m m mm Imih IX ? \ ! V EDI CINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONA 'NOI1VN 3 N I 3 I 0 1W JO A a V a S I 1 1VNOI1VN 3NI 3 Id 3W JO AIVDin 1VNO II V N 3 N I 3 I a 3 V I /^ EDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAI * ___-a ■% t-— * ^tf "S ^"Y. * 'NOIiYN 3NI3IQ3W JO AaVaBIl TVNOI1VN JNI3IQ3W JO AaVaSM 1VNOI1VN 3NI3I03W y \ 'NO 11 VN iNDIOiW JO H»Iill l»»Oll»N iNDIQIW iO 1IUII1 1VNOI1VN 3N13I0 3W INOI1VN 3NIDI03W JO AaVaSIl 1VNOI1VN 3NI3I03W JO A IIV IIB I 1 1VNOI1VN 3NIDI03W "/ ; v.. B8I1 1VNOI1VN 3NI3IQ3W JO AgValll 1YNOI1YN 3NI3IQ3W JO A B V B 9 II 1VNOIAVN 3NI S8I1 1VNOI1VN 3NI3I03W JO ABVBBI1 1VNOI1VN 3NI3I03W JO ABVBBI1 1VNOI1VN 3NI m -1 .» w? If/ * V^ ■ * Y OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NA1 1 ^r^kr IV?^ f THK STUDY OF MEDICINE. BY JOHN MASON GOOD, M.D. F.R.S. F.R.S.L. MEM. AM. PHIL. SOC. AMD F. ■■■—<-ct« "*mMtmmmtmmm***m9*»im\nm ixx"eb:&ry MA i 291900 k llOJOLf. IN FIVE Vn£UTVrETS~ VOL. IV. FIFTH AMERICAN EDITION, REPRINTED FROM THE LAST LONDON EDITION, GREATLY IMPROVED AND ENLARGED. jtfEto=¥oi1$: PRINTED BY J. «$• J. HARPER, FOR COLLINS AND HANNAY, COLLINS AND CO., AND O. A, ROORBACH, __PHILADELPHIA, JOHN GRIGG, TOWER AND HOGAN,—BOS TON, PvICHARDSON & LORD, AND HILLIARD, GRAY, LITTLE, & WILKINS. 1827. ■* \MB r ^ CLASS IV CLASS IV. NEUROTICA. DISEASES OF THE NERVOUS FUNCTION. ORDER I. PHRENICA. ♦ AFFECTING THE INTF.T.LECT. II. J3STHETICA. AFFECTING THE SENSATION. III. % CUNRTICA. AFFECTING THE MUSCLES. IV. SYSTATICA. AFFECTING SEVERAL OR ALL THE SENSORIAI, POWERS SIMULTANEOUSLY. CLASS IV. PHYSIOLOGICAL PROEM. The numerous and complicated train of diseases we are now Class IV, entering upon appertains to the highest function of visible beings; nervoui the possession of which emphatically distinguishes animals from jjj"^""^ plants, and the perfection of which as emphatically distinguishes visible man from all other animals: these are the diseases of the nervous be,nss: function ; which in the sphere of its activity embraces the powers embracing oi intellect, sensation, and muscular motion. Each of these powers of intellect, evinces diseases of its own, and will consequently lay a foundation and'mwcu- for a distinct order, under the class before us. While, as there are iar motion. also other diseases that affect several of them simultaneously, we become furnished with a fourth order, which will complete the series. All these diversities of vital energy are now well known to be Ail depend- dependent on the organ of the brain, as the instrument of the intel- ™™*tehe lectual powers, and the source of the sensific and motory. Though, brain: from the close connexion and synchronous action of various other organs with the brain, and especially the thoracic and abdominal viscera, such diversities were often referred to several of the latter ,ho«gi« in earlier ages, and before anatomy had traced them satisfactorily to aTwibel the brain as their fountain-head. And of so high an antiquity is £js°*°r this erroneous hypothesis, that it has not only spread itself through This ancient every climate on the globe, but still keeps a hold on the colloquial tinctures language of every people ; and hence the heart, the liver, the spleen, ropul"„ the reins, and the bowels, generally, are, among all nations, regarded cither literally or figuratively, as so many seats of mental faculties or moral feeling. We trace this common and popular creed among the Hebrews and Arabians, the Egyptians and Persians, the Greeks and Romans ; among every savage, as well as every civilized tribe ; nor is there a dialect of the present day that is free from it; and we have hence an incontrovertible proof that it existed as a doctrine of general belief at a time when mankind, few in number, formed a common family, and were regulated by common notions. The study of anatomy, however, has corrected the loose and Corrected confused ideas of mankind upon this subject; and while it distinctly stud/of shows us that many of the organs popularly referred to as the seat anatom5- of sensation, do and must, from the peculiarity of their nervous con- nexion with the brain, necessarily participate in the feelings and Acuities thus generally ascribed to them, it also demonstrates that & cl. iv.J PHYSIOLOGICAL PROEM GlassIV. the primary source of these attributes, the quarter in winch they originate, or which chiefly influences them, is the brain itself. We are speaking, however, of man and the higher classes of animals alone ; for, as the scale in animal life descends, the organ of a brain is perpetually diminishing in its bulk, till at length it totally disappears, and its place is supplied by other fabrications, as we shall have occasion to observe in the sequel of this introduction : which will lead us to take a brief notice of the following subjects : I. THE GENERAL NATURE OF THE BRAIN, ITS RAMIFICATION? AND SUBSTITUTES. II. THE PRINCIPLE OF SENSATION AND MOTION. III. THE INTELLECTUAL PRINCIPLE. fi^iueand ** *n mani axi^ those animals wnose encephalon approaches the dmSfon"of nearest to his in form, the brain is of an oval figure, surrounded by the brain. var}oas membranes of different firmness and density, and consists of three principal divisions ; the cerebrum or brain, properly so called, the cerebel or little brain, and the oblongated marrow. The first forms the largest and uppermost part; the second lies below and behind; the third lies level with the second and in front of it; it appears to issue equally out of the two other parts, and in turn to give birth to tho epinal marrow ; which may hence be regarded as a continuation of the brain communicating with Us different parts by the aid of numerous commissures, the querbander of flit; Gorman writers, and extended through the whole chain of the back-bone. They are similarly accompanied with a cineritious or ash-coloured substance which forms the exterior of the three first divisions, but the interior of the spinal marrow, and appears to derive its hue from the great number of minute vessels that appertain to it. Substance According to Mr. Bauer's very delicate microscopic experiments, aleordfnlto when the substance of the brain is made a subject of examination Bauer's ex- immediately after death " abundance of fibres," to adopt the words with the0" of Sir Everard Home in relating these experiments, " are met with microscope. m every part 0f j|t. indeed it appears that the whole mass is a tissue of fibres, which seem to consist entirely of an accumulation of glo- bules whose union is of so delicate a nature that the slightest touch, even the mere immersion in water, deranges and reduces them to that mass of globules of which the brain appears to be composed when examined with less accuracy or under less favourable cir- cumstances."—Mr. Bauer found that the globules of the brain, as well as those of pus, are exactly of the same size as those of the And the blood when deprived of their colouring matter.* And hence the detection of doctrine of Prochaska,t and the Wensels,J respecting the globular Prochasisa, fOTm 0f the ultimate particles of the brain, seems sufficiently con- and the r Wensels. «rmea. Muscular Sir Everard Home from these microscopic disclosures, endeavours ^how"1 to show that muscular fibres are minute chains formed by an attach- produced. ment of one globule of blood to another : and that vascularity in * See Sir Everard Home's Croonian Lecture, Pbil. Trans, for 1816, t Opp. Min. Tom. I. p. 342. t De Structure Cerebri, p. 24. PHYSIOLOGICAL PROEM. |cl.i\. "4 coagula or extra vasated blood, or in granulations produced by pus, Class IV. is effected by the escape of minute bubbles of carbonic acid gas from the brain* IL the living fluid ; which hereby opens a path to a certain extent into [f^^nd the tenacious blood or pus that is extravasated or secreted. substitute!, From this general organ arises a certain number of long, whitish, Origin of pulpy, strings, or bundles of fibres, capable of being divided and nerves- subdivided into minuter bundles of filaments or still smaller fibres, as far as the power of glasses can carry the eye. These strings are denominated nerves ; they are surrounded, to their extremities, by one or more of the common membranes of the brain, and, by their various ramifications, convey different kinds or modifications of living power to different parts of the body, keep up a perpetual communi- cation with its remotest organs, and give motivity to the muscles. As the brain consists of three general divisions, it might, at first Reason of sight, be supposed that each of these is allotted to some distinct pur- 0f the brain pose; as, for example, that of forming the seat of intellect or J,"1"'f^ne° thinking ; the seat of the local senses of sight, sound, taste, and mems not smell, and the seat of general feeling or motivity. The investiga- ^own. tions and experiments of Mr. C. Bell, and M. Magendie, to which we shall presently advert, pave the way to some important doctrines in respect to a few of these points, but leave us quite in the dark in respect to various others ; and particularly as to the source of intel- lect ; while it is difficult to reconcile even the doctrines which have thus been fairly deduced with the motific, and even with the sentient mutific powers that must exist in numerous cases of an extensive disorganization of the brain and in acephalous animals. The first and second nerves and the portio mollis of the seventh sufficiently attest their exclusive uses as nerves of the special senses ; while the As the same distribution of the greater part of the third, of the fourth, and of the at times8"13 sixth nerves to voluntary muscles, which receive filaments from no 8ub?ervient other source, prove clearly that these nerves are voluntary nerves purposes3" as well as conducive to muscular sensation. "Perhaps," says Mr. nerve??©" Herbert Mayo," it is not unfair to argue analogically from the pre-the same ceding instances that the same surface of the brain or spinal chord purpos€ furnishes to each voluntary muscle of the body its voluntary and 3entient nerves, if the two are not identical."* There is in like manner reason for believing that the fifth nerve which, at its origin, consists of two portions, is not only a nerve of voluntary motion, but furnishes branches to the special senses, and even communicates general sensation to the muscular fibres ; and that its gustatory twig is a nerve of both touch and taste at the same time. Several of these phenomena may indeed be resolved, though not the whole, into that close interunion which some parts of the brain maintain with other parts by means of ganglions, commissures and decussations of nerves ; whence injuries on one side are often accompanied with loss of motion or feeling in the organs of the other side. So the curious and ingenious, but, I fear, scarcely justi- 'zable experiments, lately instituted by Dr. Philip,! and to which we ''■" Anatomical and Physiological Commentaries, No. n, p. I. 8vo. Lond. 1822 H>j!. Trans. 1915, p, 5—90 8 oh. iv.J PHYSIOLOGICAL PROEM fNttureTf S^a^ ^ave occasi°n t0 return presently, sufficiently prove that stimuli the brain, its of a certain kind, as spirit of wine, applied to the posterior part of tionsfiand tne na^ed brain of an animal, produce the same effect on the heart, substitutes, and equally increase its action, as if applied to the anterior part. To affect the heart, however, it seems necessary that the stimulus should spread over a pretty large extent of the brain ; so as to take in, by the range of its excitement, some of the ganglions of the brain, whose office, as Dr. Philip conceives, is " to combine the influence of the various parts of the nervous system, from which they receive nerves, and to send off nerves endowed with the com- bined influence of those parts."* He hence accounts for some organs of the frame being affected by every part of the nervous system, and others by only certain small parts of it: and the wide influence possessed by the great sympathetic nerve, which is less a single nerve than a string of ganglions. We are also hereby shown why the intestines, like the heart, sympathize with every portion of the nervous system. From all this, however, it is clear that there is much yet to be learnt concerning the actual arrangement of the brain, or of its partition into three divisions, and of the respective share which the lancifui to different parts take in producing a common effect: and consequently subdivisions it seems to be altogether a wild and idle attempt to subdivide these toSthetaWe perceptible regions of the brain into still smaller and merely ima- senses and ginary sections, and to allot to each of thorn a determinate function ^un and faculty. hypotheti- That a sensorial communication, however, is maintained between ThePbrainS some part or other of the brain and every part of the body, and that a sensorial tms communication is conducted by the nerves, is unquestionable ebmmuni- from the following facts : the'bod^'by If we divide, or tie, or merely compress a nerve of any kind, the means of muscle with which it communicates becomes almost instantly para- the nerves. ... . ., • , r , lytic ; but upon untying or removing the compression the muscle recovers its appropriate feeling and irritability. If the compression be made on any particular part of the brain, that part of the body becomes motionless which derives nerves from the part compressed. And if the cerebrum, cerebellum, or medulla oblongata be irritated, excruciating pain or convulsions, or both, take place all over the body: though chiefly when the irritation is applied to the last of these three parts. For, according to the laws of the nervous action as collected from a variety of experiments by Dr. Philip,] and stated in a subsequent paper to that just referred to, " Neither mechanical nor chemical stimuli (irritating the brain by a knife, or pouring spirits of wine upon it) applied to the nervous system, excite the muscles of voluntary motion, unless they are applied near to the origin of the nerves and spinal marrow." Number The nerves issue in pairs, one of each pair being allotted to either charlcteVof side of the body. The whole number of pairs is thirty-nine ; of the nerves. which nine rise immediately from the great divisions of the brain under which we have just contemplated it, and are chiefly, though * Phil. Trans- 1815. p. 436- \ Ibid. p. 444, PHYSIOLOGICAL PROEM. [qL. iv, 9 not wholly appropriated to the four local senses ; and thirty from the p^*88^* spinal marrow through the foramina of the bone that encases it, and the brain.its are altogether distributed over the body to produce the fifth or gene- Jf™,6^ ral sense of touch and feeling, which powers, however, are by some substitutes. physiologists regarded as distinct from each other, and to communi- cate, in an especial degree, irritability to the muscles. We have thus far represented the spinal marrow as issuing from ^^jj," the brain, in conformity with the general doctrine that has hitherto marrow been held upon the subject.* It has of late years, however, been {""brata,1" contended by various physiologists, and particularly by Drs. Gall and or the brain Spurzheim, that the spinal marrow itself is the origin or trunk of the Bpinai nervous system, and that instead of issuing from the brain, it gives [£"[£«« birth to it. The argument is derived from the existence of a spinal the opinion marrow alone in acephalous monsters, and of a nervous chord without spmznefm. a brain, answering the purpose of a spinal marrow, in most inverte- Grr°^ bral animals. Whence it is inferred that the nervous column is the opinion, radical part of the system, and that the brain is an increment from it in the more perfect classes.! The question is not of much importance, though there is some- thing ingenious in thus tracing animal life from its simpler forms. Yet the opinion seems to be in direct opposition to a well-ascertained ^fB°^ndaa fact we shall have to advert to presently, namely, that the magnitude analogy. of the brain and the extent of its intellectual powers hold an inverse proportion to the size of the spinal marrow, and, consequently, upon this hypothesis, to their apparent means of supply. Nor is it the mode of induction usually adopted by physiologists on like occasions ; since they generally describe the arteries as issuing from the heart, instead of giving rise to it, notwithstanding that the heart, like the brain, has been found totally wanting in some monsters, and the cir- culation carried on by an artery and a vein alone, of which Mr. Hewson gives a very singular instance ; \ and that most of the worm genera are equally without a heart though they are in possession of circulatory vessels. We only see in these arrangements that neither a brain nor a heart are essentially necessary to animal life : and that the great Author of nature is the lord, and not the slave, of his own laws ; and is capaple of effecting the same general principle by a ruder as well as by a more elaborate design. There is one part, however, of the system of4 nervous power in the g^j1^]* more perfect classes of animals that is particularly worthy of our at- thefntercos- tention, as furnishing a rule peculiar to itself, and being without a tal nerve" parallel in any other part: and that is the origin, structure, and extensive influence of the great sympathetic or intercostal nerve, which forms a kind of system in itself, an epicycle within the two cycles of cerebral and vertebral influence. It is connected both with the brain and spinal marrow, and may be said to arise from either, * Anatomie dti Cerveau, contenant 1'Histoirc de son developpement dans le foctiu aec une exposition comparative desa structure dans les animaux, par A. J. Jourdan^ &c. Paris, 1823. t Anatomie et Physiologie du systeme nervenx-, &c. par F. T. Gall et I. Snur»>- heim, 4to. Paris, 1810. X On the Lymph. Svsf. Part. n. p. 15- Vot,. IV._5 10 ci,. iv.] PHYSIOLOGICAL PROEM. fwttairf Emitting tlie brain to be its source, it is an offset from the sixth pair thebraintits of nerves, on either side, and in its course receives a small tributary iu.1!»fiMd twiS from the fifth' and branches from all the vertebral, from whose substitutes, union and decussation it is studded with numerous ganglions or me- dullary enlargements, of which there are not less than three in the neck alone tinted by an addition of cineritious substance, a larger number in its line through the chest, and others as it descends still deeper, independently of various confluences of smaller branches that unite and form extensive net-works. Having reached the hol- low of the os coccygis, it meets its twin from the opposite side which has pursued a similar course, and been augmented by similar contributions. rrom its Thus equally enriched with the nervous stores of the brain and the andexten- spinal marrow, it sends off radiations as it takes the course of the c^ursetean aortai to au< the organs of the thoracic, abdominal, and hypogastric instrument regions, to the lungs, the heart, the stomach, and intestines, the blad- synfpatby. der, uterus, and testes ; and thus becomes an emporium of nervous commerce, and an instrument of general sympathy : and what is of infinite importance in so complicated a frame as that of man, fur- nishes to the vital organs streams of nervous supply from so many anastomosing currents, that if one, or more than one, should fail or be cut off, the function may still be continued. To this it is owing, in a very considerable degree, that the organs of the upper and lower belly, exhibit that nice fellowship of feeling which often surprises us. and that most of them are apt to sympathize in the actual state of the brain. pe human There is no animal whose brain is an exact counterpart to that of no exact man : and it has, hence, been conceived that by attending to the inotherPart distinctions between the human brain and that of other animals, we animals, might be able to unfold a still more mysterious part of the animal economy than that of sensation or motion, and account for the supe- rior intellect with which man is endowed. But no But the varieties are so numerous, and the parts which are defi- on"this cient in one animal are found connected with such new combinations, wncorein" modifications, and deficiencies in others, that it is impossible for us the supe-° to avail ourselves of any such diversities. ttohuman Aristotle endeavoured to establish a distinction by laying it down How60** as a maxmii that man has the largest brain of all animals in propor- compared tion to the size of his body ; a maxim which has been almost uni- brain'hy versally received from his own time to the present period. But it The'com- ^ °^ ^ate years, and upon a more extensive cultivation of compa- parison fails rative anatomy, been found to fail in various instances: for while cases"0"8 *^e °rain of several species of the ape kind bears as large a propor- tion to the body as that of man, the brain of several kinds of bird3 Aristotle's bears a proportion still larger. Sbmmering has carried the compa- red" by°r" riso.n tIirough a great diversity of genera and species :* but the fol- sr>mmering: lowing brief table will be sufficient for the present purpose. The weight of the brain to that of the body, forms * Diss, de bssi Encephali. Getting. 1778, 4!©-, ljmSIOL0GICAL PIIOEM. [cl.iv. i J In man from.........J_ to ^ part ClassIV. Several simi-p "" > I. Nature of oeverdi simue..........5_ thebrain.its Dog........... ...__1— ramifica- 1?l~„l „ <. * 1 o 1 tions anj Elephant............_i^ institutes. Sparro.w.............-J-g- Canary-bird...........r'T Goose..............-L-. Turtle (smallest).......s eY? M- Sommering has hence endeavoured to correct the rule of Aris- anrt ,1,us totle by a modification under which it appears to hold universally ; hoidsuni- and, thus corrected, it runs as follows : " man has the largest brain versal,v of all animals in proportion to the general mass of nerves that issue from it." Thus the brain of a horse gives only half the weight of that of a man, but the nerves it sends forth are ten times as bulky. The largest brain which M. Sbmmering ever dissected in the horse kind, weighed only lib. 4oz. while the smallest he has met with in an adult man was 21b. 5^. But the remark applies farther than to man: for this acute physio- Rule logist has been able to trace a direct proportion between the degree tnfmais'in of intelligence in every class of animals, and the bulk of the brain, ^ Sjjjj^f' where the latter bears an inverse proportion to the nerves that arise the scale of from it. And we may hence observe, in passing, as indeed we have ammal hfe- already hinted, that the nerves seem rather to be a product of the brain than the brain of the nerves : for it is much more easy to con- ceive how a fountain may become exhausted in proportion to the magnitude of its streams, than how a reservoir can be augmented in proportion to the minuteness of its channels. Upon a general survey, I may observe that the nervous structure Distinctive of all vertebral animals, comprising the first four classes of the Lin- theiac : nervous nean classification, mammals, birds, amphibials, and fishes, is charac- vtrutcbunj of terized by the two following properties. Firstly, the organ of sense animals. consists of a gland with a long chord or spinal marrow descending from it; and, secondly, that both are securely enclosed in a bony case or covering. In man, as I have already observed, this gland is (with a few ex- ceptions) larger than in any other animal in proportion to the size of the body ; and without any exception whatever, in proportion to the size of its dependent column. In other animals even of the vertebral classes, or those immediately in w'»at before us, we meet with every variety of proportion, from the ape vtries'as which, in this respect, approaches nearest to that of man, to tortoises, dh^ sca'f and fishes, in which the brain does not much exceed the diameter of the spinal marrow itself. It is not, therefore, to be wondered at, that animals of a still lower Nervous description and without a vertebral column, should exhibit proofs of invertebrai" a nervous chord or spinal marrow without a gland or brain of any ammals kind at the top ; and that this chord should even be destitute of its common bony defence. And such is actually the conformation of the nervous system in insects, and, for the most part, in worms; neither of which are possessed either of a cranium or a spine ; and in none of which we are able to trace more than a slight enlargement 12 cl. iv.] PHYSIOLOGICAL PROEM- i^Natur^V °^tne superior part of the nervous chord, or spinal marrow, as it is thebrahi.hs called, in animals possessing a spine ; often consisting of one, and tio7sfiCaand sometimes of two ganglions designed, apparently, to correspond with substitutes, the organ of a brain; the descending column chiefly taking the course a ner°vous of the esophagus and surrounding it. The nervous chord, however, "ortioinu" 1T> these animals is proportionally larger than in those of a superior larger than rank; and, though sometimes simple, as in molluscous worms, in Mlraa^',"1 0tner casesr as in insects, is possessed at various distances of minuter and en- ganglions or little knots, from which fresh ramifications of nerves ganluw111 shoot forth like branches from the trunk of a tree, and which may Qrobab?n3 PernaPs be regarded as so many distinct cerebels or little brains: minute having a close resemblance to the subordinate system of the inter- cerebeis. costa] nerve in man, as we have already traced it in its various rami- fications and connexions. Whether jn worms of apparently the simplest make, as zoophytes and infu- a nervous . rf. . J r . ,. i 1 1 j structure in sory animals, no distinct structure can be discerned, and particularly and?nfuseoBry nothing like a nervous system. The hydra or nearly transparent Eiiitnais? polypus found so frequently in the stagnant waters of our own coun- try, with a body of an inch long, and arms or tentacles in proportion, Their pecu- seems, when examined by the largest magnifying glasses, to consist ;ar ma e. Qf ^ cor)geries 0f granular globules or molecules, not unlike boiled sago surrounded by a gelatinous substance ; in some tribes solitary, in others catenated. And hence, whatever degree of sensation or voluntary motion exists in such animals can only be conceived as issuing from these molecules acting the part of nervous ganglions de- Virey's tached, or connected. And on this account M. Virey has elegantly tionSofCa" divided all animals into three classes according to the nature of their fom their nervous configuration ; as first, animals with two nervous systems, supposed a cerebral and sympathetic, including mammals and birds, amphibials of nervous and fishes. Secondly, animals with a sympathetic nervous system structure, alone, surrounding the esophagus, as mollusca? and shell-fishes, insects and proper worms. And, thirdly, animals with nervous molecules, as echini, polypes, and infusory animalcules, corals, ma- drepores, and sponges; all which in M. Virey's classification are included under the term zoophytes. T°iUCsherise ^ne on^ sense whicli seems common to animals, and which per- common to vades almost the whole surface of their bodies, is that of general henceTuap!'' touch or feeling ; whence M. Cuvier, supposes that the material of posod by touch is the sensorial power in its simplest and uncompounded state; be the base and that the other senses are only modifications of this material, feme's.01'161 though peculiarly elaborated by peculiar organs, which are also ca- Touch, pable of receiving more delicate impressions.* Touch, however, has dlffufed its peculiar local organ, as well as the other senses, for particular nuslu'iocai PurPoses> and purposes in which unusual delicacy and precision arc organs as required ; in man this peculiar power of touch is well known to be wen as the seate(] m tjje nervous papilla of the tongue, lips, and extremities when*' °** ^e finSers- Its situation in other animals I shall advert to situaled presently. in mam * Anatom. Comparat. i. 25. PHYSIOLOGICAL PROEM. [ex. iv. 13 The differences in the external senses of the different orders and Class IV. kinds of animals consist in their number and degree of energy. the^rai^its All the classes of vertebral animals possess the same number ofran,ifica- a- , • • • r , ■ • , • i ,. Uon3 all(1 senses as man. Sight is wanting in zoophytes, in various kinds of substitutes. molluscous, and articulated worms, and in the larves of several ^m^is11 species of insects. Hearing does not exist, or at least has not been "»e same traced to exist, in many molluscous worms and several insects in a external perfect state. Taste and smell, like the general and simple sense of ^jj68 as touch, seem seldom to be wanting in any animal. Number The local sense of touch, however, or that which is of a more i™h™?owcr elaborate character and capable of being exercised in a higher de- classes. gree, appears to be confined to the three classes of mammals, birds, 0f touch and insects : and even in the last two it is by no means common to ""^^J0 all of them, and less so among insects than among birds. In apes and macaucoes, constituting the quadrumana of Blumen- Exists iu bach, it resides partly in the tongue, and tips Of the fingers as in organs"™ man, but equally, and in some species even in a superior degree, in ^gr3ent their toes. In the racoon (ursus lotor) it exists chiefly in the under inquadiu- surface of the front toes. In the horse, and cattle orders, it is sup- veis' posed by most naturalists to exist conjointly in the tongue, and snout, and in the pig and mole to be confined to the snout alone ; this how- ever is uncertain ; as it is also, though there seems to be more rea- son for such a belief, that in the elephant it is seated in the probos- cis. Some physiologists have supposed the bristly hairs of the tiger, lion, and cat, to be an organ of the same kind; but-there seems little ground for such an opinion. In the opossum (and es- pecially the Cayenne opossum) it exists very visibly in the tail; and M. Cuvier suspects that it has a similar existence in all the prehensil- tailed mammals. Blumenbach supposes the same sense to have a place in the same organ in the platypus or ornithorhyncus as he calls it, that most extraordinary duck-billed quadruped which has lately been discovered in Australasia, and, by its intermixture of organs, con- founds the different classes of animals and sets all natural arrange- ment at defiance.. The local organ of touch or feeling in ducks and geese and some in varitrfa other genera of birds appears to be situated in the integument which b;rch' covers the extremity of the mandibles, and especially the upper mandible, with which apparatus they are well known to feel for their food in the midst of mud in which they can neither see nor perhaps smell it. We do not know that amphibials, fishes, or worms possess any Whethor thing like a local sense of touch ; it has been suspected in some of sense In these and especially in the arms of the cuttle-fish, and in the tenta- ^g^3 cles of worms that possess this organ, but at present it is suspicion or worms. and nothing more. In the insect tribes, we have much reason for believing such a in what sense to reside in the antennas cr in the tentacles ; whence the for- exists in mer of these are denominated by the German naturalists fuhlhorner insects1 or feeling-horns. This belief has not been fully established ; but it is highly plausible from the general possession of the one or the 14 cl.iv.] PHYSIOLOGICAL PROEM. i^lture rf other of tliese or8ans bv the insect tribes, the general purpose to thebrain,i°a which they apply them, and the necessity which there seems for some tfo^nd such organ from the crustaceous or horny texture of their external substitutes. COat. Taste and The senses of taste and smell in animals bear a very near affinity to the local sense of touch : and it is difficult to determine whether the upper mandible of the duck tribe, with which they dis- tinguish food in the mud, may not be an organ of taste or smell as well as of touch ; and there are some naturalists that in like manner regard the cirrous filaments or antennules attached to the mouths of Seat of insects, as organs of taste and touch equally. Taste in the more the h/gher perfect animals resides jointly in the papillas of the tongue and the classes. palate; but I have already had occasion to observe that it may exist, and in full perfection, in the palate alone, since it has been found so in persons who have completely lost the tongue from external force or disease. Nostrils the In animals that possess the organ of nostrils this is always the seat of where they smell; and in many quadrupeds, most birds, and perhaps most fishes, fxist. jt js a sense far more acute than in man, and that which is chiefly confided in. For the most part it resides in the nerves distributed over a mucous membrane that lines the interior of the bones of the nos- trils, and which is called the Schneiderian membrane, in honour of M. Schneider a celebrated anatomist, who first accurately described Differs in it Generally speaking it will be found that the acuteness of smell different,n bears a proportion in all animals to the extent of surface which this andmwh' membrane displays ; and hence in the dog, and cattle tribes, as well as in several others, it possesses a variety of folds or convolutions, and in birds is continued to the utmost points of the nostrils, which in different kinds open in very different parts of the mandible. The frontal sinuses, which are lined with this delicate membrane, are larger in the elephant than in any other quadruped, and in this animal the sense is also continued through the flexible organ of its proboscis. In the pig the smelling organ is also very extensive ; and in most of the mammals possessing proper horns it ascends as high as the processes of the frontal bone from which the horns issue. wsetherthe It is not known that the cetaceous tribes possess any organ of trfbeTpos8- smell; their blowing-holes are generally regarded as such; but the sess smell i point has been by no means fully established. We are in the same amphibiais uncertainty in respect to amphibials and worms; the sense is sus- ot worms. pec(e(| jG e&\st \n all the former, and in several of the latter, espe- cially in the cuttle-fish; but no distinct organ has hitherto been traced out satisfactorily. Possest by In fishes there is no doubt; the olfactory nerves are very ob- very'acute- viously distributed on an olfactory membrane, and in several in- stanstances the snouts are double, and consequently the nostrils, quadruple, a pair for each snout. This powerful inlet of pleasure to fishes often proves fatal to them from its very perfection ; for several kinds are so strongly allured by the odour of marjorum, assafcetida, and other aromas, that by smearing the hand over with these substan- ces, and immersing it in the water, they will often flock towards the fingers, and in their intoxication of delight may easily be laid hold PHYSIOLOGICAL PROEM. [cl. iv. U of: and hence the angler frequently overspreads his baits with the Class IV. same substances, and thus arms himself with a double decoy. thfbVain^us There can be no doubt of the existence of the same sense in in- ramifica- sects, for they possess a very obvious power of distinguishing the substitutes. odorous properties of bodies even at a considerable distance beyond TnTeculbut the range of their vision : but the organ in which this sense resides lhe orsan has not been satisfactorily pointed out; Reimar supposes it to exist in their stigmata, and Knoch in their anterior pair of feelers. The general organ of hearing is the ear, but not always so ; for Hearing', in most of those who hear by the Eustachian tube only, it is the or3gfn"the mouth ; in the whale tribes it is the nostrils or blow-hole. It is so, la'ah?