


trial

disappointed in the

of various remedies

proposed for the cure of these disorders, that

Vlll

PREFACE.
this

any new suggestion of

kind

is

justly

regarded with suspicion:' yet numerous instances occur in which Nature, in

some period

or another of life, effects a cure.

The

diseases

are found to cease in consequence of

some

spontaneous change which takes place in the


state of the constitution.
titioners, instead

If medical prac-

of hunting after specific re-

medies, carefully directed their attention to


trace

the

method by which

these

natural

terminations are brought about, or to ascertain the process of those constitutional alterations, in

consequence of which the diseases


it is

alluded to disappear,

probable that they


instances, to imi-^

might be enabled,

in

some

tate the salutary operations of nature.

In offering these remarks I do not lay


claim to any discovery.
that

am

well

aware

many

of the distinctions I have pointed

out were well


writers
;

known

to the older medical


in

though of

late,

some examples,
In other
in-

perhaps generally overlooked.

PREFACE.
stances I have been anticipated

IX

bj recent

authors

and, in

many

cases,

have pursued

a path of investigation aheady entered upon.


If,

indeed, I did not imagine

my work
is

to

contain something more than

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

myself with the expectation of mak-

ing any signal advances in a field in which

the most intelligent

men have been

exerting,

in various ways, their

power of observation

during

many

ages.

To

the histories of particular cases, which

are adduced as examples, I have added such

remarks as were necessary,

in order to point

out the inferences that appeared to result

from them separately, and by comparison.


These
of
this

facts

and observations form the

basis

treatise.

The remainder

consists of

inquiries

and

reflections

on subjects which
consider,

was naturally led

to

by

their

X
intiaiate

PREFACE.
connexion
with
those

matters

in

which I was principally concerned.


I anticipate
as confused

some objections

to

my

work,

and unsystematic
I

in its arrangethis

ment: but the method


particular,

have selected in

though

irregular, is not

founded

on caprice. I have followed that


has appeared to
logies,

series

which

me to

place the facts and ana-

on which

my

conclusions are founded,


I

in the clearest point of view.

proceed to
it

each topic

in

that order in

which

will,
it,

by

the consideration of what relates to

intro-

duce the reader

in the

most natural way


in

to

what

is

to follow,

and

which the subjects


illustrate

considered in

connexion mutually
is

each other.

It

with such a view that I

have brought together the cases of epilepsy,


arranged under each head, with those of maniacal affections which bear a similar relation
to

the

primary disease.
deviation

The motives
from
the

for

each

particular

most
will

simple and perspicuous arrangement

be

PREFACE.

XI

apparent to the reader as he proceeds; or


will,

at least,

become

so on a retrospective

view.

The

cases,

of which I have given brief

histories in the following chapters, are chiefly

a selection from those which have occurred


in

my

hospital

practice.

I'he

details

are

extracted, or abridged, principally from

me-

morandums and books


myself at
St. Peter's

of cases,

kept by

Hospital and the Bristol

Infirmary, and in
cases kept

part

from

register

of

by the apothecary of the former

hospital*.

To

these a few additions have

been made from cases which have elsewhere


fallen It

under
is

my

observation.
I

proper to apprise the reader that


to

look

forward

the

publication,

at

some
several

future time,

of another volume on

disorders of the nervous system, which are


* Principally by Mr. A. Kih, the a medical officer
diligence
in
his
in

late

apothecary,
ability

now
and
in

the navy
I

to

whose great

profession

have

much

satisfaction

bearing an ample testimony.

XU

PRErACE.

omitted in the present treatise; particularly

on chorea,

hysteria,

and comatose

affections.

On some
cases,

of these subjects I have already col-

lected a considerable

number of

illustrative

but have as yet by no means such an


of them as will authorize

assemblage

my
to

proceeding to an immediate publication, or


enable

me

to determine,

by an appeal

numerous
to

facts,

how

far the principles applied

the

disorders comprised

in this

volume

may be
same

extended to other affections of the

class.

CONTENTS.
CHAPTER
PHYSIOLOGICAL SURVEY OF
I.

PAGE

THE FUNCTIONS OF THE


SYSTEM.

NERVOUS
Section
I.

Peculiar Difficulties of this Subject.

Reason
1

why

the

Animal Functions are

less

understood than the

Physical.

What

the former are

Section

II.

Survey of the Intellectual Faculties in respect

to their

System.

on the

Sensation and Perception. Memory. Remarks Imagination. Judging Association of


Ideas.

Connexion with the Operations of the Nervous

or

Reasoning Faculty

Section

III.

Pursuit of the same Inquiry with respect to

other Classes of Mental

Phenomena.

divided into Passions or Emotions, and active Principles,

including
these

Propensities

and

Affections,

Pathemata Inquiry

sub-

how
25

Phsenomena are

related to the

Nervous System.

Lastly ; respecting Volition

Section IV.

Solution of an Objection to some of the pre-

ceding Remarks.

Recapitulation.

Is the

Nervous Sys?

tem the Organ of any of the physical Functions

Note A.

NoteB.

39 45 50

CHAPTER

II.

PATHOLOGICAL SURVEY OF THE DISEASES INCIDENT TO THE NERVOUS SYSTEM.


Section I. Resources for pursuing this Investigation. Morbid Anatomy. Observations on the History, Con-

nexions, and 'Conversions of Diseases.

Doctrine of
of the

the

Juvantia and Lsdentia*

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

with other Nervous Diseases*

tlV

CONTENTS.
PAGE
Application of the Inferences contained in

Section
general.

III.

Vascular System Brain, Apoplexy. Hydrocephalus. General Conclusion


State of the
in the

the last Section, to the Pathology of Nervous Disorders in


in

various Diseases of this Class.

In

66

SECTfoisr

IV.

Connexion

of

Disorders of the Nervous

System with several Diseases of the Natural Functions.


Distribution of Cases founded on this Observation.

Note C.

75 32

CHAPTER
Section
Section
I.

III.

A GENERAL DESCRIPTION OF EPILEPSY.


Definition

and Nosological Distinctions of


85

Epilepsy
II.
,

Outline of the History of the Disease

87
101

Section III. Note D.

Observations on the Pathology of Epilepsy

108

CHAPTER
Section
I.

IV.

A GENERAL BESCRIPTION OF MADNESS.


Outline of the History of this Disease

113

Section II. Madness

Remarks on the Phenomena and Nature of


Continuation of the same Subject.

Section

III.

117
Varieties

of Madness, distinguished by Authors, reduced to the fore-

going Description.

Dementia,

or Incoherent Insanity.

Supposed Derangement of the Active Powers, or Madness


without Delirium.

Disorder affecting the Temper


Madness*

132

Section IV.

On

the Pathology of the Brain in

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

connected with the State of the Uterine Functions


II.

Outline of the History of Uterine Epilepsy.

148
151

Section III. Section IV. Section V.

Cases of Uterine Epilepsy, and Observations'

Of

the Treatment of Uterine Epilepsy

181

Of Maniacal

Affections, connected with States

of the Uterine Functions

194

CONTENTS.
Section VI. Of Uterine Mania
Section VII. Section VIII.
the

XV
PAGE

Nature and Treatment of Cases of

201
Puerperal

On

Mania
Affections

203
occurring at the

Of Maniacal

Period of Life when the Cataraenia cease

208

CHAPTER
OF EPILEPTIC

VI.

AND MANIACAL CASES, ARISING FROM metastasis; or the translation of MORfilD ACTION FROM OTHER STRUCTURES TO THE BRAIN.
I.

Section Section Section


niacal

Preliminary Remarks
Metastasis to the Brain on the healing of old

215

II.

Ulcers, and Recession of


III.

Exanthemata

2\G

Of

Metastasis to the Head, producing

Ma-

and Convulsive Diseases, in Cases of Gout and Rheumatism, and of the Inflammation of Serous Membranes

221

Section IV.
to

Of

the Metastasis of Dropsical Inflammation giving


rise

the

Brain,

to Convulsive
-

or

Maniacal

Affections

225

Section V.
Section VI.
these Cases

Of

Metastatic Disorders of the Brain, conse-

quent on the Removal of Tumours

229 233

Other Facts

illustrative of the

Pathology of

Section VII.

On

the Treatment of

Maniacal and Epileptic

Cases, arising from Metastasis

237
VII.

CHAPTER
OF EPILEPTIC

AND MANIACAL CASES, DEPENDING ON A DISORDERED STATE OF THE INTESTINAL CANAL.

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

242 246 251 257

Section VII.

Cases of Enteric

Mania

270 300 305

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,

and other Hypochondriac Viscera.

338

CHAPTER

IX.

CASES OF CEREBRAL DISEASE, GIVING RISE TO THE THMNOMENA OF MANIA OR EPILEPSY ; OCCASIONED BY THE

DIRECT OPERATION OF NOXIOUS AGENTS ON THE BRAIN

AND NERVOUS SYSTEM.


Section T. Preliminary Remarks* 345 Section H. Traumatic Cases of Cerebral Disease giving
Rise to the above-mentioned Effects

rise to
.

345

Section HI.
leptic, or

Cases of Cerebral Disease giving

Epi-

Maniacal Phaenomena, occasioned by physical

Agents, which act directly on the Brain and Nervous System 353

Section IV.
Section

Treatment of the Cases described

in the last

363

Section V.
tion of

Of Nervous

Diseases, resulting from the Opera-

Mental Emotions.

Cases

of
>o

Madness from Super

stitious Terror,

and other Passions

Section VI.

Treatment and Examples

367 381

CHAPTER CHAPTER
OF CONVULSIVE

X. 385

or LOCAL CONVULSION, OR PARTIAL EPILEPSV.


XI.

TREMOR

SQS

CHAPTER
Section
Section Section
r

XII.

OF SOMNAMBULISM, OR ECSTASIS.
I.

Phseuomena and Pathology of Ordinary Sleep

walking
II.

OfEcstasis

399 407
of

III.

Of the Pathology and Treatment

Somnam4l6 423 427

bulation,

and Ecstasis

Note on Chapter XII.

Appendix*.

A TREATISE
M^tn^t^
OF

THE NERVOUS SYSTEM.


CHAPTER
I.

PHYSIOLOGICAL SURVEY OF THE FUNCTIONS OF THE NERVOUS SYSTEM.

SECTION

I,

Reason zohi/ the AniPeculiar Difficulties of this Subject. are less understood than the Physical. mal Functions

What

the former are.

REMARKABLE

degree of obscurity yet involves

almost every subject connected with the theory of the

Nervous System, and


or in disease.

its

operations, whether in health

In other departments of physiology,

every step that has been gained in explaining the structure of parts has been attended with a corresponding

progress in the knowledge of their functions.

But

although the texture of the brain and nervous system

has been diligently investigated, this study can scarcely

be said

to

have thrown one ray of

light

on the pro-

cesses for which these organs are destined.

Anatomy

and physiology here stand aloof from each other, and

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.

All the ac-

quaintance

we

possess with

the

physiology

of the

nervous system has been obtained through indirect


channels, and in this instance, contrary to the usual

and natural progress of knowledge, Pathology has


furnished the clue and the materials to Physiology.
I have no expectation of contributing materially to

improve

this part of physiology; but

it is

requisite for

my

purpose, to take a survey of the data we possess

with respect to the functions of the nervous system.

These data

will

be found chiefly to refer to the inquiry,


offices

what the functions or proper

of this system are.

They

do not enable us to elucidate the

mode
is

or ra-

tionale of the processes which are carried on in the ner-

vous structure. Yet, limited as the information


they
affiord, it will

which
work,

appear in the sequel of

this

that an important use that

may

be

made

of

it

or, at least,
it.

we

are not entitled altogether to neglect

Physiologists have generally distinguished the functions inherent in the living

body
all

into three classes,

which they have termed

vital,

natural,

and animal.

The

latter class

comprehends

those phasnomena

which are found


of the body.

to be connected
all

with the nervous


the other functions

system; the two former include

The

natural and vital

functions,

or the physical

functions, as

we

shall

term them collectively*,

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

quite without meaning, the functions of

organs being equally organic.

The

frequent repetition of such

THE NERVOUS SYSTEM.


considered
beings. as

3
of organized

common

to

all

orders

Even
;

plants display,

under modifications,
;

these universal

phasnomena of
particles
fluids;

life

for they originate

by generation
accretion of

increase by nutrition, or the continual


;

new

are supported in vigour

by a circulation of by

produce peculiar substances

a species of secretion,

and decay by the spontaAll

neous changes which ensue after death has terminated


those operations which maintained the living state.
these processes can exist without a nervous system.

But when a nervous system begins to appear, a new series of properties is displayed, remarkably different
in kind

from any of the above-mentioned


of mind*
:

the properties

for,

mean by this term, we


:

DISTINGUISH

ALL THOSE PHENOMENA WITH WHICH WE BECOME ACQUAINTED THROUGH THE


OF

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.

Indications of these properties are

discovered in those animals which are endowed with


the simplest rudiments of a nervous structure; as in

worms and

the molluscas

and they are more amply

expressions as " organic functions" and " organic organs," pro-

duces a most uncouth and unmeaning jargon.


distinctive

The most proper

term which our language affords, for those operations


to (*vo-5)

which are subservient


life, is

growth and merely corporeal

the expression " physical functions."

* Some persons will probably object to the including such phcenomena as those of sensation and appetite among the properties or

operations of mind

but the objection arises from inattention to

the only real and applicable distinction between the attributes of

mind and those of body.

FUNCTIONS OF

developed as the nervous fabrick becomes more complete; until in


infinitely

man

they display themselves in that

more

perfect state, of which all the other


It results

instances are but feeble scintillations.


this,

from
it is

as well as

from other considerations, which

unnecessary to adduce, that the operations of mind


are instru mentally dependent on the nervous system
;

and on
though

this in

account they have generally been termed,

a loose and indeterminate sense, functio?is


this

of the newoiis system; and

term

may
:

be con-

sidered as equivalent to that oi animal functions.

But a question has often been suggested


phasnomena of mind,

Are the

sensation, for example,

to be

regarded as functions of the nervous fabrick, in the

same sense

in

which the natural and

vital functions

are

operations of their respective organs?

There

is

the
it is

following difference between the two cases, which

very important to notice.

In the
functions,
result or

latter instance,

I mean that of the physical we can observe a connexion between the

end obtained, and the means which Nature


its

has provided for

accomplishment.
;

The

organs are
;

pieces of mechanism

their action

is

mechanical

the

substances which are subjected to their operation act


also

upon each

other,

and are acted upon by the


affinity.

elements without, in virtue of chemical


all

Thus,

the phasnomena

belonging to the physical functions,

the results as well as the operation, resolve themselves


into chemical and mechanical influences and effects*.
*

On

this subject I shall

explain myself more fully elsewhere,


vital principle, if

iand shall

show, that the hypothesis of the

con-

ceded, can offer no exception to the position laid down.

See

Note A.

at the conclusion of

this

chapter.

THE NERVOUS SYSTEM.


Such are the circulation of
ing powers
;

fluids

by mechanical movwhich
is

respiration

nutrition,

mode

of accretion; elimination; secretion, for the perform-

ance of which such various and complex,

though

imperfectly explained, systems of mechanism are provided.

The more complicated


more simple
to
all

processes, viz. those

of generation and growth, are compositions and combinations of the


operations.
'

With

respect

these

functions

it

may be

observed. First;

That the

result is similar in kind to

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
; ;

resources which nature has furnished in the organic

arrangement of parts for the attainment of

it,

and to

form some idea of the process.

Now,

it

is fully

evident that none of these remarks

can be applied to the case of the animal functions.

The means
at

afforded by nature in the structure of the

nervous fabrick are indeed before our eyes, and we

may
the

some

future day be enabled to determine, in conse-

quence of more attentive observation,


precise operation of this structure
:

what
it

is

for

can only be

a chemical or a mechanical one


in the composition of the

(a chemical change

component substance, or

of contained fluids

or a mechanical change in the

FUNCTIONS OF
;)

disposition or configuration of the parts

since these

are the only operations of which the structure of such

an organized fabrick renders

it

capable.

But

if

we

were perfectly acquainted with the precise nature of


those operations which are carried on in the nervous
structure
:

if,

for example,

we knew whether they


oscillations

are,

as

Sir

Isaac
or,

Newton
;

conjectured,

of

chords;

as Dr. Hartley called


or, as

them, vibrations

and vibratiuncules
logists
or,

Darwin
;

fancied, contractions

and elongations of
as

fibres

or,

as the

older physio-

supposed, secretions and circulations of fluids

some modern

theorists

have imagined, trans-

missions of electric, galvanic, or similar influences;


or any other sort of
other), of

movement
still

or action, (if there

is

any
just

which the parts of the brain and nerves may

be thought capable;
as far as

we should probably be

we now

are from perceiving the connexion


effect

between the instrumental operation, and the

which Nature has


with
it.

in

some way or another connected


for

What
is

relation,

example, or

common
fibre,

property,

there between the

movement of a
There
is

and a sensation or a thought?

no imais

ginable connexion, and yet the one phssnomenon


the universal antecedent of the other.

In

this case

we must

also remark, that

we have not

the advantage of surveying the whole train of phae-

nomena in one connected point of view, or through the medium of the same faculty the whole train is
:

not subjected to sensible observation, as in the case of


the physical
functions.

Observation can carry us


in

no further than the ultimate change

the

con-

THE NERVOUS SYSTEM.


figuration or state of the nervous parts.
to
is

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

termed, according to the definition with


set out in treating

which we always

on

this subject,

a ph(Lnome7ion of mind.

The
large *,

considerations at which I have briefly hinted,


is

but which this

not the proper place to explain at


reflecting

have induced a great majority of

persons, both in ancient and

modern

times, to regard

the resulting phsenomena, which consciousness opens to


us, as the properties

of an essence or substance, distinct

from the nervous system, and indeed from the whole


body, which they have denominated Soul^ the mental

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,

passion, appetite, &c. are to be termed affections, not

of the nervous system, but of the soul, which

is

acted

upon through the instrumentalityof that system; the


possession of which principle must, therefore, according to the notions of the Platonic school, be regarded
as co-extensive with the

endowment of animal
philosophers

life,

and not
* In note

limited,

as

Christian

have
a

B. at the end of

this chapter, the reader will find

brief abstract of the reasons

which appear

to

me

to enforce this

inference.

p
generally thought
to the

FUNCTIONS OF
it

incumbent upon them to


in

limit

it,

human species*. Now, if we are justified

regarding

all

mental

phsenomena as

affections of the soul,

and the functions

of the nervous system as instrumental processes, connected with the former,


it

remains to be inquired,
is

Whether

this

connexion

universal?

Are

there

certain instrumental processes in the material organ

connected with every species of mental operation


are

or

some

affections

of the soul, some mental acts,

capable of happening without any co-operation of the


brain and nerves
itself equally
?

This

is

an inquiry which
its

is

of

important in

relation to the philo^

sophy of the human mind and the physiology of the


nervous system
;

and

it

is

one,

the prosecution of

which

will

bring before our view several matters of

consideration extremely interesting, in the further prosecution of this work.

* Yet some of the most profound and enlightened divines have


not considered
Butler.
it

necessary to maintain this opinion, as Bishop

When

speak here of soul,

have no reference

to the theo-

logical doctrine
structible.

of a principle

necessarily immortal and indein the


it.

If there

were any other word


I

English language

expressive of

my

meaning,

should prefer

Vital principle will


to that

not answer the purpose; because the properties ascribed


principle

by those who maintain


See Notes

its

existence, are quite of a dif-

ferent kind.

and B,

THE NERVOUS SYSTEM.

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.

Imagination. Judging or Reasonis

ing Faculty.

That

sensation

a phaenomenon to which
is

an

operation of the nervous system


scarcely be disputed by any person

instrumental, will
is

who

not ignorant

of physiology.

The

fact before noticed, that

on sur-

veying the animal kingdom from the lowest to the


highest orders of beings,

we

discover clear proofs of

the presence of feeling or sensation as soon as the

nervous fabrick makes

its

appearance, affords in
is

itself

a strong presumption, which

converted into certainty

when we

survey the nervous expansions in the organs

of sense, and contemplate the careful organization by

which Nature has provided

for receiving impressions

from without, and for maintaining communications, by


intervening chords, between the extreme parts and the
centre of the nervous structure.
is still

The same
any part

conclusion

further strengthened by observing that a morbid


is

state of the nervous structure in

accom-

panied with a corresponding defect in the sentient


power, and
results

that a total

obliteration of this

power

from the dissection of a nerve, by which the


is

communication

intercepted between the extremity

and the

common centre. The dependence of sensation and


is
still

perception upon

the nervous organs

further exemplified by the

10

PERCEPTION DEPENDENT ON
powers, which results from a
It
is

total obliteration of these

certain condition of the brain.

well

known, that

they are suspended

for

a time by the effect of a

stunning blow on the head.

severe concussion of

the brain produces a similar effect for a longer space

but the most complete suspension of the sentient and


percipient faculties
is

occasioned by compression of the


is

brain
skill,

and when the case

within the reach of


is

human
some-

the removal of the compressing cause

times followed by an instantaneous recovery of these

powers*.

The
all

inference which seems obviously to result from

these considerations, has generally been received


physiologists as an undoubted fact
;

among
it

but of late

has been powerfully controverted, on the ground

that the brain has been found, in

many

instances, to

have undergone extensive


corresponding effect as

injuries

without any such


led to expect,

we should be
it is

according to the opinion, that

the organ or instru-

ment of perception.

Some
*

of the accounts which are current respecting


mentioned by Mr.
In con-

An interesting
in his

instance of this description

is

Aberuethy

Observations on Injuries of the Head.

sequence of a blow which occasioned a fracture of the skull, the


person
hospital

whom
in

this

accident had befallen was brought into the

a state of complete unconsciousness.

depressed

portion of the skull having been removed by the trephine, and the

dura mater

cut, five

ounces of extra vasated blood immediately flowed


;

out through the opening

upon which

the patient suddenly rose

up

in bed, as if aroused in a fright

from a deep sleep, and presently


similar description, though

recovered his faculties.

Examples of a
I

not so strikingly marked, have,


in extensive practice.

suppose, occurred to every surgeon

THE NERVOUS SYSTEM.


the extent of injury which

11

the brain has sustained,

without the destruction of

life,

and even without any

suspension of the perceptive faculty, are of such a


description as to leave us no alternative, if
credit to them,

we

give full
is

but to conclude that this organ

part altogether superfluous in the system, the loss of

the whole of

it

involving no detriment to any of the


it.

functions which can with probability be ascribed to

This would be to prove too much

there

must be some
and a part

way of

reconciling these facts, as far as they are true,


;

with the tenour of ordinary observations of the evidence they offer may, until
it is

presented in

a more unambiguous form, be rejected, as the result of


carelessness and inaccurate observation, or of a love
for the marvellous*.
Still it

must be allowed, that

in

a number of instances standing upon authentic record,


the brain has been discovered,

on

dissection, to

have

undergone injuries and apparent disorganizations, which


are altogether surprising.
It has
fluids,

been found greatly


in

compressed by contained
to

and

some instances
substance by
the sentient

have

lost

a considerable portion of

its

various accidents, although, during

life,

power and the mental

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

* See a surprising collection of facts to this effect in the 24th

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

cases of chronic disease in which the hemispheres of

the brain have been so


lost so

much compressed, and have


interstitial

much

of their substance by

absorpskull,

tion, as to
it

occupy but a small space within the

has been suggested* that this organ, so necessary to

life,

and

to the

most important ends,

is

so framed as

to

be capable of undergoing an indefinite degree of

distention and compression,

when gradually
its

applied,

without sustaining such injury of its structure as renders


it

incompetent to the performance of


this

functions.

That

power
its

in the brain, of

accommodation, or of

modifying

structure under certain circumstances,

affords the true solution to these phsenomena, seems to

be an unavoidable conclusion, when we consider that a

much

less

degree of compression, suddenly applied,

immediately obliterates the powers of the brain, and


destroys existence.

With

respect to those instances in which a portion

of either hemisphere has been lost by accidental injury,


I find no reason that prevents our acquiescing in the
solution proposed by Gall
to
their

and Spurzheim.
this

I allude

remark on the double structure of nervous


the

organs, and

purpose to which

structure

is
is

probably

subservient.

We

know

that one

eye

capable of affording vision after the destruction of


its

fellow.

similar

remark may be applied even


one kidney, for

to several of the natural functions;

example, performs the secretion of urine when the other


has become obstructed, or otherwise diseased.
it is

Hence
disorJournal

most probable, from analogy, that the


Wilson Philip, and Dr. Alison,
Institution.
in the Quarterly

* See Dr.

of the

Royal

THE NERVOUS SYSTEM.

13

ganization of one hemisphere in the encephalon would


leave the other
still

capable of carrying on the function


is

of which the whole brain

the ordinary instrument.

But whether the brain


yet contested,
dispute, that

is

allowed, or not, to be the

organ of sensation and perception, no physiologist has


or
will

ever,

presume, venture to
is

some portion of the nervous system

instrumental to these operations.

This conclusion
but

may

be considered as fully esta;

blished with respect to the faculties above mentioned


it

cannot be extended, without some additional


to other

proof,

classes of mental

phaenomena.

In

apoplexy, indeed, and in other cases of compressed


brain, there
is

a suspension of

all

the faculties

and

even a

total obliteration,

for the time being, of con-

sciousness.

But

this fact alone, as


is

we
is

shall hereafter

have occasion to show,


the mental operations.

not sufficient to support a


the organ of all

general conclusion, that the brain

Some

further proof

must be

adduced before we
tion, are carried

shall be entitled to conclude, that

other mental processes, besides sensation and percep-

on

in the

animal economy, through the

instrumentality of the brain and nervous system.


I believe, that on further consideration,
find reason to

we

shall

conclude that other mental operations

besides those of sensation and perception, are instru-

mentally dependent on the nervous system


the other hand,

but,

on

we

shall

not, unless I
is

am

mistaken,

discover any proof that this doctrine


all

applicable to
late writers

the

phasnomena of mind,
first

as

many

on

physiology have assumed.

We shall

consider this question as

it

relates to

14

MEMORY DEPENDENT ON
faculty by

memory, or the

which ideas presented by

perception are, after an interval, recalled or again suggested to the mind.

The
on
this

relation

which the mental actions dependent

faculty bear to those of sensation

and perIf

ception, affords a ground for presuming that similar

organic operations are subservient to both.

it

be

allowed that a certain action, or change in the

mo-

mentary condition of the nervous

fabrick, precedes every

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

a considerable analogy between these


ideas,

phaenomena; that
a
lively

when

recalled

by memory

in

and

forcible

manner, produce impressions and

emotions very similar to those which arose when they

were

first

presented to the mind.


facts

But a number of pathological


which establish
grounds.
this conclusion

may

be adduced,
satisfactory

on more

Some

facts of this kind I shall novv mention,

which tend

to display

the intimate connexion of the

mental phasnomena of memory, or recollection, with


certain organic operations carried
fabrick.

on

in the nervous

In the

first

place

it

appears, from facts which are

familiar to every body, that a certain condition of the

brain

is

necessary, in order that the individual

may

enjoy the faculty of memory, or of recollection, in a

complete

state.

There

is

scarcely any long continued

disease of the brain, which does not,

more or
first

less,

impair this faculty.

It

is,

indeed, the

mental

power which decays, as well on the approach of old

THE NERVOUS SYSTEM.


age,

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

Injuries of the either

head

will

induce the same

effects,

immediately or more gradually.

This

last

interesting

phcenomenon is more when it occurs.


Hildanus, and cited by

infrequent, and therefore

more

case

is

reported by

Van

Swieten,

of a boy of

quick parts, ten years of age,

who met

with a blow,

which occasioned a depression of the


lambdoidal
place,
left,

skull near the

suture.

No

severe

symptoms taking
it:

the

depressed

portion

of the cranium was


the boy's
that he
idiotic

without any

attempt to remove
gradually
so
to

memory was found


became incapable of
until his death.

fail,

instruction,

and continued

But those observations are more


tial

striking, although,

perhaps, not more conclusive, which show that par^defects of

memory may
;

be occasioned by dis-

ordered states of the brain


it

and particularly when


trains

also appears, that

when

the healthy condition of

the

brain

is

restored,

certain

of ideas are

recovered

which had vanished during the disease.


here remark, that there are also analogous
indicate, that trains of ideas,

We

may

facts,

which

which had

been obliterated in the natural way by the mere lapse


of time,

may

be revived, in a surprising manner, in

consequence of the preternatural excisemen t of the


brain,

which

exists in certain

morbid
I

slates.

A
in

gentleman with
I

whom
full

am

acquainted,

and

whose accuracy

have

reliance, has given

me

IG

MEMORY DEPENDENT ON
own

the following account of the symptoms which dis-

played

themselves
head,

in

his

case,

after
fall

a severe

injury of his horse.


in

occasioned
to his

by a

from

his

He

was confined

bed for several weeks,

a state of imperfect consciousness.


state,
it

On
all

his recovery

from that

was found that

recollection,

not only of the accident,

but of the circumstances


it,

which had
entirely

for

some time preceded


mind.

had vanished

from

his

considerable time elapsed

before the lost ideas began gradually to recur.

The

circumstances of his journey returned, one by one, to


his

memory,

as he repeatedly rode over that part of

the country where the accident took place, the sight

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

been observed, that persons

who had

learnt to speak

some

foreign language have lost this

acquisition in consequence of disease or injury of the

head.

injury of the head,

Mr. Abernethy has recorded the case of an which happened to a foreigner,


during his

twenty-seven years of age,


fectly well
:

who spoke English illness this man could


is

per-

only

answer
old.

in

French, and said he was but sixteen years


the follow-

But a more remarkable instance


occurred some years ago at

ing, vi'hich

Hospital:
"

St.

Thomas's
a

man was

brought

in,

who had

received

considerable injury of the head, but from which he


ultimately recovered.

When

he became convalescent

he spoke a language which no one about him could

THE NERVOUS SYSTEM.


comprehend.

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.

In the course of that

period he had entirely forgotten his native tongue and

acquired the English language. But

when he recovered

from

his accident

he forgot the language he had been


originally acquired

so recently in the habit of speaking, and regained the

knowledge of that which he had

and lost*."

Two
trine,
vi'ere

instances,

tending to establish the same docstill

but,

perhaps,

more curious than the above,

reported by the late Dr. Rush, of Philadelphia,

in

the course

of his lectures on the Principles of

Medicine f

One of them who during the


fever,

is

the story of a French countess,

anarchy had left her country, and resided in England. " She had a severe attack of
late
in the course of

which she became completely

delirious.

At

this

time she was frequently heard to a sort of jargon, which at


first

talk

and cry out

in

was

quite unintelligible to every body,


sist

and seemed

to con-

of mere sounds without meaning.


to

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

believe these observations

were never published by Dr. Rush,

am

indebted to Dr. Stock, of Clifton,

who was

a pupil and

friend of Dr.

Rush,

for

my

acquaintance with them.

Dr. Rush

used to relate them as facts of which he had personal knowledge;


or, at least, certain information.

18

MEMORY DEPENDENT ON
declared that she understood the countess, and

who

affirmed that she spoke correctly in the

Welsh

lan-

guage.

When

the lady recovered from her illness, and

again spoke to her friends in an idiom intelligible to

them, they related the fact to her, which had excited

no small
the

surprise

and

curiosity.

They were then

informed, that during her infancy she had been taught

Britanny, by a nurse

Armorican language, or the dialect of Lower who was a native of that country,
it

but had totally forgotten

many

years before

the

attack of fever, which in so curious a

manner revived

the impressions that had been so long obliterated *."

In these instances

it

would appear, that during the


a
state

unusual excitement of the brain, which was the effect


of that morbid state (probably
mation,)

of inflam-

produced

by

fever,

certain

actions

were

re-excited in the organic structure,


for

which had been

many

years totally suspended, and these renewed

actions recalled those ideas in the

mind with which

they had formerly been connected.

The

following fact,

with

which I have become

acquainted through the same channel,' tends further


to illustrate this subject,

and

to

show

that

no other

than the above solution

is

admissible.

student at an university in the United States,


I

who, as

may

observe,

is

now one

of the most
possessed

respectable

clergymen in that country,

tolerable share of classical knovvledge,

when
In
to

the con-

sequences of a fever, wdiich affected his brain, deprived

him
*

entirely of his
of

former acquisitions.
is

fact,

he

The language

Lower Britanny

well

known

be a dialect

of Welsh.

THE NERVOUS SYSTEM.

19

had now become so ignorant that he was not only


unable to read a Latin book, but even knew nothing
of the grammar.
health,

When
:

he had regained

his bodily

being of a persevering disposition, he began


first

again the
to

rudiments

every thing was quite

new

him

he passed through the accidence and syntax


to construe,

in his

grammar, and was learning

when,

one day, as he was making a strong

effort to recollect

a part of his daily lesson, the whole assemblage of


ideas which he had formerly acquired and lost, sud-

denly re-appeared to his mind, and he found himself


able to read and understand the Latin authors, as he

had done before


In
this

his illness.

case

the

brain,

or

perhaps

some part

of that organ,

having gradually approximated to the


the

healthy condition during

period of this young


far restored to the

man's convalescence, had been so


healthy state, as to be capable,
strong
effort,

when roused by a
it

of suddenly regaining the actions

had

formerly performed.
I have heard lately of a case, in which the
cir-

cumstances of the two examples above mentioned


are in

some
fit

respects reversed*.

lady, fifty-one years

of age, of sanguine complexion and plethoric habit,


after a

of apoplexy, which held her in a state of


for

inconsciousness
to

three

or four

days,

was found

have her

faculties in

some

respects impaired.

The

obtained this account from a medical gentleman,

who

after-

wards attended the lady who was the subject of the observation.

The

case was related

to

him

in so circumstantial

a way as to

leave no doubt of the correctness of the statement.

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

lady herself spoke

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,

events of a certain date.

A
all

lady in

some years ago an


her
faculties
in

attack

of apoplexy, has

recovered

respects, with one exception.

She cannot

recall

the

name

of any body,

but
is

is

able to identify well

enough the individual she


his

speaking of by describing
with

person.

Another

lady,

whom

am

ac-

quainted,
lection

after a severe fever, lost at times the recol-

of

many

things

that had

happened to her

previously to the attack.

Not

long before her illness

she had been married, and for


retained

some time she evea

no

traces

on her memory of an event so

important and interesting to her.


*

parallel case
in

to this is related

by Wepfer, and cited by

Dr. Abercrombie,

his

learned researches into the pathology

of the brain in apoplexy.

The circumstances were


same
side

as follow

An

old gentleman

was
:

seized with

hemiplegia of his right

side,

with profound sleep

the

was convulsed on the second


the 9th

day, and the palsy disappeared.

On

day he recovered
After
then began

from the

state

of stupor,

but his

faculties

were gone.
;

several weeks he began to


to

know

his intimate friends

remember words,

to repeat the Lord's prayer,

and

to read

a few

words of Latin, {rather than German,


every day.

his oxvn native

language,^
off

While making slow advance?, he was cut

by a

stroke of apoplexy.

THE NERVOUS SYSTEM.

SI

In some morbid states of the brain, which take place


during childhood, the powers of memory, and perhaps

some other

facuhies, are displayed in an earlier age

than the natural one.

We often

hear of precocity in
it is

the developement of the faculties, and

generally

connected with some diseased tendency in the constitution.

There was

lately living

in

Bristol a child,

about three years old,


birth,

whose head

exhibited,

from

the appearance which indicates chronic hydro-

cephalus.

The bones have

never closed.
;

The

quantity
is

of

fluid

is

subject to variation
is

when

the vertex
;

tolerably tense, the child


flaccid,

in the best health


it

when
dis-

she

is

disordered

but

has been so tense as

to

produce convulsions.

This child has always


faculties.

played premature developement of her

When

one year old she

cofuld talk fluently,

and exhibited an

uncommon
In

acuteness of perception.

this case I

suppose that the convolutions of the

brain are preternaturally expanded by fluid contained

within the cerebrum

hence

perhaps a premature
;

growth or evolution of the organized fabrick


texture, the operations of

that

which are instrumental to

the

action of

memory,

particularly of speech,

was
its
is

brought into a state of aptitude for performing


functions at an age when, in a healthy subject,
it

only beginning to be developed.

These
us,
if I

facts,

and the obvious solutions of them, lead

am

not mistaken, to the conclusion, that the

operations of the

memory,

like those

of sensation, are

connected with certain actions in the nervous fabrick.

As

that act of the

mind which we

call sensation is

uniformly preceded by a certain action in the material

22

MEMORY DEPENDENT ON
;

organ, the brain


recalls to itself

so the operation

by which the mind

and passes

in review ideas formerly

received from the senses, requires the instrumental aid

of certain processes, carried on in the same organic


structure
;

which processes being interrupted by a

diseased state of the brain

and nervous system, the


is,

mental power of recollection


suspended.
It is probable that

to the

same

extent,

no idea passes through

some concomitant, or rather previous operation of the nervous system or some change in the momentary condition of the nervous fabrick.
;

the mind without

The
site

organic action of the brain seems to be as requito

the recalling an idea into the mind, as the the string of a harpsichord
is

movement of

to the

generation of a corresponding musical tone.

These considerations
least they

serve,

in^some measure,

to

explain the doctrine of the association of ideas; at

connect

this last

pha3nomenon with a

class

of phaenomena, with which physiology has rendered


us well acquainted.
It is well understood that the
in

law of association prevails very extensively


actions of the corporeal organs
:

the

indeed the functions

of

life

could not,

as far as

we can apprehend, be
as

sustained without this regulation in the animal eco-

nomy

it

must be considered

one of the most

general laws of our bodily organization.

But

in the

philosophy of mind, the fact alluded to stands alone.


It

seems improbable that such a remarkable coin-

cidence should be found in the laws of the bodily


functions,

and in those which properly and exclusively

have reference to the mind.

We

are tempted
is

to

suspect that the latter phaenomenon

resolvable into

THE NERVOUS SYSTEM.


the former.

23

Now

the mental phaenomenon, the asso-

ciation of ideas,
to

the

may be so far explained by adverting conclusions we have drawn respecting the

functions of the brain.

We

have seen that a certain


is

action in the nervous

system

the necessary pre-

cursor, the physical cause, or material instrument

by

which every idea


actions, associated

is

called

up

in

the mind.

These

actions of the nervous fabrick are, like other corporeal


;

those which have already taken

place simultaneously, or in sequence, have a tendency


to recur in

the

same combination
all

this

is

exactly

analogous to what prevails in

the functions of the


recurring
in
this

body

the

actions

of the

brain

manner,

call forth the

mental ideas with which they


;

are severally connected


tion,

and thus the law of associa-

which
has
is

is

properly a law of the corporeal func-

tions,

its

sway over the mind.


difficult to

It

not

show, that

all

the observations

we have made
nation.
this

respecting the theory of

memory, may

be applied to the faculties of conception and imagi-

The most
;

familiar pathological facts lead to

conclusion
is

as those of dreams, in

which

this

faculty

alive.

How

closely are these

phsenomena

connected with the state of the body, and particularly


with the excitement of the brain
!

Sleep after any

great mental exertion, or under other circumstances

which induce vascular excitement


tion in dreaming.

in

the head,

will

generally give rise to active efforts of the imagina-

The

ordinary phcenomena of febrile


the

delirium are related to


afford
this

same

observation,

and

sufficient

proof of the above position.


shall

On
we

subject

we

have more to say when

24

REASON INDEPENDENT ON

proceed to consider the condition of the brain in

madness.

There

is

one very important faculty of the under-

standing to which none of the facts

we have adduced
or that power

bear any reference

allude to

the Judgment, or
:

Intellectual Faculty, properly so called

of the mind by which


in speculative

we

distinguish true

and

false

philosophy,
is

and right and wrong in

morals.

This

the faculty to which the

name of
on

Reason has been given in the highest sense, and


which
It
all

science depends.

would be a very interesting inquiry, Whether


or whether

the brain has any share in aiding the operations of


this faculty,
it is

a power which the mind


all
?

exercises,

independently of
corporeal

concurrence on the

part of the
scarcely

organs

But I fear we are

possessed of the

means of obtaining any


this subject.

satisfactory conclusion

on

I
it

am

not acquainted with any fact which renders


that

probable

the action
is

of the mind, which


with,
It

is

termed judgment,

connected

or

dependent

upon, any action of the brain.

may

be said, that

analogy would lead us to infer that the functions^


of the nervous fabrick are instrumental in the operation
to

of this faculty
this

since

we have found reason


case

believe

to

be

the

with

respect
to.

to

the

mental phsenomena already adverted


is

But

there

in

reality
;

bering
faculty

and judging
which only

no analogy between remembetween the operations of a


produced by
conversant with

recalls the impressions


is

external objects,

and of one which

abstract relations,*

the acts of which are altogether

THE NERVOUS SYSTEM


distinct

.'^

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

nervous system in which the reasoning, or the intellectual faculty,


is

perverted.

indeed, a

common

remark respecting
from
tions
false

lunatics, that they reason correctly

premises.

Owing

to the irregular excite-

ment of

the brain in this disease, erroneous concep-

are indelibly impressed

upon the mind

but
the

when he can be induced


lunatic often evinces as

to exert this

faculty,

sound a judgment, as acute powers of discrimination, as a man whose faculties


are uninjured by disease. If this faculty
is

really not subject to disease,


its

when

the brain

is in

a distempered state, and

functions

are generally thrown into disorder, this circumstance

seems
is

to afford

a presumptive proof that

its

exercise

independent of the brain, and belongs entirely to

the mind.

SECTION

III.
to other Classes

Pursuit of the same Inquiry with respect

of Mental Phenomena. Pathemata subdivided into Passions or Emotions, and active Principles ; including
Propensities

and

Affections.

Inquiry

how far

Phenomena

are related to the Nervous System.

Lastly;

these

respecting Volition.

Besides

the intellectual faculties, or the powers of

the understanding,

we

are acquainted with a variety

26

PATHEMATA, OR PASSIONS

of phsenomena, which are said to take place within

our minds

or which, to speak

more

philosophically,
I allude

are the subjects of our consciousness.


all

to

the passions, desires, anxieties, hopes,

and

fears,

which
life:

constitute the happiness

and misery of human

Quidquid agunt homines, votum, timor,


Gaudia, delectus.

ira, voliiptas,

As
the

all

these phsenomena are


as

known

to us

through

same medium

the operations of the under-

standing, they are, for that reason, termed affections

of the

mind, or of the soul.

By

writers
all

on the
included

philosophy of the

human mind,

they are

under the terms active and


of phasnomena
since

moral powers.
only

These

terms convey a very inaccurate idea of the whole


class
;

one department
necessary, in

of them can be said to have any immediate influence

on

action, or relation to morals.

It

is

order to avoid frequent repetitions, to

make
the
is

use of

some general
I

denomination

and

as

English

language absolutely contains none that

applicable,

hope I

shall

be excused for adopting the Greek


;

term Pathemata

in

which

I include the

whole class

of phsenomena above described.


to subdivide into

This class 1 venture

two orders.

The
:

first

of these

may
part,

be termed Passions, or Emotions

they consist of

phsenomena which are attended,

for the

most

with a strong and vehement impression on the mind,

and do not immediately, or necessarily, excite


particular action
:

to

any
fear,

such are joy, exultation, hope,


surprise,

sorrow,

regret,

remorse,

wonder, and the

AND ACTIVE
like.

PRINCIPLES.

27

The second
desires,

order of Pathemata comprises the

appetites,

and aversions;
Tliey

or

those innate

principles

which immediately excite or prompt to

voluntary action.

may

strictly,

and properly,
not,

be termed active principles.


include

We

do

however,

among them
though
:

Volition, or the action of the

Will
ciple

itself;

this is, in
it

a certain sense, a prinin

of action
respects,

but

is

clearly, distinguished,

many

from the Pathemata, and must be

considered separately.

We

have already found reason to conclude, that

those mental

phenomena termed
are produced

intellectual, at least

several of them,

through the instru-

mentality of the brain and nervous fabrick, or are


closely connected with the functions

and movements

of that system.
the

By some

it

has been supposed that

Pathemata are equally associated with operations

of the nervous system.

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,

the actions of the under-

standing and the pathemata, have no feature in com-

mon, except the circumstance that they are both the


subjects of consciousness,

or become

known

to

us

through the same channel.


there
is

In

all

other particulars

no resemblance or relation whatever between

the intellectual

phaenomena and those we are now

about to consider.
I.

Of the
;

Passions.

The

ancients referred the faculties of the under-

standing to the heart

and Galen found

it

necessary

28

THE PASSIONS INDEPENDENT ON

to enter into a disquisition, to prove that the organs^

with
head.
sions

which they are connected, are seated

in

the

Some modern
and
affections

writers have referred the pas-

to

the

head.

Perhaps

in

so

doing they have

made

as great an error as those

who

ascribed the intellectual faculties to the heart.

In

common

opinion, the passions, as well as the

affections, are referred to the viscera of the thorax

and

abdomen, as many expressions


ficiently
testify
;

in all languages suf-

such as a good and a bad heart,

bowels of compassion, and similar phrases in other


idioms.
It
is

not

difficult

to

account for these expressions,

and

to trace the notions

which gave

rise to

them

to

their cause.

They have
all

evidently originated in the

powerful effect produced on the functions of the parts


alluded to by

vehement emotions.
total

Many

persons

have experienced a
in

loss of appetite,

and even
Anger,
in the

nausea, in consequence of sudden grief orjo}^

most people, occasions a sudden increase


of
the
circulation
:

force

in

others

it

appears

to

diminish the flow of blood to the face and extremities.

Anxiety, especially
in the intestines,

if

long continued, induces anguish


Palpitation,

and a bilious diarrhoea.

or syncope,
*

is

the effect of sudden terror^'.


this

Hence

quaint epigram, founded on

circumstance, has beea


:

preserved from the comedies of Anaxandrides, of Rhodes

P%^'

yap iv^vq

/} Eo'-i?

osdoixoTa.
all the bod}-, rejoicest in

O
evils

malicious heart! thou alone, in


;

our

for

thou leapest whenever

it is

seized with terror.

THE NERVOUS SYSTEM.


it

29
their seat

was supposed that these passions have


which
is

in the part

felt

to

be so powerfully affected

by their operation.

These
sions,

notions, respecting the locality of the pas-

are very vague

and undefined.

Physiologists

have attempted to render them more accurate, without losing sight of the same principle.
jectured,

Bichat con-

that the ganglions of the great intercostal,

or sympathetic nerve, which are dispersed

among

the

thoracic and abdominal viscera, are the seat of these


operations.

This was, however, a mere hypothesis,


facts.

unsupported by any conclusive

It is

even in

opposition to the tenour of the phtenomena, of which


it
is

proposed as a solution.
its

The same emotion

will

display

principal effect

on

different organs in dif-

ferent individuals.

Terror in one person increases


in another,
its

the secretion of the liver;

effect is

confined to the excitement of an irregular action of


the

heart;

but

the

particular
if

effect

ought to be

constant and unvaried,

the mental

emotion were

connected

vvith

some

particular ganglia of the great

sympathetic.
this

The
is

vagueness of popular language on


to

subject

sufficient

prove that the feelings


referred

of

men

are very various.

The Greeks
and reins
;

most
;

of the passions to the


the

liver,

spleen, and diaphragm

Hebrews

to the bov^els

we

refer

them
vary

almost solely to the heart.

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

THE PASSIONS INDEPENDENT ON


which happen
in

affected in each individual

him

to

be

endowed with the


proof,

greatest susceptibility of impression,


irritability.

or the greatest delicacy and

There

is

no
the

or even reason to presume, that any organic


is

action carried on in these parts, precedes, or


efficient

cause of the mental emotions.


its
is

Later writers on the nervous system, and


tions, refer the passions to the brain.

opera-

This

a mere

hypothesis.

It

would seem that physiologists have


fix

thought

it

necessary to
it

upon some

locality,

as

Descartes thought
seat

worth while to conjecture the

of the soul

and being discontented with the


even with the modified one of

vulgar notion, and

Bichat, they found no other refuge but in the brain.


I

am

at present acquainted with

no

fact, either in

physiology or pathology, which furnishes any ground


for presuming that those mental phaenomena,

which

are termed passions,

take place through the instruprocesses

mentality of any corporeal

whatever.

It

seems
soul,

to

me

probable that they are affections of the

or immaterial principle,

and that primarily, and


displayed in the viscera

without the co-operation of any part of the corporeal


structure.

The phaenomena
:

are merely the effects of the sympathy between the

mind and the body


acts

they

are at any

rate

conse-

quences, and not causes.

As

the organized structure

upon the mind,

in the case of sensation

and per-

ception, so, in the instance of the passions, the pri-

mary operations of

the

mind

react

upon the body.


different organs
rise
:

They
the

act in different individuals

upon

influence of terror in

one person gives

to

violent palpitation of the heart, in another to diarrhcea.

THE NERVOUS SYSTEM.


II.

51

Of the
includes

Active Principles.
several

This term
they

phaenomena,

distin-

guished by various circumstances from each other:

may

be subdivided without end.

The common
that they excite

characteristic of the

whole order

is,

to action, or give occasion to the operation of the


will.

All the active principles might be arranged into


viz.

two departments,
according
to

Propensities

and Affections,
they
are

the

objects

towards which

directed, the former term distinguishing all those ten-

dencies

to

action

which aim at the pleasure and

comfort of the individual himself in


displayed, and the latter
directing

whom
him

they are

to seek the

good or

ill

of some other person.

The
he

agent,

who

is

under the influence of the former class of principles,


is

entirely selfish

under the

latter,

is

in

a great

measure

disinterested.

Yet

the
is

nature of man, as

well as of the lower animals,

so constituted, that, in

aiming at

self-gratification,

the
is

individual

is

led to

some mode of

action which
;

beneficial to his fellow-

creatures or to society

as, for

example, to the propaa matter that would

gation of his species

which
left to

is

be neglected
of
dut}^,
:

if it

were

depend upon the sense

or a patriotic regard to the


while,

good of one's
affections

country

on the other hand, the


safety

which immediately respect other persons, tend secondarily to

promote the
;

and comfort of the


which seems
to

indi-

vidual

as anger or resentment,

have

for its end, or, at least, contributes in effect, to deter

from the commission of injury.

32
But

ACTIVE PRINCIPLES INDEPENDENT ON


it

belongs to the metaphysician, or moral phi-

losopher, to analyze the operation of these principles.

The
to

inquiry I

am now

interested in

is this

Are they

be viewed as

phenomena
there

of the mind or soul

exclusively, without

any co-operation of the nervous

structure?

or

is

any organic process


called

in

the

nervous fabrick, through the instrumentality of which


the mental affection
is

forth or excited

In

other words,

Have
is

these

phaenomena any
intricate
in

local seat in
?

the brain, or in other parts of the nervous system

This question
than
I

much more
of

and obscure
conclusion
;

that

which we considered
despair

the last section.

almost

coming

to

any

which may appear tolerably well established


the attempt must not be relinquished.
If
it

yet

could

be elucidated by physiological data, a great advantage

would be obtained with respect


diseases
;

to the theory of mental


it

but,

unfortunately,

is

from

pathology

alone that

we

are furnished with any facts which bear

upon

it.

Before proceeding to this inquiry, with the scanty


resources
pensities

we
still

possess,

we must subdivide
and

the
;

pro-

further into appetites

desires

the

former, comprehending the bodily propensities, hunger,


thirst,

and the sexual desire:


is

the latter,

all

those

whose aim
objects
;

something more remote from sensible


the love of
short,
all

such as the desire of knowledge, or curiosity


;

the desire of possession, or covetousness

power, the propensity

to

fight

and,

in

those principles which afford the most


tives

common

incen-

to activity

and exertion.

The whole

of these

THE NERVOUS SYSTEM.


propensities might be termed, not improperly,
instincts,

33

human

as they bear a certain analogy to the active

principles of animals.

Perhaps
desire

it

would be

strictly philosophical to

genethe

ralize the propensities,

and

to

reduce them

all to

or

appetite

for

pleasure,

and

the

aversion

to pain.

With
liable to
;

respect to the appetites, they are obviously

be affected by the states of the corporeal


as the appetite for food
:

organs

by the

state of the

stomach

hence there are diseases of appetite, as

Bulimia, Pica, Satyriasis.

But these
is,

facts scarcely

bear upon the question, which


desire, or

whether the act of


is

appetency, of which a person


is

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

believe that the act

of sensation or perception

Now,
we
is

a certain state
shall get rid of

of the stomach indicates to us that a


feelins:

of uneasiness,
;

and obtain one of animal


in proportion to
is

pleasure, by eating
this intimation.

and the desire


is

All that

subject to variation
;

in

the state of the digestive organs


sure

the desire of plea-

and aversion

to pain,

in
is

which the conscious


invariable.

or mental appetency consists,


therefore,
is

We

have,

no proof from pathology that

this appetite

dependent on any action carried on in the nervous

system;
applies
petites.

and the same remark, mutatis mutandis,


with
equal
force
to
all

the

other

ap-

There

is,

indeed, one species of excess in the appe-

34
tites,

ACTIVE PRINCIPLES INDEPENDENT


that belongs to the

OK"

mind

mean

the inordinate

desires of the habitual

gourmand or debauchee.

But

every one perceives that these moral disorders do not

belong to the nervous system.

On

the whole,

vi^e

may

conclude, that the appetites

are so far dependent on the body, as to

become

active

only under certain states of the organs, or according


to the requirements or necessities of the system
;

it

being a condition of their nature to act as their operation


is

called for,
:

or

is

likely to

be efficaciously perthe appetites are

formed
desire
all

but, with

this exception,
;

uniform and unvaried


of pleasure,

the aversion to pain, and the

remain fixed principles, amidst

the changes which the nervous system undergoes.


if this
it

And

conclusion be allowed with respect to the


will

appetites,

more

readily be conceded with regard

to those desires

and aversions which enter so largely


All these, as I

into the moral history of our species.

have

said,

may

be reduced to the desire of pleasure,


to

and the aversion


of any physiologist

pain

and

have not heard

who has been


They

so ingenious as to

conjecture the site of these qualities in the brain, cere-

bellum, or solar plexus.

are constant laws of

human

nature,

liable

to

be affected

by no changes

whatever in the state of the nervous system.


are principles of action invariably impressed

They

upon the
objects

human
versally

being,

and necessary

to existence, being uni-

so

constituted

with respect to

the

at

which they prompt the individual


of pleasure,
are

to aim, that the

things and circumstances

which are sought as the


those
very
objects

sources

which

THE NERVOUS SYSTEM.

35

are most essential to the well-being of himself, and


the preservation of his tribe *.

The conclusion
is

to

which

have been led by the foregoing

considerations,

directly at issue with the inferences

which Drs.
:

Gall and Spurzheini have deduced from their observations


insist, as
it is

they

well

known, on the correspondence of certain pro-

tuberances or projections of the cranium, (from which a greater

than usual developement of the subjacent portion of the brain


inferred,) with the prevalence of particular propensities.
I

is

Although

entertain a high respect for the latter of these gentlemen, as well


his
to

on account of

moral qualities as

his talents,
I

and

the services

he has rendered
to cranioscopy.

anatomy and physiology,

liberty of doubting altogether that part of his

must take the system which refers

Dr. Gall,

in his

work on Craniology, has mentioned some pathodependence of various


its

logical observations, tending to evince the

active as well as intellectual powers

on the brain,

organization

and condition.
sities.
I

Some

of these refer particularly to the propen-

shall cite his

account of one incident, which

is

adduced
stated to

with

this

view, in which a disorder of the propensities

is

have followed an injury of the head.


between his

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

case from the fourth story; and subsequently to the

he

dis-

played great intellectual acuteness.

Nor was

this the

only change.

Nobody was
position, but

previously aware of any bad qualities in his disafter this accident

he displayed a depraved moral

character, which eventually proved the cause of his ruin.

relation of this kind proves nothing.

That an individual
If

at the

age of this youth should begin to display the influence


is

of powerful passions on his mind,


stories

nothing extraordinary.

of this kind gain credit,

the College of Surgeons

may

expect one day to march in

triumph and take possession of


;

the vacant seats of the criminal judges

and we

shall

proceed

forthwith to apply the trepan where

now

the halter

and gibbet are

thought most applicable.

36

ACTIVE PRINCIPLES INDEPENDENT ON

The

instincts of animals

seem

to stand in a near

relation to

the propensities

of man, and the same


respecting

observations

may

be

gain nothing in the

made way of

them.

We

explanation by referring

the instincts of the bee or the ant to any particular

ganglion in the nervous system of the animal.

NOW

proceed to the other class of active prinaffections,

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,

the parental affection,


brute
creation
as
in

(a principle

as

strong in
;

the

the

human

species)

also malevolent affections, as hatred, envy,

malice, revenge.
It

has frequently been asserted, and


that

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

had previously been


but even
manifest

most

affectionately

attached,

decided hatred and antipathy towards them.

In other

instances, the temper has been so much altered in

consequence of some diseased condition of the body,


particularly under certain

morbid

states of the brain

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-

THE NERVOUS SYSTEM.


sons

S7
and
easily
'

have

become

extremely irascible,

excited into dreadful paroxysms of rage.

Are

these

examples of disorder and perversion


principles, induced

in

the active

by morbid
it

states of the nervous

system

If this be the case,

must be allowed that

those actions of mind, which belong to this depart-

ment, are so closely connected with certain processes


carried

on

in the cerebral texture, that

when

the latter

are thrown into disorder, the mental operations are


liable to

be disturbed.
''^

I believe most of the facts, which appear to lead us


to this inference, admit,
different

when

strictly

examined, of a
instances

explanation.

The apparent
if

of

perverted natural affection are often,

not always,

dependent on some hallucination.

The

insane mother,
aversion for
to

who
little

neglects

her offspring,

only feels

imps or dasmons, which she imagines


in

have

been substituted

the place of her

when they were

cruelly torn

from

her.

own children, The irascible

madman
to

is

the victim of

or mortification,

some vexatious disappointment which is continually harassing him


upon
his

the effect of this

temper,

is

added the

continual irritation resulting from the want of refresh-

ing sleep,

and from a thousand

feelings of internal

uneasiness, which are molesting him.

1 have scarcely seen any instance of alteration in the temper and affections, which did not bear
a.

pretty

exact proportion to the irritamenta that were con-

nected with

it,

or which, in cases bordering on lunacy,

were not dependent on some latent hallucination, or


false impression.
in
all

If this explanation can be admitted

instances

where the affections appear to be

38

ACTIVE PRINCIPLES INDEPENDENT ON


it

perverted,

will

follow

that

we have no decided
which
has

instances of original disorder in this part of the mental


constitution
;

and

the

argument
organic
it

been

drawn
mental

in

proof of the intimate connexion of the


with
operations
in

processes

the

nervous system, must, as far as

relates to this clasg

of phaenomena, be abandoned.