*™. however, in all the more perfect animals, which usually for this pur- pose possess two distinct entrances into the organ, a larger and ex- ternal surrounded by a lobe; and a smaller and internal opening into the mouth. It is this last which is denominated the Eustachian Eustachian tube. The shape of the lobe is seldom found even in mammals simi- lar to that in man, excepting among the monkey and the porcupine tribes. In many kinds there is neither external lobe nor external External mi -if i 1 -i • -ii i organvanej passage. 1 hus in the frog, and most amphibious animals, the only in different entrance is the internal or that from the mouth ; and in the cetaceous kmds" tribes the only effective entrance is probably the same kind; for, though these may be said to possess an external aperture, it is almost imperceptibly minute. It is a curious fact that, among the serpents, Serpents the blind-worm or common harmless snake is the only species that destitut'Jof appears to possess an aperture of either sort; the rest have a rudi- a hearing ment of the organ within, but we are not acquainted with its being " previous to sound. Fishes are well known to possess a hearing organ, and the skate Fishes hear, and shark have the rudiment of an external ear ; but like other fishes have an they seem chiefly to receive sound by the internal tubule alone. or*an.a! That insects in general hear is unquestionable, but it is highly insects questionable by what organ they obtain the sense of hearing. The theorgan antennas, and perhaps merely because we do not know their exact uncertain. use, have been supposed by many naturalists to furnish the means : it appears fatal, however, to this opinion, to observe, that spiders hear though they have no true antennas, and that other insects which possess them naturally seem to hear as correctly after they are cut off. The sense of vision exhibits perhaps more variety in the different Sight. classes of animals than any of the external senses. In man, and greatly" the greater number of quadrupeds it is guarded by an upper and daren't lower eyelid ; both of which in man, but neither of which in most classes. quadrupeds are terminated by the additional defence and ornament of cilia or eye-lashes. In the elephant, opossum, seal, cat-kind, and various other mammals, all birds, and all fishes, we find a third eye- lid, or nictitatinp; membrane as it is usually called, arising from the Nictitating ° , iif« -l -I'll- membrane, internal angle of the eye and capable of covering the pupil with a thm its use. transparent veil either wholly or in part, and hence of defending the eyes from danger in their search after food. In the dog this mem- brane is narrow, in oxen and horses it will extend over half the eye- ball ; in birds it will easily cover the whole ; and it is by means of lb cl. iv.j PHYSIOLOGICAL PROEM pNtturoIfthis vei1, according to Cuvier, that the eagle is capable of looking thebraTn^its directly against the noon-day sun. In fishes it is almost always tiaoZfiand uPon the stretch, as in their uncertain clement they are exposed to substitutes, more dangers than any other animal. Serpents have neither this nor any other eye-lid ; nor any kind of external defence whatever but the common integument of the skin. Largest The largest eyes in proportion to the size of the animal belong to edOePyOe.li0n" the bird tribe ; and nearly the smallest to the whale ; the smallest Smallest, altogether to the shrew and mole ; in the latter of which the eye is not larger than a pin's head. rris. The iris, with but few exceptions, partakes of the colour of the hair, and is hence perpetually varying in different species of the same genus. The pupil exhibits a very considerable, though not an equal, variety in its shape. In man it is circular ; in the lion, tiger, and indeed all the cat kind, it is oblong ; transverse in the horse and in ruminating animals ; and heart-shaped in the dolphin. Pupil: In man, and the monkey tribes, the eyes are placed directly under vane's in the forehead ; in other mammals, birds, and reptiles more or less different laterally ; in some fishes as the genus pleuronectes, including the Position of turbot and flounder tribes^ both eyes are placed on the same side of vTries?3 the head ; in the snail they are situated on its horns, if the black points on the extremities of the horns of this worm be real eyes, of Spiders which, however* there is some doubt; in spiders the eyes are distri- ct0™- DUte(j over different parts of the body, and in different arrangements, Eyes of usually eight in number, and never less than six. The eyes of the Rep,a' sepia have lately been detected by M. Cuvier ; their construction is very beautiful, and nearly as complicated as that of vertebrated ani- Poiypesand mals.* Polypes and several other zoophytes appear sensible of the perceivees presence of light, and yet have no eyes ; as the nostrils are not in 1'6*to' every animal necessary to the sense of smell; the tongue to that of apparently taste, or the ears to that of sound. A distinct organ is not always eves.0"1 requisite for a distinct sense. In man himself we have already seen this in regard to the sense of touch, which exists both locally and generally; the distinct organ of touch is the tips of the tongue and of the fingers, but the feeling is also diffused, though in a subordi- ThcsenRe nate anj \ess precise degree, over every part of the body. It is genemi^ut possible, therefore, in animals that appear endowed with particular of "eanerant senses without particular organs for their residence, that these senses touch. are diffused, like that of touch, over the surface generally ; though there can be no doubt that, for want of such appropriate organs, they must be less acute and precise than in animals that possess them. whether Whether there be any other than the five senses common to man llVJaJs and the higher classes of animals may be reasonably doubted, but t°hanrthcnfive we occasionally meet with peculiarities of sensation that can hardly common be resolved into any of them. Thus the bat appears to be sensible ftfthebat'! of the presence of external objects and obstructions that are neither seen, smelt, heard, touched, or tasted : for it will cautiously avoid them when all the senses are purposely closed up. And hence * LeRegne Animale distribue d'apres son Organization. 4Tomes, 8yo. Paris. IP7T PHYSIOLOGICAL PROEM. [cl. iv. many naturalists have ascribed a sixth sense to this animal. It is Class IV. equally difficult by any of the known senses of fishes or of birds to a^hndii account for the accuracy with which their migratory tribes are '?mifiCil:' capable of steering their annual course through the depths of the sXtoutPs. ocean or the trackless regions of the atmosphere, so as to arrive at Spater/1 a given season on a given coast or a given climate, with the pre- «>rdsor cision of the expertest mariner. Whilst with respect to mankind whether themselves we sometimes meet with persons who are so peculiarly even^in affected by the presence of a particular object that is neither seen, m< smelt, tasted, heard, or touched as not only to be conscious of its presence, but to be in great distress till it is removed. The pre- sence of a cat not unfrequently produces such an effect; and the author has himself been a witness of the most decisive proofs of this in several instances. It is possible that the peculiar sense may, in such cases, result from a preternatural modification in some of the branches of the olfactory nerve, which may render them capable of being stimulated in a new and peculiar manner ; but the individuals thus affected are no more Conscious of an excitement in this organ of sense than in any other : and, from the anomaly and rare occur- rence of the sensation itself, find no terms by which to express it. In Germany it has of late been attempted to be shown that every man is possessed of a sixth sense, though of a very different kind from those just referred to ; for it is a sense not only common to every one, but to the system at large ; and consists in that peculiar kind of internal but corporeal feeling respecting the general state of one's health that induces us to exult in being as light as a feather, as elastic as a spring ; or to sink under a sense of lassitude, fat'gue, and weariness, which cannot be accounted for, and is unconnected with muscular labour or disease. To this sensation M. Hubner has given the name of caenesthesis, and several of his compatriots that of selbstgefuhl, and gemeingefuhl, " self-feeling or general-feeling ;" and its organ is supposed to exist in the extremities of all the nerves of the body, except those that supply the five external senses.* I scarcely know why these last should have been ex- cepted : for the sensation itself is nothing more than a result of that general sympathy which appears to take place between different organs and parts of the body, expressive of a pleasurable or dis- quieting feeling according as the frame at large is in a state of gene- ral and uninterrupted health or affected by some cause of disquiet* II. As the nerves thus generally communicate with each other, II. Principle and with the brain where this organ exists, it has been a question in andmotlon! all ages by what means they maintain this communication, and what is the nature of the communicated influence ? or, in other words, what is the fabric of the nerves, and the quality of the ner- vous power ? Upon these points two very different opinions have been enter- Nervous tained from an early period of the world, which under different whether modifications have descended to our own times : for by many physi- 0°'bd0ij,ow7,e cylinders. * Comment, de Caenesthesi. Dissert. Aug. Med. Auct. Chr. Fred. Hubner, 1794. Nature and Origin of Mental Derangement, bv A. Crichton, M.D. 2 vols. 8vo, 1798. Voi. IV.—3 16 03,. iv.j PHYSIOLOGICAL PROEAi, Class IV. ologists, both ancient and modern, the nerves have been regarded ofsenSn as solid capiUaments, or tense and elastic strings, operating by tre- and motion. mors or oscillations, like the chords of a musical instrument; and by others as minute and hollow cylinders conveying a peculiar fluid. Original The word nerve, which among the ancients was applied to tense tteternJof chords of every kind, and especially to bow-strings and musical ae^e. strings, affords a clear proof how generally the former of these Hypothesis hypotheses prevailed among the Greeks. It was not, however, the cratc'/and hypothesis either of Hippocrates or Galen ; for by them, while the GaJen: nerves were regarded as the instruments of sensation and motion, the medium by which they acted was supposed to be a fine ethereal fluid, elaborated in the organ of the brain ; to which they gave the name of animal spirit, to distinguish it from the proper fluid of the supposed arteries which was denominated vital spirit. "Not," says Galen, an_eihereai M that thig animal irit ig of the substance of the soul, but its prime agent while inhabiting the brain."* But with respect to the man- ner in which the animal spirit operates upon the nerves they spoke with great modesty ; for though they thought they had been able tc trace a tubular form in some of the nerves, and particularly those of vision, they had not been able to succeed in others. And hence, •att ex- says Galen, " it is impossible for us to pronounce absolutely and themselves without proof, whether a certain power may not be transmitted uncertain from the Drajn through the nerves to the different members ; or maintained whether the material of the animal spirit may not itself reach the euuoTwith senticnt and moving parts ; or, in some way or other, so enter into the rest of the nerves* as to induce in them a change which is afterw*ards the body. exten(jeo« t0 ^\iG organs of motion."! The ques- In a state not much less unsettled, remains the subject at the pre- anunsettied sent moment. Dr. Hartley, in the beginning of the seventeenth state. t century, revived the hypothesis that the nerves are bundles of solid Sypothesis capiUaments conveying motion, sensation, and even perception, by 3tfringsat°ry a vibratory power, and supported his opinion with great ingenuity and learning ;| but the opposite hypothesis that they are minute tubes filled with the animal spirit of the Greek physiologists, had acquired so extensive a hold ever since the discovery of the circu- lation of the blood, which presupposes the existence of tubular ves- n°hailB h° se's *°° su^^e *° Dc traced by the senses, that it never obtained hypothesis more than a partial and temporary assent; and hence, from the hamyand" t*mes of Sydenham and Boerhaave almost down to our own day the Boerhaave last has been the popular doctrine ; is to be traced in the general arfho^ow tenour of medical writings ; and has been especially maintained by cylinders^ Sabatier and Boyer. an animal In effect, no fibres of the animal frame can be less adapted to a Nervous communication of motion by a series of vibrations than those of the adaestednto nerves' since none exhibit a smaller degree of elasticity; and Nations, though we have little reason to confide in their tubular structure, vltnoproof or to believe that any kind of flui<* is transmitted in this way, the of their h.!fufar. ! ?/ Hipporaatis elt Platonis Decretis, Lib. vn. A. Tom. i. p. 967. Ed. Basil. 1542. T W. Sect. C. p. 969. t Observations on Man>his frame. &c. bis duty, and his expectations. 2 vols, 8yo. PHYSIOLOGICAL PROEM. [ex. jv. 19 close affinity which the nervous power is now known to hold with Class IV. several of the gases that chemistry has of late years unfolded to us ; of sonsSn and the wonderful influence which some of them possess over the Litttedoubt moving fibres of the animal frame, seem to leave no question that however of the nervous power itself is a fluid, though not, perhaps, of their and'pecu- precise nature, yet resembling the most active of them in its sub- liar fluid: tilty, levity, and rapidity of movement. Nor is there upon this sup- which, like position any difficulty in conceiving of its transmission by solid fibres gases"3 or capiUaments of a particular kind, the neurilemma of Bichat, does not whilst we behold the ethereal fluids, now referred to, transmitted in need of the same way by substances still more solid and unporous. v&£Z for But there is another question, closely connected with the present its trans- subject, that has also greatly interested physiologists both in ancient miS810n' and modern times, and is not yet settled in a manner altogether satisfactory. It has appeared that the nerves are instruments both of sensation Whether and motion. Are these two effects produced by the same nervous and motion fibres or by different ? or by the same fluids or by different ? That p0c™mon there must be two distinct kinds of fibres, or of fluids, is clear, be- °r rr°n> cause, as we shall have more particularly to observe when we come to sources? treat of paralysis, the muscles of a limb are sometimes deprived of ^feecJ)v°ust both sensation and motivity at the same period, sometimes of sensa- proceed tion alone while motivity continues, and sometimes of motivity alone [[°™ fibres while sensation continues. And hence Hippocrates and Galen, of aa'l<*.s- the last of whom has treated of the subject with great minuteness toCCt°hVns in many of his writings, while they speak of only one kind of animal fr™£k3' spirit, speak of two kinds of nerves, those of sense and of motion ; distinct sets equally issuing from the brain, and mostly accompanying each other, operated and forming parts of the same organs. up°" by lhe mi ...... iii i • i same ner- 1 his distinction is supported by the concurrent observations and vous fluid. experiments of physiologists, and especially by the curious investi- "p^ted gations of many of those of our own day, among whom should be °y modem particularly noticed the names of Fleurens, Rolando, Charles Bell, gilit"0 °" Magendie and Shaw. M, Rolando attempted to show by a long Rolando's train of interesting, but very painful, and hence unjustifiable experi- province of ments, carried on through animals of almost every kind, that the ^rdebc'eurm. cerebrum is the ordinary source of sensation, and the cerebellum bciium. of motion : for, according to his observations, in every instance in which the former is much broken down, or in any other way injured, drowsiness, stupor, or apoplexy, is sure to follow ; the animal being still capable of exercising locomotive power, but without any guidance or knowledge of what it is about, or where it is moving to. But the moment the cerebellum is wounded, the locomotive power is instantly lost.* These investigations were valuable as leading on to others more accurately conducted and followed up by more cor- rect conclusions. That these distinct portions of the brain are Suci|,ate endowed with separate powers, as observed by Rolando, has been powers sufficiently ascertained by other pathologists ; and especially by M. ^j^Jj conversly ascribrrts * Saggio soprala vera Struttura del Cervello. &c. e sopra k Fonzioni ttella Sistema Nervosa. JSassari. 1809. 20 cl. iv.] PHYSIOLOGICAL PROEM. Class IV. Fleurens* who does not seem, at the time, to have been acquainted otaZ with Rolando's experiments, and consequently gives us the weight and motion. af an ^connected testimony. But it seems to have been better established, as M. Magendie remarks,! since these experiments, that the converse of M. Rolando's constitues the law and order of nature: for sensation seems now proved to be dependent upon the cerebellum, instead of upon the cerebrum, while motivity takes its rise from the cerebrum instead of from the cerebellum. Followed Mr, Charles Bell has successfully followed up these distinct and rieii fntJ established powers of the two departments of the brain,J into the mam.'™' sPmal marrow, which he has sufficiently proved to consist of a His demon- double chord; an anterior connected with the crura of the cere- nouhie' brum, and productive of locomotion, and a posterior connected with t-hord of the crura of the cerebellum, productive of sensation. And he has chain. further shown that these two distinct powers are communicated to mechanism evei7 part of the body by nervous fibres according as they issue continued to from the one or the other of these respective channels : that, for the of uio body, most part, every nervous fascicle distributed over the body and limbs, has a double origin, and issues equally from both the ante- oiempifned "or anc* Posteri°r trunk of the spinal medulla ; and is consequently intheportio alike sensific and motific : while those which proceed from one seventh tlie alone, are limited in their power to the peculiar property of jrerve. their source, of which the portio dura of the seventh nerve af- fords a striking example : being, when uncombined, simply a nerve of motion, without the attribute of sensation, but exercising motion over all the organs of the face that are connected with the function of respiration, whether in the cheeks, lips, and nostrils; and hence operating equally in the acts of speaking, singing, suck- ing, drinking, spitting, coughing, and sneezing. And he has con- firmed these discoveries by the striking fact, that the nerves of the head, which issue like the spinal medulla, from both departments of the brain, possess the same double power, and are, in like manner, nerves of sensation and motion; of which the fifth pair offers a notable example, bestowing at the same time sensibility on the head and face, and performing various muscular motions common to all animals : so as to be analogous to a double spinal nerve, or rather to the spine itself, and enriched, like the spine, with gan- ponfirmed ghons in particular parts. Many of these experiments have since PorCa°ryein" been repeated, and the results to which they have thus led, though mXemer's. in some resPects opposed by other experiments of M. Fodere,§ have generally been confirmed by M. Magendie, Mr. Shaw, Mr. Broughton, and various other anatomists : and we hence see the reason of those frequent decussations, and other interunions of nerve with nerve, by which those possessing a single origin, and consequently a single property, hereby exchange filaments, and become enriched with a new power, the respective filaments being enveloped in the same sheath. * Archives Generates de Medecine, i. ir isiz^"1611068 3Ur US Fonctions' &c> Journ- de M>y«°logief Tom. n, m. p^fa, I Idea of the Anatomy of the Brain. 1809. 5 Recherche? Experim£ntales, &c. Journ. de Physiologic JuiHet, 15?3. PHYSIOLOGICAL PROEM. fci,. iv. 21 There is much, however, in this recondite subject, that still Class IV. requires elucidation ; and particularly in regard to that continuation 0f sensation of sense and motion, in many cases which we shall hereafter have Mucheiucl- to notice, in which the brain, through a very considerable extent, dation still both in its white and cineritious substance, has been found in a spectmg the mollescent or pulpy state ; often indeed entirely disorganized, and continuance as soft as soap ; while, in other instances, the spinal marrow, powers in a through an extent of six or seven inches in length, has been found fzed'Ita'ta equally dissolved, and its chain completely destroyed; one set of of brain limbs being rendered rigid and motionless, with an augmented sensi- mamw. bility, at the same time that the sensation and mobility of the rest have been scarcely interfered -with. And hence a separate and specific power has, from an early age, been ascribed to the nervous fibres themselves, while the brain has been contemplated as their radix. This, in truth, was the peculiar hypothesis of Glisson, J*/^''16818 and nearly so of Haller, with respect to the motory power ; and Huiier, and Girtanner, who trod in the same footsteps, with a clear and com- Girtanner- prehensive mind, considerably enlarged upon it, and gave to the moving energy the name of vis insita, as, by way of distinction, he Visinsitaas applied that of vis nervea to the energy or power of feeling. And tinguished as he believed that other organs besides muscles, and indeed plants j,™™,,™3 as well as animals, are possessed of fibres endowed with the same Why power, and that a brain is by no means essential for their produc- "ntbie tion, he, in like manner, changed the name of muscular to that ofnbre- irritable fibre : and contended that a principle of irritability is com- mon to fluids as well as to solids, and co-extensive with organized nature.* By what means these fibres unite into solid masses or hollow coats, and what are their respective powers when thus complicated, shall be glanced at hereafter ;| at present, we must confine our- selves to their actuating principle, whatever that may consist in. Oxygene was at this time the popular aura of the philosophers, Oxygene as caloric had been a short time before. Lavoisier had just proved to befits its close connexion with several of the vital functions, and hence Princli)lc> the chemical divinity of Girtanner wa3 oxygene. He paid unbounded homage to its influence, attempted to show that irritability, and even life itself, are dependent upon it; and that in the animal sys- tem it is distributed to every part by means of the circulating blood. But the still more striking properties of the galvanic fluid, began n"mfafl'uid now to be discovered and to captivate the general attention ; and since its the time drew nigh in which oxygene was doomed to fall as pros- trate before the shrine of Galvanic aura as caloric had fallen before that of oxygene. And it is curious to remark, how nearly this dis- ^^^^ covery was not only made but completed in all its bearings, and by nearly ami- the very same means, about fifty years before the attention of Gal- acentury3 vani was directed to the subject; for as we are told in the Philoso- before. phical Transactions for 1732,J that the Queen's physician, Dr. Alex- * Me moires sur l'Irritabilite, considered comme principe de vie dans la nature or- ganised. Journ. de Phys. 1790. t See the introductory remarks to Order III. of the present class, Neurotica, OlNETlCA. .': Vo!, xxsvn. p. 324. IZ ch. iv.] PHYSIOLOGICAL PROKAl. Class IV. II. Principle of sensation and motion. Has a close affinity with the nervous influence ; but not proved to be the Fanciful and com- plicated conjecture of Rolando. Result of the inquiry. Nervous system i differently elaboiated but a secernent organ: possesses two or more sets ander Stuart, being engaged in a course of experiments upon the frog, observed upon thrusting the blunt end of a probe into the spinal marrow, after decapitation, that the muscles of the animal's body were thrown into convulsive contractions ; and that the same hap- pened to the muscles of the head when the probe was thrust into the brain. And by additional experiments he advanced so far as to infer that what the nerves contribute in muscular motion, cannot be produced by oscillations or elasticity, but must be owing to a fluid contained in them ; but which fluid he was unfortunate enough to conceive was a pure and perfectly defecated elementary water; using the word water, however, in a general sense, as merely op- posed to sal volatile, or fermented spirits, which he thought the term animal spirits was calculated to import. Whatever be the nature of the active and ethereal fluid which waa thus traced by Stuart, and has since been fully established by Gal- vani, there can be no question of its having a powerful influence upon many branches or divisions of the nervous system, though not upon all. Its effects upon the muscles of an animal for some hours after death are too well known to be particularized : and Dr. Philip seems to have shown, by various trains of experiments,* that it is equally capable of maintaining respiration, and the operation of several of the animal secretions, especially those that induce digestion, for as long a period. But in drawing from such facts the corollary that the " identity of galvanic electricity and nervous influence is established by these experiments ;" he seems, like those who have anticipated him in the same doctrine, to proceed farther than he is warranted : for we have no right to say more than that galvanic electricity is a stimulus exciting the nervous influence into a state of continued secretion, or continued action ; which may possibly be done by various other stimuli, as well as by that of gal- vanism. M. Rolando, however, has proceeded farther than this; for while he regards the nervous fluid and that of galvanism as identic, he contemplates the cerebellum and its appendages as a galvanic machine in which the cerebellum itself constitutes the formative pile, the medulla oblongata, the conductor in which the fluid is accumulated, and the spine and nerves the channels through which it is conveyed through the muscles for the purpose of exciting voluntary motion. But this puts us into possession of only one half of the powers of the brain,—the motific. For the sensific powers, M. Rolando has revived the old doctrine of vibrations, already no- ticed, and conceives that all sensations are commenced at the ex- tremities of the nerves, and are conveyed from the circumference to the centre of the system by vibrating chords.t Upon the whole the nervous system seems to present itself, in the different classes of animals, under various scales of elaboration ; but in every scale to be a secernent organ through its entire range; operating by means of two or more different sets of fibres, which may be secretories or conductors of as many different fluids or modifications of the same fluid. * Phi). Trans. 1815. p. 5—90. t Coster, Archives Generates de Medicine, Mass, 1823, PHYSIOLOGICAL PROEM. [cl. hi. In the higher and more complicated classes of animals it consists JjL*?n8c|J- of a cylindrical chord, or spinal marrow, a central or ganglionic of sensation compages and a brain, all communicating and acting in harmony.* $dfi£°l*n' In some of the inferior classes we find the cylindrical chord alone, »ercr:eotnories and in others the ganglionic compages : while in the lowest of all ductors of we trace a variety of distinct and granular molecules, which seem j|j|F»™J to act the part of nervous ganglions, though we cannot discover their n.odifica- r a a tions of a Connexion. common The brain has so much of the general structure and character of «uio\ a gland, as to be admitted to be an organ of this kind almost with- genially out a dissentient voice in the present day. This is a point conceded bdfg\eadJ° even by Dr. Cullen, notwithstanding that by supposing the energy Cuiien'^^ of the brain to be a mere quality rather than a specific essence, and ypo to be incapable of undergoing any change of recruit or exhaustion, he finds no adequate use for its glandular conformation. As we are justified, however, by all the force of analogy in regarding it as a gland, though unquestionably a gland of a peculiar kind, and as we are equally justified on the same ground of analogy in regarding the nervous power or energy by which it maintains a communication with every part of the system, as a fluid of a peculiar kind, we are almost driven to the necessity of contemplating it as the source from which this fluid issues and by which it is supplied as it becomes ex- hausted. And more especially when we reflect upon the enormous proportion of blood which is sent from the heart to the head, as the most extensive laboratory of the entire frame, and which, according to Haller,f amounts to one-fifth, or on the lower estimate of Monro,J to one-tenth of the entire current poured forth from the left ventricle of the heart, while it is well known that the weight of the human brain is not more than one-fortieth part of the entire body. It is probable that the nervous fluid on its first secretion and in its ^™sfifs. simplest state, is as homogeneous as that of the blood ; but that, perhaps- like the blood, it becomes changed by particular actions, either of J]um°scue° the particular parts of the brain, or of particular nerves themselves, j;^™^ into fluids possessing different powers, and capable of producing parat"fuiary very different effects. And as modern experiments have induced ^d°enrsedana us to believe with Galen, that the nerves are a continuation of the capable of matter of the brain,§ it is not improbable, that many or all of them are %%£££* endowed with something of its secernent power, and are capable ^^ of assisting in the secretion of the same fluid in its simplest state, fibres a Con- or in some of its simpler modifications, And we may hence see fhneu^°tnerof the reason of that complicated mechanism which distinguishes the of the brain, higher classes of animals, and how it is possible for a nervous system ^bM^ to exist, though with inferior powers, under a less composite themselves fabrication. whence a This, however, is not mere conjecture : for in acephalous and ^tve°™mBy anencephalous monsters we are compelled to admit it as a fact; and exist under m different ramifications of the nerves, we can trace such different fivce°™rpuadT fabrication. Proofs of * De Nervi Sympathetici humani fabrica, usu, et morbis, &c. Auctore J. Lobstein, this. Parisiis, 1823. , t Elem. Physic, x. v. 20. % On the Nervous System, p. 3, $ De Hippocr. et Plat. Decret. Lib. in. Tom. i.p. 921. 2i cl. m.J PHYSIOLOGICAL PROEM Class IV. II. Principle of sensation and motion Hence Bometi 08 a sensific power and sometimes a motory. This view accordant with Hunter's remarks, A brain necessary where all the local senses ere complete and perfect Not neces- sary where only a ge- neral sense of touch. effects actually produced ; and as it has sufficiently appeared that the operative power is a quick and subtle fluid, we are directly lea to conclude that such difference of effects must depend on a diversity of fluids or on various modifications of a common fluid in different trunks or ramifications : the last of which explanation is by far the simplest and easiest. And hence, in certain parts of the system, the nervous influence becomes capable of producing the effect of sensation ; in others of motion. And hence, again, the sensific influence is rendered capable of exciting in one set of organs a sense of sight, in others of hearing, smell, or taste, while that of touch is diffused over the surface generally. This last by its extensive diffusion is, by Mr. Hunter, called com- mon sensation; and his view of the subject is in perfect consonance with the present. " It is more than probable," says he, " that what may be called organs of sense (local organs) have particular nerves whose mode of action is different from that of nerves producing common sensation ; and also different from one another ; and that the nerves on which the peculiar functions of each of the organs of sense depend are not supplied from different parts of the brain. The organ of sight has its peculiar nerve : so has that of hearing ; and probably that of smelling likewise : and on the same principle we may suppose the organ of taste to have a peculiar nerve, although these organs of sense may likewise have nerves from dif- ferent parts of the brain; yet it is most probable such nerves are only for the common sensations of the part, and other purposes answered by nerves."