We
facts

shall

have occasion to consider more


subject

fully the

bearing on this

when we

enter

upon

the description

of madnesSo

Of
There
is

Volition.

another faculty of the


its

mind, which,

though connected in

operation with the phaenoin nature, totally dis-

mena above mentioned,


tinct

is yet,

from

all

of them.

mean

Volition,

or that

mental act of which we are conscious, that precedes


every voluntary

movement or

exertion of the muscles.

There

is

no reason

to believe that Volition has


its

any
It is

local seat in the body, or that

exercise

is

preceded

by, or effected by

means of any organic change.


as
far as

an act of the mind, in the performance of which


the nervous
share.

system,

we know, has no
same
relation

Volition

may be

said to stand in the

to the passions

and propensities, which Judgment, or


Sensation and Percep-

the Rational Faculty, holds with respect to the other

powers of the understanding.


tion,

Memory and

Imagination, present to this highest

intellectual faculty the objects

on which
arbiter

its
;

powers are
surveys the

exerciscd

It stands as

supreme

THE NERVOUS SYSTEM.


testimony of the inferior faculties
;

39

compares, discerns,

judges what

is

true

and what

false

what

right

and what

wrong

in morals;

what

is

expedient and what inex^


life.

pedient in the business of

human

In like manner,

the Will compares the various motives

which are

presented to
tites,

it

by the desires and aversions, the appe^

affections,
its

and other active and moral powers,

and makes
is

own

choice from

among them.

It

important to observe, with respect to the theory of

the mind, as well as to that of the nervous system,


that these two highest powers, the principal or govern-

ing

ones,

in

both classes of mental


learn, distinct

faculties,

are,

as far as

we can

from and independent

of the organization; although the objects on which

one

is

exercised,
its

and the means by which the other


are furnished

produces
organs.

effects,

by the corporeal
act of the

Volition, as

we

well

know; even an
;

Will to move the limbs


lytic
;

may

take place in a parabrain, the

but

it

becomes abortive, unless the


its

nerves and muscles, be in a state to obey

mandate.

SECTION

IV.

Solution of an Objection to some of th^ preceding Remarks. Recapitulation. Is the Nervous System the Organ of any

of the physical Functions

Notwithstanding what
going sections,
fabrick
is,

has been said in the fore-

it

cannot b^ denied that the nervous


;

in

one sense, the organ of the whole mind

40
since
all

REPLY TO AN OBJECTION.
when
the brain
is

compressed, as in apoplexy,
are suspended.

the phasnomena

of mind

This

may be

thought to indicate that the function of the


is

nervous system

instrumentally subservient to the


the mental processes without ex-

performance of
ception.

all

No

mental process, indeed, whatever can go on


is

while the brain


function
tion,
:

in

a state of inaptitude for

its

the acts of sensation, perception, recollecall

conception, or imagination, are


:

performed by
these faculties

the aid of organic operations

but when

are reduced altogether to a state of inaction, the reason-

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

be applied to the passions and

the active

powers; they must be quiescent, while the perceptions or ideas

which

call

them

into action cease to

present themselves.

It does not, however,

from

this

consideration, follow, that these faculties,

when they

have an opportunity of exerting themselves, require


the co-operation

of any organic action.

They may

be no further dependent on the brain than in so far as


they can only act,

when the

ideas with which they

have to do, the materials on which they are exerted,


are supplied by those operations which the soul per-

forms by the aid and co-operation of the bodily instrument.

These are the commencement of every


:

train

of mental actions

every series of operations begins

with the body, and ends with the body, though the

more remote

links are

withdrawn from

this

intimate

connexion with the organized instruments.

EECAPITULATION.
I shall

41
which

now

briefly recapitulate the inferences

I have obtained from facts adduced in the foregoing


sections.
It

appears certain, that every sensation of which


is

the mind

conscious,

as

well as every subsequent

act of apprehension or perception, of recollection or

memory, of conception and imagination,


in itself

although

an

affection of the soul or immaterial part of


its rise,

our system, must always take


with

or

commence
of the

an operation
;

in

the

organic

structure

nervous system

the consequent operations of judgas


well
as

ment or the

rational faculty,

the phas-

nomena of
love or

passion
are

or emotion, desire or aversion,

hatred,

mental

processes
it

or affections

of the soul, with which I think


that

must be concluded,
this conclusion

we have no proof of

the connexion of any co-

operating organic process.

And

may

be drawn, perhaps more confidently, with respect tc


Volition.

The

theory of those processes which belong to the

mind, the disorders to which they are subject, and


their general

economy,

is

the province of the metaI

physician or moral philosopher.

am

only concerned

with the functions of the nervous system, which are


the vincula between the I

mind and

the body.

am

sanguine enough to hope that the time will


to

arrive

when we may be enabled


cerebral and

ascertain

the

nature of the

nervous functions,

and

perhaps to understand thoroughly the whole of the


process which
fabrick.
is

carried

on

in this part of

our bodily

At

present,

however,

we must

confess that

42

ULTIMATE CHANGES IN THE BRAIN.


are not in
it.

we
to

possession

of one fact that belongs

We
assured

may
that

indeed,
all

as

suppose,

be

pretty

well

the

operations

carried

on

in

the

nervous fabrick

itself are

of the nature of mechanical

or chemical changes; since these appear to be the

only processes of which

its

structure renders

it

capable.

The

nervous and medullary fibres of the brain


oscillations,

may

be capable of
tiuncules
;

or vibrations, or
structure

vibra-

though

by

their

they

do not

seem

to be well qualified for this


;

mode

of mechanical
contractions

operation

or they

may

be subject to
less
;

and elongations, more or

analogous to the pha3or


there

nomena of muscular
secretion
fabrick,

action

may
the

be

and
All

circulation

of fluids in

nervous

or a transmission of galvanic or other similar


these

influences.

are

mechanical or chemical
I believe, safely conclude,
in

operations;

and we may,

that the ultimate changes

the

condition

of the

nervous

structure,

which immediately precede the


afl^ections in the

phaenomena of sensation and other


mind,
are

chemical

or

mechanical

changes.

But

further than this general conclusion


to proceed
until

we cannot hope
perfect

our knowledge of the structure of


shall

the

nervous

fabrick

be

much more

than

it now is. Even when we have reached

the utmost that

we

can hope to obtain, towards


of the nervous function,
that
it

elucidating the

theory

does not seem probable


ulti'

we

shall

understand the way in which the


is

mate operation of the organized fabrick

subservient

PHYSICAL FUNCTIONS.
to the consequent

43
;

pheenomena of mind

since

we

are,

and are

likely to remain,

utterly unacquainted with

the nature of the soul, of which these phsenomena are


affections.

While we are
it

entirely

ignorant of the

nature

or essential

properties

of mind,

we cannot

understand how

can be acted upon, or excited

into operation by any action of a material organ, such

as the functions of the nervous structure.

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

arrived at the conclusion of

what I

think necessary to say on the functions supposed to

belong to the nervous svstem.

Here

must make

some remarks on

the opinion of several physiologers,

who

consider this structure as the organ not only of

the mental phaenomena, but of several of the physical


functions;

who

regard

it,

for

example, as a chief

agent in the function of secretion, and as the cause

and depository of that principle termed


irritability.

muscular

It

must be allowed

to be, at the first view, extremely

improbable that the same organ should

be instru-

mental to operations so distinct as those which we

have just ascribed to the nervous system, and the


physical functions above mentioned.

There
it

is

also another consideration, which renders that these physical functions


I

probable

are

inde^

pendent of the nervous system.


that analogous

allude to the fact,

tribes of organized beings

pheenomena are displayed by those which are not endowed with

perves or brains.

The

nervous system

is

co-extensiye

44
with
the
:

PHYSICAL FUNCTIONS.
manifestations of

mind

in

the

organized

world

those beings which have no nerves display no


;

mental faculties

but even plants possess organs which


;

perform secretion

and the zoophytes, or the apathic

class of animals, are

endowed with

irritability,

though

they neither have nerves


consciousness or feeling.

nor betray indications of

But
all

this question

seems

to

me

to

be settled beyond

controversy by an argument derived from some

imperfect specimens of

human

organization

mean

children which have been born without brains, which


nevertheless were possessed of the function of secretion,

and endowed with

irritable muscles.

There are

even well authenticated relations, by which


that a

we

learn

human

foetus

can be formed possessed of both


all

these properties, and yet destitute of

rudiments of

the nervous system*.


*
I

shall not enter further into this subject,

which has

lately-

been treated with great ability by Dr. Alison,

who

has placed, in

a very clear point of view, the arguments which evince that


secretion

and

irritability are

independent of the nervous system.

I refer the

reader to his remarks, entitled, " Observations on the


ascribes Secretion and

Theory which
of the Nerves.

Animal Heat
D.," &c.

to the

Agency

By W.

P. Alison,

M.

On

the subject of

animal heat
It

have elsewhere expressed roy opinion.

must indeed be allowed that the physical functions are

subject to be influenced by the state of the animal functions, and


that this influence takes place through the
It is needless to cite

medium
which

of the nerves.
is

examples of

this fact,

familiar to

every pbysiologer.
subsists

It is

a necessary result of the connexion that

between the animal and the physical system.

PHYSICAL FUNCTIONS.

45

OTE
Some
of

A.

my

readers will probably be staggered at the

assertion, that all the natural

and

vital functions are to

be

resolved into chemical and mechanical operations. The expressions in which this proposition is announced will
therefore require
I

some explanation.
inhere
in
it

do not mean to deny that there are certain properties


to
life

peculiar

the living solid, or which

as

lonw as

continues, and are lost after death.


to

This

admission, however, presents no exception


proposition.

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

peculiar aptitude for certain

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

of this function to perceive that

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

precisely on mechanical principles.


If

we survey the remainder

of those processes in the

46

PHYSICAL FUNCTIONS
for

animal economy which have


for a time, in continuity

their

end to maintain
reason to con-

and perfection, the complicated

fabrick of the living body,

we

shall find

clude that they are carried on by mechanical and chemical

powers, brought into action under peculiar circumstances.

At

least the laws

of mechanism and of chemical affinity

serve so far to explain these processes, as to afford reason


to presume, that
if

our knowledge of the intimate structure

of parts vtere more complete, the whole theory of the


operations dependent upon them, would, on these principles,

be explained. Until the discovery


as
that

made by Harvey,
in It

the theory of the circulation


perplexities

was involved

as great

of secretion

now

is.

was just

possible to discover that there was an apparatus provided,

apparently

titled to

perform some operation upon mecha-

nical principles; but this

was

all

that could be determined,

and
to

this

is

all

that

we can now determine with


observe a very curious
system,
to

respect

secretion.
in

We

mechanical
operates in

structure

the glandular

but we do not yet


it

sufficiently

understand
a

it

know how
in the

producing

chemical change
through
it.

composition of the

fluids transmitted

There

is

indeed a class of physiologers, (among

whom
who

are reckoned

many

highly distinguished

writers,)

think they aie authorized,


this process

by the

difficulty

of explaining
affinity*

on the ordinary principles of chemical

however modified by mechanical operations, to conjecture


the presence of a peculiar agent, which they term the
Vital Principle. This agent
is

supposed to be an extremely

attenuated
fluid,

fluid,

analogous to the electric or galvanic


like

and possessed,
affinities

the electric fluid, of the

power
to

of modifying, under particular circumstances, the ordinary

chemical

of substances; so as to give rise

results diff'erent

from those which would take place

in the

absence of such a principle.


1

shall

not enter into the merits of this question, which

MECHANICAL AND CHEMICAL.


has of late undergone
for

47
sufficient

much

discussion.

It
[

is

my

purpose to observe, that the position

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

take the instance of secretion before alluded

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

a fluid analogous to electricity to be present

in the gland,

and by virtue of
mical
affinities,

its

controlling
assist the

power over ordinary che-

to

operation of the glandular

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

blood to aggregate themselves

result of chemical

and mechanical powers.

What
Thus
far

have said respecting secretion


a very

may be

applied

to any other process in the living body.

respiration

is

complicated function.

It is
is

performed by

the

aid

of voluntary muscles, and

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

the rest of the operation


in the

is

che-

mical, viz. the

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

heat, I shall content myself with referring to

analogies which lead to this inference.


first

some of These are, in

the

place, the relation which the degree of animal tem-

perature, peculiar to each species, preserves to the capacity

of the respiratory organs, and the extent of the changes

produced on the blood


animal.
air

in the respiratory

function of the

Secondly; The relation between the quantity of

consumed by any animal, and the degree of heat produced in any given time. Thirdly; I refer to the facts
developed
in

the experiments

of Black, Crawford, and

particularly the late experiments of

DrfDavy.
what they mean by
chemical

Those who
vital

refer tbe

production of animal heat to the

principle, have not explained

this

expression

but

it

can,

presume, be nothing else

than to represent the


agent.
sessed

vital principle as a peculiar

This principle cannot be imagined to be posof the


it
:

of producing
or other exist

power of creating the matter of heat, or where it did not before in some form
it

therefore only disengages the matter

of heat from some previous


influenc-e

compound by
:

a particular

in other words, it on the chemical affinities In no manner, therefore, operates as a chemical agent.

can we escape from the conclusion, that the production


of animal heat takes place on chemical principles.

The phsenomena of

nutrition, generation, growth, are

as yet very imperfectly understood.

They seem
in part

to be,

how^ever, modifications of secretion, conducted according


to very peculiar laws,

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

are led to this opinion

some animals

is

strictly a secre-

The germination
in the

of seed, and the developement of

eggs

process of incubation, require chemical agents.

MECHANICAL AND CHEMICAL.

49

the organic structure they

such as heat and moisture: peculiar actions are set up in contain; but the capability
set in operation
parts.

of these actions can itself only be imagined to result from

a certain mechanical structure, which

is

by

the chemical properties of

its

component

On

the whole, I cannot imagine that any person the subject, and lays aside
all

who
pre-

carefully CQusiders

judice or attachment to pecuHar modes of expression,


will

refuse to admit that

there

is

sufficient

reason to
vital

coQchide the whole of those processes, termed


natural functions, to

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
:

of the phrases which are peculiar to naturalists and physiologists,

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

and ever varied contrivance, of machines in which

we

live

50

EXISTENCE OF THE SOUL,

NOTE
'ascribing
that
elass of

B.

phaenomena with which we


the

become acquainted through


to the Soul, or in describing
terial

medium

of consciousness,

them

as affections of
is

an immaso

principle, I

am

using language, which

much

cut of the usual course of physiological disquisitions, as to


require
[

some explanation.
first

would, in the

place, wish

it

to be understood, that I

make no

reference whatever to the celebrated vital principle

of Hunter and his followers.


the mental

The

soul,

of which
is

suppose

phaenomena

to be affections,

to

be recognised
flatter

on very

different principles.

On

this subject I shall here


I

briefly express

my

ideas, although

do not

myself

with the expectation of saying any thing new: which, in


fact, is

impossible.

Nothing can be more unphilosophical than to ascribe attributes to a thing or being, the existence of which
is

in

any degree a matter of uncertainty, or requires

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

defence on the two following con-

siderations

It has often

been observed, with justice, by those


to

who
ness,

are

challenged

prove the existence of a soul


in

distinct

from
all

the

body,

which thought, conscious-

and

the properties of

mind

inhere, that the thing

does not require any proof

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

the former are the properties


the second are the

of body, those shown by

phaenomena of mind.
of some
first

AW

properties

must be

qualities

substance or

essence.

The
is,

essence to which the

set of properties belong,

bj common agreement, termed body or matter; that


which the second,
these essences
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
:

expressive as these words,

if

there were only a general


If any
x,

consent to use them for the purpose.


challenge

body should
I

me

to

prove the existence of


to

can only
only

answer him by requesting him


of
J/
:

prove the existence

the very

demand

is

frivolous

and absurd

it

proves that the person


first

who

puts

it

has no notion of the

principles of logic.
if

But
tical
;

any one chooses to assert that


the
properties

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

EXISTENCE OF THE SOUL,


from the contemplation of the one class is quite irreconcilable with a notion which
:

results, indeed,

a notion which
results

from the contemplation of the other class

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

the oniy instance in

which

the qualities of the one essence can enter into any sort of
relation to those of the other
;

and here they come into


less

the relation of contrast.

Some
X and y

writers,

and among them no


thing.

a philosopher

than Dr. Priestley, have made an attempt to prove that

ment

We never witness the phaenomena of mind except


:

are the

same

They

offer the following argu-

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

very safe to give us this challenge

we cannot

escape

out of the material universe; we have no faculties capable of being employed in such a pursuit; therefore we cannot
detect

mind or soul altogether separate from matter.


I

But

apprehend that
of
;

it

is

meant

to in

assert

that

the

properties

mind are only found


and
to call

connexion with
from matter,
in a

organization

to infer that they result

state of organization,
to

upon the immaterialist


from
he can very

show them somewhere


it.

in a state of separation

organized matter*.

If this be the challenge,

soon comply with

The whole
of the

universe displays the

most

striking

proofs

existence and operation of

* This

is

Dr. Priestley's argument:

"

The power of

sensation, or

perception, never having been found but in conjunction with a certain

organized system of matter,


this

we

ought, as philosophers, to conclude, that

power necessarily
it

exists in,

and

results from, that organized system,

unless

can be shown to be incompatible with other known properties

f the same substance."

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

or substance of that nature which

we

call

mind, separate

from organized body, not only somewhere but everywhere.


2.

The second
that

observation

to

which

I advert,

is

an

attempt, which appears to have been fully successful, to

prove

the

mental phaenomena cannot result from

the properties of matter, whether organized, or in any

way
comit

modified.

It

is

founded on experience, and a comparison


particles.
is

of the results which universally arise from different


binations

and arrangements of material

In

all

combinations whatever of material parts,

found that the powers or properties of the entire system,


are nothing

more than the sum


all

or aggregate of the

powers

or properties of

the parts.

Figure, magnitude, and


repulsion,)

motion,

(in

which are included attraction and

are the universal powers or properties of material


ticles,

par-

and from the combination of material particles


It

nothing has ever been known to result but some modification of figure, magnitude, and motion.
is

therefore

directly in opposition to the evidence of universal expe-

rience to suppose that a combination of material particles

can give origin

to

such phasnomena as those of pleasure

and pain, hope and joy,

volition, Sec* But some metaphysicians have said,

" The Creator,


particles,
it

being omnipotent, could endow material


state

in

a
If

of organization,
to bestow."

with whatever powers


is

pleased

him

This

a mere play upon words.

the powers bestowed were such as could not result from

any possible modification, or composition of the powers of


the parts, the

endowing of such a system with new

* 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

EXISTENCE OF THE SOUL,


can

mean nothing
it

else

than the adding to

it

of some new thing possessed of such properties.

On
tinct

the whole,

appears to me, that the existence of


dis-

a separate sentient, percipient, cogitative principle,

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

a thing so certain and indisputable,

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;
;

animals are suspected to be altogether devoid of feeling,

and

to be possessed

of mere

irritability;
-f.

a principle comas
it

mon

to animals and vegetables

Irritability,

is

merely a modification of mobility, a species of attraction,


or a susceptibility of being acted

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

objected to on any grounds, except those on which the advocates for

materialism found their attacks on the doctrine of an immaterial principle.

If organized matter alone


all

is

capable of conscious feeling,

it is
:

probably capable of

those other operations attributed to the soul

at

least no reason can be alleged to the contrary.


\

On

this supposition

zoophytes are termed, by Lamarck, " animaux

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

from some peculiar substance, possessed


life,

of chemical properties, inherent in a fibre during

which

is

dissipated soon after death, (the doctrine of the


it

Vital Principle,) or

results

from a peculiar
parts

state of

com-

position

or organization

in the

of the fibre, (the

doctrine of those

who do
is

not admit the Vital Principle)

and

this

supposition
result,
(viz.

evidently a tenable one, since the


that

supposed

peculiar

mode

of mobility,

termed

irritability,) is

only a modification of the properties

of the component particles.

On
as

either supposition, the

phaenomena of

irritability,

well

as all

those of the

natural and vital functions, generation, growth, &c., are

altogether within the region of matter and

its

properties.

56

PATHOLOGICAL SURVEY

CHAPTER

IL

PATHOLOGICAL SURVEY OF THE DISEASES INCIDENT TO THE NERVOUS SYSTEM.

SECTION
tomy.
Observations on

i.

Hesources far pursuing this Investigation


Conversions of Diseases.
Ladejitia*

Morbid Ana^
Connexio7is, the

Doctrine of

the History ^

and Juvantia and

"While we remain
parts

entirely unacquainted

with the

theory of those processes by which the component

of the nervous structure perform the

offices

allotted to them,

and are therefore ignorant

in Avhat

the ordinary and healthy action of these organs consists,

we

shall

never be able to form a clear and


of those

distinct

conception

changes or variations

from the healthy


of the Nervous

state,

which constitute the disorders

System.

An

artist,

who

is

unac-

quainted with the principle of motion in any piece

of machinery, can never

fully

understand the derangeliable.

ment
is

to

which

its

mechanism may be
disorders, or those

It

therefore impossible for us to discover the proxi-

mate causes of these

morbid con-

ditions of the system, of

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

awkward and imperfect attempts would make who endeavoured to


its

mend a

clock without understanding

mechanism.

OF NERVOUS DISEASES.

57

We

must confine ourselves

to a careful collection of

the facts which dissection unfolds, and

compare them

with the most complete and accurate account of the

symptoms and
results of

the history of diseases, and with the

experiments on their treatment.

Our

pro-

ceeding

must, in short,

be founded, in a great measure,

upon empirical*

principles.

The
I.

resources

we

possess for this investigation

may

be mentioned under three heads.

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

condition of the nervous system which differ from the


state of health.

II.
living,

We
to

are also enabled, by observations on the


trace

many

interesting

phaenomena
on
their

relating

to the

connexion of these disorders with those of


light
origin,

other functions, which throw


and, in

some

cases, direct us to a cure.


is

The
not,

con-

versions and mutual relations of diseases,


to

a subject
till

which the attention of physicians has

of late years, been

much

directed

but

it is

a resource

which

affords the

means of extending

the science of
assistance

pathology in

many of its departments. The

The very

opposite method, however, from that of


:

modern
to

empirics, or ignorant pretenders

it

is

often

observed that the


hy-

most ignorant of our profession are the most addicted


pothesis.

58
to be derived

INTIMATE CONNEXION
from
this

investigation

is

not more

important in any other branch than

in the difficult

research into the pathology of the nervous system.


III.
is

An
all

attention to the Juvantia

and Laedentia,

another

channel

of knowledge.

To

this

head

belong

experiments on the effect of remedies, and

the histories of cases which have been subjected to

various methods of treatment.


particular instances

From

a variety of

we

are enabled to deduce

some

general inferences respecting the

modes of
to

practice,

and even

to

throw an indirect light on the causes


combat.

and nature of the diseases we have

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

the observations suggested in the forefirst

going section, we are

led to notice a fact

which

of great importance in the pathology of the nervous


It

system.

would appear that many of the diseases

of this class are more nearly connected with respect


to their causes

and the morbid conditions


in

in

which

they consist,
classed

than

most of the disorders that are


other departments of nosology.

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

between these forms

so apparent,

common
and

observation, that
it.

and so much within the it seems almost


is

superfluous to notice
to

This

the case with respect

apoplexy

paralysis,

which are continually


condition.

passing into each other, and evidently depend upon


different degrees of the

same morbid

The connexion
it

of

apoplexy with epilepsy was


;

noticed as long ago as the time of Hippocrates

and

has been observed by

his

commentator Martianus*,
observations,
disorders,

that the latter disease

frequently terminates in the

former.
illustrate

Many
the

facts

and

tending

to

relation of these

have been

collected by

Morgagnif.
is

Epilepsy
palsy,

a distinct disease from apoplexy and


its

and yet

relation to both is very near


other;):.

and

they

all

frequently pass into each


partially recovered

Persons

who have

from a recent apoplexy


of the genuine

are often assailed by convulsions, which display most

of the pheenomena of epilepsy, and

fits

epileptic character frequently occur after

an attack of

hemiplegia

II.

On
1.

the other hand, persons


vers.

who

fall

* Annot. in

Hippoc. de Gland,
lib. 1.

103.
'

t Morgagni de Sed. Morb.


X

cap. 4. item cap. 9-

Dr. Ferriar has mentioned a case to which palsy was con-

verted into epilepsy,

and the patient died comatose. and

In his brain

were found scrofulous tumours, and water


Ferriar's
11

in the ventricles.

Dr.

Med.

Hist,

Reflect, vol.

ii.

p. 11.

Dr. Percival has related a case in which palsy, the sequel of

fever,

was converted into epilepsy, and afterwards into amaurosis.

60

INTIMATE CONNEXION"
fits
;

victims to repeated

of epilepsy, perish under

all

the

symptoms of apoplexy
a severe
fit,

and others, who recover from


fits

or from frequently repeated

of epilepsy,

are often found to labour under hemiplegia, or other

modifications of palsy.

Sometimes persons who have


lose
this disease,

long suffered under epilepsy,

and

become permanently paralytic*. There are cases which appear


so nearly intermediate
it

in their

phasnomena

between apoplexy and episay under which disease


classed.

lepsy, that

is

difficult to

they ought most properly to be


description

Of

this

are

those

fits,

which are frequently

re-

peated,

and

generally

continue for a short time,

leaving the patient nearly in the

same

state as before

the attack

but which have, during the continuance

of the paroxysm, none of the characteristic features

of epilepsy.
suddenly
previous

The

patient in

this

disease

is

seized

with

vertigo,

or
is

falls

down without any


a profound

symptom, and

like a person in

sleep, with

the pupils of his eyes dilated, and in a

state of perfect insensibility.

The

stertorous breathing,

which generally occurs


in fits

in true apoplexy, is
;

wanting
circum-

of this description

but in all other

stances they resemble, during their continuance, apoplectic attacks


:

yet the course of this disease


to that of epilepsy,

is

much

more analogous
this

and paroxysms of

sort

are

by many, and as we shall afterwards

The
*

case terminated in the restoration of health.


vol.
i.

(Essays Medical

and Experimental,

p. 148.)

Many

of these transitions will be illustrated by cases to be


t!ie

detailed in

following pages.

OF NERVOUS DISEASES.

6l

show, on good grounds, regarded as modifications of


that complaint.

There are some


appearance than

cases,

though of

less

frequent

those just

mentioned,

which are

intermediate in character between epilepsy and paralysis; the


fits

temporary duration and repetition of the

following the course of the former disease, and the

symptoms of the paroxysm resembling an attack of


palsy*.

Apoplexy and hemiplegia betray a


on which the
rise to the

like affinity to

mania: the condition of the brain and nervous system,


latter disease

depends,

is

nearly allied to

the morbid state of the

same
:

fabrick,

which gives
find palsy

former complaints
at

for

we

and

mania concurring
to

one time,

and

in other cases

passing into each other.

Maniacs are very subject expire suddenly under an attack of apoplexy in


;

case of this description

is

related

by Dr. Ferriar.
hand

The

patient was suddenly aflFected with a tingling pain, succeeded by

numbness

in the

thumb and

fingers of the right

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

about half an hour.

It

returned periodically.

See Dr. Ferriar's Med. Hist, and Reflect.

Dr.

Mead

has observed, that physicians have recorded several


palsies,
:

remarkable instances of periodical


lowing account from Carolus Piso

" An aged man was

and he quotes the

fol-

seized

with a sleepiness and great lassitude, which was followed by a dead


palsy, stupor, loss of
fever.

memory, and some degree of


lessening,

folly, with

These complaints returned regularly every new moon and the


last fits

for

two years, the symptoms gradually Mead's Works,


18 V.

had

but a faint resemblance to those he suflered in the beginning."


p.

63

INTIMATE CONNEXION

Other cases, after a violent paroxysm of delirium, the


patient
is

found to have
side.

lost the

power of voluntary
on the other hand, a degree of

motion on one

Paralytics,

are subject to various appearances of impaired intellect:

the most frequent of these


is
:

is

fatuity,

or imbecility, vi^hich
attacks of the disease

the general effect of repeated

but maniacal delirium

is

by no

means a
epilepsy.

rare occurrence under similar circumstances.


is
still

Insanity

more intimately connected with


this disease are often fol-

In very severe and inveterate cases of

epilepsy, the

paroxysms of

lowed by attacks of maniacal delirium,


generally of the most violent kind.

which are
fits

These

of

madness most commonly abate


the epileptic attacks have ceased
hovi'ever,

in a few days after


:

in other instances,

the maniacal state

is

of longer continuance,

and epilepsy is sometimes the harbinger of a permanent and hopeless insanity.


Vertigo
it is

is

sometimes a

distinct disease;

that

is,

the only morbid affection of the nervous system

that manifests itself;

though, like
it

many
is

distempers

of the class

we

are considering,

usually

com-

bined with some disordered functions in other parts of


the constitution.

Very
is
is

frequently, however,

it

happens that Vertigo


It

the harbinger of

some more grievous malady.


These
facts

most commonly symptomatic of apoplexy.

It like-

wise precedes attacks of epilepsy.

were
as

even noticed by Galen,

who

considered vertigo

allied in its nature to both these disorders*.


* In Apljiorism.

Vertigo

Comment.

i;i.

17-

OF NERVOUS DISEASES.
occurs also in chorea
;

63

and occasionally in almost


partial convulsion

every other disease in this class.


Fits of tremor

and attacks of

occasionally continue for

some

time, and occur repeat-

edly without any loss

of consciousness.
identified

In these

instances they cannot be

with the more

frequent and more severe diseases of the description

we

are considering.

The manner, however,

of their

occurrence,

and the symptoms which precede and


find

follow them, are sufficient to prove their relation to


epilepsy,

and we sometimes
is

them,

at

length,

assuming decidedly the character of

this disease.

Chorea
there are

an affection in many respects distinguished


class of diseases
;

from other species of the same

yet

some circumstances which

indicate a con-

nexion in pathology between chorea and paralysis,


as well as between the former disease

and epilepsy.

In chorea
and,

it

generally happens that the muscles

on
are

one side are more severely affected than on the other


in

some
to

instances,

the disordered

actions

confined

one side of the median

line.

I have

several times observed that the

same

individuals have

been subsequently attacked by palsy, and that the

same half of the muscular system, which was previously agitated

by chorea,

is

now subdued by hemiis

plegia*.

In epilepsy also the convulsion

sometimes

confined to one side of the median line.

The

limbs,

which have long been agitated by a

Among

the following cases of chorea several instances of this

description will be mentioned.

64
violent chorea,

INTIMATE CONNEXION
fall

into a state very

much resembling

a genuine paralysis.
Conversions of chorea, epilepsy, and paralysis, are

by no means rare occurrences*.


Chorea, as
in
it

is

well

known, resembles epilepsy,


In chorea, however, even
imbecility has appeared,

inducing,

after

a long continuance in a violent

degree, a state of fatuity.

when some degree of mental


the case
is

not so hopeless as when the functions

of the brain, which are subservient to the intellectual


faculties,

have been injured by epilepsy or

paralysis.

I have seen a boy,


idiot, after

who had

nearly the aspect of an

a long continued and severe chorea, restored

by a course of cathartic medicines.

Somnambulism is an affection which has excited more attention, as a matter of curiosity, on account
of
its

singular pheenomena, than as a subject of patho-

logical inquiry

and of medical treatment.

It

seems

to combine, in a surprising

manner, the functions of


the appearances of

the waking state with


sleep.
It has generally

some of

been regarded as connected

with sleep and with dreaming, and as constituting no


considerable deviation from the healthy state.

Dr.
the

Darwin

was, as I believe, the


day seen a
child, in

first

who advanced

* I have this

whose case there has been the


:

following remarkable succession of

symptoms

Three years ago


fits

the child laboured under hooping cough, and the

of coughing

threw her into paroxysms of tetanic epilepsy.


subsided after continuing some months.

Thesie

symptoms

She was next seized


side,

suddenly with a slight hemiplegia of the right


she nearly recovered, but
agitates,
is

from which

now

troubled with chorea, which


side.

though

in

no very severe degree, the limbs of the same

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

to the author's fanciful hypothesis respecting the nature

of epilepsy, yet
state of the case.

it

appears to point out to us the true

This

is

evident from

some

facts

and

observations, which will be adduced in the succeeding

pages.

Hysteria

is

a disease which, in turn, puts on the


this
it

form of almost every individual distemper of


class.

" Sometimes," as

Sydenham has

observed, "

causes an apoplexy, which also terminates in a hemiplegia


;

exacdy resembling that kind of apoplexy


fatal to

which proves
sons."

"

some aged and corpulent


it

per-

Sometimes

causes terrible convulsions,

much

like the epilepsy."

"

Sometimes

it

seizes the

vital parts,

and causes so violent a palpitation of the


persuaded those about her
It strike against the ribs."

heart, that the patient is

must hear the heart

may
an

be added, that hysteria gives

rise occasionally to
first

alarming trismus, which has at

all

the appear-

ances of an ordinary locked jaw, and induces the

medical attendant to expect the other symptoms of


tetanus.

The

event of these cases

is,

however,

much

more favourable than wound '^.


Before I conclude
this

that of tetanus arising from a

my

remarks on the subject of


to

section, I

must add

what has been already

* Various

examples of the mutual conversion of nervous

disorders will be found in the cases to be inserted in the following

pages of this work.

am

here adducing only facts already well

known, which are

sufficient to establish

my

conclusions.

66
said,

PATHOLOGICAL INFERENCES
that the morbid appearances discovered

on

dis-

section are

very analogous in

most of the diseases

above mentioned.
to point out

In

fact, it is

much more

difficult

some minor

differences,

by which they

may
their

be distinguished from each other, than to trace

common resemblance*. What these appearances

are,

is

a subject that

belongs to a future part of this work.

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.

Vascular System Brain, various In Apoplexy. Hydrocephalus.


in
the

in

General Conclusion.

The

mutual conversions of disorders of the nervous

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

should seem, when they have their seat


structure,

the

same

depend on similar deviations

from the healthy condition of the system.


various, even in the instance of

The

pre-

disposing circumstances, or remote causes, are indeed

one and the same

disorder

but the particular condition of the organic

* See

M.

Pinel on Insanity, p. 133 of the English translation.

DEDUCED FROM THE PRECEDING REMARKS. 67


from which the phasnomena of the disease immediately result, is probably always similar in the
structure,

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

be presumed that the causes


in slight modifications.

differ

from each other only

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

a great measure similar must exist in the other


this is

forms; and

an inference by no means unim-

portant with respect to the theory of disorders of the

nervous system in general.

In several of these complaints, as

it is

well

known,

the most apparent circumstance in the morbid state

of the brain consists in a disproportionate circulation

of blood through that organ, or in an undue accumulation


in

the

head

whether attended with those


,

appearances which accompany inflammatory, or what


is

termed increased vascular action, or merely amount-

ing to simple congestion f.

As

it is

well

known

that

* Notwithstanding the objections to

this expression,

which so

many modern why we should

writers have

made,

cannot discover any reason


is

discard

it.

The proximate cause


a disease.

what logicians
however,
if

would term the

real essence of

It is,

we

use words in their strict sense, not the cause of the disease, but the

cause of the symptoms or immediate


of the disease
is

effects

by which the existence

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

such a state exists in several of these disorders,


are entitled,
if

the doctrine just laid

down be
is

founded,

to infer that a similar condition

actually

present in other complaints of the


the proofs of
it

same

class,

although

are not so decidedly manifest.


it

This

conclusion
to be

is,

however, so important, that

deserves

more

particularly examined.
it is

In apoplexy
sists in

well

known

that the most apparent

circumstance in the morbid state of the brain, con-

an excessive action of the


;

arteries

belonging

to the encephalon
tion

or,

at least, in
vessels
;

an unusual repleis

and distention of the

or in what
;

termed

an increased determination
ducing
skull.

to the head

often pro-

effusions of blood,

or

of serum, within the

If the foregoing remarks are well founded,


this fact

we

have from

reason to believe, that the imme-

diate cause of other disorders,

which by

their frequent

conversions and transitions, are shown to be allied to

apoplexy,

consists

in

a deviation from the healthy


dif-

condition of a similar kind, though probably very


ferent in degree,
stances.
It
is
is

and modified by a

variety of circum-

now

generally agreed that acute hydrocephalus


consists,
in

an inflammatory complaint, and

the

first

stage, of increased vascular action* in the brain,

or

its

membranes, which terminates

in serous effusion.

The inflammatory
*

stage of this complaint displays

When

speak of increased vascular action, I only mean to

describe that state of the circulation, either general or local,


is

which

commonly

so termed, without professing to adopt the patho-

logical theory

on which the phrase

is

founded.

DEDUCED FROM THE PRECEDING REMARKS. 69


phaenomena, which bear a near analogy to most of
the manifestations of disease in the nervous system

above mentioned, such as stupor,

vei^tigo, convulsion,

and delirium.
that announces

The
;

disease

sometimes commences
is

with an epileptic Jit


its

at least this

the

first

thing

existence.

In other instances a

furious maniacal delirium occurs within a few hours


of the attack, or of the period at which the presence

of the disease

first

becomes known or apprehended,


co-exist

and while circumstances


supposition that
it

which preclude the


rise

can have given

to effusion.

In these cases we must allow that several remarkable


forms of neurosis are the products of cerebral inflam-

mation

that the physical condition of the brain,


to

on

which they appear immediately


inference,
correct,

depend,

is

con-

nected with vascular excitement in that organ.


if

This
us

cannot

fail

to

afford

an

useful direction in cases of a

more doubtful

character,

where the symptoms of congestion, or of the inflam-

matory

state,

are less obvious,

or altogether elude

detection.

The same forms


fever;

of disease, particularly delirium,


in the course of continued

coma, convulsion-fits, occur

and

in this instance

they

may be

traced to
if

a condition of the brain, closely bordering upon,


not decidedly consisting
in,

inflammation.

Fits of

convulsion in fever are often symptomatic of suppuration in the brain


;

but I have met

vvith this

symp-

tom, when the event proved that no such fatal mischief

had taken place. These conclusions from analogy, are confirmed by


a general survey of the phasnomena of nervous diseases,

70
especially

CONFIRMED BY
as

DISSECTIOiJ'
dissection.

displayed

by

When we
discovered in

generalize the appearances which are

the heads of persons


diseases

who have
part,

laboured under the


are found to resolve
into

we have enumerated, they


the most

themselves, for

the effects
;

of

inflammation and of increased vascular action

such

are the adhesions of parts chiefly within the cranium,

the effusions of serum into the cavities, the distention

of vessels, abscesses, the haeraorrhagic effusion into


the ventricles, basis, and interstitial openings of the
brain, the redness, or other discoloration of surfaces,

the thickening of membranes, which occur to us in such


variety,

and

in

such numerous instances, on the dis-

section of those bodies

which have

fallen victims to

diseases of the cerebral system*.

* Othef species of disorganization, besides the undoubted con^

sequences of inflammation, are indeed occasionally discovered in


the

encephalon,

in

some forms of nervous disease;


rarely,

such as
;

tumours, general hardness of the siibstance of the brain


times,

some-

though more

a preternatural

softness, ossifications,

or spiculae of bone; other alterations of texture.

These varied

appearances are probably the causes, or more generally the consequences, of disordered vascular action
;

perhaps of inflammation.

When tumours
phalus,
I

are discovered in the substance of the brain,


in

which often happens


destruction of
this
effect

epilepsy,

and sometimes
and

in

hydroce-

believe they contribute to the disease,


life,

to the ultimate

by inducing inflammation.

That they have

may

be inferred from the serous

eff"usions,

and other
I

indications,

which almost

always accompany them.

once

attended, for several months, a boy,

who

at length died of

hydro-

cephalus.

Several ttimours were found in the cerebellum, as


In the course

well as a large quantity of serum in the ventricles. of this boy's illness, the
sions, so

symptoms had been, on repeated occa-

niuch relieved by topical bleeding, blistering, calomel,

AND THE EFFECT

OF REMEDIES.

71

We

shall

conclude these observations by remarking,

that the doctrine of the Juvantia


in general, to

and Lgedentia

points,

the same

result.

Disorders of the

nervous system are indeed frequently complicated with


various affections of other structures^ or of the functions allotted to

them

and, from this circumstance, a

diversified method of practice must often be adopted

in treating

them

still, if

we were

called

upon

to point

out one particular indication, or principle of practice,

which

is

generally applicable, to a greater or lesser

extent, to distempers of the nervous system, I suppose

there would be no hesitation in concluding

it

to consist

purgatives, &c., that he had appeared almost convalescent

but

as soon as the measures directed to the reduction of inflammation


in the brain

were intermitted, they immediately

I'eturned.

In this

case the tumours appeared to be the exciting cause of inflam-

mation in the encephalon


as

which, although repeatedly reduced,


at

the

cause was

permanent,

length

gained ground, and

destroyed the patient by effusion.


It is

true that in

some instances of these complaints, no other

vestiges of disease

have been found than redness of the


vessels
:

memthat
the

branes,

and distended

but
is

it

is

highly probable
life in

inflammation of the encephalon


acute stage, and
it is

capable of destroying

impossible to say

of inflammation under these


in its

how slight the vestiges circumstances may be. It is only


can be traced with a very decisive

secondary

effects that it

evidence.

We
"various

shall,

in

the course of the following pages, have

many
made

opportunities of confirming these remarks by particular facts in

forms of nervous diseases.

Here the observation

is

chiefly

with reference to the conclusion drawn from


disorders,

the near

alliance of these

and

in order to obviate

an objection

that might be

made

to the general inference

drawn from morbid

appearances on dissection.

73
in the

EFFECTS OF REMEDIES.
means adapted
to restraining the determination

of the blood towards the head, and diminishing the

quantity of that fluid that


brain.
It

is

circulating through the


either gene-

must be allowed that bleeding,

rally or locally, is

not a measure universally applicable

to all states

and periods of such disorders; that on


it

many
not

occasions

not only
:

fails to

afford benefit, but

aggravates the evil

still

I believe

that

there are

many

cases of severe or long continued affection

of the brain and nervous system, in vvhich measures

adapted to the indication above mentioned, have not


afforded, or might not afford, relief to a greater or less

degree, at

some period or other of


fact,

the disease.

But the
head
disease,

that evacuations of blood from the

fails to
is

afford relief in

many

cases of nervous

by no means a decisive proof that the


particular instance, does not

affection, in this

depend

upon, or
fulness in

is

not connected with, increased vascular


brain
;

the

since

we

often experience a

similar disappointment in those cases where

we know

the disease to consist in an over-distended state of the


vessels.

1 have

sometimes seen repeated venesections


evidently

ordered for patients labouring under attacks of paralysis,

which

had

proceeded
;

from deterafter every

mination of blood to the head


successive

when,

abstraction of blood,
:

the disease

seemed
which

rather aggravated than relieved

and
I

in cases

appeared to be precisely similar,

have witnessed the

most decided

benefit to accrue

from discontinuing the

practice of depletion, and adopting a gently stimulating plan of treatment


:

and I can make a similar


other
disorders

assertion

respecting

several

of the

VARIETY OF MORBID EFFECTS.


nervous
system.

73

But such

cases

are

exceptions,

though perhaps not very unfrequent ones, to a general


observation.

question has probably, before this time, occurred

to the reader.

How
?

one cause can give


I

rise to

such a

variety

of effects

do not pretend
rise to different

to

understand

the rationale of action in the morbific cause, or to

explain

how

it

can give

morbid

states;

how, for example, the proximate cause of epileptic


fits

is

momentarily so modified as

to

become the

immediate cause of an attack of epileptic delirium.


Until our acquaintance with the physiology of the
cerebral structure
to

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

one instance; or how, by a


a

slight modification in the state of the system,

new

of a very different description,

is

substituted

for the former.

The
infer,

only modifications

we can

distinctly trace, or
find a patient, in

are in the degree.

When we

consequence of accumulation of blood in the head,


subject to vertigo, then to partial paralysis, by

and

by attacked by hemiplegia, which, in process of time,

becomes converted into apoplexy, we


loped this variety in the phaenomena.

infer

that a

progressive increase in the morbific cause has deve-

In other instances the constitution

may

be,

and

is,

more predisposed
than another
;

to exhibit
this,

one set of phaenomena

and

perhaps, under similar morbid

74

VARIETY OF MORBID EFFECTS.

alterations in the state of the circulation through the

brain.

Perhaps also there

may be some

difference in the

kind of vascular action.

It is probable that

a change
or simple

may

take

place from venous congestion,

distention of the vessels, to that state


tutes inflammation,

which consti-

and that these

different conditions

are connected

with particular

modifications of the

morbid phaenomena.
it

If this supposition be allowed,

enables us to account for the sudden conversion of

these disorders into each other*.


* These inferences are rendered more probable by several cir-

cumstances connected with the vascular action in other parts.

We know
a part
is,

that an increase in the circulation of blood through

under certain circumstances, productive of an increase

of sensibility.

Inflammation of the organs of sense, a

state

accompanied by
and the

increased distention of vessels, occasions an increase of sensibility.

When
ear,
parts,

the eye

is

inflamed

it is

extremely sensible of

light

under similar circumstances, of sound.


as

Even

insensible

bones and tendons, become extremely sensible when

inflamed.

An

increase of circulation through a part will also occasion

increased sensibility, without inducing inflammation:

we have an

instance in the effect of rubbing the fingers

when

cold.

But

there

is

a state of increased vascular distention, in which


is

an unusual quantity of blood


of sensibility

accumulated

in a part,

without

any increase and even with a diminution of the ordinary degree


:

this

state is

commonly termed
in

that of simple
it

congestion, or of venous congestion, from a supposition that


consists in

accumulation of blood

the

veins;

and that sup-

position
in
this

is

founded on the circumstance, that the colour of parts


is

state

generally of a purple cast, resembling that of

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

morbid phaenomena, we are led

to another train of

observations, which, in a practical point of view, are

not less important than the remarks

we have made
I

on the near

affinity

of disorders of the same class.

allude to the fact long ago noticed,

and now

fully

ascertained, that diseases of the nervous system are

often found, on inquiring into their previous history,


to have been preceded by chronic distempers of various

kinds, affecting other structures,

and more especially

by disordered conditions of some of the natural functions,

and occasionally of the organs allotted to them.


he conjectured, on the ground of these analogies, that
is

Tt

may

those disorders of the nervous system in which there

an increased

excitement in the functions of the brain and nervous structure


in general,

an unusual intensity of feeling, or exertion, depend on


through the encephalon which apof,

a state of the circulation

proaches
this

to,

or

is

of the character

inflammatory action

of

class

are delirium, mania, perhaps spasm and convulsion:


sensi-

and that the opposite phcenomena of torpor or diminished


bility

and energy, stupor, coma, palsy, &c. depend on a simple

congestion or dilatation of the vessels, without that condition

which

constitutes

what
it it

is

commonly termed

increased arterial

action; or,

when

attains a certain degree, active inflammation.

At

the same time

must be confessed
is

that the distinction between

congestion and inflammation

a subject involved in

no small

degree of obscurity.

76

REMARKS ON THE PATHOLOGY


The connexion
of disorders of the nervous fabrick

with diseased states of other parts of the system, and


particularly with complaints of the viscera, which
in the gastric
lie

and hypochondriac regions, was noticed


to

by the ancients, and seems


the

have furnished many of


;

common

terms for various complaints

some of

which are

still

used, though the ideas on which they

were founded have long been forgotten.


physicians have been

Modern

more

intent in endeavouring to

trace the origin of diseases in the altered structure of

the organs most remarkably and obviously affected


and, in their anatomical researches, have top

much
:

overlooked the morbid appearances of distant parts


but, of late, the admonition of

two or three
path
to,

distin-

guished writers has contributed to lead the attention of medical practitioners into
this neglected
:

and

the general truth of the doctrine alluded


longer with any body a matter of doubt.
It

is

no

would seem, however, that those physicians who


for the sources of nervous diseases in the

have sought

state of viscera

remote from the brain, have in general

assigned a double origin to complaints of this description.

They

consider one set of nervous diseases as

depending on a primary affection of the brain, or other


parts of the nervous structure
;

and

in this class they

seem disposed

to include, generally, all those cases in in


this

which any considerable vestiges of disease


structure are displayed

by anatomy.

On

the other

hand,

it

is

often taken for granted,

that in those

disorders of the nervous system which depend on the


state of the natural functions, the in the brain are deceptive,

symptoms of

disease

having no real foundation

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

cannot be denied that cases do occasionally

occur, the

phasnomena of which seem


after attacks

to afford coun-

tenance to this opinion.


palsy,

Persons have died under


of apoplexy, in

and sometimes
brains,

whose
mists,

though examined by accurate anato-

no

clear vestiges of organic disease


:

have been

discovered

and a similar assertion may be made


convinced that the pathology of these

respecting epileptic and maniacal disorders*.


I

am

fully
is

diseases

at present so imperfect, that

regard one supposition on this

we can scarcely subject as more proimagine

bable than another.


the

It is difficult to

how

all

phgenomena of diseased brain can

arise

from
but

affections of the prima? vi^, without the intervention

of local disease in the cerebral structure


is

itself:

it

equally

unknown

to

us

how

disorders of the digestive

functions should induce such local diseases.


sidering this subject,
it is

In conall

necessary to discard

pre-

conceived opinions, and to collect simply the inferences

from
I

facts.

am however
fallen

persuaded, on surveying the facts

which have

under

my own
or

observation,

that

among

those cases of nervous

cerebral

disease,

which are consequent upon


* I have seen

irregularities in the natural

two

fatal

cases of epilepsy, in which, on exa-

mination of the brain, nothing preternatural was discerned, except

trifling

quantity of fluid in the ventricles.

There was no

indi-

cation of organic disease in any other part of the body.

78

NERVOUS DISEASES DEPENDENT

or vital functions, a great majority will be found to

depend upon actual


in the brain, or

disease,

and often organic disease

some other
first

part of the nervous fabrick,

which, though in the


tion,

instance a secondary affec-

becomes

in the sequel

a morbid cause of no
less difficult

less

real existence,

and often not


not mistaken,
:

of cure, than
itself.

those diseases which primarily affect the brain This,


if I

am

is

the general conclusion

we must adopt
to,

in

and those instances before alluded which the functions of the nervous system are
itself is free

deranged, while the structure

from disease,

must be regarded as exceptions


servation.

to

a general obbe evident

From what
that I lay

has been said, I trust

it

will

no claim to the merit of discovery in bring-

ing forward the proofs of connexion between nervous


diseases

and complaints of the natural functions.


a relation
exists, is

The
doc-

fact that such

already well estaillustrate this

blished
trine
tions,
will

my

endeavour

will

be to

by a considerable selection of cases and observa-

and to make
if

it

the basis of distinctions which


It is obvious, for

be useful in a practical view.

example, that
epilepsies, of

we can

discriminate one class of


is

which the primary cause

a disordered

state of the alimentary canal,

from another form of


in

the

same

disease,

which originates

a disturbed and

unnatural condition of the functions belonging to the


uterine system, this distinction would probably lead to

some considerable improvement

in

medical treatment.
first

The

.cases

which belong to the

class

require
latter

a different mode of practice from those of the

and both require

to

be treated, in

some

respects,

ON DISOllDERS OF THE NATURAL FUNCTIONS. 79


differently

from those affections which are idiopathic,

or have their primary seat in the cerebral structure


itself:

a class of disorders which every

new

acces-

sion to medical experience evinces to

be more and

more

rare.

On

this principle the facts

and observaIn one


will

tions I

have

to offer will

be distributed*.

department those cases of nervous diseases

be

placed which originate in a suppression, tardy appearance, or other deficiency of the periodical functions of

the uterine system.

second class

will include those

instances of similar disease which

are the result of

torpor, or iiTegular action in the intestinal canal, or of

disorder in the functions of the stomach.


division will consist of
affections

some

cases in

Another which morbid

of the brain and nervous system are conliver.

nected with disease of the

fourth class
functions,

may

comprehend disorders of the animal

which

may

be termed idiopathic, since they arise in conse-

quence of the operation of causes, which act immediately

on the functions of the nervous system, or

induce primary disease in the structure of the brain.

cannot conceive any thing more preposterously absurd, than

the attempt to classify diseases with all the divisions

and tech-

nology of a botanical or zoological system, and


essentially

to force

what

is

disorder and confusion, to assume the appearance of

that order and symmetry which nature displays in the arrange-

ments of the organized world.


so
as

Equally mistaken

is

the censure,

commonly
if

repeated, of setiological classification in nosology;

medicine could ever acquire the character of a systematic


Etiological classification
is

and complete science.


of terminology and

the only

mode

arrangement that can be of any practical

advantage; and

this is all that

we have

to consult.

80

NERVOUS DISEASES DEPENDENT ON


this class

To

belong,

for

example,
arise

those

cases

of

madness and of epilepsy which


of mental emotions,
as
grief,

from the influence

terror,

and the

like.

Another
ture.

class of nervous disorders appear to depend on diseases of the heart, whether of function or struc-

Several cases of this description have casually

fallen

under

my own

observation,

but I
to

am

afraid

they are not sufficiently numerous


fact of this connexion in a

establish

the

manner

satisfactory to all
distinct

my
from

readers.
all

Another

division

of diseases,

the foregoing, are those which arise from the

metastasis

of inflammatory disorders, such as rheu-

matic and cutaneous inflammation, and the inflam-

mation of serous membranes.

These cases
to the order in

will

be placed, not exactly according

which they are here enumerated, but


likely to

in that connexion in which they are most


illustrate

each other, and the relation which they bear

to

the causes from

which they

originate.

For the

same reasons

I shall transgress the regular

mode

of

describing disorders monographically, and set before

my

reader a comparative view of epileptic and


cases in

ma-

niacal

connexion,

after

premising general

descriptions of these diseases, with


their pathology.

some remarks on

This

mode

of proceeding, though
is

contrary to established custom,


will enable

the only one that

me

to

throw some

light

on the relation of

nervous diseases to the other disorders which precede


or accompany them
;

and

have selected epilepsy

relation

and mania as specimens, because they exhibit this more distinctly than other affections of the

same system.

My

research into the nature of these

DISORDERS OF THE NATURAL FUNCTIONS.

81

disorders will occupy the greater part of the present

volume

the remainder will contain observations on

other complaints nearly allied to

them.

In a suc-

ceeding volume I propose to treat in a similar manner


of apoplexy and the various forms of paralysis, of
chorea, and

and

to

some other show that all

diseases of the

same system
are equally

these

affections

referrible to

derangements of the natural functions.

82

THEORY OF LOCAL

NOTE
Some
writers

C.

have been disposed to reject the doctrine

of particular determinations of blood, on account of certain


difficulties

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

gencies of the system, are not yet so perfectly understood


as to warrant us in refusing to admit

what appears

to

be

a matter of fact, established by the evidence of our senses.

We

often

find

patient

labouring

under intense and


flushed and

oppressive pain in the head, with vertigo,

heated
stricted.
arteries,

in the face,

while the extremities are at the same

time cold, and the vessels on the surface generally conIf

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

feet are then

appearance of a constricted state of the vessels. If the plunged into hot water and rubbed, while
is

blood

taken from the temples, and the head


is

is

covered

with cold wet cloths, a different state

soon produced.
to that

The

pulse at the wrist

becomes
is

in

due proportion

in the carotid,

and the headache

relieved. In a case of this

description

we have

a sensible proof of determination of

blood to a particular part.

person

who doubts
in

the possibility of a change of

capacity in the vessels of one part, without any corre-

sponding alteration

the general state of the circulation,


it

may be

convinced of

by plunging one arm

into a vessel

DETERMINATIONS OF BLOOD.
On

83

df hot water, and the other into a vessel of cold water, at


the same time.
find

again withdrawing his arms, he will


effect

one somewhat larger than the other from the


its

of distended vessels, with

the external veins dilated,

and

the pulse of the brachial artery 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

a particular determination can only happen

can take place.


usual
is

When

a greater quantity of blood than


part, this

conveyed to a given
or
in

either by an increase in the


dilatations,

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

every part of the

an

increased

frequency of pulse can


This phsenomenon

be no cause of local determination.


the artery
that

therefore be the result of an increased dilatation of


:

is,

if

the artery acts merely by systole

and diastole, there must be a greater dilatation than usual


at

each diastole of the artery.


is

But the

diastole, accord-

ing to the received notion,


of increase;
it is

not a condition capable

simply the passive state of the artery,


here the operation of an external agent^ so

* It

is

true that
is

we have

that the case


arises

not exactly parallel with that in which the determination

from internal causes.

This instance, however, proves that the


is

structure of the vascular system

such as to admit of local variations

of capacity; and

we have

other examples of similar effects produced by

operations beginning in the constitution.

The

state of the circulation in


is
:

the extremities, produced by the action of cold applied externally,


similar to the effect of a shivering
fit

upon the same part of the system

and the phtenomena which


are precisely
similar,

result

from the external application of heat

with respect to the state of the sanguiferous

system, with those which take place in an inflamed part, as in the arm,

when

affected

by

erysipelas or phlegmon.

84

THEORY OF LOCAL DETERMINATION.


alternates with
its

or the state of collapse, which


traction,

con-

and

its

extent

is

determined by the
to

elasticity
to

of the tube.

These considerations appear

me

demon-

strate that local determinations are impossible, unless the

arteries are

those of elasticity and

endowed with some other property besides muscularity, formerly and com-

monly
reality

ascribed to them.

The

property with which they in


is

appear to be endowed

a capability of variation

in their calibre, or average diameter at a given time, or

that of

becoming
this

at

one lime more capacious than

at

another; and

property must be a

vital one, (that is,


is

a property resulting from that state of the solid which

peculiar to the living body,) since the variations alluded


to take place in

consequence of the operation of

internal

causes, or in connexion with particular states of the constitution.


drical

This temporary increase of the average cylinis

diameter of a particular artery,


systole,

altogether inde-

pendent of the degree of


I shall not
until

supposing such a
:

mode
which

of action to belong to the arterial system

a subject

attempt

to discuss

it is

permanent
in

dilatation,

some new circumstance arises which occasions a change. That the


in

the constitution,
is

alteration

really a
is

change
actually

the temporary capacity, or that the vessel


for

larger

the

time being,

convinced, by comparing
carotid, or other artery,

my

have often been perception on feeling a own


I

when

beating forcibly with a large


1

and

full

pulse, with the sensation

experienced on exa-

mining the same vessel under diiFerent circumstances. The


difference of perception, arising from this comparison,
similar to that
is

which occurs on

fixing the fingers on a

large and a small cord.

This property of the arteries

is

precisely that

which

Dr. Parry has described under the term Tonicity.

DISTINCTION OF EPILEPSY INTO THREE FORMS. SS

CHAPTER

III.

A GENERAL DESCRIPTION OF EPILEPSY.

SECTION
Definition

I.

and Nosological Distinctions of Epilepsy.