* We see farther that for the purpose of elaborating the exquisitely fine and active fluid that, differently modified, excites the local organs of sense, and excites them in perfection, it is necessary that the nervous system should exist in its highest scale of fabrication, and be crowned with the apparatus of a brain, though this is not the only use to which the brain is subservient: and hence it was long ago pointed out by Galen, that it is from the brain alone the nerves appropriated to the local senses take their rise.f For though we have instances of the existence of a few of these senses where the nervous system is found in a less finished form, they are never com- plete in number, nor apparently in acuteness. The sense of touch, on the contrary, which, as we have already observed, is regarded by Cuvier as produced by the sensific fluid in its simplest and least compounded state, or as Galen has itj "is the dullest and rudest of all the sentient powers," flows for the most part, as the latter has also remarked, from the spinal marrow alone, since it is from this column that the nerves of touch almost ex- clusively arise. And hence we have little difficulty in conceiving how a sense of this kind may exist in moluscae, shell fishes, and the Iarves of insects, which have no other nervous system than a me- dullary column, with a slight increment at the upper extremity, or no increment whatever ; and have no other sense, or none but in n very imperfect degree. * On the Animal Economy, p. 26). t De Instruments Odoratus. Edit. Basil. Tom. I. p. j Loco citat. R8] PHYSIOLOGICAL PROEM. [ol. iv. 25 The nervous power producing motion, and which has properly Class IV. been denominated irritative, appears to be of a. still lower descrip- of sensation tion than that of touch. It is hence common to the great mass of HJ^JJjJ?1'™- muscular fibres, and is probably capable of being secreted by these irritativ'o fibres generally ; so that every fibre supplies itself, where it receives aTower"' no supply from any other source. Yet the proper source or description reservoir of this modification of nervous fluid seems to be a sifio. ganglionic system ; that which, in the higher classes of animals we have already noticed as formed by the curious structure and rami- fications of the intercostal nerve, and that which appears to be a copy of it in worms and zoophytes, who have no other nervous or- ganization whatever. From the copiousness with which this central }JV" "n'J™ system furnishes a recruit to the involuntary organs with which it is organs peculiarly connected in mammals, we may see why these Organs are htusteVnor able to persevere in one uninterrupted train of action, without wearied. exhaustion or weariness from the beginning to the end of life; and why several of them, as the heart, the lungs, and the stomach, H«n«oan should be able to exhibit proofs of irritative power for a considera- of irritative ble period of time after the death of the system, and especially J}™"afier when roused by particular stimulants. Fishes in general have few pretensions to this structure, and hence they die sooner than most other animals, and exhibit little muscular irritability afterwards. Yet it is remarkable that in those genera which make the nearest approach to a ganglionic system, as the cod and carp, we have examples of a like power. The fishmongers of the metropolis have gtrikin,4s'd taken advantage of this endowment in the cod-kind, and introduced the fashion of crimping or corrugating the flesh, by the stimulus of codTsh.5 °f transverse incisions ; and in some curious experiments on the carp, Singular lately instituted by Mr. Clift, he found its heart leaping, when out i"Scarp? of water, four hours after a separation from the body.* If the "ne™9/0*" apparently isolated molecules found in the make of the polype and production various worms are ganglions of nervous irritation, extending their andPworms: vital influence through certain ranges or peripheries, we are also a"d. P'0^11' hence enabled to account for the peculiar tenacity with which the sections. principle of life adheres to them, and the wonderful power of re- production which belongs to detached segments. The curious and striking experiments which have lately been made fuhpp07tedv upon animals by Dr. Philip and M. Le Gallois, confirm the general by various view now offered so far as they bear upon it. These have consisted pcnmenis" in an examination into the different effects produced on the heart and lungs by suddenly destroying or cutting off the communication of the whole brain ; by slowly destroying it; by destroying it in the posterior part alone; and in the anterior part alone; and by de- stroying, in like manner, the spinal marrow at the neck, or where it unites with the brain; in its middle or dorsal, and in its lumbar re- gion. The animals operated upon were chiefly rabbits. According to the experiments of M. Le Gallois,! after the de- ^fBri;f struction of the brain, the action of the heart still continues for a Le Gaiioi*. considerable period of time unimpaired; while on the destruction of * Phil. Trans. 1815. p. 90. + Experiences mv la Principe de la Vi^&*« Vol. TV.— I iJG ti„ iv.j PHYSIOLOGICAL PROEM. nVrfnclo? i^e 9P'na^ marrow at its upper or cervical extremity, this action bc- ofsenTatioS comes instantlv so debilitated as to be no longer capable of support- ed motion. [ng tne circulation. Wlicnce he infers that it is from the chord ot the spinal marrow, and not from the gland of the brain, that the heart derives the principle of its life and motions. Sen's of 'rhe exPeriments °f Dr- Philip* aro at variance with the above of rhi"ip.° M. Le Gallois, and his conclusions are, therefore, somewhat dif- ferent. They seem to show that both the brain and spinal marrow may be destroyed, and yet the heart continue to act forcibly and steadily, provided the lungs be excited by the artificial breath of a- pair of bellows. The brain and spinal marrow were destroyed by a hot wire, the animal being first stupified by a blow on the occiput. Frogs and a few other animals were here employed as well as rabbits. It is not exactly stated how long, under this process, the heart continued to beat. Yet, contrary to what Dr. Philip seems to have expected, but in porfect concurrence with the hints I have just thrown out, he found that certain stimuli applied to the brain, whether in the ante- rior or posterior part of the head, increased very sensibly the action of the heart, the animal being still prepared as just stated. The same effect ensued when the same stimuli were applied to the cervi- cal and even the dorsal part of the spinal marrow : but not when ap- plied to the lumbar. Conciusim j)r> Philip hence concludes.that there are three kinds of vital from hisP power: muscular, possessed by the lowest kinds of animals that are m^enuTn"" destitute of both the others ; nervous, or that which is here denorai- accordance nated the medium of touch or simple feeling, chiefly derived from, buna now or dependent upon the spinal marrow, and possessed by animals proposed, somewhat more advanced in the scale of life ; and sensorial, con- stituting what we have just regarded as the medium of the local senses, and appertaining to the higher classes. He adds, that each of these may exist alone, and consequently independently of the rest; but admits that where the nervous principle co-exists with the mus- cular, it exerts an influence over it, so that the latter may even be overborne or destroyed by such influence; and that when the sen- sorial co-exists with both, it exercises over both an equal degree of control. "ctilai6" ***■ ?ut tne nervous organ in its most elaborate and perfect principle, state, as in man, is not only the seat of sensation and motion, but of intelligence: it is the instrument of communication between the mind and the body, as well as between the body and the objects by which the body is surrounded. And as a failure or irregular per- formance of its functions in various ways lays a foundation for an extensive division of corporeal diseases, so a like failure or irregula- rity of performance in other ways lays a foundation for as numerous a train of mental maladies. StomS u°f the nature °lthe mind or soul itself' we k"°w little beyond but little what revelatio?j has informed us; we have no chemical te«t that excTptVrom can reach its essence ' no ZhiiX» ^at can trace its mode of"union royelatron. * Phil. Trans. 1815, p. 15 and 444. PHYSIOLOGICAL PROEM. [;cx. iv. sJ? v,ith the brain ; no analogies that can illustrate the rapidity of its 9.LA3S}V' movements. And hence the darkness that, in this respect, hung lectuai oyer the speculations of the Indian gymnosophists and the philoso- Pr,nciPlc- phers of Greece, continues without abatement, and has equally re- sisted the labours of modem metaphysicians and physiologists. That *^r* the mind is an intelligent principle we know from nature; and that that it is it is a principle endowed with immortality, and capable of existing l^Vife"'1 after death in a state separate from the body, to which, however, it powers, and is hereafter to be re-united at a period when that which is now mor- re-unlon tal shall put on immortality, and death itself be swallowed up of vie- w0'jy{augjlt tory—we learn from the God of nature. And with such informa- only by a tion we may well rest satisfied : and, with suitable modesty, direct ^f com" U" our investigations to those lower branches of this mysterious subject muuication. that lie within the grasp of our reason. I cannot, however, drop the subject altogether, without observing "ennt^v*e. that the discussion concerning the particular entity of the mind, sics con- seems to have been conducted with an undue degree of heat and cnta" hove confidence on all sides, considering our present ignorance of what- often ex- ever substance has been appealed to as constituting its specific unbecoming frimo waimthand "arne* . . . . confidence. Is the essence of the mind, soul, or spirit, material or immaterial? whether its The question, at first sight, appears to be of the utmost importance material ox and gravity ; and to involve nothing less than a belief or disbelief, immaterial not indeed, in its divine origin, but in its divine similitude and im- mortality. Yet I may venture to affirm that there is no question The which has been productive of so little satisfaction, or has laid a foun- Unsat'is(at dation for wider and wilder errors within the whole range of me- t°ry""« taphysics. And for this plain and obvious reason, that we have no wuh'orrois, distinct ideas of the terms, and no settled premises to build upon. „"(£,,,.tertn Corruptibility and incorruptibility, intelligent and unintelligent, or- affords a ganized and inorganic, are terms that convey distinct meanings to Idea."01 the mind, and impart modes of being that are within the scope of our comprehension. But materiality and immateriality are equally be- yond our reach. Of the essence of matter we know nothing, and ,„!«« no: altogether as little of many of its more active qualities: insomuch known-. n6r that, amidst all the discoveries of the day, it still remains a contro- most active vertible position, whether light, heat, magnetism and electricity are ^le\*iiot\ material substances, material properties, or things superadded to l° ''gf"» ,. , c , • , >. or heat . matter and of a higher nature. . netisin and If they be matter, gravity and ponderability are not essential pro- clect£icitJfli perties of matter, though commonly so regarded. And if they be things superadded to matter, they are necessarily immaterial, and we cannot open our eyes without beholding innumerable proofs of material and immaterial bodies co-existing and acting in harmonious union through the entire frame of nature. But if we know nothing of the essence, and but little of the qualities of matter, of that com- mon substrate which is diffused around us in every direction, and constitutes the whole of the visible world, what can we know of what is immaterial ? of the full meaning of a term that, in its strictest ^™acte3"w1 sense, comprehends all the rest of the immense fabric of actual and totally possible being: and includes, in its vast circumference, every e*- un nw r &> ex. iv.j PH1S10LUG1CAL PROEM. ClassIV. Sence and mode of essence of every other being, as vyeii btiosv a.- kctunite" above the order of matter, and even that of the Deity himself? Svhethtr" Sna11 we take the quality of extension as the line of separation extension between what is material and what is immaterial ? This, indeed, is tSctivi*" the general and favourite distinction brought forward in the present property jay ; hut it is a distinction founded on mere conjecture, and which whether'' will by no means stand the test of inquiry. Is space extended ? by'space. every one admits it to be so. But is space material ? is it body of any kind? Des Cartes, indeed, contended that it is body, and a material body: for he denied a vacuum, and asserted space to be in the a part of matter itself: but it is probable that there is not a single a'ckSno"w-day espouser of this opinion in the present day. If then extension be- ledgedtobe long equally to matter and to space, it cannot be contemplated as corporea. ^Q pecujjar and exclusive property of the former; and if we allow it to immaterial space, there is no reason why we should not allow it to immaterial spirit. If extension appertain not to the mind or thinking principle, the latter can have wo place of existence ; it can exist no where : for where or place is an idea that cannot be se- parated from the idea of extension. And hence, the metaphysical Immaterialists of modern times freely admit that the mind has no place of existence; that it does exist no where ; While, at the same time, they are compelled to allow that the immaterial Creator. or universal Spirit, exists every where, substantially as well as virtually. whether Nor let it be supposed that the difficulty is removed by adding to Tpmpcrty matter the quality of solidity in conjunction with that of extension, of matter. an(j hence distinguishing it as possessed of'solid extent ; for the Apparontiy quality of solidity is less characteristic of it than any we have thus far taken notice of; and is perpetually fleeing from us as we pursue it. That matter is infinitely divisible we dare not say, because we should hereby reduce it to mathematical points, and because, also, there would, in such case, be no certain or permanent basis to build ' upon, and to ensure a punctuality of material cause and effect: and imt obliged hence, Sir Isaac Newton was obliged to suppose that it is possessed forirauted. of ultimate atoms which are solid and unchangeable. But of these the senses can trace nothing, and our admission is nothing more than conjectural. !lharaoterof ^et not ^e auth°r5 however, be misunderstood upon this abstruse Ine mind as and difficult subject. That the mind has a distinct nature and is fr'tfmnaJu. a distinct reality from the body; that it is gifted with immorta- reveaaied kty' entlowed witn reasoning faculties, and capacified for a state of evidence: separate existence after the death of the corporeal frame to which it is attached, are, in his opinion, propositions most clearly deducible from revelation, and, in one or two points, adumbrated by a few shadowy glimpses of nature. And that it may be a substance strictly immaterial and essentially different from matter is both pos- 6ut us sible and probable; and will hereafter, perhaps, when faith is turned e^ence into vision> and conjecture into fact, be found to be the true and ge- wikurnn, nuine doctrine upon the subject. But till this glorious era arrive ; or till, antecedently to it, it be proved, which it does not hitherto «eem to have been, that matter, itself of divine origin, gifted e-ers at I'll BIOLOGICAL PROEM. [cl.iv. at; j»resent, under certain modifications, with instinct and sensation, £MSS{V° and destined to become immortal hereafter, is physically incapable, lectuai under some still more refined, exalted, and spiritualized modification, P"nc,P,e' of exhibiting the attributes of the soul, of being, under such a con- stitution, endowed with immortality from the first, and capacified for existing separately from the external and grosser frame of the body; and that it is beyond the power of its own Creator to render it intelligent, or to give it even brutal perception, the argument must be loose and inconclusive : it may plunge us, as it has plunged thou- sands before, into errors, but can never conduct us to demonstra- tion. It may lead us, on the one hand, to the proud Brahminical and and the Platonic belief that the essence of the soul is the very essence of the concerning Deity, and consequently a part of the Deity himself: or, on the jt on the one other, to the gloomy regions of modern materialism, and to the cheer- engendered less doctrine that it dies and dissolves in one common grave with Snthe'otiic- the body. is fun of It is no fair objection, however, against the immaterialist, that by fn°abriont contemplating the mind as a distinct essence from that of the body, ®fejjjcvicw man is hereby rendered a compound being, possessing at one and the subject, same time two distinct lives mysteriously united in an individual Impound frame, and running in parallel lines till the hour of death. For being: whilst the known and obvious laws and faculties of the mind and body are so widely different, as they are acknowledged to be on all hands, some such composite union has been and must be allowed under every hypothesis whatever. And least of all have the skeptical ,aI"^pegc0u' physiologists of the present day any right to triumph upon such an regarded objection; who, drawing no light from nature, and rejecting that of ^e™°|a, sacred writ, contemplate the mind as formed of the same gross mo- physioio, dification of matter as the body, and doomed to fall with it into one f,!oderr common and eternal dissolution. For even these acute materialists, ume3, with all the aid of physiological, anatomical, and chemical research, instead of simplifying the human fabric, have made it more clumsily complex, and represented it sometimes, indeed, as a duad, but of late more generally as a triad, of unities, a combination of a corrup- tible life within a corruptible life two or three deep, each possessing its own separate faculties or manifestations, but covered with a com- mon outside. This remark more especially applies to the philosophers of the Hypothesis. French school: and particularly to the system of Dumas,* as modi- fied by Bichat; under which more finished form man is declared to of uichav consist of a pair of lives, each distinct and co-existent under the names of an organic and an animal life ; with two distinct assort- ments of sensibilities, an unconscious and a conscious. Each of these lives is limited to a separate set of organs, runs its race in parallel steps with the other; commencing coetaneously and perishing at the same moment.! This work appeared at the close of the past century ; was read and admired by most physiologists ; credited by many ; and became the popular production of the day. Within ten or twelve years, however, it ran its course, and was as generalb * Principes de Physiologie. 4 Tom. 8vo. Par. W0O-«?, r Pecherches surla Vie et la Mori. &c. IV.] PHYSIOLOGICAL PROEM. Class IV. lit intel- lectual principle. Hypothesis of Riche- rand and Magendie. Hypothesis ot Spurz- lieim. cither rejected or forgotten even in France : and M. Richerand first, and M. Magendie since, have thought themselves called upon to modify Bichat, in order to render him more palatable, as Bichat had already modified Dumas. Under the last series of remodelling, which is that of M. Magendie, we have certainly an improvement, though the machinery is quite as complex. Instead of two distinct lives M. Magendie presents us with two distinct sets or systems of action or relation, each of which has its separate and peculiar func- tions, a system of nutritive action or relation, and a system of vital. To which is added, by way of appendix, another system, com- prising the functions of generation.* Here, however, the brain ig not only the seat but-the organized substance of the mental powers : so that, we are expressly told, a man must be as he is made in his brain, and that education, and even logic itself, is of no use to him. " There are," says M. Magendie, "justly celebrated persons who have thought differently ; but they have hereby fallen into grave errors." A Deity ^however, is allowed to exist, because, adds the writer, it is comfortable to think that he exists, and on this account the physio- logist cannot doubt of his being. " L'intelligence de l'homme," says he, " se compose de phenomenes tellement differens de tout ce que presente d'ailleurs la nature, qu'on les rapporte a un etre parti- culiere qu'on regarde comme une emanation de la Divinitc. II est trop consolant decroire dcet etre, pour que le physiologistemette en doute son existence ; mais la severite de language ou de logique que comporte maintenant le physiologie exige que Ton traite de l'intelli- gence humaine comme si elle etait la resultat de Paction d'une organe. En s'ecartant de cette marche, des hommes justement celebres sont tomb^s dans des graves erreurs ; en la suivant, on a, d'ailleurs, le grand avantage de conserver la meme methode d'etude, et de rendre ^ tres-faciles des choses qui sont envisagees generalement comme presqu' au-dessus de l'esprit humain."—" II existe une sciencedonf le but est d'apprendre a raissonner justement e'est la logique, mais le jugement errone ou l'esprit faux (for judgment, genius, and imagin- ation, and therefore false reasoning, all depend on organization) tiennent a l'organization. II est impossible de se changer a cef egard ; nous restonstels que la nature nous a faits."| Dr. Spurzheim has generally been considered, from the concurrent tenour of his doctrines, as belonging to the class of materialists; but this is to mistake his own positive assertion upon the subject, or to conclude in opposition to it. He speaks, indeed, upon this topic with a singular hesitation and reserve, more so, perhaps, than upon any other point whatever ; but as far as he chooses to express him- self on so abstruse a subject, he regards the soul as a distinct being from the body, and at least intimates that it may be nearer akin to the Deity. Man is with him also possessed of two lives, an auto- matic and an animal : the first produced by organization alone, and destitute of consciousness ; the second possessed of conscious- ness dependent on the soul, and merely manifesting itself by organ- ization. « We do not." Rflv« h* « attempt to explain how the body ization. " We do not," says he, ! £r-ci-S EJementaire de Physiologie. 2 Tom. 8vo. Paris. 1816,1817 t Precis Elementaire, &c tit supra, passim. PHYSIOLOGICAL PROEM. Icl.iv. iil and soul arc joined together and exercise a mutual influence. We mLA,ss^v do not examine what the soul can do without the body. Souls, so iectua'i far as we know, may be united to bodies at the moment of conception p»«cipie- or afterwards ; they may be different in all individuals, or of the same kind in ever% one ; they may be omanations from God, or something essentially different."* The mind of this celebrated craniologist seems to be wonderfully skeptical and bewildered upon the subject, and studiously avoids the important question of the capacity of the soul for an independent, and future existence : but with the above declarations he cannot well be arranged in the class of materialists. The hypothesis which has lately been started by Mr. Lawrence! Hypothesis is altogether of a different kind, and though undoubtedly much sim- rence^Im- pler than any of the preceding, does not seem to be built on a more ^'J^' stable foundation. According to his view of the subject, organized not more differs from inorganized matter merely by the addition of certain stable' properties which are called vital, as sensibility and irritability. Masses of matter endowed with these new properties become organs and systems of organs, constitute an animal frame, and execute distinct sets of purposes or functions, for functions and purposes carried into execution are here synonymous. " Life is the assemblage of all the functions (or purposes) and the general result of their exercise."J Life, therefore, upon this hypothesis, instead of being a two-fold Regards life or three-fold reality, running in a combined stream, or in parallel property6 lines, has no reality whatever. It has no esse or independent exist- ^'^"^j ence. It is a mere assemblage of purposes, and accidental or and acci- temporary properties : a series of phsenomena,§ as Mr. Lawrence without has himself correctly expressed it;—a name without a thing. " We at)yreaI know not," says he, " the nature of the link that unites these phae- a* mere' nomena, though we are sensible that a connexion must exist ; and ^"p^fg this conviction is sufficient to induce us to give it a name which the or series of' vuloar regard as the sign of a particular principle ; though in fact mena?" that name can only indicate the assemblage of the phenomena which have occasioned its formation."|| The human frame is, hence, a barrel-organ, possessing asystematic Hence the arrangement of parts, played upon by peculiar powers, and executing frame"a particular pieces or purposes ; and life is the music produced by the barrel- general assemblage or result of the harmonious action. So long as \,fl the mu- either the vital or the mechanical instrument is duly wound up by a c^ngY/' regular supply of food or of the wince, so long the music will con- the music tinue : but both are worn out by their own action ; and when the wheTthe machine will no longer work, the life has the same close as the machinc music ; and in the language of Cornelius Gallus, as quoted and longer appropriated by Leo X., wo'k" —redit in nihilum, quod fuit ante nihil. There is, however, nothing new either in this hypothesis or in the Tni:i ° Jl Hypothesis not new: * Physiognomical System, &c. p. 253. Svo. Lond. 1815. hut started 1 Introduction to Comparative Anatomy and Physiology, &c. 8yo. 1816. ^ Aris" I Id. p. ITO. §' Id. p. 1-2-7. I| Id. p. 122.' Sof" CL. IV.J PHYSIOLOGICAL PUOEM. Class IV. III. Intel- lectual principle. Aristotle, who thus illustrated it, and named it the system ofharmony Opposed by all the other sects of materialists in his day: especially by the Epi- who united with the Platonists and Stoics Their grounds of opposition applicable to the same doctrine in its present modifica- tion. General result and general itnty. Another subject closely connected herewith. present explanation of it. It was first started in the days of Aristotle by Aristoxenus, a pupil of his, who was admirably skilled in music, and by profession a physician. It was propounded to the world under the name of the system of harmony, either from the author s fondness for music, or from his comparing the human frame to a musical instrument, and his regarding life as the result of all its parts acting in accordance, and producing a general and harmonious effect. How far Mr. Lawrence's revised edition of this hypothesis may prove satisfactory to other classes of materialists I cannot tell: but if he should succeed, he will be more fortunate than Aristoxenus who pleased neither the other materialists nor the immaterialists of his day. From the latter, indeed, he could expect no countenance: but even the Epicureans, though they held that the mind was cor- ruptible, as formed of matter, which they had no reason to believe was then or ever would be otherwise than corruptible under any modification whatever, held, at the same time, that it had a sub- stantive existence, distinct from that of the grosser frame of the body, and possessed of other and far higher properties : being formed of the finest, lightest, smoothest, and most moveable material elements, and hence exquisitely etherealized and volatile: —est animi natura reperta Mobilis egregie, perquam constare necesse est Corporibus parvis, et Iambus, atque rotundis.* The atomic philosophers, therefore, joined with the Platonists and Stoics in opposing the system of harmony, and that chiefly upon the two following grounds, which will apply with as much force to its present as to its primary form. First, admitting that an assemblage and exercise of all the functions of the machine are necessary to maintain the phaenomena of life, we are left as much in the dark as ever concerning the nature of the principle by which this harmo- nious instrument becomes gradually developed and is kept in perpe- tual play. And next, that the life or well-being of the animal frame does not depend upon an assemblage and exercise of all its functions or purposes, since the mind may be diseased while the body remains unaffected ; or the body may lose some of its own organs, while the mind, or even the general health of the body itself may continue perfect.! In the darkness, therefore, which continues to hang over the mysterious subject before us, I feel incompetent to enter into the question concerning the actual essence of the mind, and am perfectly content to take its general nature, powers and destiny, from the only volume which is capable of giving us any decided information upon the subject; to follow it up as far as that volume may guide us, and to stop where it withdraws its assistance. Closely connected with the present question is another of nearly as much perplexity, and the consideration of which has not been attended with much more success, but which must not be passed by on the present occasion without being glanced at. * Lacret. De Rer. Nat. m. 204. priLI!ib^et'.:953Rer, Nat',n" 105~"m **<*«»*■» Yit. Epicur. PoJiwac, Anti-J<»- PHYSIOLOGICAL PROEM. [cl.iv. &J Whatever be the nature or substance of the mind, the brain is Class IV. the organ in which it holds its seat; and whence it maintains an lectuai'6 intercourse with the surrounding world. Now, it must be obvious ^"'^j^f to every one who has attended to the operation of his senses, that means the there never is, nor can be any direct communication between the '"^l ™ain' mind, thus stationed in the brain, and the external objects the mind intercourse . . . with the perceives ; which are usually, indeed, at some distance even from surrounding the sense that gives notice of them. Thus, in looking at a tree it No'di'rect is the eye alone that beholds the tree, while the mind only perceives communi- a notice of its presence by some means or other, from the visual Jarei"ever organ. So, in touching this table it is my hano alone that comes in between the contact with it, and communicates to my mind a knowledge of its senses and hardness and other qualities. What then is the medium by which 0lbjeec^frnal such communication is maintained ? which enables the mind to have what a perception of the form, size, colour, smell, and even distance of medium of objects, correspondent with that of the senses which are seated on ^j?™""'" the surface of the body ? and which at the same time that it conveys this information, produces such an additional effect, that the mind is able, at its own option, to call up an exact notion or idea of those qualities at a distant period, or when the objects themselves are no longer present ? Is there, or is there not, any resemblance between J1""**^" the external or sensible object, and the internal or mental idea or to be ex- notion ? If there be a resemblance, in what does that resemblance J^gf by consist ? and how is it produced and supported ? Does the external hypotheses. object throw off* representative likenesses of itself in films or under tion of** any other modification, so fine as to be able, like the electric or Epicurus. magnetic aura, to pass without injury from the object to the sentient organ, and from the sentient organ to the sensory, or mental pre- sence-chamber ? or has the mind itself a faculty of producing, like Of Aristotle. a mirror, accurate countersigns, intellectual pictures or images correspondent with the sensible images communicated from the external object to the sentient organ ? If, on the contrary, there be of Plato no resemblance, are the mental perceptions mere notions, or intel- psychoio- lectual.symbols excited in the mind by the action of the external sists- sense ; which, while they bear no similitude to the qualities of the object discerned, answer the purpose of those qualities, as letters answer the purpose of sounds ? or are we sure that there is any OfBerkeiey external world whatever ; any thing beyond the intellectual principle that perceives and the sensations and notions that are perceived; or even any thing beyond those sensations and notions, those impres- sions and ideas themselves ? Several of these questions may perhaps appear in no small degree whimsical and brain-sick, and more worthy of St. Luke's than of a work of physiological study. But all of them, and at least as many more, of a temperament as wild as the wildest, have been asked and insisted upon, and supported again and again in different ages and countries, from the zenith of Grecian science down to our own day, by philosophers of the clearest intellects in other respects. and who had no idea of labouring under any such mental infirmity, nor ever dreamed of the necessity of being blistered and taking nhysic. Vol. IV ~ 34 Class IV. III. Intel- lectual principle. The obscu- rity of the subject proved by the nature of the questions proposed. These hypotheses thrown down by later writers who have little suc- ceeded in establishing any other. The difficul- ty felt by Locke, who studiously avoided the abstruser part of the subject, and elucidated what was capable of elucidation in his Essay on Human Understand- ing. Character of this work ;l« iv.j PHYSIOLOG1CAL PROEM Avoids all the unin- telligible jargon of former times; and clearly developes the growth and fea- tures of the mind from its earliest appearance. The nature of the questions themselves, therefore, when put b; the characters referred to, sufficiently manifest the obscurity ol me subject to which they relate : and to enter into the discussions to which they have given rise, would lead us to an irrecoverable dis- tance from the path before us. Those who are desirous of following them up and of witnessing an exposure of their absurdity, cannot do better than apply themselves to the metaphysical writings of Dr. Reid, Dr. Beattie, Dr. Campbell and Professor Stewart; who if, on the overthrow of so many Babel-buildings, they have not been able to raise an edifice much more substantial in their stead, have only failed from the insuperable difficulty of the attempt. No man was more sensible of this difficulty than Mr. Locke, nor has taken more pains both to avoid what is unintelligible and unpro- fitable, and to elucidate what may be turned to a good account and brought home to an ordinary comprehension. It was his imperish- able Essay on Human Understanding that gave the first check to the wild and visionary conceits in which the most celebrated luminaries of the age were at that time engaged ; recalled mankind from the chasing of shadows to the study of realities, from a pursuit of useless and inexplicable subtleties to that of important and cognoscible subjects ; or rather to the only mode in which the great inquiry before him could be followed up with any reasonable hope of success or advantage. To this elaborate and wonderful work which has conferred an ever-during fame, not only on its matchless author, but on the nation to which he belonged, and even the age in which he lived, the phy- siologist cannot pay too close an attention. It is, indeed, of the highest importance to every science, as teaching us the elements of all science, and the only mode by which science can be rendered really useful, and carried forward to ultimate perfection ; but it is of immediate importance to every branch of physical knowledge, arid particularly to that which is employed in unfolding the structure of the mind, and its connexion with the visible fabric that encloses it. It may, perhaps, be somewhat too long; it may occasionally embrace subjects which are not necessarily connected with it; its terms may not always be precise, nor its opinions in every instance correct: but it discovers intrinsic and most convincing evidence that the man who wrote it must have had a head peculiarly clear, and a heart peculiarly sound : it is strictly original in its matter, highly important in its subject, luminous and forcible in its argument, perspicuous in its style, and comprehensive in its scope. It steers equally clear of all former systems : we have nothing of the mystical archetypes of Plato, the incorporeal phantasms of Aristotle, or the material species of Epicurus ; we are equally without the intelligible world of the Greek schools, and the innate ideas of Des Cartes. Passing by all which, from actual experience and observation, it delineates the features, and describes the operations of the human mind with a degree of precision and minuteness which has never been exhibited either before or since ; and stands, and probably ever will stand, like a rock before the puny waves of opposition by which it has since been assailed from various quarters. The author mar PHYSIOLOGICAL PROEM. Jul. iv. 35 -speak of it with warmth, but he speaks from a digested knowledge Class IV. of its merits : for he has studied it thoroughly and repeatedly, and ieciuaitc there is, perhaps, no book to which he is so much indebted for what- PrinciP,e' nver small degree of discrimination, or habit of reasoning he may possibly be allowed to lay claim to. Upon one point he is perfectly clear, and that is that the chief Has been objections at any time urged against this celebrated production have stood inf proceeded from an utter mistake of its meaning, of which he could *°™®ti, give numerous instances, if such a digression were allowable, from points. the writings of many who have the credit of having studied it pro- foundly. The remark applies to several of the most popular psychologists of both North and South Britain, but especially to ^^'^ those of the continent, and more particularly still to M. Condorcet, from whom the French in general have received an erroneous idea of several of its leading doctrines. It is to this book the medical ^JUJlhe student ought to turn himself for a knowledge of the laws that student the regulate the developement and growth of the mind, as he should do of tne°mtai: to the labours of Haller or Hunter for a knowledge of those that ^d"Hunter regulate the developement and growth of the body, and I shall hence give that of draw largely upon it through the remainder of this introduction. ,he ° y' The whole then of the metaphysical rubbish of the ancient schools What the being cleared away by the purging and purifying energy of the when first Essay on Human Understanding, mankind have since been enabled formctl' to contemplate the body and mind as equally, at birth, a tabula rasa, or unwritten sheet of paper ; as consisting equally of a blank or vacuity of impressions; but as equally capable of acquiring impres- sions by the operation of external objects, and equally and most skilfully endowed with distinct powers or faculties for this purpose ; those of the body being the external senses of sight, hearing, smell, J>owers or taste, and touch ; and those of the mind the internal senses of percep- the mind tion, reason, judgment, imagination, and memory. wlth'uiosV It is possible that a few slight impressions may be produced a of the body. short time antecedently to birth; and it is certain that various fvTsii/ht1 instinctive tendencies which, however, have no connection with the impressions mind, are more perfect, because more needful, at the period of birth, before than ever afterwards ; and we have also frequent proofs of an here- ccruiniyd ditary or accidental predisposition towards particular subjects. But instinctive ■ 1 tendencies fhe fundamental doctrine before us is by no means affected by such collateral circumstances. External objects first impress or operate upon the outward senses ; First and these senses by means hitherto unexplained, and, perhaps, ™ external altogether inexplicable, immediately impress or operate upon the objects. mind, or excite in it perceptions or ideas of the presence and qualities of such objects ; the word idea being here employed, not in any of ^a. the significations of the schools, but in its broad, popular meaning, employed as importing " whatever a man observes, and is conscious to himself by LockR he has in his mind ;"* whatever was formerly intended by the terms archetype, phantasm, species, thought, notion, or conception, or whatever else it may be which we can be employed about in think- * Lo^kfi, on Human Understanding, B. i. eh. i. § 3. ib cl. iv.J PHYSIOLOGICAL PIJOKAL Class IV. jng>* And to these effects Mr. Locke gave the name of ideas oj iec'tuai sensation, in allusion to the source from which they arc derived. ideasof' But the mind, as we have already observed, has various powers senmion. or faculties as well as the body; and they are quite as active and theminf lively in their respective functions : in consequence of which the on itself, ideas of external objects are not only perceived, but retained, thought of, compared, compounded, abstracted, doubted, believed, desired; and hence another fountain, and of a very capacious flow, from which we also derive ideas ; viz. a reflex act or perception of the ideas of mind's own operations ; whence the ideas derived from this foun- reflexion. tam &re denominated ideas of REFLEXION. ideas are The ideas, then, derived from these two sources, and which have two kinds, sometimes been called objective and subjective, constitute all our anJdesub-e experience, and, consequently, all our knowledge. Whatever stock jective: of information a man may be possessed of, however richly he may derived7 be stored with taste, learning, or science, if he turn his attention in- from these wards, and diligently examine his own thoughts, he will find that sources. he has not a single idea in his mind, but what has been derived from the one or the other of these two channels. But let not this impor- Number tant observation be forgotten by any one ; that the ideas the mind of the ideas possesses will be fewer or more numerous, simpler or more diversi- mtasured*' fied, clear or confused., according to the number of the objects pre- bythe sented to it, and the extent of its reflexion and examination. Thus the'mmd. a clock or a landscape may be for ever before our eyes, but unless we direct our attention to them, and study their different parts, al- though we cannot be deceived in their being a clock or a landscape, we can have but a very inadequate idea of their character and com- position. ideasof two The ideas presented to the mind, from which soever of these two descriptions 1 • i r- i • i i from each of sources derived, are of two kinds—simple and complex. sources]"3 Simple ideas consist of such as are limited to a single notion or simple perception ; as those of unity, darkness, light, sound, simple pain or ideas, what. r ^ A , • „, J' . .,, 6V . \ . r -v ~ uneasiness. And in the reception of these the mind is passive ; for it can neither make them to itself, nor can it, in any instance, have any idea which does not wholly consist of them ; or, in other words, it cannot contemplate any one of them otherwise than in its totality. Complex Complex ideas are foimed out of various simple ideas associated eas.w a. together or contemplated derivatively. And to this class belong the ideas of an army, a battle, a triangle, gratitude, veneration, gold, silver, an orange, an apple : in the formation of all which it must be obvious that the mind is active : for it is the activity of the mind alone that produces the complexity out of such ideas as are simple. And that the ideas 1 have now referred to are complex, must be plain to every one; for every one must be sensible that the mind cannot form to itself the idea of an orange, without uniting into one aggregate the simple ideas of roundness, yellowness, juiciness, and sweetness ; and so of the rest. ofriSto"1 • ComP,ex ideas are fo™ed out of simple ideas by many opera- ideas by tions of the mind ; the principal of which, however, are some com- various mental operattens. * Locke, B. I. ch. i. $ 8. PHYSIOLOGICAL PROEM. [ex. iv. 3^ bination of them, some abstraction or some comparison. Let us ClassIV. take a view of each of these. iectu"ie" And first of complex ideas of combination. Unity, as I have l^"™'^ already observed, is a simple idea ; and it is one of the most common ideasof simple ideas that can be presented to the mind ; for every object £°m.in' without, and every notion within, tend equally to excite it: and being a simple idea, the mind, as I have also remarked, is passive on its presentation: it can neither form such an idea to itself, nor con- template it otherwise than in its totality: but it can combine the ideas of as many units as it pleases, and hence produce the complex idea of a hundred, a thousand, or a hundred thousand. So beauty is a complex idea; for the mind, in forming it, combines a variety of separate ideas into one common aggregate. Thus Dryden, in delineating the beautiful Victoria in his Love Triumphant, Her eyes, her lips, her cheeks, her shape, her features, Seem to be drawn by Love's own hand ; by Love Himself in love. In like manner the mind can produce complex ideas by an oppo- Complex site process ; and that is by abstraction or separation. Thus abstraction. chalk, snow, and milk, though agreeing, perhaps, in no other respect, coincide in the same colour ; and the mind contemplating this agreement, may abstract or separate the colour from the other pro- perties of these three objects, and form the idea which is indicated by the term whiteness; and having thus acquired a new idea by the process of abstraction, it may afterwards apply it as a character to a variety of other objects ; and hence particular ideas become general or universal. Other complex ideas are produced by comparison. Thus if the c.omPlex mind take one idea, as that of a foot, as a determinate measure, and comparison. place it by the side of another idea, as the idea of a table,, the result will be a formation of the complex idea of length, breadth, and thickness. Or, if we vary the primary idea, we may obtain, as a result, the secondary ideas of coarseness and fineness. And hence, complex ideas must be almost infinitely more nu- Hence com- merous than simple ideas which are their elements or material; as farXmoreG words must be always far more numerous than letters. 1 have in- ™™esirrlpie. stanced only a few of their principal kinds, and have applied them only to a few of the great variety of subjects to which they are re- ferrible, and by which they are elucidated, in the gieat work on Human Understanding. It must, however, from this imperfect sketch, appear obvious that Meas ,. • , , •. possess a many of our ideas have a natural correspondence, congruity nBturai and connexion with each other ; and as many, perhaps, on the con- e°"eesp°rn|[" trary, a natural repugnancy, incongruity, and disconnexion, natural Thus, if I were to speak of a cold fire I should put together ideas Exempu-' that are naturally disconnected and incongruous ; and should con- ned- sequently make an absurd proposition, or, to adopt common lan- guage, talk nonsense. I should be guilty of the same blunder, if 1 were to talk of a square billiard-ball, or a soft, reposing rock ; but a warm fire, on the contrary, a white, or even a black billiard-ball, and ■jb .jl. iv.J PHYSIOLOGICAL PROEM. ui,1nfeiV' a nard' ru8Sed rocki are congruous ideas, and consequently con- ieciu"ite" sistent with good sense. Now it is the direct office of that discur- OfficlPof she faculty of the mind which we call reason, to trace out these na- reason to tural coincidences or disjunctions, and to connect or separate them these con- by proper relations: for it is a just perception of the natui al connex- gruiiiesand ion and congruity, or of the natural repugnancy and incongruity of tfesTf.'just our ideas that shows a sound mind and constitutes real knowledge. o7tCheePm°an Tne wise man 1S ne who has industriously laid in and carefully assorted proof of an extensive stock of ideas; as the stupid or ignorant man is he who, mind.'and from natural hebetude, or having had but few opportunities, has a source of collected and arranged but a small number. The man who disco- ledge vers the natural relations of his ideas quickly, is a man of sagacity ; what.man' an^i m popular language, is said, and correctly so, to possess a quick, ignorant sharp intellect ; the man, on the contrary, who discovers these rela- Ma" of tions slowly, we call dull or heavy. If he rapidly discover and put ManCof together relations that lie remote, and, perhaps touch only in a few duiness points, but those points striking and pleasant, he is a man of wit, genius, and genius, or brilliant fancy, of agreeable allusion and metaphor; if he immagina- intermix ideas of fancy with ideas of reality, those of reflexion with those of sensation, and mistake the one for the other, however nu- merous his ideas may be, and whatever their order of succession, he Madman: is a madman ; he reasons from false principles, and, as we say in judgment.18 popular language, and with perfect correctness, is out of his judg- ment. Association Finally, our ideas are very apt to associate or run together in of ideas. trains . anfj Up0n this peculiar and happy disposition of the mind we lay our chief dependence in sowing the seeds of education. It often happens, however, that some of our ideas have been associated er- roneously, and even in a state of early life, before education has com- Sympathies menced; and hence, from the difficulty of separating them, most of pathtes';" the sympathies, and antipathies, the whims and prejudices that oc- whimsand casionally haunt us to the latest period of old age. General re- Such, then, is the manner, in which the mind, at first a sheet of tkm.tula* white paper, without characters of any kind, becomes furnished with that vast store of ideas, the materials of wisdom and knowledge, which the busy and boundless fancy of man paints upon it with an almost endless variety. The whole is derived from experience, the experience of sensation or of reflexion ; from the observations of the mind employed either about external sensible objects, or the internal operations of itself, perceived and reflected upon by its own faculties. iacuuL to These faculties are to the mind what organs are to the body : the mind they are its ministers in the production, combination, and resolution areatothens of different trains of ideas, and in supplying it with the results of its & OWn .ac.tivitv> We sometimes, however, are apt to speak of them spoken of as distinct and separate existences from the mind, or as possessing existence's, ? s?rt of independent entity, and as controlling one another by their ousie"°ne" indlvldual authonties, and occasionally, indeed, as controlling the Exempli- miml itself: for vve accustom ourselves'to describe the will as being fted. overpowered by the judgment; or the judgment as being over- powered by the imagination : or the mind itself as being carried PHYSIOLOGICAL PROEM. [cl. iv. 39 headlong by the violence of its own passions. By all wnich, how- ClassIV, ever, we only mean or should only mean, that, the mind does not, on lectuui" such occasions, exert its own faculties in a fitting or sober manner, p«nc»pie. or that from some diseased affection, it is incapable of doing so. For Faculties the faculties of the mind are so many powers ; and, as powers, are distinct mere attributes of the being or substance to tvhich they belong, and 'JJJXfinc"01 not the being or substance itself. These, therefore, being all differ- from each ent powers in the mind or in the man, to do several actions, he ° exerts them as he thinks fit; but the power to do one action is not operated upon by the power to do another action : for the power of thinking operates not on the power of choosing, nor the power of choosing on the power of thinking : any more than the power of dancing operates on the power of singing, or the power of singing on the power of dancing,* as any one who reflects on these things will easily perceive. The body has its feelings, and the mind has its feelings also : and The mind it is the feelings of the latter which we call passions, a mere Latin feaSiingS°a'sB term for the feeling or sufferings of colloquial language. The feelings *e" as the of the body are numerous and diversified, as those of simple ache or ease, hunger, thirst, heat, cold, and a multitude of others. Those of J^** are the mind are still more numerous and more diversified, for they com- sions. prise the multifarious train of grief, joy, love, hatred, avarice, ambi- ^nud"deirv°er- tion, conceit, and perhaps hundreds more : all which, whether of sjfied. body or mind, Mr. Locke has endeavoured to resolve into different xaiBp es modifications of pleasure or pain, according as they are productive of good or evil. But the analogy we are thus conducting between the mind and Hence ~ . . the m'Dtl the body holds much farther : for as the latter is subject to diseases subject to of various kinds, so also is the former. The body may be enfeebled Jf™",?, aa in all its powers, in only a few of them, or in only a single one. So well as the also may the mind: " The powers of perception and imagination," T°hJse dis. observes M. Pinel, " are frequently disturbed without any excite- j^3 may ment of the passions. The functions of the understanding, on the stitutionai other hand, are often perfectly sound, while the man is driven by his ,^ent,PperT-a passions to acts of turbulence and outrage." And these infirmities, °°icai and whether of body or mind, may be constitutional and permanent, pe- accidental riodical or recurrent, or merely incidental and temporary. The body ™d tempo- may be of a sanguineous temperament, of a plethoric temperament, illustrated. of a nervous or irritable temperament; and the mind may, in like manner, possess an over-weening confidence and courage ; be cha- racteristically dull and inactive; or be ever goaded on by restless- ness and eager desire ; it may be quick in apprehension and taste, but weak in memory ; strong in judgment, but slow in imagination : or feeble in judgment, but rapid in imagination : its feelings or pas- sions may be sluggish, or all alive ; or some passion may be pecu- liarly energetic, while the rest remain at the temperate point. When the corporeal deviations from the standard of high health ^en the are but slight, they are scarcely entitled to the name of diseases,— from perfect but when severe or extreme, they become subjects of serious atten- body^fghtf hardly called dis- * Locke, p. 129. v\see; but 40 cl.iv.J PHYSIOLOGICAL PROEM. Class IV. III. Intel- lectual principle only when severe or extreme. The same in the faculties of the mind, slight aber rations scarcely noticed, but when strongly marked, real dis- eases- The mind and body reciprocally influence each other. Hence the mind an interesting piece of Btudy to the pathologist. tion. It is the same with the different states of the mind with which I have just contrasted them. While several, or even all the mental faculties are slightly weak or sluggish, or inaccordant with the action of the rest, they are scarcely subjects of medical treatment—for other- wise half the world would be daily consigned to a strait waistcoat: but when the same changes become striking and strongly marked, they are real diseases of the intellect ; and, in the ensuing order, the genera will be found taken from the peculiar faculties of the mind that chance to be thus affected. The mind and the body bear also, in many cases, a reciprocal in- fluence on each other; which is sometimes general, and sometimes limited to particular faculties or functions. It is hence that fever or cephalitis produces delirium ; and vapours or low spirits dyspepsy. The mind, therefore, like the body, becomes aq interesting field of study to the pathologist, and opens to his view an additional and melancholy train of diseases. It is these which will constitute the subject of the first order of the class we have now entered upon, and which are entitled to a deep and collected attention. CLASS IV. NEUROTICA. ORDER I. MRENICA. DISEASES AFFECTING THE INTELLECT. ERROR, PERVERSION, OR DEBILITY OF ONE OR MORE OF THE MENTAL FACULTIES. The word phrenica is Greek from the Greek noun 4>£»v, " the Class iV mind" or " intellect." The diseases comprised in the order, are p™?*.1, so closely associated with each other that, however the ordinal Affecting names may differ in different systems of nosology, they are, for the origin6 of' most part, grouped in some form or other under a correspondent *r3m3rdina! division. And hence the present order will be found to run nearly Comprises parallel with the Deliria of Sauvages, the Mentales of Linneus, the closely8 Paranoias of Vogel, the Vesaniae of Cullen, and still more with those associated! of Crichton, and the Alienation mentale of Pinel: although the ge- United6 in neric divisions are widely different from all of them, and are attempted p}™"^*11 to be rendered something clearer and more exact. The order com- nosology. prehends the six following: I. ecphronia. insanity. II. empathema. ungovernable passion, III. alusia. illusion. IV. aphelxia. revert. V. paroniria. sleep-disturbance. VI. MORIA. FATUITY. Each of these will be found to include various distinct species of General ^ disorder proceeding from a morbid condition of one or more of the c mental faculties or feelings, or an irrespondence of them to others ; sometimes originating in a diseased state of the body, and sometimes producing such a state, as has already been explained in the preceding proem. Vol. IV.- < XI cl. iv.j NEUROTICA. u.itu. i. GENUS I ECPHRONIA. INSANITY. CRAZINESS. DISEASED PERCEPTION, WITH LITTLE DERANGEMENT OF THE JUDO MENT, OCCASIONALLY SHIFTING INTO DISEASED JUDGMENT WITn LITTLE DERANGEMENT OF THE PERCEPTION ; DISTURBING THE MINI* GENERALLY ; DIMINISHED SENSIBILITY ; IRREGULAR REMISSIONS. Gen. I. The generic term ecphronia, in the Greek writers ^c kind, in M. Pinel, whose book is, nevertheless, of great merit. phTeUu Delirium or wandering is made a pathognomic symptom in his defi- P^^f. nition of the genus ; in other words, a want of correspondence be- tween the judgment and the perception ; and consequently this symp- tom should be found in every species which he has arranged under it. M. Pinel, however, has given us one species which has no such symptoms, and which is purposely intended to include cases of what he calls mania without any such discrepancy ; on which account he has denominated it manie sans delire. All such cases, however, jjjjj*^ ^0I1* are reducible to modifications of rage or ungovernable passion, and deiiriunT ought by no means to be confounded with mania; the judgment gj^bie being, in these instances, not at variance with the perception, but pasBion. overpowered by the predominant fury or passion that has been excited. They all belong properly to our next genus; under which they will be considered. Much difficulty has also been felt in defining ecphronia or insanity, ^™^h°.f so as to draw the hne between real disease and habitual waywardness ing ™*™*s or oddity; and hence while some definitions are so narrow as to lu0aToQdity set at liberty half the patients at Bethlem or the Bicetre; others of temper, are so loose and capacious as to give a strait waistcoat to half the 'vny]c] ■44 ql. iv.j- NEUROTICA. |ord. i, Gen. I. M. Dufour, undertook with great learning and ingenuity to prove toauuT' that, as all our knowledge of an external world is derived from the Crazmess. action of the external senses, whilst mental sanity depends upon the essentially soundness of these senses, mental insanity is alone to be referred to nu6oue£ a diseased condition of one or more of them. And in proof of this hypothesis, he gives the case of a person who lost his senses because he could condittoanodf not be persuaded that the objects he saw in consequence of an inci- the external pient cataract, arose entirely from that complaint. " When he found that he could not remove the dark web which appeared to him to be constantly floating before his eyes, he fell into such frequent fits of violent passion that he became quite insane* But as soon as the disease was completed he became more tractable, and submitted to the operation like a reasonable man." But this only shows us that Ira furor brevis est, or else that the insanity was caused, not by the cataract, but by the frequent fits of violent passion. Thousands of persons have had ca- taracts in every form, and other external senses than the eye diseased in every form, and have been born defective in several of these senses without the least mark of insanity ; while other persons, apparently in the most perfect possession of all the five senses, have been stark mad. And hence the doctrine of M. Dufour, boasts of few advo- cates in the present day. Hypothesis In insanity or delirium without fever, it is far more obvious that andLCone- there is a morbid condition of the judgment, or of the perception, diiiac, or Qr 0f both. Mr. Locke, and after him M. Condillac, refers it to the former alone, and characterizes madness, in the general sense of the false term, by false judgment; by a disposition to associate ideas incor- ju gmen. rccfly.^ an(j t0 mistake them for truths ; and hence, says Mr. Locke, " madmen err as men do that argue right from wrong principles."* Battle's Dr. Battie on the contrary, refers madness to the latter faculty alone, or false8*'8 and characterizes it by false perception; but the perceptions in mad- percoption. ness seemi for any thing we know to the contrary, to be frequently as correct as in health, the judgment or reasoning being alone dis- eased or defective. h^'othescs ^ ^ difficult to say which of these two explanations of madness is imperfect^ most imperfect. It is sufficient to observe that neither of them, ra"spect!vhat taken alone, describes a condition of the faculties strictly morbid, and consequently neither of them defines madness. For we are daily meeting with thousands of mankind who are under the influ- ence of false judgments, who unite incongruous or discrepant ideas, and draw from false associations right conclusions, yet whom we never think of regarding as out of their senses. While on the con- trary if false perceptions be sufficient to constitute madness, every man is insane who mistakes at a distance a square for a round tower, the bending azure sky that terminates an extensive landscape for the sea, or the distant rumbling of a heavy wagon over the streets for a peal of thunder : and we should none of us be safe from such a charpe for a single day of our lives. * B. ii. Ch, xi. § 13. cl.iv.J \ERVOUS FUNCTION |or». i. 45 Dr. Cullen seems to have embraced Mr. Locke's view of the sub- Gen. I. ject: for his definition of insanity (vesaniae) in the latter editions of insamt'^18' his Synopsis is •' injured functions of the mind in judging (mentis ju- ^fen^3' dicantis) without pyrexy or coma." Dr. Crichton, on the contrary, hypothesis seems rather to adhere to Dr. Battle's view, though he enlarges and hwwel improves upon it; and hence his definition is " General derangement f">m , of the mental faculties, in which diseased perceptions are mistaken criciuon's for realities; with incoherent language and unruly conduct." an'improvo. Diseased is certainly a better term than false, which is that of mentupon Dr. Battie; but " unruly conduct" does not essentially belong to madness, even under this excellent writer's own explanation : for of the three species which he comprehends under this disease as a genus, viz. mania furibunda, mania mitis, and melancholia, whilst the last, as he afterwards illustrates it,* evinces these symptoms only oc- casionally, he expressly tells us of the second, that the diseased are Jj^uion " all happy, gay, and cheerful;" that " good humour characterizes not true to this insanity, and hence the patients are in general very tractable."! {jjgt°]!y" But the chief objection to Sir A. Crichton's definition of insanity, and not is his limiting it, in respect to the mental faculties, to the power of comple" y perception while the judgment remains totally unaffected. " In {j^™1"^ regard to lunatfes," says he, in another place, " and men who are disease to of a sound mind, the faculty of judging is the same in both, but they ofeperce!£ have different perceptions, and their judgments therefore, must be tion. different."^ Now if the faculties of perception, attention and memory be liable to derangement, as the same writer admits, and there be " a general derangement of mental faculties in insanity," there seems no suffi- cient ground for exempting the faculty of judgment. And a little attention to the history of an insane patient will, I think, sufficiently support the opinion of Mr. Locke and Dr. Cullen upon this point, and show that this, if not the faculty chiefly diseased, labours under at least as much disease as that of perception. We have already observed in the proem to the present class, that fn^? s of all the powers of the mind are as liable to be affected with diseases, the mind, and diseases of various kinds, as those of the body; and that either Jj^nl' 0f the body or the mind may be enfeebled at the same time in the whole the hody, of its powers, in a few of its powers, or in a single power. A sound ,.f'being mind supposes an existence of all the mind's feelings and intellectual dlscased' powers in a state of vigour and under the subordination of the judg- ment, which is designed by nature to be the governing or control- ling principle. And thus constituted, the mind is said to be in a state of order or arrangement. It often happens that this order or arrangement is slightly broken in upon by natural constitution, or some corporeal affection ; but so long as the irregularity does not jUt s^sht essentially interfere with the mental health, it is no more attended to mentsB>n than slight irregularities or disquietudes of the body. Yet whenever attended"6 it becomes serious and complicated, it amounts to a disease, and the t0' aatnyit mind is said, and most correctly so, to be deranged or disordered, interfering J with the mental or * Of Mental Derangement. Book in. Oh. in. Vol. n. health. r Id. Book i. C]i. v. pp. 181, 182. Vol. i. % Id. Vol. i. p. 401. it) Gen. I. Ecphronia. Insanity. Craziness. Upon this principle the ensuing genera tire founded. Tbejudg- meni and perception both dis- eased m insanity, and some- limes, though not necessardy other men tal powers: nor arc the judgment and percep- tion always equally affected at the same time. Illustrated •} NEUROTICA. foHD ■H Further illustration. This derangement may proceed from a morbid state of any of the intellectual or any of the empassioned faculties of the mind, for the perception may not correctly convey the ideas we receive by the ex- ternal senses, or the judgment may lose its power of discriminating them ; or the memory may not retain them, or the imagination or the passions may be in a state of unruly excitement: all which will lay a foundation for different kinds or genera of diseases, and in fact form the foundation of those appertaining to the present order. Now an attentive examination into the habits of an insane person will show first, that the judgment and the perception are both in- jured during the existence of insanity ; and next that though, from a violent or complicated state of the disease, the morbid condition often extends to some other, or even to all the other mental faculties, yet it does not necessarily or essentially extend to them ; for a mad- man may be furious or passionate, yet every madman is not so ; his memory may fail or his attention be incapable of fixing itself, or his imagination be wild and extravagant, but these do not always occur, The faculties, however, of the judgment and the perception are affected in every case, though they are not always equally affected at one and the same time : for the morbid power seems, for the most part, unaccountably to shift in succession from the one to the other, so as alternately to leave the judgment and alternately the percep- tion free or nearly free from all estrangement whatever, the disease being, however, always accompanied with irregular remissions; and often with such a diminution of sensibility that the patient is unin- fluenced by the effects of cold, and hunger, and very generally un- susceptible of febrile miasm. Thus a madman will often mistake one person who is introduced to him for another, and under the influence of this mistake will reason eorrectly concerning him, and although he may have been for years his next neighbour, will ask him when he came from China or the East Indies, by what ship he returned home, and whether his voyage has been successful. In all which the error may be that of the per- ception alone. But if, as is frequently the case, the patient address his visiter by his proper name, he gives a ground for believing that he perceives him aright, and that the error is that of the judgment, which thus unites incongruous ideas, applying a visionary history to a real and identified person. At anoiher time, he may, from the first, perfectly recognise the individual so presented to him ; and to prove his recollection and the correctness of his perception, mav rapidly run over a long list of his relations, and a long string of anec- dotes respecting his former life: after which he may suddenly start, and looking at the visiter's walking-stick, tell him "that that drawn sword will never save him from destruction, nor all the men that slept with him in the same bed the night before—that bis rival is now pushing forward with all speed on a black horse with a large army behind him, and that to-morrow he will fight and lose his crown. In such a case, and it is by no means an extreme one, the percep- tion and the judgment travel soundly and in harmony at the outset of the interview; but they soon separate and abandon each other as ol.iv.] NERVOUS FUNCTION". |obd.i. 4't far as cast and west. It is not always easy to say whether the fresh EG^Nt }• paroxysm of insanity that thus suddenly displays itself is limited to inanity.1*" the one faculty or to the other, or is common to both. For if the Noways perception suddenly wander, the judgment has a new train of ideas easy to presented to it, and must necessarily take a new direction. Yet it is w^fchX? difficultto conceive how the judgment can be thus abruptly led astray ""'^jf™05' if it continue sound ; and hence it is more probable that the judg- ment itself is at fault, and admits a train of ideas which, however congruous to themselves, are incongruous to those furnished by the faculty of perception ; or both may equally wander, and accompany each other in the visionary scene, as they at first associated in the real. It is obvious, however, if I mistake not, that both faculties are affected in the derangement of insanity jointly or in irregular succession. How far a morbid state of the mental faculties may in any case depend upon the mind itself, as distinct from the sensorium or in- strument by which it is connected with the body, it is impossible for us to know till we become acquainted with the nature of this con- nexion, and perhaps also with the essence of the mind, which, in our present state of information, seems to be a hopeless subject of in- quiry. But we may possibly obtain some insight into the manner in p,orrect which correct ideas of perception are changed in their nature and perception rendered incorrect or incongruous by a diseased judgment, by at- {J^aWn- tending to a process of variation that is frequently occurring in per- correct by a feet sanity and acuteness of mind. " The ideas we receive by sen-judgment; sation," says Mr. Locke, in adverting to this process, " are often in grown people altered by the judgment without our taking notice of it." And he explains this position by observing that when a ball of any uniform colour, as of gold, alabaster, or jet, is placed before the eye, the idea thereby imprinted in the mind is that only of a flat cir- cle variously shadowed, with different degrees of light and brightness coming to the organ of sight. " But having by use been accus- tomed to perceive what kind of appearance convex bodies are wont to make in us; what alterations are made in the reflexions of light by the difference of the sensible figures of bodies, the judgment pre- sently, by an habitual custom, alters the appearances into their causes ; so that from that which truly is variety of shadow or co- lour, collecting the figure, it makes it pass for a mark of figure, and frames to itself the perception of a convex figure and an uniform co- lour."