Few

diseases are better characterized by their


:

sympis

toms than epilepsy


such a variety in the

yet,

in

this

instance,
it

there

phaenomena
in

as renders

difficult

to contrive a definition

a few words which

may

comprehend every form of the complaint. Sauvages has defined it, " Spasmus clonicus, periodicus, chronicus
nition

artuum,

cum sensuum

obscuratione;" a defilittle

which was adopted with


Hoffman's description
:

alteration

by

Cullen.

is,

as usual,

somewhat

more

precise

he terms

this

disease,

" Universalis

externarum partium prseter voluntatem concussio, et

vehemens

agitatio,

cum sensuum,

tarn

internorum,
but pre-

quam

externorum, interceptione stipata:"

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

says, " Variantur

vero et convulsiones et sensuum Isesiones, tam gradu,

quam

specie;

nam

interdum, loco

sivorum, spasmus valde rigidus

motuum convulmembra corporis totius


vim explicare
sit,

prehendit, ut base distenta nee per

liceat;

ac totum corpus subinde tam rigidum ac


si

baud secus

ligneam statuam quis movere

velit."

86
It
is

DISTINCTION OF EPILEPSY
impossible to include these different forms

of the disease under any single description,


is

and

it

therefore obviously necessary to divide epilepsies,

with reference to the pheenomena of the paroxysm,


into at least

two species

these I shall distinguish

by

the terms convulsive, and tetanic epilepsy.


1

The more common


be defined to be,
fits,

form, or convulsive epilepsy,


disease manifesting itself

may
in

"A

sudden

attended with total or partial loss of

sense and consciousness, and a general convulsive agitation of the voluntary muscles."
2.

The less
fits

frequent, or tetanic form,

is

distinguished

by sudden
ness,

of coma, or loss of sense and conscious-

without convulsion, but attended with a tonic


;

trunk becoming during the

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

coming on without any premonitory symptoms.


these
fits

In

the muscular system remains in a completely


;

relaxed state

the patient generally falls to the ground,

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

are at other times subject to the convulsive


into,

attacks.

These forms of disease frequently pass

or supersede each other.

They occur under

similar

circumstances, and follow a parallel course through


their

whole

history.

1 shall distinguish this last species of paroxysm by

INTO THREE FORMS.


a term which

87

Sauvages has applied in a different


fits

way*.
relaxed,
sleep,

Those

which consist

in a

sudden

loss

of

sense and consciousness, the muscular system being

and the patient lying

in a state

resembling

and at the same time without that state of the

circulation

which

is

peculiar

to

syncope,

may be

termed
leptic

fits

of Leipothymia, or more particularly epi-

Leipothymia, in order to distinguish them from


similar paroxysms,

somewhat

which

fall

under the

description of apoplexy f.

SECTION

11.

Outline of the History of the Disease.

PERSON who

is

subject to epileptic

fits,

often, withis

out any previous indisposition of which he

aware,

and without any sensation or symptom which enables

him
total

to anticipate the attack, is suddenly seized with a


loss

of feeling and consciousness,

and

if

he

happens

to be in

an erect posture,
of leipothymia

falls

to the ground,

* Sauvages'

definition

is,

" Virium muscupulsu


I
is

larium totius corporis subitanea imminutio,

superstite."

This definition applies well enough

to the

paroxysm
it

distinguish
aflixed to

by the term, but


t The

in the

nosology of Sauvages

a form or modification of syncope.


fits,

described as epileptic leipothymia, are not easily

distinguished from attacks of apoplexy,

by the symptoms of the


sufficiently proves
I

paroxysms merely, but the tenour of the disease


that they

belong to epilepsy.

In the following pages

shall

produce

many

instances of leipothymic paroxysms

which were

manifestly connected with epilepsy.

88

GENERAL ACCOUNT

sometimes with so much violence as to occasion hiin


serious injury.

Hence

this disorder

has been vulgarly

termed the " Falling Sickness."

In other instances

the patient has peculiar feelings, which render

him

aware of the approach of


for

his

malady, so that he

has time to place himself upon a bed in preparation


it.

I have seen individuals

who were

firmly per-

suaded that they could often, by certain exertions,


prevent the attack of the paroxysm.

Those

patients

who

are aware of the approach of

the paroxysm,

describe very differently the feelings

which they experience.


sight
or, as it is

The most
fit

frequent

symptoms

immediately preceding the


;

are a sudden dimness of

termed, a darkness coming over the

eyes; often with a sensation of giddiness, and of noise


in the ears,

which

is

said to be a ringing or a buzzing


is

noise.

Sometimes there

a headache, pain over the

temples, with or without vertigo, and a sense of weight

and

fulness
is

in other instances

no disagreeable senin

sation
fit,

experienced in the head previously to the

but the attack seems to

commence
;

some extreme

part, as in

a foot or hand
rigid

a convulsive tremor, or

sometimes a
place,
first

contraction of the muscles, takes

at the extremity of the limb,


:

and gradually
In

ascends towards the head


the paroxysm of

when

it

reaches the head

coma and

convulsion ensues*.

This
epileptica,

symptom
and
it

is

usually termed by medical authors the aura

is

described by them as a sensation of a cold


I

vapour
alluded
I

affecting

the part and rising upward.

have met with

a great number of patients who have perceived the affection


to,

but

never once heard

it

described in this way, though


It is

have been very minute in

my

inquiries.

generally reprc-

OF THE EPILEPTIC PAROXYSM.

SQ
in

many
are
is

cases

the

symptoms which usher

the

fit

more

like those

of the hysterical paroxysm. There

a distressing sense of inflation in the praecordia,

attended with a general agitation and uneasiness, difficult

respiration,

palpitation

of the heart; rattling


;

of wind in the bowels, eructation


ricus, or

the globus hyste-

a feeling of some hard body rising up from

the stomach towards the throat, and there occasioning

a distressing degree of constriction


rition,

frequent mictu-

as in hysteria; the urine pale and copious"^'.

In a few cases the premonitory symptom has been a


sense of chilliness affecting the spinal column.

As

the patient
;

is

seized, he often

screams out as

if

in a fright

immediately a violent convulsion of the


;

voluntary muscles ensues


side are

generally the limbs on one


;

most agitated

those of the face chiefly

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

the teeth, as the

jaw

by
it.

the convulsive action of the muscles attached to

The

patient breathes in an irregular and unnatural


;

manner

often with noise

and he frequently foams


agitations, after a

at the mouth.

These violent

few

sented as a convulsive tremor

commencing

in

a limb.

Some-

times there

is

even a perceptible convulsion of the large muscles


case to be adduced below, in which the

of the limb, as in a

patient averred, that, by grasping firmly the muscles of the leg in

which the
*

agitation began, she could prevent the attack of

coma.
to the

These symptoms
:

may

be said to indicate an approach


is in

nature of hysteria
epilepsy.

but the disease

other respects a genuine

90
minutes,

DESCRIPTION OF EPILEPSY.
either

cease

altogether,
is

or undergo

some

short remission which

followed by an exacerbation.
is

The

duration of the

fit

very various

it is

finished

in three, four, or five minutes,

or continues two or
is

three hours
five

but the most frequent duration

from

minutes to a quarter of an hour.


the convulsion ceases the patient generally

When
from

remains in a state of stupor and sleep for a time:


this state

he sometimes relapses into the confits

vulsion,

and a frequent repetition of

takes place

but more generally the comatose state gradually gives

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.

Sometimes, though but

rarely,

the patient

is

able to get up and walk about almost immediately


after the
fit

subsides.

The paroxysm
some
patient
is

of tetanoid epilepsy

is

similar,

in

particulars, to the attack

now

described.

The

seized suddenly;

his limbs are stretched,

and the whole trunk extended and fixed by a rigid spasm the eyes are widely open ; not reverted, but
;

staring frightfully

the pupils contracted, and quite


:

insensible to the stimulus of the strongest light


gitur

" Eri-

quoque penis in infantibus; in adolescentibus semen ejicitur, et seepius urina ad magnam distantiam
prorumpit*."

The

convulsive

and tetanoid forms of

epilepsy,

though very different in appearance, are yet very closely


* Hofifmann mentions this

symptom.

have never observed

it.

VARIETIES OF SYMPTOMS.
allied in

91 some-

pathology.

Fits of both descriptions

times attack the

same individual within the space of

a few hours.
Variations in Symptoms.

There are great


lepsy.

varieties in the

symptoms of

epi-

We
are

have already observed that there are examples


fits

of epileptic

without convulsion
seize

and that there


instantaneously,

some which
their

the

patient

while others are preceded by symptoms which give

warning of

approach.

Neither are the head-

ache and stupor which follow the paroxysm universal

symptoms
the
fit

who recovered from and scarcely complained of almost immediately,


:

have seen patients

pain in the liead.


rences.

But these are not frequent occurappearance of which there


is

The symptom

in the

is

the greatest degree of regularity,

the state of stupor

or insensibility during the paroxysm.

In a very great

majority of cases this amounts to a complete

coma
totally

the patient, for a certain space of time,

is

deprived of sensibility and consciousness

but I have

seen cases in which, on the most attentive and careful

examination,

it

appeared that a degree of conscious-

ness remained through the whole paroxysm, and that

the patient

knew and

distinguished

the by-standers

through the whole time*.

This has been the usual

Sauvages lays
;

this
is

down

as a characteristic of uterine epi-

lepsy
I

and Dr. Ferriar

inclined to follow
their opinion.

him

in this distinction.

am

by no means of

After a diligent inquiry

92

VARIETIES OF SYMPTOMS
fits

character of the

in

some

individuals, but

it

more

frequently occurs as a prelude to the total abolition of

the disease.

Hence

it

may

be considered as depend-

ing on a lower degree of the morbid state, which


constitutes the proximate cause of ordinary epilepsy.

I believe, however, that in


is

all

cases of epilepsy there


;

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

of languor and vertigo.

Most of
Epileptic

these remarks will be confirmed by cases,

of which 1 shall adduce in the sequel brief relations.


fits

occur during the waking hours, but

they happen more frequently during sleep.

There aro
experience
part,

many
during

persons
sleep

who

are subject to their attack equally


:

and when awake

others

them only when

asleep, and, for the

most

soon

after falling asleep.

In one case*, which was under

my

care, a

fit

scarcely ever failed to seize the patient


;

immediately after he had fallen asleep


respecting this point, in a considerable

and
it

this

number

of cases,

has

appeared

to

me

that there

is

no species of epileptic attack acobliteration of consciousness


I

companied with a more complete


feeling than those

and
have

termed uterine; the instances in which

had reason
during the

to
fit,

believe that a degree of perception

was retained

of which several will be mentioned in the sequel,

are cases of a different description.


*

As

the case

have alluded

to
it

is
:

shall subjoin here

a brief account of

somewhat remarkable,

Elias Stroud, a rustic labourer, of stout make, short neck, aged

twenty-four years, enjoyed good health

till

about two years ago,

when he was suddenly awakened

in

the night

by a spasmodic

AND CIRCUMSTANCES.
of a few moments during the day-time. a child subject to
fits,

QS

occurred even when he endeavoured to gain the repose


I

have seen

during the process of dentition,


the paroxysm in like
;

who was
repeatedly
position

seized

Avith

manner
recurred
the
dis-

almost as soon as he closed his eyes

and

this

through a
the
fit

whole night,

while

to

seemed not

to exist during the

waking
It

state.

must therefore be concluded, as many authors


is

have remarked, that there

some
which

peculiarity in the
is

state of the brain during sleep,

highly favourfit.

able to the appearance of the epileptic

action of the muscles connected


violently

with

the

left

shoulder, which

extended the arm, and drew the head down to the

shoulder: the muscular system was then affected generally: his


senses confused, and, for the time, almost lost
:

the

fit

lasted four

or five minutes, and

left

him

in a tremor,

which was succeeded by

a perspiration.
time.

This affection has recurred every night since that

The only cause he can


shoulder, which
got well.

assign for

it is,

that about

two years and


fell

a half ago he was thrown out of a wagon

and
;

on his
it

he bruised, and broke the skin

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

to the Bristol Infirmary,

practice, with
benefit.

a view of relieving him, but without the smallest


fits

At

that time his

were epileptic paroxysms, which


first

never failed to seize him immediately on his

going to sleep

they occurred during the day,


minutes.

if

he happened to doze for a

fiew

He
I

went out just

in the

same

state,

with respect to his


to

disease, but very

much

reduced by the attempts made

cure

him; and

have since been informed that

his complaint continues.

94

VARIETIES OF SYMPTOMS

,The disease occurs in nearly the same degree of


frequency in both sexes.
It has

been said

to
;

be more
but this

incident to the male than the female sex

remark

is,

as I believe, without foundation.

There
have:

is

no temperament which
its

is in

a very decided
I

manner more subjected


witnessed
habit,

to epilepsy than others.

appearance in every variety of

from the most exquisite examples of the sanI

guine to the most strongly marked melancholic.

have, however, observed a greater proportion of cases


in persons of

blooming and delicate complexion, and


:

of light flaxen hair

and

this

remark particularly
proofs of a

applies to a form of the disease which will be hereafter

distinguished,

and

in

which the

general plethora of the sanguiferous system are, per-

haps, the most evident*.

At no

period of
this

life is

the

body exempt from the attacks of


there are several

malady, but

occasions at which
at others.
it

its

commenceIt occurs in

ment
from

is

more frequent than


;

very young infants

in

which case

generally arises

irritation in the bowels,

and speedily disappears


is

as soon

as

the exciting cause


first

removed.

Again,

during the

dentition,
is

many
all,

children are assailed


or

by
the

it

and there

often in

many
fits,

children of

same

family, a predisposition to

when under
the
first

the irritation excited by this process.

But the disease


after

thus

produced generally ceases soon


is

dentition

completed.

Epilepsy often appears, for


the
it is

the

first

time,

about
;

eighth,

or from

that

to

the twelfth year

and

under these circumstances

* See

Chapter V. on Uterine Epilepsy.

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

females at the establishment of the catamenia


if

but

these

periods pass over,


the changes

and the disease


great

subsist

through
stitution

which the habits of the conis

then undergo, there


life.

danger of

its

continuing through

But

if

the appearance of the

catamenia sometimes
of this disorder,
to
it
;

assist the constitution to get rid

it

much more

frequently gives rise

or,

rather,

the laws

of the animal

economy
up
in the

require a

new

set of operations to be set

system at

this time, in the place

of which,

when they
this class

are not regularly performed, a variety of tumultuous


efforts

ensue
is

none
is

and among phEenomena of more frequent than epilepsy. In


;

fact there

no time of
its

life,

in females, at

which

it

so frequently

makes

appearance.

Hippocrates has said that epilepsy scarcely ever


appears after the twentieth year of
authority of facts and experience
to that of Hippocrates,
is

life

but as the

now

superior even

we

are under the necessity of

contradicting

him

in this instance.

There

is,

however,

thus

far,

a foundation in truth for his remark, that the


this disease,
is

appearance of

after

the age mentioned

by Hippocrates,

much more
life.

rare than during the

preceding periods of

We

must

not,

however,

omit to mention, that persons in advanced age are


particularly subject to attacks of leipothymia*.
*

Very aged persons


in

often

become subject
lie

to

fits

of sudden

vertigo,

which they

fall to

the ground, and sometimes speedily


in a state of ineonsciousness.

recover their senses; at others

96
The
all

VARIETIES OF SYMPTOMS
predisposition to epilepsy, like the liability to
is

other disorders of the nervous system,


or appears
patient,
to

often
I

hereditary,

affect certain families.

had once a
five,

who

died about the age of twenty-

from the

effect

of another disorder.

He had
fits

laboured under

this disease

from infancy, and had

within a few days of his death.


subject to

His father had been


child of the

them from a very

early age, but got rid of


first
fits

them

as he

became

adult.

men-

tioned individual was

seized

with severe

when

a few weeks old, which recurred very frequently, and

soon put a period to

its

existence.

In

this instance

the predisposition seemed to increase with each suc-

ceeding generation.
I

have alluded to the intimate connexion which

appears to subsist between different disorders of the

nervous system.
that

One

circumstance, connected with

observation,
I

bears

a reference to our present


that a predisposition to

subject.

mean

the fact,

epilepsy will sometimes appear in

some

individuals of

a family, while their nearest relatives are affected by


other maladies of the
idiotism
:

same

class

as palsy, or connate
all

but the disorder to which, of

others,

epilepsy would appear, from this and similar observations,

to be

most nearly

allied, is

mania.

I believe

these diseases

more frequently pass

into each other,

have a

relative,

upwards of ninety years

old,

who has

for

years been subject to this complaint.


diately
;

He

generally rises

some imme-

but on one occasion lay some hours insensible.

Another

kinsman of mine, who died


during the
last

after attaining his eightieth year, was,

two or three years of

his life, subject to

fits.

PREDISPOSITION HEREDITARY.
and, what
is

97
fre-

more
than

to

our present purpose, more


to

quently appear in persons related


consanguinity,

each other by

any others of the same class;


strictly

except those affections which are

considered

as merely modified appearances, or as sequelas of the

same

disease.
is

There

another remark connected with hereditary


I

predisposition, which

must not omit

to

mention

before I take leave of this subject.

The
in

predisposition to various diseases shows

itself,

particular families, at certain periods of age.

We

often hear of phthisis pulmonalis appearing in

or

all

the children of the


at their seventeenth

same
or

parents,

many when they


In

arrive

eighteenth year.

other families a similar disposition manifests itself at a

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

tendency to the disorder of their kindred.

I could

adduce
tion

easily

many

other facts, in proof of the observaare


often

that

predispositions

temporary,

and

occur at different ages in different individuals, and


that these varieties prevail through families.

The same remark may be


position
to

applied to the predistreating


of.

the disease

am now
:

attended a gentleman, some time ago, of middle age,

who was
this

attacked by epilepsy

an elder

sister

of

individual

had the same disorder some time


appearance

before,

and

I subsequently witnessed the

of a convulsive disease, in which the characters of

98

TERMINATIONS AND CONSEQUENCES


epilepsy were combined in a younger
all

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

other respects subject to

severe diseases, has had no returns of her convulsive


fits.

These circumstances

in

the history of the disease

are of great importance,

when we attempt

the con-

sideration of particular cases with a view to prognosis.

Terminatiotis,
\.

and Consequences of Epilepsy.


in

Epileptic
;

fits

children

often
is

terminate

in

sudden death
dissection.

the cause

of which

obscure, and

hitherto unexplained by any appearances observed in

In more advanced years,


disease has
this

and especially
there
is little

after the

become

habitual,

danger of
is

event, unless the repetition of the

paroxysms

very frequent.
takes
place,

Sometimes a rapid succession of


the

fits

patient falling into one almost as

soon as he has escaped from the former.


case
there
is

In this

great
;

danger of the disease proving


or
if

instantaneously fatal

the patient does not expire


his falling into

under the violence of convulsion, of


a state of coma, from which he
2.

will not recover.

Severe

epileptic

fits

give

occasion

to
fact,

almost
every

every
*

modification

of paralysis*.

In

have

this

day seen a case

in

which

epileptic

fits

in

a child,
is

three years old, were followed by hemiplegia.

The

child

of a

plethoric habit: the

first

appeared while the variolous eruption


fit

was coming out; the

third

left

the child hemiplegiac.

OF EPILEPSY.
species
lesion
this

99
to

of disease

which
is

is

known

depend on
and
the

of the brain,

found to have resulted from


hemiplegia,

cause;

among
the

these a partial

amaurosis, are some of the most frequent occurrences.


3.

Whether
is

fits

are very severe or not,


if

disease seldom continues long, especially

the recur-

rence

frequent, without giving rise to some dimi-

nution in the acuteness of the faculties.

This
is

first
:

appears in the complaint, that the


in

memory
there
is

impaired

severe and inveterate cases

a complete

fatuity, or

a state

much

resembling natural idiotism.

4. Another concomitant of epilepsy is that affection which has been termed " mania epileptica." It is,
in fact, a
fit

of raving delirium, resembling the delirium

of phrenitis, and probably depending on


physical

a similar
author

condition

of the

brain.

The

first

who
all,

noticed this feature in the history of epilepsy,

was, I believe. Dr.

Mead*.
it,

It has
writers,

been

little, if

at

observed

by subsequent

until

the late

Dr. Percival described

in his valuable

monograph

on Mania.
it

Yet

it is

of so frequent occurrence, that

can scarcely have been unknown to any physician

connected with an hospital for the reception of patients


subject to disorders of this class.

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,

with epileptic symptoms;

which keep lunar periods, are generally accompanied " which, he adds, " was attested to me
Bethlehem Hospital, who upon that account usually

as a constant observation, by the late learned Dr. Tyson, formerly

physician

to

called such patients' epileptic mad.'"

100

CONSEQUENCES OF EPILEPSY.

term " epileptic delirium," generally appears when the


patient
is

expected to revive from the comatose state


fit;

consequent on a severe
it

but, in other instances,


fit.

appears

without any

previous

The
is

face

is

flushed,

and the aspect of the patient


intoxication
;

like that

of a

man under

he attempts to

start

from bed and run about, and on being withheld,


vociferates

and endeavours

to

overcome

resistance.

Sometimes an appearance of maniacal hallucination


displays
itself,

but more generally the disorder reIt

sembles phrenitic delirium.


one,

commonly

continues
patient

two, or three days,

during which

the

requires confinement in a straight waistcoat, and then

gradually subsides, and


previous state.

the patient returns into his

remark which I have made, connected with


is,

this

affection,

that

it

has given

rise to

a suspension in

the recurrence of the epileptic

fits.

This fact

may

be

noticed in the history of a case inserted below*.


5.

more unusual circumstance


is

in the history of

epilepsy

the appearance of a species of

somnam-

bulism, or of a kind
patient
is

of ecstasis,
reverie,

during which the

in

an undisturbed

and walks about,

fancying himself occupied in some of his customary

amusements or avocations.
This singular affection
subsequent chapter.

This takes place during

the waking as well as the sleeping hours.


will be

considered fully in a

* See case 14th, in

Chapter V. below.

PATHOLOGY OF EPILEPSY.

10]

SECTION

III.

Observations on the Pathology/ of Epilepsy.

HOPE

to be enabled

to

throw some

light

on the

pathology of this disease by the cases to be adduced


in the following pages, which, as before observed, will

be

distributed

according

to

the functions, o n dis-

ordered states on which they are supposed to depend.

What
to

I have to say at present


little

on

this subject will,

therefore, be

more than the anticipation of results established ; and the chief reason for be afterwards
offering
it,

now

is

to direct the attention of the reader

into the train of observations to be followed out in

the sequel.

The immediate

cause of an attack of epilepsy, or

that physical change which, in a constitution prepared

by natural predisposition, or by the action of morbid


circumstances,
sion of the
fit,

is

the immediate precursor and occa-

appears to me, as I before hinted, to


into

be a preternatural influx of blood

the vessels

of the encephalon, or an unusual fulness in some part of the vascular system of that organ.

The
First,

reasons on which I found this opinion


:

referred to the following heads

may

be

consideration of the intimate relation and


transitions,

frequent mutual

or conversions,

of dis-

orders of the nervous

with

the certain

and cerebral system, connected knowledge which we have attained,

that several maladies of this class depend on the state

102

PATHOLOGY OF EPILEPSY.

of the circulation above described.

On

this subject I

have said enough


Secondly,

in the last chapter.

A comparison of the circumstances which


known
are
to

in a variety of instances are

give rise to

attacks

of epilepsy.

They

such as are found

to occasion a

morbid plethora of the brain.

Thus

epilepsy often occurs in persons

rapidly increased in bulk and fulness

who have of habit: in men


:

of indolent habits,

who

live luxuriously

the quantity

of blood in the body being excessive, a slight change


in its distribution occasions excessive local plethora. It occurs in females

who

labour under suppression

or retention of the catamenia, or

when

the flow

is

scanty and

difficult.

Such women are

chiefly subject

to the attacks at the periods of menstruation,


is

when

it

well

known

that in the defect of the natural relief

of the system, a variety of morbid determinations take


place,

sometimes

to the vessels of the stomach, occa;

sioning violent gastrodynia with haematemesis

some-

times to the pulmonary vessels, giving rise to ha3moptysis


;

at others to the external vessels of the head,

when

the consequence

is

a profuse epistaxis

all

these

phasnomena have been witnessed over and over again


by every medical
practitioner.

When

epileptic

fits

appear under the same circumstances, we have reason


to believe that they arise
viz.

from an analogous cause,


a

a determination to the vessels of the brain.

The appearance

of epilepsy from metastasis


to the

is

phsenomenon which leads


old sores or
artificial

same

inference. After

the repulsion of cutaneous eruptions, the drying

up of

discharges, the retrocession of

gout, rheumatism, or

indammations of serous mem-

PROXIMATE CAUSE.
branes,
it

103

is

well

known

that inflammatory affections

of various organs, and various local determinations,


frequently ensue.

And

epileptic

fits,

as

we

shall in

the

sequel

observe,

occur under
is

all

these circum-

stances.

The

inference

obvious.

Under
are well

a variety of morbid circumstances, which

known

to occasion
fits,

an inflamed state of the

encephalon, epileptic

or

pheenomena very

similar,

occur in the usual course of things.

The

fits

of con-

vulsion, after severe injuries of the head, are

examples

of this description
the

we may add

the paroxysms of
in the acute

same

kind,

which sometimes happen

stage of hydrocephalus, and in cephalic fever, in combi-

nation with other marks of cerebral inflammation


this

in

case they are sometimes, but not always, indithe


fits

cations of suppurative inflammation:

which

occur in children from dentition, appear to arise from

a temporary affection of the encephalon of the same


character
;

though obviously arising from the


this process,

irritation

occasioned by
hydrocephalus.
Epileptic

they sometimes usher in

fits

occur sometimes in consequence of


also from loud
sitting

great muscular exertion, the effect of which on the


circulation
in

the head are

is

obvious

speaking.

They

brought on by

in hot

and crowded rooms.


as a

Violent emotions, which power-

fully increase the action of the heart,


effect
;

have the same


;

sudden

fright, giving rise to palpitation

or

a paroxysm of rage.
in the

But

I think there

is

no instance
than

history of this disease in which

we can more
effect,

clearly trace the connexion of cause

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

chapter an account of two cases,

one of convulsive, the other of tetanoid epilepsy, which

were occasioned by severe hooping cough


not in
the

in one, if

both

of these instances, a

it

is

evident
injury
;

that

brain

sustained
the

considerable

appaforced

rently

from

violent

impetus

of blood

into the cerebral arteries during the

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

present in other instances, unless there


to forbid this supposition
:

some reason

and

this

can scarcely be

pretended.

The

instances which
to

seem most

likely

to furnish

an exception worms, or

the pathological

doctrine just laid

down, are those cases of epilepsy which proceed from


irritation of the intestinal canal.

I believe I

shall be enabled in the sequel to afford

satisfactory

proof, that in
*

many

instances at least of this descripthis

See Note D., at the end of

Chapter.

The
to

reader also will find in that note an account of two remark-

able cases, illustrative of the

same

subject,

which were reported

me by my

friend Dr. Laird, physician to

Guy's Hospital.

PROXIMATE CAUSE.
tion,

05

the morbific cause I have suggested

is

actually

present.

Thirdlv,

The phasnomena

of the paroxysm

itself

are

such as indicate determination of blood to the head.

Such are the flushed and turgid appearance of the


the stupor or insensibility which accompany the
well as the vertigo

face,

the vehement action of the carotid, the dilated pupils,


fit,

as

which often precedes

it,

and the

headache, with throbbing of the temples, which almost


universally follows
it.

Fourthly,

The consequences
life,

of the disease lead to a


the state ofepileptic

similar inference, whether


patients during

we regard
is

or the appearances discovered on


It

dissection after death.

not an

uncommon

occur-

rence to meet with cases of epilepsy in which the


brain has sustained so

much

injury, during a

paroxysm

of unusual violence, as to leave a permanent fatuity,


or palsy, of

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-

brain are various, and this

not the place for entering

any detailed account of them.

they resolve themselves into the evidences of

inflammatory action.

The

appearances, by far most

common,

are

turgid

state

of the

vessels

which

ramify upon the tunica arachnoides, and sometimes a

reddened condition of the cerebral substance


effusion of

itself;

serum into the

cavities or

on the surface of

the encephalon.

Tubercles are often found in the

106

PATHOLOGY OF EPILEPSY.
;

brains of epileptics

but they appear to act as occa-

sional causes, inducing, at times, local determinations


to the head, as in in

a case mentioned

in the last chapter,


rise to

which the presence of tubercles gave

repeated

attacks of cerebral inflammation, which terminated in

hydrocephalus.

There are indeed many cases on record,


after a

in which,

patient has fallen

a victim to epilepsy,

no
kind

morbid appearance whatever has been discovered in


the brain
;

and more than one instance of

this

has fallen under


it

my own

observation.

In these cases

is

probable that dissolution has sometimes been

the

consequence of the extreme exhaustion occa-

sioned by the severe and protracted agitation of the

paroxysm
sudden
either in

and

at

others,
to

has

arisen

from some
or in

impediment
or

the

process

of respiration,
glottis,

a spasmodic stricture of the


arrested

the disturbed

action of the system of


:

muscles which expand the thorax

or,

perhaps, in
to

some
heart
is

instances,
itself.

from the spasm extending


this description in

the

Perhaps the immediate cause of death

some accident of

most of those

patients

who

perish during

some

violent

paroxysm
the
cases
irrita-

whether that paroxysm

itself

has been the result of


as
in

some
just
tion

disease

of function merely,
to,

now

alluded

or

has arisen from the

of tubercles or exostoses.

In other instances,

however, as when there are indications in the ence-

pbalon of a high degree of inflammatory action, or


of extensive disorganization, effected by
sisting disease,
a

long sub-

we may presume

that the brain has

PROXIMATE CAUSE.
become so much changed
and
the
in its structure, that
its
it

107
has

been incompetent to perform


death has

requisite functions,

ensued

in

consequence.

Patients

under these circumstances generally sink, not through


violent

agitation of

any particular attack,

but

by the gradual approach of coma.

108

CASES ILLUSTRATIVE OF

NOTE
Sarah Ponchard, aged
About

D.

nine years, was admitted an

out-patient at St. Peter's Hospital, Feb. 9, 1821.


three years ago she was troubled by severe hoop-

ing cough, which

brought on
fits

fits

of tetanic epilepsy.
stiff, and her She laboured under

When
these

seized

with these

she became

limbs were stretched out and fixed.


fits

four months.

She continued

in

a bad state of

health after she got rid of the cough, and about two years

ago was

afflicted

with a weakness and partial paralysis of

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.

involuntary jerking motions of the limbs of the same side.

R
Feb. 23.

01. Terebinth, ^ss. in

Aq. Cinnam.

cum

Syrup, Tolu, 3J.


is

ter in die.

She

is

much

better, but

sometimes attacked
liable to fall
to

by

fits

of vertigo, in which she

is

the

ground.
Repeat the medicine.

March

9-

She

is

continually getting better.

Continue.

23.

She can now walk very well

her limbs are

stronger:

yesterday she was seized with headache; and,


talked in a wild and rambling manner.

for a time,

Her

bowels are regular.


Six leeches to be applied
Episp. ad nucham.
Pulv. Cath. gr. xv. omni nocte.
to

her temples.

THE PATHOLOGY OF EPILEPSY.


March
30.

109
;

She has

a troublesome

cough

in

other

respects has no aihneot.


Mist. Sal. Ant. Op.
c.

T.

Scill.

Repet. Pulv. Cath.

April 13.

She

has

now no

disorder at

all.

Discharged cured.
Elizabeth Howell, aged eleven,
out-patieut at the Infirmary.

August 28, 1820, an


While

When

nine years old had the hooping-cough.


of the right arm,

labouring under this disease she was one night seized with

a spasmodic

stiffness

which was soon


that time she

followed by a general convulsion.

From

has been subject to similar

fits,
;

her about once in a fortnight

which generally molested but lately she has been


fits

generally disordered, and has had febrile symptoms, which

her mother attributes to a cold, and the


three or four times in a night.

have occurred

They always come on with a spasm of


Sometimes,
it,

if

the right arm. any body catches hold of the arm and rubs

the affection goes off for the time;

otherwise she
fit.

is

soon affected with the symptoms of an epileptic


is

She

convulsed

her eyes are reverted

she foams at the

mouth; sometimes
severe headache.

bites her tongue; afterwards she has a

What

is

remarkable

is,

that she retains


fit.

consciousness and perception during the

At

least her

mother very confidently


has been
said to

declares, that she repeats

what

her during that time.

She often has

severe vertigo.
l>latural functions.

She
is

has lost her appetite.

Her

bowels were,

till

lately, very costive,

but are now open.

She

often complains of severe shooting pain in the abdo;

men

often shivers, and

feverish.

Pulv. Cath. 9j. omni nocte.


Mist. Cath. ter in die.

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.
;

She has had only two appears more collected


avers that she

fits
;

since she was here.

The

girl

and, on being strictly questioned,

never has lost her consciousness during

the

fits,

but

recollects all that

happens during them.


d.

Pil.

Cath.

3. o. n.
j.
t.

Emuls, Tereb. cochl.


6.
is

Appetite better;

fits

less

troublesome: she
she has not

now

seized,

about twice

in

each night, with the spasm


:

of her hand, which has not gone up her arm

had one severe

fit,

viz. affecting

her head.

Repeat.
13.

One
fits

slight

fit

yesterday night: she has had

three slight

since she was here.

Appetite natural.

Is

Stronger, and feels better.


Affus. Frigida.

Emuls. Tereb.
20.

3ij. ter in die.

Spasms nearly
fit.

as before; occur

more than
tongue

once

in a

night for the most part.

Once

she was affected


;

with the severe


white.

Bowels opened by the mixture

Soon

after this period she ceased to attend.

She had

certainly derived benefit from the measures adopted, but

they were not continued long enough to afford decided


relief.

The

other cases referred to, in page 104,

shall here
to

insert in the

words

in

which they were communicated

me by Dr. Laird. " The first was


period of
life,

that of a gentleman, about the middle


full

and of rather

habit of body.

He became,

THE PATHOLOGY OF EPILEPSY.

1 1 1

early in the spring of last year (1820) the subject of cough,

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.

insensibility; of short duration,


in

however, and terminating


of unconsciousness the

the expectoration of

some remarkably tenacious and


state

viscid

mucus.

During the

eyes were fixed, the tongue protruded from the mouth,


the countenance bloated, and the pulse quick and weak.

The

difficuliies

by which the powers of

life

seemed

in this

struggle to be sometimes nearly extinguished, appeared


to arise

from

stricture of the glottis

in the first

instance

probably of a spasmodic nature, and the danger by which

he was threatened to be apprehended from instant suffocation.

Under general and

local loss of blood, inhalation,

and the continued exhibition of conium, ipecacuanha, and


mercury, the complaint gradually gave way

have been
mischief,
brain."

since

neither

; and there any symptoms of pulmonary

nor any disturbance of the functions of the

" In the second case sudden insensibility; which, from


the account I received at the time, partook
character of apoplexy
in a

more of the

than
;

of epilepsy, was followed,

few hours, by death

and on examination of the


full

body, the lungs were found so gorged with blood, and the
bronchial cells, with even the larger ramifications, so

of effused

fluid,

that it

was made a question, by

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

basis of the brain,

by which the substance of that

112

ILLUSTRATIVE CASES,

&C.

organ was lacerated.

We

have then, in these instances,


in

an additional illustration of the mutual influence of the


brain and respiratory system,
tions,

their respective condifully into

and must admit the necessity of inquiring

the state and affections of each under any obscurity with

regard to their pathology."

DESCRIPTION OF

lyiADNESS.

}\3

CHAPTER

IV.

A GENERAL DESCRIPTION OF MADNESS.

SECTION

I.

Outline of the History of this Disease.

There

is

no other disorder so

difficult to

describe as

madness,

and there
.

is

none of which so imperfect


It is

and erroneous ideas are entertained.


to found a general observation

common
and

on some
kind
is

striking

often

peculiar

case.

Of

this

the remark,

so frequently repeated, that madness begins in


single hallucination, or false impression,

some

and gradually
In a great
its first

extends

itself to

other trains of ideas.

majority of cases the disorder seems, at


to

onset,

involve

every succession
It
is

of images
chiefly

that

passes

through the mind.

distinguished

by

a general incoherence of thought; the ideas appear


scarcely to follow any connected course
;

the attention
to

passes in a hurried
another.

manner from one assemblage


in

There are indeed instances


its

which madness makes

approach gradually

a certain waywardness, or

singularity of character, is observed for

perhaps for years, before the individual

is

some time; set down


the

by

his

friends

as

a lunatic.
all

But

in

general

disease breaks out

at once: the

manners of the

patient are unusually impetuous, his conversation hurI

114
ried, his

GENERAL DESCRIPTION
mind
full

of projects, which he pursues with

restless

activity.

He

betrays the absolute derange-

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

once made evident,


generally a
:

and

the necessity of restraint

becomes obvious.
is

At

the

first

attack of madness there

considerable

disorder of the whole system


all

febrile

excitement

the functions disturbed

the bowels
is

are confined, the appetite impaired, and often there

an

entire
;

disinclination

to

food;

the sleep

is

dis-

turbed
is

the patient incapable of repose.

The

pulse

accelerated;

the face flushed; the eyes red; the

pupils contracted.

more incoherent at the commencement of madness than at a more advanced period. In this state of things, the mind

The

ideas of the patient are often

sometimes rambles, from one object to another, so


rapidly, that the association

which connects the ideas


;

can with

difficulty

be traced

it is

often impossible to

confine the attention of the patient for a sufficient time


to allow of obtaining an answer to

a short question

re-

specting his health or feelings.

As

the complaint goes

on, and the general excitement of the bodily functions


lessens, the ideas acquire

a greater consistency ; the imbut the thoughts occur


:

pressions

still

have the character to which the term of


is

maniacal or insane
in trains

applied

more evidently connected and coherent

the

ideas are

association.

now found to be joined by new The patient is now able and

habits of
willing to

OF MADNESS.

115

answer questions, though frequently he makes absurd


replies
;

and,

when under
becomes

the influence of

some

vivid

hallucination,

violent

and

intractable.

The

disease often remains long in this state; there

are sometimes

relapses

into

the greater degree of

incoherence
settled

but in general the ideas become more


until either the

and connected;

morbid impresis

sions gradually disappear,

and the same condition

insensibly restored

or they

become more

firmly, and,

by degrees, indelibly impressed, and the patient turns


out to be an incurable lunatic.

The

character of this disease differs, in a variety of

instances,

from what
description.

may
It

be regarded as the more

ordinary

sometimes breaks out at

once with paroxysms of the most violent and frantic


rage.

The

lunatic regards every

body as

his

enemy,

and

assails the by-standers with the

most clamorous

invectives.

This form of madness is generally accompanied with a high degree of constitutional irrita'
tion
;

considerable
;

excitement of the

sanguiferous

system

strong pulsation of the vessels carrying blood


;

to the head

increased heat and thirst.

It

is

in fact

a more acute disease than the most


mania.

common form
kind.

of

On

the other hand, those which are termed

cases of melancholia are of a


this disorder the

more chronic

In

patient

is

sorrowful and dejected;

always dwelling on the most gloomy ideas; anticipating


future evils
:

his imagination

is

not contented with

spreading a shade of dreariness and despondency over


the prospects of this
life,

but expatiates with greater


futurity.

freedom in the unknown regions of


this

It is

tendency which has given

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

of false impressions, connected with

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

of the melancholic class,

means

so acute as those which occur


febrile

frantic
;

madness; a low degree of


and oppressive pains

action

exists

often dull

in the

head

a deficiency of the secretions, particularly those which


belong to the intestinal canal;
rexia, dyspeptic disorders,

whence ensue ano-

and torpor of the bowels, to


generally

a greater or

less degree.

Melancholy
and gradual.

madness

is

permanent

disease, especially

when

its

progress has been slow

The

other forms of madness undergo

remissions, and the patient often completely recovers


his sanity.

The

recovery in some instances

is

perma-

nent

in others

liability to

the disease remains, and


life,

the individual continues, through his

subject to

occasional relapses.

This modification of the disease,


termed Recurrent Madness, has
:

which ought

to be

received the epithet of Periodical

a term evidently

improper, since

it

is

not meant to imply that the


its

disease observes any definite period in

returns.

NATURE AND CHARACTERISTIC OF MADNESS.

17

SECTION
Remaiks on
the

II.

Fhanomena and Nature of Madness.

It seeais
few or
inquiries

to

be generally acknowledged that there are


subjects

no

within

the

range of medical
difficulties

encumbered
distinction

with

greater

than

a correct

of the

characteristic

circum-

stances of madness.

Numerous

are the definitions

which have been

offered,

and soon abandoned, or

proved to be incomplete.

Of

late it

seems to have

been considered as nearly impossible to lay down any


absolute criterion by which the existence of this disease

might be determined.

The confessed obscurity of this subject, and the many abortive attempts which have been made to
elucidate
it,

would
enter

afford

an apology for declining


it.

altogether

to

upon

Since,

however,

the
lie

inquiry seems to relate to matters which do not

beyond the reach of human observation,


to be given

it

ought not

up

in despair.

I shall therefore

make an
and
disit is

attempt to analyse the nosological character of madness,

and to discover what are

its

peculiar

tinguishing phaenomena.

If this endeavour, as

too probable, should


fate of

fail,

I shall only experience the

my

predecessors.

The

nosological writers in general describe insanity

as consisting in

some

error of the judging or reason-

ing faculty.

Sauvages has prefixed to the


title
is

whole

order of " Deliria" the


cantis;" and yet there

of " Errores mentis juditrite,

no observation more

118

NATURE AND CHARACl'ERISTIC


writers of this
believe,

and more frequently repeated even by


description, than the remark, first

made, as I

by Mr. Locke, that


erroneous premises.

madmen

reason correctly from

Dr. CuUen has entered in a

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
;

which belongs to madness.

" It may," he says, " be

considered to be, in a person awake, a false or mis^

taken judgment of those relations of things which,


as occurring

most frequently

in

life,

are those about

which the generality of men form the same judgment

and

particularly

when

the judgment

is

very different

from what
formed."

the

person

himself had

before usually

This

definition,

like

many
this

others which have been


respect, that
it

offered, is defective in

includes

within the limit of madness a great

number of persons
to be regarded

whose
sense

peculiarities are

more properly

as examples of caprice.
it

In a certain paradoxical

has often been maintained that the majority

of mankind are mad.

But

this

comprehensive species

of insanity

is

not the object which


definition.

by a nosological
of which
racter,
folly.
is

we wish to describe That kind of madness


from eccentricity or

we

stand in need of a distinguishing chadiffierent

something

Dr. CuUen himself was not quite contented with


this
djefinition,

for

he afterwards adopts a different


additional circumstances.

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,

and commonly producing disproportionate emotions."


I think
real
it

very questionable whether there

is

any
in

ground for the additional remark contained

this definition.

The emotions
and are

of a lunatic are indeed

often vehement,

forcibly expressed;

but

it

may
arise,

very well be doubted whether they are out of just

proportion to the mental impressions from which they


or are in reality

more

vivid than those

which

many

sane persons, of susceptible temperament, would

experience, were they actually placed in the precise

circumstances

with which

the

imagination of the
will often

lunatic environs

him.

A madman

fancy

himself a king, and then he will utter expressions of


violent indignation if he is

not treated with

all

the

respect and obedience to which his elevated station


entitles

him

but I believe there

is

many an

autocrat

who would be just

as grievously affronted, if his royal

honours were treated with as much freedom and con-

tempt as the poor lunatic


due,

is

fated to experience.

Give

the latter the obeisance which he fancies to be his

and he

will

be

infinitely gracious

and conde-

scending.
I believe define or
it

will

be found requisite, in attempting to

form a correct idea of the nature of madness,


Indeed, the more
I

to exclude, as before hinted, all reference to the state

of the judging or reasoning faculty.


I reflect on this subject, the
to

more nearly

approach
in

a conviction that the judging faculty


;

is

nowise

involved in the calamity

that no defect of the reason-

l*^
iftg

iCATURE ANi) CHAUACTFRISTIC


power
tiie

constitutes

any part of inadness*.

Men

indeed arrive every day at such diversities of opinion

from

same

data, that
to

it

seems impossible, by any

rule or criterion,

define the limit of error

which

might be allowed without consigning the individual to

*
in

A very

remarkable and interesting case of insanity

is

recorded

the Gentleman's

Magazine

for

1762, which strongly exemis

plifies

the observation

that the

reasoning power

retained by

lunatics,

and that they are capable of arguing correctly on the


This
is

premises furnished by their hallucinations.


of Mr.

the case

Simon Browne, a dissenting teacher, of great intellectual powers, who became convinced, to use his own expressions, that he
had
fallen

under the sensible displeasure of God, who had caused


left

his rational soul gradually to perish, and


life in

him only an animal


in

common

with brutes

that

it

was therefore profane

him

to

pray, and incongruous to be present at the prayers of others."


this

In
his

opinion he was inflexible, at a time


subsisted in their full vigour.
at the table of

when

all the

powers of

mind

Being once importuned

to say grace

a friend, he excused himself


repeated, and the
;

many

times; but the request being

still

company kept
and, after some

standing, he discovered evident tokens of distress


irresolute gestures
this ejaculation:

"

and

hesitation,

expressed with great fervour


let

Most merciful and Almighty God!

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

"

But the most astonishing proof


is,

of his intellectual excellence and defect

"

Defence of the

Religion of Nature and the Christian Revelation, in

Answer

to

Tindal

"

with a dedication to the queen, in which his halluitself.

cination discovers

Cases analogous to

this

are

by no means rare occurrences,

though

it

is

not usual to meet with instances in which the facts

are of so striking a description.

The
work on

case of

Simon Browne has been already extracted by

Dr. Arnold from the Gentleman's Magazine, and inserted in his


Insanity.

OF MADNESS.
the imputation

121
the difficulties

of insanity.

Hence

with which this subject has been unnecessarily en-

cumbered.
It

seems likewise, for the reasons above hinted

at,

that

we may

exclude from the characteristics of

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

impressions from which they take

We
field

shall cursorily

survey the state of the other

intellectual faculties*,

and endeavour
in

to

reduce the

of observation within narrow limits.

There are diseases


or impaired
ness.
;

which sensation

is

erroneous

but these are totally distinct from

mad-

Erroneous sensation occurs in the dilopia or


but in these cases there

double vision, in the paracousis and parageustia of


nosological writers;
is

no

correspondent error of perception.


sion on the organ of sense
is

The

false

impres-

immediately corrected

by the mind, and no mistaken apprehension takes


place.

Disorders of this class are quite distinct from


is

those cases in which the perception


that

depraved, so
objects

the

mind apprehends the presence of


is

which are not

really presented to the organs of sense,

and of which there


former case, there
perception

I
;

no actual sensation.

In the

may

be said to be sensation without


perception without sensareference at present to the

in the

latter,

purposely omit to

make any
it

active principles,

and the question, whether they are the subject of


for if

disease in

madness:

be the case,
it

it

is

a comparatively

rare occurrence, and the consideration of

cannot enter into our

idea of the pathology of this disease in

its

ordinary form.

122
tion
:

NATURE AND CHARACTERISTIC


whereas
in the healthy state
is

of the organs and

of the brain, perception


as
its

connected with sensation

proper and inseparable consequent.


to consist chiefly and any error or defect of the power of

Neither can madness be said


essentially in

perception,

distinctly

considered;

since lunatics

in

general have very acute perceptions, and distinguish

very clearly and correctly the persons and objects that

surround them.

It

must be allowed that confused

and

indistinct perception

may

be observed to take
arise

place in

some
also,

states

of disease which

occa-

sionally in the course of madness.

The

ravings of a

maniac are
it

on some occasions, so incoherent, that

is

difficult

to distinguish in

them the proofs of


:

his

possessing the power of clear perception

still it

canis

not be thought that any defect of

this

faculty
;

a general or characteristic
lunatics, in general,

trait
all

of the disease

since

amidst

their hallucinations,

evidently possess the power of perception in a very


perfect state.
If,

then,

we determine
viz.

to exclude

from our idea of


of intellectual

madness the above-mentioned


phaenomena,

classes

sensation and perception, as well as

the reasoning or judging faculty,

we

at least reduce

our inquiry within narrower bounds.

But what now

remains?

What

are

we

to regard as the essential

circumstances of madness?
It will be found, if I
faculties of the

am

not mistaken, that the

mind, to which we must direct our


imagination, or reverie
and, in fact,
is

chief attention in investigating the nature of madness,

are

memory and

that the habit which characterizes a lunatic

that of

OF MyVDNKSS.

123

confounding the results of these two mental operations,

and

mistaking

the

ideas

of reverie for the

impressions of

memory and

reflection.
it is

We

may

remark, that the mind, when

not

occupied in receiving new impressions from external


objects, or in exerting the faculty of perception,
is

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

with various degrees of rapidity.

But

although

the

mind
is,

is

never altogether

vacant of

thoughts, there
exertion

during the waking hours, a state of

and a

state of repose.
is
it

In the former of

these, the attention

alive

the

mind

is

in

a state of
a parti-

energetic reflection

recalls impressions in

cular mode, of which one characteristic circumstance


is,

that

it

is

attended with
;

the consciousness of a
;

voluntary

exertion

it

compares ideas

it

actively

pursues certain associated


exclusion of others
;

trains of thought to
false.

the

it

judges of true and

This

condition of the
active reflection.

mind may be termed the state of But when wearied, or otherwise


the

indisposed
exertion

to

any pursuit that requires the active

of the faculties,
is

mind

sinks

opposite state, which

one of

inactivity

into an and repose.

The

ideas that present themselves follow their

own

course, or succeed each other in those trains in

which

they spontaneously occur.

This

latter

habitude
It
is

may
that

be termed the state of passive reverie.


condition into which the
it

mind
;

naturally returns

when
to

has no motive to exertion

when approximating

124

NATURE AND CHARACTERISTIC

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
:

of this kind are the expressions, fantasy,


air.

imagination, day-dreams; building castles in the

Sometimes, in these processes, the feelings become

more or
mind
is

less interested

occasionally they are so


is

much

excited that the attention

again awakened, and the

roused into

its

posture of active reflection.

In ordinary circumstances the mind possesses the

power of immediately distinguishing the impressions


produced by these two modes of mental operation

from each other


which occur
in

the images, or assemblages of ideas,

combination during the state of reverie,


;

are recognised as such

and the recognition


and
those

is

attended

with the persuasion that such impressions are fantastical

and

unreal

assemblages

of

thoughts, which were


recollection

combined by

active and attentive

and
;

reflection,

are distinguished by the


is

mind

as such

and the recognition


the
lost,

attended with

the conviction of their truth and reality.

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

of accurate perception will yet remain


faculty,

and judgment, or the reasoning

may

still

exist

unimpaired, and be exerted with energy and clearness,

upon those materials which are presented


the

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

or matter of fact, from the most


If in the

whimsical suggestions of his imagination.

course of his day-dreams he has represented himself as


possessed of
all

that his heart

most

desires, as great,
in real belief:

opulent, or renowned, he
if his

becomes so

temper

is

vindictive,

and he has been dreaming

of the satisfaction he should enjoy in punishing his


enemies, were he powerful and possessed of authority,

he becomes a king or an emperor


desponding mood, and
griefs

if

of a timid and

in the habit of

brooding over

and

fears,

and placing himself

in imagination

under some extreme agony, or imminent danger, the

phantasm
and he

is

converted into a substantial conviction,


is

retains the belief that such


if

his predicament,

as clearly as
ties
;

the impression were founded on reali-

he

is

overwhelmed with despair*.


to

Such appears
his reveries,

be the condition of the

the native bias of his temperament, or upon his previous habits,


the

even

madman
upon

the character of which depends

most

idle

and

fantastical of
effect,

them, produce upon his mind the same


leave exactly the

and

same impression,

as in a sane person

The

hallucinations of the

maniac generally

refer to

a class

of ideas with which his former habits of mind have rendered


familiar.

him

In a healthy state his reveries would turn

upon such

subjects, but they

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

NATURE AND CHARACTERISTIC


medium
of actual perception,

takes place through the

or of the assemblage and combination of the ideas of


perception,
reflection.

by the active exertion of memory and

To sum up

this

account in a few words,


to consist in the

the character of madness seems

circumstance that the impressions of reverie are so modified by the disease as to be no longer distin-

guishable from those of attentive and active reflection.

There
to differ

is

one form of madness which


this description,

may be
it;

thought

from

and to involve circumI allude to

stances which I have excluded from

those cases of maniacal affection, in which the lunatic


fancies that
present,

he perceives things and persons as actually


existence, or are absent.

when they have no

In

this instance it

may appear

that there

is

an erro-

neous perception.

I believe, however, that


little

even cases
considera-

of this description will be found, on a


tion,

to be quite consistent with the account I have

given of genuine madness.

When

the maniacal hallucination becomes exalted


it

to a very intense degree,

represents unreal objects

as actually present

some

particular phantasms, the

creations of reverie or imagination, are presented to

the

mind

in such vivid colours as to produce a similar

effect to

that of actual perceptions;

the patient in
to place

other respects
or

makes no mistake with regard


is

time; his perceptions of surrounding objects are


directed
his

correct and uniform, whenever his attention


to perceptible things;
reverie,

but he

is

so intent upon
totally

that for the


his fancy

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,

walk up and down a


objects

street sufficiently alive to external

to avoid falling in

the

way of

horses

and

carriages, or running against foot-passengers, but so

intent

upon the scene presented by


of which

his reverie, as to

be busily employed in issuing commands to troops of


soldiers,

he imagined himself to be the


to enfilade to the right

general,
left,

and directing them

and

and perform a variety of evolutions.


and consistent with
termed
;

All this he

performed with a voice and gesture which were perfectly natural,


reality.

To

this

modification
hallucinations,

of madness

belong

those

maniacal

by

some authors
with
is

idolo-mania, or dasmonomania
fancies

in

which the lunatic


conversation

that

he sees and

holds

imaginary beings.

The

conception of the mind


it

so vivid and intense, that


entirely

withdraws the attention


;

from surrounding objects


no actual

of which, never-

theless, there is

inability to

form a correct

perception
* This
Horace,

and represents the phantasm as an object

is

analogous to the case of the lunatic mentioned by

whom

he considers as more sane than the majority of

his

countrymen.
Fuit haud ignobilis Argis,

Qui

se credebat miros audi re tragcedos,

In vacuo la&tus sessor, plausorque theatro


vitce servarat munia recto More; bonus sane vicinus, amabilis hospes, Comis in uxorem, posset qui ignoscere scrvis.

Csetera qui

128

NATURE AND CHARACTERISTIC


In one instance, which
fell

really present.

under

my

notice,

person
to

who was

liable

to

this

affection

would reply

a spectre which appeared to

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
:

from the phantasm.


to this

may depend

of the perceptive and sensitive faculty

but this case,

occurs, seems to be distinguished from those which

are strictly of the class of maniacal hallucinations,


in

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

establish the existence of this


it

form
This

of disease, and to discriminate


affection, in

from others.

which the fancy conjures up an unreal


it

scene,

and represents
if

as actually present,

may be
It
is

termed, by way of distinction, ecstatic mania.

a rare ph-cenomenon,
in

we compare

it

with those cases

which the hallucination

refers to past occurrences,

or leaves, at least, the perception of the present scene

undisturbed by the intrusion of phantoms*.

The

affection,

which

have denominated ecstatic

* Dr. Cullen

has remarked, that in madness " there

is

some-

times a false perception, or imagination of things present, that are

not

but this

is

not a constant, nor even a frequent attendant of


false

the disease.

The

judgment

is

of relations long before laid

up

in the

memory."

First Lines, Par. 1558.


if

This observation

would have been perfectly correct


impressions of memory.

he had said that the hallu-

cinations seldom refer to the scene actually present, but to the

OF MADNESS.
mania, has a near relation to
tlie

129

pheenomena of somhave occaprobably

nambulism, or

ecstasis, as I shall hereafter

sion to observe.

These

affections

depend
under

on similar morbid conditions of the brain.

But

to return to the description of mania, I

its
it

usual aspect,
consists in

have been led

to

conclude that

such a modification in

the impressions

of reverie, as renders them no longer distinguishable

from those of attentive recollection or


plained, while

reflection.

How
are

such a modification can take place cannot be ex^

we continue

so ignorant as

we now

of the functions of the brain.

physical cause those affections of the

duced which are


conviction
respect

know not by what mind are pro^ termed impressions of memory, and
state,

We

which, in the healthy


of reality
;

are

attended with the


in

nor do we know
differ

what
which
are

these

operations
to

from

those

are

peculiar

the phgenomena of reverie;


to

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

be diminished by adverting to the conclusions

obtained in the foregoing inquiry into the functions of


the brain.

We

have found reason to conclude that a certain


in the configuration, or otherwise

momentary change
in the physical

condition of the cerebral structure,

takes place in conjunction with, or rather precedes,

or

is

at least intimately

connected with every indi-

vidual perception, in the mind.

This operation
in

in the

brain

is

a thing

totally
;

distinct

kind

from the

consequent perception

but

it

is

in the present con^-

130

NATURE AND CHARACTERISTIC

stitution of things the requisite instrumental cause of

every perception.

As

it is

subservient to perception,

I shall term this operation of the brain the perceptive action

meaning aWays by this expression to designate, not the mental phaenomenon of perception, but that
;

change
sical

in the configuration, or otherwise in the

phy-

condition

of the organ,

which

is

its

uniform

antecedent.

But perception
which
is

is

not the only mental pha^nomenon

produced through the instrumentality of an


;

organic process in the brain

a particular change in

the state of the organic structure precedes every act

of memory, or takes place whenever any idea,


ginally the produce of perception,
to the mind.
is

ori-

again suggested
to extend this
recol-

We

have found reason


to

conclusion
lection,

not

only

the

ph^enomena of

but to those of reverie or imagination.

It
is

appears then that a certain operation in the brain


the physical cause of each impression of
well as of every

memory,

as

phantasm which

is

presented to the

imagination.

An
to

impression of

memory

bears that sort of analogy

the

corresponding perception,

which renders
it

it

probable that the organic operation by which

is

preceded

is,

to a considerable extent, similar to that

operation through the agency of which the idea was


originally presented
it

to the

mind.

We

may

regard

as probable that these operations in the organized


in

fabrick,

whatever changes they respectively consist,


that they are in reality modifi:

are similar in kind;

cations of a similar process

in other words, that the

organic

operation,

which re-suggests an

idea,

is

OF MADNESS.
repetition,

131

under some modification, of the perceptive


first

operation, which

impressed
it

it.

If this be granted,

will scarcely

be disputed that

a similar relation probably exists between the organic


operations,
flection

connected

with the

phsenomena of
of the
brain,

re-

and memory,
that the

and those of reverie or imaginawhich


are merely modifications

tion

or

operations

belong to the

latter class,

of those belonging to the former.

We
a

have then only further to suppose,


state

that in
is

diseased
:

of

the

brain

this

distinction

abolished

that the two processes, always analogous,

now
shall

pass into each other, or are confounded, and

we

form a probable theory of the nature of insane


;

hallucinations

the impressions of reverie

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

and conceive how

those of the other.