* And the same change occurs still more conspicuously in f"rt{1a"efl, looking at an engraving or a picture, in which the only idea pre- sented by the eye to the perception is that of a plane variously shaded or coloured; but which the judgment immediately changes and multiplies into other ideas of life and motion, and running streams, and fathomless woods, and cloud-capt mountains. And if in a sane state we find Ihe judgment capable of thus varying the ideas of perception presented to it, we can have no great difficulty, I think, in conceiving by what means such a variation may be pro- duced and may ramify into incongruities of great extravagance in a judgment deranged by disease. * Hum. rndrrot. B^ok II. Ch. i*. $ P. ib cl. iv.J NEUROTICA L^lD- *■ E?!,L?a Nor is tliere much difliculty in conceiving how the paroxysm insanUy.'"' should be subject to remissions or even intermissions more or less WhencT' regular ; or the derangement be limited, as we frequently find it, remissions and especially in melancholy, to particular subjects or trains of "ons'oMhe »>eas. For first all diseases have a tendency to remissions or inter- paroxysms missions ; but those connected with the brain or nerves more than '"ndnhowy any others, as is evident in hemicrania, epilepsy, hysteria, and pal- confined1 aet pitation of the heart. And next, there is no man in a state of the times to most perfect sanity whose judgment is equally strong and exact Kef" upon all subjects: and few whose judgments are not manifestly ic,eas7 influenced and led astray by partialities, or peculiar incidents of a thousand kinds; insomuch "that we dare not, on various occasions, intrust to a man of the strictest honesty and the clearest head a particular subject for his decision, whom we should fly to as our counsellor upon every other occurrence. And it is not, therefore, very extraordinary that, in a morbid state of the mind, and particu- larly of that faculty which constitutes the judgment, there should be an aberration in some directions or upon some subjects which does not exist upon others. The corpo- The corporeal indications differ as much as those of the mind, t-wns'vary*" and generally as being governed by the latter. We have hence as those of sometimes, as an opening symptom, an extraordinary flow of high spirits, at others extreme terror. The countenance is pale and ghastly, and strongly expressive of inward emotion ; the speech hurried and tremulous, and the extremities bedewed with a cold sweat. In other instances the eye glares malignantly, the face is flushed, and evinces a dreadful ferocity ; the objects of terror become objects of vengeance, and the patient is furious. In some there is an unusual degree of suspicion, and an anticipation of evil, and a belief in imaginary plots or conspiracies. In others great irascibility and malignity, and a desire to commit some act of despe- ration, vengeance or cruelty. All this is often combined with head- ache, giddiness, throbbing of the temples, or impaired vision. There is little or no sleep, for the mind is in a state of too much excite- ment, though at times the patient lies listless and refuses to be roused.* Remote Concerning, therefore, the remote or even the proximate cause insanity, of the disease, we have yet much to learn. From the view we have a^e'a'sed taken in the proem of the close connexion between the mind and condition of the brain, it seems reasonable to conceive that the remote cause is theenco-0 ordinarily dependent upon some misconstruction or misaffection of Sow°far ^e cereDral organs : and hence every part of them has been scruti- thisestab- nized for proofs of so plausible an hypothesis, but hitherto to no liusecaons. purpose whatever. The form of the cranium, its thickness, and other qualities ; the meninges, the substance of the brain, the ven- tricles, the pineal gland, the commissures, the cerebellum, have all been analyzed in turn, by the most dexterous and prying anatomists of England, France, Germany, and Italy, but with no satisfactory result. The shape or thickness of the scull has been started, indeed'. * Annual Report of the <:iasgrow Asylum for Lunatics, 1821 cl. iv.J NERVOUS FUNCTION. [ord. l. 4i> as a cause, by many anatomists of high and established reputation ; fGek- h but the conjecture has been completely disproved by others, who insani°y.ia" have found the very structures supposed to be most certain of pro- CrazineBB ducing madness, exist in numerous instances with perfect sound- ness of intellect. A particular shape of the scull seems, indeed, to be often connected with idiotism from birth or soon after birth, but with no other species of mental derangement whatever. Morgagni engaged in an extensive course of dissections upon this Morgagoi. subject, and pursued it with peculiar ardour : and his results are given in his eighth epistle from the second to the eighteenth article. In some cases the brain was harder, in some softer, than in a healthy state ; occasionally the dura mater was thicker, and was studded with soft, whitish bodies on the sides of the longitudinal sinus. This sinus itself sometimes evinced polypous concretions ; and the pineal gland, or several of the glands in the plexus choroides were in a dis- eased state. Dr. Greding,* with a like spirit of investigation, arrived at a like diversity of facts. Meckel tells us that he found Meckel. the brain denser and harder than usual ;t Dr. Smithf described a bony concretion, and Plenciz and various others represent the brain as bony or calculous in various parts; while Jones, in the Medical Jones' Commentaries, found it softer than usual with a thickening of the membranes and a turgescence of the ventricles. From all which, Nothing nothing precise or pathognomic can be collected, since all such pathogno- morbid appearances have been traced under other diseases as well ^^ as under insanity. been coi- M. Pinel is firmly decided upon this point: and after a very p^' extensive course of investigations he asserts, with respect to the cranium, that there are no facts yet clearly established which prove the faculties of the mind (except in the case of idiotism) to be, in any degree, influenced by its size, figure or density: while with respect to the contents of the cranium, " I can affirm," says he, " that I have never met with any other appearances within the cavity of the scull, than are observable on opening the bodies of per- sons who have died of apoplexy, epilepsy, nervous fevers, and con- vulsions ;" and his successors M. Esquirol and M. Georget concur in the same remarks. The last, after having examined three hun- dred lunatics on their decease, to settle the point before us, thus concludes : " Toutes les alterations que nous avons observees sur les alienees de la Salp€triere sont consecutives au developpement de la folie, excepte celles des cerveaux d'idiotes, qui sont primitives et liees a l'etat intellectuel." The observations of Haslam are nearly to the same effect: for Hasiam they concur in showing that, except in so considerable a misforma- tion of the scull or its contents, as to induce idiotism from an early period of life, as in the case of cretinism, nothing decisive can be obtained in reference to insanity from any variations of appearance that have hitherto been detected. The dissections of Greding extended to not fewer than two hun- Greding. t Vermischte mediciuische und chirurgische Schriften. Altenb. 1781. j Hist, de l'Acad. Royale des Sciences, &c. Ann. 1760. Berol. 4to. 1767 § Med. Observ. and Inqoir. Vol. vr. Y0L. TV.--7 ■j{) at. iv.J NEUROTICA. Gen. I. Ecphronia. Insanity. CrazinesB. What periods of life most subject to insanity. What tem- peraments chiefly predispose or pursuits excite the disease. ^Vheu.er uriginating from a dis- eased con- dition of the epigastric or other abdominal organs. Common proximate cause of Pinel. dred and sixteen maniacal patients, the whole of whom, however, died with disorders unconnected with their mental ailmenta : three of the heads were exceedingly large, two exceedingly small ; some of the scull-bones extremely thick, others peculiarly thin ; in some, the frontal bones were small and contracted, in others, the tempo- ral bones compressed and narrow.* In a table containing an aggregate of the patients received into the lunatic asylum at Bicetre during a considerable part of the French revolution, from 1784 to 1792, by far the greatest number admitted were between the ages of thirty and forty : next, those between forty and fifty ; next to these, patients between twenty and thirty ; then those from sixty to seventy; and lastly, those from fifteen to twenty ; below which we have no account of any admis- sion whatever. Hence different stadia of life seem to exercise some control, and the period most exposed to the disease is that in which the influence of the passions may be conceived to be naturally strong- est and most operative. "• Among the lunatics confined at Bicetre," says M. Pinel, " during the third year of the republic, and whose cases I particularly examined, I observed that the exciting causes of their maladies, in a great majority of instances, were extremely vivid affections of the mind ; as ungovernable or disappointed ambition, religious fanaticism, profound chagrin, and unfortunate love. Out of one hundred and thirteen madmen, with whose histories I took pains to make myself acquainted, thirty-four were redviced to this state by domestic misfortunes : twenty-four by obstacles to matri- monial unions which they had ardently desired to form ; thirty by political events connected with the revolution ; and twenty-five by religious fanaticism." Those were chiefly affected who belonged to professions in which the imagination is unceasingly or ardently engaged, and not controlled in its excitement by the exercise of the tamer functions of the understanding, which are more susceptible of satiety and fatigue. Hence the Bicetre registers were chiefly filled from the professions of priests, artists, painters, sculptors, poets, and musicians : while they contained no instances of persons whose hne of life demands a predominant exercise of the judging faculty: not one naturalist, physician, chemist, or geometrician. But there are other organs that also betray very prominent signs of diseased action in insanity as well as the brain, as those of the epigastrium and the adjoining regions : and hence other physiolo- gists have sought for a remote or even a proximate cause of the malady in these, rather than in the encephalon. This was the case among several, though not the majority, of the Greek physicians as we have seen already ; and it is to this quarter that M. Pinel refers the proximate cause in almost every instance in our own day. It is here he supposes the disease to commence, and contends that the affection of the brain and of the mental faculties is subsequent to the abdominal symptoms, and altogether dependent upon them: and in proof of this he adverts to various dissections which have shown a considerable derangement, not only in the function but ' Vermis<:hte Schriften, ut supra «l. iv.) NERVOUS FUNCTION, [ord. j. 51 even in the structure of one or more of the abdominal organs, and Gen. I. particularly a displacement of the transverse colon. insanity1.18' But this is to give a weight to the morbid appearances occasionally gJ,*gpjJaion manifested in these organs, above what is allowed to like misforma- and abdo- tions in the cranium. Yet there can be no doubt that, in most g^toften cases of insanity, the brain and epigastrium suffer jointly ; and that affected ii- i /• 1 • . i jointly: and the disease may, and often does, commence m some structural or the disease functionary affection of the abdominal organs is perfectly clear from gf^jy'6*" the frequency of this complaint during pregnancy and in child-bed : originate in its being connected with a peculiar state of the genital organs, as e' we shall presently have occasion to show, and its following upon a sudden suppression of the menstrual or hemorrhoidal discharge. Nor is it difficult to account for this association of influence T.hi* aBS0L' from the extensive distribution of the par vagum, and more particu- influence larly of the intercostal nerve over the abdominal viscera : on which c*Plained account a Tike sympathy is by no means uncommon in various other disorders. Thus while a concussion or compression of the brain produces nausea, sickness, and constipation, worms are frequently Found to excite convulsions or epilepsy. The fair result of the whole inquiry appears to be, that insanity, inference in every instance, to adopt the language of Sir A. Crichton, " arises general from a diseased state of the brain or nerves, or both :"* but that in '"V1"'^ many instances this diseased state is a primary affection, and in others a secondary, dependent upon a morbid condition of the epi- gastric or some other abdominal organ : for, in whatever this mor- bid condition may consist, and whatever symptoms it may evince, it is not till the sensorium has by degrees associated in the chain of unhealthy action that the signs of insanity are unequivocal. And, in like manner, dyspeptic and other abdominal symptoms are not unfrequently brought on by a previous diseased state of the mind : and it is hence peculiarly difficult, and perhaps in some cases alto- gether impossible, to determine, where we are not acquainted with the incipient symptoms, whether melancholy or hypochondrias, has originated in the state of the abdominal viscera or of the cra- nium ; or in other words, whether the one or the other be a pri- mary or a secondary affection. When, however, we are made acquainted with the history of the Where trie incipient symptoms, we have a tolerable clue to guide us ; and, for the ineipi- the most part, may safely decide that the region primarily affected, tom^are is that which first evinces morbid symptoms : and hence, while we clear, the shall have little scruple in assigning the origin of most cases of be "aVslgne'd liypochondrism to a morbid condition of one or more of the digestive t0 its P"" organs, we need have as little in assigning the greater number of cases of mania to a primary misaffection of the brain or the nerves. In what that misaffection consists is a question that has never P'o^mafe been settled to the present hour, and from our total in acquaintance insanity, with the nature of the connexion between the brain and the mind, it never will be in any very satisfactory manner. The morbid changes, indeed, which we have already seen are frequently to be traced in * f)f Mental Deransemcnt, Vol. I. p. 13? ■iSJ cl. iv.J NEUROTICA. i-oBD' J K?*h?on& the 9tructure of the brain' show vcr>' sufficiently that a considerable insanity1!*" degree of diseased action has been taking place there ; but as these crazhe*s. changes are also found in other disorders of the head as well as in mania, and more especially as we cannot tell whether they have preceded or been produced by such action, they give us little infor- mation as to the nature of the diseased action itself. cuiien's Dr. Cullen has offered a series of ingenious arguments to prove ypot esi». tj^ mania consists in some inequality in the excitement of the brain,* or of the nervous power,t and in most cases in an increased excitement. Dr. Cuiien's idea of the nervous power, as we have already had occasion to observe, is very far from being explicit : for lie defines it " a subtile very moveable fluid included or inherent in a manner we do not clearly understand in every part of the medullary substance of the brain and nerves." While in other parts of his writings he represents it as never either recruited or exhausted, and thus conceives it to possess qualities beyond the ordinary endowment? of living matter. Yet his general principle appears to be well Crichton's founded, and Sir Alexander Crichton has availed himself of it in hfgPhiyhpro- givm£ a fuller explanation of this highly probable hypothesis : and, babie; and after appealing to the doctrine which has already been advanced with the pa- and supported in the preceding pages of the present work, that the docSmet'of nervous power is a peculiar fluid secreted in the medullary substance the present of the brain or the nerves, he endeavours to show that the cause of insanities is a specific morbid action of the vessels which secrete the nervous fluid in the brain ;| and which may hereby be altered not only in quantity but in quality.§ From the quickness of the external senses, the irascibility, heat of the skin, flushed countenance, and uncommon energy which maniacs evince, we have reason to believe this morbid action to be, for the most part, a preternaturally increased action ; and we are hence able to account for the various exacerbations and remissions which it evinces, sometimes periodically, and sometimes irregularly. Yet as the health of the faculties of the mind must depend upon a healthy energy of the vessels, too scanty a secretion of nervous fluid must be as effectual a cause of mental derangement as too copious a flow : and hence torpor of the vessels of the brain may prove as certain a cause of a wandering mind as entony, and, consequently, typhous fever may become a source of delirium as well as inflamma- tory. And as the various secretions can only be elaborated from the blood, and are often affected by its condition, we may see also how madness may be a result of acrid narcotics and other poisons intro- duced into the blood by absorption, or a transfusion of blood from animals of a different nature, of which Dionis has given some very striking examples. Se^Ds^fai That there is. a tendency not only to an increased secretion of power is sensorial power in the head in most cases of insanity, but to an accu- SSd mutation of it from all parts of the body, and especially from the sur- insanity. face, it is clear from the patient's diminished sensibility to external impressions, and his being able to endure the severest winter's cold, and J Of Mental Derangement, Vol. I. p. 174. § Id. Vol. i. p. 169, cl. iv.J NERVOUS FUNCTION. [ord. r. a fasting of many days, without inconvenience or indeed conscious- G^N* }• ness. But that there is in some cases, a diminished secretion of insanity.' ' this fluid producing a general debility of the living fibre, is also clear p™*f"etshBat from the great tendency manifested by some maniacs, whose brain it is some- gives no proof of increased excitement, to a gangrene in their extre- mhiished. mities, and, where they are uncleanly, about the buttocks. The insensibility from this cause is sometimes so considerable as to effect, not only the diffuse organ of feeling, but some of the local senses as well. And hence some patients lose their hearing, and others are capable of staring at the meridian sun without pain, or any change in the diameter of the iris.* Sometimes, however, the increased secretion of sensorial power is so considerable as not only to affect the head, but to augment the corporeal sensibility generally. And hence Hoffman makes accumulated sensation an ordinary symptom of this disease,! mistaking the exception for the general rule: and Riedlin gives us an instance of a maniac, who, instead of calling for and being able to endure large quantities of snuff, sneezed and was convulsed on smelling the mildest aromatics.J It is a melancholy reflection that insanity is often the result of an ^^ hereditary predisposition. This, indeed, has been denied by a few result of writers; but their opinion has unhappily been confuted by the concur- ^redupoel- rent voice of those who have thought differently, and the irresistible tion. evidence of daily facts. Mysterious as the subject is we have perpe- illustrated tual proofs that a peculiarity of mental character is just as propa- gable as a peculiarity of corporeal; and hence wit, madness, and idiotism are as distinctly an heir-loom of some families asscrophula, consumption and cancer of others. In most of the latter we have already observed that something of a constitutional make or phy- siognomy is often discernible; and the same is contended for by many authorities in the disease before us. Yet, if we examine the whether i i 11 r- i f i manifested marks accurately we shall find that they merge, for the most part, by external into the common symptoms of a sanguineous, or a melancholic tern-Slgns- perament: either of which constitutions exercises such a control over the disease as to give it a peculiar modification whatever be the nature of the exciting cause ; which is in truth of little importance to the constitutional turn the malady may take, though well worth attending to in the moral treatment. " The violence of the maniacal j^jjj?^ paroxysms," observes M. Pinel, " appears to be independent of the disease nature of the exciting cause ; or at least, to be far more influenced ™d°bvtheCt" by the constitution of the individual, and the peculiar degree of his tempera- physical and moral sensibility. Men of a robust constitution, of tT/the an mature years, with black hair, and susceptible of strong and violent ®|„^ns passions, appear to retain the same character when visited by this dis- illustrated. tressing of human misfortunes. Their ordinary energy is augmented to outrageous fury. Violence, on the other hand, is seldom charac- teristic of the paroxysms of individuals of more moderate passions. with brown or auburn hair. Nothing is more common than to see men with light-coloured hair sink into soothing and pleasurable reveries ; while it seldom or never happens that they become furious * Blnmenb. Bibl. i. p. 736. t Opp. Suppl. n. 2. I Lin. Med. 1696. p. •!<>. ■« cl. iv.j NEUROTICA. L°"D- T Gen. I. Ecphronia. Insanity. Crazinesg. Insanity whether more com- mon to England than other countries ? and whe- ther of late an increas- ing malady? Is not a prevalent disease nor apparently so prevalent as in many other countries. Nor an increasing Examina- tion of Powell's data which have led to a contrary conclusion. or unmanageable. Their pleasing dreams, however, are at length overtaken by, and lost amidst the gloom of an incurable fatuity. Those of the greatest mental excitement, of the warmest passions, the most active imagination, the most acute sensibility, are chiefly predisposed to insanity. A melancholy reflection !—but such as is calculated to call forth our best and tenderest sympathies." It has long been a current opinion that insanity is a disease more common to our own country than to any other: and this opinion has of late been rendered more seriously alarming by the following assertion of Dr. Powell, secretary to the commissioners for licensing lunatic establishments, and which is given as the result of his official tables of returns from 1775 to 1809 inclusive, divided into lustra or periods, of five years each. " Insanity appears to have been considerably upon the increase : for if we compare the sums of two distant lustra, the one beginning with 1775, and the other ending with 1809, the proportion of patients returned as having been received into lunatic houses during the latter period, is to that of the former nearly as 129 to 100." " The facts also," says he, " which present them- selves to the observation of the traveller, whatever direction he may take through this country, and all the local information which we receive upon the subject supply us, as I am led to think, with suf- ficient proof that the increase must actually have been very consider- able, though we cannot ascertain what has been its exact proportion."* The first part of this opinion, or that which regards insanity as a disease peculiarly prevalent in England, does not seem to rest on any established basis : for, calculating with Dr. Powell, that the number of lunatic paupers, and those received into public hospitals, which, under the ai of parliament are not cognizable by the com- missioners, together with those neglected to be returned, compared with the returns entered into the commissioners' books, bear the proportion of three to two, which is probably far above the mark, still the aggregate number of insane persons for the year 1800, con- trasted with the general census for the same year, will only hold a ratio of about 1 to 7300 : while if we take with Dr. Burrows, the proportion of suicides committed in foreign capitals as a test of the extent to which insanity is prevalent in the same towns, which is nevertheless a loose mode of reckoning, though it is not easy to obtain a better, we have reason to conclude that insanity is com- paratively far less frequent among ourselves than in most parts of the continent: the suicides of Paris, Berlin, and Copenhagen, as drawn from tables collected by Dr. Burrows for this purpose, being in proportion to the relative population of London as 5 to 2 for the first, 5 to 3 for the second, and 3 to 1 for the third.t Nor does the idea that insanity is an increasing disease in our own country appear to rest on a stabler foundation. Taking Dr. Powell's result as drawn from full and incontrovertible data, and comparing the supposed march of the disease with the acknowledged march of the population, although the former may possibly be said * Med. Trans. Vol. iv. p. 131. Art. Observations on the Comparative Prevalence of Insanity at different periods. t Inquiry into pertain errors relative to Insanity, &c. p. 9S.Rro. 1820 CX-. iv.j NERVOUS FUNCTION. [ord. i. 55 to have overstepped the latter by a few paces, the difference will Gen. I. hardly justify the assertion, that " insanity is considerably upon the ^sanity.18" increase." And if we take into view the intensity of interest with Craziness- which this subject has for the last twenty years been contemplated by the public, the operation of those feelings of humanity which have dragged the wretched victims of disease from the miserable abodes of prisons and neglected workhouses, and placed them under the professional care of the superintendents of licensed establishments, and above all, the augmented number of such establishments in consequence hereof, and the great respectability of many who have the management of them, thus giving the commissioners returns which by the power of their Act of 26 Geo. III. they could not otherwise have been in possession of, we may, I think, fairly con- clude that this apparent overstep, be it what it may, in the march of insanity beyond that of the population of the country, is a real retrogression. At this conclusion, we might, I think, fairly arrive, even if the Admitted data selected by Dr. Powell were full and incontrovertible ; but he ter himself himself has candidly admitted, that instead of being full and incon- l°urbaetg.nac" trovertible they " are subject to numerous inaccuracies, and that any deductions which may be made from them must be imperfect." It is still more consolatory to learn that the direct deductions from the parochial and district establishments are not only not in accord- ance with Dr. Powellvs, but such as seem to show that a retrogres- sion, instead of an advance, has actually taken place. Dr. Burrows and opposed has industriously collected many of these, and, as far as they go, tables of they lead to such an inference almost without exception.* Yet it is I^Xseem probable that even this inference does not give us the precise fact, to prove a and that it is as chargeable with an error on the favourable side, as sforTfather the opposite account is on the unfavourable ; since the increase ofthan ad" licensed houses, whose returns seem to have swelled the list of the commissioners beyond its proper aggregate, has been considerably supported by a transfer from the establishments which have thus fallen off. And hence, allowing the error on the one side to compen- General sate that on. the other, we are brought to the conclusion which, after all, appears more natural, that the career of insanity is only varied in its uniformity by temporary contingencies, but that it is by no means a prevalent disease in our own country. * Inquiry, &c, ut supr. p. 66 et alibi. )li CL. IV.j NEUROTICA. [ORU. t- SPECIES I. ECPHRONIA MELANCHOLIA. MELANCHOLY. THE DISCREPANCY BETWEEN THE PERCEPTION AND THE JUDGMEN'i LIMITED TO A SINGLE OBJECT, OR A FEW CONNECTED OBJECTS, OR TRAINS OF IDEAS : THE WILL WAYWARD AND DOMINEERING. Gen. i. We have already stated that whatever be the exciting cause of p^g'l' mental alienation, the symptoms are, in every instance, greatly modified by modified by the prevailing idiosyncrasy, and hence, though a love crasy.10Syn" OI" solitude, gloom, fear, suspicion and taciturnity are the ordinary signs of the present species, these signs often yield to symptoms widely different, and sometimes even of an opposite character ; and we hence become possessed of the four following varieties: * Attonita. Gloomy melancholy. p Errabunda. Restless melancholy. y Malevolens. Mischievous melancholy. ^ Complacens. Self-complacent melancholy. Mute, gloomy, retiring melan- choly. Roving, restless melancholy, evin- cing a constant desire to change the abode. Morose or mischievous melan- choly ; occasionally terminating in suicide or the injury of others. Self-complacent and affable me- lancholy ; occasionally rejoicing in a visionary superiority of rank, station, or endowment. These varieties observed by Fracas torio. The same variety of symptoms, as chiefly modified' by the pre- vailing temperament, are noticed by Fracastorio. u The phlegma- tic," says he, " are heavy; the sanguine, lively, cheerful, merry, but not witty ; the choleric are in rapid and perpetual motion, im- patient of dwelling upon any subject. An acuteness of wit belongs By uiocics. to most of the varieties, but not to all."* And hence Diodes in opposing Galen for holding, after Hippocrates, that gloom and terror are pathognomic signs of melancholy, observes, " Upon serious consideration I find some patients that have nothing of these qualities: and others that exhibit every diversity of feeling: for some are sad without being fearful; others fearful without being sad ; some neither, and some both." Singular Besides these modifications there is another of a very peculiar modifica- j^n(j noticec| by jjr# Spurzheim in order to show that the faculties noticed by 0f the mind are double, and that each hemisphere of the brain * Delntellectione. Lib. II ex. iv. j NERVOUS FUNCTION. [ord. i. d: contains a distinct set. As I have never met with an instance of Gem- *• this variety I must describe it in his own words. " Tiedemann," Ecphronia says he, " relates the example of one Moser, who was insane on Meiancho- one side, and who observed his insanity with the other. Gall at- Meiancho- tended a minister who, having a similar disease for three years,Iy" heard constantly on his left side reproaches and injuries, and turned his head to that side in order to look at the persons. With his right side he commonly judged of the madness of his left side : but sometimes in a fit of fever he could not rectify his peculiar state. Long after being cured, if he happened to be angry, or if he had drank more than he was accustomed to do, he observed, in his left side, a tendency to his former alienation."* It may appear strange to those who have not studied the subject *[ow ™!t or . . shrewdness with much attention that persons who are possessed of a diseased of remark or even a defective judgment should at any time be of quick and ^fuua lively apprehension, and thus be witty without being wise. But judgment. the faculty of wit is dependent not so much on the judgment as on the imagination, and particularly on the memory, on the possession of a large stock of ideas stored up for ready use, and brought forth with rapidity. " And hence," says Mr. Locke, " some reason illustrated ,,• /.i , ■ , i ft'0"1 Locke. may perhaps be given of that common observation, that men who have a great deal of wit and prompt memories, have not always the clearest judgment or deepest reason. For wit lying most in the assemblage of ideas, and putting those together with quickness and variety, wherein can be found any resemblance or congruity, there- by to make up pleasant pictures and agreeable visions in the fancy; judgment, on the contrary lies quite on the other side, in separating carefully, one from another, ideas wherein can be found the least difference, thereby to avoid being misled by similitude, and by affinity to take one thing for another."! And hence, we may easily ^cnacs?0„ae, account for that gayety and those ebullitions of a vivid fancy which vivacity so often assume the character of wit in persons whose minds are person8"6 deranged, and especially in the sober faculty of the judgment. Mirth and wit, however, though sometimes found in the present species of insanity, are by no means its common characters ; but on the contrary, as we have already observed, a love of solitude, Yet gloom, and taciturnity, and an indulgence in the distressing emo- and'gioom tions of the mind. And hence, whenever hypochondrism merges ^etc0om" into actual insanity, it almost always takes this form; as melan- them. choly, from a sort of natural connexion between the two, often as- sumes many of the symptoms that essentially appertain to the hy- pochondriac disease; the morbid state of the brain influencing the abdominal organs in the latter case, as the morbid state of the abdo- minal organs influences the brain in the former. The disease shows itself sometimes suddenly, but more generally progrm°nof by slow and imperceptible degrees. Among the earliest symptoms meianchoij-. may be mentioned head-aches, frequent attacks of giddiness, sud- den confusion of ideas, a great disposition to anger, violent agita- , tions when irritated, and an uncommon sensibility of nerves, where- * Physiognomonical System, &c. p. 144. 8vo. 1816. t On Human Understanding, Book n. Oh. xi. § 2 Vot. TV—8 ,>$ cl.iv.] NEUROTICA |obd. i. Gen. I. Spec. I. Ecphronia Melancho- lia. Melancho- ly. External signs some- times very strons. a E. Melan- cholia. attonita. Mute retiring me- lancholy. Often commences gradually and is mis- taken for hypochon- flrism. Well described in Hamlet. Predomi- nance of some single trains of ideas. Love of silence and solitude. as noticed by Hippo- crate*. by the patient is apt to be carried to as great excesses from &msk> of joy as from those of grief. There is a desire of doing well, but the will is way ward and unsteady, and produces an inability of firmly pursuing any laudable exertion or even purpose, on account of some painful internal sensation, or the perverseness of the judgment led astray by false or erroneous ideas which command a firm conviction in the mind.* And if the disease occur in a person possessing that temperament which has been conceived to predispose to it, and was by the Greeks denominated melancholic, the external signs become peculiarly marked and prominent, " the patient," says Hippocrates, in his book on insanity, " is emaciated, withered, and hollow-eyed : and is at the same time troubled with flatulency and acid eructa- tions, with vertigo and singing in the ears: gets little sleep, and when he closes his eyes is distracted with fearful and interrupted dreams." The first variety most commonly commences with this cha- racter, and creeps on so gradually that it is for some time mistaken for a mere attack of hypochondrism or lowness of spirits,! till the mental alienation is at length decided by the wildness of the patient's eyes, the hurry of his step whenever he walks, his extraor- dinary gestures, and the frequent incongruity of his observations and remarks. The first stage of the disease is thus admirably ex- pressed by Hamlet: " I have of late, but wherefore I know not, lost all my mirth, forgone all custom of exercise; and indeed, it goes so heavily with my disposition, that this goodly frame, the earth, seems to me a sterile promontory; this most excellent ca- nopy, the air, look you, this brave o'erhanging firmament, this ma- jestical roof fretted with golden fire, why it appears no other thing to me than afoul and pestilent congregation of vapours." But while the external world is thus in general falsely recognised by the perception or falsely discriminated by the judgment, the mind is so completely possessed by some particular trains of ima- ginary ideas that the attention is perpetually turned to them, and the judgment mistakes them for substances -, and, so far as it is sensible of surrounding objects or scenery, is perpetually blending the vision with the reality. It is not that the patient's ideas are incon- gruous with themselves but with the world around him ; for the remarks of the melancholy man, when his attention is once correctly fixed, are for the most part peculiarly shrewd and pointed. But in the gloom that hangs over him under the variety we are now con- templating, he can rarely be brought into conversation, seeks for solitude, sits moping in one continued posture from morning to night; or if he walk at all, seeks for orchards, back-lanes, and the gloomiest places he can find. " One of the chief reasons," says Hippocrates in his epistle to Philopoemenes, "'• that induced the citizens of Abdera to suspect Democritus of craziness, was that he forsook the city, and lived in groves and hollow trees, upon a green bank by a brook side, or by a confluence of waters all day and all night." * Crichton, of Mental Derangement, passim. T Palret. de l'Hypochondrie et du Suicide, passim. 8v0. Paris, 1822. '-l. iv.J NEKVOUS FUNCTION. jord. i. ^y Sauvages under the variety of melancholia attonita gives an ex- Gen. I. treme case of the present modification, though not from personal a^ m6u„.. knowledge. " The patient," says he, " never moves from place to cho!i- i' Gen. I. Spec. I. a E. Melan- cholia attonita. Mute retiring me- lancholy. Illustrated in the Abbe de Ranee: and the austerities of La Trappe. 0E. Melan- cholia crrabunda. Restless melancholy Constant desire to change the abode or pursuit. Instanced in the cha- racter of Ophelia unknown cause, the disease upon the mind was thrown upon the motific fibres ; and he was attacked with a chorea; the intellect recovering its powers as the muscles of loco-motion were more and more thrown into the most ridiculous but involuntary gesticulations. He was restored from this and to perfect health by the use of tonics, and especially the sulphate of quinine.* Other excitements by which the present species is produced are immoderate exercise ; insolation, or long exposure to the direct rays of the sun; sudden transitions from heat to cold ; powerful stimuli applied to the stomach. In the case related by Sauvages, the disease appears to have pro- ceeded from a heated imagination exercised upon false views of re- ligion : and perhaps there is no cause more common or more opera- tive, especially in timid minds ; and more particularly still where the conscience is alarmed by a review of a long catalogue of real delin- quencies, and a dread of eternal reprobation. Few persons have given a more striking example of this than the Abbe" de Ranee when first touched with remorse for the enormity of his past life, and before the disturbed state of his mind had settled into that turn for religious seclusion and mortification which pro- duced the appalling austerities of La Trappe. " To this state of frantic despair," says Dom Lancelot in his letter to La Mere Ange- lique, of Port Royal, " succeeded a black melancholy. He sent away all his friends and shut himself up in his mansion at Veret, where he would not see a creature. His whole soul, nay even his bodily wants, seemed wholly absorbed in a deep and settled gloom. Shut up in a single room he even forgot to eat and drink: and when the servant reminded him that it was bed-time, he started as from a deep revery, and seemed unconscious that it was not still morning. When he was better he would often wander in the woods for the entire day, wholly regardless of the weather. A faithful servant, who sometimes followed him by stealth, often watched him, standing for hours together in one place, the snow and the rain beating on his head; whilst he, unconscious of them, was wholly absorbed in painful recollections. Then, at the fall of a leaf, or the noise of the deer, he would awake as from a slumber, and, wringing his hands, hasten to bury himself in a thicker part of the wood; or else throw himself prostrate, with his face in the snow, and groan bitterly. The same causes operate in the production of roving or rest- less melancholy, forming the second variety, and exhibiting a modification which often depends obviously upon a difference of idiosyncrasy, though the cause is not always to be explained, and under the operation of which the patient has a constant desire to change his pursuit or his residence. And hence, while Albert Durer is entitled to the approbation he has so long received for his admirable picture of melancholy under the guise of a pensive female leaning on her arm with fixed looks and neglected dress, Shakspeare has equally copied from nature in his description of the beautifui * Magendie. Journ. de Physiologie. Ayr. 18-'2. cl. iv.j NERVOUS FUNCTION. [ori>. i. 61 and interesting Ophelia, who, instead Of shutting herself up from Gen. I. the world, and seeking silence and solitude, is represented as pecu- 0E.Meiai'- liarly busy and talkative, and unwittingly divulging the fond secret ^^*nd_ of her distraction to every one she meets, as well in verse as in Restless prose. Sadness is the prevailing colour of the mind ; but it is often often"0*1015, as Jaques expresses it, " a most humorous sadness," so blended evinces with sallies of pleasantry and wit, that it is impossible to listen to humorous them without smiling, notwithstanding the gravity of the occasion. ped8ncer-piion " Humorous they are," says Burton (and unhappily for himself from Bur- no one knew how to describe the disease better,) " beyond allton" measure ; sometimes profusely laughing, extraordinary merry, and then again weeping without a cause ; groaning, sighing, pensive and almost distracted. Multa absurda fingunt et a ratione aliena ;* they feign many absurdities, void of all reason : one supposeth him- self to be a dog, cock, bear, horse, glass, butter. He is a giant, a dwarf, as strong as an hundred men, a lord, duke, prince. Many of them are immoveable and fixed in their conceits; others vary upon every object heard or seen. If they see a stage-play, they run upon that a week after ; if they hear music or see dancing, they have naught but bag-pipes in their brain ; if they see a combat, they are all for arms ; if abused, the abuse troubles them long after. Restless in their thoughts and actions, continually medi- tating, ----velut segri somnia, vante Finguntur species :— more like dreamers than men awake, they feign a company of en- tire fantastical conceits ; they have most frivolous thoughts impos- sible to be effected ; and sometimes think verily that they hear and see present before their eyes such phantasms or goblins they fear, suspect, or conceive: they still talk with and follow them. ' They wake,' says Avicenna, ' as others dream.' Though they do talk with you, and seem to be very intent and busy, they are only think- ing of a toy; and still that toy runs in their mind whatever it be : that fear, that suspicion, that abuse, that jealousy, that agony, that vexation, that cross, that castle in the air, that crotchet, that whim- sie, that fiction, that pleasant waking dream. If it be offensive, especially, they cannot forget it; they may not rest or sleep for it; but still tormenting themselves, Sisiphisaxum volvunt sibi suis." How melancholy a reflection that the writer of this spirited Reflection description, should have drawn many of its features from himself: JJ£Svethde- andthat the work from which it is copied, engaged in for the purpose \f^nte of diverting his thoughts, and replete with genius, learning, and the t. Gen. I. Spec. I. 3 E. Melan- cholia crrabunda. Restless melan- choly. y E. Melau- cbolia malevolens. Morose me- lancholy. Description. Language sometimes sarcastic. Sometimes the vehicle of deadly hatred: impudence and pro- faneness. The patient occasionlly sensible of this and expresses sorrow: but soon relapses: the desire opposed by the will. Case in proof that the exciting cause pro- duces less influence than the tempera- ment. throw him into a violent fit of laughter. Before he was over- come with this horrid disorder he, in the intervals of his vapours, was esteemed one of the most facetious companions in the uni- versity." The third variety, in which the alienation assumes a morose or mischievous character, is perhaps the most common form under which the disease makes its appearance. Sometimes the patient is extremely passionate and will quarrel furiously with every one alike in whatever tone or manner he is addressed, and expresses himself with great violence of language, occasionally with gross unqualified abuse, but occasionally also in a style of repartee that was never evinced in a sane state. More generally, however, he selects his objects of resentment: which are, for the most part, unaccountably taken from his nearest relations and kindest friends. Against these he harbours the blackest suspicion and jealousy, believing that they are haunting him to take away his money or his life, or to put him to torture. He loads them with every term of the deadliest hatred, or scowls at them with contempt, and denounces them as fools and idiots. Under the distressing influence of this horrid form of the disease the mother abominates her infant family, and the wife her husband : the most chaste become lascivious: and lips, which have hitherto uttered nothing but the precepts and the language of piety, become grossly profane, and are the vehicles of oaths and impudence. The unhappy individuals are at the same time not only sensible of what they say or do, but occasionally sensible of its being wrong, will express their sorrow for it immediately afterwards, and say they will not do so again. But the waywardness of the will, and its want of control by the judgment, urge them forward in spite of their desire, and they relapse into the same state almost as soon as they have expressed their regret. Mr. Locke has, with great ability, pointed out the proper distinction between these two faculties of the desire and the will, and has exemplified it by the chastise- ment with which an indulgent father frequently finds himself called upon to visit an offending child, and which he wills to perform though his desire is in the utmost degree reluctant. The disease before us is pregnant with examples of the same kind, and strikingly shows the correctness with which this great master of his subject analyzed the human mind. We have already observed that the peculiar turn or modification of the malady depends in general far less upon the immediate and exciting cause, than upon the constitutional temperament, or some operative principle which we cannot always develope. And in proof of this it may be hinted that I have drawn the principal lineaments of the description just laid down from the case of a lady of about sixty years of age, respecting whom I was lately consulted, and whose exciting cause has been, manifestly, suppressed grief for the death of an only son, and separation from a daughter who was the remaining solace of her advancing years, in consequence of her having married a gentleman whose station is in a remote part of the globe. Possessed by nature of a high and commanding spirit, ind of a peculiar degree of energy and activitv. she rffeetvtrdlv sue- « l. iv.j NERVOUS FUNCTION. [ord. i. 63 ceeded, by a violent internal struggle, in subduing the pangs that at Gen. I. first suffocated her ; and has for several years talked of her daughter ys^Kul\ln. and her daughter's children, for the latter has since become a choj™ mother, without emotion. But with the loss of fine feeling for her Morose mt- daughter, she has lost, at the same time, all fine feeling upon other lancholy- subjects ; and her judgment has sunk amidst the general wreck. The love of her nearest relations has turned to contempt or hatred: the ardour and animation of her mind, which restrain her from ta- citurnity and retirement, have rendered her forward and invective ; rational expostulation has yielded to sudden and unmeaning fits of violence and blows, and the voice of piety to exclamations that would formerly have shocked her beyond endurance. She, too, is often sensible of her doing wrong, and in letters of great sobriety and excellence, often complains of her own conduct, and the burden she is become to her friends ; but the intervals of sanity are only of a few hours' duration, and with all her calmness she is sure to relapse.* For many months she was intrusted in her own house to the control of a professional female attendant, who, with great dexterity, at length succeeded in obtaining a due degree of autho- rity over her without personal restraint; and under the regimen of perfect quiet and seclusion from the world, she seemed to be in fail- way of recovery ; but the mischievous fondness of her nearest rela- tions has since removed this faithful watchwoman, and her senses have again been bartered for her liberty. The symptoms most afflictive to the relations of the patient in this Tendency variety of insanity, is the tendency to behold them with indifference ^d abusive or even violent aversion, and to utter exclamations and employ Ian- ^""f^ guage of the most offensive kind to a serious and a delicate ear ; and for. it is the symptom apparently most unaccountable to those who have not studied the disease with much attention. 1 have already re- marked that in insanity the corporeal sensibility is greatly diminished, but it is not more so than the moral sensibility; and as the moral sensibility disappears, all moral restraint disappears also : and for the very reason that the insane man has little feeling of cold or hunger, he has also little feeling of decency or religion. In the present variety the worst passions are in a state of excitement, and the lan- guage most freely employed is the language of the passion that pre- dominates, and there being no longer any moral restraint, it is em- ployed in its utmost vehemence and coarseness. And as the fond affections have given way to the irascible, it should seem to follow of course, that the greater the love or friendship formerly, the greater the hatred at present. There is one consolation, however, though a small one, that we ™fh™e"- may reap from this distressing contemplation, and to which the condition friends of the sufferer should not be indifferent. It is that, with this Xdlng01 blunted sensibility of mind, the patient has no pain from a conscious- oneconso- ness of his degraded condition. And it is singular to observe, whatlatlor may also contribute to alleviate the distress of the sympathizing heart, how completely his unconsciousness prevails even after a pa- * Compare with the Report of the Glassrow Asylum for Lunatics, 1S2! 64 cl. iv,j NEUROTICA. [ori>. '• Gen. I. Spec. I. Y E. Melan- cholia ma- levolens. Morose melancholy. & E. Melan- choly com- placens. Self-com- placent me- lancholy. Description. The elated feeling often connected with erro- neous ideas of religion. Striking case in exemplifi- cation. tient's restoration to health, so that few look back upon what thej have undergone with the horror that would be expected; while many, even in the apprehension of a relapse, contemplate it, and turn then- eye to the abode of misery where they were lately inmates, without dread. . , The fourth variety or self-complacent melancholy is perhaps less frequent than any of the rest; but it occurs occasionally, and is often accompanied with a high-coloured and ruddy complexion, and other marks of a sanguineous habit ; " Such persons," says Butler, " are much inclined to laughter, are witty and merry, conceited in discourse, pleasant, if they be not far gone, and much given to music, dancing, and to be in women's company." Aristotle gives the case of an inhabitant of Abydos, who, labouring under this variety of the disease, would sit for a whole day as if he had been upon a stage, listening to visionary actors; sometimes acting himself, and occa- sionally clapping his hands and laughing as overjoyed with the per- formance.* Such persons have not unfrequently thought themselves called upon to undertake some desperate adventure, and are exqui- sitely elated with the new and lofty character they are about to embrace. These stimulant feelings are not unfrequently connected with erro- neous ideas of religion, and excite in the mind of the patient a belief that he is supernaturally endowed with a power of working mira- cles, or undergoing the severest mortifications without injury. The German Psychological Magazine is full of examples of this kind; and among others relates the case of a gens-d'arme of Berlin, whose name was Gragert, of a harmless and quiet disposition, but rather of a superstitious turn of mind. From poverty, family misfortunes, and severe military discipline, he brought on a series of sleepless nights, and a mental disquietude that, according to his own report, nothing could dissipate but a perusal of pious books. In reading the Bible he was struck with the book of Daniel, and so much pleased with it that it became his favourite study : and from this time the idea of miracles so strongly possessed his imagination, that he began to believe he could perform some himself. He was persuaded more especially that if he were to plant an apple-tree with a view of its becoming a cherry-tree, such was his power that it would bear cher- ries. He was discharged from the king's service and sent to the workhouse where he conducted himself calmly, orderly, and indus- triously for two years, never doing any thing that betrayed insanity . at which time Dr. Pike examined him, that he might be discharged and sent to his family. He answered every question correctly, ex- cept when the subject concerned miracles: in regard to which he retained his old notions; adding however, at the same time, that, if he found upon trial after he was at home that the event did not cor- respond with his expectation, he would readily relinquish the thought and believe he had been mistaken; and confessed that he had already removed one error in his mind in this way; for there was an old woman whom he had at one time considered as a witch, but whom he afterwards discovered upon trial to be no such thing. * Lib. de Reb. mir. cl. iv.J NERVOUS FUNCTION. [or». i. 05 Upon the medical treatment of diseases of this kind we shall not Gen. I. have to say much; but as the plan chiefly adviseable for the present 8S£EMe\ln. species is equally adviseable for the ensuing, it will be most expe- choiiacom- dient to reserve the discussion of it till the latter has been described sdf^om- in its order. ?laefn\me- lancholy. Medical treatment. SPECIES II. ECPHRONIA MANIA. MADNESS. THE DISCREPANCY BETWEEN THE PERCEPTION AND THE JUDGMENT GENERAL ; GREAT EXCITEMENT OF THE MENTAL, SOMETIMES OF THE CORPOREAL POWERS. This species appears under almost infinite varieties of character, Gen. L, of which, however, it may be sufficient to mark the following, mo- Spec. II. dified for the most part by the predisposing causes that we have already noticed, as modifying the preceding species: « Ferox. Furious and violent madness. j3 Exultans. Gay and elevated madness. y Despondens. Gloomy, despondent madness. ^ Demens. Chaotic madness. The exciting causes, like the predisposing, are chiefly tfiose Exciting already enumerated under melancholy ecphronia, as sudden and vio- cau3es" lent mental emotion ; bad passions indulged habitually ; false views of religion, especially the dread of reprobation and eternal punish- ment ; sudden reverses of fortune, whether from bad to good, or from good to bad; preying anxiety, or lurking discontent; deep protracted study, unrelieved from week to week by an interchange of exercise or society, and breaking in upon the hours of sleep; un- kindly child-bed; a suppression of various periodical evacuations ; and sometimes even a virtuous restraint of sexual orgasm in a vigor- ous constitution, without taking purgative or other means to reduce the irritative entony. Of these one of the most frequent causes, is that of child-bed, and Puerperal recovery from child-bed, though it is not always easy to develope duce'd by° the immediate mode by which this change in the constitution actsg™S?y! upon the brain ; for it has occurred not only where there has been chain of some organic affection from puerperal fever, a sudden cessation of not'eaVto the lochia, or a sudden relinquishment of nursing, but where the be followed recovery has been unattended with a single unfavourable symptom, and the mother has ardently persevered in the office of a nurse. It shows us, however, very sufficiently, how strong is the chain of sym- pathy between the brain and many remote organs of the body, and especially those subservient to the function of generation. Vol. IV —9 b6 ct. rv.J NEUROTICA. Lu*"- ' Gen. I. Spec. II. Ecphronia Mania. Madness. Proportion- ate influ- ence of this cause: and cftects on different periods. Effects on different habits and agos. Restrained orgasm a cause: strikingly illustrated from Kem- nesius. Additional example in the author'i own prac- tice. M. Esquirol, not long ago, communicated a paper to the SocieHe de Mc'decine upon this important subject, enriched with the results of the Hospital de la SalpcStriere, for the years 1811, 12, 13, and 14. During these four years, eleven hundred and nineteen women were admitted, labouring under mental derangement: of whom ninety-two (nearly an eleventh part of the whole) had become de- ranged after delivery, during, or immediately subsequent to the pe- riod of suckling. In the higher ranks of society the proportion oi puerperal maniacs he calculates to be not less than a seventh of the whole. Of the above 92 cases, 16 occurred from the first to the fourth day after delivery : 21 from the fifth to the fifteenth ; 17 from the sixteenth to the sixtieth day; 19 from the sixtieth to the twelfth month of suckling: and in 19 cases it appeared after voluntary or forced weaning. Of the above 92 cases, 8 were idiotic, 35 melancholic, and 49 maniacal. The respective ages were as follows : 22 from 20 to 25 years ; 41 from 25 to 30 years ; and 12 above 30. Fifty-six out of the ninety-two were entirely cured, and thirty-eight of these within the first six months. Fright was the most frequent cause.* I have said that a virtuously restrained orgasm in a full habit, and where no steps have been taken to reduce the entonic vigour, has occasionally induced mania. There is a curious instance of the powerful effect of such a state related by Kemnesius in his History of the Council of Trent, which though it did not terminate in mad- ness proved quite as fatal. In the year 1419, Rossa, nephew to the King of Portugal, and Archbishop elect, of Lisbon, was taken seri- ously ill at Florence. His physicians told him that his disease pro- ceeded from an excessive irritation of the genital organs, and that he would certainly die unless he committed fornication or married. With a courage worthy of a happier issue, he resolved on death, and met it without breaking his vow of celibacy.! The following instance, however, will prove that mania itself is sometimes a consequence of the same firmness of mind. A clergy- man of exemplary character, and one of the most distinguished preachers I have the pleasure of being acquainted with, was many years ago very unexpectedly attacked with a paroxysm of mania, the cause of which it seemed impossible to unfold. He recovered in about six months, and returned to a regular and punctilious dis- charge of clerical duty. He is a man of exquisite taste, warm ima- gination, exalted and highly cultivated mind. With these qualifica- tions, in less than a year after his recovery, he married his maid ser- vant, and the world imagined he was gone or going out of his senses a second time. A confidential statement of his situation soon proved to myself that nothing could be more prudent or praise- worthy than the step he had thus taken, and which had excited so much astonishment among his friends. He was fully convinced, he said, though he had never communicated it to any one, that the cause of his unfortunate malady was a genital irritation, exciting to a constant desire of matrimony, which he was not in a situation to * Quarterly Journal of Foreign Medicine, No. I. p. 98. f Kemnes. Concil. Trident, Part in. De Ccelibatiisacerdottim. iv.j NERVOtS FLN( TluN. [ord. i. b'5 comply with, and which compelled him to exercise from day to day GEN' '• a severe restraint upon his feelings. On being fully restored to health, Eqduonhi he found the same morbid propensity beginning to return. " I felt," ^.a",ia- said he, " it would again drive me mad if I did not relieve it, and my principles forbade me to think for a moment of relieving it im- morally. To what respectable family could I now offer myself, hav- ing so lately been discharged from private confinement ? The ser- vant who lived with me was a very excellent young woman: her disposition was amiable, her mind well capable of cultivation, and her form and manners by no means unpleasing: and hence, after mature deliberation, I determined upon marrying her if she herself would venture upon so perilous a risk." He married her accord- ingly;—has ever since, for upwards of twenty years, enjoyed an almost uninterrupted share of health, and has been more than ordina- rily happy in his family. Other examples of a like kind are to be found in Paullini,* Martini,! and Vogel;J but it is unnecessary to copy them. And hence castration has been often advised, and sub- mitted to, and occasionally with success. It is from a like sympathy of action between the brain and other Accidental parts of the body, that we meet with instances of the one or the other kinds other species of disease before us, produced occasionally, and, per- "0fdtra "tion" haps, in habits of great sensibility, by suppressed irritations of much smaller moment, as those of herpes, scabies, tinea ;§ a suppressed hemorrhoidal flux ;|| suppressed perspiration ; suppressed plica,H or an ulcer of long standing suddenly dried up.** Furious mania, constituting the first variety, sometimes makes ^^Mania its attack very abruptly, and commences with the patient's being Furious sensible of some indescribable movement in his head, which excites m0d^tfmes iiim to loud and sudden shrieks, at the same time that he runs up commences and down the room, and mutters something to himself that is alto- BU en y" gether unintelligible : though the symptoms even in this abrupt and violent attack admit of much diversity. More commonly, however, the disease is the work of time, and ™^on, its growth is thus admirably described by Dr. Munro in his reply to shows itseic Dr. Battie. " High spirits, as they are generally termed, are the f^j^m first symptoms of this kind of disorder. These excite a man to take ^j^ a larger quantity of wine than usual, and the person thus afflicted, ,y from being abstemious, reserved, and modest, shall become quite the contrary, drink freely, talk boldly, obscenely, swear, sit up till midnight; sleep little, rise suddenly from bed, go out a hunting, return again immediately, set all his servants to work, and employ five times the number that is necessary. In short, every thing he says or does, betrays the most violent agitation of mind, which it is not in his own power to correct. And yet, in the midst of all this hurry, he will not misplace one word or give the least reason * Cent. in. Obs. 14. t Observationi, ch. h. 10.- t Beobachtungen, p. 9. § Act. Nat. Cur. Vol. vm. Obs. 28. Descottes, Journ. de Med. T. lxvi. Petit, Trait§ Oeuvre porthnme. T. in. II Sanctacrux, De Melancholia, p. 29. Lentihus, Miscell. i. p. 36. If Hoffman, Beechreibung der Weicbselzopfes. &e. Eph. Nat. Car. Cent. I. «• Obs. S6. ** Vowstns. Lib. *. Ohs. 24 cl. iv.] .NEUROTICA. loRU- l" Gen. I. for any one to think he imagines things to exist that really do not, ?EEMCn"' or that thev appear to him different from what they do to other peo- ferox. ' ple# They who see him but seldom admire his vivacity, are pleased nmiBcss. with his sallies of wit and the sagacity of his remarks; nay, his own family are with difficulty persuaded to take proper care of him, till it becomes absolutely necessary from the apparent ruin of his health and fortune." This picture is drawn from a rank of life something above that of mediocrity, but its general features of ebullient spirits, and hurry and bustle, and " much ado about nothing," will apply to every rank. Such a person, says Sir A. Crichton, in allusion to the pre- Progressive sent description, cannot be said as yet to be delirious, but that event Bymptoms. goon f0u0WSi an(j ^e has then the symptoms common to the dis- ease, symptoms which only differ from a difference in the train of thoughts which are represented in his mind. He begins to rave and talk wildly, and incoherently : swears as if in the most violent rage, and then immediately afterwards bursts into fits of laughter, talks obscenely, directs offensive and contemptuous language against his relations and those around him ; spits at them ; destroys every thing that comes in his way; emits loud and discordant screams and continues this conduct till he is quite exhausted. The state of rest which follows is generally short and sleepless ; the patient is obstinate ; he will not speak a word ; and clenches his teeth if any thing be offered him to swallow ; or else cunningly pretends to drink a little, but immediately squirts it out on the person who offers it. Instantly he again breaks out into all the wild and extravagant language'and actions he committed before If kept in strict coer- cion he has often so much command over himself as to behave mildly and modestly ; and were it not for the general expression of his countenance, and the peculiar glistening appearance and rapid movement of his eyes, he might impose on many of the by-standers, Length of and make them imagine that the frenzy was over. The length of [ndmteriai the paroxysm and of the interval varies greatly in different indi- variabie. viduals. But, generally speaking, the more violent the fit the sooner it ceases from exhaustion ; and hence sometimes it ceases in a day or two, and sometimes runs on to a month or even more : returning at the distance of a few weeks or at certain periods of the year. 0 E. Mania Jn the SECOND VARIETY Or ELEVATED MADNESS, the passions, and Elevated especially the irascible ones, are less busy, and the imagination is TralnTf chien so that the covetous man is still conversant about purchasing ?feformeritS ^an(^s anc* tenements, and amusing himself with perpetually aug- life» menting his possessions : while the devotional character is for ever engaged in a routing of prayers, fasting and ceremonies, visions and revelations, and fancies himself to be inspired and lifted into heaven. Fhantoms The phantoms are all of a pleasurable kind, and mostly such as afford "urabL>ea* the deluded sufferer a vast opinion of his own rank or talents. kind; often Donatus gives the case of a lady at Mantua, who conceited she was nrustrEtted> married to a king, and would kneel down and affect to converse cl.iv.] NERVOUS FUNCTION. [ord. i. o.m with him as if he were present with his attendants ; and if she found Gen. I. by chance a piece of glass in the street, she would hug it as a jewel ^MalVa sent her from her royal lord and husband.