Whether

this transition

of the organic operation of

reverie, into that belonging to recollection, consists in

a morbid increase in the intensity of action in the


organic
structure
it

of the
consists,

brain,

or in

what other

diseased change
to

we

shall never be enabled

explain,

unless

we

discover the nature of those

operatipns by the instrumentality of which the mental

phaenomena are developed.

What
the

have here said in allusion to the operations


is

of the brain
reader

merely proposed as a conjecture, which


at

is

liberty

to

adopt or

reject,

as

he

prefers.

Whatever opinion may be formed

respect-

ing

it

will not, in

any degree, involve the preceding

132

VARIETIES OF MADNESS.
in

attempt to analyse the morbid phasnomena

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.

the Active Powers, or affecting the

Disorder

Madness without

Temper.

In

the foregoing section I have attempted to

outline of the theory of maniacal hallucinations.


shall

now proceed

to consider

whether

it

may

serve as

a general description, or only applies to some particular cases of

madness.

Nosological writers

have divided

this disease into

a variety of
affections.

species,

which they regard as different


accidental variations, or

Are these only


?

must

it

be allowed that there are in reality several

distinct kinds of insanity

most elaborate

classification
in the

of the different

forms of insanity occurs

work of Dr. Arnold.

All his diversities, however, reduce themselves under

two prhicipal

varieties,

which he terms Ideal and


former he describes as a

Notional Insanity.

The

disease of the faculty of perception: the patient per^-

ceiving external objects erroneously, or forming false


ideas respecting things present to his senses.

In the

other species,

or

Motional Insanity, the author sup-

poses the faculty of perception to remain unimpaired,


while the judgment
is

disordered,

andforms erroneous

INCOHERENT INSANITY.

133

atid tinreasonable notions respecting the relations

of

things

as zvhen

a mail fancies that he

is

ruler

of the elements, or has the power offlying through


the air.
I have already endeavoured to

show

that halluci-

nations of this description aie explicable without sup-

posing any disorder of the judgment, or the reasoning


faculty
;

which faculty the lunatic possesses, and can

exercise

when he

will, in

a powerful manner, even on

the false premises which his imagination sets before

him.

His hallucinations are the suggestions of a


This

M'andering phantasy or reverie, which he mistakes for


the impressions of recollection and reflection.
is

the true character of Dr. Arnold's notional insanity.


is

Again, when the lunatic

so intent

upon

his day-

dreams that

his attention is entirely

withdrawn from

external objects, as in that form of the disease which I

have termed ecstatic mania, the case assumes exactly


that description to which Dr. Arnold affixes the term

of ideal insanity.

In

this

instance the fact seems

to be, that the perceptive

power remains unimpaired,


;

except in some particular cases

but the attention

is

wholly absorbed in the unreal scene conjured up by


the ima^iination.

There
which
is

is

common

modification of this disorder,

termed by Dr. Arnold " incoherent insanity,"

and by Pinel "dementia."


muttering or raving in an

The

patient

is

perpetually

incoherent

manner, and

passing so rapidly and incessantly from one train of


ideas
to another, that
it

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

opinion, that madness consists in a disordered state

of the association of ideas.


of Mr. Locke.

This was the conjecture


in reality

But

it

is

only a casual

modification, often an aggravation of symptoms, and

frequently

gives

way

to

a different

state.

have

witnessed a transition from this incoherent raving, in


the

space

of twenty-four
;

hours,

to

the

ordinary

maniacal reverie
connected

in

which the

ideas,

though turning
in

on the same hallucinations, followed each other


trains,

which were not too rapid in

their

transitions to be traced.

may

observe that,

in

order to be enabled

to

unravel the

strange and whimsical combinations of

thought, which are often to be observed in the wanderings of a maniac,


it is

necessary to advert to the

uew

associations which have been formed since the

com-

mencement of

his disorder.

a lunatic speedily

The susceptible mind of admits new catenations of ideas


is

the principle of which

nothing else than the acciIdeas of


in succes-

dental fact of their successive occurrence.


objects,

which have been presented to him

sion, will afterwards suggest

each other, and the most

whimsical and incongruous combinations of thoughts


are thus brought together and permanently connected.

These phasnomena, which, when explained, are found


to

depend upon well known laws of the system, are

exceedingly perplexing to a casual and uninformed


witness.

Before we dismiss the consideration of the theory


of madness,

we must endeavour

to

arrive at
is

some

conclusion on the question, whether there

a species

DISEASE OF THE ACTIVE POWERS.

135

of maniacal disease, in which the active powers are


primarily
disordered,

without

any affection of the

intellectual faculties.

Such

cases, if they exist, will

require a very different pathological description from

the preceding, and lead to a very different theory.


I

must allow that there

is

common

persuasion
It
is

among

physicians that such a disease exists.

even described, by

M.

Pinel,

one of the best practical


;

authors on the subject of madness


cases,

who

has adduced

which he regards as decided examples of this chaThis species of disease


;

racter.

is

termed, by
is,

M.

Pinel,

" mania without delirium

" that

madness without

any lesion of the understanding.


this dreadful

The

victims

of

malady display a propensity


rage,

to violent

paroxysms of
way.

Avhich

exerts itself
to

upon every
in their

person indiscriminately

who happens

come

Notwithstanding the authority of general opinion,


and, what
is

of

more consequence, the testimony of

such a writer as

M.

Pinel, I cannot persuade myself

of the accuracy of the reports on which the exist-

ence of this

disease

rests.

That a human

being,

in the possession

of a clear understanding, having,

therefore, a correct apprehension of social relations,

of his

own

interest,

and what he owes


by a

to others,

should be suddenly transported


rage,

paroxysm of
to

without any incitement in

what seems

be

universally

and necessarily connected with the moveI

ments of anger,
at variance with

mean an apprehension of
the

real

or

unreal injury or oflence, would be a phaenomenon quite

known

law^s of

human
in

nature.
niind,

passion

or emotion

taking

place

the

136

is

THERE ANY PRIMARr


or idea

implies an impression
forth.

adequate to

call

it

An

emotion without a corresponding impresis like

sion

on the understanding,

a volition without a

motive, or like an effect without a cause.


It

may

be replied that this remark


it

is

well founded,

in so

far as

relates

to

a sound mind, but that

madness
It

subverts, or throws into confusion, the pro-

cesses of the mind.

must be allowed that the mental phsenomena

take place, under disease of the brain, in a different

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,

under the influence of ungovernable fury,


is

without any impression on his mind that

calculated

to excite anger, even without any fancied ground of

offence

against

his

unfortunate

victim,

cannot be

imagined to result from the operation of any natural


causes.

Such a maniac must be


:

literally

possessed by
being,

a daemon

his action is not that

of a human

however insane.

Yet M. Pinel

describes this as the

proceeding of a man, who,

in the

common
full

sense of

words, must be called sane, as being in

possession

of his intellectual faculties.


I

am

convinced

that experience will not support

this representation.

All the atrocious murders com-

mitted by lunatics have been perpetrated under some


hallucination.

hundred

celebrated

instances
\a ill

of

such commissions on historical record,


every reader.

occur to

Such

facts are allowed

on

all

hands to

DISEASE OF THE ACTIVE POWERS?


be extremely
rare,

137

and hence the probability increases

of an incorrect report.
I believe the true explanation of these

phsenomena

to

be

the following.

The

individuals

who

are the

supposed subjects of this


state, free

affection, are, in their ordinary


illusion,

from any maniacal

and are hence

supposed to have an undisturbed possession of their


intellectual faculties
:

but they

fall

at certain periods

under the influence of some sudden hallucination,

which excites their rage


times

to

a vehement degree, and

gives rise to atrocious attempts.

Perhaps

this

some-

amounts
inflicted

to

nothing
of

undefined
affront,

impression

more than a vague and some grievous injury or


It
is

upon them by the person against


is

whom
cealed
rise,
;

their

malice

directed.

often happens

that the imaginary cause of anger

studiously conits

and hence the opinion may have taken


the paroxysm

that

of rage

has

arisen

inde-

pendently of any such impression*.


1

may

observe, that in

all

those instances of
to

mad-

ness,

which have been represented


the active
I

me

as

examples
without

of disorder affecting
lesion

principles,

of the understanding,

have discovered, on
in reality other-

adequate inquiry, that the case was


wise.
I

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

respecting them, and

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

been observed that insanity reverses


;

the whole moral character


pensities

that the habits and prothat the

undergo a complete revolution;


:

temper becomes completely altered

but even in cases

which

verify this

statement, a disorder of the underprevalent illusion, often gives rise to

standing, or

some
the
arise

the peculiar

tendency.

The
of

habits

are

also

very
sensa-

much under
tions
tions,
spirits.

influence

the

internal

which

from the state of the natural functo the

and the impression they give

temper and

When
and

the stomach
all

is

oppressed by imperfect

digestion,
difficulty,

the secretions are performed with


is

a constant irritation

thence excited in the

system, which occasions peevishness, fretfulness, and

low

spirits,

in a person

accounted sane, and gives a


turn to his thoughts
:

moody and

discontented

the

* I have at different times seen a

number

of maniacal patients,

whose disorder has appeared, on a


after

superficial view, to consist in a

deranged state of the pathemata, or feelings.

In all these cases,

an accurate examination,
of
the

have discovered some moibid


less

bias

understanding,

some hallucination, more or


sufficient

strongly

marked, which has been

to

account for the

ph?enoinena.
sional

This species of disease generally appears in occaintervals the patient


is

paroxysms: during the


if

tolerably

sane, and,

questioned at these times, he will exhibit no disorder

of the understanding; but

when

the attack of his disease


illusion.

comes on,

he

is

found

to be

under the influence of some


this

It

has been remarked, that


is

occasional recurrence of violent

paroxysms

the particular form


epilepsy.
1

which madness assumes when

combined with
by no means
in

have seen several instances that were


this observation.

accord uith

INFLUENCE THE TEMPER AND HABITS.

139

same causes acting on an insane person determine Thus we find the complexion of his hallucinations.
melancholic patients, for the most part, dyspeptic
;

a fact from which the very term of hypochondriasis

had

its

origin.

On

the other hand,


easily

when

all

the

internal

functions

go on

and prosperously, a
arises,

general sense of animal enjoyment, a perpetual state

of comfortable and pleasurable feeling

by which
is

a cheerful flow of
liable

spirits is

promoted.

This state

to interruption
it

in

every instance of disease

but, as far as

exists, it

determines in a great measure

the natural temper, and has a great influence on the

general habits.

SECTION
On
the

IV.

Pathology of the Brain in Madness.

With

respect to the pathology of the brain in mania,

most of the observations offered on the subject of


epilepsy

might be repeated.

On

the

appearances
further

of the brain after death I shall

make some

remarks in the course of the following chapters

where they

will

be most properly placed, as bearing

immediately on practical conclusions.


It has been a

common

complaint

among morbid

anatomists that nothino; has been found in the brains

of maniacs sufficiently distinct to elucidate the disease.

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

PATHOLOGY OF THE BRAIN

IN BIADNESS,
all

made on

the nature of nervous disorders,

that can

be expected to be found are the

common

vestiges of

increased vascular fulness, whether inflammatory or


congestive, if there
be,

as

it

is

commonly, and,
difference
in

imagine,
states.

correctly

thought, any

these

To
in

the effect of increased


refer all the

vascular

action

I suppose

we may

phasnomena usually
;

found

the brains of maniacs

without excepting

that preternatural hardness,


authors,

so often mentioned

by

or

even

the

depositions

of bony

matter,

which are frequently seen about the processes of the


dura mater.
I shall

dismiss this subject for the present with

the following complaint of

M.

Pinel.

He

says,

" I

have attended at

thirty-six dissections in the hospital

of Bicetre, and I can declare that I have never met


with any other appearances within the cavity of the

cranium than are observable on opening the bodies


of apoplej:y, epilepsy, nervous fevers, and convulsions." " From such data," he adds, " what light can be thrown on the subject of persons
died
of insanity*?"
it

who have

This remark, however, pronounced as


unsuspicious,
is

is

in

a manner so
light

calculated

to

throw much
view
in

upon the

subject, in the point of


it.

which I
*

am now

contemplating

M.

Pinel on Insanity.

Translation, p. 183.

THEORY OF PARTICULAR DETERMINATIONS.

141

CHAPTER

V.

OF EPILEPTIC AND MANIACAL CASES, DEPENDING ON THE STATE OF THE UTERINE FUNCTIONS.

SECTION
Remarks on
the

I.

Pathology of Nervous Diseases, connected

with the State of the Uterine Functions.

Before we

proceed to consider the phasnomena of


it is

these affections particularly,

necessary to premise

some general observations on


in the nervous system

the pathology of diseases


their rise

which take

from the

circumstances of the uterine function, or depend on


that state of the constitution

which coincides with the

appearance or cessation of the catamenia.


It is well

known

attention to the

to every person who has paid any phaenomena of the animal economy^
is

that the

constitution

endowed with a power of


;

giving rise to variations in the distribution of blood


in other words,

that the proportional quantities of

blood flowing towards different parts are subject to


changes, which take place according to certain laws,

and

in

relation

to

particular

states of the

system.
is

The

utility

of this resource in the animal economy

very evident.
site for

In many instances the functions requithe

the preservation of the individual, and

maintenance of the species, could not, according to


the present constitution of nature, be carried on with-

out

it.

For example, the

fcetus could not

grow and

142

THEORY OF

be developed, or the uterus undergo the changes that


are necessar}', if a

much
it

larger proportion of blood


it,

were not determined towards


gestation, than

during the period of

what

has been accustomed to receive

under ordinary circumstances.


period a
takes

At

the end of this

new determination

is

required,

and actually
blood
to

place.

The

vessels

conveying

the

mammary
infant.

glands become enlarged, the breasts swell,

a secretion of milk ensues for the nourishment of the

The

ordinary proportion of blood would be

very inadeq^uate to this supply.


striking instances of the

These are the most


I

phaenomenon

allude to,
;

which the physical history of the body displays


it

but

is

probable that less obvious changes of the same

kind

happen every hour, according

to

the require-

ments of the system.

To
to

every gland, at the period


it

when

its

secretion

is

be increased,

is

probable
it

that an augmented flow of blood takes place; and

has often been conjectured, not without reason, that


the state of the brain, which gives rise to sleep,
is

brought about by a temporary plethora, induced in


the vascular system of the encephalon.

We

are as yet unacquainted with the methods which


:

nature employs for bringing about this change


obvious, indeed,
that

it is

the last

step

in

the process

which gives
part

rise to the
is

determination of blood towards

a particular organ,
;

a dilatation of the vessels of the

but by what previous means, or owing to what


contrivance
it

peculiar
agencies,

and
pass,

arrangement of physical
that a particular set of

comes

to

vessels dilate,

or that their calibre becomes greater

than

it

was

before, just at the time

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
;

can say, indeed, that

this

a part of the operation of the Vis medicatrix,

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:

logy of the diseases we are employed in investigating.

We observe
1.

in the first place,

That

particular determinations of blood are not

incidental or insulated phasnomena, but have certain


relations to the general state of the animal
2.

economy.
system

That the arrangement or method


to partial disorders in

in the

by which these phasnomena are brought


is liable
;

to take place,

consequence of which

determinations happen unduly, or at times,

and

in

modes and degrees

pernicious rather than salutary.

Among

the circumstances

connected
is

with

these

remarks, one of the most important

the fact that

particular determinations supply the place of,


;

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

one particular direction, when

it

ceases,

a neces-

sity for

some supplementary or
a new

vicarious action seems


if,

to have been created; so that,

owing

to

any im-

peding circumstance,

healthy determination
is

does not ensue, a morbid one

very apt to follow.

144

THEORY OF
constitution
is

The

subjected to a sort of tumultuous

action, irregular efforts take place,


set up in various functions.

and disorders are

We

shall find the

most

striking

illustrations,

and at the same time unex-

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

a long time, has been dried up,

particularly if

be done suddenly, a determination to

the head

is

very apt to ensue, giving rise to vertigo,


It is equally

headache, and sometimes to apoplexy.


well

known,

that

after

some

cutaneous

eruptions

have been repelled, disorders of the stomach or other


parts frequendy ensue
;

and

that, after habitual epiis

staxis or haemorrhois has ceased, the constitution


liable to other

htemorrhasies or undue determinations.


it

On
times

the other hand,

has frequently been observed


will

that natural and

healthy determinations

somewell

supersede and overcome morbid phasnomena


description.

of the same

Thus pregnancy
pulmonary

is

known

to suspend the progress of

phthisis,

and even

to supersede that disease as long as the

new
illus-

and temporary condition of the system continues.


This undoubted fact
in

physiology serves to

trate, to a certain extent, the

theory of menstruation
it

so

far,

mean, as to point out what purpose

answers in the animal economy.


jected to circumstances, which,
provision,

The
if it

female

is

subthis

were not for


to,

on the principle just adverted


to

would

render her liable

extreme dangers.
fluid,

So great a
the energy of

portion of the vital


the constitution
is

so

much of

directed

in a particular

channel'

PARTICULAR DETERMINATIONS.

]45

during gestation and the subsequent period of suckling,


that
after

these

exertions
to

have ceased the system


train
if

would be subject
dies,

a formidable

of mala-

from irregular determinations,

nature had not

provided a supplementary resource, to divert the accu-

mulating energy of the constitution into a particular


channel.

Such a resource

is

afforded in the periodical

returns of the catamenia.

As

the female constitution

is

designed to undergo

the occasional effort of pregnancy, and as menstruation is the destined successor

and supplement

to this

temporary exertion,

the

periodical determination to

the uterine vessels constitutes a part of the original

arrangement, or systematic relation of functions, in


the female economy.
It

takes place about the age

when

the growth
is

is

nearly complete, and the energy


for the evolution

of the system of the frame.

no longer required

The
if

female constitution being so by nature arranged,

from any accidental cause the vascular fabrick of


its

the uterus does not assume

proper action at the

time

when

it

comes
its

to' hold

an important place
;

in the system of natural determinations


it

or

if,

after

has

performed

office,
all

this

function

becomes

suspended or suppressed,

the evils follow, which,

from the preceding observations, might be calculated


upon.
quence.

Morbid determinations take place in conseThese are various in kind. The pulmonary
it

system, as

is

well

known, often

suffers

not unfre-

quently the gastric;

and the stomach


;

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

more generally than


apoplexy,

the nervous
epi-

fabrick,

and we thence witness the phaenomena of


mania,

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.

considerable and long continued determination to the


uterine

system

having ceased, other supplementary

actions speedily ensue.

Sometimes these have the

character of healthy

processes, as

when a

free
is

and
fol-

copious production of milk takes place, and

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

puerperal peritonitis, or phlegmasia

dolens occur,

some pulmonary or other chronic which gestation had suspended, becomes now
If the brain is the part that sustains the

renewed.

impetus, and there be any predisposition to a maniacal


state,

the

same cause

gives rise to an attack of puer-

peral mania.

On
that

a similar principle we
to
is

may

explain the fact,


their

women, who attempt

suckle

children

when

the secretion of milk

very scanty, become

liable to

hysterical complaints,

and sometimes even


expenditure of blood,

to maniacal paroxysms.

The

and the determination towards the


is

mammary
is

system,
re-

just sufficient to divert the constitution

from

storing the determination to the uterus, and

yet too

sparing to

affiard relief

by

its

own

effect.

It affords confirmation of these

remarks to observe,

PARTICULAR DETERMINATIONS.
that pregnancy,

147

when

it

takes place, arrests the course

of those diseases, which seem to arise from scanty or


absolutely deficient menstruation.
is

This

effect,

indeed,

apt to ensue
it

whether

when any new determination is set up, Under the former be morbid or natural.
fall,

head some cases


limbs,

in

which uterine epilepsy has


lying-

ceased on the appearance of a disease in the lower

somewhat resembling the phlegmasia of


:

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

take leave of this subject

will

be proper

to observe, that different constitutions differ very con-

siderably with respect to the degrees of relief which

they require through the

medium

of the catamenia, in

order that the health of the system


tained.

may be main-

What would

be adequate and abundant for


is

the safety of one constitution,


in

scanty and defective

another.

On

this

account
told

we must
that

not always
flow of the

conclude,

when we
is

are

the

catamenia

regular and apparently natural in

the

quantity and duration, that the source of disease

may

not

lie

in

the state of this process.

148

OUTLINE OF THE HISTORY-

SECTION

II.

Outline of the History of Uterine Epilepsi/.

This

disorder

chiefly affects

young females of the


those

sanguine temperament; I

mean
light

who have

fair

and ruddy complexions,


light eyes,

sandy or reddish

hair,

with a

full

developement and vigorous

action of the sanguiferous system, and a delicate and


irritable

constitution.
its

It

makes

appearance, in general, about the age

when

the catamenia usually

commence, or

at

no long

period afterwards, and before the long habit of recur-

rence has given this function a firm hold in the constitution.

There

are,

however, cases in which


life,

it

has

taken place at a later period of

when, from any

accidental cause, the flow of the catamenia has been


obstructed.

In many instances the catamenia have taken place


naturally for
to cold or

some months, when, owing


weather, or wetting the

to

exposure
the

damp

feet, at

period of their recurrence, and while they are actually


taking place, a suppression follows, and epileptic
are the consequence.
fits

In other cases, and without


is,

any assignable cause, the flow


period,

at

some

particular

much more
and
over,

scanty

than usual,

and of an

unnatural quality; and then about the

commencehas
affected
epileptic

ment,
passed
with

sometimes
the

even after the orgasm

head

becomes suddenly
vertigo,

pain,

strong

pulsation,

and

OF UTERINE EPILEPSY.
fits

149

ensue.
fail

In other examples, the catamenia altoto

gether
age,

make

their

appearance at the proper


to

and the person becomes subject


until
itself,

disorders
fits,

of the head at the same time, and to epileptic

which continue
system displays
during
life.

the

function

of the

uterine

and often more or

less severely

There
the
fits

is

often nothing peculiar in the character of


to uterine

which belong

epilepsy, that disfits

tinguishes
arising

them remarkably from the


the

of epilepsy

from other causes.


aura

They sometimes com;

mence with
tids,

epileptica

at

others,

are

preceded by pain

in the head, pulsation of the caro:

and vertigo

not unfrequently they take place


sign.

without any premonitory

The
more

character which
particularly to
is

has appeared to

me

to belong

the paroxysms of uterine epilepsy

the

form I
have

have

termed

Leipothymia.

Some

authors

denominated

this disease Epilepsia hysterica*.

The

* Sauvages

has given the following account of uterine or

hysterical epilepsy,

which he uses
1.

as

synonymous expressions:

" Distinguitur," he says, "

Sexu
;

aegrotantis; 2. Praegressis

aut intermixtis insultibus hysterias


menstruationis quoad periodos
;

3. Insultus

sequuntur tempus

4.

Aut a

terrore similive pathe-

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

the only one that

is

founded on

for the first affords

no
:

distinction, since females are subject

to

other forms

of epilepsy

secondly, hysterical

paroxysms as
with uterine

frequently occur in combination


epilepsy
;

with enteric

as

examples of
remark
is

this description will

be cited in the sequel


to this

the fourth

by no means peculiar

form of the

150
term
with
is

OUTLINE OF THE HISTORY


not improper, but
it

has been connected

an

erroneous

opinion.

There

are,

indeed,

cases of epilepsy which are preceded or

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

the throat which hysterical

women com-

plain of; sometimes by crying and laughing. Indeed there are fits which it is extremely difficult to dis-

criminate,
really

and some cases where the two diseases


but these observations

pass into each other:

cannot be applied particularly to the form of epilepsy


I

am now

considering.

apprehend that hysterical

symptoms

as frequently attend epilepsy,

ring in females from other causes, as

when occurwhen it arises


facts will

from disturbance of the uterine system, and coincides


with the periods of the catamenia.

Some

be related in the following pages, which confirm this

remark.
Before I proceed to lay

down any

indications or

principles of medical treatment in

this disease, I shall

submit to the reader some brief notes of several cases

which have occurred to


I

me

chiefly in hospital practice.

must request
will,

his attention to

them, as they form, in

some measure, the basis of


or
at least,

my

remarks on treatment
have afterwards

afford

an exemplification of the
I

practical rules

and inferences which

to offer.

disease, or even to the female sex

the

fifth

observation

is,

as I

have observed

in the text, contrary to fact.

See the cases in the

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

whole of the recommendations with respect

to practice,

which I venture
particular section,

to offer, will be

summed up

under each head or subject of the

work.

In

this,

reference will be sometimes

made

to

the practice detailed under particular cases, where a

comparison with the event,

whether favourable or
;

otherwise, gives a sort of authentic appeal

or affords

occasion for pointing out cautions and improvements.

SECTION

III.

Cases of Uterine Epilepsy, and Observations.

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

consequence of a severe cold,


that

the catameuia disappeared, and she has never experienced

Two months

after

period she

became

affected with headache and giddiness, attended with shiverings.

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

the 20th she

had quite recovered her

faculties,

but

still

complained of her head.


inflamed.

The blood

last

taken was slightly

Repet. Ven. Sect, et fluant Jxvj.


Pulv. Febrif. omni nocte.
I

did

not see her again until the 27th,

vphen I learnt that

the catamenia had began to flow soon after the last bleeding

they had ceased on the 26th.


the aperient mixture.

She was now taking nothing but

31.

Attacked yesterday by headache, attended with diarrhoea


Repet.

and

thirst.

Vena

Sectio,

Mist. Laxans Antimon.

Feb. 3.

Complains of headache.

Cathartic

pills

and mixture

were

prescribed, and

twelve leeches ordered

to

be applied to

her head.
8.

She has now no complaint.


Allowed
to attend as

Discharged from the Infirmary.


patient.

an out-

Observations.

This

is

well

marked case of

leipo-

thymia, depending on suppression of the catamenia.

The

attack probably arose from an ill-directed effort of the constitution to restore the function.

The

effect of the eva-

cuation of blood, not only in relieving the symptoms of


determination to the head, but also in restoring the natural
flow of the catamenia,
is

in this case clearly

marked.

CASE
Mary Laning,
January 18, 1821.

II.

admitted in-patient at the Infirmary,


complexion, dark hair and

girl of fair, rather florid

UTERINE EPILEPSY.
eyes, aged eighteen years.

153

About

six

weeks ago she was

seized, in the afternoon, with a convulsive catching of the

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

recurred after long intervals.

The

last

time

she had

them was two months ago, when they were very


before that time they had been wanting several
Ven. Sec.
Pil.

scanty

months.
et fluant sang. Jxvj.

Bain. Calid. post V. S.


Cath. o. n.

Mist. Sal. Antim.


19.

Head

relieved.

Pulse

full

and

strong.

Bowels only

twice moved.
Repet. Venae Sectio.
Mist. Cathart. ter indies.

22.

Bowels very open;


left

blood not inflamed;

complains of

pain in her

arm.
o. n.

Pil.

Cath.

Mist. Sal. Antim. ter indies.

Haust. Cath. manfe Bain. Calid.


quot.

25.

On

the morning, after going into the

warm
thigh,

bath,

comstili

plained of a sense of coldness in her right


continues.

which

Sometimes the pain troubles her


Repet. Ven. Sect.

in her

arm.

Other-

wise she feels well.

(Blood not inflamed).


;

Feh. 3.

Pulse

full

and strong

violent pain in her head

and

in her right thigh.

VenaB Sectio repet.


Fiat Pontic, in brachio.
8.

Pain and sense of constriction in the epigastric region.


Empl. Lyttae ad
epigast.

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

Cucurb. Cr. Nuch.


Pil.

Bain. Calid,
:

alt.

noct.

Cath. o. n.

Emuls. Tereb.
she
is,

17'

Cupping not performed


Is tolerably well,

however, better.

Can-

not take the emulsion of Turpentine.


23.

but has had no catamenia.

Ferri Carbonat. 5ss. ter indies.

Mist. Cathart. quotidie mane.

March

6.

No

catamenia.

Omit

Ferri Carb.

Tinct. Melampodii, g"". xxx. ter indies.

Bain. Calid.

o. n.
r.

Mist. Cath. p. 14.

n.

Repet. Tinct.

Melamp.
5i. o. n.

01. Tereb. Rect.

22.

Catamenia flowing scantily


Is relieved.

for

two days.

Complains of

shooting pains in her hands.


24.

April l6.

Feels herself quite well, but has

had no catamenia.

Mist. Myrrhas

cum

Ferro.

Jij. ter in dies.

28.

Catamenia have appeared and flowed naturally


She now appears quite
well.

for

two
in

days.

Has become a nurse

the Infirmary.

Observations.^ In this case the connexion of epilepsy,


together with
other

symptoms of determination
is

to

the

head, with a want of the catamenia,

clearly marked.

In

women who
often
It
is

menstruate irregularly, the attacks of epilepsy

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

of a misplaced determination occurs.

The

the system,

decisively

recommended, in relieving marked in this instance. The

epilepsy was cured by relieving vascular plethora.

UTERINE EPILEPSY.

Ii5

CASE
Sarah Boon*,
1820.
ast.

III.
15,

20.

Admitted in-patient, June


full habit,
;

girl

of sanguine temperament, rather

who
but

has never been regular with respect to the catamenia

has had, at distinct intervals, a slight appearance.

About

seven or eight months ago she became subject to epileptic


fits,

which have continued to trouble her since that time.


fits

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.
;

She has two or three

Fiat Ven. Sec. et fluant ^^vj-

Pulv. Cath, o. n.

Mist. Aper.

ter indies.
y4<,

16.

The blood

is

not inflamed.

Pulse

and

full.

Bowels

confined.

Repet. Ven. Sec. et fluant Jxvj.


Mist. Cath. 4ta. qu^que hora donee alvus fusa
sit.

17.

The blood not


:

buffy.

Fits as frequent as ever.


still,

She was
;

now

seen under one

lying quite
if

breathing easily

with a

pulse of 9O; looking as


sion of light.

asleep

the pupils contracted on admis-

Repet. V. S. ad Jxvj.
Epispast. inter Scapulas.

19.

She thinks herself rather better;


V.
S.

but the

fits

are

as

frequent as ever.

ad 3XVJ.
fits,

20.

She was not bled yesterday, and had two


She says she
ad Jxvj.
is

accom-

panied by some convulsions.

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.

She had but one


this is

fit

yesterday, vvhicli

about the usual time:

the only

day when she has


no headache.

had but one.

She

feels

herself

much

better; has

Her
feels

pulse

is

104, full: her tongue clean.


fit

23.

She was bled yesterday, and had no

all the

day

she

her head

much

relieved.

Pulse 110, and


little

full.

25.

No

fit

yesterday.
fit

Some

pain in the head.

26.

She has had no


It

since the 21st.

No

appearance of the

catamenia.
dolens.

Swelling of the right arm, resembling phlegmasia

has been poulticed, and


is still
fits.

is

to-day better.
fits.

28.

Her arm
S.

affected.

She has had no

July

No

No

catamenia.

Phlegmasia of the right

leg; skin red.

It is to

be poulticed.
still

12.

Redness of the leg gone: leg


it,

swelled.
Pil.

She
Cath,

is

to

bandage
25.

and use a spirituous


ter in die.

lotion.

Takes

o. n.,

and Mist, Cath.

No

catamenia.

Leg

swelled, and painful

up

to the knee.

Pulse quick,

and rather

full.

V.
28.

S.

ad ^xvj.

Felt better for the bleeding.

Her

legs

now

both swelled;

swelling painful and hot, and pits a


feels well,

little.

Bowels open.

She

except her

legs.

Sept. 7.

Her

legs

somewhat improved under

the use of leeches

and

blisters,

and purgative medicines.

29.

Swelling almost gone.


out-patient.
I

No fits. No catamenia. No fits. No catamenia.


fits

Made an

saw her repeatedly many months


and
in
in

afterwards, and found that she continued free from her

good health, except that the pains


occasionally.

her legs

still

troubled her

Observations.

The

effect of

bleeding and evacuations


It

in uterine epilepsy is strongly exereiplified in this case.

seems as if the determination to the head was removed ; but the necessary discharge by the catamenia not succeeding, a

new morbid

determination took place, occa;

sioning the attack of phlegmasia

an occurrence by no

means unusual.

UTERIl^E EPILEPSY.

l57

CASE
Elizabeth Downton,
set.

IV.
15.

April 13, 1820.


fair

A girl
hair.

of sanguine temperament,

complexion, brown

More than

twelve months ago her skin

became
chiefly

beset with

patches of the lepra vulgaris,

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

appearance of the lepra,

months ago, but subsequently she was attacked by


and she was sometimes
that time she had never

epilepsy.

The

fits

occurred frequently, generally twice or

thrice in the course of a week,

much

convulsed in them.

At

menstruated.

The catamenia
;

first

made

their
to

appearance

about six months ago


taking place the
her.
fits

and previously

this

change

ceased, and have not since troubled

The abdomen
appetite
is

has been tumid for several months.

Her

deficient,
is

but she says that her bowels


natural.
gr. x. bis die.

are regular.

Her pulse
Pil.

Hyd.

14.

Pulv. Cath. to open the bowels.


Is

22.

better.

Her

appetite good.

Bowels not painful on

pressure.

Repet. Pil.
Mist. Sal. Antim.

26.
she
is

The
better.

eruption continues nearly as before; in other respects

The catamenia

are beginning to flow.

She was ordered


use a

to take Pulv. Febrif. gr. vj. ter in dies,

and

to

warm

bath, as soon as the catamenia should cease.

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.

Let her have some cold water thrown on her

^ther.
Spir.

Ammon.
fits

Foet. n|.

Capt. cochl. parv.

j.

subinde.

May
had one

1.

She has had


V.

every night since the suppression;

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.

4ta quaque hor&.


first

pretty well.

No

fit

since the injection was

used,

and

the bleeding.

10,

Has been
fit
:

well since last report, but


agitation,

is

now

threatened

with a
attacks.

viz.

by an appearance of
Foet. 3j.

which precedes the

Spir.

Ammon.

when

the agitation

comes on.

Emuls. Terebinth,

ter indies.

Enema omni
12.
l6.

nocte.
fit

She had a

slight

on the day of the

last report.

V.S.

et fluant sang. 3xvj.;

no buffy coat.

20.

Had

yesterday a violent

fit.

V.
27.

S.

ad

^'^^j-

Pulv. Cath. o. n. Mist. Cath. ter indies.


4.

June

She says
is

that the eruption sometimes goes in,


fits

and

that her head

then worse, and the

come

on.

To-day she
full.

has complained of headache;

her pulse was very

She

was ordered

to be bled.
relief.

small quantity was obtained, which,

however, afforded

V.

S. et fluant sang. 3xyj.

Episp. ad
Pil.

Nucham.
2. o. n.

Cath.

Mist. Aper.
epigast.

Ung. Antim. Tart, super


7.

The head

relieved

by the bleeding, although a small

quantity flowed.

Yesterday the catamenia began to flow, without any symptom


of disorder in
siderable time.
the

system.

No

fits

have occurred for a con-

UTERINE EPILEPSY.
15.
time.

'159

The catamenia were

copious, and continued their usual

No symptom
girl

of disease has appeared.

She has no

ail-

ment, except the remains of the leprous eruption.


This

Discharged.
fits

went out

well,

and had no recurrence of her

during half a year.


ordered, and her
fits

Afterwards her bowels became


returned
;

much

dis-

but were then unconnected wijh

the catamenia.

CASE
Sarah Harris,
Sept. 25, 1820.

V.

admitted out-patient at the Infirmary,


slender form^ sangtiine

girl

of short stature,

comthe

plexion, pale-red hair, aged seventeen yeats.

About

five

months ago she became subject


in

to

catamenia, which have occurred regularly with respect to


the period,
sion.

and were

due quantity until the

last

occa-

The

period of return was about fourteen days ago,

when more

she suffered
scanty,

more pain, and the menstruation v/as and of paler colour than usual. A few days
felt a stiff-

afterwards, about eight days ago, she suddenly

ness of one hand, the muscles of which were spasmodically

contracted.

This affection ceased

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
;

small in the arm, but full and hard in the carotid.


tite deficient.

Appe-

Fiat Venas Sectio. fluant sang. Jxvj.


Pilul. Cathart. 3.

omni nocte.
c.

Mist. Cath.

Mist. Menth.

Rheo.

bis terve indies.

Empl. Lytt. super nucham.

160
27.

CASES OF
Her head was immediately
fits

relieved
;

by the bleeding.

She

has had no

or spasm of the hand

but sometimes complains

of a feeling of deadness or numbness, at others of a pricking or


tingling sensation in the
side.

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,

she cannot take

and has taken but


fl.

little

of the mixture.

Repet. Ven. Sec.

^''^jaa. gr. iv, 0. n.

Hydr. Submur.

Scammonii,
;

Mistur. Cathart. bis indies.

30.

She has had no

fits

but to-day, as she was walking to

the Infirmary, she was seized with the contraction of the hand,

and
the

the sensation arose towards her head,


fits.

which used

to precede

She thought she should have


Pulse frequent
;

fallen

down

in

fit,

but

escaped.

strong and

full in

the carotids.

Has

been griped by the medicine.


Repet. Ven. Sec.
Mist. Cath.
fl.

Jxvj.

mane

quotidie.

Emuls. Terebinth. 4ta. quaque hor^.


Oct. A.

small quantity of blood was obtained on the 30th.

On

the

next day the

catamenia appeared,

and flowed more


Sleep

copiously and of more natural appearance than before.


undisturbed.

No symptom

of her complaint has occurred, except

a very

slight degree of the contraction

which has occasionally

affected her fingers.

Bowels

freely opened.

She could not

retain

the emulsion.
Pulv. Cathart. ut antea
o. n.

Mist. Cathart.
11.

manb

quotidie.

Fingers
is

still

slightly affected with twitchings.

In other

respects she

well.

Pulv. Cath. altera, noct.


Blist.

Cath. manfe quotidie.


to be

18.

She now considers herself perfectly well, and wishes


(Wednesday).

discharged.

Advised to continue her medicines some time longer.


the catamenia then occurred,

Nov.
over.

1.
;

Saturday

She remained perfectly well until and are not yet quite
;

On Sunday some

twitching of her fingers occurred

but,

with that exception, she has been perfectly well.

She was ordered

UTERINE EPILEPSY.
to lose

I5l

2xij

of blood, by

way of

precaution, as her pulse was full

and frequent.

She was
and

relieved,
;

and remained

free

from

fits

during several

months afterwards
dies,

she neglected to attend, and omitted all reme-

in the following

May came

to the Infirmary,

having suf-

fered a relapse.

CASE
Elizabeth Sutton.

VI.

Nov. 25, 1819.

girl

of sanguine complexion, eighteen years of age.

About two
which
first

years ago she was attacked

by epileptic fits, came on without any apparent cause, and

troubled

her almost every day.

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.

Empl. Lyttae ad Nucham.


Pulv. Cath. o. n. Mist. Cath. ter indies,

Nov. 27'

The pain
Pil.

in her

head was lessened by the bleeding.


of the powder).
well, except

Repet. Ven. Sec,


Cath.
o. n. (instead

Dec.

1.

She

feels herself pretty

a pain in her

head

chiefly in the fore part.

Let twelve, leeches be applied to the temples, and repeated


occasionally.
4.

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

the 9th she complained of pain in her


again.

which

she lost blood


in

On

15th

the catamenia

returned,

a scanty degree.

From

this

time she continued to


re-

complain of pains

in her head,

and giddiness; which were

lieved, from time to time, by the application of leeches and


blisters,

but not wholly removed.


out-patient.

On

Feb. 21 following she was


again

made an

The catamenia had once

made

their

appearance, and were then scanty.

March
scanty.

She attended afterwards as out-patient. Catamenia returned a few days ago 22.

they were

She has had much pain


Mist. Lax. Antim.

in the temples

and

vertigo.

Fiat Setaceum in Nuch&.

jjpril 5.

Is quite relieved of the vertigo,

and the pain

is

much

lessened since the discharge has been free from the seton,

26.

Catamenia have returned

scantily

complains of pain in

her head.

On

June 7 she was again


Pil.

bled.

The

medicines she was

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

exception of slight pains in the back of the head, and some

remains of the vertigo.

Discharged.

On
fits.

July 8 she was again admitted, having suffered a return of


;

her symptoms

viz.

pain and vertigo, but without any renewal of


relieved

She was, at

first,

she was bled, to the

amount of

by a warm bath: on the 11th Jxvj, and the venesection was

repeated on the l6th, with

much

benefit.

Soon

after the bleeding


after-

the catamenia began to flow.

Topical applications were

wards adopted; and on the 17th of August she was again


charged, in a

dis-

much improved

state of health.

Observations.

This was a

very obstinate case of deter-s

UTERINE EPILEPSY.
mination of blood
deficient flow
to the

163

head, evidently connected with a

of the

catamenia.
fits
:

At
it

first

this

disease

displayed itself in epileptic

was restrained by

bleeding, discharges, purgatives, and local applications,

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
:

after the imperfect attempts of the constitution to relieve


itself

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,

with the defective

menstruation, was very distinctly marked.

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,

admitted in-patient Dec.

1819.

hair, aged about twenty years, who has been subject four years to
girl

of sanguine complexion, dark brown

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

other function seems to deviate

much from

the natural state.

She

is

subject to feel a strong pulsa-

tion in the left hypochondre.

Present

state.

Pulse
Cath.

full.

Three days ago she had

several violent

fits.

Veil. Sect,
Pil.

fl,

sang. 5*vj.

164
Dec. 4.

CASES OF

fit

occurred to-day, which continued about an


little

hour; she was very

convulsed.

Pulse

still full.

Van
Pil.

Sect.

o.

fluant sang. Jxvj.

Cath.
fits

n. Mist.

Cath. m. quotid.

Dec. 11.
affected

No

since the last

bleeding;

but she

is

now

with severe pain


in the

most violent

down the right leg, from the hip, but The knee also is in pain. The pain ankle.
In other respects she
is

keeps her awake at night. Ven. Sec.

well,

fl.

Jxij.

Pulv. Febrifug. o. n.

Jan.

1,

1820.

Her

leg

is still

very painful.

Liniment. Terebinth.

Emplast. Lytt. super Ischium.


Tinct. Colchici
3j. ter indies.

4.

No

relief to the

pain in the leg has resulted from any of the

remedies prescribed, but, since this


epileptic
fits

symptom commenced,

the

have entirely ceased.

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

from any ailment.

The

epileptic

fits

then

returned, and she had several before the ^nd of February, when

she went out of the Infirmary.


\v\

the following

month she again attended


chiefly of nausea, pain

as an out-patient.

She now complained


epigastrium.

and pulsation ^t the

The

fits

sometinies recurred at the period of the

catamenia.

She continued

to attend

during the

summer

of 1820.
after

She
Whit-

now

entirely got rid of the

fits,

which never occurred

suntide, (23th of

May).

large; and she said she had


herself pregnant.

Soon afterwards her abdomen became lately been married, and supposed
last

September 30.
report.

She has attended frequently since the

No

fits

since Whitsuntide. Catamenia have only occurred

once since that time.


felt

Abdomen tumid
child,

thinks she has distinctly


\

the motion of

Pain in her back very troublesome

UTERINE EPILEPSY.
has no other ailment.

\65
and stomach in
et

Keeps her bowels

regular,

good order, by the use of the Mist. Menth.


nesia.

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,

Mary-Anne Banbury, admitted

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

she has lately undergone a third.

At

the early part of her complaint the catamenia were

wanting.

The
is

returns of

them are now more frequent


full.

than the natural periods.

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.

Mist. Cath. o. m. Sept. 4.

She has had no

fits

complains of headache and

pain in her limbs.

Pulse quick and strong.


Repet. Venae Sectio, et Medicamina.

14.

Head

relieved

by the bleeding.

No

returns of the cata-

menia.

Feels herself pretty well.

Pulse 106, strong.

She has

taken the medicines regularly.


Repet. Vena; Sectio, et Medicamina.

25.

Much

relieved.
:

any morbid symptom

they are

The catamenia have now present.

taken place without

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

symptom has been


medicines.

more troublesome since she


Pulse quick, strong, and
full.

off her

purgative

Repet. V. Sectio et Medicamina.

Four days ago the catamenia began and on that day She complains of vertigo and headache. Pulse she had two fits.
20.
;

quick and strong.


Repet. V. Sectio et

Med.

22.

The

bleeding removed the vertigo, and the catamenia

ceased at the same time.


Repet. Med.

30.
strong.

Pain and tenderness in the epigastrium.

Pulse quick

She has been

living

on a

full diet.

Spare Diet.

Repet. Med.

Nov.

10.

Notwithstanding the injunctions laid upon her, she


freely.

has been living too

Pulse quick and strong.

Complains

of vertigo and headache.

Repet. V.
-

S. et

Med.
Bowels opened
thrice or

l6.

Head

relieved

by the bleeding.
Pulse 100, and

four times in a day.


Repet.

softer.

Pil,

Cath. et Mist. Cath.

23.

She has taken a cold.


in her

Pulse

120.

Tongue

furred.

Has pain

head

makes no other complaint.


Pil. Cath. o. n.

Misti Lax. Ant.


.

Hirud. temporib.

Dec.

8.

Leeches not applied.

Pulse quick, but she

feels her-

self quite well.

The catamenia now have


well,

flowed twice without any


to

ailment.

Thinks herself

and wishes

cease attending.

Discharged.

Observations.

It

may be concluded

that this case of

epilepsy was connected with disordered functions of the


uterine system, from the occurrence of
strual period
fits

at the

mencomtheir
is

when

the flow of the catamenia was


first

mencing, and from the age at which they


appearance
;

made

a time of

life

when

the periodical function

UTERINE EPIIEPSY.
as yet scarcely established
;

l67

when
is

turbed,

and

its

suppression

it is more easily dis^ most commonly accom-

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.

Afterwards the menstrual orgasms became more fre-

quent than natural


titions

but the disease was probably


of the
uterine

still

of

the character of dysmenorrhcea, and the frequent repe-

only ineffectual
efforts

efforts

system.

These
2.

were

still

accompanied by

fits.

The

beneficial effect of freely evacuating the system

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

any prelude, except

headache.

She

fell

down

168

CASES OF

quite insensible, and in that stale was brought into the

Infirmary.

She was immediately


wards took Mist. Cath.

bled, to the
gij,

amount

of 5xviij, and aftergr.


i,

with Antim. Tartar,

which
in

opened her bowels, and made her vomit.


31.

Blood taken not inflamed.


Pulse 90,

She has a cough and pain

her chest, apparently a pneumonic affection from cold.


plains of headache.
full.

Com-

V.

S. et fluant^xvj.

Epispast. ad Sternum.

Pulv. Feb. omni nocte. Mist. Feb. ter indies.

Sept. 4.
5.

She has been


morning.

better yesterday

and to-day.
fits,

On
this

the afternoon of the 4th

she had two

and one
she was

again

She

had
lost

no warning
her senses, she

of their attack,
felt as if

except that, just before she


going to
faint.

The

fits

lasted

about an hour each time, and she


After they had ceased, a violent
full.

was much convulsed


headache remained.
7.

in them.

Pulse 90, not


fits

She had two

yesterday, and two on the preceding day,

subsequently to the report. V.


8.

S.

She had one


better,

fit

yesterday before the bleeding, but none

since.

9.

Is

but complains of pain in her thighs and legs,

which are somewhat swelled.


14.

She had two

fits

to-day

the

first

since the bleeding.

V. S. ad Jxvj. Emuls. Tereb.


18.

No

fit

since the bleeding.

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

The emulsion makts her


catamenia.

vomit.

She had two

She had another

Now takes
25.

Mist. Lax. Ant.


full.

Her head

aches, and she feels generally unwell. Pulse

She was
26. 27.

desired to be cupped, but refused, and

was bled.

Blood not bufled.

She was
to

relieved.

An

issue

was ordered

be

made

in

her arm.

UTERINE EPILEPSY.
30.
Oct.

l69

Leeches
I.

to her head.

The headache removed by

the leeches.

Issue begins

to discharge freely. 5.

She has been

better since the issue has discharged.

11.

Is apparently well,

and gaining strength daily.


the

Yester-

day

the catamenia

made

their appearance.

l6.

The catamenia continued


Pulse quick.
V.
S.

usual

time,

and were

natural.

To-day she .complains of a return of headache, and


ad jxvj.
rather

has a slight cough.

17*

Her headache was


Twelve leeches

worse

after

the

bleeding.

to the temples.

21.

Head aches:

the pain seems to her to be in the scalp:


strongly.

carotids pulsate too

The

leeches last applied relieved

her head at the time.

Repeat the Leeches.

Epispast. ad Nucham.

A
again

few days

afterwards she was discharged, free from any


lives

ailment.
if

She

near the Infirmary, and says she will apply

she should have any return of her complaint.

Note.

Juli/,

IS21.

have not heard that Eliz. Millard has

had any return of her complaint.

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.

the returns of the catamenia, and occur at the

at the usual period

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.

Venae Sec. fluant sang.


Pil.

Mist. Cath. ter indies.

June

3.

Complains of tenderness of the epigastrium


PU. Cath.
o. n.
c.

pain on

pressure.

Mist. Menth.

Rheo.

ter d.

170
30.
Feels herself well.

CASES OF

Continue.

July 3.
10.

Repeat the medicines.

She has had no


days.

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.

She has had ho

fits

is

quite well.

Cbntiniie the aperient medicines.


I

heard no more of her.

Observations.

It is very

remarkable that the evacuant

measures adopted

in this case

were so soon

etfectual in
fits,

interrupting, at least, the return of the epileptic

which

had previously accompanied,


the periods of the catamenia.

in

so unvarying a manner,

CASE

XI.
June
10, I8I9.

Mary A few

Ford, admitted
weeks ago,
first
fits

out-patient,

at the

time when she expected the


their appearance.
life,

catamenia, they did not


then, for the
fit.

make
in

She was

time

her

seized with an epileptic

Similar

have since occurred frequently.


S. et fluant sang. Jxvj.

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

now occur almost

every day.

Repet. Venae Sect.


Capilli.

Erapl. Lyttffi

Nuch.

Pulv. Cath.

o. n.

Mist. Cath. 4ta qu^que hor&.

30.

She has had no

fits

since she adopted the remedies last

prescribed.

Complains of vertigo and headache.


Repet. VeniE Sect.

Pulse

120,

and

full.

Repet. Pulv. Cath.


Mist. Cath. ter indies.

UTERINE EPILEPSY.
July 8.

171
last:

She has had three


Ven. Sect.

fits

since she

was here

coughs

and

spits blood.

Pulv. Cath. o. n.

M.

Lax. Ant.

cum

T.

Scill. 4.

qq. h.

Empl. Lyttae Stern.


\6.

Had one
Her head

short attack just after


is

she was here the last

time.

relieved.

The catameuia
Pulse

took

place soou

after the bleeding,

without any morbid symptom.


epilepsy.

Since then she

has had no

symptom of
and

still full

and frequent.
were

On
The

this

account she was directed

to lose twelve

ounces of blood.
Scil.,

cathartic pills

saline mixture, with Tinct.

ordered to be repeated.

She came not again

to the Infirmary;

and

conclude that no

recurrence of her complaint took place.


Ohsei'vations,

This

is

a recent case of epilepsy, produced

by a suppression of

the catamenla;

and the history of the

treatment illustrates the method to be pursued in order to

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.

admitted out-patient, June 11, 1819.

girl

of stout make, dark complexion, black hair and


ago,

eyes, aged twenty-five.

Tea days

when

the catamenia were beginning to

172

CASES OF
fit.

appear, she was seized with an epileptic

She has

had

fifteen

fits

since that time.


Venae Sect, et fluant sang. Jxvj.
Pulv. Cath. o. n.
Mist. Cath. ter die.

The
27.
night,

bleeding was repeated on the I7th.

She has been

free

from

fits

during six days, until last


fit.''

when
8.

she had, what she terms, " only a fainting

July

Since she was here she has had three attacks, which
fits.

resembled fainting

Ven. Sec.

et fluant sang. 5xvj.

Pulv. Cath. o. n.

Mist. Cath. bis indies.

15.

She has had no


V.
S.
Pil.

fits

complains of headache and tremor.

Hyd.

laxant. 2. ter indies.

Mist. Cath. ter indies.

22.

It is

now

the period of the catamenia, and she


Episp.
Pil.

is

troubled

with

fits

again.

Nuch.
o. n.

Cath. 3.

Emuls. Terebinth. 29.

4ta.

qu&que

horS..

No

fits

since she

was

last

here: has vertigo and tremor.

V. Sect.
Pil.

Cath.

o. n.

Mist. Cath. ter indies.

Aug.

5.

She has had no

fits

for several

weeks until to-day,

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.

Argent. Nitrat. ter indies.

12.
side.

fit

to-day and yesterday: has vertigo and pain in her

Empl.

Lyttae;

Nuchce.

Ven. Sect.
Pulv. Feb. p.
X.

6ta.

quRque hora.

UTERINE EPILEPSY.
19.

173
fits

She was

better after the bleeding.

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.

Emuls. Terebinth, ter


Sept. 2.

die.

Has had no

fits

since she

was here.

Complains only

of pain in her head.


9. 16.

Repeat the emulsion.

Repeat the emulsion.

She has

lately

had a

fit.

She has

several times

had

fits

of tremor, which hold for a long time.

Vertigo.

Arteria Tetnporis sec. et fluant sang.

Repeat the Turpentine.


19.
fit

Was much
V.

relieved

by the bleeding, but had a

slight

last night.
S. fluant sang. ^\i}.

Empl. Lytt. Nuchae.


30.

Had two

fits

yesterday evening:

has headache.

-With

these exceptions
report.

she has been free from ailment since the last

Art.
Pil.

Temp.
Cath.

sec. et fluant ^xij.

3. o. n.

Mist. Cath. ter indies.

Oct. 7-

She

is

much

better:

has had no

fits.

Her

pulse

is

harder than natural.


V.
S. et fluant Jxij.

Repet. Med. 24.

She has had no

fit

during the

last three

weeks.

Vertigo

and headache troublesome.

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

been very well


vertigo.

.since

that time, and

free

from headache and

The catamenia, which had been


Pil.

absent for two months,

have taken place naturally.


Cath.
o. n.

Mist.

A per.

174
Nov. 21.

CASES OF
On
the day preceding that on
fits.

which the catamenia

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,

preceded by a rigor, with nausea and

vomiting.
Zinc. Sulphat. 9j. alt. dieb,

mane.

Pil.Cath.

o. n.

Mist, Cath. Mist. Menth.


c.

Rheo.
fits;

et

Magnes.

part. seq. ter indies.

Dec. 5.

She has had no

vertigo

sometimes troubles her:

has pain in the region of the navel when she dilates the chest

stomach relieved by the emetics


Ven. Sec.

but they agitate her much.

et fluant sang. ^x.

Empl. Canth. ad latus sinistrum.


Hydrarg. Submur.
Pulv. Ipecac,
gr.

gr. v. ter indies.

xxv. altem. dieb. manfe.


;

p.

Says she has taken cold

has

lost

her voice.

Pulv. Feb. o. n.
Eniplast. Lytt. Sterno.

l6.

She has had a


tremor.

fit

of short duration, followed by amentia

has

now

Erauls. Tereb. ter indie.

26.

She has had no


and wishes

fit

for three

weeks.

The catamenia have


fits.

returned naturally, without any recurrence of the


herself well,
to be discharged.

Thinks

She was discharged, under the condition of attending again any recurrence of her fits took place.
Observations.

if

The
vi'ith

most remarkable circumstances

in

the history of this case are,


1.

The

strongly marked and obstinate connexion of the


the catamenia.
relief

epileptic attacks
2.

The uniform

experienced
at

by evacuations,
intervals^

particularly

by bleeding.
such distant

This patient's attendance was

UTERINE EPILEPSY.

175

and so interrupted, that an opportunity was not afforded of following up the advantage obtained for the time

by such measures. Those attacks, which she termed


probably paroxysms of leipothymia.

fainting

fits,

were

CASE
1817.

XIII.
out-patient,

Elizabeth Hoken, admitted

March

17,

A girl of stout make,


years old,
epileptic

pale unhealthy aspect, twenty-four

who

has been subject about twelve months to

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

are very scanty.

The

occur in the day-time.

attributes the first attack,

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
:

with flatulence and diarrhoea.


Ven. Sec. et fluant sang. Jxvj. Empl. Lyttae arapl. lat. sinistr.
Pil.

Cath. 3.

o. n.
Scill. 3j.

Mist. Salin. c.^Tinct.

4ta.

qu&que hor&.
:

22,

Is better.

Sleep undisturbed
Pulv. Cath. o. n.
Mist. Cath. ter indies.

bowels not very open.

29.

Feels herself well.


are inflamed.

She has been well purged, and her

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.

Seven days ago she had a

stipated.

Complains now of disordered stomach and bowels.


Pil.

Cath. o.

n.

Mist. Cath. ter indies.

}76
27.
four

CASES OF
Symptoms
continue.

Pulse

full.

Has had

three or

fits.

Ven. Sect.

Empl. Lyttse ampl. ad


Piilv.

epigast.

Feb.

gr. x. o. n.

Pil.

Hyd.

laxant. 2. ter indies.

Much relieved by the May 3. Complaints


Has no complaint
Repeat the
17.
in

bleeding.

Pulse 72,

still full.

of her stomach, &cc.


fits.

entirely

removed.

her head, or

last prescription,
is

with the exception of the

blister.

Says she

now

in perfect health.
to return if

Discharged; with an injunction

she should have

any more

fits.

Observations.

In

this case epilepsy

was connected with

scanty menstruation.

The

defect in the uterine function

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.

good prospect of her getting

rid of the

Her attendance

at the Infirmary

was

not long enough continued to ascertain the event.

CASE XIV.
Elizabeth Cole,
complexion, brown
a girl of slender habit, fair sanguine
hair,

aged sixteen years, who has

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

said to trouble her

very frequently, some:

times occurring repeatedly in the course of a day


others, she passed

at

some days without any


fits

attack, and she


fort-

supposes she has been free from them as long as a


night.

more troublesome about the period of the catamenia; which flow, as she
are

She thinks that the

UTERINE EPILEPSY.
says, sparingly, and are

177

accompanied with much pain. Her

aspect

is

imbecile.
Fiat Ven. Sec. et fluant sang. 3xvj.
Pil.

Cath. omni nocte.


in a day.

Mist. Aperiens.

l6.

Several

fits

Pulse strong and quick.

Fiat V. S. fluant sang. Jxij.

Warm

Bath, or Pediluvium.
Pills at night.

R
30.

Repeat the Cathartic Pulv. Antim. gr. v.


Opii, gr. i.

Quarts qq. hora.

Several

fits

in

a day.

No

headache.

V.S.
Fiat Setae, in

Nuch^.

Pulv. Cath. o. n. Mist. Cath. ter die.

Jvly

8.

No

relief.

Pulse

full

and quick.

Fits returned twice

about three days ago, and to-day four times*


Emuls. Tereb. ^.
14.
ter indies.

No

fits

for ten days.

Nausea.

Rejects her food.


in-patient.