* He relates another exuitai.s. case from Seneca of Senecio, a madman of considerable wealth, mad^ who thought himself and every thing about him great; that he had a great wife and great horses, and could not endure little things of any kind ; so that he would be served with great pots to drink out of; great hosen, and great shoes bigger than his feet: " Like her," says Burton, " in Trallian, that supposed she could shake all the world with her finger, and was afraid to clench her hand lest she should crush the world to pieces like an apple, "t Yet even here the train of thoughts or ideas which occupies the The illusion mind of the maniac in many instances throw no light whatever on connected the nature or origin of the complaint; and we can still less avail with the ourselves of them than in various cases of melancholy. dTsease.' ° This is particularly observable in the third variety or despon- v e. Mania dent maoness ; for though this modification of the disease may ^"Jjf/J^ occasionally be produced by suspicion, terror, or a guilty conscience, madness. it is far more frequently the result of a melancholic idiosyncrasy, m^d rarely or a debilitated state of the constitution at the time of the attack, in explanatory consequence of which the sensorial fluid is secreted perhaps even exciting less freely, instead of more so, than in a condition of health : so pa"heolo"y. that the patient sinks by degrees into a state of insensibility ; unless he should be roused with false courage and find means to put an end to his existence before this period arrives. In demrntia or chaotic madness this state of sensorial exhaus- 3 e. Mania tion and consequent insensibility is still more obvious, though there chaotic is, perhaps, less constitutional tendency to the depressing passions, jj"1^*8' The judgment is here more diseased and weakened than in any other form, and, none of the kindred faculties assuming a para- mount power, there is a general anarchy and confusion in the ideas that flit over the sensory without connexion or association of any kind. And hence Pinel has admirably characterized it, as consist- Description ing in a " rapid succession or uninterrupted alternation of insulated ideas and evanescent and unconnected emotions ; continually re- peated acts of extravagance ; complete forgetfulness of every pre- vious state ; diminished sensibility to external impressions ; aboli- tion of the faculty of judgment ; perpetual activity without object or design, or any internal sense of its taking place."J These maniacs are often ungovernable except by means of coer- Additional cion, but they are more easily restrained than those who are in a state of phrensy. They are intractable, and neither listen to entreaty or to menaces. Fear of corporal punishment, however, makes them obey. They willingly avoid the light, burying themselves under the bed-clothes, or under the straw of their cells. They are totally regardless of decency and cleanliness, and from some strange motive are often found smearing themselves over with their excrement. * De Hist. Med. Mirab. Lib. H. Cap. I. t Anat. of Melancholy. Part i. Sect. 3. X De l'Alienation Mentale. Chap. m. iii. § 176. cl. iv.] NEUROTICA. L'uK Gen. I. For the most part they have little appetite, and refuse the food EcpEh?onia offered them ; yet a sense of hunger seems sometimes to return Mania. wjm great keenness, when they will greeddy devour their feces. Of Madueai. thg nature of the ideas that take piace jn trie sensory, and are expressed by an unintelligible muttering, we know nothing further than that, from the screams and howlings with which their jargon is accompanied, there can be no doubt that they are often excited by painful sensations of body or mind. General It is happy for those who suffer under this as well as under the inrefer^nco preceding form, that they rarely sustain a long conflict; the ex- to the haustion of sensorial power by repeated paroxysms soon leading to variety. a total torpitude, and consequently a death of the sensorial organ; though there are instances in which a paroxysm of more violence than usual has produced a favourable change, and suddenly restored the patient to his senses. in reference in gloomy madness, in which there is often a chronic affection of ' some of the abdominal organs co-operating with a diseased condi- tion of the brain, we find least to justify hope ; the patients generally become weakened by fresh paroxysms, and often sink into a state of idiotism. in reference The first variety, on the contrary, if the constitution have not been seriously broken down by intemperance, or the patient be not suddenly carried off by the violence of the attack on its commence- ment, will often work its own cure by its own ardour ; and will gradually soften into a soberer state from mere mental fatigue. in reference While in the milder and more pleasurable modification of the second second. variety, in which the secretion of sensorial power is upon the whole perhaps less than in a condition of sanity (since, though the stimulus of the disease may tend to increase it a little, the total privation which the patient enjoys of all the vexations, and anxieties, and wearing vicissitudes of real life, reduce it to a moderated and even tenour it could not otherwise possess,) nothing is more common than for maniacs to continue to a very advanced age. I am at this moment interested in the case of a clergyman who has reached his ninety-sixth year, and has been in a state of quiet insanity for more than half a century. Disease For the most part those are most easily as well as most rapidly curedewhen cured, whose insanity of whatever kind it be, has been produced by producedby accidental causes, as intoxication, sudden transition from cold to causes. heat, retention of habitual discharges, or a revulsion by a transfer Hence the of morbid action from other organs. And hence the comparative and easy facility with which a cure is effected in insanity after child-birth. cure of Whilst, on the contrary, those are least likely to obtain a perma- Mwamty* nent recovery who possess an hereditary taint; the disease may difficult of indeed leave them for a time, but the predisposition remaining, they removal commonly fall victims to fresh attacks after intervals of a year or compared two, or even of a few months. with an « Mania and melancholy," says Dr. Greding, writing while he tahft.'My was physician to the workhouse at Waldheim, " have continued theTisease na^ a ?ear wun Pome^ an^ remained forty years and upward with variable cl.iv.] NERVOUS FUNCTION. johd.i. 71 others, among whom one patient only in this workhouse attained Gen. i. the age of eighty-five."* !"£"• The chance of recovery is considerably greater upon the first than JJania. Madness. upon any subsequent attack, and especially if the disease have not f10m six exceeded three months duration when the patient is first put under £"{£ yesa™ medical treatment. If it have, at this time, lasted a twelvemonth, the or longer. prospect of success is diminished by half: if two years, not above a easiest fourth part as many recover ; and if more than two years the expecta- ™ "^lu^f tion is small, though, where the second year is not much exceeded, under three a cure is by no means to be despaired of.' Sanding. The treatment of ecphronia has generally been discussed under Compara- the two heads of medical and moral. Both have undergone a beyond this very great improvement within the last twenty or thirty years ; the ^™a™"u' first by being considerably simplified, the second by being more process of thoroughly studied and raised to a higher degree of importance. n7edicaids' Nothing can be more injudicious than the ordinary routine of ™d moral. medical treatment, which, till within a few years, was equally treatment. employed in almost all the larger lunatic establishments in our own ^'"nd^. country and on the continent, especially at Bethlem, the Hospice criminative, d' llumanite, and the Hotel Dieu ; and which consisted in a course of venesections, emetics and purgatives administered in every case indiscriminately, and often, indeed, without even the personal in- spection of the consulting physician or other superintending medical officer ; and if to these means of cure we add the occasional use of bathing in various forms and various temperatures, we shall very nearly have exhausted the merely medical process that till of late was ordinarily had recourse to. Upon the cruel and disgusting scenes which, from the late par- liamentary inquiry, and the report of the Committee which followed, are well known to have occurred not long ago, in the largest and most celebrated receptacle of lunatics in this metropolis, it is now unnecessary to dwell. But from the official communication of M. Esquirol to the French government, concerning the residences for lunatics throughout France, it is perfectly clear, that we have not transgressed in a greater degree than our neighbours. Filth, straw, and dirty rags, were all these miserable beings possessed in many depots to mitigate the coldness of the air and the dampness of their paved, crammed, and suffocating cells. And in some instances they had neither straw nor rags, and were perfectly naked, except from a layer of dirt. " J' ai vu," says M. Esquirol, with just in- dignation, " un malheureux imbecile, tout nu et sans paille, couche sur le pave. Exprimant mon e"tonnement d' un pared abandon, le concierge me rcpondit que 1' administration ne lui passait, pour chaque individu, qu' une botte de paille tous les quinze jours. Je fis remarquer a ce barbare que le chien qui veillait a la porte des alienls etoit loge plus sainement, et qu' il avoit de la paille fraiche et en abondance. Cette remarque me valut un sourire de pitie. Et j' etois dans une des grandes villes de France."! It is satisfac- * Vermischte Schriften, ut supra, &c t Des Etablissemens des Alieues en France, et des moyens d' ameliorer le sort de ces Infortunes. Paris, 1819. 72 cl. rv.j NEUROTICA. [oud. l. Gen. I. Spec. II. Ecphronia Mania. Madness. Medical treatment. A reducent .plan how far advis- able. Venesec- tion where called for: has been repeated extrava- gantly : by Plater seventy times. Caution necessary even from the first : as increased instead of diminished action may be neces- sary. General points of considera- tion ante- cedently to a decision. Occasions for repe j ted bleeding not common- Purgatives less objec- tionable and more Useful. Occasional benefit of a spon- taneous diarrhoea. tory, however, to know, that a more judicious and discriminative practice has in all these asylums been introduced since the above period, and that it has been followed by an abundant success. Admitting the proximate cause of insanity to be in most cases an increased action of the vessels secreting the nervous fluid, venesec- tion and cathartics and a general reducent regimen seem indicated as an ordinary mean of relief; and are unquestionably called for when the pulse is full and strong, and the temperament is sanguine- ous : and the success which has so frequently accompanied this practice stamps it with the highest sanction it can receive. But there is great reason to believe that even where the demand for blood-letting is unequivocal, it has been carried to a mischievous extent, and ruined its own benefit. Thus Plater made a point of repeating it once a week, and tells us that he has sometimes had re- course to it for seventy weeks running.* Much caution, however, is necessary even in the first trial: for as a sound intellect depends apparently upon a certain degree of ex- citement in the sensorial vessels, and a certain quantity of the fluid secreted, derangement may take place also, as we have already ob- served, from diminished instead of from increased action, and di- minished instead of increased secretion. And such we have reason to believe is the cause of delirium whenever it occurs in profuse hemorrhage, and in typhous fevers ; and it is obvious that in all such instances a reducent plan must necessardy tend to augment instead of to carry off the disease. And hence the patient's general habit and temperament, the nature of the exciting cause, the probability of visceral congestion, the violence or mildness of the maniacal symptoms, the progress they have made, and the length of time he has laboured under them, are all to be taken into consideration be- fore we can determine upon the expediency of bleeding even at first. And if, when we have decided upon its propriety, no benefit be pro- duced from a second or a third repetition, we have no encourage- ment to proceed further, and should withhold the lancet altogether, To a series of purgative medicines there is less objection, pro- vided they are not rendered too violent. The abdominal viscera, it has already appeared, form in many instances an important link in the morbid chain of action, and are sometimes the primary cause of the disease : and it is hence of great moment that they should be effectually cleared of viscid or arimonious matter that may irritate or clog them up. But, beyond this, by keeping up such an increased action in the abdominal region as the organs may bear without de- bility, we may diminish or change the morbid action in the head by remote sympathy, or entirely withdraw it by a revulsion. A spon- taneous diarrhoea has been known in various cases to carry off the disease as by a charm : and the use of this class of medicines is the more necessary, as the bowels of maniacal patients are apt to be extremely costive. If the black hellebore of the ancients, which appears to have been a different plant from that of the modern dis- pensatories, were ever entitled to half the antimaniacal virtues * Observ. Lib. I. p. 86, CL. iv.j NERVOUS FUNCTION. [«hd.i, 73 ascribed to it, it was most probably upon the obvious ground of its **EN- r- being a purgative attenuant and deobstruent. Ecpluonh?' Dr. Dubuisson has lately revived the use of the modern black ?fa'J'a- hellebore in various species of mental alienation, as chronic mania, Medical' melancholy, and hypochondrism : in all which he speaks of its treatmcnn effects, after an extensive trial, as highly successful. He has given it also in every form, as that of powder, decoction, watery extract and tincture ; but prefers the extract as least irritating.* His opi- nion, however, is not supported by the result of general practice, and appears to be by far too sweeping and indiscriminate. Spleis- sius, nevertheless, affirms that in his hands, when given freely, it proved sedative and produced sleep. | Upon no other description of medicines can we place any rational Li"le. dependence. Emetics, narcotics, and other sedatives, and antispas- upon any modics, have been tried for ages in every form and in every propor- of'modi-89 tion ; sometimes alone, and sometimes in conjunction with blisters «nes. and the warm or cold bath. There are instances in which they have BiTs'teis! all appeared to produce some benefit, but the far greater number in which they have failed prevents us from placing any reliance upon them. Of the narcotics, the chief that have been had recourse to are q^^8, opium, aconite, bella donna, and the stramonium. Far more mis- doubtful: chief than good seems to have followed from the use of all of them, with the exception of the first, which would probably be found a remedy of high value if we could duly discriminate the proper states or modifications of the disease for its use. Dr. Cuiien's experience of it in mania he admits to be small, but he has correctly estimated its general effects in telling us, that in some cases he found it useful in moderating the violence of the disease, but that in others he found it manifestly hurtful. A monographist upon this malady could not, ^"moreTs- perhaps, be engaged more usefully than in turning his attention to criminative the peculiarities which produce this difference. On the continent it has also been given sometimes alone, but more usually in conjunc- tion with nitre or camphor or both ; but in all these forms also with variable success.J Upon what ground St. John's wort was ever advanced to the rank 'Jjm®r^aP of a powerful sedative I know not; but, in this class, it at one time high esteem, took the lead and held it for ages. Its antispasmodic powers were ^nds™1" regarded of so high a character as equally to put to flight hysterics, hypochondrism, and madness of every kind, and especially that which was formerly described under the name of daemonomania,§ whence, indeed, its technical name of hypericum or fuga dsemonum, under which it was also celebrated. It occupied a place in a late edition of the pharmacopoeia of the London College, and was at one time noticed as an antispasmodic even by Dr. Cullen, who re- jected it however, most deservedly, in his maturer courses of lec- * Des Vesanics ou Maladies Mentales. Pari3, 1816. f Annotat in Zapat. Mirabil. p. 136. I Friborg. Coll. Soc Med. Hafn. n. p. 176. § Abrah. Maycv. Archiv. der Prnotischen Ars'neykuride Vol. TV.—V 74 CL. lv.j NEUROTICA [olltf. Gen. T. Stec. II. Ecphronia Mania. Madoegs. Medical tieatment. Camphor. Its effects different in different hands or different cases. tures. Its only sensible qualities arc those of a slight resinous bitter not worth the trouble of extracting. Camphor is a sedative far better entitled to attention, and ap- pears to have been tried with more extensive success than any other medicine of the same tribe. It has been given alone and in union with other sedatives, chiefly with opium, nitre, and the mineral acids, none of which however seem to have improved its powers. Ber- ger, Fischer, and Herz, speak favourably of its effects abroad ; and in our own country it has had equal commendations from physician;- of distinguished talents. Dr. Mead thought highly of it ; Sir Clif- ton Wintringham tells us that he found it, given to the amount of half a drachm in the evening, diminish the phrensy, procure sleep, and produce perspiration. Unfortunately, however, here, as in the case of opium, we have so many proofs of its utter inefficacy, as to render us at present incapable of placing any dependence upon it in any quantity or with any auxiliary. Dr. Cullen had a patient who began with five grains for the night's dose, and advanced it gradually to thirty, without any benefit, though without any increase of the pulse. At this time it was carried by accident to forty grains, which produced syncope, and nearly proved fatal. The patient, however, recovered from the accidental symptoms, but unhappdy no impression was made on the constitutional disease.* The warm and cold bath have also had their votaries, but no cer- tain benefit appears to have been derived from either. The last may be useful as a tonic in a state of convalescence, but has rarely produced real benefit during the progress of the disease. Weber, however, thought it useful, and published several cases to this effect.! From an idea that the disease consists in an undue determination loMie^ead, to the head, or an undue excitement of the vessels secreting the formerly by nervous fluid, WendtJ surrounded the head with cataplasms of others. *" pounded ice in the form of a night-cap ; and Daniel, with a still applied ice more ingenious spirit of adventure, applied cataplasms of the same to the head kind to the same organ while the body, with a view of encouraging bath to the a revulsion more effectually, was plunged into a warm bath. The body at the process will be found described in his Beytr'age zur medicinischen Process ' Gelehrsamkeit, published in quarto at Halle in 1749. And I men- tion the fact as an act of justice to the author, since the same pro- cess has of late years been revived in France and in our own coun- try, as a new discovery. Daniel thought it highly beneficial; and by its recent revivers it was at one time held up as a specific : but whatever success may in a few rare instances have attended it, the nol'aWeto practice has not been able to work itself into public favour : and a pretensions. s.ober attention to its effects does not seem to justify its further con- ' tinuance. M. Pinel was at one time favourable to an employment of jets of cold water directed upon the head while the body was immersed in tepid water; but his successor M. Esquirol is decidedly of opinion that it is injurious ; and in many cases has induced dis- organization of the cerebrum, and rendered the madness incurable. * Mat. Med. Vol. n. p. 294. t Observ. Med. Fascic. i. p. 26. See also Act. Med. Berol. Dec. i. Vol. vu n 61 •. Nachrrcto, Vrfh ftem Klinrsclren Institute ztt Enlanecn. 17S3. Pvn Bath, warm and cold. Pounded lately had recourse to in our own country as a new discovery. Has been supposed a iv.J XRRVOl'S FUNCTION {ord. i. (0 After all we have chiefly to depend on moral treatment. Firm- Gen. I. ness on the part of the attendant, with conciliatory manners, has Ecp^oniY' done wonders; but a sense of authority must be maintained, though jJ}Mia- occasional severity should be necessary for this purpose : yet it will Mora' & rarely be needful to exceed the coercion of the strait waistcoat. It chiefly to is needless to add that the diet should be of the simplest kind, that bedepand- every thing which can tend to produce excitement should be prohi- Firmness of bited, and that in public institutions, the patients should be divided aus promoting a habit of moral order and quietism ; but every good man how far will indulge the hope that it may afterwards introduce into the mind a V18a the higher blessing of spiritual peace and consolation. Yet the at- ^"be-un' tempt must not be begun too soon, and in no case till the patient too soon. has acquired not only a spirit of subordination but of tranquillity. Before this period nothing can be so absurd as to attempt devotional Before corf- instruction of any kind : for the subject of religion can only be ad- no benofit' dressed to the reason or to the passions: the former of which does ^derive!0 not exist in a state to be influenced, and the latter of which, if they from such could be influenced at all, would only add to the excitement, and SxpTaW- increase the disease. The clear duty of the priest and of the phy- sician is in this case one and the same : it is to bring the mind home to the world around it: to draw it down and fix it upon things of time and sense, instead of rousing it to things invisible and eternal : to enable it to behold God in the materialities of his works, instead of urging it to a contemplation of him in the spiritualities of his word. To instigate a madman to an abstract and elevated commu- nion with his Creator, who is incapable of holding an intercourse upon ordinary topics with his fellow creature, is to cure a frozen limb by pouring boiling water upon it, or to teach the optics of Newton in a nursery. In many cases the cure mainly depends upon withdrawing the pa- 0^™^a'e tient's mind as much as possible from every former scene and every be derived former companion, in setting before him a new world, and giving an Tj[?™Z£ the entire change to the current of his recollections and ideas-; There ^"^ all former * Report of tbe Glasgow Asylum forLunatics, M20. connexions. 7b' cjl. iv/} NEUROTICA. l_ORi». i- Gen. I. are particular cases, however, and perhaps particular periods of the Kcpifionia disease, if we could accurately hit upon them, in which the sudden Mania. . admission of a well-known friend or relation, and a sudden recal of Moraf83' the mind to its former images and habits, tend to produce a most Yetinafew salutary excitement, and disperse the maniacal cloud like a dream. instancaes!w Dr. Gooch has given an interesting illustration of this remark in the particular case of a lady, twenty-eight years of age, of good constitution but seasons, the susceptible mind, who fell into a state of melancholy, in the ordi- nas'been nary sense of the term, a few months after a second child-birth, and vtcTabio.r" at length became furious. " She was now," says he, " put under interesting the care of an experienced attendant separated entirely from her nmstration. husband, cliildren, and friends; placed in a neat cottage surrounded by agreeable country (it was the finest season of the year), and visited regularly by her physician. For several weeks she manifested no improvement; sometimes she was occupied with one notion, sometimes with another ; but they were always of the most gloomy description. At length it became her firm belief that she was to be executed for her crimes in the most public and disgraceful way ; every noise she heard was that of the workmen erecting the scaf- fold ; every carriage, the officers of justice assembling at the exe- cution. But what affected her most deeply was that her infamy had occasioned the disgrace and death of her children and husband, and that his spirit haunted her. As soon as the evening closed, She would station herself at a window at the back of the cottage, and fix her eyes on a white post that could be seen through the dusk ; this was the ghost of her husband ; day and night he was whistling in her ears. Several weeks passed in this way ; the daily reports varied, but announced nothing happy ; at length her hus- band became impatient and begged to have an interview with her, thinking that the best way to convince her he was not dead was to show himself. This was objected to ; he was told the general fact that patients are more likely to recover when completely separated from their friends ; and that if she saw him she would say it was not himself but his ghost. But the husband was obstinate, and an interview was consented to. When he arrived at the cottage he was told that she had had a tolerable night, was rather more tran- quil, but that there was no abatement of her gloomy notions. " As soon as I entered the drawing-room, where she usually spent the day (I copy his own statement which I have now before me and which he wrote down at the time of the occurrence,) she ran into a corner, hid her face in a handkerchief, then turned round, looked me in the face, one moment appearing delighted at the thought that I was alive, but immediately afterwards assuming a hideous ex- pression of countenance, and screaming out that I was dead and come to haunt her. This was exactly what Dr."-----had antici- pated, and for some minutes I thought all was lost. Finding that persuasions and argument only irritated and confirmed her in her belief, I desisted, and tried to draw off her attention to other sub- jects. It was some time since she had either seen me or her child- ren ; I put her arm under mine, took her into the garden, and began to relate what bad occurred to me and them since wo parted : this ul. iv.j NERVOUS FUNCTION. [ord. i. 77 excited her attention, she soon became interested, and I entered Gen- I- with the utmost minuteness and circumstantiality into the affairs of Icidfrc-niu' the nursery, her home, and her friends. 1 now felt that I was gain- Ma"ia- ing ground, and when I thought I had complete possession of her Moraf33' mind, I ventured to ask her in a joking manner, whether I was nottreatment- very communicative for a ghost; she laughed ; I immediately drew her from the subject, and again engaged her attention with her children and friends. The plan succeeded beyond my hope ; I dined, spent the evening with her, and left her at night perfectly herself again." He went the next morning in a state of intense anxiety to know whether his success had been permanent; but her appearance at the window with a cheerful countenance soon re- lieved his apprehensions. While he was there Dr. ----came in ; he went up stairs without knowing the effect of the interview, and came down, saying, " it looks like magic !" With a view of con- firming her recovery, she was ordered to the sea-side to bathe. As soon as the day of her departure was fixed, she began to droop again, the evening before it she was very low, and on the morning of her setting off was as bad as ever. This state continued for several weeks in spite of sea-air and bathing, and ceased as sud- denly as it had done before, apparently in consequence of inter- views with friends, calculated to remove the apprehensions by which her mind was haunted. She has since then continued perfectly well, and has had another child without the slightest threatening of her former malady.' '* This was a bold venture, and the physician must be of a temper An experi- more than ordinarily sanguine who would predict a like success bold and upon every similar attempt. Yet we have already had occasion to n°0rt'tobe' observe, that puerperal insanity is more easily recovered from than rashly most other forms of the disease. Med. Trans. Vol. vj. • 7h • ... i\\\ NEUROTICA f",;i> ' GENUS II EMPATHEMA. UNGOVERNABLE PASSION. THE JUDGMENT PERVERTED OR OVERPOWERED BY THE FORCE OF SOME PREDOMINANT PASSION ; THE FEATURES OF THE COUNTE- NANCE CHANGED FROM THEIR COMMON CHARACTER. Gen. II. The term empathema is derived from the Greek 5r«%c«, " passio," rfthe'eene- " affectio," whence e^7rx6ti<;, u cui insunt affectus seu perturbationes ; ricterm. affectu percitus vel commotus." ftcuitfes of We have already had occasion to observe that the various facul- Jhaebimind M ties of the mind are just as liable to be separately diseased as those disease as of the body : for as the faculty of digestion may be impaired while body.of the that of respiration or secretion remains in perfect health, so may The the perception or the judgment be injured while the memory or the the mind0 imagination continues in its former activity. It is the same with rqbie'-yand tne Patbetic faculties. These I have stated are to the mental part are to'the of the human frame what feelings properly so called are to the cor- feehngsn're poreal; and hence both may be excited pleasurably or painfully ; m thei b°dy" tney may ^e m morhid excess or in morbid diminution ; and their inmorbid influence may equally vary according to the peculiarity of the diminution: Passi°n or the sense affected. Each will therefore furnish a distinct may be division of diseases : the first constitutes the genus before us ; the exited ory second will be found in the ensuing order. Si^b"^" The Present genus, however, has never hitherto been properly passions arranged or digested. Pinel is constantly describing the species the present tnat belong to it in his general remarks and illustrative cases, but genus. allots no place to it in his nosological arrangement, with the excep- nevergenU9 tion of the third species, which, as I have already observed, he has bj£*et\ irregularly ranked as a subdivision of mania, under the name of arranged or manie sans delire, although he admits that the judgment and per- ttsgspecies ception, and, indeed, all the reasoning faculties of the mind are in regarded by most cases undisturbed. In like manner, Sauvages has incorrectly modifica- merged the whole family into a single species under the genus tions of mania, to the utter confusion of both. mania, by . ' ... _ Sauvages It is not a little singular that Dr. Crichton, who has written so same7bV excellently on the diseases of the passions, and has illustrated his Csrimhofditi- observations with such a variety of examples, should both in his cationsof "Inquiry into the Nature of Mental Derangement," and in his insanity, u Synoptical Tables," either have assigned no place to these dis- eases, or have transferred them, like Sauvages, to insanity,—under his nomenclature, delirium; although, as I have just remarked, the perception and the judgment (a diseased condition of which are ux. iv.j NERVOUS FUNCTION. [ord. i. 79 usually appealed to as constituting pathognomic symptoms of in- Gen- Ir- sanity) are, for the most part, strikingly clear in empathema, and ma.pat ° often peculiarly acute. This last faculty, indeed, is frequently ^"fvern" perverted by the prevailing emotion or passion of the hour; as passion. where a man under the influence of despair, reasons himself into the lawfulness and expediency of suicide ; but the argument, though deflected, runs still in a right line ; or, in other words, consists of correct reasoning built on a perception of false ideas as its premises, of which we have had various examples in the philoso- phical suicides of Germany. In the greater number of cases, however, the judgment, instead of being perverted, is merely over- powered by the impassioned emotion ; there is neither false judg- ment nor false perception. Ungovernable passion or empathema, nevertheless, though not Ungovern- strictly insanity, is as much a mental derangement as insanity itself, passion. though not insanity, Ira furor brevis est, still a mental de- ls as clear a truth as is to be found in the whole learning of the How con- Roman empire ; and hence the elegant and fanciful mind of the bevmtpneted Greeks added the term mania to that expressive of any passion or Groeksand emotion whatever, when in a state of violence or misrule, as doxi- mania, erotomania, chrysomania,— and in this sense mania is often used in the colloquial language of our own day. For poetry or vernacular speech mania thus employed is intelligible enough; but it is not sufficiently correct for medical or physiological purposes, under which predominant passion must necessarily be distinguished from delirium. The genus empathema has three species ; the first characterized howdistin- by the rousing power of the prevailing passion ; the second, by its guished. depressing power ; the third, by symptoms different from both, and which will be explained in its order. 1. empathema entonicum. empassioned excitement. 2.---------atonicum. empassioned depression. 3.---------inane. hare-braced passion. SO ex. iv.j NEUROTICA |'oud. 1. SPECIES I. EMPATHEMA ENTONICUM. EMPASSIONED EXCITEMENT. THE PREDOMINANT PASSION ACCOMPANIED WITH INCREASED EXCITE- MENT, ARDOUR, AND ACTIVITY ; EYE QUICK AND DARING ; COUN- TENANCE FLUSHED AND TUMID. Gen. h. The varieties are innumerable : the chief are as follow. Spec. I. a. Laetitiae. Ungovernable Joy. 3 Philautiae. Self-love. Self-conceit. y Superbiae. Pride. ^ Glorias famis. Ambition. e Iracundiae. Anger. £ Zelotypia?. Jealousy. The All these, and, indeed, all other passions whatever, are as much are direct direct and indirect stimulants to the mind as provocative foods or tothemVnd• drinks are to the body. Employed occasionally and in moderation bo*h may be of use to us, and are given to, us by nature for this and hence purpose : but when urged to excess they throw the system off its useful or healthy balance, rouse it by excitement or depress it by exhaustion, mischiev- and weaken the sensorial vessels by the wear and tear they produce. Hence As those we are now contemplating are attended with increased possess action, they have some few symptoms in common, how widely soever toms in they may differ in others ; of which the chief are an augmented tem- SomeUmes pcrature and an accelerated pulse. If carried to such a degree that discover the judgment loses its power, or in other words the man has no bjTseparate longer any command over himself, they betray themselves by their "f"etui' effect en particular features and particular organs, according as the separate emotion is of a painful or a pleasurable character, or as the pain or organs. pleasure predominates in those cases which partake of both. Some There are some organs, however, that seem to be equally affected equally under a vehement excitement of whatever may be the prevailing affected by passion, as the brain, the heart, and the lungs ; for head-ache and excitement apoplexy, palpitation and anhelation are alike common to sudden passions. ^s °^ extreme joy, terror, and rage. The thoracic effects are indeed Hence the most striking ; and hence it is that the praecordia have been ouTpopuiar more generally supposed in all ages and countries to be the seat of fetology mental emotion than the encephalon ; and the state of the heart, as light and jumping for joy, oppressed and breaking with grief, or black and bilious with hatred, has been more commonly appealed to than that of the animal spirits ; though the latter is the cause, and the former the mere effect. uTehewt I<; may be tllou8nt' perhaps, that the vulgar character of the heart «a?dtoabe as indicative of hatred or revenge, is merely figurative and has no ex. iv.] NERVOUS FUNCTION. [ord. i. 81 foundation in nature. But this is not the case ; for anger when long Gen> ir< indulged is well known to affect the functions of the liver, and has Em^thema often laid a foundation for jaundice, and consequently for a deeper ^m™*"m" colour as well as other properties of the blood that circulates through ed excite- the heart: a fact so well known, that the seat of anger has, in the unseat of poetical language of most countries, been transferred to this organ, hatred. and bilious or choleric and irascible are convertible terms in the popular language of our own day. We have endeavoured to account for the difference of effect How produced by the sensorial fluid in the different organs of local sensa- different I- i • i t. . . , • , organs are tion, by supposing some degree of change to take place in the nature excited by of this fluid by the action of the respective sentient nerves at their p^ons. origin or extremity. It is possible that other changes may take Whether place in the sensorium from the influence of peculiar mental impres- sions, and that certain classes or ramifications of nerves may be more affected by particular impressions than others. And we may hence account not only for the sympathy of the liver with the senso- rium when urged by anger, but for that of other organs under other empassioned excitements; and this not merely whether pleasur-p]easuraHa able or painful, but according to the peculiarity of the pleasure or ot painful, the pain which forms the source of incitation. Thus while anger ingtothT stimulates the liver, fear has a tendency to produce a diarrhoea and 3e9c0fc incontinence of urine ; grief disorders the stomach, and affects the pleasure lachrymal glands ; sudden fright divests the muscles of locomotion, Exempli"-' and produces palsy ; while mirth throws them into involuntary action, fieth and compels a man to leap, laugh, and sing. This, however, is to digress ; for our present business is to con- template the mental rather than the corporeal effects of the passions when urged to excess, or intemperately protracted. The instances of derangement produced by a sudden fit or aE.ento- immoderate flow of joy are numerous, and not difficult to account L^uthE. for. As this impassioned emotion, when indulged with a rampant Ungovemed domination over the judgment, is a direct stimulus of a very power- it/'stimu- ful kind, acting not only on the nerves but on every part of the body,lant effectB- it cannot take place without producing great sensorial exhaustion, succeeded and consequently cannot be persevered in without remissions of^reat^ languor and lassitude, like the effects of intoxication from strong exhaustion. wine or spirits. The misfortune is, that when the elevating faculties sometimes of the mind, and especially the imagination, are once let loose by mental"16 the operation of this passion, and both run wild together, the mental excitement excitement will sometimes continue after the strength of the body prevais< is completely prostrated. And when this strength is sufficiently whence a recruited for the external senses to convey once more to the percep- permanent tion true and lively impressions of the objects that surround them, ancewith the perception which has been also morbidly affected by the violence f™^essi0,1B of impassioned paroxysms will not receive or convey them in a true external state, and a permanent derangement is the consequence. Cardan* Exemnii gives the case of an artisan of Milan who having had the good luck to fied- find an instrument that formerly belonged to Archimedes, ran mad with * Pc SapientiA, lib. ii. Vol. IV.