On
fits

the 27th of September she

was admitted an

The

now occurred

frequently; generally in three days.


to

She was ordered


and
Sp.

go into the shower bath every morning;

to take every third

hour a draught of Camphor. Julep, with


the next day her head was shaved,

Ammonias

Feet.

On

and

she took a cathartic powder.

29-

She has had several


rather full.
I

fits

to-day

her pulse

is

in general
effect

frequent and

resolved

now

to try the

of

the evacuating system.

Frequent venesections were prescribed,

with purging, blisters to the neck, &c.

The
fits

disease sometimes

appeared mitigated by bleeding, but the

continued to recur

every third or fourth day, although this plan was pursued as


far as
it

seemed
to

safe

and expedient.

In the following month she


benefit

seemed

derive

some temporary
of Valerian
Blisters

from a seton in her

neck and a shower bath.

She took the Oil of Turpentine and the


;

Ammoniated Tincture
from time to time.

topical bleeding
to

was ordered

were of service

her in so far

that they relieved the pains in her head.

As

blisters

seemed to relieve her,

determined to try more

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

rubbed with a dry caustic.

Feb. 3.

Seems

to

little

the issue on the head.


12.
Fits as violent

and frequent as formerly.


glasses to the shoulders,

Apply cupping
16.

and draw blood.

severe

fit

last night.

Pulse frequent; not affected by

the Tinct. of Digitalis, lately administered.

Try the Infusion of digitalis,

giving ^ss. every sixth hour.

24
fits

She has again been

delirious,

during which time the

did not trouble her.

29.

Under

the full

effect

of digitalis.
Fits as before.

Pulse intermitting
It
is

stomach

rejects every thing.

evident that

neither the drain nor the digitalis relieve her.

Dry up

the issue.

Omit

the present medicines.


.

Solut. Arsen. D"s. Fowler.

No

material

alteration took place


fit

until

the 7th

of March,

when she expired under a

of the usual character.

App&aj'ances observed on Dissection,


the head, between the

On the
side,

left side

of

membranes of
same

the encephalon, a

slight effusion of amber-coloured fluid

was observed.

In

the vessels of the pia mater, on the

a number of

small globules of air were seen, resembling a string of

beads

these were clearly proved to be contained in the

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

was much more copious than


brain,

appeared

which was proper extend down the spinal column.


part of the

The

cineritious

cerebellum was preter-

iiatu rally soft.

But the observation,


tvith

that

is

probably the most important


this

respect to

the

pathology of
through

case,

is

the fol-

io wing: ^-

The
filled

left lateral

sinus,

its

up by

a substance, very different in its hat tire

whole length, was from a

utrin epilepsy.

179*

recent coagulum, and apparently consisting of a depositfon

of lymph, which had become organized.

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 pericardium six ounces.

In the

abdomen, the
between
its

villous coat of the stomach, about

mid-way

extremities, was disposed in folds, from the


;

contraction of the muscular fibres

giving

it

internally the

shape of an hour-glass.

On

the interior surface a

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,

but not otherwise of

diseased appearance.

Remarks.
sinus,

The morbid appearance found


to

in the lateral

seems

the distress this


for the

be adequate to account for a great part of poor woman had suffered in her head, and

most severe of her symptoms. The impeded circu-

lation accounts for the deposition of

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,

except from measures calculated to

deplete the vessels of the head.


particularly topical bleedings
;

Such were general and


;

blisters

drains of various

descriptions; the shower bath, and most of the

means of

reducing general and local plethora.

When we
it

consider that she

became

affected with this

disease about the time

when menstruation commences,


effort

seems probable that the


this

of the constitution in
of the san-

establishing

function,

or the irritation
its first

guiferous system, which accompanied

appearance,

gave

rise to the

primary disease: and

this conjecture is

strengthened by the remark, that the

fits

were more

fre-

quent about the menstrual period.

Probably that degree

180

Cases, &c.

of disorganization was soon produced which prevented the


assistance of any remedies in restraining the epileptic
fits.

CASE XV.
Mrsi

a marfied lady, aged about thirty-five yearSy

of melancholic temperament, a native of one of the most

southern countries of Europe, had been for several years


subject to slight
fits

of leipothymia, which occurred during

her sleep, and generally attacked her about the period of


the catamenia.

After she had resided

some time

in

Engin

land the catamenia became more scanty, especially


winter,
find her

the

and her complaint increased

and she began to

memory

impaired.

By

the assistance of the

warm

bath, small bleedings, and a relaxing regimen, the uterine

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;

under which she was much convulsed.

On

her

recovery from this paroxysm she gradually sunk into a


state of incurable

characters
state,

of melancholy
I last

despondency, which has assumed all the derangement; and from this

when

heard of her, she had not recovered.

P. S.

Since the foregoing Cases were prepared for the press,

four other strongly marked examples of uterine epilepsy have

come

under

my

observation

all

of which coincide with


all

my ideas

respect-

ing the nature of this disease. In

of them the disorder was con-

nected with a very rare, or with a very scanty flow of the cata-

menia.

TREATMENT OF UTERINE EPILEPSY.

181

SECTION
Of the
In

IV.

Treatment of Uterine Epilepsy,

the observations I

now propose

to offer

on the

treatment of uterine epilepsy,

I shall

occasionally

make
in

allusion to the pathological remarks contained


illustrating

a former section, with the view of

my

observations,
principle
;

and connecting them with some general

but I shall rest no conclusion of import-

ance on any other foundatioji than that of practical


certainty

and

actual

experience.

If,

indeed,

my

readers will take the pains to examine and compare

the foregoing histories of cases, they will find a sufficient

countenance and authority for

most of the

positions I shall venture to lay

down.

The measures

to

be adopted in cases of uterine

epilepsy, differ according to the circumstances of the

uterine function under which the disease takes place.

On

this

account

my

observations will

be arranged

under different heads.


I propose to consider,
in the
first

instance,

the

measures which are to be adopted


suppression
;

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

catamenia, after having taken place, cease to recur at


their regular times,

and the patient becomes subject


intervals
;

to epileptic

fits

at

uncertam

or, lastly,

when
and

nienstruation fails to occur

at

the usual

age,

182

PRINCIPAL 1NDICATI9N$.
this disease
is

paroxysms of
short,

appear in

its

stead

in

whenever epilepsy
In
all

connected with amenoris

rhoea.

these instances, if there

any founda-

tion for the pathological principles before laid

down,
All

these paroxysms indicate an attempt of the constitution to restore or set

up the uterine

function.

these cases
ticulars
effort
;

aife

therefore analogous in essential par-

they

must be considered as denoting an


proper course,

of the system to establish a natural determina-

tion;

which^ being diverted from

its

gives rise to

morbid congestion

in the brain,

and

to

the obvious consequences of that state.

The

practical

rules to be observed in all these cases are similar.

A
sists

second division of cases of uterine epilepsy conof those which are connected with dysmenor-

rhcea.
are, for

The catamenia

in these instances appear, but

the most part, scantily and laboriously prois

duced, and the orgasm

productive of epileptic
1 shall

fits.

Of

this

form of the disease

proceed to

treat,

after considering the

methods

to be pursued in cases

of the former description.


I.

The

first,

second, third, fourth, and eleventh cases,

in the foregoing section, afford tolerably characteristic

examples of epilepsy of amenorrhoea; and the

results

of the measures adopted are sufficient to point out the

most important conclusions with respect

to practice.
to relieve the

The

practical indications are,


to the

first,
;

morbid determination
thirdly, if that

head

secondly, to restore
:

the natural determination to the uterine system

or,

cannot be done, to bring the constitu-

tion into a state in

which the injurious


a
less degree.

effects of

ame-

norrhcea are

felt in

EFFECT OF BLEEDING.

One

of the most important resources


the
first

we

possess for

fulfilling

indications
effect

is

the abstraction of blood.


is

The immediate

of bleeding, in such cases,

generally a relief of the pain

and oppression

in the

head, and a subsidence of the pulsation in the carotid

and temporal
lancet
is

arteries.

Sometimes the use of the


by a restoration of the

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

be formed by comparing cases 2,


But, perhaps,

last section.

some

light

may be thrown

this subject

principle

by taking into consideration the on which the efficacy of bleeding, in the

of these disorders, appears to depend.

If a person labouring under an attack of pneumonia,


hepatitis, or other

inflammatory disease,

is

freely bled,

so that either absolute syncope, or a degree of relaxation approaching to syncope, be induced, one of the

following effects will

commonly ensue
to the

First,

The

morbid determination
consisted,
entirely

inflamed part,

or the

particular state of the vessels in


is

which the disease


will

overcome, and the disease


:

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,

secondly, the pain, and other signs of


still

local inflammation,

remain in the part affected,


:

remove them or, thirdly, when the patient recovers from his fainting state, and
and require other
efforts to

the pulse regains

its

force;

or sometimes,

after

an

interval of sleep or collapse, the disorder of the part

184

EFFECT OF BLEEDING
have entirely subsided,

originally affected is found to

but a

new morbid
is

determination to some other part


discovered, sometimes of less imlife in

of the system

portance, at other limes endangering

a greater
this

degree

than

the

original

affection

and

new

disease often requires a repetition of bleeding, which,


in its turn, ushers in

a fresh attack in some other organ.

It

is

needless to adduce particular facts as exempli-

fications of the last assertion, as every medical practitioner

must repeatedly have witnessed such phae-

nomena.
joints

They occur most

frequently in

cases

of

inflammation of the external parts, particularly of the


;

such as are denominated

rheumatic

but

they are also frequent in inflammatory disorders of a


different description.

If a patient recently attacked


is

by

pleurisy,
is

which

confined

to

one side of the

thorax,

bled until syncope supervenes, the disorder

often shifts to the other side.

After inflammation of

the peritonaeum has been suddenly relieved by bleeding, the head


is

often attacked.

In short, the migratory


disorders
is

tendency of

many inflammatory
it

trait

extremely well known; and

is

equally well
is

known

that the change of determination

very often an

immediate consequence of bleeding.


It

must therefore be allowed that evacuations of

blood, sufficient, with respect to quantity, to reduce

the action of the heart and the circulation, have not

only this immediate


effect,
viz.

effect,

but have also a secondary


distri-

they give rise to a change in the


to

bution
system.
tions,

of blood

various

parts

of the

vascular

In other words, they excite new determinain general

which

show themselves immediately

IN CASES OF SUPPRESSION.
after the collapse,

85

induced by the evacuation, ceases.


arise after bleed;

Now

the

new determinations which

ing are sometimes morbid phaenomena

sometimes
In-

the restoration of natural and healthy processes.

stances of both kinds occur in the recitals of the fore-

going cases.

In some instances the natural deter-

mination to the uterine system, and a flow of the


catamenia, followed: in others, an attack of phleg-

masia or painful affections of the joints.

Either event

was

salutary in cases of uterine epilepsy.


effectually to obtain

In order more
be conducted
in

by means of

venesection the proposed objects, the operation should


that

way

in

which

it

may

be most

likely to produce a powerful impression on the system.

It should be performed

while the patient

is

sitting

up, and a nearly erect position of the trunk should be

maintained until syncope begins to take place.


is

If

it

to be repeated,

its

effect

should be promoted by

other antiphlogistic measures.

With

respect to

may

be required,

number of bleedings which or the quantity of blood to be drawn


the
it

at each operation,

is

impossible to lay

down any

general rule.

The

practitioner

must be guided by the


long as this will bear

strength of the patient.


further reduction, he

As

must not be deterred from perse-

vering in the plan

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

of the foregoing cases,

particularly

the

second case,

which an epilepsy of long duration


until after repeated bleedings.

was eventually cured, although the recurrence of the


fits

was not interrupted

18^

TREATMENT OF EPILEPSY
beneficial effect of bleeding
is

The
it,

much promoted
thus

by immersing the body,


in

or, at least,

the lower part of

warm

bath.

The

influence of heat,

equally applied to the skin, through the

water warmed to the degree of

96

or

medium of 98 of Fabr.

produces a general relaxation, expands or diminishes


the constriction of the extreme vessels on the surface

of the body, and thereby occasions a determination of

blood

into

the

cutaneous

and

superficial

arteries.

When

this effect takes place suddenly,


it

and

in

debili-

tated body,

is

alone sufficient to induce syncope.


it

Conjoined with the abstraction of blood,


ticularly

is

par-

adapted to overcome any impediment that


blood through

may

exist to the free transmission of

the capillaries,

and to promote the action of the


all

exhalant vessels on

the surfaces
is

and no function
subject to
its

connected with the circulation

more

influence than the determination


vessels of the uterus,

of blood into the

and the flow of the catamenia.


efficacy of a

Among
moting

the foregoing cases there are several instances

which point out the

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

and put into bed, the

effect

of the bath
* There
tiously,
is

may be promoted and

maintained

by

one case, indeed, in which a hot bath, used incaurise

gave

to

a suppression.

This was just

at the

comThis

mencement of

the flow,

and under peculiar circumstances.

instance, however, should induce caution.

OF AMENORRHCEA

EMMENAGOGUES.

187

fomentations to the feet and to the lower part of the

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

Terebinth, with an ounce of


sufficiently powerful.

Oleum

Ricini,

makes an enema

Blisters applied to the

sacrum and over the pubes

are thought, by some, to be powerful in determining


to the uterine vessels.
their efficacy.

I have

had no experience of

The
these
is

medicines indicated in these circumstances are

those termed emmenagogues.

The most
is

powerful of

the Oil of Turpentine, which

one of the most

diffusible stimulants in the

whole materia medica.


medicine has induced

In
has-

a variety of
maturia, and

instances this
it is

not,

a priori, unlikely to promote


I have not found
;

the flow of the catamenia.

it

so

efficacious in uterine epilepsy as I could wish


fact, I have never been driven to rely chiefly

but, in

upon

it.

In cases of maniacal
of the catamenia,
it

affection,

connected with defect

has very considerable powers, as

1 have ascertained by a sufficient

number of

experi-

ments. In epileptic cases

it

ought not to be neglected.

The form
is

in

in which it can best be given, in this view, an emulsion, each draught containing from half a to

dram

two drams of the

oil,

to be taken three times

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.

If these measures succeed in producing a free and

copious flow of the catamenia,


quickly relieved, the
patient
is,

fits

cease,

the head becomes and the health of the

for the present, restored.

But

if

they

fail

of exciting

the

action of the uterine

system,

they

generally relieve,

and

often

remove the

epileptic

tendency, by diminishing plethora, and giving rise to

some new determination. Should the efforts made


function

to

restore the

uterine
to

prove
is

abortive,

all

that

remains

be
is,

attempted

to fulfil the third indication;

which

to brins the constitution

into a state in

which the

defect
injury,
fits.

of this function

and particularly

may be productive of less may not give rise to epileptic


it

First;

With
after

this

view

is

important, in the

first

place, to avoid the return of a plethoric state of the

system,

it

has been already reduced

by the
is

measures above mentioned.


regimen.

This purpose

to be

attained by observing an antiphlogistic and attenuating

The
be
1.

following are the particulars that require to

chiefly attended to with

a view to

this indication.

The

diet should be as sparing as is consistent

with a due regard to the preservation of constitutional


vigour.

SUPPLEMENTARY DISCHARGES.
2.

189

Exercise in the country, and frequent changes

of air, should be recommended.


3.
larly,

Some

laxative medicines should

be used regu-

with the intention of keeping the bowels in a

state

more relaxed than


;

is

natural in health.

Secondly

The

effect

of

artificial drains,
is

by issues
;

or setons, in reducing plethora,

considerable

but

they appear to have a further efficacy than this in


instances of uterine epilepsy.

In several of the fore-

going cases

it

may be
epilepsy

remarked, that a new morbid

determination taking place in the system, suspended


or

removed

in

cases

in

which no other
as
after

remedies succeeded.

In

some

instances,

bleeding, a disease took place in the lower extremities,

resembling phlegmasia dolens


affections
;

in

some rheumatic

in others cutaneous diseases, occasioned a

mitigation of the epilepsy.

In

all

th^se instances the


fits

new

disease

is

vicarious, to

and suspends the


well

of
in

epilepsy,

according

a principle

known

pathology.

This consideration, as well as the result

of actual experiment, indicates the propriety of establishing

by art a supplementary disease or drain


in

which,

some
the

degree,

will

probably answer the

purpose of the natural one.


setons
in

This

may
:

be done by

nape of the neck

perhaps more

favourably by issues or setons on the sacrum, or above


the knees.

If these applications are too troublesome,

an

issue in
in

one or

in

each arm

will

have a similar

effect,

a certain degree.

If there are any consti-

tutional disorders
sions,

which may act as drains or diver-

they should be encouraged.

Of

this

nature

EFFECT OF PREGNANCY.
are cutaneous diseases, discharges from the legs, and other local maladies*.

Thirdly;

Before I conclude this chapter I must

observe, that
relieving this,

Nature has yet a resource


and many other forms of

in reserve for

disease,

which

depend on a want of the catamenia.


are almost peculiar to unmarried

These disorders
Pregnancy

women.

generally removes the disorders connected with defects

of the catamenia.
take place, I

But even
very

if

pregnancy should not

am

much

disposed to believe that

diseases of this kind

would generally be removed by


even a complete amenorrhoea

marriage,

and

that

would, in general, be eventually cured by itf.


*

On

the subject of the beneficial effect of drains

I shall

enter

more

at large in a following chapter


still

on a form of

this disease, in

which they are a

more important resource.

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

to recur at the periods

of menstruation, which was cured in the


I shall cite his
**

way

alluded to above.

own

statement.
sensibilis, affectibus

Fcemina 30 annorum, constitutionis valde

animi, praesertim iracundise dedita, h parentibus morbo melancholico affectis progenita, hactenus
sterilis,

ex inopinato mariti
tempore, cum
ipsi

morbo

insigni oppressa fuit

mcerore.

Quo

menses Jluerent ,

et sub eojiuore
;

nuntius de ipsa mariti morte accein

deret tristissimus

ilia

vehementi terrore perculsa,

mensium

suppressionem protinus incidit.


dita,

Hinc anxia,
;

inquieta, insomnis red-

nullum assumpsit cibura

sed verba sine ordine loqui caepit.

Turn spasmodic'a primum

faciei tortur^,

quam cynicam
;

vocant

correpta, deuique graves, atrocesque toleravit convulsiones

quibus

nee sanguinis missiones, nee uUa remedia opem

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

defective, or a laborious flow of

the catamenia, accompanied by attacks of epilepsy,

a disease of which examples occur in the foregoing


section, particularly in the second, sixth,

and eleventh
to

cases,

the practice

to

be pursued

is

adopt the
of dys-

measures which are most beneficial

in cases

menorrhcea
tiiose

in

general.

Moderate bleedings, and


uterus, are principally

means

w-hich

promote relaxation of the system,

and a determination towards the


minime

remisit penitus; ted circa tempus menstruu7n pertinaciter

recrudult,

cum

tanta

mentis perturbatione,
in

ut

a multis furori

vicina haberetur.

Hinc

usum

vocavit thermas ac acidulas,

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

PRORSUS FUIT LIBERATA."


In commenting upon this
decisive,

the author adds

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

fluunt, familiaris esse solct

ita quoque eadem ad corporis superficiem prorumpente, pabulum malo epileptico subtrahitur. Optimum autem auxilium ex matrimonio redundavit; quippe quo libido extinguitur, menses snppressi

retocantur, aerumnee atque soUicitudines depelluntur, et


pori ingens accedit mutatio."

toti

cor-

The author has

related another case of uterine epilepsy, p. 18

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

appetiit, vires coUegit, menses ordinem serva-

paroxysmi

epileptici petiitus remiscrunt."

Frib.
See Case VII.,

Hoffmann.

0/)f/', torn, iii, p.

21.

in the foregoincr section.

192

TREATMENT OF

to be relied upon.

vein should

be immediately

opened, and a quantity of blood drawn, which must

be determined by circumstances.
flow,

If there
it is

is

any

though scanty, actually subsisting,

desirable

to avoid syncope,
total

which

is

sometimes followed by a
In
this

cessation of the

discharge.

case the

bleeding should be so conducted as to produce a perceptible degree of relaxation in the pulse


is
;

and

if this

not obtained by a single operation,

it

should be
is

repeated.

The immediate

effect

of this measure

generally a relief of the pain and oppression of the

head, and a lessening of the pulsation in the carotid

and temporal
vessels
is

arteries.

The

constriction of the uterine

often

removed

at the

same time; the pain

in

the back and loins, indicating a difficult and imperfect


effort, subsides,

and the flow of the catamenia becomes

free

and

natural.

At

the

same time the other measures, described


this section, for

under the former head of

promoting a
occur

free discharge, should be adopted.

In those instances in which epileptic


being aware of any
ciency, the

fits

about the period of the catamenia, the patient not


obstruction
or
particular defi-

same

practice

must be pursued.

In such

cases the relief obtained by the system at the periodical

orgasm

is

probably insufficient

the determination to

the uterus, and consequent flow, though not remark-

ably scanty in proportion to what


individuals, appears
to

is

observed in other

be deficient with respect to


or
takes

the

particular habit of the patient,

place

too slowly, and with a greater effort and irritation of


the system than
it

ought.

Whether

this

notion

is

UTERINE EPILEPSY.

193

well founded, or not, experience sufficiently establishes

the propriety of adopting the practice I have recom-

mended.
eighth,

I wish to refer the reader to the seventh, cases,

and ninth

which are of the character

just described.

If the scanty and laborious production of the catamenia should continue, and the fits should obstinately

recur at the periodical returns, similar methods

must

be repeated at the commencement of the constitutional orgasm.

A
warm

moderate bleeding, together with


bath and relaxing medicines, such

the use of the


as
saline

purgatives

combined with antimony and


M'ill

other diaphoretics,

often

give rise to

a more

copious and effectual discharge,


epilepsy will be kept off.
I

and the attacks of

The

use of enemas, such as

have before described, and sometimes a few doses


oil

of the

of turpentine, from half a dram to two

drams

in a draught,

mixed with cinnamon water, ^r


fluid, will

some other aromatic to the same end.

contribute powerfully

If the dysmenorrhoea should be invincible,

much
on
arti-

may be done
ficial

to

obviate

its

injurious

effects

the habit by constant exercise, purgatives,


drains.

and

In proof of these positions I beg to


to

refer the reader

what I have noted

in the case of

Elizabeth Sutton, in the foregoing section.

194

OBSERVATIONS ON

SECTION
Of
Maniacal

V.
of the

Affections, connected with States

Uterine Function.

Maniacal
is

afFections are connected, in a variety of


states of the uterine function.

modes, with the

Ttiere

even a greater diversity in the complaints that

may

be referred to this head than in the phaenomena of


uterine epilepsy.

sudden suppression of the catamenia, produced


to cold,

by exposure

by over excitement, or by any


attack of mania.

powerful mental emotion which disturbs the system,


is

occasionally the prelude to an

Such attacks are sometimes of short duration, and


subside as soon as the catamenia are restored.

In

other instances the disease induced

is

more permanent

than the exciting cause, and will even remain obstinately fixed in the system,

although the periodical


re-established
:

function of the uterus becomes


this is

but

not the usual course of the disease.

When
miti-

arising

from the cause above mentioned, disorders of


subdued, or very

this class are generally

much

gated, by

its

removal.
afFections in

Maniacal
in the

young women are not unfre-

quently conjoined with a great degree of irregularity


returns

and circumstances of the catamenia.


cause of the disease
considering the

In such instances we may, with probabihty, conclude


this to be the
;

variety of disorders
arise

which we continually observe to

from morbid conditions of the uterine system.

UTERINE MANIA.
In such cases we also obtain much
relief

19^5

with respect

to the affection of the nervous system, if the

catamenia

can be restored to their regular periods and natural


condition.

Many women who

experience no interruption to

the regular periodical return of the catamenia, display

a degree of excitement and


at

irritation in the
:

system
chiefly

the

period

of menstruation
;

these

are

females of very irritable habits

a condition of body

which generally accompanies the highly sanguine complexion.

The

greatest degree of excitement generally

happens

in cases

of dysmenorrhoea, or when the flow


is

of the catamenia

slow, scanty,
is

and

difficult.
is

In

such instances there

often

much of what

termed
spirits

nervous disorder, or affection of the animal


this

often

assumes a character resembling that of


is

hysteria,

and

attended with

fits

of crying and laughtake

ing:

in

other instances maniacal impressions


:

hold of the mind

an unusual vehemence of feeling


or there

and expression

is

observed, depending on unnaturally

vivid impressions

on the fancy

is

torpor

and dejection of mind, with a despondent

disposition,

and often with some melancholy hallucination.

These symptoms often disappear with the temporary circumstances which had given
rise

to

them,

but they are important as marking the tendency of


the constitution, and are sometimes the harbingers of

a more permanent disorder.

The
They

following cases of madness occurred chiefly in

persons of plethoric habit and sanguine complexion.


afford specimens of maniacal disease connected

196

CASES OF

with dysmenorrhoea, or with suppression of the catamenia.

CASE
Rebecca James,

I.

admitted June 5, ISCO.

A
talks

plethoric

young woman, of sanguine temperament,


In August,
1819,
she

aged about

thirty.

was

in

this

house, with the same disease she


incessantly
;

now

labours under.
boisterous
;

She
ex-

is

sometimes

very

tremely irritable; subject to sudden flushings of the face.

When
sullen

the slate of excitement subsides she remains in a

mood, or

cries

and laughs. Her eyes appear suffused.


Pulse very rapid.
for

Her bowels

are rather torpid.

Cata-

menia irregular; often wanting scanty when they do appear.


Sang. Jxxiv

a time, and

always

ex Nuch^

extrahantur ope Cruent. Cucurb.

Episp. Nuch. postea.

Mist. Emetic statim.


Pil. et

Mist. Cathart.
;

June

6.

Slept last night

bowels freely purged.


little

She

is

noisy.

Pulse rapid and firm.

Skin hot; tongue a

furred.

Fiat Venae Sectio.

Pulv. Antim. Opii et Jalapii.


15.

Cold shower bath was ordered.


Is

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-

Convalescent. She went out soon afterwards, appa-

rently well.

She applied
Bowels rather

in

March, 1821,

as an out-patient
in her

in great fear

that she shall have a relapse.


costive.

Pain

head and in her chest.

She has had no appearance of the cata-

menia now

for six weeks.

UTERINE MANIA.
She was ordered
opening
pills.

197

to lose sixteen

ounces of blood, and take some


prescribed for her

The Turpentine Emulsion was


this

three times in the day, with the Tinct. of Black Hellebore.


In

a few days after


:

medicine was administered the cat^I

menia flowed

she had previously been relieved by bleeding.


relieved,

saw her soon afterwards completely


health as usual.

and

in

as good

In the following June she


state of

came again

into the Hospital, in

derangement, and was restored by evacuants.

CASE
Anne Marsh, aged
An
unmarried

II.

thirty-five,

admitted

May 25,

1816.

woman, of middle

stature, full robust

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

plexion, viz. light blue eyes, light

brown
:

hair.

form.

At

present

her

countenance

is

extremely wild

the

pupils of her eyes are contracted, her bowels costive, and

her breath offensive.

She

is

very unmanageable, and at


is

times utters a loud dismal shriek, which

always the fore-

runner of a violent struggle

she kicks and tears every

thing near her until she gets into a profuse perspiration.

State of the naturalJunctions,

-Bowels costive
is,

breath

offensive; appetite keen; catamenia irregular; whenever

they are

in

the least checked, (that

when they
is

fail

to
:

appear

at the

due

time,) the disorder flies to the

head

latterly, if

any thing vexes

her, her

head

affected.

She

says, that

if

she can cry well her head will not be so

much

198
distressed.
is

CASES OF

When

at the best,

she talks incessantly.

She

very

irritable,

and cannot bear stimuli of any kind.


the

Treatment.
blister.

Shave

head,

and keep open a perpetual

Cathartic Powder, 3ss. every morning.

27.

Although the

blister
is

has discharged freely and the bowels

have been purged, she

not relieved.

Laxative Saline Antimonial Mixture, in Mint Water, every

4th hour.

June

5.

Febrile

symptoms abated

skin moist

bowels and

urine natural.

Repeat the medicines.


12.

Complains that the pain

in her

head

is

most excruciating

particularly about the forehead.

Twenty ounces
15.

of blood were taken from the temporal artery,


to continue her medicines.

and she was ordered


20.

Is considerably
Is

calmer
sits

takes her medicines regularly.


in

much

better;

up

bed; at times talks rather

incoherently.

July 2.

Continues to improve gradually.


Is
still

Nov.

15.

much

better,

and

is

employed

as a servant in the

house; but
the evening.

says that her head

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

the house, and goes out whenever she pleases.

In March, 1819, she had another attack. She was suddenly seized with darting pain across her forehead ; her

countenance was flushed

her eyes suffused

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.

Sec. Art. Teroporis, et fluant sanguinis ^xvj.

Haust. Cath. 6ta qq. hora.

Lowf

diet.

This single bleeding, with the other measures prescribed,


stored her.

re-

UTEllINE MANIA.
Aug. 20.
disorder.

199

She was

subsef|uentl^ again attacked, aiul relieved

by the same means.

Since then she has been free from

the

Nov.
and
takes
if

19, 18 19-

She

lives

now

as

a servant

in the city,
is still

and
not

has suffered no relapse of her complaint.

She

irritable;
:

spoken to
with,

hastily, will

become

flushed in the face

if

interfered

she does very well.

She

is

talkative.

If she

any

beer, or the least quantity of spirits, her

head becomes

affected.

She was advised

to

have an

issue, but

would not submit

to

its

application.

CASE
Susan Lewis,
aged
thirty-five,

III.
full habit, fair

woman

of

conipiexion,

admitted Sept. 13, 1820.


fifteen children.

The mother of

About

four years ago

she complained that she was unwell, and said she was sure
she should be deranged at

some time

or another.
:

About

November
head.

last

she bore her last child

during gestation

she complained of what she called rheumatic pains in her

From
regular
:

the period of her last delivery she has never been

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.

Continue the medicines.

Soon

after this

date she became an

out-patient, with

com-

paratively trilling ailments.

200

CASES OF UTERINE MANIA.

CASE
Mrs.
,

IV.

aged about forty, of strongly marked sanan unusual degree of

guine temperament, who had borne several children, had


evinced, after the birth of the
last,

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
;

imaginary causes; and with


absolute coercion
:

difficulty

restrained

without

her sleep was disturbed, and she had

scarcely any intervals of tranquillity.

These symptoms
in

abated as she recovered strength, but they recurred


at

a greater or less degree about the periods of the catamenia;

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

subject to returns of excitement at the periods of the

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

sustenance, passed her evacuations invoall

and, in spite of

eflbrts,

sunk under her


state of

disease, after lying for

was not permitted

to

some time in a examine the body.

coma.

'

NATURE AND TREATMENT.

201

SECTION
Of the

VI.

Nature and Treatment of Cases of Uterine Mania.


it

I SUPPOSE

will

be readily allowed that the theory

of maniacal affections, occasioned by suppression of


the catamenia, as well as of the

connected with
struation,
is

dysmenorrhoea
to

more chronic forms, and irregular men-

analogous

that of epileptic attacks

occurring under similar circumstances.


Besides the argument for this conclusion, arising

from the analogy of the circumstances under which the two diseases appear, there is an additional one in the
fact before alluded to,

that a large majority of cases,

of either description, take place in

marked sanguine

women of strongly temperament. The changes induced


any peculiar constitution by similar

in the functions of

causes are likely to be analogous.


But, independently of
all

these considerations, the

phaenomena of the
eifect of remedies,

disease,

and experience of the

sufficiently point out

what course

ought
mania.

to

be pursued

in

the

treatment of uterine

One

observation which I have


is

made
the

respecting the
following.

treatment of these disorders


uterine mania,

In

of

stimulating

more may be expected from the effect emmenagogues than in analogous


;

instances of epilepsy

and frequent and copious bleed-

ings are not, in general, so necessary or so safe in the

former disease as

in the latter.

Yet

there are instances

of maniacal affections brought on by sup[)rcssion of

202

TREATMENT OF

the catamenia, in which the immediate abstraction of

blood to a considerable amount, joined to the use of


the
tion

warm

bath, will presently restore the natural funcdisease.

and remove the

These are cases of an

acute kind, in which the marks of determination to


the brain are strongly

marked *.

The most
this

efficacious

emmenagogues

in

cases

of

class

are

the

Tincture of

the Oil of Turpentine.

Melampodium and The former may be given


this

in doses of thirty to sixty drops three times in a day.


I

have repeatedly prescribed


;

medicine in cases of

amenorrhoea

and the flow of the catamenia has so

frequently ensued, that I


sessing

am

persuaded of

its

pos-

some power of promoting


is

this discharge.

But

the Oil of Turpentine

generally

more

efficacious.

This medicine
lant;
it

is

a most powerful and

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,

each dose containing from half a dram to a dram of


the rectified
oil,

to

be taken three times in a day.


to give

Sometimes
the
oil

have preferred

two drams of
Clysters of

at night,

or a double

quantity during the

day, together with

some

brisk purgative.

Ol. Ricini and Ol. Terebinth., of each an ounce, are


often
successful
in

bringing

the

same

result.

The

use of the

warm

bath should be ordered at the same

* Sec Cases

I.

and

II.

UTERINE MANIA.
time.

20S

Other stimulants, such as the balsams, and


but I have not
to

the preparations of cantharides, have probably similar

powers

made enough experiments


to decide as to their
effi-

upon them
cacy.

enable
I

me

Chalybeates

have seldom or never prescribed,

being persuaded of the impropriety of giving them in


cases of this description.

Exercise by walking,

if

the patient can bear


cases

it, is

of great assistance in
struation.

all

of defective men-

In other respects the treatment of uterine mania

must be conducted on the same plan


epilepsy;
said

as that of uterine

and

I refer the reader to

what has been


particularly to

on the regimen

to be

adopted in the obstinate


:

and protracted cases of that disease

the observations on the use of issues, and the manage-

ment of the

intestinal

and gastric functions.

I have
viaa

reason to believe that disorders of the primse

are often contributing causes to maniacal affections, of

which the
cause*
;

state

of the catamenia

is

the principal
miti-

and that much may be done towards


to the

gating the disease by attention

state of the

stomach and bowels.

SECTION
On
I

VII.

Puerperal Mania.

HAVE

already remarked that the phaenoniena of

puerperal mania appear to


Sec Uic cubf of

me

to

depend upon the

Anne Marbh.

204
same

TREATMENT OF
principle in pathology, to

which I have referred

those of maniacal affections connected with dysmenorrhoea, or the suppression of the uterine function*.

Puerperal mania chiefly occurs in females of the


sanguine temperament;

a circumstance in which

it

coincides with the disorder before described.

In
disease

the

following

case

of puerperal

mania,

the

was immediately removed


rise to

by, measures which

unexpectedly gave

a flow of the catamenia.


1,

Martha Cook,

admitted Feb.

]81f3.

married woman, aged thirty-eight years,

who

has

followed the trade of a milliner;

of sanguine tempera-

ment, light brown hair, blue eyes, fresh complexion, disposition gentle, habits temperate and domestic. She has

had

six children.

After the birth of the two


is

last

she was

attacked by a disorder, which


peral fever, and

said to have

been puer-

became maniacal.
on

* Since

wrote the substance of the above observations

puerperal mania, the following remark of Dr. Ferriar has occurred


to

me, which proves that he regarded

this disease in the

same

light in

which

have considered

it.

"

am

inclined to consider the puerperal

conversion.

During

gestation,

and

after delivery,
is

mania as a case of when the milk


so greatly dis-

begins to flow, the balance of the circulation

turbed as to be liable to

much

disorder from the application of


cold, affecting the head, violent

any exciting cause.


noises,

If, therefore,

want of

sleep,

or uneasy thoughts, distress a puerperal


is

patient, before the determination of blood to the breasts

regu-

larly

made, the impetus may be readily converted

to the
its

head,
force,

and produce

either hysteria or insanity, according to


(I

and the nature of the occasional cause."


to the constitutional

should say, according


See Dr.
**

predisposition of the individual).

Ferriar's Medical

Histories and Reflections, vol.

ii.

On

the

Conversion of Diseases," p. 4S.

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

twelve leeches to be applied to

the temples.
01. RIcini, ss.
8.

manb

quotidie.
is

Continues nearly in the same state;


if

very noisy: some-

times shrieks out violently, as

suddenly hurt.

Emplast. Lyttas ad Caput. Repet. 01. Ricini.


15.

No

perceptible alteration in the maniacal state.

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

Mist. Aperiens Acida. 4ta qq. h.

22.

Is able to sit

up

in

bed

is

extremely languid.

Pulse 64,

and small.

Discharge considerably abated.


Bitter Tonic Mixture.

Appetite better.

She

talks rationally.

Repeat the Aperient Mixture

if

the bowels are constipated.

March 2. Able to walk about the ward without any Has meat and a pint of porter daily.
Continue the Mixture.
24.

assistance.

Discharged quite recovered.

Observations.

In

this case the

maniacal affection con-

tinued undiminished

until a flow of the

catamenia was
it

occasioned by the use of the hot bath; after which

immediately subsided, and sanity was soon restored.


fact leads to the inference that, in similar cases, the

This

way

to

attempt a cure

endeavour to restore the natural determination to the uterus, by which the whole system obtains
is

to

its

habitual and periodical relief:

and

if this

cannot be

206

TREATMENT OF
other instances,
it.

done, to supply the place of the natural determination by


the measures which, in

we have

ascer-

tained to be the best supplements for

The

following case

may be
it

considered as an instance of

puerperal mania, although


delivery.

came on some time

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

has been indisposed three

months

melancholy

Present

state.

Skin
;

continually crying.

hot; pulse quick,

full

and strong;
a state

bowels very relaxed


Treatment.
as possible,

urine scanty and high-coloured.


to be kept in as tranquil

She

was ordered

and

to take half

an ounce of Ol. Ricini occasionally.

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

the mental disease as before;

June 30, 1817-

Her melancholy continues;


can be got

it

is

with the

greatest difficulty that she

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.

Urine scanty and


in

Catamenia have never appeared since she has been


moist.

the house.

She sleeps well.


Hydrarg.
g. x. bis indies.

Haust. Laxans manfe quotidie.


Pil.

Warm
She was
lowed.
still

bath twice a week.


sore
;

Her mouth was made

the remedies were discontinued.

obstinate in refusing food,

and no amendment
effect of the

fol-.

When

she had recovered from the

mercury, a

coKl shower bath

was ordered, but she

fainted.

UTERINE MANIA.
A

207

mild nourishing diet was ordered for her, and laxatives

as occasion might require.

Jan. 21, 1818.


Pil.

No amendment
Hyd.
bis indies.

has taken place.

30.

Warm

bath of 110 F.
affected; appetite

Feb. 9.

Mouth

improved; takes her food

at the table without forcing; sleeps well.

April 23.
benefit.

Seldom speaks.
if

She has been reduced by mercurials, without much Skin always cold: sits in a fixed
disturbed.

posture, and cries

Laxatives occasionally.

Omit

the mercurials, &c.

May
indies.

1.

Dec. Cinchonse

^ij.

cum

Acid. Nitrici gutt. 30 ter

July 14.

Takes a draught of the Infusion of Rhubarb and


in the

Quassia, with Carbonate of Soda, three times

day.
for the first

Aug. 30.
time since she

She had menstruated, though sparingly,

came

into the house.

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,

with febrile symptoms, and


in pain.

it

was impos-

to ascertain

where she was

Effervescing draughts

were prescribed.

Aug. 16.

After vomiting for some hours, she expired.

Dissection,

Skull very

thin.

Effusion of bloody serum

between the dura and pia mater.


of fluid
in the cavities

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

and the colour pale.

The

gall

bladder was

full

The ileum

exhibited traces of recent inflammation;

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

failed at a certain period

of gestation

viz. at

when

the disease

commenced.

may be remarked,

that subsequently to delivery the

natural

determination to the uterine system was never


discovered in the brain display the

restored.

The appearances
effects

of the morbid determination to the head.

It is not

my

intention to enter further into the treat-

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

public are already in possession of


that can be given on
this subject.

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

the catamenia cease

a time when the consti-

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

have so often adverted


I

for the truth of the observation,

believe every old

UTERINE MANIA.

209
it

woman

in

England

will

vouch

at least I hear
class.

appealed to every day by dames of the lower

Women who
become

are naturally predisposed to maniacal

complaints, (and I presume that no individual can


the victim of insanity, unless he has a constiit,

tutional tendency to
fathers, or springing

either derived

from

his fore-

up anew

in his original

conform-

ation*,) are

very liable to these attacks about the


the catamenia disappear
;

period

when

or rather soon
is

after they

have ceased.
in females
life,

This predisposition

greatly

promoted
sedentary

who

lead at this time an inactive,

indulge in too stimulating a diet, and

are careless of the state of their bowels.


effect is

similar

produced occasionally by causes of almost an


description
:

opposite

women

of the lower orders,

who

labour hard, and exert themselves beyond their

strength, particularly in hot weather, (circumstances

which stimulate the vascular system,) are


disorder.
stitious

liable to this

Solitary

and contemplative

habits,

super-

apprehensions, the effect of false representa;

tions of religion

all

mental habits which render the

impressions of reverie vivid, and withdraw the attention

from objects of sensation and perception, tend


All the latter are to be
;

to foster this predisposition.

regarded as concurring causes

they have often existed

many

years, without producing


to be

a morbid
if

effect

and
of

would continue
source, by

harmless,

the habitual reitself

which the constitution has relieved

have treated on the doctrine of natural predisposition in

my

Researches into the Physical History of Man.

210

CASES OF
irritability,

a burdensome plethora, or of accumulating

had not ceased


I shall here

to avail

it.

add notes of three

cases,

which I look

upon, in the point of view

of uterine mania.

now explained, as instances The phenomena in all these cases


for

would have obtained


madness,
if

them the term of

religious

the circumstances which prove that they

had

their origin in a physical cause were not suffi-

ciently manifest.

Sarah A

aet.

fifty-eight.

Jan. 4, 1819.

very fat short

strongly

woman, of melancholic complexion, marked features. Her brother and sister died
:

maniacal

the former cut his throat.


for several years, led a very solitary inactive
;

She has,
life
;

kept a huckster's shop


all

used to read a great deal,


It

and spend
Pulse
tite

her time alone.

seems that she was

in

the habit of indulging herself in eating and drinking.


full.
;

good

Bowels regular at the present time. Apperather voracious. She appears always cheerful,
Pil.

and

struts

about the ward.


Cath. Mist. Cath.

Low

diet.

Oct. 22.

No

material alteration.

Seems

to

have been reheved


little
;

by the shower bath, which she has used.


rulous.

Sleeps

is

gar-

Pulse natural.
Let a

Begs for a
full diet

full diet.

be

tried.

AfFus. Frigida.

Cathartic draught twice in a week.

Dec. 28.

The

full

diet rendered her

more noisy and

trouble-

some.
Pil.

Cath.

o. n.

Dec. Aloes. Co et Aq. Menth. aa ^iv.

Magnes. Sulphat.
Capt. cochl.
vj.

Jj-

M.

raanb quot.

UTERINE MANIA.
No
but

211

remedy produced any material


was
worse

alleviation of her disease,

she

on

full

diet,

and

more tranquil when


full

kept low.
October 14, 1820.
After taking a very

meal of broth, she

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,

and some other stimulants.


There had been no increase or alteration
refer to the

She expired.

in the

symptoms which

head.

She was clear

in

her perceptions.

Dissection.

Calvaria heavy

vessels of the dura

mater

turgid
skull.

considerable adhesions of the dura mater to the

large piece of
its

bony substance

at the inner

margin of

the falx, near

origin.

Vessels of the pia mater turgid:

that

membrane was

thickened, and opake

in

patches, particularly about the

situation of the glanduloe pacchioni.

Effusion of serous fluid beneath the pia mater, entering

between the convolutions. Substance of the cerebrum Vessels of the medullary texture minutely firm and hard.
injected.

Lateral

ventricles

considerably
jij

distended

with

fluid

they contained about

of serous fluid.

Plexus choroides pale.

Very small piece of


Abdomen.
Liver small
;

gritty substance in the pineal gland.

Vessels of the cerebellum loaded with blood.

Great

quantity of fat over the

parietes.

not diseased.
'In the case

Observations.

of this patient there was a pre-

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

which were calculated

to give rise to intes-

torpor and scanty secretions in general,

and a

full

diet, in

which she was very prone to indulge.

In addition

212
to

CASES OF
her disposition
to

these circumstances,

reverie

and

abstraction probably contributed to determine the form of

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

tongue somewhat furred;


nights.

and feeble ; skin cold and shrivelled bowels constipated; sleepless She answers questions very rationally ; is con-

scious of her deranged state.


Treatment.

Head shaved, and covered with cold wet


gr. v.

cloths.

Calomel,

statim sumend.

Haust. Cath. 4t& quaque hora donee purgaverint alvum.


Pediluvium.
o. n;

These medicines were continued


the neck.

and a day or two afterwards

leeches were applied to the head, and a blister to the nape of

25.

Pain and sense of weight removed


:

pulse quickened

tongue clean

bowels purged.
tongue a
;

Aug.
purged

2.

Complains of great heaviness across the forehead


;

eyes affected by light


;

giddiness

little

furred

bowels

stools watry,
five.

black, and fetid

pulse

full, intermitting

about one in

Purgatives were continued, and soon after a bitter infusion,

with carbonate of
scribed.

ammonia and aromatic


is

confection,

was

pre-

September 4.

She

in

an improving

state.

Allowed
change of

to

go

into the country, under the care of her

friends, for

air.

Anne Howell,

aged about

plexion, melancholic

fifty-three, of dark comtemperament j an exquisite example

UTERINE MANIA.
of what
is

2l3
viz.

termed religious madness;

melancholy,
:

with hallucinations turning on religious subjects


history of the case proves that her disease
entirely in a physical cause.

yet the
origin

had

its

She
aspect:

lies

in

bed:

has the most gloomy and dejected


in

moans and complains

a tone of unvarying a solitary


pitiable

despair: sometimes utters the most frightful shrieks and


yells, so that it is necessary to confine her in

apartment.

When

interrogated, she gives a

most

account of her miseries, which she solemnly avers to be


realities,

and not the effect of derangement.


is

She believes

that she

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
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.

that her heart


is

is

hardened and dried up within her.


is

She
is

as fully

persuaded that she

eternally

damned

as she

of her existence.

The

disease

made
;

its first

attack about the period

when

the catamenia cease

and

in

consequence, as

it

appears, of

hard labour, exposure, and over exertion at that period.

She was working


large
tan-yard.

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

into the hospital she under-

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

likely to relieve her, has

been

tried,

with

little

success.

She
alka-

has undergone purging, topical bleeding,

warm

bathing, slight
;

doses of mercury, tonics, bitter and mercurial laxatives


lines

and absorbents, &c.

At one time dark coloured patches

appeared on her thighs, and subsequently on different parts of her

body

and she was at that time sane.


a slight return
of the

At another

period she

experienced

catamenia;

but these ap-

pearances were of short duration.

In general bitter laxatives,

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

a very strong pulsa-

perceptible on pressing the lower part of the

abdomen;
this

viz. that of the

descending aorta.
is

She complains much of

beating, and says that there

something alive within her.

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

of the nervous system,

arising

from the translation of disease from other structures


to the brain,

bear an analogy in
in

many

particulars to

that

class of disorders

the same system,

which

originate from an irregular state of the uterine functions.

On

that account

it

seems proper

to proceed,

in this place, to the consideration of the

phaenomena

presented by the former.

The
cases

pathological fact, on which the theory of these


principally

depends,
all ages.

has been

recognised by

medical authors in

Hippocrates was aware

of a certain relation between external disorders, such


as cutaneous eruptions
internal diseases
tions
;

and ulcerations, and several


particularly
fact,

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

the cars, or efflorescences


it

on the head, or other


but
if
it

external parts,

produces no injurious
it

flow

upon

the internal viscera,

occasions asthmas, dyspnceas, diar-

216

MANIACAL AND EPILEPTIC


;

diseases are vicarious of each otiier

and adopted the


to account

obvious hypothesis of peccant humours


for
it.

great

number of writers have followed him


and a multitude of
it,

in this supposition;

cases,

which

have a reference to
their works.

are to be found recorded in

The pheenomena which


tures to the brain

occur in consequence of

the metastasis of disordered action, from other struc-

and nervous system,


situation

differ

accord-

ing

to

the nature and

of the

preceding

disease.

I shall adopt this principle of arrangement

in the following remarks.

SECTION

II.

Metastasis to the Brain on the healing of old Ulcers, and


Recession of Exanthemata.

One

of the most frequent and most striking examples


is

of metastasis to the head,

that which ensues

on

the healing of old ulcers, or the disappearance of


eruptive disorders.

Accordingly, this

is

one of the

phfenomena most frequently observed and recorded.

Hoffmann has
rhoeas; or,
epilepsy.
'ihKio.
If

collected

a number of facts of
by any natural
[ji.\v

this

if it

cannot pass
:

off
*'

vent, gives rise to

His words are


T>]i/

I?

Oxoroi<7

vcci^ioTa-iv iova-n i^cctSeii


I?

Hi(pa'Kny

xa*

ovchtx x.a)

rov uXXon ^furei, xou

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,

TotovTOKTi liriKniSwov irrtn


?V."

iXi^xsaGai

inro

rccvTni;

t?{' vovaou'

x. r.

HiPPOCRATES

dc

Morbo

Sacro, cap.

iv.

CASES FROM METASTASIS.


description from the works of Tulpius, Hildanus,

217
and

other writers*; and Sauvages,


epilepsy, reckons

among

the forms of

one which he terms exanthematic


species,

and among those of mania a corresponding

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

have been frequently noticed by writers of the present


dayj.
I have

met with repeated instances of disorders

in

the head, attended with a variety of symptoms, which

could be clearly traced to the healing of old ulcers, or


the

suppression of

artificial

drains.

remarkable

case of this description occurred to

me

in the instance

of a woman, considerably upwards of ninety years


old,

who, notwithstanding her advanced age,

had

enjoyed very good health until a short time before


she applied to

me

for relief.

subject to ulceration of her legs,

She had long been and had seldom been


hands of a surgeon

without some drain of this sort during thirty years.

At
of

length happening to
skilful in

fall

into the

who was
all

curing ulcerated legs, she got rid

her old sores, and

was presently afterwards

troubled with an affection of the head.

When

saw
to

her she complained of vertigo,


debility

attended with great

and anorexia.

She would not submit

Hoffmann de Morborum Transmutatione.

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*.

MANIACAL AND EPILEPTIC


artificial

drain

formed

in

tier

leg,

which

she was advised to

undergo,

and

in

short time

The
eruptive
in

relation
diseases,

between
is

convulsive

affections

and

well

marked by what occurs


I

the

acute exanthemata.
fits,

allude

to

the con-

vulsion

which not unfrequently occur


;

in children

as a prelude to the eruption of small-pox

and some-

times as consequences of the recession of the rash in


measles, and scarlatina.

But attacks of epilepsy are

by no means rare as consequences of the disappearance of the chronic or non-febrile disorders of the
skin.

Dr. Ferriar has mentioned the case of a gentlesubject to epileptic


fits

man who became

in conse-

quence of the disappearance of scabies,


of some external application, and

after the use

who was suddenly


Hoffmann has

cured of them, after a variety of remedies had been


tried,

by reproduction of the

itch.

reported a similar instance.

In this case epilepsy

made
v\ith

its

attack after the skin had been twice rubbed

an ointment prepared for extinguishing the cutaIt is well

neous complaint.

known

that the repulsion


is

or cure of porrigo purulenta in children

often fol-

lowed by convulsive
* Dr.

fits.

Parry has recorded a case parallel


lived freely,

to

this.

An

old

man, who had


ot his legs,

had a chronic inflammation of one


Both these affections were
In a few

accompanied by oedema.
lime

greatly relieved by the application of a tight bandage.

days he was, for


epilepsy.
peutics.

tlie

first

in

his

life,

seized

with violent

See

Dr. Parky's Elements of Pathology and Thera-

CASES FROM METASTASIS.

219

In other instances the brain and nervous system

become
tion
is

affected

in a

different

way

viz.
;

by the

dis-

turbance of the intellectual faculties

and

this affec-

various, according to the nature of the external

disorder that preceded.

Acute eruptive diseases prorepelled, stupor

duce, in general,

when

and delirium

while the disappearance of more chronic eruptions gives


rise to

degrees of mania.
is

Delirium from the recession


:

of erysipelas
often finishes
tion

a phaenomenon of the former class

it

its

course in a few hours

the inflamma-

which takes place


being

in the brain, as well as in other


this

internal parts, in
disease,

consequence of the translation of

more prone

to pass into effusion than

that which ensues on other inflammatory disorders.

In the following case a recession of the eruption of


rubeola
delirium.

was immediately followed by an attack of

Mary Hamlet,
1818,
in the

admitted at the Hospital April 21,

evening.

woman

of sanguine temperament, aged twenty-five

years, recently delivered.

She was attacked a few days


ho-^pital

ago by measles.
rium followed.

The

eruption was suppressed, and deli-

She was brought into the

under

a phrenzy warrant.

The
dened
hot
; ;

vessels

of the tunica conjunctiva are slightly red;

the eyes suffused

the scalp
;

and the skin generally

the pulse quick and soft

the bowels regular.

She

is

very unmanageable.

The head was ordered


cloths: this

to

be shaved, and kept covered with wet

was

to

be done after the apphcation of twelve leeches.

Piilv. Catli. statim.

22d, morning.

Slept a
:

little

in the

night: at times her body


lively.

was much agitated

her countenance

now

She continues

220

MANIACAL AND EPILEPTIC


complains when the epigastrium
Skin cool.
Pulse irregular.

incoherent: at times has the appearance of suffering, and says she


is

in pain all over

is

pressed.

Bowels

freely purged.

Secretion of

milk suppressed.

She was ordered


doses,

to take, every third hour,

a powder, consisting

of Nitrate of Potass, Tartarized Antimony, and Jalap, in small

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.

In the evening a powerful reaction was found to have taken


place.

The pulse was


:

20, full and strong

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.

Continue the medicine.


23.

Breasts drawn.
:

Very
red

restless: skin cool:

pulse quick

easily compressed.

Tongue

and glossy.
V.

The temporal and

carotid

arteries

I)ulsate strongly.
S. fluant ^viij-

Hirud. 12. ad tempera.

Haust. Cath. statim.

P.

M.
:

She has passed a worm from the stomach.


but the delirium continues.

Much

relieved

Emp.
24.

Lyttae

ad caput.
restless night.
;

She has passed a


freely

Is noisy.

have been
the tongue

evacuated

the stools offensive.

Her bowels The skin cool

somewhat

furred.

Pulv. Cath. statim.

Opiate draught at night.


25.

She

slept during the night;

is

drowsy; her tongue dry


Skin
hot.

some appearance of sordes about the


easily compressed.
offensive.

teeth.
;

Pulse 130,

Bowels relaxed

stools

dark-coloiued

and

Urine scanty.

The

pupil of the eye dilates and con-

tracts occasionally.

Secretion of milk continues scanty.


to be given immediately,

cathartic

powder was ordered

and

mercurials to be repeated at short intervals, with diaphoretics,


until the

mouth should become

affected.

She was again

bled.

CASES FHOM METASTASIS.


On
the 27th

221

ptyalism

came

on.

From

that time she con-

tinually improved,

and was discharged, cured, on the 22d of

May

following.

In this case the immediate exciting cause was the


suppression of an exanthema, or the metastasis of inflam-

matory action from the cutaneous texture to the brain,


or, most probably, its membranes ; but the circumstances of the case prove that there were other concurring causes, which probably contributed to the effect. I mean, in the first place, that condition of the system which exists after

delivery

this is well

known
;

to

predispose strongly

to

attacks of maniacal disease


state

and, secondly, the disordered

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

had supervened, great caution was observed

the use of the lancet.

Local applications to the head,

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

on the following day.


until

the

constitution

But the disorder continued to recur became under the influence of

mercury.

SECTION
Of
vulsive Diseases, in Cases

III.

Metastasis to the Head, producing Maniacal

and Con-

of Gout and Rheumatism, and

of the Inflammation of Serous Membranes.

It

is

well

known

that severe affections of the brain

occasionally take place after the sudden disappearance

222

MANIACAL AND EPILEPTIC

of gouty or rheumatic inflammation of the joints, and


of the inflammation of serous membranes, as of the
pleura and

peritoneum*.

The consequences
fits
;

of this

metastasis are sometimes epileptic

in other in-

stances, delirium of the raving kind, which often termi-

nates in a slate of coma, the harbinger of death f. Among the cases of epilepsy detailed in the fore-

going pages, there are some instances in which the


disease

was suspended or removed by the superinflammatory disorder of the joints.

vention of an

Several cases have occurred, within

my

knowledge, in
to

which rheumatic affections of the joints seemed


alternate
with,

and

to

alleviate,

and, for the

time,
is

overcome diseases of the


brief outline of a case in

brain.

The

following

which an inveterate epilepsy


on the subsidence of the
brain

seemed

to be

suspended by inflammatory rheumatism.


;

The

fits

never recurred
the

but,

rheuniatic pain,
the patient.

disease of the

destroyed

The encephalon

bore the clearest vestiges

of inflammatory affection.

Mary
pital.

Jenkins, an

old inhabitant of St. Peter's

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

* Dr. Parry observes, that he


cases, the

mutual succession of gout, mania, and epilepsy.


in several instances,
fits

"

have seen," he says, "


superseded
p.

of epilepsy wholly
SfC.

by those

of gout."

Elements

of Pathology,

376.

t Apoplexy
lation,

is

sometimes the immediate

effect of this trans-

but the consideration of this disease belongs to a future

part of this work.

CASES FROM METASTASIS.


disease.

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

imagine, the cessation of the epileptic

paroxysms.

small dose of rhubarb and calomel was ordered for her every

night, with a view to the state of the bowels.

Aug. 20.

Diarrhoea somewhat relieved.

She

is

troubled with

severe pains in her head, attended with giddiness.

Shave the head


Pulv. Cath.

apply a blister to the occiput.

gr. xxv.

Cold shower bath afterwards.


23.

Her

pains are extremely severe in the limbs.

Calomel

Pulv. Antim.
Pulv. Opii,

aa gr.

ij.

o. n.

gr. j. o. n.

The rheumatic

disorder

became mitigated, but

the affection of

the head increased, and she gradually sunk into a comatose state;

under which she expired on the 4th of September.

The

vessels

of the pia mater and

of the brain were


lateral ventricles

found highly injected with blood, and the

distended with a large quantity of serous fluid*.

Observations.

In

this instance the

morbid appear-

ances were, perhaps, in great part the effects of the


previous disease, which had subsisted so

many

years

but

which,

being

subsequently

aggravated,
is

put a

period to existence.
the
the
first

When

the brain

affected for

time,

in

consequence of similar metastasis,


are

vestiges

of inflammation

sometimes comago I attended a

paratively slight.

About

six years

boy who laboured under a


of the chest.
* I

slight

inflammatory affection

This disease was removed by the applime


the outline of a

have before

case of chorea, which

alternated in a most distinct


tism.
I

The circumstances

of

manner with inflammatory rheumathis case will be mentioned when

proceed to consider the pathology of chorea.

224

MANIACAL AND EPILEPTIC


;

cation of leeches

but after having passed two days,


state,

apparently in

a convalescent

the patient was

suddenly attacked by violent delirium, and died comatose


in

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

mentions that he has seen three instances of affection


of the head supervening on the metastasis of rheumatism, in

which the patients died comatose;

yet,

on

dissection,

no other morbid appearance was discovered

than slight marks of inflammation in the pia mater.

The
I

inference which results from these cases,


is,

comunless

pared with other analogous phaenomena,

am

greatly mistaken, not that the disease

which
of the

has attacked
flammation,
encephalon,
is

the brain

is

not of the nature of in-

but

that

acute

inflammation

coming on under such circumstances,


life

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
;

such as mere discoloration of membranes,

and increased turgescency of blood-vessels. With respect to the practice to be followed


of this description,
it

in cases

certainly ought not to be founded

on any
disease,

theoretical ideas respecting the nature of the

but

chiefly

on experience of the
state

effect

of

remedies,

and the

and circumstances of the

CASES FROM METASTASIS.


patient in

225
of

each particular case.

own

observation would not induce

The me

result

my
on

to venture

copious bleedings with great confidence.

Unless the
I should

excitement of the circulation


prefer
to afford
relief

is

excessive,

by cold applications

to

the

head and topical bleeding, or by shaving the head,

and covering

it

with a

blister,

according to the degree

of heat and circulation in the scalp, using at the

same

time a hot bath,

or fomentations, with stimulating

applications to the lower extremities, and administer-

ing frequent doses of calomel with diaphoretics, and

opening the bowels by means of enemas, containing


oil

of turpentine and castor

oil.

With
into

this

department of cases

may be

connected

those instances in which phthisis has been converted

mania; a

fact

which has been repeatedly men-

tioned by practical writers.

SECTION
Of the

IV.

Metastasis of Dropsical Inflammation to the Brain,

giving rise to Convulsive or Maniacal Affections.

THIRD example
in

of metastasis to the encephalon


complaints.
Several
cases

occurs

dropsical

of
*.

epilepsy have been recorded which supervened on the

disappearance or diminution of anasarcous effusion

* Dr. Ferriar,'in the

essay above

alluded

to,

has given an

account of a case of

this description,

from Lieutaud.

226

METASTASIS TO THE BRAIN


has
*.

Mania
stances

also

occurred

under similar

circum-

On

the dissection of the head, in

some

cases of this
fluid

description,

a considerable quantity of serous

has been found in the cavities of the encephalon

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,

and a new deposition of it one structure

in the brain.

translation

of inflammatory action, or vascular determination from


to the other, has not, as far as I

know,

been suspected.

That such, however,


by the following case
aged
thirty-four,

is,

at least in

some

instances, the real nature of the case, will, I


:

think, be proved

George Coles,
Sept. 20,

was admitted an
disease
six

in-patient at the Infirmary, labouring under anasarca, on

1820.

He

had been

ill

of that

months.

He was
to

bled, took purgatives and diuretics,

and

seemed
28th,

be getting rather better, until the night of the


diarrhoea, and pain in his

when he was attacked by


the
fit,

bowels.

On

vulsive

morning of the SQth he was seized with which lasted about half an hour.
after the
fit

con-

About an hour

he was lying comatose, but

* Dr.

Mead

has mentioned a case in which the

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

the effect of hydragogue medicines.


that the translation of disease

Analogy and experience indicate


was the
real cause.

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

during the day.

In one of these,

which

took place about four o'clock, he was

much

convulsed, foamed at

the mouth, respired with a deep sound.

About 3XX of blood were taken from


a sinapism applied
eflfect,

the temporal artery,

and

to the

nucha, the
gr.

blister

not producing any

and he was ordered two

ofelaterium every fourth hour.

30.

He

has taken

five

of the powders.

His bowels have been

opened three or four times, and once or twice involuntarily.


has partially recovered
his consciousness

He

and perception; but,

when

left

undisturbed,

lies

asleep, breathing sonorously. Pulse 88,

strong.

He

is

under an almost constant tremor, resembling rigor of

ague, but so strong as to shake the bed.


Hirud. XXX. Capiti.
Vesic. ampl. Nuchas.

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

but, about eleven o'clock,

more sensible^ P. M., gradually sunk and expired.


fits,

and seemed

to be

He was
appearance

never before subject


his

to

fits.
;

On
the

the

day of

their

head

seemed swelled

dropsical

effusion

appearing to be determined towards


Dissection.

it.

Six

hours after death,

great quantity
;

of blood flowed from the incision in the scalp


the skull-cap was removed, and an opening
longitudinal sinus, fully half a

and when
into the
5

made

pound of blood flowed out

which, after standing some time, coagulated. The veins of the brain were rather turgid, and would, doubtless, have

been more so

if

the sinuses had not been opened

first*

228

METASTASIS TO THE BRAIN


slight effusion of
in

There was a

serum under the arach-

noid membrane, and

the ventricles.

At

the basis of the brain, at the posterior part of the


side,

middle lobe, on each


quantity about
portion
half

an ounce.

was a coagulum of blood, in A small surrounding


but
its

of the pia mater, on the right side, near the


;

effused coagulum, was evidently inflamed

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.

Fluid was also found in the abdomen, but there was no

appearance of disease of structure in any of the abdominal


viscera.

The

foregoing case

is

the only instance I have seen

of hydropic metastasis producing convulsive or comatose disease


;

but I have

now a

patient at St. Peter's

Hospital
is

who

has long laboured

under

ascites,

and

also troubled with vertigo and pain, evidently de-

pending on determination of blood towards the head.

The remarkable

circumstance in

her

case

is,

that

the affection of the head, and the abdominal disease,


alternate with each other.
sion,

When
in
this

the dropsical effu-

which

is

evidently

case

an

effect

of

inflammatory action, increases, the disease of the head


is

diminished.

When

the exhalant arteries emit a

greater quantity of fluid into the abdominal cavity,

the determination to the head

is,

for the time, sub-

dued. Both of these disorders are relieved by bleeding,


topical or general,

and the dropsy by

saline purgatives

and

diuretics.

IN CASES OF Diiopsy.

229
fall

With
under

respect to the pathology of cases which


description,
it is

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

hydropic inflammation to the head, a

much more

decidedly marked determination of blood to the brain


will

be found to have taken place than in that class

of cases which were considered in the last section.

Should
in the

this

prove to be the fact in general, as


I

it

was

two cases

have just related, our reliance must

be placed more upon the abstraction of blood.

We

must, however, at present be guided in practice by


the

phaenomena of particular

cases,

rather than by

any general presumption respecting the pathology of


the whole class.

SECTION
Of Metastatic

V.

Disorders of the Brain, consequent on the

Removal of Tumours.

Tumours, formed on any


for the

part of the body, require a

particular determination of the fluids towards them,

maintenance of an extraneous growth.


first

This,

if the disease has not arisen in the

place in conrise,

sequence of some constitutional disorder, gives

by

its

continuance, to a particular state of the habit


it

with which

becomes so connected,
drain.

that,

on the
from the

removal of the tumour, the system

suffers

want of an accustomed

person

who

has
is

recently lost a tumour under such circumstances,

in

230
a situation
delivered.

METASTASIS TO THE BRAIN


not unlike
tliat
is

of a

woman

recently

The consequence

the diseases of plethora,


diathesis.
:

and of a nature bordering on inflammatory

The
result.

effects

of this metastasis are various


fits

someis

times epileptic

ensue;

at others,

mania

the

The

subject will be best illustrated by insert-

ing a case of each description.

Sarah Harris, aged

twenty-four years. Jan. 24, 1820,


of sanguineo-raelancholic tem-

A
bone.

healthy looking

girl,

perament.

She complains of severe pain under the

left

parietal

On

the opposite side of the head she has a cicatrix,


a

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

times several occurred

in

a day.

About
:

three or four

years ago she got nearly rid of them


her, as she says, for a year together.

they never troubled

About the latter end December she scalded herself, and the fits then she has now been for some time troubled with returned
of last
:

great giddiness and pain in her head,


Abrad.
27.
capilli et vesicat.

ad caput admoveatur.
entirely

The

blister

and shaving of the head have


feels well in

removed
fits

the pain.

She now

her head.

Has had no
Lax. Ant.

since

she was admitted.

31.
ailment.

Has taken constantly


Head
well

the

Mist.

Has no

Feb. 3.
flowing.
7.

has pain in the back.

Catamenia now

Pulse slow,

soft, natural.

Tongue

white.
diet.

Pain in the back to-day abated.

House

12.

Tongue
V.
S.

furred.

An

attack of vertigo seized her yesterday

evening, with headache, and has


fl.

much

troubled her to-day.


3ss.

^xvj.

Afterwards Pulv. Ipec.


Eflferves.

M.

Aper.

Haust.

ON THE REMOVAL OF TUMOURS.


16.

231

Vomited,

after

the emetic,

a large quantity of black

matter, of bitter taste.


Pil.

Head
o. n.

relieved

by the bleeding.

Cath.

Mist. Aper.
Is

25.

good deal purged.

now

well.

She was soon afterwards discharged.


Observations.

The

proximate cause of epilepsy was

here evidently of the nature of inflammation, or increased


action.

The

disease first occurred after the removal of a

tumour, which acted as a drain.


accident, which produced a

In consequence of an
irritation in

new

the system,
in the

the

fits

had been renewed, with continued pains

head,

and vertigo. These disorders were relieved by evacuations,


general and local, and entirely subsided after the return of
the catamenia.

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

of the tumour was

followed by an attack of complete insanity.

and
the

Hora 8. P. M. She has undergone large evacuations, is much exhausted her countenance pale skin cool
;
; ;

pulse at the wrist scarcely perceptible

it

was counted

in

temporal artery, and was found to be 110.


is

Her

tongue

dry

there

is

no remarkable heat of the scalp.


Vin. Antim. T. h.

She

is

persuaded that the devil has possession of her.


Haust. Opiat.
Hirudines
xiv.
c.
s.

ad tempera.

Empl. Lyttse ad Nucham.

Head ordered

to be

shaved and kept covered v^th wet cloths.


slept

March

7.

She was relieved by the leeches, and

well.

232

METASTASIS TO THE BHAIN


Skin cool.
Pulse at the

Urine copious and high-coloured.


Wrist encreased.

Haust. Cathart. 6ta qu^q. horS, donee alvus soluta

sit.

Postea Pilula ex Calomelan.


Mist. Salin.

gr.

iij.

et Opi'j gr- j- 6ta qq. h.

cum

Sp. ^ther. Nitres, et Liq. Antimonii. T.

Stia quaq. hor^.

Bain. Calid. vesp.


8.

Milk

diet,

Pulse at the wrist rapid


beating with
is

easily

compressed.

Temporal
well
last

arteries

considerable

force.

She

slept

night, but

delirious this morning.


:

Skin cool: tongue moist:

bowels purged

stools offensive

not very dark-coloured.

Hirud. 12. ad tempora.

Empl. Lyttse

capiti.

Repet. Haust. Cath. pro efFectu.


p.

Pulse at the wrist fuller and


last

less frequent.

She was much


of

purged

night.
is

Her countenance has


perfectly rational.

lost its expression

anxiety, and she

Says she has appetite.


S. Jij.

R Infus. Rosae. JviijCapt.


3ij.

Magnes.

M.
iij.

4ta qq. h.

R Pulv. Ipec. Comp. 3ss.


Ft. Pulv.

Calomel,

gr.

M,
Pulse small and

Suraeud. bis indies.

11.

Sleep disturbed.

Aberration of mind.

quick.

Bowels griped and purged.


Omitt. Calomel, et Pul. Dover.

Repet. Haust.

lax. et habt.

Haust. Anodyn. ter indies.

She has a severe inflammation


Cold Lotion
17.
Is
soft,

in

one of her knee joints.

to the knee.

perfectly

rational:

bowels

open:

appetite
sleeps well.

natural.

Pulse

regular, easily compressed.

She

Knee

continues inflamed.

Anodyne Draught
25.

at night.

Laxatives in the day.

Again

slight aberration

of mind.

Pulse small, feeble,

130.

Scalp hot: pulsation in the carotids powerful.


Haust. Cath. statim.
Hirud.
xij.

ad Temp.

Emp.

Lyttse Nuchae.

ON THE REMOVAL OF TUMOURS.


26.
Relieved.

233
symptom

From

this

time she had no further

of maniacal disease.

large abscess was formed in her knee

she became exhausted by the great discharge; a profuse diarrhoea

came
to

on,

and, in spite of the use of cordials and astringents,

carried her off on the 11th of August.

The body was

not suffered

be examined.

Observations.

The

origin

and

termination

of this
its

case of mania are remarkable, and tend to illustrate

pathology.

The

disorder

came on

after the

removal of a

tumour, the growth of which had previously determined,


in a different direction, the vascular

energy of the system,


disorder of the head

and thereby

relieved the head.

The

continued, with some intervals, which were obtained by


the efficacy of purgatives, and the evacuant
to the

means applied
in the

head

itself,

until a
in

new cause of

local determination

had been supplied


knee.

the abscess which formed

As soon

as

the

suppurative inflammation

took
If the

place in this part the disorder of the brain ceased.


discharge had

not been so profuse, or

if
it,

the
it is

woman's
probable

strength could have been supported under

that the local disease, which destroyed her, miglit have

been the means of restoring her

to health

and

sanity.

SECTION

VI.

Other Facts illustrative of the Pathology of these Cases.

Other

examples of metastasis might be found,

in

which disorders of distant parts suddenly subside, and


are followed by affection of the head.

But

I believe

they

may
.

all

be shown to be analogous to some of the


it

above mentioned cases; and


enter into a

would be useless

to

more

particular enumeration of varieties,

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

complete with respect

pathology as possible, I shall


cases which are the converse
;

now

insert

some notes of

of those hitherto related


affections

viz.

in

which maniacal

were cured by the substitution of another


In these instances the origin of the

diseased action.

maniacal disorder was various, but the disease was in


all

cured by the supervention of contagious fever.

John Lewis,
eight.

admitted June 26, 1816.

A shopman, of honest and decent character, aged twentyTemperament melancholic,


hair

and

eyes dark,

habit thin, forehead high.

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.

Head shaved and


Magnes. Sulphat.
3J.

blistered.

manfe quotidie.

July 6.

In the

same

state.

Cupping
18.

glasses to the neck.

Sixteen ounces flowed.

Head much
1,

cooler.

Appetite improved.

Bowels regular.

Shower bath every morning.

June

1817.

Remedies of the same description have been


little

continued up to this time with

decided benefit.

He

has

been rather worse during the


Ven. Sec.

last fortnight.

fluant 3xij.

Pulv. Cath. bis in septlmana.

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

such that mule lunatics arc placed

same ward

THE PATHOLOGY OF THESE CASES.


became convalescent
continued well.
I8I9.)

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

neighbourhood of Chepstow. This case Observations.

is

not otherwise remarkable

than as affording an instance of an obstinate disease cured

by the supervention of
to the following case
:

fever.

The same remark

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

under considerable debility.

Mutters to herself:
hensions
:

occupied with superstitious appreis irritable.

roused, she

Warm

bath twice in a week.

Full diet.

Purgatives as occasion

may

require.

May

Considerably improved.
Continue as before.

July 28.

Has a

return of her symptoms.

Pulv. Ipecac. 9j. statim.

Haust. Cath. eras manfc.

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.

Amar. cum Acid. Sulph.

this time she had no return of mental derangeShe was employed about the house for some time,
left Bristol for

and then

Ireland.

with persons labouring under contagious fever.


opportunity of frequently witnessing the
nicated to maniacs.
effects

We

have thus an

of fever

commu-

9,36

FACTS ILLUSTUATIVE OF
admitted June 17, 1817. married woman, aged twenty-eight

Anne Jauncey, Description. A


years, the

slender make, has

She is of tall and mother of three children. brown hair, dark grey eyes, a low fore-

head, sharp features.


History.

She

Her

natural disposition

is

irascible.

has never been


is

before affected

with

maniacal symptoms: this attack

supposed to have been

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-

santly on different subjects.


as
if

Frowns and

closes her eyes,

intolerant of light.

Treatment.

Shave
diet.

the head.
et nocte.

Haust. Cath. mane

House
July 20.

The purging

has l>een

continued.

Little

or

no

amendment.
Cold shower bath.
Continue the purgatives,

Aug.
drowsy.

17"

No

improvement has taken place.


in

Pulse
the
;

full,
:

not
is

quickened.

Complains of weight and pain


be aware of their situation.
S. et fluant sang. ^^vj.

head

She has had an interview with her husband


to

neither of

them appeared

V.

Syncope followed
I'lie

blood of loose consistence.

bleeding relieved her.

From
pain

this time

she continued to be
attended
with

troubled increased

occasionally
pulsation

with

in

her

head,

of the carotid and temporal arteries, and a

renewal of her restlessness and maniacal symptoms; which were


generally relieved, for the time, by the application of leeches to
the head, blisters to the nape of the neck
stantly kept open,
;

her bowels were con-

and she generally used the shower bath.


1818, she had a slight attack
in

About

the 2d of January,

of contagious fever,

which subsided

about a week.

From

that

time she gradually recovered, and

was

dis-

charged, cured, on the 26th of the following June.

Full

THE PATHOLOGY OF THESE CASES.


diet

237

was allowed her from the time of her becoming con-

valescent from fever.


Observations.

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

tendency to congestion in the head.

similar

excitement to disease of the brain

is

occasioned by the suppression or cessation of habitual


haemorrhages.

SECTION
On
the Treatment

VII.

of Maniacal and Epileptic Cases, arising

from

Metastasis.

Although,

with a view to comparison and to patho-

logical arrangement, I have brought

under one head a


I

variety of cases depending

on metastasis,
all to

have no

design to infer that these disorders are


exactly
in

be treated

the

same manner
down,

but the diversities of

practice which are called for, as well as the general


principles to be laid
this

will

be best

illustrated

by

arrangement.

I have before observed that the pathology of these

disorders

is

similar,

in

some

respects,

to

that

of

uterine cases.

We

are thence led to inquire

they are to be treated in a similar

how far manner. The

principal indications are very analogous, but they are

not always to be attained by similar means.

238 TREATMENT OF DISORDERS OF THE BRAIN,


1.

In the

first

place, venesection

is

not so generally

applicable in metastatic as in uterine cases.

In such examples of metastasis to the brain, as are


consequent on the stopping of any habitual hasmorrhage,
as

of hasmorrhois or epistaxis, especially


in

if

occurring

vigorous

and

plethoric

persons,

the

abstraction of blood

may

be ventured upon as freely


it

as in those cases in which


in the foregoing chapter.

has been

recommended

The same

observation

may

be made when
ulcers

it

supervenes on the healing of old

which have been attended with a considerable


unless

discharge.

The same

rule,

am

deceived,

observed in cases of hydropic metastasis.

may be The deter-

mination which takes place towards the brain in cases of


this description,

appears to be considerable, and


is

scarcely less powerful than that which

the sequel to

haemorrhages.

In cases of metastasis, when the primary disease


has been situated in serous membranes, the disease of
the encephalon

probably

differs

considerably

from

that which occurs in the forms of disease above

menof

tioned

the marks of increased vascular action, or


plethora,
is

arterial

are less decided.

The

theory

these cases

not so well understood as to afford a


;

safe guidance to practice


to

but, as far as I

can venture
1

draw an inference from \he facts of which

am

in

possession, 1 believe that topical bleeding, by cupping


glasses or leeches,
is

preferable, in such instances, to


:

venesection
action in

in

the

arm

the

strength

of vascular

the head and neck, and the degree of heat

of the scalp, as well as in the extremities, are circum-

ARISING FROM METASTASIS.

239

Stances which must be considered in directing these

measures.

When

the disease arises from the recession of the

exanthemata, the same observations

may
The

be applied.

On
is

the disappearance of measles, for example, large


circulation

general bleeding would be improper.


in

such cases weak and irregular.

In the metait

stasis

of erysipelas producing mania, I have seen


relief.

employed without any


general circulation
hot, that
I
it

It

is

only

when

the

is

strong,

and the skin generally

promises advantage.

may

remark, that in general the abstraction of


in

blood

seems more to be indicated


Purging
a

instances of

epilepsy than in those of maniacal affection.


2.
is

remedy which

may
;

safely
it

be

employed in cases of this description


answers
If there
in a great
is

and

often

measure the purpose of bleeding.


febrile action,
it

any general
;

should be
in cases
variable.

employed vigorously
3.

but with

some caution
is

of exhaustion, or when the pulse

feeble
is

and
to

The most important


determination
;

indication

produce a
that

new

or,

if possible,

to

restore

which existed previously

to

the metastasis.

hot

bath should be used to determine to the skin, especially

after the recession of

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,

other cases, to the nape of the neck.

Irritating ointments

and liniments, as one containing

tartarized antimony, or liquor

ammoniae and

oil,

may

S40 TREATMENT OF DISORDERS OF THE BRAIN,


be used in

many

cases*.
all

Sinapisms to the soles of


the corresponding parts of

the feet or legs, and


this

regimen,

may

be adopted.

Among
relief

the cases related in the foregoing sections

of this chapter, there are several in which a decided

was obtained from some discharge, which,


;

in

general, took place spontaneously

and

this

confirms

the propriety, on other accounts sufficiently manifest,

of establishing issues or setons in some part of the

body.

In cases which are not likely to terminate too

speedily, a seton or issue should be inserted without

delay.

But on the advantage


I
shall

to

be derived from

drains

express

myself more fully

when I

proceed to consider the cases of epilepsy, or maniacal


affection,

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

met, some years ago, with a remarkable instance of the

benefit accruing

from

this
its

measure
rise

in

a case of phthisis, which

appeared
tive

to

have taken

from the repulsion of an erup-

disorder.

The

patient,
all

several

months

under

the

who was a young man, laboured symptoms of genuine phthisis.

He

expectorated purulent matter, had hectic fever, with debili-

tating perspirations,

and had become extremely emaciated.

On

discovering that

he had formerly been subject to a cutaneous

disorder of the legs,

which had discharged

freely,

and the sup-

pression of which had preceded the attack of pectoral disease, I

ordered him
tarized

to

rub his legs with an ointment, containing tar-

antimony.

While he was using

this

application

the

disease of the legs

re-appeared, and became very considerable.


;

From

that time he gradually recovered

and

have not heard of

his suffering

any recurrence of the complaint

in his chest.

ARISING FROM METASTASIS.


as to bring
this

241

on ptyalism.
the

In the

first

case reported in

chapter,

patient recovered as soon as the


affected

constitution

became
I

by

this

remedy
effect

and

have witnessed an equally decisive


instances.

in

other

am

by no means disposed
less

to

approve

of the frequent,

much

of the indiscriminate use

of mercury, in disorders of the brain and nervous

system

but in cases

of the description I

am now
it

referring to, I

am

persuaded, by experience, that

has a peculiar efficacy.

We
febrile

have

seen,

in

the last section,

that a

new
It

disease

supervening has often

the effect of

removing, or suspending, the disease of the brain.


is

probably on this principle that mercury

is

effica-

cious in relieving patients


disorders
;

who

labour under maniacal

and

it

in those cases of

seems most likely to afford benefit mania which arise from metastasis.
it

In

metastatic

epilepsy

does not appear to

be

so decidedly useful.

242

NERVOUS DISORDERS DEPENDING

CHAPTER

VII.

OF EPILEPTIC AND MANIACAL CASES, DEPENDING ON A DISORDERED STATE OF THE INTES-

TINAL CANAL.

SECTION

I.

Introductory Remarks.

Medical
morbid

practitioners have long been

aware that a
canal.

variety of diseases in the nervous system arise from a


state

of the stomach and

intestinal

But the ideas commonly entertained respecting the


nature of these affections are not very defined
consistent.

or

I believe the notion

which most generally prevails


that they arise by

respecting the supervention of nervous affections on


disorders in the intestinal canal,
is,

what

is

termed sympathy,
of the
brain than

and without any other

disease

what

is

implied

by the

expression that the whole nervous system sympathises,


in

some unknown way, with the


stomach
or
intestines.
It

irritated
is

portion of

the

not

commonly
is

imagined that any inflammatory process


state of the digestive organs

set

up

within the cranium, in conse(^uence of the disordered


;

or that organic disease


is

of any part of the nervous system


step

an intermediate
the abdomen,

between the original malady

in

ON ENTERIC IRRITATION.
and the subsequent manifestation of
state of the animal functions..
its effects

243
in the

am

persuaded, however, after a long continued


that the general progress of

attention to this subject,


disease,

where morbid

aftections of the intestinal canal

are followed

by disorder of the nervous functions,

involves an intermediate affection of the cerebral and

nervous fabric

itself.

The

proofs of this opinion I


:

cannot bring into one connected statement


result

they will

from the accounts of particular


chapter.

cases,

of dis-

sections,

and from other observations, which are to be


this

comprised in

The

disease

which I

suppose to be produced in the brain, and other parts


of the nervous system,
is

a state of morbid plethora in


I shall not

the blood-vessels belonging to that fabric.

pretend to determine whether this always constitutes a

degree of inflammatory
to

affection,

or
I

sometimes

amounts only

simple congestion.

have indeed

before observed, that I do not

know

in

what

consists

the difference between these states.

By what

train

or connexion this disorder super-

venes on the idiopathic or primary affection of the


alimentary canal, I do not pretend to conjecture.
is,

It

however, by a different process from that which


:

subsists in the case of metastasis

in that instance

disorder of a

new
;

part takes the place of the old one,

which subsides

in the case

we

are

now

considering,

on the
morbid

contrary, disease supervenes in the nervous

structure,

without
affection

in

any degree
previously

diminishing
existed
in

the the

which

intestinal canal.

Q44f

ISIEllVOUS

DISORDERS DEPENDING

I have reason to believe that the disorder of the


intestinal canal itself
is

much more
it

frequently of an

inflammatory nature than


pected to be.
rise

has generally been sus-

In that state of the canal which gives


alternating

to

costiveness,

with

diarrhoea,

and

accompanied with indigestion, flatulence, and eructations, anorexia,

and nausea, transient but often acute


secretions in the

pains in the hypochondria, livid and yellow suffusions

of the skin,

viscid

mouth, white

furred tongue, redness of the fauces and palate, the

whole

train of

symptoms

often depend

upon a low

degree of chronic inflammation in the mucous

mem-

brane of the intestinal canal*

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;

a pain in the right

side, in the

commonly
With
this

fixed, but

sometimes shooting back

towards the spine.

there

is

often a slight, but

perma-

nent, yellow suffusion of the eyes

and countenance, great anxiety,


the returns or

frequent distention

of the abdomen, and, before


is

exacerbations of pain, the urine

of a bright green colour.


fissures;

The
the

tongue and

lips

grow dry, and are divided by

former

is

covered by a rough bilious crust, and the legs swell


the evening.
is

slightly in

The

pain in the side

is

sometimes very

severe,

and

then attended with pain on the top of the right

shoulder.

These symptoms altogether give such a strong sus^


it is

picion of an hepatic affection, that


find cases

not to be wondered

of this kind too readily treated as such.

observation,
suffered this
all

however,

particularly

in

if we From careful my own case, when I I

complaint several years ago,

have no doubt that

these

symptoms may

be produced by acidity in the stomach,


tiie

and a spasmodic

affection of

duodenum, without any organic

ON ENTERIC IRRITATION.
frequent,
if

245
cases where

not

an ordinary

state,

in

severe nervous disorders supervene on complaints of

the stomach and bowels.


cases
this

In some of the following


dis-

was certainly the condition of the


chapter I propose
to describe

ordered parts.

In

this

first

some

examples of maniacal disease connected with disorder


of the alimentary canal, and then to proceed to cases of epilepsy arising from a similar cause.
I wish to

follow this order, because the examples of the former


description,
distinctly

which I have to adduce, display more


in

and decisively the relation of disorders


system to
distempered
states

the

nervous

of the

intestinal functions*.

lesion of the liver.

The
little

distinction

is,

that the pain

may

be

felt to

change
likewise

its is

place a
soft,

on the expulsion of wind.

The

pulse

though very irregular.


is

The

secretion of

mucus

from the Schneiderian membrane


discharge

interrupted,

and sometimes
and

nearly ceases, though the patient feels a frequent inclination to


it.

He

is

generally, but not obstinately, costive,

subject to torpor (of mind) and nervous oppression,

slight

inflammation of the fauces also attends

this

disorder, returning

once in eight or ten days."


vol.
ii.

Ferriar's Med. Hist, and Reject.

p. 27-

In order to avoid a frequent repetition of

many

words,

shall

distinguish

the

cases which belong to

this

department by the

epithet " enteric."

246

DESCRIPTION AND PATHOLOGY

SECTION

II.

Description and Pathology of Enteric Mania.

This

is

one of the most frequent forms under which


nothing peculiar in the character of the
It

maniacal disorders present themselves to our notice*.

There

is

mental disorder which occurs in enteric mania.

most frequently takes place

in constitutions

approach-

ing to the sanguine, and in persons between the ages

of twenty-five and forty years.


periodical or recurrent
:

It

is

in

many

cases

most frequently commencing about the beginning of summer. The


the attacks
first

attack

often

makes

its

appearance after the


circumstances which

patient

has been subjected to

occasion irregularities in the functions of the stomach

and

intestines.

have notes of a variety of cases


been fed upon

which

occurred

immediately after a long voyage;


has
salt

during which
provisions,

the patient

and

has

suffered

his

bowels to become

constipated.

Irregular diet, and the habitual use of

For a complete

and

truly

graphical

description

of this

disease

we

are indebted to the late Dr.


vol.
i.)

Edward
is

Percival.
I

{See

Dublin Hospital Reports,

The only

point in which
the following.

am
He.

disposed to differ from the excellent author

seems

to

regard the depraved state of the intestinal canal as a


feature of maniacal disorders in general
in
:

common
opinions

and gives

it

prominent place
I

his general description of the disease.


to

The

have been led

adopt by the comparison of various

forms of nervous disease, induce


cular, rather than

me

to consider this as

a parti-

an universal character.

OF ENTERIC MANIA.
ardent
spirits,

24?

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
in

engage
mental
be
the

a greater diversity of pursuits

than the

powers of the individual qualify him


found
to

for, will often


;

precede the

attacks

of this disease

patient having neglected the state of the natural functions,

which an unusual excitement of the nervous

system had contributed to throw into disorder.


trifling

A
the

degree of incoherence, a hurry and confusion

of thought;

sometimes an absurd degree of energy,


trifling object, is

manifested in the pursuit of some


first

symptom which
him, he

betrays the actual condition of

the patient.
resist

In an attempt to reason with him, or

commonly becomes
would appear

violent

he has

often very early a lurking suspicion of his deranged


state
:

at least this

to be the case

from

the frequent and positive assurances he


contrary, even at times

makes

to the

when

i.o

suspicion has been

hinted*.

The
general,

diseased state of the alimentary canal

is,

in

very strongly marked.

The whole
it

of the

functions of this system are


all

more or

less disturbed

the secretions belonging to


the

are in a depraved

state:

pheenomena of the disease are such as


after saying

have sometimes observed a maniac,


I

something
in

extremely absurd, (although

have taken care that nothing

my

countenance or manner of conversing betrayed


his

my

impression of
the apparent

insanity,)

as if suddenly struck himself with

incongruity of what he had been saying, break off and protest that

he was in his ri"hl senses.

248

DESCRIPTION

AND PATHOLOGY

suggest the existence of a chronic inflammatory action,

having

its

seat in the

mucous membrane, through a


of which
there are, in

great portion of the canal:

many
I

instances, unequivocal proofs.


shall

enumerate the
alvine

most prominent circumevacuation.

stances of this disorder under a few principal heads.


1.

State of the
is, if

Obstinate
a great
without an

constipation

may

use the expression, the natural


It often prevails to

character of this disease.


extent,

and we are
six,

told,

on inquiry, that the patient


or eight days,
If cathartics are admi-

has

passed

seven,

evacuation of the bowels.

nistered under this state of disease, a large quantity of

excrement
unnatural
:

is

discharged, the appearance of which

is

the faeces are often of a dark


;

brown

colour,

resembling coffee grounds


straw
;

or they are like chopped

but very often they are of a dirty green colour,

consisting, for the

most

part, of indurated bile

they

are generally extremely foetid.

We

are often told, on inquiry, that the patient's

bowels are open, more loose than natural.


examination
it

On

further

appears that a long continued torpor


;

has recently given way to a diarrhoea

which, for the


of lessening
it.

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

a very partial degree discharged.


;

The

evacuations are generally thin and watery

or

contain mucus,

mixed with

vitiated

bile,

and the

recent aliment in

an undigested

state.

Sharp and

transient pains are experienced in various parts of the

OF ENTERIC MANIA.

249

abdomen; a quantity of wind


time to time,
or
rattles

is

discharged, from

about in the

bowels

at
fre-

length dysentery, with tormina, supervenes, and

quently carries off the patient,

or reduces

him

to

extreme emaciation.
2.

The mouth and


red,

fauces, if examined, generally

present a diseased aspect.

The

fauces

and velum
covered in
;

pendulum are

the vessels injected,

patches with mucus.

The tongue
:

is

often red

some-

times red with white streaks


cially

more
viscid,

generally, espe-

when

there
fur.

is

diarrhoea,
is

covered partially with

a brownish

The mouth
thirst,

and the patient


all

generally spits out a frothy slime in

directions.
fetor

There

is

an ardent

and a peculiar

of

the breath, which indeed extends to the whole person,

and would induce a suspicion that the secretions are


loaded with absorbed excrementitious matter.
3.

The

appetite

is

in

an unhealthy

state.
all

In

many
and

cases

the patient has an aversion to

food,

cannot be induced, without force, to take enough for


the bare support of
life.

In other instances he has a


it,

keen and voracious desire for


without selection,

and greedily devours,


falls in his

every thing eatable that

way.
4.

The

skin

is

clammy and

cold

there

is

often a

remarkable coldness of the extremities, resulting from


the

damp

state of the skin,

and a want of energy

in

the extreme vessels.

In some cases of long duration appear

there are papular or scaly eruptions; and in exhausted

and

debilitated subjects,

furunculi

in various

parts of the body, which are

much

disposed to become

sloughy.

250
5.

DESCRIPTION

AND PATHOLOGY
often flushed
;

The complexion
with

is

the eyes wild,

glossy,

a superabundant lachrymal secretion


is

the tunica conjunctiva

not unfrequently injected


scarcely tolerant of lights

with blood

the patient

is

and the pupils are


6. tains

The

urine

more than naturally contracted. it conis scanty and high-coloured


:

matters

which should

naturally

pass

by the
general

alvine evacuation.
7.

The
full

pulse

is

rapid and

irritable:

in

neither

nor strong.

The

carotid beats with greater

force than proportional.


8.

The

patient often passes


:

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

progress and continuance of this condition of

the system are very various.


affords relief,

Sometimes a diarrhoea
in

and the disease either continues


or the patient recovers
is
:

mitigated form,

in the latter

case the disorder

frequently recurrent.

In other

instances the diarrhoea carries off the patient.

In more protracted cases, the diseased state of


the
rise

mucous membrane of the


is

intestinal canal gives

to glandular obstructions in

the mesentery

at

least it

a fact that disorganizations of

this descrip-

tion 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.

OF ENTERIC MANIA.

S51-

Remarks on

the Pathology of this Disease.

On

the ratio

symptomatum

I shall

add

little

to

what has already been suggested.


I shall not attempt to explain the

manner
is

in

which

disease of the brain, producing mania,

excited

by

the morbid state of the intestinal canal above described.

That

the former train of

symptoms
its

is

connected with

the latter, as an effect with

cause, I infer from the

analogy of other nervous diseases,


to be dependent
tions
;

which are found

on morbid

states of the enteric func-

and from the

fact, that in

the particular instance

of mania, agents which produce a change in the state


of the intestinal canal, relieve, or aggravate, or modify,
the character of the cerebral disorder.

Before I attempt to lay

down any
to

general indi-

cations for medical treatment, I shall proceed to

some

other

topics

which belong

the

subject

of this

chapter.

SECTION

III.

Description of Enteric Epilepsy.

The

appearance of epileptic

fits

is

sometimes con-

nected, in so obvious a manner, with the presence of


irritating

matters in the stomach and intestines, that

the occasional origin of that disease, from this circumstance,

could not remain

unknown

to medical prac-

titioners.

Accordingly

this

modification of epilepsy

252

DESCRIPTION OF
it

has been long recognised by medical authors, and


holds a place in most or
all

of the nosological arrangearising

ments.

But

epileptic

fits,

from

irritation

in

the bowels, as well as those which take their origin

from other obvious causes, have been regarded as


accidental

and

transient

phaenomena
in

and

it

has

never occurred, as far as I know, to any one, to consider

whether

this

disease

is,

the

majority
the

of

instances,
functions,

symptomatic

of disorder in

natural

or of ailments in
in

which the brain only

participates

a secondary way.

When
it

epilepsy

has become a permanent complaint,


for an idiopathic affection
;

has been taken


little

and too
if

attention

has been bestowed on what has been termed sympathic


epilepsy.

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

of that description which

generally termed sympathic.

The

disease

had

origin in a disorder of the intestinal canal, or in

some

other

of the natural functions,

and could only be

cured by removing the primary complaint, and not

by the exhibition of a
this

set of

medicines supposed to be
:

possessed of certain anti-epileptic powers

yet

it is

to

mode of treatment

that cases, such as I describe,

have generally been subjected.


Epilepsy, w^hich arises from enteric disorder, be-

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

other parts of the nervous fabric,

though at

the result of gastric or intestinal irrita-

ENTERIC EPILEPSY.
tion,

253

has taken a firm hold in the system, through the

influence of habit, or by the effect of disorganization,

occasioned

by long continued morbid

action.

In

other instances this disease

may be
it.

cured by a plan

of treatment directed to the removal of the morbific


circumstances which occasion

The

longer

the
is

duration of the disease has been, the less prospect


there of entirely overcoming
it
:

still, if

the disorder in

the abdominal functions

is

within the reach of medi-

cine, the case is not, after

any period of time,


effects

alto-

gether desperate.
after a patient has

Nature sometimes
been

a cure mani-

many

years subject to the

recurrence of

fits,

and even
injury.

after the brain has

festly sustained

much

Similar changes in the

state

of the constitution to those which take place

spontaneously,

may be
:

expected sometimes to follow


will

the efforts of art

and some cases

be adduced in
is

the sequel which prove that although enteric epilepsy

occasionally a deplorably obstinate disease, yet there

are other instances, even of long standing, which

may

be

much

relieved, if not entirely


fits

overcome.
connexion with the

Epileptic

often occur

in

presence of

worms in the more frequently the case


than adults.
I shall,
v^-hich

intestinal canal.
in

This

is

children than in adult

persons, because children are

more subject
in

to

worms
of be
irri-

however, mention some instances

of
the

this

kind

have
In

occurred
either

patients
it

latter

description.
fits

case

may

doubted whether the


tation of

are occasioned by the


effect arising

worms, or by the noxious

from

vitiated secretions, in the canal

and from the accumulated sordes


It is

which are co-existent with worms.

254
certain
this

DESCRIPTION
that

OB^

equally severe effects often arise from

cause,

when

there are no

worms

or,

at least,

when none can be


examination.

discovered by the most careful

From

this

remark I must make one exception,

I have reason to which applies to the tape worm. the irritation arising from the existence of believe that this

animal in the intestinal canal

is

in itself

a sole

cause of epilepsy, as well as of

many
by

other disorders.
it,

The whole system


tape

is

disturbed
is

and a con-

siderable febrile excitement

often produced.
in

The
is

worm

is

not always enveloped

a nidus of

retained sordes, or excrementitious matter, which

the case with lumbrici, and generally with ascarides.

Enteric epilepsy takes place at every period of

life.

The
viae.

convulsive attacks, to

which young infants are


dentition,

liable,

generally proceed from irritation in the primae

During the period of


an irregular
state

when

the confall

stitution is generally disturbed,

the bowels often

into

and

this

circumstance

is

some-

times the precursor of convulsive paroxysms.

In such

cases there are often other indications of disorder in

the brain besides the


siness
;

fits

of convulsion, such as drow-

sometimes a degree of stupor, almost amount-

ing to

coma

grinding of the teeth during sleep, and


;

frequent startings
strong,

a hot and dry skin, with a


pulse.

full,

and rapid

The abdomen
on

is,

at the

same time,
flatus.

tumid and hard,

and distended with


in

It is discovered,

inquiry, that the bowels

have been for some time constipated or


state,

an irregular

or that the stomach has been recently loaded

with indigestible food.

On

examining the alvine eva-

ENTERIC EPILEPSY.
cuations,
off in
is
it

255

is

generally found that the aliment passes


state.

an undigested

In

many
is

instances there

a deficiency of

bile,

but this
:

not a constant or

essential feature in the disease

the whole quantity of


is

matter discharged

is

often greater than

natural to
the

the age of the child.

The

breath

is

oftensive;

tongue white

and the child picks


all

his nose.

In short,

there are nearly

the

pheenomena which are supin the intes-

posed to denote the presence of worms


tinal canal
;

though

it

often appears, on examination,

that

none

exist.

These disorders quickly subside under a proper regimen, but they are liable to recur when the primae
viae

are sutfered again to

fall

into a distempered state.

Like other
this

infantile ailments,

they generally subside

after a period.

The

instances are very rare in which

complaint continues from the period of dentition.


enteric epilepsy

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-

quent inquiry indicates the principal morbific cause to


be in the state of the intestinal canal.
cases,

In these

as in others, there

is

often an affection of the


is

head, which, though secondary,


vascular depletion.

real,

and requires

In adult persons enteric epilepsy occurs at every


age,

and

it

is

liable,

at every period, to

become a

protracted and habitual disease.


epilepsy,
it is

Like other forms of

not so incident to the old as to the


is

young.

If there

any predisposition to

this

malady

256
in the system,
life.

DESCRIPTION OF
it is

generally called into action in early

There
of the

is

nothing very peculiar in the character

fits

which occur

in this

form of the disease

they are sometimes


vulsions
;

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.

in this disease as in enteric

mania

however, a very manifest deviation from the state of

The bowels
permanent

are constipated.

Sometimes

this is

state,

only alleviated, from time to time,

'by purgative medicines,

which are required


In
other
cases

in frequent

and enormous doses.


of

constipation

alternates with diarrhoea.


rally

The

evacuations are gene-

an unhealthy appearance,

and

display

diseased state of the secretions of the intestinal canal,

and of the
times there

liver,

and an imperfect action of the

digestive structure.
is

The

appetite
at

is

variable

some-

anorexia;

others,

a craving and

unnatural appetite, approaching to pica, or to that

morbid inclination
stances which
is

for

various

unwholesome sub-

often fancied to arise from

worms
in

and, perhaps, indicates an unusual


secreted
fluids.

acrimony

the

This unnaturally craving appetite

ENTERIC EPILEPSY.

9,57

may be
the

considered as a characteristic of enteric epi-

lepsy, as well as of enteric mania.

The tongue

is,

at
is

same

time,

furred

and sometimes the skin

beset with I
is

eruptions*.
this disease

apprehend that the pathology of

very similar to that of enteric

mania.
is

The
the

dis-

tempered state of the intestinal canal


in both disorders
:

same
ex-

according to the different morbid

predispositions of the nervous system, the


citing

same

cause or irritation in a remote part of the

constitution, gives rise in the brain of

one person to a

disease
sions
;

which manifests

itself

in

maniacal impresdif-

and in another individual occasions a

ferently modified disorder in the state of the

same

organs, the

symptoms of which are

attacks of epilepsy.

SECTION

IV.

Treatment of Enteric Epilepsy.

The

principal indications

which

refer to the treatment

of epilepsy arising from


canal, are diflferent

disorder

of the intestinal

from those on which we rely in


In one of these cases

uterine and metastatic epilepsy.

our principal endeavours are directed to the relief of


the sanguiferous system,

and the re-establishment of

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

orgi^n than the brain, or to give a

the efforts of the vascular system.


vve

In the instance
will

have now to consider, our chief indication

evidently be to
canal,
in

remove the disorder of the alimentary


the fundamental cause of the disease
or in
the
functions

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,

but more urgent, affection of

the brain.
If the patient
is

subject to frequent

and severe

paroxysms,
relief

it

will

be proper to afford him a present

by measures directed immediately to the state of


is

the brain, which


It
is
still

often manifestly loaded with blood.

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

If the habit of the patient


as will bear the loss of blood,

rather
will

full,

and such

be proper, under

these circumstances, to open a vein, and take sixteen

or twenty ounces from an adult of middle age.

In
be
it

some

instances

this

operation

will

require
;

to
if,

repeated, in order to produce an effect


will generally

but

as

happen, a

relief

has been obtained of the


it

most urgent symptoms by one venesection,

will

be

preferable to use cupping glasses, applied to the nape

of the neck, for any further abstraction that


necessary.

may be

ENTERIC EPILEPSY.
If there strong
is

259

much

heat in the scalp, attended with

action

of the

temporal

arteries,

redness

of

the tunica conjunctiva and of the palate, intolerance of


light,

tinnitus aurium, the

head should be shaved, and

covered with cloths dipped frequently in water, cooled

down

to thirty-two degrees.

blister should, in this

instance,

be applied to the nape of the neck, and

leeches to the head, after the

more

effectual

means of

depletion above mentioned have been resorted to.

By

measures of

this description,

varied according

to circumstances, the violence of the

symptoms

will

be

commonly reduced

in a

few days: the more evident

marks of determination to the head will be lessened, and the frequent return of the epileptic paroxysms put
off^for the present.

Similar measures are

still

more

clearly called for

in cases of epileptic delirium.

The whole

of the plan

just mentioned should be adopted in instances of this

description

blood should be immediately taken from

the jugular vein or temporal artery.

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

can be ascertained, by inquiry into previous circumstances,

by the presence of

flatulence, acid eructations,

tension and fulness of the


indications,

abdomen, and by other


should

immediate

relief

be sought

by

260

TREATMENT OF
There are some cases
in the in

emetics and purgatives.

which strong vascular action


emetics dangerous
;

head

may

render

but these instances are not nu-

merous.

It is often proper to begin

by prescribing
often

five or six grains

of Calomel, with one, two, or three,

of Tartarized
excite

Antimony.

This mixture

will

vomiting and purging at the same time.


it

If

necessary,

may

be followed by a dose of IpecacuIf


it

anha, to promote the former action.


act

fails

to

on the bowels, a

cathartic powder, or a dose of


given, succeeded

cathartic pills

may be

by cathartic

draughts every fourth or sixth hour*.


If the bowels are obstinately constipated, and do

not speedily yield to cathartic doses, clysters of the

same kind should be


Ol. Terebinth, with
as

used.

have succeeded in

obtaining relief by injections of an ounce or two of

much

of Ol. Ricini, mixed

with gruel, in cases which appeared to be very obstinate.

The

use of a

warm
it

bath promotes the relaxation of

the bowels, and contributes to relieve the system in

other respects

may

be used as a general remedy in

cases of this kind.

After

the

intestinal

canal

has

been

thoroughly

evacuated by such means, and the acute symptoms


of cerebral affection reduced, by the measures before
noticed,
"

what remains

to

be done

falls

under the

The combination
easily

of Calomel and Tartarized

Antimony

acts

more
alone.

and speedily on the stomach than the

latter salt given

ENTERIC EPILEPSr.
second division of practice.
I

26l
the

mean

more con-

tinued treatment required in this disease, considered


as a chronic affection.

In protracted cases of enteric disease


little

we

often find

to

be done by cathartic medicines.

long

continued diarrhoea has, in

many

instances, exhausted

the strength of the patient, and evacuated the intestinal

canal of

its

more

solid contents.

At

the

same time a
a

morbid secretion keeps up the

irritation in the system,


:

which the previous circumstances had excited


as vulgarly termed,
fill

depraved appetite, a feeling of emptiness, or sinking,


it is

with a perpetual craving,


his

induce the patient to


time, with

stomach, from time to


Flatulence, acid

unwholesome substances.
this

eructations, a sallow countenance, a foul tongue, red-

dened fauces, are indications of

second and often

very obstinate stage of the disease.

Under

these circumstances
its

it

is still

better to eva-

cuate the intestinal canal of

contents, the products

of disease, by a few doses of Calomel, followed by


draughts of Rhubarb and Magnesia, in some aromatic
water.
If the stomach
is

not unloaded by this process,

emetics of Ipecacuanha, with a grain or two of Tartarized

Antimony, should be given, and vomiting en-

couraged by means of

warm

fluids.

After the use of these measures, a moderate action

should be kept up in the alimentary canal by means


of somewhat stimulating laxatives.

The compound
:

decoction of Aloes
day, with half a
this

may be

given three times in the


in

dram of Carbonate of Soda

case the patient

may

take at night

pills

com-

posed of the Mercurial and

Compound

Aloetic Pills

262
or
if

TREATMENT OF
the bowels are loose, a scruple of Hydrargyrus
Creta, with

cum

some Aromatic powder.


fol-

In some instances of a similar description the


lowing formulas
the patient.
will

agree better

with

the state of

Pil.

Hydrarg.
Asafoetidas,

Gunim.

Extr. Coloc.

Comp.

5a gr. v.

Bis vel ter indies sumend.

This
lowing:

medicine

may be

alternated

with

the fol-

Infus. Sennas,

Infus. CalumbEe,

AquEE Piment.

aa 3v.

Sodae Carbonat. 9j.


Ft. Haust. ter indies

M.

sumend.

The
of

beneficial effect resulting

from anv medicines


evacuating the

this class is

very

much promoted by

stomach occasionally by means of emetics of Ipecacuanha, and the bowels by strong purgatives.

Of

all

the remedies I have ever tried in that state


I

of the intestinal canal

am now

considering, I have

found none so frequently useful as the Oil of Turpentine*.

The
first

efficacy of this

medicine

is

exempli-

was

induced to

make a

trial

of this remedy in conse-

quence of reading an account of


Percival, then of Dublin.

its

efficacy

by the

late

Dr. E.

This account was delivered with so

much accuracy and

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

have since that time


of cases,

prescribed

same medicine
it

number
5ij,

and

have ascertained that


day.

most serviceable when given

in pretty

large doses, as to that of 3ss to 5j, or even

three times in a

Even

the latter quantity can be very well borne

by the

ENTERIC EPILEPSY.
fied in

Q63

soni of the cases in the following section, parti-

cularly

No.
;

I.

II.

III.

and v.

The

precise

manner

in which the Oil of Turpentine acts I

explain

but the fact

is,

according to
in a great

am my experience,
unable to
its

(and I have prescribed


in

it

number, probably

many hundreds

of cases, and attentively observed

effects,) that it

very soon changes materially the state of


It occasions

the intestinal canal.

moderate and regular

evacuations, corrects the tendency to a frequent repetition

of griping and irritating stools, and relieves, or

completely removes flatulence.

At

the

same time the

Oil of Turpentine exerts a peculiar sedative or tran-

power on the nervous system. It lessens irritability, the disposition to starting and convulsive
quillizing

twitching of the muscular

fibres,

and promotes

sleep.

The

best

way of administering
If
it

the Oil of Turpenis

tine is in

an emulsion, of which a dose

to be given

three times in a day.


vertigo or nausea,

occasions a troublesome
in the day,

when taken

a double In can

dose of the emulsion

may

be given at bed-time.
oil

some

instances twenty or thirty drops of the

be taken more easily undissolved.


for the emulsion
is

The

best vehicle

milk.

I generally order half

an

ounce* of

it

to be taken three times in a

day

in

a tea-

cup-ful of milk.

stomach

in

many
oil,

instances,

when given

in the

form of an emul-

sion carefully prepared; of

which half an ounce, containing half

a dram of the

may

be taken in a cup of milk.


oil,

The emulsion

should be prepared by diffusing the

by means of honey, or

mucilage, in some strong aromatic water, such as


or

Aqua Carui
oil.

Cinnamomi.

Half an ounce of the emulsion contains half a dram of the

264

TREATMENT OF
a continued and persevering employment of
this

By

medicine, combined with

some
I

auxiliary measures to

be afterwards mentioned,
disorders of the class

have frequently observed


consideration, which

now under

seemed

at

first likely

to baffle every effort, relieved,

and sometimes removed.


I believe that the cases of epilepsy, in

which Drs.

Latham,

Percival,

and

others,

have found the Oil of


have found

Turpentine so

useful,

were instances of enteric disease.


I
it

In a great number of such cases


efficacious,
its

and can well understand the probability of


In
it

being useful in instances of this description.

cases of idiopathic disease of the brain I believe

to

be nearly useless.
I

apprehend also that the nitrate of

silver

has

been found useful chiefly in cases of enteric epilepsy.

This medicine, as well as several other metallic


of copper and

salts,

such as the sulphate and oxyde of zinc, and various


salts

iron,

have a certain

efficacy,

in

many
in

disorders of the
the
to

stomach, connected with

pains
led

head.

My

own

experience

has

not

me

place any considerable reliance on this

remedy, or upon any others of the same class in cases


of epilepsy, though
disease in
frequent.
it

has appeared to mitigate the


fits

some

instances, or to render the


salts are

less

In chorea the metallic

more

useful,

and the

nitrate of silver has been in the trials I

have

made
It

of their powers certainly the most efficacious.


principally in enteric epilepsy that
all

is

that class

of medicines, termed nervines or antispasmodics, have

acquired their reputation. In disorders of this description there


is

commonly a troublesome degree of flatu-

ENTERIC EPILEPSY.
lence
are
;

Q65
:

a great variety of internal feelings


frequently

such cases

more

combined with symptoms of


sensations,

hysteria,
spirits,

with variableness of the temper and animal


with
fancied

than

any

other.

Patients

who

labour under these

distempers

often

experience, or fancy that they derive, great relief from

Camphor, Asafoetida, Valerian, and other drugs of the same description *.


I believe that the reputation of drugs of this class
is

now

as

much below what

it

ought to be, as
I

it

was

formerly above their real merits.


are at present too

am

sure that they

much

neglected.
in

In case of enteric disorder,

which there

is

troublesome diarrhoea, some of the foregoing remedies

may be combined with absorbents, or Hydrargyrus cum Creta may be given at night with Aromatic
powder, and

an infusion of Rhubarb and Cloves,


I

or Carui, in the day.

have been told that

pills

of Cayenne Pepper have been given with advantage


in

some

instances,

and that

this

stimulant

is

parti-

cularly useful,

combined with the Carbonate of Iron


efficacy

but I
either.

have had no experience of the

of

Combinations, according to circumstances, of the

above mentioned remedies,


*

will

do much towards
given, are

The

best forms in

which these medicines can be


Foetidus in

the Spiritus
foetida,

Ammonise

Camphor Julep

Pills of

Asa-

with

Oxyd

of Zinc; Tincture of AsafcEtida,

Ammoniatcd

Tincture of Valerian,

Camphor made into Pills, with Extract of Henbane; Compound Galbanum Pill. In whatever form such
Sometimes
effect.

medicines are administered, the doses should be frequently repeated.


clysters of Asafoetida, with Oil of Turpentine,

have a good

266

TREATMENT OF

restoring a healthy state of the intestinal and gastric


secretions.

But whatever

class of alteratives

we may

resolve to use, their efficacy will be greatly promoted

by occasionally evacuating the


of cathartic
pills,

canal.

brisk pur-

gative every third or fourth day, consisting of a dose

followed by a cathartic

draught,

will contribute

much

advantage.

Occasional emetics
purpose
I

are almost indispensable.

For

this

generally

order a scruple or half a


there
is

dram of Ipecacuanha, when


I

any suspicion of the stomach being loaded


have some-

either with alimentary matter or mucus.

times prescribed, with advantage, five grains of Ipe-

cacuanha every morning, and at others an


dose, one or
little

alterative

two grains three times


or

in a day, with a

Aloetic powder,

some other

purgative, in

small doses.

The efficacy of most by warm clothing, by

of these medicines

is

promoted

the occasional use of the

warm

bath, with frictions of the

abdomen.
time, should

The

diet,

in

the

mean

be carefully

restricted.

All vinous and fermented liquors should

generally be proscribed.
in small quantities
:

Animal food should be taken


the

indeed

whole quantity of
run
into

ingesta should be small,

and of such kinds as are most


to

easy

of assimilation, and least likely

fermentation, or oppress the digestive organs.

of epileptic

There are some cases of enteric disease, productive fits, which differ from the instances
to.

already alluded

The

disorder of the intestinal

canal consists in an obstinate and almost invincible


torpor.

Very strong doses of

cathartic

medicine

only produce an inconsiderable and altogether tern-

ENTERIC EPILEPSY.
porary
effect.

Q67

If they are discontinued the bowels

are never fully evacuated, and the scanty relief which the natural degree of action in the canal allows, takes

place once after an interval of several days.


state

This

of torpor and insensibility

is

permanent, and

does not give way to alternations of diarrhoea.

The
without
doses,

practical indication

is,

in these cases, to pro-

vide the most effectual means of relieving the bowels,

encreasing

their

insensibility

by excessive
cathartics.

and by the constant use of powerful


of the
principal resources
is

One

we have under

these circumstances

the constant use of mild enemas,

which act rather as diluents than as stimulants.


rectum every day,
water,

large quantity of water should be injected into the

or

twice in the day,

viz.

every

morning and evening.

Many

persons prefer
it

warm

and obtain from the use of


I attended a

sufficient relief.

In other instances cold water has been found more


effectual.

man

about two years ago

who

had a variety of troublesome


habitual costiveness.
health,

disorders, the effect of

This person now enjoys good

and a greater degree of vigour than he has

experienced for

many

years.
injects

His remedy

is

an enema

of water,

which he
it

always as cold as he

can procure
bag.
excite

every morning, by means of a leather


injects

He
his

first

two quarts, which speedily


evacuate
their

bowels

to

contents,

and

he then immediately repeats the operation.


Saline purgatives, taken in a very dilute state, are

among

the best remedies for cases of this description.

Many

persons are sufficiently relieved by taking half

268
an ounce of
morning.
should

TREATMENT OF
Epsom
this

Salt in half a pint of water every

When

regimen

is

necessary, the patient

rise early,

and, after taking his habitual dose,

should walk or ride for some time before his breakfast*.

Some persons find a more easy relief from the use of Oleum Ricinij of which they take a dose every
nighttIt

would answer no purpose

to

go through a catawell acquainted.


rule,

logue of purgative medicines, with the properties of

which every medical practitioner


It

is

may

be laid

down

as

a general

that

the

stronger, or

more

drastic cathartics, should never

be

used when a
milder class.
torpor,

sufficient effect

can be produced by the


is

If the

disorder

merely intestinal
should

the

frequent use of mercurials

be

avoided.

When

they are given with a view of probile,

moting a flow of
doses of neutral
*

they should

be followed by

salt,

or

some

active purgative.

The

The

late

Dr. Craufuird, of Clifton, mentioned to

me

a case of

epilepsy occurring in a

woman

of middle age, which, after remain-

ing obstinate under a great variety of treatment, was at length


speedily cured by a dose of

Epsom

Salts, taken every night at

bed-time.

t Some persons
sufficiently

find

a dose of olive

oil,

taken every night,

purgative.
is

One

of the best purgative mixtures for


I

habitual use

the following form.


it

know some persons who

have had recourse to

daily for years, without inconvenience.

Infus. Sennffi, Jj.

ad
giv.

3ij.

Aquse Menth. P.

Infus. Calumbae, (vel Infus. Cortic. Aurant.) Jij.

Magnes. Sulphat. ^.
Capiat cochl.
iij.

M.

manfe quotidie.

ENTERIC EPILEPSY.

26*9

chief art by which, in the constant use of purgative

medicines,

we can prevent

the loss of their activity,

and the necessity of constantly encreasing the doses, is by frequent changes, or by giving a variety of
medicines in succession.

There are cases of


morbid tendency
is

enteric epilepsy, in

which the

so strong, that whatever

means
some-

may be adopted
canal, a

to maintain the action of the intestinal


to the

renewed determination

head

will

times occur.

Number

vii.,

among

the following cases, affords a

strong instance of this description.

In such cases,

although the bowels are kept open, a sense of fulness


in

the head,

with vertigo,

strong

pulsation

of the

carotids, and other symptoms, threatening a return of

the

jfits,

sometimes take place.


it

Under such circum-

stances

becomes

absolutely necessary to resort, from

time to time, to some means 6f relieving the vascular


plethora of the brain.
relief is generally

The

best and most effectual

obtained by the occasional appli-

cation of cupping glasses to the nape of the neck.

Twelve, sixteen, or eighteen ounces of blood,


taken in this

may be
but the

way from an

adult,
it is

and the operation


necessary
:

may
it

be repeated as often as

use of this measure should not be resorted to unless


is

required.

In very urgent cases

it

is

better to

open the temporal artery or jugular vein.


the application of leeches
is

In children

the best

ing the head, unless the


requires a

severity

of the

method of relievsymptoms

more speedy evacuation.

270

CASES OF

SECTION

V.

Cases of Enteric Epilepsy.

The

four following

cases

were accompanied with

some of the most

characteristic

symptoms of

enteric

epilepsy, viz. diarrhoea, voracious appetite,

depending
of

on morbid secretion

and, in two instances, there was


oil

much
fourth
to

emaciation.

In three of these cases the remarkable


effect.

turpentine was given with

The

was not long enough under medical treatment admit of any satisfactory conclusion, and the dis-

order had been, in this instance, very inveterate.

CASE
Henry Parker,
An
idiot,
aet.

r.

18. St. Peter's


fits

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
;

diarrhoea; his food passes off in


:

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
:

skin has a yellow tinge.

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

night; the diarrhoea then becomes more troublesome, and,

when

the eruption again appears, the diarrhoea


Ol. Terebinth. 5J. statim.

is

relieved.

Jan. 8.

ENTERIC KPILEPSy.
9.

271

The dose purged him,


Habeat
Et

and brought away undigested

matter, but nothing like worms.


01. Terebinth,
oij.

ter indies.

R Pulv.

Rhei.

Hydrarg.

cum Creta
gr.
ij.

Sing. gr. v.

Pulv. Aromat.
ft.

M.

Pulv. post singul. dos. Terebinth. Sumend.

April 10.

He

took twelve of the powders; they relieved the

stomach from the unpleasant sensation of heat produced by the


turpentine.

The
allowed

turpentine
full diet.

has

been given

regularly,

and he has been

The

fits

return

now once
and

in

about seven days; they are not so


but a short time.

violent as formerly,
state of his

last

The voracious
is

appetite continues.

The

yellowness of his skin

considerably diminished, and his general appearance


proved.
dually.

much

im-

The bowels The tongue

are regular; the eruption disappeared grais

little

furred.

He

appears aware of the

improved

state of his health,

and grateful
?]

to his attendants.

Magnes. Carbonat.
Pulv. Rhei,
3ij.

Syrup. Papav. Albi,

^.
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

some days, but it produced no The oil of turpentine of his appetite.


in the day.

was then resumed, and was given twice

Twenty-one days have now elapsed without any


fits.

He

complains of headache

the pain

is

con-

fined to the forehead.

Leeches were ordered


in seven days,

to be applied to the

temples about once

and the head

to be kept shaved,

September.

The

fits

have gradually ceased.


slight:

The paroxysms
but a few

have been

latterly

much more
still

they lasted

minutes, and he was rendered aware of their approach by languor

and headache.
Jan.
1,

18 19.

He is He

in

a state of idiotism.
fits:

has experienced no return of the


is

he

complains occasionally of headache, which


tive.

relieved

by a purga-

He

Vv-as

discharged from the medical ward and put upon

272
the

CASES OF
diet of the house.

common
3,

Till this time he

had been allowed


though

meat every day.

Nov.
the

I8I9.

He
is

continues in a

much improved

state,

no medical care

taken of his health, and though he fares upon

common
fits.

diet of the paupers in the house.

He

has had no

returns of his complaint except once,


slight

when he had some very

Sept. I, 1821.

He

has long been free from the symptoms of

epilepsy.

CASE
William HiGGS.

II.

June 28, 181 9.

boy, nine years old, of dark hair, dark eyes, large

pupils,

upper ridge of the forehead strongly projecting.


subject to
as
it

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

has a very idiotic

and sleeps much.


to
Is

He
and

complains of headache; the pain being confined


troubled with diarrhoea;
:

the forehead.

is

emaciated,

seems

almost starved

has

voracious appetite.

Pulse feeble.

Magnes. Sulphat.

3ij.

secunda quaque bora donee alvus soluta


gr.
iij.

fuerit.

R
ft.

Pulv. Ipecac,

Sodae Borat.

gr. viij.

M.

Pulv. Sumend. 4ta. quaque hoia postefFectum med. purgantis.

Light nourishing diet.


Jtitij

10,

Bowels completely
01. Tereb. 3SS.

relieved.

Not

so drowsy;

in

other respects in the same state.

R
Aug.
13.

manh

bis in Tana.

Improved,
01. Terebinth.

Appetite continues voracious.


3ij. in

R R

aqua manfe quotidie.

Magnes. Calcinat.
Pulv. Calumbas, Pulv. Rhei,
^a g. v.

5ss.

M.

ft.

Pulv. Sumend. omni nocte.

Let him have half a pound of mutton daily, and a pint of milk.

ENTERIC EPILEPSY.
Sept. 3.

11^

Sumat

pulv. ut antea bis in septimana, et 01. Tere-

binth, ut antehfic.

Nov.
11.

Omit the Has had no


3.

Spirit of Turpentine.
fits

for

many months.
appetite.

Is

apparently in

perfectly good health.

Has a natural

CASE
William Williams.

III.

April 29, 1818.

robust man, aged forty-three years,

who

has served

eleven j'ears as a soldier.

From

his

ninth year he was

subject to epileptic

until his sixteenth year,

return of them until


recurred,
vals.

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
;

has escaped a month without them.

He

attributes

the

return of his disorder to a blow on the top of the head,

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

has a voracious appetite.

have lately been very frequent;

they attack him every second or third day, and sometimes


are

renewed several times in a day.


impaired.
3ij.

His faculties are

much

R. 01. Terebinth. Kect.

bis indies ex haust.


fit

Aq. Menth. Pip.


that has occurred

Mai/ 11.

He

has had a

to-day, the

first

since he began to take the 01. Tereb.

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.

Argent. Nitrat. j. ter indies.

scalp

was ordered

to

be scarified on the vertex, and a

seton to be applied in the nape of the neck.


Sept. /
last

Has had

three

fits

since the seton

was inserted

the

occurred four days ago.


Argent. Nitrat.
gr. iss. ter indies.

274
Oct. 28.

CASES OF
Of
late the
fits

have been more frequent than they

used
It

to be.
is

evident that he receives no benefit from the Nitrate of

Silver.

Omitt. Argent. Nitr.


Capt. 01. Terebinth.
3ij. ter

die in haustu
fit

Aq. Menth. Pip.

Nov. 13.
pentine.

He

has had one

since the 28th of the last month.


after taking the

Complains of an Unpleasant sense of heat

Tur-

Continue the Turpentine draught three times in a day, with the


addition of Tine. Rhei, Siss. to each draught.

18.

Attacked by a
fits

slight rigor, attended with a feeble pulse.


less

Since the

have become

frequent has been subject to occastage of an intermittent.


gr. x.

sional rigors, resembling the

first

Ammoniae Carbonat.
Confect. Aromat. 9j.
Mistur. Camphor,

^ij-

M.
sumend.
be withdrawn.
;

ft.

Haustus statim inter

rigores

The
Jan.
1,

seton discharges but

little

let it

1819-

He

has had no

fits

since the 4lh of

December.

Omit the Turpentine.

Nov.

3, 1S19-

This

man

is still
it

in the

house as a paupqr; he
slight that

had a
think

fit

about six weeks ago;

was so
it:

he did not

it

worth while to speak about

he states that he cannot


attributes the relief

recollect

when he had a

fit

before.

He

he

has experienced to the Turpentine.

Dec. 4, 1820.

Williams has been discharged from the house


fits.

some
Jan.

time, cured of his

He had

taken no medicine, except

an occasional cathartic, since the omission of the turpentine, on


1,

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

and the benefit he

derived from the use of Turpentine, and other remedies,

which tend to
disease.

relieve disorder of the alimentary canal,

sufficiently indicate that there

was the

seat of the primary

CASE
Sarah Treganny,
aet.

IV.
Sept. 27, 1818.

24.

A
by

girl

of sanguine temperament,

who was very

healthy

until she reached her tenth year.


fits,

She was then attacked on witnessing the execution of two women. At


fits

first

the

were ushered in by something like the globus

hystericus, and they

wanted the peculiar character of epithe genuine form of that disease.

lepsy.

After about two years they altered their appear-

ance, and have


is

now

She

subject to headache; occasionally seized with vertigo


:

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.

She now seldom passes a night without one or more


fits.

Some

years

ago she often escaped them for a

week.

She was

four years, as her friends say, a patient at the

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.

purgative doses occasionally, given at the discretion of her


friends.

She

is

now
;

idiotic

and quite helpless.


;

Her

appetite

voracious

has diarrhcea Pulse feeble


:

is

emaciated

has a pallid coun-

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

for the last seven days.

Stools very offensive.

The

medicine purges her.

R
ft.

Pulv. Rhei, Sodae Carbonat. aa.


gr. x.

Pulv.

Sumend. manfe

alternis dieb.

01. Tereb. ut adhuc.

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.

Pulv. Laxans pro re nat&.

13.

Has had one


Emp.

fit;

appears more sensible: complains of

headache.
LyttEB

Nuchs admoVv
the Turpentine.

26.

Bowels

costive.

Omit
gr.
iij.

Pulv. Aloes, gr.

ij.

Calomel,

Pulv, Antim. gr.


ft.

v.

M.

Pulv.

Sumend.

o. n.

Haust. Cath.

o.

m.
after

27.

One

fit;

very

violent:

which her bowels were

opened.
28.

Repet. Terebinth.
5.

Warm

bath.

Nov.
7.

Two
fit

fits,

One

yesterday, and two" this morning.

She has
14.

hitherto been
fits

on

full diet.

This

is

now

omitted.

Has

daily.

Omit the Turpentine.


gr.
iij.

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.

able to walk up and

down

Warm

bath,

and continue

Argent.

* See Williams's Case.

ENTERIC EPILEPSY.
Dec. 4.
voracious.
Jarj, 1,

27?
Appetite not so

No
ISI9.

fit

since the 20th of


Is

November.

Bowels regular.

nnich more sensible.

Fits frequent.
gr. x. gr. vj.

Omit
M.

the Nit. of Silver.

R
ft.

Tereb. Chize.

Oxyd, Zinci,
Pil

Sumend.

ter indies.

S.

Fits

more frequent.

Head

aches.

Hirud. ad tempora omni septiraana.


01. Tereb. bis indies.

19.

Her mother took her out


improved.

of the house.

She was certainly

much

The two
different

following cases were, in


;

some

respects,

from the preceding

but in others correspond

with them.
other

In both of these instances there were

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

of pallid complexion, dark eyes and hair, aged


first

eleven years, who, about ten weeks ago, was

seized

by
in

which

still

continue to trouble her.

They occur
;

the daytime, and chiefly in the

morning

and generally
ten

happen

several times in a day.

They continue about


when

minutes, and she complains of a severe pain in the head


after they cease.
first

Her mother

says that

the disorder
fits;

assailed her she


is

was convulsed during the

but

that

not the case at present.


pulse

They have now the

character of leipothymia.

Her

is

natural

rather full.

Abdomen somewhat

278
tumid
;

CASES OF
functions of the bowels irregular.

fortnight ago
;

she was adoaitted a patient in this Infirmary

she then

took cathartic medicines and

Ol. Terebinth.

Rect.

sj.

every night.
the
fits,

These remedies immediately put a stop to and she went out, supposing herself cured but
;

the disorder returned.


Venae Sect.
Pil.

fluant sang. 5vj.

Cath.

2. o. n.

Mist. Cathart. 3iss. ter indies.

29'

She has been well purged ; the


lasted nearly an
if

fits

continue
in

to-day she

had one which


sibility,

hour: she lay

state of insen-

and looked as

she was asleep the whole of the time

she

is

not subject to any convulsive attacks.


Continue the purgatives.

Nov.

3.

She has had a


Omitt.

fit

every day since her admission.


prescript.
,

Med. antea

R 01. Terebinth.
Sumat
ter indies in

Rect. 3ss.

Emulsione,

cum Aqu& Menth.

P.

AfFusio frigida manfe quotid.

From this period the fits immediately ceased, and The 01. Tereb. disagreed with her stomach, and
which she continued
to take until nearly the

did not recur.


the dose

was

diminished to twenty drops, and again increased to twenty-five;

end of November,

when she was discharged. On December the 4th


had
left off

she attended as an out-patient.

She

her medicine, and her bowels had consequently become


:

again constipated

her

abdomen was hard and tumid


left

she had

pain in her head and in her

hypochondre

the last

symptom
and
her

appeared to depend on flatulence.


Leeches were ordered to the head
the Emulsion of Turpentine
;

a cathartic powder

These remedies relieved


side,

was resumed. She afterwards got a pain her.


of exposure attend at
the
to

in

and cough, the

effects

cold

for

which

symptoms she continued following March.


Feb. 7, 1821.
I

to

Infirmary until the

have seen Margaret Becher to-day.

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.

Observatio7is.'This case requires


facts are sufficient to

no comment: the
oil

prove that the

of turpentine has

some
were
fits

specific effect in cases


It

of

fits

depending on enteric
that

irritation.

may

be

observed

other

purgatives

tried

nearly a

week

before

ordered, but without any beneficial result,

immediately ceased after

was and that the the use of this remedy was


the

turpentine

commenced.

CASE Mary Chadwick.

VI.

Hospital, Jan. SO, 1817.

A young
leptic fits
:

woman

of sanguineo-melancholic temperament,

who, during the

last five years,

has been troubled with epi-

they attack her every week, and sometimes two


:

or three times in a day

the least agitation of


to her

mind brings
through the

them on

her

life is

a source of misery

frequency of these attacks.

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-

modic action of the stomach


turbed

at night

her rest

is

dis-

by

dreams,

which

sometimes are followed by


to a pain in the left
;

fit.

For two years she has been subject


side,

near the region of the heart

has a slight cough


irregular.

no

expectoration.

Catamenia somewhat
:

Remedies ordered

gr. j. bis indies.

Purgatives twice a week.

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.

the right side.


Omitt. Argent. Nitr.

R
ft.

Calomel,

gr. 5.

Pulv. Ipecac.

Comp.

gr. x.

M.

Pulv.

o.

nocte sumend.
g'ij-

Tinct. Cinchonse,

Acid. Nitr.

dilut. 5iv.

M,

Capt. cochl. min. ter indies ex aqua.

Mai/

6.

Somewhat improved
fluid, yet

on some mornings she vomits


sore.

hardly any

nausea troubles her: mouth

Head-

ache

is

the

most troublesome symptom.


Continue the Tinct.
Habt.
Pil.

Fits as usual.

Terebinth,

gr. v. bis indies.

15.
firm.

Fits

not severe;

headache: bowels open.

Pulse

120,

Vense Sect, fluant sang. Jxvj.

Blood-crassament firm
Continue

considerable in proportion to the serum.


Terebinth.

Pil.

Continue the Tincture.


27'
Fits less frequent.
pills
:

Continue the

three times in the day, and the acid drops.

June 10.

Nausea

sense of weight about the epigastrium.

Pulv. Emet. hac vespere.


Pilulje Cath. iv. eras manfe.

Continue the drops and

pills.

The

turpentine was continued in the form of a


relief.

pill until

the
less

February of 1818, with evident


frequent and violent
;

The

fits

became
It

the general health improved.

was novy
3ij.

changed
her

for the 01. Terebinth. Rect., of

which she took

three

times in the day.


in
side,

She was bled

at four several times for the pain

and had

blisters applied.

July 15, 1818.

The

fits

have now entirely

left

her:

they
fort-

became

at first less frequent,

and she used


:

to pass

a week or

night together without any attack

but when she had them at

these distances of time they were very severe.

ENTERIC EPILEPSY.
22.

281

Has pain
;

in

her

left
;

side: cough; pulse 120, irregular;


:

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.

Hirud. xx lateri admovend.


Setae, inser. in latus.
Pil.

Hydrarg.

gr. x. bis indies.

Oct. 7.

Pain in the side increased.

Mercurials injurious.

Cough

increased.

R Emuls. Cetacei cum T. Scill. et


Syr. Papav. Alb. ter indies.
Pill

of Squill, Opium, and Digitalis.

i6.

Pulse 130.

Pain

in

the side continues

very irritable

since the application of the seton.

V.

Sectio. fluant sang. Jxvj.

Repet. Pil.

cum

Pulv. Antira.

gr.

iij.

in sing.

Repet. Emulsio.

27-

Complains of pain

in

the

left

side,

near the

heart

increased by drawing in a full breath.

Pain in the top of the

head

chiefly troublesome in the night,

and before she

rises in

the morning.

Bowels somewhat confined.

Catamenia regular.
Pulse QO,

Tongue
and
full.

white.

Urine high-coloured, but not scanty.


Venag Sect, et fluant ^xx.
Pil.

Cath. omni nocte.

Mist. Salin. Antim.


4t&.

quaque hora cum Tinct. Biuret,


r.

gutt. 30.

Sp. ^ther. Sulph. p.

n.
;

Crassament of the blood was firm

serum milky.
by the bleeding and other

Nov.

4.

Considerably relieved
Pulse 100,
full.

remedies.

Continue.

25.

She has been

in the

country several weeks.

Continue the Diuretic draught.

Dec. 4.
Jan.
1,

Has some glandular


1819.

swellings in her neck.


in

She has been

the country; says she

is

per-

fectly well.

Discharged cured.

282
Observations.

CASES OF

This

is

a well

marked case of

enteric

epilepsy, complicated with disorder of the chest, which

threatened to assume a phthisical character.


disease, however, subsided.

This

latter

The
tine.

epilepsy was cured, as

history of the case, by purgatives,

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

mentioned in page Q66.

They
fits

tolerably

well the connexion of epileptic

with a great degree

of torpor in the intestinal canal.

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,

fainting; preceded by pain in the bowels and right

hypo-

chondrium.
time past.
afterwards.

The catamenia have been

regular for

some

These particulars were obtained by inquiry

On

the evening of the 25th instant she was seized with

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

she ever had.

An

apothecary.

ENTERIC EPILEPSY.
who saw
her, bled her to the

283
sixteen ounces,

amount of

and administered a cathartic dose.

On

the next day,

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

was followed by a remission of the


of severe pain in her head
relieved
full
:

fits.

She complained
pulse

her bowels had not been


:

her

abdomen was

tense

tongue clean

and irregular.

The

following remedies were ordered

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.

Since the morning the


fits,

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

carotids beating with considerable

Hirud. 10 ad tempera.

Emplast. stiraulans ad pedes.

Antim. Tartar.,
Calomel,
aa gr.
iij.

statim. et

Repet. Antimon.
et Haust. Catliart.

12

P.M.
fits

Bowels
continued

freely

purged

the convulsions have ceased

for the present.

The
15.

to

recur until June

15,

when she was


Since the

admitted into the Hospital.

She was

this

day admitted into the Hospital.

7th she has been taking the 01. Terebinth, with Fetid Spirit, and
the

Enema

of

Opium, &c.

The

latter

has afforded some relief at

times.

16.

Draughts of camphorated mixture ordered.


Twelve leeches
to the temples.

A
17.

blister to the

nape of the neck.

Convulsions and hysterical symptoms troublesome.


Bain. Calid.

Enemn

foetid,

T. Opu.

584
19.

CASES OF
Aqua Carai
fort.

Mist. Rhei et Magnes. in

Enema
July
4.

purgans et anodyn. altera, vicibus.

Pilul. Cathart. o. n.

Haust. Cathart. ter indies.

28.

Purgatives contin\ied.
\6.

Avg,
charged.
21.

She has had no

fits

now

for three

weeks.

Dis-

Attends as an out-patient.

Sept. 11.

Bowels much swelled;


the

flatulent; pain in the right

side; sick in her stomach, chiefly in the morning.

These symp-

toms have again ushered


rence soon after they
Oct. 3.
Fits

in

fits

of these she had a recur-

came

on.
severe
:

frequent and
;

the
;

cathartic
;

medicines

have been neglected

abdomen

tense

flatulent

nausea, and

sometimes vomiting; appetite has failed: pulse


ation regular.

full;

menstru-

Ven. Sect. Empl. Lyttae ad Nucharn.


Pil. Cath'. 3. bis indies.

Haust. Cath. ter indies,

27.

The

fits

have changed their character.

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

be choked by constriction of the throat

never loses her

State of the bowels improved


feels

abdomen

soft,

though tumid

no pain on pressure;
11.

stools

still

dark-coloured.
fit:

Nov.

Three days ago she had an epileptic


have now ceased.
Emuls. Tereb.
ter indies.

the hyste-

rical attacks

Jan. 12, 1821.

Cucurb. Cruent. ad Nucharn, unde


Sanguinis ^xij exsugantur. et p.
r.

n. repet.

Teh. 19.

Pil. Colocynth. c. Asafoet.

April 6.

Cupping has been occasionally


fits

repeated.

She has
have quite

had no

epileptic 18.

since

it

was ordered.
to

May

Is quite free

from epilepsy, and seems


relief

recovered.

She has obtained

from purgatives, and general

ENTERIC EPILEPSY.
and
topical
if

285
and
will

bleeding.

Wishes

to be discharged,

apply

again

she should have any return of her complaint.

CASE
William Sherborne, A man of shoft stature,

VIII..

admitted March 20, 1817.


spare habit, dark complexion,

dejected aspect, aged about twenty-five years.

He

has

been unwell twelve months.

At

first

he was troubled

with costiveness, loss of appetite,

and frequent nausea:

when these complaints were most urgent he had vertigo. Three months ago he had, for the first time, an epileptic
fit.

Since that lime he has had two

fits

at irregular interhis limbs.

vals,

preceded by tremblings and catchings of


state.

Present

He has

vertigo and stupor: pains in his

stomach and hypochondria increased on pressure.


natural. Van. Sec.
et fluant sang. ^xij.

Pulse

Emplast. Lyttae ad epigast.


Pulv. Cath. h^c nocte.
Pil.

Postea

Hydrarg.

gr. x. ter die. et

Mist. Cath. bis quotidie.

21. 22.
25.

He

feels

himself somewhat relieved.


in the region of the

Complains of pain
Bowels not
Pil.

stomach.
at all affected

sufficiently

open

mouth not

by the

Hydrarg.

Omit

it.

R
29.

Calomel,

gr. v. 6t&. qq. h.

Continue Mist. Cath.

He

has
to

now

the trembling
fit.

and shaking of

his

limbs,

which used

precede a
Ven. Sec.
fl.

Jxvj.

Repeat the Calomel and Mist. Cath.


^pril 2.

Complains of

his

stomach.

Repet. Eraplast. Lyttae.


5.
Is

much

better in every respect.

The

shakings have been


;

relieved ever since he

was bled and

well purged

the pain in the

epigastrium was removed by the


9.
diet.

blister.
;

He makes no complaint
Medicines given according

is

very desirous of the house

to the effect.
diet.

Let him have the house

286
16.

CASES OF
Bowels constipated,
01. Ricini, 3j- statim.

Calomel,
19.

gr. v.

6ta qu&que horS..


j

Again

his

bowels are confined

complains again of the

catchings and startings.


01. Ricini, ^j- statim.
Pil.

Cath. 3. orani nocte.

Hydrarg.

2.

manfe et meridie.
pills,

21.

Notwithstanding the cathartic

he

is

still

costive:

has severe headache and giddiness.


Arteria

Tempo ris
^.

Sec. et fluant Jxij.

01. Ric.

statim.

Pulv. Cath. Jss. omni nocte.

Mist. Cath. 4t&. quaq. hor&.

27.

Head

aches.
Hirud. 10 temp.

Empl. Lytt. Nuchae.


Continue powder and mixture.
28.
It is still

extremely
is

difficult to

keep his bowels open, and


I

when

costive he

troubled with headache.

now

ordered him a

cathartic

powder every
to this,

night, cathartic pills in the morning,

and

Magnes. Sulph.
his

3ss. o. 4. h.,

and directed a seton

to be inserted in

neck
10.

however, he would not submit.


but complains of pains in his limbs.

May

6.

Is better,

Headache and drowsiness.


V.
S.
fl.

Pulse

full.

3xvj.

Pulv. Feb. 6. qq. h. Mist. Cath. bis die.

He was

relieved

by

the

last

prescription

and during the and mercurials, so

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.

floating before his eyes.

Hirud. 12. temp.


Cath.
3. bis indies.

Jai
5.

1.

Is considerably better.
is

Says he

quite well.

He was

soon afterwards discharged.

ENTERIC EPILEPSY.
Observations.

287

The history of

this case displays clearly

the origin of the disease in the alimentary canal, and the

gradual supervention of the disorder in the head, in connection with


it.

CASE
John Bullock,

IX.
at St. Peter's Hospital,

out-patient

Oct. 9, 1820. man of meagre habit, short stature, dark complexion,

aged

years subject to epileptic

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.

Mist. Cath. ter indies.

13.

He

had a

fit

on the evening

after

he was here,

(viz.

on the

9th,) but

none since then.

the muscles of the shoulder.


lation
;

He was seized last night with pain in He has palpitation and rapid circubreathes.

pain in his chest

when he

Bowels relaxed
in

discharge from them of a black colour.


his

He

complains of pain

head and dimness of

sight.

Ven. Sec. fluant Jxvj.


Pil. Catli. 3.

omni nocte.
c.

Mist. Aper.

T.

Scill. et

T. Digitalis.
full

23.
strong.

No

fits

for three weeks.


;

Pulse in the carotid


is

and

Headache
Pil.

otherwise he

better.

Hirud. temper.

Cath. frequenter.

Feb.

6,

1821.

He

got better, and neglected his attendance at


fits

the Hospital.
tolerably
well,

He

had no

for three

months.

Finding himself

he omitted the means necessary for keeping his

bowels open.

His complaint returned, and he has had three

fits

288
lately.

CASES OF
Complains of headache and drowsiness.
;

Bowels very

costive

flatulence very troublesome.


glasses,

Pulse quick.
nape of the neck.

Cupping

and a

blister afterwards to the

Cathartic
I

pills

and mixture.

have heard no more of him.

Observations.
it

This case

is

analogous to the preceding;


in

displays the connexion of disease

the

brain

with

obstinate constipation of the bowels.


intestinal canal,

This state of the


is

depending on deficient secretions,

more
three

apt to occur in the melancholic temperament.


last cases are

The

of the description alluded to in page 0,66.

CASE
Richard Durham,

X.

in-patient at St. Peter's Hospital,

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

drinking late at night.


his

In consequence of his sedentary

occupation

bowels were generally much constipated.

He

has been troubled with headache for years.


the last

During
leptic
fits.

two years he has been subject


first

to epi-

He

is

seized with a
:

hand

sometimes

in the right foot

spasm in the right his hand feels drawn

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,

In consequence, as he says, of the

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

bowels are con-

Present symptoms.
has
fits

Partial hemiplegia of the right side:


his senses

occasionally

does not lose

during them,

ENTERIC EPILEPSY.
but
is

289
is

conscious and knows those around him, yet

unable

to speak to them.

The
Aug.
pentine.

functions of the digestive organs are impaired.


01. Terebinth. Rect.
4.
3ij.

ter indies.

He

has derived no benefit from the use of the tur-

R
M.
13.
Fits

Extr. Coloc. Co. gr. x.

Confect. Hydrarg. gr. v.


ft.

Pil.

iij.

omni nocte suinend.


quotidie.

R Magnes. Sulphat. 3iv. manfe


not so frequent:

has

little

or no appetite:

hemi-

plegia unrelieved.

R
ft.

Extract. Nucis Vomicce, gr.

iij.

Pil. ter indies suraend. Pil.

Habeat
19.

Colocynth.

c.

Calomelane, p.

r.

n.

Continues the

Nux Vomica:

feels relieved.

Electricity

was ordered.

He

derived no apparent benefit from electricity.

It

was

dis-

continued, and he used the shower bath.


Oct. 21, 1820.

This man's condition

is

now very much imand


his
diet
is

proved.
first

He

has been an inhabitant of the Hospital ever since the

report;

and consequently
epilepsy.

lives regularly,

very simple.
lost all

His bowels are now regularly open.

He

has long

symptoms of

The

last

fits

he had, more than


is

six

months ago, were very


the use of his limbs.

slight.

His palsy

lessened,

and he

has

now no complaint except

a partial hemiplegia, which allows

him

Says he derived more benefit from the

shower bath than from any other medical application.

CASE
Daniel Boyle,
1821.

XI.

out-patient at the Infirmary,

March

15,

A
fit.

man

of middle stature, aged seventy-nine years, who,


first

about ten years ago, had, for the

time, an epileptic
to trouble

From

that time similar

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

has attended, and has taken his medicines reguin

His bowels have been moved two or three times


stools
2.

a day,

and the

have been dark-coloured, or black.


reports continued from the
last.

Ma^

Similar

He
:

has

persisted in his medicines, with the addition lately of a cathartic

draught each morning.

His appetite

is

better than formerly

he

has had no symptom of his disease.


Continue.

23.

No

fits;

he has had a catarrhal cough.


Pil.

Cath.

o. n.

Mist. Sal. Antim. Opiat.

30.

No

fits;

cougli well.

Take the

pills

now

twice a day,

if

he can bear them so often,

Emuls. Terebinth.

Jan. 6.

He

is

now very
Cath.

well, but cannot

do without the

pills,

his bowels becoming obstinately costive.


Pil.
o. n.

Solut.

Magnes. Sulph.
;

q. &.

mane

quotidie.

Aug.

Is quite well

except that he requires the constant use

of laxative medicines, though not in such large doses as formerly.

Has had no

fits

for five months.

September,

He

has lately suffered a recurrence of the

fits,

which came on while he was stooping

in his garden. Pulse only 34.

CASE
John Harris,
1820.

XII.

out-patient at the Infirmary, Oct. Q6,

robust country labourer, aged thirty-two years, who,


in the

a week ago, was seized

night with epilepsy.

He

had three
ing day.

fits,

each of which lasted about an hour, and was

affected with headache and stupor the

whole of the followfive

On

being questioned, he says that about four or

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
;

pain across the epigastric region


breath.

when he draws
:

a full

Pulse in the arm natural


in proportion.
fl.

in the carotid harder

and stronger than

Ven. Sec.

3xvj.
0. n.

Pulv. Cath.
Mist, Catli.

cum Emuls.

Tereb. ^ss. 4ti qq. h.


;

28.

Bowels relieved about ten times in a day


;

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

removed, and he now coughs

without uneasiness.

Pulse natural.
T.

Pulv. Feb. 6ta quaq. hor^.

Mist. Sal. Ant.

c.

Scill.

Nov.l.

Still

very unwell:

was troubled with much

flatu-

lence until the medicines

purged him a good deal, when he His gums


fits.

voided two lumbrici, about eleven inches in length.


are sore through the effect of the Calomel.
Pil.

He

has had no

Cath. 3.

o. n.

Mist. Cath. 4ta quaque hor&.

Much carotid. No
4.

pain in his head.


fits.

Pulse strong and

full

in

the

Bowels opened six or seven times in a day.

Art.

Temp.

sec.

Ep. Nnchse.
Continue Cathartics, with Emuls. Tereb., as before.
8.

The Turpentine emulsion occasioned a


went
off,

suppression
to take

of
it.

urine, which, however,

though he continued
Pulse
full

Urine

still

turbid

head pained.
fl.

and

strong.

Ven. Sec.
Pil.

3xvj.

Cath.

o. n.

R Infusi
Spir.

Sennae,

Infus. Calumb., aa ^iv.

^ther. Nitros.,
aa ^ss.

Liquor. Potass. Subcarbon.


ft.

M.

Mist. capt. cochl.

iij.

ter indies.

292

CASES OF
few days after
this date

he was brought into the Infirmary,


complaint he was somequite
well,
his

labouring under an attack of erysipelas, which was at that time a


prevalent disorder.

On

account of

this

what further evacuated, and went


and
compressible,

out,

about the
soft

20th of December, the following month, with


having
experienced

abdomen

no

recurrence

of his

epilepsy.

Observations.

This
worms.

case would
I

be termed by some

epilepsy

from

am

inclined,

on comparing

it

with

other cases, to ascribe the disease to

the morbid

condition of the intestinal canal, independently of the

worms.

The

history of the case indicates that the disorder of the

brain was consequent on that of the abdominal functions

and shows, likewise, that the former consisted


plethora of the vessels in the head.

in

a morbid

In the following case there was

intestinal irritation,

connected with the presence of worms.

CASE
Jemima Davis.
August

XIII.
13, 1819.

girl,

about eleven years of age, of sanguine temperahair, &c.,

ment, red

some time subject


last

to epileptic fits;

but we cannot learn


has had two
fits

how

long this has been the case.

She She

during the

week, which were brought


sufficient

on by
is

terror: she has


it

been frightened by a ghost.

emaciated, as

appears,

from the want of

nourishment.

She picks her nose frequently, grinds her

teeth at night, and starts in her sleep.

Her
;

appetite

is

good; bowels tense, and subject


clean.

to diarrhcea

her tongue

She

is

free

from febrile symptoms.

Complains

chiefly of headache.

ENTERIC EPILEPSY.
R Pulv. Stanni, gr. R Calomel, gr.iij.
Pulv. Jalap,
ft.

293

xij. ter

indies.

gr. xij.

M.

Pulv. Cath. manfe sumend.

Light diet.

30.
Is

She discharged a quantity of worms


well.

after the

powders.

now
Nov.

Discharged, cured,

11.

Has had no

return of her complaint.

I have
fits

observed

repeated

instances

of epileptic

occurring in individuals

who had

formerly been

subject to tape- worm, although there


believe
least,

was reason
;

to

that

the

worm had
its

been destroyed

or,

at

when no proof of
this

existence had been dis-

covered for several years.

The two

following cases

exemplify

observation, and are, in

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
:

medicines, finding that they alleviated a complaint of the


head, which has troubled him
plaint he gives an

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

tremor and palpitations.


'four years ago,

He

says that he

was troubled

with tape-worms about twelve years ago, but was cured,


since which period

by taking two ounces of oil of turpentine he has never had any symptom of
;

them.

His other complaints, however, have continued


in the

and about a month ago, when sleeping, early


ing, he was attacked by an epileptic
fit
:

morn-

two days ago,

nearly at the same hour, he had a similar attack..

cines.

He was He

ordered to lose blood, and take some cathartic medidid

not attend regularly, residing

at

the

distance
his

of several miles from Bristol, and being


business.

much engaged by
:

On He

Nov. 16 he added the following particulars


has

fits

now

fits

nearly every week.


first lies

Is

subject to palpitations

and tremors when he


during sleep.

down

at night.

The
is

come on
;

Before they occur his inspiration


fit.

sonorous

if

then awakened, he escapes the

He
lence,

is

hypochondriacal;
is

his

bowels loose;

subject to

flatu-

which

most troublesome before the


very irregularly,

fits;

his appetite is

voracious.

Pulse quick.
attended

This

man

and

after

some time
from
c.

desisted entirely

from attending.

Some

cathartic medicines, &c.


relief
pills,

were ordered
containing
et

for

him

he obtained temporary

Nitrate of Silver, and

from Mist. Menth.


to take the

Rheo

Magnesia; he could not be induced


June, 1821.

Turpentine

emulsion.

Hulbert has been recently

in the Infirmary,

on

account of symptoms threatening phthisis.


fits.

He

is still

subject to

He

has had no indication of worms.

CASE XV.
Samuel Tillet,
January 15, 1821.
admitted out-patient
at the Infirmary,

A man

of dark complexion, by trade a carpenter, aged

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

to be able to work at his trade

improved in his health, so as when, as he was walking ;


This affection con-

home

the evening, about a month ago, he suddenly

found himself unable to articulate.


tinued about half an hour,

and then subsided.


fit,

Some
which

hours afterwards he was seized with an epileptic

was very long and severe.


Present
state.

Since

the period above referred to he


fits,

has had no repetition of

but

is

still

troubled with

a severe pain in the temple, over the left eye.

He

has also
feels

a pain just above the scrobiculus cordis.


full

Abdomen

and tense

this has

been the case for several monihs,

particularly after his meals.

He

has a cough, and a red

appearance of the posterior part of the pharynx.


Ven. Sec.
Pil.

fluant tang. oxvj.

Empl. Lyttse ad Nucham.


Cath.
o. n.

Mist. Cath. ter indies.

20.
that he

His morbid

feelings

have been much relieved.


loss of blood,

He

fancies

was not benefited by the

but very

much by

the blister.

He

has passed from his bowels a large quantity of

black or dark-coloured stools.


PiL Cath.
o. n.

Cough

relieved.

Mist. Cath.

mane

quotidie.
indies.

Emuls. Terebinth, ter


24.
Stools
still

of a black colour.

Says that he had a tapefeels


it

worm

about six years ago, and fancies that he


irritating his bowels.

now

moving and

01. Terebinth.

^.

eras

mane.

Mist. Cath.

27.

His stomach rejected the


left

oil.

Puhe

full.

Pain

in the

temple, over the

eye.

Cucurb. Cruent. ad Nucham. Empl. Lytt. ad Nucham.


Pil.

Exsugantur Jxvj.

Cath. o. n.
,

Mist, Cath. ter indies.

Feb. 3.

Discharged cured.

2^6

CASES OF

CASE XVI.
Hannah Vowles.
April 17, 1817.

stout fat girl, of a square

make, pale complexion,

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

pain in her head con-

tinued six weeks, and purple blotches

came out over

the

whole body. While these symptoms were present she was attacked by a convulsive fit. She was bled, and soon
afterwards recovered.

right
her.

About a week ago she was arm and shoulder, which

seized with a pain in her


is still

very troublesome to

On
fits

the 14th she had two fits; which, except one,


first

were the

she has suffered since the primary attack.

The
down

seize her suddenly,

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

and, when she recovers her senses, complains of violent

headache.
is

She says that her bowels

appetite

bad

menstruation returns every fortnight.

She now

labours under headache and stupor.


Ven. Sec. fluant sang, ^^^j*
Pil.

Cath. 3.

o. n.

Mist. Cath. ter indies.


2-3.

For several days she has had a

fit

daily,

and yesterday

had two.

Mist. Cath. ^Iss.

Antim. Tartar,

gr. j.

M.
r.

Sumat. 4ta quaque hora.


Tinct. AsafcEt. gutt. 30. p.
n.

May

6.

She has had no

fits

since she began to take the last

medicine.
Continue, and take
Pil.

Cath. 3. altern. noct.


fit,

27.

Nine days ago she had a

which was followed by

ENTERIC EPILEPSY.
another on the following morning.

297

Since that time she has been

much

troubled by

vertigo.

Ilirud. 12. ad teinpoia.

Pulv. Cath.

gr. 25. o. n.

M. M.

c.

Rheo.

ter indies.

Empl. Lytt. ad Nucham.

June

4.

The

leeches drew no blood, but her head


fits.

is

belter.

She has had no

Pulse 112, rather

full.

Ven. Sect,

fluant sang. 5^vj.

Repet. Med.

She recovered from

this

time, but ceased to


I

attend

at

the

Infirmary, as convalescent patients often do.

accidentally

met

with her mother, at the house of a patient, in September I817i

and learnt that she had experienced no return of her


regained perfect health.

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.

but the decided benefit,

CASE
William Vowles.
the Infirmary.

XVII.
1817.

Feb. 17,

Out-patient at

boy, nine years of age

rather short for his

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.

The powder was discontinued


cathartic mixture given instead of

after a
it

few days, and a dose of

in the

morning.

298
March
12.

CASES OF
He
has not had one
fit

since he began to attend.

Repeat the Mixture.

April 30.

He

has been here repeatedly since the above reports


:

the mixture always continued

he has had no

fits,

and

is

now
15,

discharged as cured.

His mother brought him


following.

to the

Infirmary again on

May

The

fits

have recurred

he had an attack two evenings ago,

and again on yesterday morning. Pulv. Cath. 9j. omni


Mist. Cath.
^ij.

noct.

manfe quot.
;

24.

Complains of headache and dizziness

he has taken only


before yesterday;

two of the powders.


each continued about
V.

Had two
five

fits

the day

minutes.

S. et fluant Jx.

Pulv. Cath. o. n.

27.
well
;

Syncope followed the bleeding.


has had no
fits.

He now

seems quite

Bowels not much purged.

31.

His stomach

rejects the powders.


gr. iv.

No

fits.

Calomel,

omni nocte.

Mist. Cath, ter indies.

June

7.

Seems

well.

Purged eight or nine times

in a day.

Continue.
14.

Feverish symptoms.

The

cathartic medicines have acted

too

much.

Pulse

full

and quick.

V.

S. et fluant ^x.

Take only the Cathartic Mixture.


July \6.
Is quite well.
in

Take a dose of Cathartic Powder twice


Sept. 24.

a week,

Has again had an


Pulv. Cath.
alt.

epileptic

fit.

noct.

Oct. 1.

Had

fit

every day for the last three days.

V.

S. 3x.

Repet. Pulv. Cath.

Repet. Mist. Cath.

25.

The powders have


lately.

not been given as prescribed.

Had

two

fits

Pulv. Cath. gr. xv. o. n.

Mist. Cath. ter indies.

ENTERIC EPILEPSY.
Nov.
1.

299

Had one
Pil.

fit

in the present
o. n.

week.

Cath.

Infus. Sennffi, nianb.

8.

Two

fits

yesterday.

Empl. Lytt. ad Nucham.

Keep

the pari sore with Sabine ointment.

Repeat the Cathartics.


26.
usual.
Fits yesterday

and the day before; continued longer than

He was

not troubled with them while the blister was

open at the nape of the neck.


Continue Cathartic
Pills.

Dec. 31.

No

fits

since he was here


gr. iv. o. n.

last.

Calomel,

M. Menth.
Jan. 17.
fit

c.

Rheo.

He

takes the

Calomel every night; has had only one


month, and that a
slight one.

in the course of the last

Continue.

Feb. 4.
sent

He
to

has

left

off taking the

medicines, and his mother

him

school

to

learn arithmetic,
fits.

supposing him cured

of his complaint.
Let him

He had two
c.

persist in taking four grains of

Calomel every

night,

and the

Mist. Menth.

Rheo

in the morning.

To
(1

use exercise in the

open
14.
is

air,

and not to go to school.

Mouth
24.

not affected by the Calomel.

doubt whether

it

regularly given).

March
his

He
fits.

has been attending since the

last report;

and

mother declares that she has given


has had no

his medicines regularly.

He

Discharged.
his complaint.

Returned on April 29 with a recurrence of


Will not take
pills

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.

His gums are

sore.

Pulse

and

strong.

V.

S. fluant ^vj.

Mist. Cath. manfe quotidie.

300
16.

CASES OF ENTERIC EPILEPSY,


Has been
Pil.

well since the last report,

Cath. 3.

o. n.
r.

Mist. Cath. p.

n,

20.

Quite well.
Continue
Pills,

Mist. Cath. altern, dieb.

June

6.

Quite well.
Continue the purgative medicines.

^ttg. 8.

As

before.
Pills
is

Let him have the


Sept. 2.

every other night only.

Continue.

He

Dec, 30.

He

has had no

fits

now shedding several teeth. now for seven months.

Discharged, with an injunction to attend to the state of his


bowels.

Observations.
epilepsy.

This was

a very obstinate case of enteric

The event proves

that perseverance in the use

of purgative medicines, with the occasional assistance of

other evacuating remedies, will sometimes cure a disease

which appears very unpromising. The doses which he took were so powerful, and long
continued,
as
to

occasion

considerable disorder of the


to

system.
attacks

The remedies seem


of his

have warded oif the


artificial

complaint by

maintaining an

disease; for as such the constant catharsis he underwent

must be considered.
J

have scarcely a doubt that this boy would have derived

benefit from the use of turpentine.

SECTION
Of the

VI.

Treatment of Enteric Mania,

The

treatment of maniacal cases,

connected

with

disorder of the intestinal canal, must depend on the

TREATMENT OF LNTERIC MANIA.


same
the
general principles wliich

301
.1

we have considered

in

fifth section.

The

chief object of our endeavours

must be
which
it

to restore the alimentary canal to a state in


shall

no longer occasion the excitement of


preliminary measures are
requisite
in

disease in the nervous system.

The same
epilepsy.

cases of this description as in the instances of enteric

We

must endeavour

to relieve the

secondary
in

and often obstinate disease, which has taken place


the encephalon.

The

abstraction of blood has comparatively a small


:

place in the treatment of enteric mania

however,

it

cannot, with impunity, be omitted under certain cir-

cumstances.

When

the

disease

commences
particularly
in

with

symptoms approaching
rium,

to phrenitis, with raving deli'


pulse,

a rapid

bounding

the

carotids,

a flushed countenance, reddened


it

eyes, heated

scalp, dry tongue, intense thirst,

would be wrong to
It

omit bleeding either from the arm or jugular vein.


is

much

safer to attempt to relieve the sanguiferous


this
;

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

often exceed sixteen or eighteen ounces at one operation: in a great

many

instances the loss often, twelve,


efi^ect

or fourteen, will be sufficient to


especially

the purpose,
applications,

when combined with


auxiliary
fifth
it

local

calculated to assist in bringing about the

same

result.

These

means are the same


section
:

as were

menat

tioned in the

such as shaving the head,

and covering

with

cloths

welled with

water,

302

TREATMENT OF
:

thirty-two degrees of Fahrenheit

in other instances

the cold affusion

the application of leeches to the

head, or cupping glasses to the nape of the neck.


Blisters

applied to the same place, or to the whole

occiput, contribute, in a very important manner,

on

some

occasions, to produce a similar effect

in other

instances blisters

aggravate the disease^ by creating an

additional irritation.

When

the head

is

hot,

and the
:

face flushed, blisters on the scalp itself are injurious

when the symptoms


to

external parts of the head are cold, while


exist

which indicate a determination into

the vessels of the encephalon, they

may be

expected

produce a beneficial

effect.

General bleeding

will scarcely

be required in two
and,

cases out of ten of enteric mania;


necessary, one moderate bleeding

when

it

is

will, in

the majority

of instances, be sufficient; combined with the other


antiphlogistic measures I have described.

In the subsequent course of the disease circumstances will in

some

cases arise which require a repe-

tition of bleeding, or the application

of cupping glasses.
benefit

Some

patients experience so

much

by occa-

sional bleeding, either general or local, that they

come,

from time to time, to entreat that

it

may

be done.

The uneasy

sensations to which lunatics are so liable,

such as a feeling of fulness and vertigo, are often


sensibly mitigated by
it.

In the treatment of the alimentary canal, we must be directed by the same rules as
epilepsy.
in cases

of enteric

Emetics may be given when there

is

no strongly

marked

fulness

and increased action

in the carotids

ENTERIC MANIA.
and temporal
arteries,

303

or after relief of this

has been obtained by bleeding.

symptom In many instances a

dose of Calomel, with one grain of Tartarized Anti-

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-

sisting of eight grains

of Tartarized Antimony, given


effect.

with comparatively litde

The bowelg ought

to

be completely purged

by

powerful cathartic doses, given as frequently as the


strength of the patient will admit, until the
full effect

takes place.

If they are slow in their operation, they

should be assisted by purgative enemas, containing


Oil of Turpentine with Castor Oil.

"We must not be


or even loose, for

withheld from the use of purgatives by an assurance


that the bowels have been open,

some time

even in this case they are often

found to

contain a great mass of feculent matter.

For the subsequent treatment of the


I

intestinal canal
in the

beg to refer the reader

to

what has been said

foregoing section.

The

disorder of this part of the

system

is

of the same description in enteric mania as

in enteric epilepsy,

There

is

and requires the same treatment. no other medicine, on the whole, so valuable

in these affections as the rectified Oil of Turpentine.

It possesses a particular property of allaying


in the nervous system, at the

irritation
it

same time

that

restores

a healthy action in the


is

intestinal canal.

When

there

a craving appetite, connected with flatulent pains,


to denote the

and those symptoms which are thought


a diseased
state of the

presence of worms, but which more certainly indicate

mucous

surface of the canal, I

304

TREATMENT OF

consider the use of Turpentine as particularly indicated,


I generally give
it

in the

form of the emulsion already


be taken three
is

mentioned

of which from half an ounce to an ounce,

containing half a

dram or a dram,
will

is

to

or four times in the day.


larger

If this medicine

given in

doses
in

it

frequently occasion hasmaturia.


it

Even
is,

smaller quantities

sometimes gives

rise to

nausea and vertigo.


however,

The

emulsion above mentioned


to

less offensive

the stomach than the


is

oil in

any other combination, and


in milk.

generally retained

when taken
to

The warm
relieve

bath, by

its

relaxing effect, contributes

the system

when under

the influence of

intestinal irritation.

If diarrhoea with tenesmus occur the use of cathartic medi-

spontaneously, or follow
cines, they

may be

relieved

by the use of the warm low


in cases of enteric

bath and anodyne enemas.

The
mania.

diet should not be too

The

disease
to,

is

generally accompanied with,

or gives rise

great emaciation and debility; and

patients under these circumstances sink rapidly under

the effect of remedies, unless they are supported by a


nutritious diet.

Except

in

those cases which require,

for a time, the antiphlogistic regimen to be conjoined

with general depletion of the blood-vessels,


to

it is

better

allow the patient broths,


his

and as much of milk


to require.

and farinaceous food as


rhoea,
solid

stomach seems
is

In protracted cases, where there

emaciation, diar-

and a craving appetite, a moderate portion of


animal food should be given
every day.
is

In
very

some much

instances the irritability of the system

allayed by a daily allowance of ale or porter.

ENTERIC MAJflA.

305

When
evacuated,

the

intestinal
its

canal has been thoroughly


restored
to

and

secretions

a more

healthy state, by the means

recommended

in this

and

the preceding section, the recovery of strength in the


habit in general, and the removal of disorder in the

nervous system, depending on irregular circulation,

is

much promoted by
often produced

exercise in the country,

and the

use of a cold shower bath.

The

latter

remedy has

a much greater

effect

than was anti-

cipated from

it.

I must observe, before concluding, that there are


cases of

mania which appear

to

have their origin in

intestinal irritation,

and which, nevertheless, continue


or,

unmitigated after the disorder of the alimentary canal

has been in a great measure,

perhaps, entirely sub-

dued, and the whole system of the digestive organs


restored to a tolerably healthy state. In these instances

the secondary disease has

become

idiopathic.

The

pathology and treatment of cases of this class will

be considered in a future chapter on encephalic or


neurotic mania.

SECTION

VII.

Cases of Entenc Mania.

The

following selection of cases will tend to illustrate

the preceding remarks

on the pathology and

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
:

his face flushed


full
;

eyes

wild and glistening

pulse rather slow, and


:

not par-

ticularly strong in the carotid

complains of pain, when


livero

pressed,

in

the region of the

He

can give no

account of himself.
lected from his

The following
:

wife

She
;

particulars were col-

observed that he
;

was not

quite well for several days before the attack


disinclined to take food
restless
;

w-as costive

complained of occalittle

sional headache, with giddiness, and got very

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

very offensive, and looked like rotten flesh.

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

admitted his face was flushed

head was shaved he had leeches applied to the head, and was purged all without a blister to the nape of the neck
:
:

diminishing the violence of maniacal excitement.

ENTERIC MANIA.
Three grains of Emetic Tartar produced no
his

307

stomach, and six grains

eflFect upon made him vomit repeated only

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.

After the 23d some stimulants and opiates were tried,

but soon discontinued.

From

that time

he gradually sunk

into a state of stupor, and expired on the 6th of

December. was a peculiar and During the whole of his illness there strongly fetid smell emanating from him; which was very

perceptible in the body previously to dissection.

Dissection Twelve

Hours

after Death.

Abdomen.
were, in

The

intestines were distended with flatus,


:

and also contained a considerable quantity of faeces

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

vascular than natural

and

this intestine, as well as the

stomach, contained
to the coats,

much

tenacious mucus, which adhered


easily

and was not

wiped

off.

The remainder
was
firm, but

of the canal was not examined.

The

liver

appeared healthy
tained but

the gall bladder contracted, and con-

little bile.

In the thorax

the right lung firmly adhered

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,

mixed with serum.

The luug op

the

same

side

was quite

308

CASES OF
and pleura pulmonalis,

collapsed, and the pleura costalis,

coated with a layer of coagulable lymph.

The

left

lung

adhered extensively to the

Head.

Much
The

side,

but was otherwise healthy.

fliiid
:

blood flowed when the longitu-

dinal sinus

was cut

the arachnoid

membrane was much


effused
fluid

thickened, and almost opaque:

there was
all

under

it.

brain was firm

the ventricles were full

of serum. There was also serum


Observations.

at the basis

of the brain.

The

state

of the inner surface of the

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

the period of each attack of mania he has laboured

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

time he voids worms.


gr. v.

R Pil. Hydrarg.

Submuriat.

nocte sumend.

Haust. Cathart. 4ta. quaque hora.


20.

Venae Sec. fluant sang.

5x1].

01. Ricini, manfe quotidie, Js

24.

Remains nearly
Pil.

in the

same

state.

Cath. 3. omni nocte.

01. Terebinth. Rect. gutt. xxx. ter indies.

ENTERIC MANIA.
31.

309

He

has been violently purged


:

the stools have contained

a considerable quantity of blood


subsided:
his strength
is

the

tumor of the abdomen has


he seems
to

reduced:

have

lost

all

symptoms of mania; complains of pains


arteries pulsate too strongly.

in his

head:

carotid

Cucurbit. Cruent. inter Scapulas, admov. ut fluat


sanguis ad 3xij. Empl. Lyttae Nuchas admov.
01. Ricini, Jss. quotidie.

Nov. 10.
Dec. 5.
complaints.

Discharged cured.

He

has had no relapse with respect to any of his

Observations.

This was

depending on intestinal irritation of worms.

irritation

a well marked case of mania chiefly, perhaps, the


:

The
sioned

disorder in the intestinal canal seems to have occa-

considerable

disturbance in the sanguiferous

system, and the head became affected with the

symptoms
and were

of increased determination,

which required,

relieved by, the evacuation of blood.

Similar changes

probably

occur in cases in which

we

cannot so trace

the succession of phaenomena.

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
;

A slender youth, about eighteen years

refused food

has been without sleep


talkative;

constantly raving,

and incoherent. Is noisy and

hot, vessels of conjunctive full.

sometimes he weeps. Scalp Looks as if he had been

310
drinking hard.

CASES OF
Mouth
parched.

Tongue

furred.

Pulse

quick and feeble.

Skin cold.
and keep
it

Warm

bath, shave the head,


cloths.

covered with cold wet

Calomel,

gr. viij. statim.


Jij. 4t&.

Haust. Cath.

qq. h.

donee alvus

solut. fuerit.

Low
14.
risen in frequency

diet.
;

Circulation more general

bowels purged.

Pulse has

and
Cath.

fulness.
Jxij.

Vense Sectio. fiuant sang.


Pil.
o. n.

Haust. Cath.
15.

o. 4. h.

Slept four hours;

many dark and


altered.

offensive stools;

in

other respects his state

is little

In the blood which was


in quantity in proportion

drawn
to the

the crassament

is

lax,

and great

serum.
Continue Purgative Draught.

Let him have Tamarind Drink.


16.

Slept well

scalp continues hot.


viij.

Symptoms

as before.

Hirud.

ad

sing.

temp.

Continue cold cloths to the head.


Calomel,
gr. v. h. s.
5j.

Postea

01. Terebinth.

ter indies.

He
24.

asks for food.

Let him have mutton broth, and milk


6. qq. h.

for

breakfast.
Pil.

Cath.

iij.

si

opus

fuerit.

Haust. EfFerves.

4. qq. h.

Omit Turpentine,

On

the 27th

Emp. Lyttae Nuchse. and the 31st leeches were applied


as follow:

The reports subsequently are More tranquil. Nov. ]


.

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

pulse in the temporal artery

exceedingly rapid.
Sectio. Art.

Temp.

fluant sang. Jxvj.

Repet. Haust. Cath.

ENTERIC MANIA.
Partial collapse occurred after the bleeding:
relieved.

31

he was much

7.
8.

Shower bath ;
gr.
iij.,

cold.

Stools copious; clay-coloured.

Noisy.

He was

ordered

Calomel,

with Aloes and Tartarized Antimony, every

fourth hour.

On
is

the 15th his


tranquil;
:

mouth became

affected

by the mercury; he

more

bowels moved three or four times in the day;


is

stools bilious

he

extremely feeble.
the Calomel and other medicines.

Omit
19.

Great heat of the scalp.

Temporal and carotid

arteries

beat with considerable force.


Sectio. Art.

Temp;

et fluant sang. Jxij,

Haust. Cath.

20.

Greatly reduced by the bleeding.

He

slept last night.

Stools pass involuntarily.


lips livid
;

Pulse hardly perceptible at the wrist;


:

skin ulcerated at the sacrum

he seems

to be sinking.

Let him have wine according to circumstances,

^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.

Wine and Arrow Root

occasionally,

Dec. Cinchon,
28.

Constantly rubs and picks his nose.


Pulv. Rhei, gr. xv.

manb sumend.
as

Dec. 24.

Symptoms continue
Is

on the 28th. Lucid

intervals,

of long duration.
Jan.
6.

much

improved.
n.
diet.
4

01. Tereb.

3iij. o.

Continues nourishing

He

continued to improve from

this time.

As

soon as he gained
to

sufficient strength,

he was sent by the apothecary

walk daily

along the banks of the canal.


assisted his

This, with cold bathing, greatly

convalescence.

taken away by the captain

He grew remarkably fat, and was who had left him on August 3, I8I9.

312
Observations.

CASES OF

In

this case

a considerable relief was

obtained by topical bleeding, &c. and by acting on the


intestinal canal;

but the disease seems to have been cured


This occasioned a profuse and

by

the complete relaxation of the system produced by

bleeding on the 20th.


in the event salutary.

long continued discharge from the bowels, which proved

CASE
Gard Luke,
Oct.
4, 1818.

IV.
in-patient
at

admitted

the Hospital

A man

of colour, a native of Jamaica, aged forty years,


:

has been in his Majesty's navy for some years

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
'*

Well," says he,

*'

one day, while


should do,
knees.

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,

on the rocks, and tinking what cried, holding my head down on

me

my

This

me

staid

some time

all

said,

fear,

tings for

got home to England."


This hallucination was the leading feature of his disease,
as far as relates to the mental

symptoms.
it.

If he could not
for,

obtain from the nurse any thing he asked


say he

he used to
is

would

tell his

Father of

If asked,

Who

your

Father.^ his reply was,

God

Almighty.

to the ceiling, and say he was there.


passionate, but easily quelled, if he
his

He would point He was extremely


to

was allowed

have

own way. From the

date of his admission to the period of his

ENTERIC MANIA.
deatli,

313

the following were the

symptoms under which


:

laboured, in respect to the natural and vital functions


P^'rexia,

he.

dyspnoea,

hurried

circulation.

Tension of

abdomen, morbidly dry


pated bowels.

skin, voracious appetite, consti-

After an uncertain period the above symp:

toms would be changed for the following


debility;

Languor and
tongue more
the
effusion in

lowness of
;

spirits

no appetite;
;

furred than usual

pulse less frequent

abdomen

diarrhoea.

During

this latter state

of the case

his hallucinations disappeared.

He

complained of pains, which he referred generally

to

the umbilicus and right hip-joint.


relieved

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

substance more conspicuous than


Pineal gland con-

Ventricles distended with fluid.


grit.

tained no

so united

Abdomen. The whole of the abdominal viscera were by adhesions, apparently the effect of chronic

inflammation, as not to be separable without destroying the


parts.

The omentum was


like the pancreas.

enlarged, diseased, and firmly

attached to the parietes of the abdomen.


it

When

cut into,

looked

The

surface of the intestines

was covered with numerous small cartilaginous bodies. The mesenteric glands were enlarged, and as hard as
cartilage.

The
was

lungs adhered to both sides of the thorax.


fluid.

The

pericardium contained
flabby,

The

right side of the heart

The

left ventricle

and the cellular substance loaded with serum. was thickened.

Observations.

In

this case,

although the mental hallu-

314

CASES OF

cination appears, from the man's story, to have discovered


itself first,

while he was under the impression of grief and

anxiety, yet the subsequent history of the symptoms, which

were accurately observed, evinces that the disease of the


cerebral function had
its

foundation in the state of the


is

abdominal viscera.

This

manifest from the disap-

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

of the organs gave

way

to relaxation,

which was evinced by diarrhoea suc-

ceeding to constipation, anorexia to voracious appetite,

languor and debility to a state of comparative tone and


vigour, the morbid excitement of the brain, on which the

hallucination depended, disappeared.

That the condition of morbid excitement, both


vascular action, or an inflammatory state,
this case,
is

in the

brain and in the abdominal viscera, was a state of increased

proved, in

by the appearances discovered on

dissection.

CASE
Elizabeth Jones,

V.
6,

admitted Jan.

1816.

An

unmarried woman, aged

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

months, and has gradually


friends

become worse,
ordered

thought

it

necessary

to have her confined.


in a similar

One

of her sisters has been dis-

way.

Present symptoms.
ing, or crying.

She

is

continually talking, laugh-

State of the 7iaiurnl functions.

Bowels

generally in a

constipated state; tongue covered with a dark brown fur;

breath very offensive

pupils

more

dilated than natural.

ENTERIC MANIA.
Treatment.

315
it.

Head shaved
R Pulv. Jalap.
manb
ft.

a blister applied to

5ss.

Hydr. Submur. gr. v. Antim. Tartar, gr. ij. M.


Pulv.
altern. dieb.

sumend.

Jan. 20.
talks less.

Bowels open.

Urine natural.

Tongue
n.

clean.

She

Pulv. Aperiens, 5ss. manfe p.

r.

Shower bath every second morning.


Feb. 12.

She has improved considerably.


Continue the Aperient Powder.

Continue the shower bath.


28.
slight

In other respects nearly in the same

state.

She has a

cough, with oppression on the chest.


Venae Sectio.

fluant ^xvj.
;

Saline Apert. Mixture, with Tinct. Opii Camphorat.


three or four times in a day.

March

6.

Cough
Empl.

better

has some pain in the chest.

Lyttae part, dolent.

Repet. Mist.

April 5.

Pectoral
far

complaint has been removed.


is

Mental

derangement so

removed that she

allowed to walk out of

the house occasionally without

any attendance.

Continue the Saline Aperient, without the Tinct. Opii Camph.

May

17, lSl6.

Discharged cured.

Observations.

There

is

nothing

else

remarkable in

this

case but the

gradual

diminution of the symptoms of

mental disorder holding a proportion to the improvement


in the state of the natural functions.

CASE VL
Elizabeth Eden, admitted March
20, 1815.

An
stout

unmarried woman, aged twent3'-six, of short and

make,

large head, large dark eyes, dark hair, short

neck, who, about three years ago, laboured


affection similar to her present disease;

under an

from which she

31^

CASES OF

recovered through the use of purgative medicines and the

shower bath.
Present symptoms.
while speaking.

She
and

is

incoherent, and talks and

sings continually; has a pecuhar

way of

rolling her eyes

State of the natural

vital functions.

Bowels

constift^r;

pated; urine scant}'; tongue covered with a white


pulse very frequent and strong
Treatment.
:

head very hot.

Head shaved.
the Temporal arteries.

Twenty ounces of blood taken from


Mist. Cath.

cum Antim.

Tart, quant, sine vomitu sumere potest,

manb
April 12.

quotidie.

Continues the Cathartic mixture.

Uses the shower

bath every morning.


July 18.

Appears

to

be quite recovered, and has been

made

a deputy nurse of the insane ward.

CASE
John Laundry,

VII.

admitted July 10, 1S16.

coppersmith, aged forty-two, of short and meagre

habit, florid complexion, sanguine


irritable disposition.

temperament; highly
last

He

has been confined the

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,
:

and very incoherently

extremely weak
Treatment.

pulse Q5f feeble.

Head shaved.
:

01. Ricini, ^ss. occasionally, to keep the bowels open.

Diet, chicken broth and gruel.

Aug.
20.

I.

Derangement as before
Continue.

strength improved.

No

alteration,

except that his appetite

is

improved.

Bowels and urine naturah

ENTERIC MANIA.
Oci.
6.

317
other respects im-

Deranged as before: health


Diet, mutton broth.

in

proved.

A pint of porter daily.


24.
Still

deranged

strength improved.

Cucurb. Cruent. Scap. et extrahantur sang. Jxvj.


Discontinue the porter.

Nov. 14.
regular.

He

has been of late

less noisy.

Bowels and urine

Sulphat. Magnes. manfe quotidie.

Dec. 12.
respects

Derangement nearly as before;

health

in

other

much better. March 15. He has had


;

slight febrile affections


side,

during the last

few days

complains of a pain on the right


Abrad.

low down. Head


Pulse 110.

aches; skin hot and dry.

Bowels constipated.
Capiti.

Capilli.

Empl. Lyttae

Einpl. Lyttse lateri affecto.

Pulv. Febrif. statim.

Magnes. Sulphat.
19.

5j.

post horam.

Fever considerably abated.

Pulse 86,

full

and strong.
fit

29.

About

eight P.

M. he was

attacked by a

of apoplexy.

vein in the arm, and a branch of the temporal artery, were

opened, but he expired in about sixty-five minutes from the time

of the attack.

Dissection of the head.

Extravasation

on the surface Sub-

of the brain.

Ventricles contained an unusual quantity of

serum.

Plexus choroides very large and vascular.

stance of the brain harder than usual.

CASE
Alice Lowe.
Aug.

VIII.

9, 1816.
sta-

An
ture,

unmarried woman, aged twenty-four; of short


cheerful disposition.

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,

covered with a brown fur

complains
rational,

of pain about the forehead.


except at times.

Appears tolerably

Head

shaved.
,

Blister applied.

Pulv. Cath. 3ss.

Antim. Tart.
ft.

gr.

ij.

Pulv. altern. dieb. sumend. man^.

Sept.

2.

Is
;

more tranquil
appetite good.

bowels open

urine natural

tongue clean

Continue the Powder twice


12.

in the
;

week.
;

Complains of pain
full,

in her right side


;

breathing oppressed

pulse 108,

and rather hard


is

bowels affected with diarrhoea:

the pain in the side

a symptom which frequently troubles her.


latus.

Empl. Lytt. ad

Pulv. Cath. Antimonial. statiin.

14.

Pain in the side quite removed

appears rational and

collected.

R
ft.

Pulv. Jalap,

gr. xij.

Potass. Supertart. Jss.

M.

Pulv.

manb
to

quotidie sumend.

22.

Continues

improve daily.

Takes the powder occa-

sionally.

Oct. 5.

Discharged cured.

CASE
Anne James,

IX.

admitted July 15, J813.


thirty-five,

married
;

woman, aged
who,

occupied as a

niantua-maker

for the last

three years, has been

affected with a slight degree of insanity, for

which

it

was

not deemed requisite to put her under confinement.

She

is

of the melancholic temperament;

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.

Bowels constipated; urine highly coloured and scanty;


breath offensive.

She uses exceedingly


indecent gestures.
Treatment.

offensive language,

and makes

Cathartic
Blister to the

draught, with Antimon. Tart., every

morning.
head; to be kept open.
Blister healed.

A%ig. 1.

Continues the mixture.

Uses the

shower bath every morning.


16.

Shower bath continued


She
is

mixture every other morning.

Sept. 27.

much

better,

and

is

permitted to walk about

the house, without being confined by a straight waistcoat.

few weeks after the

last

report she escaped and went to

London, where she now


her

resides.
is

letter

from her friend has


is

given information that she

much

better,

and

enabled to gain

own maintenance.

CASE
Jane Young.
January
8,

X.
1816.
;

married woman, aged thirty-two


;

of sanguine tem-

perament; short and thin


Present
thirst;
state.

the mother of a family, affected

with insanity without any assignable cause.

Bowels

constipated;

tongue

white;

dry skin; countenance wild;

pulse quick;
:

com-

plains

of pain about the

forehead

talks rationally at

limes.
Treatment.
Ftb. 12.

Cathartic Powder every morning.


Continues nearly in
the

same

state.

Takes the

powders prescribed.
Shower bath every second morning.
*

320
March
19.

CASES OF
She
is
;

considerably better.

Tongue clean: coun-

tenance more serene

bowels open.

Discontinue the Powders.

Extract. Coloc. Co. 3iss.

Pulv. Ipecac. 9].

Calomel. 9ss.
ft.

M.
Capt. 2. omni nocte.
pills

Massa

in Pil. xxx. dividenda.


;

j^pril 28.

Continues the
:

bowels regular; tongue clean


is

appetite good

she

is

free

from pain, and

rational.

June 15.

Discharged as cured.

CASE

XI.
29, 1816.

Elizabeth Harding, admitted Aug.

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.

She has been insane before

this time,

but was cured, and


is

remained sane three years. Her present attack have been occasioned by domestic troubles.
Present state.
is

said to

extremely violent, and uses obscene expressions.

Natural functions.
tremely offensive
Treatment.
;

Countenance wild and desponding. She Bowels constipated; breath expupils

much

contracted.

Head
R
Calomel,

shaved, and a large blister applied over the

back

part.

Pulv. Jalap,

gr.

xxv.

gr. v.
gr.
ij.

Tart. Antimon.
ft.

M.

Pulv. manfe altern. dieb. sumend.

Sept. 12.

No

material alteration has taken place.

Arter.

Temp,

secatur et fluat sang.

Ibj.

Pulv. Cath.Sss. manfe quotidie.

24.

Pain in the head not so severe.

Countenance assumes a

milder aspect.

Not

so talkative.

Bowels regular.

Continue.

Shower bath every other morning.

ENTERIC MANIA.
Oct. 12.
Is Is

321
maniacnl symptoms.

apparently convalescent.

No
is

Nov.
Dec.

4.

considered quite well, and

employed as a nurse

in one of the wards.


5.

Discharged cured.

She was re-admitted on


It
is

May

2,

1819.

reported that her attacks have always been pre-

ceded by intemperance.
Present
feeble
:

Her pulse is noisy and incoherent. no increased heat on the scalp. Tongue white.
state.

She

Eyes suffused.

Passes off urine involuntarily.

Haust. Cath. 6th. qu&que hor&.

R Antini. Tart. gr. j.


Calomel,
ft.

gr.

ij.

M.
gr. v.

Pulv.

Suraend. quaque horS, donee vomuerit.

4,

Pulv. Antiraon.

Extr. Hyoscyam.

g. x. o. n.

Mist. Aper. 4ta. quaque hor^.

Pulv. EfFerves. ter indies.


6.

More

tranquil

answers questions.
fetid.

13.

Stools dark

and

Pulse continues feeble.


5ij.

Magnes. Carbon.
Pulv. Rhei, 3ss.

Tinct. Lavend. Co. Jss.

Aq. Menth. P.
Capt. cochl.
15.
ij.

^viij.

M.
all

tertia

qu&que hor&.
her medicines, and have an

She was ordered


Scalp
hot.

to

omit

allowance of meat every day.


18.

Pulse feeble.

She has noisy

restless nights.

Omit

the allowance of meat.

Hirud.

viij.

ad Caput.
c.

Postea
*

frigidis linteis operiatur.

R Haust. Cath.
in the

Antim. Tart.

gr. |. ter indies.

AflPusio frigida.

21.

Much

same

state.

Ordered to be cupped on the


In the evening
ft

head, and lose in that


blister applied.

way

3xij. of blood.

322
25.
Relieved.

ENTERIC MANIA.
Ordered to have
bitter infusion 3ij. ter indies,

and the allowance of meat.

Aug. 20. Nov.

She was discharged cured,

Continues well, and follows her occupation as a market

woman.
Observations.

In

this case the disease in the

head was

evidently connected with a disordered state of the intestinal canal; evinced not only

by the constipated state of


;

the bowels, but by the subsequent effect of remedies


the

by

the fetid alvine discharges, and the morbid secretion from

mucous membrane.

HEPATIC EPILEPSY.

323

CHAPTER

VIII.

EPILEPTIC AND MANIACAL CASES, CONNECTED WITH DISEASE IN THE LIVER, AND OTHER ABDOMINAL VISCERA.

SECTION

I.

Epilepsyf connected with Hepatic Disease,

S^c.

That

epileptic

fits

often arise from irritation in the


canal,
is

stomach and

intestinal

a fact well known.

The dependance

of such symptoms on organic disease


is

of the larger viscera of the abdomen


involved in greater obscurity.
so coincident with the
tions in pathology, that

a subject
fact is

The former
train

common
we
find

of our observaadmitit

no

difficulty in

ting

it

the

latter

is

one which bears with

no
dis-

evident probability, and which

we should not be

posed to admit without a direct proof founded on


decisive examples.
It has

happened
in

to

me

to witness several cases of

epilepsy,

which,

on examination, the symptoms

which point out the existence of active inflammation,


or those of chronic disease of the larger abdominal
viscera,

and particularly of the

liver,

were discernible:

and

in these instances I have observed that remedies


to
relieve the

which were adapted


abdominal
the

disorder of the

viscera, if they

were successful, removed at

same

time, or greatly alleviated the affection of the

32;4

EPILEPSY CONNECTED WITH


In other instances I have admitted

nervous system.

patients into the hospital, or elsewhere

commenced a

course of medical treatment for some disease of the

abdominal

viscera,

and have afterwards discovered

that the subjects of such a disorder

had

also

been

labouring under attacks of epilepsy.

It has likewise

happened that
first

epileptic

fits

have occurred, for the

time,

in

persons already under treatment for

diseases of the description above mentioned.

From
there
is

these observations

it

must be inferred that

some sympathy, or connexion depending on


morbid
state of the brain state

circumstances, unexplained by any principles in pathology, between that

which
of the

gives rise to epilepsy,


liver,

and a diseased

and other large viscera of the abdomen*. I shall now add the details of a case which

first

drew

my

attention strongly to this subject.

CASE
Sarah Avery,
fair

r.

girl of slender

make, middle

stature,

complexion, aged twenty-three years, became

my

very well marked case of epilepsy, in connexion with


of the
liver,

extensive disease

pancreas,

spleen,

stomach, and

mesentery,

is

detailed in the 10th vol. of the

Edinburgh Medical

and Surgical Journal, by Mr. Clifton.


lasted an

In this case there was a

severe pain from the shoulder to the elbow of each arm,

which
have

hour before the paroxysm.

do not remember

to

seen this

attended

symptom mentioned by any medical author, but I once a patient, who laboured several months under symp-

toms of hydrocephalus, in whose case a violent pain in one arm,


similarly situated, was a most distressing subject of complaint.

On

examining the body, tumours as large as a small nutmeg, and


in the cerebellum

marks of inflammation, were found


liver
:

and

in the

the cerebral ventricles were full of serum.

HEPATIC DISEASE.

325

patient in St. Peter's Hospital, on July 4, 1816, " She has

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
:

a day without a paroxysm

or, if she

escapes by day,
the
fit is

is

generally assailed in the night.


she
is

While

violently convulsed

afterwards affected

upon her by pain

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.

under which her disorders had rather inas


to give
;

The symptoms were such


primary disease.
inquiry, and

me

a suspicion

that the liver was the seat of disease

perhaps of the

This suspicion was confirmed, when, on

on referring to a register of cases, I obtained


:

the following account

This patient was in the Hospital four years ago, and


she was brought into the medical ward in June, 1812.
health had been previously broken

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,

or experienced the regular returns of the cata-

menia, for twelve months.

At
which

this

for which,
I

time (June 1812) she laboured under jaundice ; and for the symptoms accompanying it, (of

have not a detailed account,) she was put under a

course of Pil. Hydrarg. with doses of Rhubarb, Soda, and


bitter infusions.

On

this

plan her health rapidly improved,

and she was discharged cured on the 21st of the ensuing


August.

During her stay

in the

Hospital on that occasion she

325

EPIXEPSY CONNECTED WITH


slight
fits
;

was subject to
I

but got rid of them as she

recovered of the jaundice.

now

return to the history of the case during the later

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.

pressure, in the right

instance, to apply relief.

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

an unusual quantity of blood

after the application of

the leeches, one of them having opened a small branch of an

She remained

for

two days very


^iv.

faint.

Pulse extremely

She was ordered

of Port wine daily.

She gradually recovered from the weakness occasioned by the


loss

of blood.

18.

The

pulse sufficiently strong

she has had no

fits

since the

leeches were applied.

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

better; her side very sore

on pres-

much

troubled with flatulence.

Venae Sec. in brachio, fluant ^xvj,


Hirud.
vj.

hypoch. dextro.

R Pulv.
Syrup
Repet.

Rhei,
aa gr. x.

Magnes. Carbon,

Tinct.Zingib.aa3J.
at
ft.

Aq. Menth.

haust.

cum

flatus argeat

sumend.

Pil. Cathart. o. nocte.

25.

Bowels

relieved.

Repet. Mist. Menth. et Magnes.

R Pilul. Hydrarg.
Aug. 12.
Side
still

gr. x. bis indies.

painful.

She has had some

slight

fits

of

HEPATIC DISEASE.

327

convulsion, without loss of consciousness, but accompanied with

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.

time she gradually recovered, without any renewal

of her disorder.
Sept. 30.

She has

lately

been taking an Infusion of Gentian,


three months since she had a
to
fit

with some Senna.


attended with coma.

It is

now

Appears

have recovered perfect health.

Discharged cured.

Observations.

On considering the history of

this case,

combination of symptoms during both the periods when she was under my care, and the
after its termination, the

nature of the remedies which her case seemed to require,

and which were successful in relieving her,

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

other instances, that the secondary disease

required remedies applied to the organ actually affected byit,

not less than if

it

had been the original and only

disorder.

In the two following


large organs in the
section;

cases,

which were inveterate

and incurable ones, disease of the liver,

and other abdomen, was discovered on disit

as well as extensive disorganization of the

nervous fabrick.

In these cases I had

not in

my

power

to ascertain whether the abdominal or nervous


;

disease had the priority with respect to time


fact of their combination deserves notice.

but the

328

EPILEPSY CONNECTED WITH

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.

Is also subject to pain

in the left

hypochondrium, and in the right shoulder.


for

She took

some time

pills,

containing five grains of

Oxyd

of Zinc, with ten grains of Chio Turpentine;

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

fourteen days without any

Previously to her being seized with a

fit

of epilepsy, she

used to complain of a sense of

chilliness,

commencing

at

the lower part of the spinal column, and proceeding up-

wards towards the head

she then lost her consciousness.

The

use of the turpentine changed the character of 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.

dropsical, and purgatives, with diuretics,

subtried,

The

use of mercury had been previously

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

body afforded some curious and

interesting

appearances.

Dissection of
Skull thin
;

Ai^^E HvLSE,
in several places.

bone nearly transparent

No

bleeding points.

Dura mater had a natural appearance.

HEPATIC DISEASE.

329

Pia mater and tunica arachnoides displayed the marks


of inflammation.

Between
observed.

the pia and dura

mater a sHght effusion was

The

vessels

of these

membranes were,

in

general, not turgid, but rather pale.

firm.

The substance of the cerebrum and cerebellum was The internal carotid arteries were ossified, where
vessels running on

they unite at the sella turcica.

The

the dura mater,

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.

herent to the pleura costalis.

The lungs exhibited marks


bore the marks of inflam-

of disease: there was more fluid than usual in the pericar-

dium, and that meinbrane


mation.

itself

The heart was healthy. Effusion into the cavity. Abdomen, Liver. The substance, on cutting

into

it,

appeared

diseased.

Some

of the vessels appeared ossified.

small

portion of the organ was healthy.

Spleen large, but healthy in

its

texture.

Mesenteric glands enlarged and diseased.

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-

that these morbid appearances were more strongly marked


in the medulla spinalis than in the brain
;

and

this

stance, when considered in connexion with the peculiar

sympthe

toms which had preceded the


ascending along
instances, to
slate of the
it

fits in this

case, (I

mean

sense of cold or chilliness felt in the spinal column, and

towards the head,)

may

lead, in other

some

practical indications of importance.

The
little

medulla spinalis has hitherto been too

330
examined

EPILEPSY CONNECTED WITH


in cases
;

of epilepsy, and other

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

author adds, that these eight cases were not chosen


others, with a

from among many


theory.

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

appearances were found in the


coverings *.

spinal

marrow, or

its

In the case of

Anne Hulse,

besides the morbid ap-

pearances discovered in the nervous structure, traces of


extensive disease were found in the abdominal viscera.

The

disorder in the functions of these parts, which laid the

foundation of the change in their structure, was probably


connected, in the relation of cause or of effect, with the

morbid condition of the nervous system.

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

I refer the reader to

to be

found in the eighth volume of

Dr. Esquirol's memoir, of which a tiie London Medical

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

opportunity of inquiring which disease had the priority ia


respect of time,
it is

impossible to decide positively which


;

was

the cause,

and which the consequence


it

but the usual

tenour of observations renders


order of the nervous system had

probable that the disorigin in the disturbed

its

functions of the abdominal viscera.

CASE
John Bennet, upwards

III.

of thirty years of age, was

admitted upon a frenzy warrant, June 19, 1812.

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,

very sullen and

He was

ordered to take

composed of Calomel, Extract of


to

Colocynth, and a small dose of Pulv. Dig., so as

keep the

bowels very open, and


Pulv. Dig. gr.
ss. b.

to

moderate the pulse.

He

began with

d.

Afterwards the cold affusion was used

every morning on his head.

In the following year, in the month of


cold,

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

were prescribed again

after these

symptoms

had subsided, and appeared

to relieve his complaints.

In the latter part of August,

1813, his
bled

fits

and maniacal

symptoms were
artery,

violent.
in

He was

once in the temporal


to

and once

the jugular vein,

and had leeches applied

the temples, and was freely purged.

He

returned, after the use


fits

of these

measures, to his usual

state.

His

still

recurred

339,

EPILEPSY CONNECTED WITH


him weak and deranged; and
his disorder,

frequently, and left

on the whole, seemed gradually gaining ground.


cation of leeches at intervals, and the use of purgatives,

The

appli-

and of the

blue

pill,

were adopted repeatedly.


fits.

Nothing was found materially

to retard the return of his

When

they

came on they were

mitigated by bleeding and emetics.

In June, 1817j his disease was very severe, and his general
health greatly impaired.

His bowels costive, and

all the

functions

of the intestinal canal irregular.

He was

ordered to take Pil.


to

Cath. 3.

alt.

noct. and

to

have eight leeches applied

his

forehead every week.

No

perceptible
I

benefit

was derived.
the

His stools were like


be continued as

chopped straw.

directed

purgatives to

long as this appearance continued.


the nape of the neck.

seton

was

also put into

July 7.

He

felt

himself better.

Yesterday he had three

fits.

Rept. Haust. Cath. altern. noct.

24.

Is

worse than usual.

Lost sixteen ounces of blood.


Stools are watery,

Aug. 20.
containing
Sept. 2.

Purging has been continued.


Fits return as before.

bile.

Little, if

any, amendment.
four days
his

30.
agitated

For the

last

body has been repeatedly

by epileptic attacks.
relief.

Anti-spasmodics were given him,


they recurred very rapidly, and

without

On

the 30th

he expired.
It

has been observed of late by the apothecary, (Mr. Kift,)


fits,

that the longer interval elapsed between the

the

more severe

they were.
his

Previous to the

fit

taking place he was very irritable,

countenance appeared
it

bloated,
cast.

and more than ordinarily

sallow;

assumed a yellowish

Dissection of the head.

The

tendinous expansion of

the occipito-frontalis muscle adhered very firmly to the

pericranium.

The cranium adhered firmly to the dura The dura mater was much thickened
the effect of disease.
It

mater.
evidently from

adhered, in some places, to the

subjacent pia mater.

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

cerebrum contained not more

fluid

than natural.

The cerebellum was


were found effused
in

soft,

and about two ounces of fluid

it.

Cavity of the thorax.

Right lobe of the lungs diseased,

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

vessels of the intestines appeared unusually

empty.

In the two following cases, which were speedily


relieved, there

were symptoms of acute

hepatitis, con-

nected with the appearance of epilepsy.

CASE
Elizabeth Button.

IV,

Augusts, 1820. comoften


is

girl,

ten years old, of slender form and pallid

plexion.

Her abdomen

much

enlarged

she

is

troubled with flatulence to a considerable degree, which


causes a rattling noise in her body.
deficient
;

bowels generally loose.


to detect

Her appetite very Her mother has never


She
is

been able
She had

worms
She

in her evacuations.

often troubled with headache.


lately a
fit.

fell

down suddenly

insensible,

334
and lay as

EPILEPSY CONNECTED WITH


if

she was dead about five minutes.

Similar

attacks have occurred repeatedly within the last fortnight

before which period she never had any such symptoms.

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.

The Calomel purged her


slight pressure is

freely,

and the bowels have been

moderately affected by the emulsion.

when

made on

the region of the liver

She complains of pain and ;


inferior

there seems to be

some swelling and hardness of the

margin of that organ.

Ten

leeches to be applied over the right hypochondre, and

afterwards a blister-

Calomel,
9.

gr.

iij.

ter indies.

She has
it.

been

considerably

purged

by

the

Calomel.

Omit
10.

Mist. Aperiens ter indies.

All these symptoms are


Belly
still

now

relieved.

She makes no

complaint.

tumid.

Pain and tenderness of the hypo-

chondre removed entirely.


Calomel,
gr.
iij.

o. n.

Mist. Aper. Jiss,

manb

quotidie.
this

14.

She was well when she rose

morning, but was

after-

wards attacked with intense pain


Skin very hot and dry.

in the fore part of the head.

Pulse very frequent.

An

appearance of

great oppression in the countenance.


ing, but

She has nausea and retchlittle

throws up nothing except a

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

Mist. Cath. iss. donee catharsis insequatur.

HEPATIC DISEASE.
17.

335
after the bleeding.

Head somewhat
fits
;

relieved,

immediately
I

She has had no


be in danger
relieved
of.

which was what

had apprehended her


the pills

to

No

vomiting after the emetic.

She was much

by the purging which followed one dose of mixture, and she took no more of them.

and

Has
light.

still

some headache, and much of

vertigo.

Pulse of the
Dislikes the

carotid fuller in proportion than that of the wrist.

Ardent heat of the neck and head.

Head to be constantly washed with cold Ten leeches to the forehead.


Aperient Mixture.

water.

19.

Head

presently relieved by the leeches;

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

six or seven times a day.


for the present,

Let her have meaL.broth every day, and,


continue her medicines.

20.
Sept.

Bowels much relaxed.


18.

Has continued

the

mixture regularly.

Is

now

stronger, and quite well.

She requires nothing but an aperient

medicine to keep open the bowels.

Made an
27.

out-patient.
flatulence,

She complained afterwards of

and tumid

state

of the bowels, which were removed by purgatives.


Oct. 17.

She was discharged cured: no ailment remaining


effect

except a slight cough, the


into the country.

of a cold taken.

She

is

going

Observations.

In

this case I

apprehend that there was


the

obstruction in the bowels of considerable duration;


the existence of this disease

signs of hepatic affection were pretty well marked, though


is

not absolutely

beyond

doubt.

It

probably supervened on the former disorder, and

ushered in the

fits, which did not recur after the measures adopted for removing it.

336

EPILEPSY CONNECTED WITH

CASE
Anne Holvey,
Of
florid
jst.

V.
October 28, iS19.

twenty-six.

complexion.
fits.

When

she

came

first

mention of any
such.

hepatitis, aiui her disease

Complained of the was considered and treated as


:

made no symptoms of
could

Had

acute pain in the region of the liver

not bear the slightest pressure on the right hypochondre.

Menstruation regular
Fiat
Veiiffi

in general

the last time very scanty.

Sectio et fluant sang. 3xvj.

Pulv. Feb. 6. qq. h.

Mist. Cath. bis indies.

Nov.

6.

Much

benefited

by the bleeding; pain quite

re-

moved from the

side;

can bear pressure:

mouth

sore.

Has

menstruated very copiously.

Pulse frequent; rather hard.


stairs,

few days ago, when walking up

she was seized with


left

an involuntary twisting and shaking of the


at the time, but

foot

It

went

off

occurred again, and then the convulsive agitation

rose along the thigh to the trunk, and, reaching her head, she
fell

down

in a state of insensibility

and convulsion.

The

left

leg

and side were most convulsed.


after recovering her senses, but

She was languid and fatigued


in her head.
left foot,

had no pain

The same
She stopped

convulsive shaking seized her


it

a third time.

from

rising to her

head by grasping and holding

tight the muscles of the leg.

On
before,

being questioned whether she had ever been subject to

fits

she said that about three quarters of a

year ago she

had two; but was never similarly affected before or since that
time.

Nov. 13.

Is

quite

well; except that she

is

much

troubled

with wind in the stomach


ever of
fits.

and

bowels.

No symptoms

what-

M. Menth. c. Rheo, M. Cath. aa. 5j.t. d.


Pil.

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

a case of slight leipothymia, which


its

I insert on account of

evident connexion with the

state of the natural functions,

and of the probable co-

existence of disease in the liver.

CASE
Sarah Reynolds,
aet.

VI.
July 31, 180.

twenty-seven.

pallid unhealthy looking


;

woman

complains of severe

pain in her head

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
:

chiefly about the fore part of

a sensation of fainting and loss of consciousness

but

immediately recovers
rather
full.
is
:

herself.

Her pulse

is

regular, and

She
bilious

very subject to complaints, which she terms


a disordered state of the stomach, attended

viz.

with headache.
appetite, and

Has

lately a sensation of painful heat in

the stomach and right hypochondrium.


is

She has

lost

her

often sick, and vomits in the morning.

Cannot

lie

hepatic region.

on her right side, or bear pressure on the Catamenia regular.


to lose fourteen

She was ordered


temporal artery.

ounces of blood from the

Episp. Nuchffi.
Pulv. Feb.
o. 6. h.

August 26.

M. Cath. quotidie. The artery did not

afford blood.

Six leeches

were applied
of her

to the temples,

which bled in considerable quantity.


relieved, and she has had no more Cannot bear pressure on the epigasIs

Her head has been completely


fits.

Bowels open.

trium, and on the right hypochondre, at the edge of the liver.

troubled with flatulence.


Pil.

Cath.
Cath.

3. bis die.
c.

M.

M. M.

Rheo.

aa.

bis die.

Pulv. Emet. eras.

MANIA CONNECTED WITH


Sep. 30.

Has been
is

getting well, ever since she

was here
lately

last,

of

the complaint for which she then applied.


cold,
effects

She has

caught

and

now

labouring under cough and


for

headache, the
to lose sixteen

of catarrh,

which she was directed

ounces of blood.

SECTION

II.
the Liver,

Maniacal Affections connected with Disease of and other Hypochondriac Viscera.

The
liver,

observations in the preceding section

on the

connexion of epilepsy with organic disease of the

and other large viscera

in the

abdomen, pre-

pare us for admitting the same fact in the instance

of maniacal disorders.

Medical authors were long

ago aware of some relation between morbid states


of the parts within the hypochondria and disorders

of the mind, particularly dejection or low


habitual melancholy, bordering

spirits

hence the term hypochondriasis has been attached to

upon

insanity.

But I

apprehend that

all

the knowledge possessed formerly

on

this subject

may
fail

be reduced to the remark, which

could scarcely

to

be made, that dyspeptic symphypochondria,

toms, and flatulent distention of the colon producing

a sense of oppression in the


often

were

conjoined

with

the

desponding condition of
to.

mind I have
indeed,

just

adverted

These symptoms,

sometimes put on the aspect of disease in

the great organs,

when

there

is,

in fact, nothing

more

than a disordered function of the intestinal canal,

HEPATIC DISEASE.

$39,

accompanied, perhaps, with some degree of chronic


inflammation of the mucous membrane, which occasions tenderness on
pressure,

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,

until the researches of

anatomists were of
it.

Dr. Cheyne was, as


:

from time to time, directed to far as I know, the first who


to

pointed out the fact


allude
to
it

he was naturally induced


to

in

attempting

establish

a similar

doctrine with respect to apoplexy.

In his valuable
cited,

work on comatose
the authority of
the

diseases,

Dr. Cheyne has

on
to

Mr. Todd, one of the surgeons

House of
is

Industry, a statement, which, if strictly

correct,
fully
lects

most remarkable, and tends more powerthe connexion of disordered intelliver,

to establish

with disease of the

than either

my own

experience, or the testimony of any physician, with

whose works I

" Mr. Todd, an accurate anatomist," says Dr. Cheyne, states, " that

am

acquainted.

in every dissection he has

made

after idiotism,

and

mental derangement, {aiid he has made upwards of four hundred,) he has found the liver more or less
diseased.

He

observes after insanity


;

generally
is

great change of colour

but the organ

no more bulky,

with a thicker edge, and always connected by preter-

340

MANIA CONNECTED WITH


sometimes of great extent, to the

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

during the last ten or twenty years particularly, have

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

doubt not the fact that disease

in

the liver

existed, in

many of the
;

cases examined by the former

gentleman

though I confess that I

am somewhat
it

staggered at the great


is

number of

instances in which

recorded, and feel disposed to suspect that in some,

out

of the four

hundred
not,

dissections,

the

morbid

appearances were but

slight,

and consisted of phasproofs

nomena which would


been
regarded
as
disease.

by every anatomist, have


of visceral

unequivocal

Within the sphere of


in

my own

observation

and

inquiry, the instances have not been very

numerous
with

which organic disease of the


has

liver,

or other large

viscera,

been

discovered
I must,

in

conjunction

maniacal disorders.

however, confess that

I have laboured in investigating this subject under

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

St. Peter's Hospital.

He

was, from the time of his


his

admission, in a very infirm state of health

mental

HEPATIC DISEASE.

341

disorder had never been very severe, and ultimately

subsided into a state of morose dejection, in which he

seemed
troubles.

to be perpetually brooding over his domestic

Dissection, as

it

will

be noticed, displayed
liver,

organic disease both of the brain and of the


other hypochondriac viscera.

and

not disposed to regard as accidental.


will

The combination I am The reader


this point.

form

his

own judgment on

George Batt,
bruary 26, 1815.

admitted under a frenzy warrant, Fe-

A
light

tall

and muscular man, of


is

fair

complexion, blue eyes,

brown hair, high forehead, broad face, aged forty-

two.
his

He

a married

man, by

trade a hatter.

Some of

paternal relations have been afflicted


is

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

appeared that his wife was a

woman

of loose

character, and that circumstance preyed

Present sijmptoms.

Pain, or sense of weight across the


:

upon

his mind).

forehead, over the eyes

pupils contracted

tongue white
:

bowels costive
very restless.
Treattnent.

urine scanty and high coloured

he

is

Head
Not

to

be shaved.

blister to

be applied to

it.

Purgative draught, with nauseating dose of Antim. Tart.,


every morning.

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.

Shower bath every morning.


Magnes. Sulph.
3ij.

Bis indies in Infus. Rosse.

April

4:.

Sodse Phosphat. 3jAntira. Tart. gr.


ss.

Mane

quotidie. (In broth, if he will not tate a draught).

342
May
31.

MANIA CONNECTED WITH


Fiat V. S. et
Epispast.
fl.

sang. Jxvj.

Nuch.

June 12.

Under

the treatment above described he gradually


fit

recovered; and on June 12 was thought

to

be discharged.
while living in
violently
if

Happening, however,
separation from him,

to discover that his wife,

had

become pregnant, he was

enraged, and would have taken

summary vengeance,

some

persons had not gone to her assistance.


Hospital, to prevent mischief, and
still

He was

detained in the

took laxative medicines

occasionally, and the shower bath every second morning.

August
but
viscera:

12.

The symptoms
belly
is

of mental disorder have subsided,

he labours under considerable disease of the abdominal


his

swelled,

and painful on pressure: urine


bowels irregular: he coughs,

scanty:

thirst

troublesome:

his

and

his breathing is oppressed:

complains of being always chilly,

and stands

shivering, with his hands in his breeches pockets.

He

took some powders, composed of Jalap and Supertartrate of

Potass, and had a blister on his chest,

which

relieved his dropsical

symptoms
improved

and, after some time, a mixture of

Rhubarb and Aro-

matic Confection in Mint water.


state of health.

He

gradually acquired an

Dec. 12.

He

often

appears quite sound in

his

intellects.

Appetite, and other functions, natural.

After this period he had occasional returns of his dropsical

symptoms
Squills.

which were relieved by similar remedies, and by


his

When

bowels were constipated he became very


In this

stupid and sleepy, but was relieved by purgatives.

way

he went on, often unwell, but exhibiting scarcely any remains of


his derangement, until October,
slight febrile

1817, when he was attacked by


fever being then prevalent in the

symptoms, typhus
attack

house.
the
7th,

The

commenced on
near the

the 5th,

and on the evening of

while

sitting

fire,

he suddenly expired, no

previous indication of danger having been noticed.

Dissection.

Head. On the removal of the skull bleeding points were observed over the surface of the dura mater; which

HEPATIC

DISJEAS-E.

343

adhered extensively to the skull, particularly about the


great longitudinal
sinus.

In several places there were


to indicate that local inflam-

appearances which seemed

mation had existed^at different periods. The skull was not so deeply furrowed by the marks of
the vessels as
it is

generally observed to be.


vessels minutely injected
;

Dura

mater.

The

the

mem-

brane thickened, and exhibiting marks of chronic disease,


particularly in the duplicature of the longitudinal sinus.

Between
serous
disease.

the dura and pia mater there

was some effused

fluid,

and

the

latter

membrane bore marks of

Both on
lymph.

the surface and between the convolutions of

the brain there was an appearance of a layer of coagulable

The

vessels of the

cerebrum were turgid, and

its

sub-

stance was firm.

The
The

ventricles
:

contained a considerable quantity of

serous fluid

the plexus choroides was turgid.

substance of the

cerebellum was firm, and

its

vessels not unusually loaded.

In general

all

the separable parts of the brain were

separated by the effused fluid.

Thorax.

Lungs

healthy, but

extensively and

firmly

adhering to the parietes.

Pericardium contained a considerable quantity of serous


fluid.

at the

heart appeared to have been inflamed it adhered apex to the pericardium. Liver was generally enlarged, and its right Abdomen.

The

lobe in a diseased state.

Gall bladder distended.

Spleen diseased

its

substance like grumous blood.


;

The
tines,

kidneys were enlarged


pancreaS;

but the stomach, intesparticular

omentum, displayed no

ap-

pearance.

344
Observations.

HEPATIC MANIA.

This

man
larger

laboured long under some

severe

malady of the
during his

abdominal viscera

as

it

was

evident,

life,

by the frequent distention of


;

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

of these parts was primarily affected, and which

secondarily?

The

history of this
this

particular case
;

would

not enable us to answer

inquiry

but the facts

we

possess are so numerous, indicating that disease in the

abdominal viscera has a tendency


brain
;

to

produce disorder in the


so well esta-

while the converse

is

by no means

blished, that

we must conclude

the abdominal viscera, par-

ticularly the liver, to have

been the primary seat of disease

in this instance.

Vexation and

distress of

mind seem

to

have been conIt should

tributing causes to the mental disorder.

be

noticed, that his constitution was naturally predisposed,

by hereditary conformation,

to this disease of the brain.

ENCEPHALIC MANIA, OR EPILEPSY.

345

CHAPTER

IX.

CASES OF CEREBRAL DISEASE, GIVING RISE TO THE PH.ENOMENA OF MANIA OR EPILEPSY; OCCASIONED BY THE DIRECT OPERATION OF

NOXIOUS AGENTS ON THE BRAIN AND NERVOUS


SYSTEM.

SECTION

I.

Preliminary/ Reinarks.

Having
epilepsy,

surveyed those instances in which disease of

the brain, giving rise to the phasnomena of mania or


is

consequent upon disorder in some other

part of the constitution,

we come now

to

mention
by the

cases of a similar affection in the cerebral structure,

which

arise

without any such intervention,

immediate action of injurious causes on the nervous system itself.

The noxious
In the
first

causes which exert their influence on

the brain are of very different kinds.


place

we must reckon under


Such
and
injuries

this depart-

ment mechanical
both to epileptic

injuries

of the brain, arising from

blows on the head.


fits

have given

rise

to maniacal attacks.

Secondly
disease

A
their

variety

of physical
effect

agents

induce

by

immediate

on the nervous
:

system.

Such are opium, and other narcotics


;

variety of stimulants, as alkohol

the habit of

dram-

346
drinking

ENCEPHALIC CASES IN GENERAL.


is

a very frequent cause of mania.

All these

cases must, for obvious reasons, be included in this


chapter.

Thirdly;

Violent emotions,

passions,

long con-

tinued anxieties, by their effect on the nervous system,


often give rise to disease in that structure.
It
is,

therefore,

necessary
:

to

divide

the present

chapter into three parts

the

first

of which compre-

hends what
arising

is

to be said respecting cerebral diseases


:

from mechanical injury


third,

the second, including

those cases which are the effect of physical causes:

and the

examples of similar derangement, ensu-

ing from the operation of mental emotions.

SECTION

IL
to

Traumatic Cases of Cerebral Disease giving Rise above-mentioned Effects.

the

The

encephalon

is

capable of receiving such a variety

of mischiefs from external injury, and the degrees and


effects of

inflammation within the

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

should be found that

every form of cerebral disease arises occasionally from

blows on the head.

Many

observations on disorders arising from this

cause are to be found scattered through the writings


of medical authors.

Sauvages has made a distinct

TRAUMATIC

CASES.
is

347
one of the

species of the traumatic epilepsy, which

most frequent occurrences of


blow on the head, received

this class.

Dr. Bateman
I

has mentioned a case of chorea, which arose from a


in

fall.

have notes of

some by a

cases of maniacal disease which were excited


similar cause.

In short, I believe there


is

is

no

species of nervous disease which

not occasionally

so produced.

As

there

is

no opportunity of adding much that can


what
I

be practically useful with reference to these cases, I


shall include

have to say on the subject

in

short compass, and chiefly confine myself to the relation of a

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,

occasioned by the blow was not ascertained, but he soon


after

and partially hemi-

plegiac on his left side.

He

was admitted

into

the

Hospital as a patient of
blister,

Dr. Wells, who ordered him to have a

and per-

petual diain at the nape of the neck, and to take cathartic

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.

have been forced inwards upon the brain, and penetrating


to the depth of the eighth part of an inch.

An
as

epileptic

fit

took

place

while he was under the

operation, and the

same

disorder assailed

long as he remained

in the Hospital,

peared somewhat mitigated.


his

He

him occasionally though it apwas taken away by

owner, and obliged to go to sea before the wound was healed. It is probable that some considerable disorganiz;ition

had been induced

in

the

encephalon, bj
perhaps, by the

the long continued


irritation

compression, and,

occasioned by a sharp fragment of bone forced

in

upon the dura mater.


In the foregoing case the symptoms

may be

ascribed
it

to compression of the brain.

In the following

can-^

not be supposed that any such circumstance existed.

CASE
Rees Williams,

11.

out-patient, Feb. 15, 18 19.


;

robust man, aged about nineteen


until

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

generally after intervals of three or four days

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

Cathartic medicines were prescribed for this patient, his bowels

being habitually costive, and a seton was ordered to be


the nape of the neck.

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

had been very

much relieved as long as Some blood was now


was marked by
th? cicatrix

the seton continued to discharge.

taken from his temporal artery, a seton

again inserted into the

nape of his neck, the part of the head


blistered,

was

and evacuant medicines


were very

were given.
After these measures the intervals between his
fits

much

prolonged.

designed to have carried topical depletion


it

as far, and to have persisted in

as long as

possible, without

endangering his
effect

life;

and,

if this

attempt

failed, to

have

tried the

of trepanning; but the patient became troublesome in the


intellects being

ward, his

impaired and his temper violent, and in

my

absence he was discharged.

CASE
William Harris.

III.
1,
J

May

818.

A man
lie

of melancholic temperament, aged sixty years


:

has been married sixteen years

of intemperate habits

of violent and sometimes sullen temper.

Three years ago


: :

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

and unmanageable, unless coerced.

He
be

is

extremely dirty; skin cold; pulse

at the wrist

small, quick, and feeble.


felt.
is

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.

Haust. Cath. 3ta. quaq. hora donee alvus soluta


fuerit.

(These prescriptions were given


2.

in the evening.)

Calomel,

gr.

ij.

Antim. Tartar,

gr. j.

M.

In Pulv. sumend. quaq. hora donee vomuerit.

350
4.

CASES OF
He
has been freely purged
:

he was

much more

quiet after

the operation of the medicines.

Is

now

noisy and violent, and

asks for strong drink.

Pulse about 100, strong.

V.

S. et fluant sang. 3xij.

AfFusio tepida.

Mist. Aperiens, 4ta quaq. hora.

Hyoscyami,
5. 6.
Is tranquil since his

gr. x. bis die.

bowels have been moved.

Bowels constipated to-day.


Haust. Cath. 3. qq. h.

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.

lintea frigida capiti admov.


p.
r.

Enema

purgans statim injiciatur et repet.


gr. v.

n.

R
In

Calomel,

Cambogis,
Pil.

gr.

ij.

statim sumenda.

Bain. Calid.

10.

Bowels moved once by the enema; very


Repeat the
Pill,

fetid stools.

of Calomel, &c. in the evening.


fur,

In a sinking

state.

Tongue covered with a dark

and dry.

He

is

insensible.

He was
11.

ordered a cordial draught every third hour,


little

and a
Slept

wine.
after

some hours
Skin
;

taking the wine.

Is

tranquil.

Bowels opened by the enemas.

Stools less dark and offensive

more

natural.

moist.

Pulse 90, soft and compressible.

He
in

is

conscious

says he can eat something.


is

Complains of pain
on pressure.

the right

hypochondrium, which

increased

Tongue

dry, dark,

and tremulous.
aa gr.
iij,

Calomel and Antim. Powder,


6ta quaq. hora.

Cordial Mixture

of Dec. Cinchon. 5vj.


Tinct. Lavend. 3J.

Animon.

ppt. 9ij.

dose to be taken every 3d hour.

TRAUMATIC MANIA.
Repeat warm bath. Empl. Lytta; hypoch.
dextro.

351

Wine

3ii.

twice to-day.
left side

In the evening he had a partial paralysis of the


face.

of the

13.

Pulse feeble.

Extremities livid and cold.


is

He

is

sensible

and

tranquil.

His mouth
Blister

affected

by the mercury.

on the

right side of the head.

Continue the Mixture, with the addition of some Confect.

Aromati

Wine, &c.

He

gradually sunk, and expired on the l6th.

Dissection Thirty -si.v

Hours

after Death.
to adhere strongly

On

removing the
;

skull,

it

was found

to the dura mater

particularly in the course of the great

longitudinal sinus.

Vessels of the dura mater gorged with


effused,

blood.

About four ounces of serum were found

between the dura and pia mater.

Substance of the cerepale

brum

firm.
liver

Lateral ventricles distended with serous fluid.

The

was of natural
full

size

much

indurated.

Gall bladder

of

bile.

Spleen small, and firm.


if filled

portion of both the lungs appeared as

with

effused blood.

CASE
Peter Wessel,
Sept. 20, 1816.

IV.
at

admitted

St.

Peter*s

Hospital,

Prussian mariner, very

tall

and stout, of sanguine

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

other times he was able to do his duty on ship-board,

except ascending the mast, which he could not attempt without great danger of falling. He behaved tolerably
well during the

three or four days after his arrival,

voyage from Jamaica to Bristol but, became so frantic as


;

in

to

render confinement needful. ing to intoxication.


Present
irritable
state.

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

to the Hospital. his hands,

Is continually pressing his


it

forehead with
pain.

and complaining that

gives

him much

Treatment.

Head
Blood

shaved.

Temporal artery

divided,

and

Jxvj. of blood taken.


Blister to the head.

Saline purgatives, with antimonials.

Sept. 25.

much

inflamed.

Still

very noisy.

Repeat bleeding from the arm.


It
is

unnecessary to give minute details of

this

case.

The

disorder was treated by antiphlogistic remedies, local and general,

which gave a temporary

relief;

the pain in the head

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

mania, which can be traced

have here a case of true encephalic to a local injury of the head;


very

and we clearly observe the connexion of mania with


inflammation of the encephalon.
I

much

regret that

the body was not examined; but the principal points in


the nature of the case are perspicuous enough without.

Respecting the treatment of cases of epilepsy, or of mania, proceeding from injuries, little need be said.

NOXIOUS EFFECTS OF PHYSICAL AGENTS. 353

When there is any depression


ascertained,
it

of the skull, or any injury

of a particular portion of the cranium that can be


is

obvious that the trephine should be

used,

if

the case be of such urgency as to warrant

exposing the patient to the pain, and degree of danger,


attending the operation.

In other respects I
will
fall

may

refer the reader to

what

be said on the treatment of those cases, which

under the following department.

SECTION

III.

Cases of Cerebral Disease giving rise to Epileptic, or Maniacal Phenomena, occasioned by physical Agents, which
act directly on the

Brain and Nervous System.

These
in

cases
to

may

be distributed under three heads,

relation

the noxious causes that give rise to

them.
1.

Disease in

the

brain,
its

whether consisting in
effects,

chronic inflammation and

in tumours, or

other spontaneous changes of structure, often exists in

connexion with a scrofulous habit, and gives

rise to

various forms of disorder in the nervous functions.


.

In the second place I

may mention morbid

changes of structure, which are not manifestly connected with a scrofulous constitution.
3.

Various noxious matters taken sometimes with


at others

the aliment;

as

poisons,

occasionally as

medicines, which stimulate the nervous system, and

induce diseased action.

One
A A

of these

is

mercury ; a

354!

CASES OF CEREBRAL DISEASE

substance which so irritates the nervous system, in

some
by
it.

constitutions, as to induce severe

and dangerous

disease.

Maniacal

affections

have often been excited

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

of the lower class.

Where the

natural predisposition to these diseases

very strong, they are brought on by the use of


diet,
is

which contains no noxious or poisonous

articles,

but

simply of a more stimulating or exciting nature

than the constitution of the individual can support.


Patients of this class enjoy good health as long as

they are very abstinent, and use plenty of exercise

but as soon as they indulge in a


the victims of

full diet,

they become
affections are

some

disease.

Maniacal

the class of nervous disorders which are principally


excited in this way.
5.

External
;

heat

is

often

the exciting cause of


;

disease
effect

frequently hot

rooms

but particularly the

of alternations of cold and heat, which happen


spring.

in

the

We

find

many
it is

persons

subject

to

attacks of recurrent, or, as

often termed, periodical

mania,

who

experience a renevval of the disease every

spring or summer, unless they adopt precautions to


protect

themselves

from

the

stimulating

effect

of

returning warmth.

The
some of

following cases will exemplify the agency of


these causes.

PRODUCED BY PHYSICAL AGENTS.

355

CASE
Thomas Weston,

I.

out-patient,

October 28, I8I9.

man

of dark complexion, black eyes and hair,


:

who

has been amaurotic for several years


lethargic,

he

is

constitutionally

fuller habit than formerly.

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,

especially in the carotid.

Eyes
to

He

has habitually bad health, and has long

been
head.
I

afflicted

with

symptoms of determination
this

the

proposed to order a seton in


as

man's neck, but he objected

to

it,

he gained

his subsistence

by carrying burdens on his

shoulders.

He was
issue
in

ordered to lose sixteen ounces of blood, and have an


;

each arm

and take cathartic

pills

every night, and

cathartic mixture three times in the day.

Nov.

4.

Head

relieved

by the bleeding

the lethargic dis-

position has disappeared.

No

fits.

Pulse natural.

Continue Cathartics.
10.

Much

oppressed by vertigo. Ven. Sec. fluant ^^vj.

He

has an issue only in

one arm.
Empl.
Lytt.

ad Nucham.

Fiat fonticulus prope genu.

Repet. Med. Cath.


17.
Suffers

much from
Repeat

hagmorrhoids.

tlie Pills.

Mist. Aper. 6ta quaque hor^.

24.

He
1.

says he

is

in better health than for several years.

Dec.

He

is

often

troubled with a severe pricking and


rises

shooting pain, attended with a sense of numbness, which

from the heel towards the knee of one


great trochanter.

leg,
is

and thence towards the

In other respects he

better.

Ven. Sec.

Empl. Lytt. ad calcem.

3S6
8.

CASES OF CEREBRAL DISEASE

sense of coldness

and numbness
is

in the thigh

pain

less

severe; in other respects he

well, but starts

and moves

his

limbs during his sleep.


P.ulv.

Pulse small.

Empl. Lytt. ad Nucham.


Feb.
o. n.

Mist. Cath. bis indies.

29.

The

shooting pain seizes

him
3j.

in the thigh frequently

he

has symptoms of nephralgia.


Liq. Potass. Subcarb.
Sext^^ quaq.

hora in Infus. Lini.


aa. gr. x. o. n.

Pulv. Feb. et Pulv. Lax.

Mist. Cath. p.

r.

n.

Jan. 19.

Pain nearly as before.

He

is

drowsy and

lethargic.

Ven. Sec. fl. Jxvj. Empl. Lytt. ad femur. Continue Pulv. Feb. and Mist. Cath.
Feb. 8.

The pain

in the thigh nearly

removed.

Mist. Aper. ter die.

June 15.
good health.

The pain and numbness

still

affect the

posterior

part of the thigh occasionally.

In other respects he has tolerably


still

He

is,

however,

troubled with drowsiness, and

feels vertigo, with a noise in his ears,

when he

inclines his head.

Bowels

rather constipated.

He

still

keeps an issue in his arm,

but has not had medicines regularly. Cucurb. Cruent. ad humeros

exsugantur sang. Jxvj.

Emp.

Lytt.

ad Nucham.
Pills

Let him have Cathartic

and Mixture.

He came
cation.

again, to be discharged, on the

3d of Jan. 1821,
feelings,

after

an occasional attendance of fourteen months from

his first appli-

He was now
numbness

free

from

all
;

morbid

except some

relics of the

in his thigh

and said that he had enjoyed


for

better health for

some months past than


fits

twenty years before

he applied.

He had no

since his admission.

Observations.

This

man's brain appears to have been


removal of the epilepsy, and
with the

long the seat of considerable disease before his epileptic


fits

came

on.

The speedy
all

the gradual relief of

the other symptoms,

exception of the blindness, which probably depended on

PRODUCED BY PHYSICAL AGENTS.


disorganization,
that

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,

twenty-two years of age,

History/.

Shape

short and- broad


:

complexion
:

fair,

with large blue eyes

dark hair

high forehead

lively

and affectionate
other children.

disposition.

Her mother observed some:

thing peculiar in her from infancy

she was not playful as

Her mother

has been deranged in her intellects, and

continues to talk oddly.

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.

Antim. Tartar, manfe

quotidie.

Uses the shower bath every morning, the mixture

every second morning.

March

18.

Continues the same remedies.


visit

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

occasion her constitutional tendency to scro-

fulous affections

showed

itself in

a more decided manner.

358
The

CASES OF CEREBRAL DISEASE


glands of the
:

neck were frequently swelled and


repeatedly attacked

inflamed

she

was

symptoms.

When

these disorders

her mental alienation

with her hands folded,

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.

Towards the summer of


ulcerations
in

the neck,

in spite of all

General debility and exhaustion followed ; and increased, attempts to relieve her by tonic medicines
irritable,

and regimen: her stomach became extremely

and she sunk*.


Dissection.

Skull remarkably heavy and


thickened.

thick.

Dura mater

considerable quantity of serum between the dura and

pia mater.

Vessels of the pia mater pallid.

The membrane

itself

thickened.

Fluid within the pia mater.

Substance of the brain very firm.


Pineal gland large, and rather a large piece of grit in
it.

The
sinuses.

longitudinal

sinus

contained

firm

coagulum,
lateral

resembling a polypus, which

extended into the


little fluid,

The

ventricles contained very

and the plexus


in the viscera

choroides was pallid.

Abdomen.

There was

no mark of disease

of the abdomen, except in the mesentery.


the mesentery were very pallid
;

The

vessels of

and the glands extremely

small and indurated.


Obsertations.

Cerebral inflammation,
of the
life.

alternating with
:

scrofulous inflammation

absorbent glands

the</