—11 63 (l. iv.] NEUROTICA. [oRO. ». Gen. II. the fit of transport into which ho was hereby thrown : and Plutarch, aSBEento'' ™ his lllV of Artuxerxes, has a like story of a soldier who, having had !yrus in battle, became so overjoyed lent. Boerhaave *and Van Swietent the high honour of wounding (_ to produce death Exempli- fied. Further illnstration. ento- nirum u "governed that he lost his wits from the moment. j°y- relate cases of epilepsy that have followed from the same cause. Exhaustion Occasionally the exhaustion of sensorial power hereby produced BoTudden8 is so sudden and total, that the whole nervous system seems instan- "n^otaUs taneously to become discharged of its contents, like a Leyden phial loaded with electricity when touched with a brass rod, and death takes place at the moment. There are various instances on record in which a like fate has followed upon the injudicious production of a pardon to a culprit just on the point of his being turned off at the gallows. Valerius Maximus relates two anecdotes of matrons who, in like manner, died of joy on seeing their sons return safe from the battle at the lake Thrasis ; the one died while embracing her son, the other had been misinformed, and was at that moment lamenting his death. The power of surprise was added therefore in this case to that of joy, and she fell even before her arms could clasp him.| Marcellus Uonatus, Pechlin, and other collectors of medical curiosities are full of incidents of this kind : and a case not very unlike occurred a few years since to the present author, in the person of an intimate friend and most exemplary clergyman. This gentleman, who had consented to be nominated one of the exe- cutors in the will of an elderly person of considerable property with whom he was acquainted, received a few years afterwards, and at a time when his own income was but limited, the unexpected news that the testator was dead, and had left him sole executor, together with the whole of his property, amounting to three thousand pounds a year in landed estates. He arrived in London in great agitation, and on entering his own door dropt down in a fit of apoplexy, from which he never entirely recovered ; for though he regained his mental, and most of his corporeal faculties, his mind was shaken, and rendered timid, and an hemiplegia had so weakened his right side that he was incapable of walking farther than a few steps. Could this passion be employed as a medicine, and administered with a due regard to time and measure, from its powerful influence on the whole system, there can be no doubt that it might be made productive of the most beneficial effects. And there is hence no amidfeine* reason f°r hesitation in admitting many of the wonderful cures which Has been are reported to have been occasionally operated by its sudden incur- sion. Corineus gives the case of a tertian ague thus removed : Lory that of a stricture of the pylorus with incessant vomiting ;§ and Trellian, what we should less have expected, a radical cure of melancholy.il In the second variety we have noticed the predominance of self-conceit. The ordinary feeling here is still of a pleasurable kind, but never amounts to the paroxysms of the preceding : its effects therefore on the soundness of the mind are more gradual, but Description, in many instances quite as marked. It is a vain and preposterous * De Morb. Nerv. lib. ix. cap. 12. t Comment. Tom. m. p. 144. I Lib. is, cap, 17. § De Melancholia, Tom. i. p. 37, H Lib. xli. p. 17 This emo- tion highly useful if it could bo nieted out and productive of wonder- ful cures. Exempli- fied. 0 E. ento- nicum PhUautiae. Ungovern- able self- conceit. gl. iv.J NERVOUS FUNCTION. [ord. i. S3 estimation of one's personal powers or endowments, accompanied Gen. II. with so immoderate a love of one's own self on this very account, ^i If^'_' as to make the possessor blind to every instance of superiority in "i0""1. another person, and hence to save him in a considerable degree ungovem- from the pain he would otherwise endure ; for the self-conceited man *„n0Cgft.e' is not easily mortified or humiliated, and hence not easily cured of the malady. " A wise man," says Mr. Mason in his Treatise on Self-knowledge, " has his foible as well as a fool; but the difference between them is, that the foibles of the one are known to himself and concealed from the world : the foibles of the other are known to the world and concealed from himself. The wise man sees those frailties in himself which others cannot; but the fool is blind to those blemishes in his character which are conspicuous to every one else."* It was under the influence of this disease that Menecrates, as we learn from ^Elian, became so mad as seriously to believe him- self the son of Jupiter, and to request of Philip of Macedon that he might be treated as a god. But it is not always that the man thus deranged falls into such good hands as those of the Macedonian monarch; for Philip humorously determining to make the madman's disease work its own cure, gave orders immediately that his request should be complied with, and invited him to a grand entertainment, at which was a separate table for the new divinity, served with the most costly perfumes and incense, but with nothing else. Mene- crates was at first highly delighted, and received the worship that was paid to him with the greatest complacency, but growing hungry by degrees over the empty viands that were offered him, while every other guest was indulged with substantial dainties, he at length keenly felt himself to be a man, and stole away from the court in his right senses.! The passion of pride has a close affinity to that of self-conceit: ykonto- but is less confined to self-endowments, and is a relative as the former superbiai. is a personal vanity. The proud man may indeed have the same JJjf]^ preposterous estimation for some supposed gift of person, but the Description, grasp of the passion does not terminate here; for he carries the same estimation to every thing that in the remotest degree apper- tains to him, and is hence as vain of his birth, or family connexions, his wealth, his estates, his country, his office, his honour, or his reli- gion : and he is hence open to more numerous mortifications, and JS^™^ is in fact more frequently mortified than the mere egotist. Examples numerous of a deranged mind from ungovernable pride are to be found in "o^an every rank of life ; but as those in the loftiest have the cup of intox- self-conceit? ication most frequently offered to them, and drink deepest of its principally contents, it is here, among kings, and courtiers, and prime ministers, to be found. and commanders, that we are to look for the most striking instances of this malady. Many a crown won by good fortune, and which might have been preserved by moderation, has been lost by the delirium of pride and vain-glory ; of which the history of Demetrius f™*^' of Macedonia furnishes us with one of the most memorable exam- ples : who, in his disgraceful fall, was obliged to abandon, among * Parti. Ch. "H *■ Lib. xn. cap, 51, 34 CI. IV.J NEUROTICA. [ORD. Gen. II. Spec. I. y E. ento- nicum Superbia:. Ungovern- able pride. Pride of humility what ? Exempli- ' fied. Prudential advice of Seneca. i E. entoni- cum Glorias famis. Ungovern- able ambition. Description- Why more dangerous to the un- derstanding than either of the preceding. Cases so common as to render examples unneces- sary. fotill more dangerous in disap- pointment, and produc- tive of de- spondency. E E. ento- nicum Iracundise. Ungovern- able anger, and its compounds' More mU chievoub in tlieir result than the pleasurable amotions. the other idols of his heart, the unfinished robe which was to have hung over his shoulders, containing a magnificent embroidery of the sun, the moon, and all the stars of heaven, designed to have represented him as the sovereign lord of the whole. There is, however, another kind of madmen, to adopt the words of Butler,* opposite to these, " that are insensibly mad and know nothing of it; such as affect to contemn all praise and glory, and think themselves most free when they are most mad: a company of cvnics, such as monks, hermits, and anchorites, that contemn the world, contemn themselves, contemn all titles, honours, offices, and yet in that contempt are more proud than any man living. They are proud in humility, proud in that they are not proud.—They go in sheep's russet, many great men that might maintain themselves in cloth of gold, and seem to be dejected; humble by the outward car- riage, when as inwardly they are swollen full of pride, arrogancy, and self-conceit. And therefore Seneca advisethhis friend Lucilius in his attire and gesture, his outward actions especially, to avoid all such things as are most notable in themselves ; as a ragged attire, hirsute head, horrid beard, contempt of money, coarse lodging, and whatever leads to fame that opposite way."t When the passion of pride is united to that of ardent desire after something beyond us and above us, it constitutes the next feeling of ambition : and hence this also is an inflating emotion, a tympany of the mind, and may be called prospective vanity, as pride is rela- tive vanity, and self-conceit personal. It is the more dangerous to the understanding in consequence of the double force with which it overpowers the judgment: and hence the slave of inordinate ambi- tion is far more restless, and in a far higher degree of excitement, than the slave of either of the other two kinds of vanity ; and as be- ing dependent upon a greater number of contingencies, he is most of all open to reverses and downfals. Examples are not necessary, and would be a waste of time. Whenever the stimulant ideas or thoughts that are connected with any one of this train of passions pass over the mind, the blood, as is justly observed by Sir A. Crichton, rushes with impetuosity to the head, the sentient principle is secreted in preternatural quantity, and the excitement is at last so often renewed, and increases to such a degree, as to occasion an impetuous and permanent delirium. But when the expectations and high desires, which pride or vanity na- turally suggest, are blasted; when these passions are assailed by poverty, neglect, contempt, and hatred, and are unequal to the con- test, they now and then terminate in despondency or settled me- lancholy .| But rf such be a frequent effect of the stirring passions of a plea- surable kind, it is not difficult to conceive that those accompanied with pain, as the passion of anger, and all its compounds, suspicion, revenge, and especially jealousy, must make a much wider inroad upon the domain of a well-ordered mind, and introduce confusion and derangement. Nor is the effect confined to the head ; for a * Anat. of Melanch. Part i. Sect. ii. Vol. i. p. 189. t Epist. v. % Of Mental Derangement, Book in. Ch. n. ox. iv.] NERVOUS FUNCTION. [ord. i. «.V stimulus thus violent affects the entire system, and, as we have al- Gen. II, ready observed, has a peculiar sympathetic influence on the liver; £ E.Ecntoni producing, in many instances, a very diseased secretion of bile, and J;^*™" altering it in a very short period, not only in its quantity but in its ungovema- quality. At the same time every vessel is exhausted of its irrita- Jj^f"' bility, and the whole strength is so prostrated, as occasionally to lead compounds. on to obstinate faintings, convulsions, and death. The expressions extensive"1' and gestures are always violent and offensive, and are similar to ^P°sreal those of maniacal rage; the eyes are red and inflamed, the counte- nance is flushed, swollen, and distorted, and the person is ungovern- able. Such was the case in 1392 with Charles VI. of France, who Exempii- being violently incensed against the Duke of Bretagne, and burning Ued' with a spirit of malice and revenge, could neither eat, drink, nor sleep for many days together, and at length became furiously mad as he was riding on horseback, drawing his sword, and striking pro- miscuously every one who approached him. The disease fixed upon his intellect, and accompanied him to his death. In jealousy, as in ambition, there is a combination of irritating £.E- ento- passions, and the combination is still more complicated ; for it is a zeiotypiae. compound of suspicion, hatred, eager desire of revenge, occasionally ^b"fovem' intermixed with love. To hot climates it appears to be endemic, and jealousy. there is not perhaps an eastern dynasty that does not offer numerous examples of its sanguinary phrensy, and diabolical career. It is not often, however, that any of the varieties of this species ^mnesdia! terminate in permanent insanity, although the case of Charles VI. of France forms an pxception to the general rule. As moral treatment mr^{pall> appears to be of more benefit in the preceding genus than medical, discipline; it is almost the only treatment that can be recommended in ungovern- able passion, though the violence of the excitement should unques- tionably be reduced by venesection and purgatives. After this, time and perfect quiet must be chiefly depended upon : yet judicious conversation, and more especially a judicious choice of subjects may accomplish much. A deaf ear is generally turned to.the precepts of the moralist, but if attention can be obtained for them, Epictetus and Mason's Self-knowledge, Pascal's Thoughts and Lord Bacon's Essays, will furnish valuable remedies ; and so also, and of a much more powerful operation, will the still better penned ethics of a book which in every Christian country should be uppermost in the mind without any suggestion. Moral castigation, however, if not too sudden or severe, is that which generally works most effectually ; and few ^."^.^ madmen of this kind have been able to meet a serious reverse of for- f^'e%i'ot tune or condition in life without being the better for it, if not de- j™™™. stroyed by its first shock. Self-conceit, which is a mere product of self-ignorance, is best removed by an acquaintance with the world, and especially with men of real talents and genius, in which sphere the man who labours under it will soonest learn his own emptiness, and the means of remedying this defect. And hence the advantage of a public education over a private one ; in which talents are brought into a fair competition with talents, and every one learns to appre- ciate his powers, not by the standard of his own vanity, but by the -->tamp of merit that Ins passed the mint. 5li cl.iv.] NEUROTIOA |okd. J- SPECIES II. EMPATHEMA ATONICUM. IMPASSIONED DEPRESSION. THE PREDOMINANT PASSION ACCOMPANIED WITH DIMINISHED EX- CITEMENT, ANXIETY AND LOVE OF SOLITUDE : EYE FIXED AND PENSIVE ; COUNTENANCE PALE AND FURROWED. Gen. II. The mental emotions productive of these effects are at least as Spec. ii. numerous as those which harass the frame by increased excitement. The following may serve as examples : a Desiderii. Ungovernable Love. £ Auri famis. -------------Avarice. y Anxietudinis.------------■ Anxiety. ^ Mceroris. ------------- Heart-ache. e Desperationis. ------------- Despondency, ah these As increased sensorial excitement produces various symptoms hi excUe°some common, whatever be the nature of the governing passion at the corporeal tjme . there are also various symptoms common to decreased senso- symptoms ..'. i /• 1 i in common, rial excitement under each of these depressing passions : as a greater or less degree of torpor in every irritable part, especially in the cir- culating and absorbent systems ; whence paleness of the counte- nance, coldness of the extremities, a contraction and shrinking of the skin, and general surface of the body : a retardation and small- ness of the pulse, want of appetite, deficiency of muscular force, and a sense of languor which overspreads the whole frame. a e. atoni- The ardent desire which is distinguished by the name of longing, Desiderii. is directed towards objects of various kinds that are absent, and Ungovern- equally relate to places and persons. It is a painful and exhausting oriov°e"g'" emotion, as compounded of hope, love, and fear, and peculiarly agi- tates the prrecordia: and hence the striking and beautiful apoph- its direction thegm of the wise man, " Hope deferred maketh the heart sick." It andits ope-is felt by children at a distance from home, and who are eager to periods'of111 return to the embraces of their parents ; by foreigners who have a life; strong and inextinguishable love for their country, and are anxious to return to the scenes and the companions of former times : and by the youthful pair who have vowed an eternal attachment, and are sure that they cannot live without each other ; but whose union is producing opposed by bars that are felt to be insurmountable. And hence the sickness; present variety includes the three modifications of home-sickness, sickness; country-sickness, and love-sickness. The first is for the most r>nd love- part trnnsitorv ; the second- the heimivchr of the Germans, has some- cl. iv..] NERVOUS FUNCTION. [ord. i. b't times, and especially among the Swiss, when their manners were 9EJ1, n* simpler, and their domestic virtues and feelings much stronger than fE^aton!- they seem to have been of late years, produced not only a perma- cum nent melancholy, but hectic fever. Yet it is to the third that our ungovern- attention is chiefly called on the present occasion, from the greater ^jo've"8'"8 frequency of its occurrence and the severer and more tragic effects The to which it has led, where obstacles have arisen in its progress. frequent' We have, on the present occasion, nothing whatever to do with and most • severe* the gross passion of concupiscence, which is as different from that Present of pure and genuine love as light from darkness. The man of lust 1e0™et\0o'ta°iy has indeed his love, but it is a love that centres in himself and seeks distinct alone his own gratification ; while the passion we are now speaking conc/pu-8 of puts self completely out of the field, and would voluntarily submit cence; to every pain, and sacrifice even life itself, in promoting the hap- piness of the beloved object. Yet constituted as we are by nature thongh for the wisest and best of purposes, a pure corporeal orgasm stdl en- whTa°pVim> weaves itself with the sentimental desire, though subordinate to it in corporeal virtuous minds, and the flame is fed from a double source. " Nuptial orgasra' love," says Lord Bacon, " maketh mankind ; friendly love perfect- ed it: but wanton love corrupteth and embaseth it."* What it is that first lights up this flame is of no importance to the Origin of present subject. A peculiar cast of form or of features acknow- ofnoTm-10" ledged by all to be moulded according to the finest laws of symmetry, pwiance; and productive of a high degree of external grace or beauty ; or judgment a figure or a manner that to the eye of the enamoured beholder 0sVe?power- gives token of a mind adorned with all he can wish for; or an ac- ed, what- tual knowledge, from long acquaintance, of the existence of such immediate internal cultivation and excellence, maybe equally causes of the same g^e^em common effect. And hence this is of little or no account; for the The excited passion being once excited, the judgment runs a risk of being over- ^"rfse to powered by its warmth and violence ; and the moment it is over- romantic powered, the new train of ideas that are let loose upon the mind imagina- are of a romantic character ; and as soon as any obstacle starts ^"taciea up as a barrier in the vista of hope, instead of being damped or growing repressed, they grow wilder and more vivid, till at length the senso- more* *" rial system is worn out by the vehemence of its labour ; and though visionary: • . whence tlis the excitement is really less than at first, because there is less vascu- mind led lar vigour for its support, it is still greater than ever compared with the'hody"1 the weakened state of the sentient organ. exhausted. Yet love-sickness itself, whatever mischief it may work in the Though a" corporeal frame, by sleepless nights, a feverish pulse, and loss of j^"^:,81*16 appetite,! and however, from the exalted state of the imagination, rarely leads and the increased sensibility of the bQdy, it may transpose the reality whaTa''' of life into a kind of visionary existence, and so far produce mental h°P? .of i iiit •• i i • i attaining derangement, rarely leads to direct insanity, so long as there is the the desired remotest hope of the attainment of its object. But if hope be sud- °emZLs. dently cutoff by an inexorable refusal, the intervention of a more But if in J J this state of excitement * Essays, No.*. .^* j Schurig. Gyneaolog. p. 94. oB", despair Horstius, An Pulsus aliquis amatoritis concedcndu- often fol- miizer, De Natura Amoris, Gioss. 1611. 4to. '«»■.. nr\<] -^ ex. iv.j NEl ROTK a [orp. i. Gen. II. Spec. II. a E At<-ni. cam Desi- derii. Ungovern- able long- ing or love. sometimes suicide or other murder. Exempli- fied. (i E. atoni- cum Aurifamia. Ungovern- able ava- rice. The pmo- tion alto- gether op- posed to the preceding. Description. Singular example. y E. ato- nicum Auxietatis. Ungovern- able anxiety. Occasional causes. fortunate rival, the concealment of the object of adoration, or any other cause whatever, the mind is sometimes incapable of resisting the shock thus produced by the concurrent yet opposite powers of desire and despair ; and in a moment in which the judgment is com- pletely overwhelmed, the love-sick maniac calls to his aid the de- moniacal passion of revenge, and, almost at hazard, determines upon a plan of murder directed against his rival, his mistress, or himself. The story of Mr. Hackman and Miss Rae will at once, perhaps, oc- cur to the recollection of most of the author's readers in proof of this assertion. He himself had some acquaintance with the former: and is convinced from what he knew of him that nothing but a paroxysm of insanity could have urged him to so horrible an act. The operation of the passion of avarice when it has once obtain- ed an ascendancy over the mind is altogether of a different nature from that of the preceding variety, though it often produces a wider and more chronic alienation. It has not a stirring property of any kind belonging to it; but benumbs and chills every energy of the body as well as of the soul, like the stream of Lethe ; even the im- agination is rendered cold and stagnant; and the only passions with which it forms a confederacy are the miserable train of gloomy fear, suspicion, and anxiety. The body grows thin in the midst of wealth, the limbs totter though surrounded by cordials, and the man volun- tarily starves himself in the granary of plenty, not from a want of appetite, but from a dread of giving way to it. The individual who is in such a state of mind must be estranged upon this point, how much soever he may be at home upon others. Yet these are cases that are daily occurring, and have been in all ages: though perhaps one of the most curious is that related by Valerius Maximus of a miser who took advantage of a famine to sell a mouse for two hun- dred pence, and then famished himself with the money in his pocket.* And hence the madness of the covetous man has been a subject of sarcasm and ridicule by moralists and dramatic writers in every period, of which we have sufficient examples in the writings of Aris- tophanes, Lucian, arid Moliere. There is another mental feeling of a very afflictive, and too often, like the last, of a chronic kind, which is frequently found to usurp a dominion over the judgment, and to imbitter life with false and visionary ideas, and that is a habit of axxiety or preying care ; which not only drives the individual who possesses it mad, but runs the risk of doing the same to all who are about him, and are harassed with his complaints and discontents. This is sometimes the effect of a long succession of misfortunes or vexatious troubles ; but seems in some persons to depend on a very high degree of nervous sensi- bility, united with a choleric or melancholic temperament. Their age, wealth, or situation in life is of no importance, and though their digestive powers are good, and "they are not hypochondriacs, they are always apprehensive and full of alarm, and flee from every appear- ance of joy as they would from an apparition, or even sooner. In the language of Butler, who knew too well how to describe them. * T il>. vn. Cap. vt cl. iv.j NERVOUS FUNCTION [on». i. afl 14 The old are full of aches in their bones, croups and convulsions ; Gen.ii. dull of hearing, weak sighted, hoary, wrinkled, harsh, so much so that yS%.*%£• they cannot know their own selves in a glass, a burthen to themselves cum a' and others. If they be sound they fear diseases ; if sick weary of 1}™^ their lives. One complains of want, a second of servitude, another *™° aux'- of a secret or incurable disease, of some deformity of body, of some bescrip* loss, danger, death of friends, shipwreck, persecution, imprisonment,lion' disgrace, repulse, contumely, calumny, abuse, injury, contempt, in- gratitude, unkindness, scoffs, scouts, unfortunate marriage, single life, too many children, no chddren, false servants, unhappy children. barrenness, banishment, oppression, frustrate hopes, ill success : Csetera de genere hoc, adeo sunt multa, loquacem, Delassare valent Fabiura. "' In the mean time," continues the younger Democntus, ;i thus much I may say of them, that generally they crucify the soul of man. attenuate our bodies, dry them, wither them, rivel them up like old apples, and make them as so many anatomies."* Nothing can be more different than this constitutional pining, and <5.e. ato- the pains produced by heart-ache, or the reality of severe grief. Sforor'is. The former is talkative and querulous ; the latter is dumb and flies YvfL0™1t" from company. The sensorial exhaustion is so considerable that the ache. °a mind, with its attention upon the full stretch, has scarcely strength S'th"^ enough to collect the train of ideas on which alone it resolves to rulous dwell; and hence all conversation is irksome, the presence of a friend anx,ely" disquieting, and the deepest solitude is anxiously sought for. And Sometimes not unfrequently the discharge of nervous power is so considerable apoplexy, and sudden as to produce a general torpor of the brain ; which, if it *}£„ *„ do not happily terminate in quiet sleep, is the inlet of apoplexy, other cor. Even in the former case the inirritability of the nervous fibres con- p016*1™''5, tinues to such an excess that the sufferer has no natural evacuation for perhaps several days, feels no hunger, cannot be persuaded to take food, is incapable of sighing and sheds no tears. And hence Tears and the appearance of tears and sighings are good omens, and are cor- ol^f™1 rectly regarded as such ; since they show that the general torpitude w»y- is giving way in the organs that most associate with this painful emo- tion of the mind to a slight return of irritability. As soon as the flow of the sensorial principle is a little increased the praecordia struggle with great anxiety, and the heart is overloaded and feels ready to break or burst, whence the name of heart-ache, so ap- propriately applied to this variety of suffering. Sometimes, also, hys- Yet teric flatulency oppresses the respiration, and convulsion, and, not convulsion* unfrequently, death itself ensues. Of this last effect Erndtl has given death ftseir numerous instances.! But if recovery should take place it is usu- in case of ally long before the judgment re-assumes its proper sway *in the the°mTnEC.II. i E. Atoni- I'tim Mcc- roris. Ungovern- able heart- ache. Descrip- tion. c E ntoni- cum Des- pcrationis. Ungovern- able de- spondency. Despair how dis- tinguished from the preceding. Illustrated. et. fv.j Neurotica. [oltl>. Causes in- numerable. Suicide a frequent result. Guilty consc'ence its effects in driving a culprit to a surrender of himself to justice. The feeling sometimes from ima- ginary causes; or false i;leas ex- cited by itinerant ureachers. Shakspearc has given u, an admirable copy in the character of King Lear finely imagined to be a result of filial ingratitude. Despair makes a near approach to heart-ache in the overwhelming agonv it produces, and its pressing desire of gloom and solitude, but, generally speaking, the feeling is more selfish, and the mind more hurried, and daring. Despair, as it commonly shows itsell, is utter hopelessness from mortified pride, blasted expectations, or a sense of personal ruin; heart-ache is either hopelessness from a sense of some social bereavement, or relative ruin. The gamester who cares for no one but himself may rage with all the horror of despair; but the heart-ache belongs chiefly to the man of a warmer and more generous bosom, stung to the quick by a wound he least expected, or borne down, not by the loss of fortune, but of a dear friend or relative, in whom he had concentrated all his hopes. The well-known picture of Beverley is drawn by the hand of a master : and he is represented as maddened by the thought of the deep dis- tress into which his last hazard had plunged his wife and family : but if his selfish love of gaming had not triumphed over his relative love for those he had thus ruined, he would not have been involved in any such reverse. While Beverley was in despair; it was his wife who was broken-hearted. The sources of this most agonizing emotion arc innumerable, and from the total shipwreck of all hope on which it is founded there is no passion of the mind that drives a man so readily to an act of suicide. To live is horror ; the infuriated sufferer feels himself an outcast from God and man, and though his judgment may still be correct upon other subjects, it is completely overpowered upon that of his actual distress, and all he thinks of and aims at is to withdraw with as much speed as possible from the present state of torture, to- tally regardless of the future, or falsely satisfying himself by a per- version of his judgment, that there is no crime in his doing so. One of the severest causes of despondency is a conscience labour- ing under a deep sense of guilt for some —undivulged crime fnwhipt of justice. And so severe has the anguish been, in many cases, that the torment- ed wretch thus haunted by himself, and hating the light of heaven, has been compelled, as the less evil of the two, to surrender himself to the laws of his country, and court the disgrace of a public execu- tion. Yet the same miserable feeling has sometimes followed from an ideal cause, especially in a mind of natural timidity, or constitu- tionally predisposed to a gloomy view of nature. For such, by a mere exercise of their own meditations, but far oftener by the coarse, but impassioned oratory of itinerant preachers, are induced to be- lieve that the Almighty has shut them out for ever from the pale of mercy, and that the bottomless pit is yawning to receive them. And under the influence of such an impression they too frequently work themselves up into a state of permanent insanity, or hurrv them- cl. iv.] NERVOUS FUNCTION, [ord. i. 91 selves by their own hands into the horrors of a fate from which they Gen. ir, feel assured that no repentance or power of religion can save them, ^ufo',"' In tho midst of great public calamities the passion of ungoverna- cum P<*»- ble despondency is apt to become epidemic, and particularly, as M. Ungoveru- Falret has well observed, where the constitution of the atmosphere, aWo ?*" i • • ii i , • •!■ . spondency. from being moist and hot, and consequently relaxing and debilitating, common in favours its spread. In 1806 the feeling of desperation was so com- fa?amu1es'c mon at Paris, that sixty suicides occurred during the months of June ""J pecu- iti s~t i-i /»i • i harly in a and July ; at Copenhagen, in the course of the same entire year, three relaxing hundred: and in 1793 about thirteen hundred at Versailles alone.* atmosPhere- The sensation, however, whether general or individual, is most acute where there is little corporeal exertion, and consequently where there is time to cultivate and brood over it. Hence suicide is fre- quent in the distress of sieges, in the first alarm of civd commotions, or when they have subsided into a state of calmness, and the mis- chiefs they have induced are well pondered; but it seldom takes place in the activity of a campaign, whatever may be the fatigue, the privations, or the sufferings endured. On the fall of the Roman em- £al1 of the pire, and throughout the revolution of France self-destruction was empire! so common at home, as at last to excite but little attention ; it does ^p"'^^1 not appear, however, to have stained the retreat of the ten thou- sand under Xenophon, and, according to M. Falret, was rare in the French army during its flight from Moscow. In all these varieties of empathema the art of the physician can do Remedial but little, and in many of them nothing whatever. Yet where the Medicine heart suffers acutely and the mind is deeply dejected, sedatives and ™*£f antispasmodic cordials may occasionally be found useful; and, as avail: the abdominal viscera are greatly liable to be affected, the appetite to someThJes fail, the liver to be congested, and the bowels rendered costive, these bH n.. i\.| NEl'iMTlCA. |ord. i. i;f.n. ii. cation, while, if it be forcibly snapped off, it will shoot out the wider Emp^the"' and grow ranker than ever. ma atoni- The excitement of an opposite passion, or train of feelings, has EnTp'as- sometimes been accompanied with success : for there are instances Sr0stion.e" m which the slave of imaginary pain and misery has for ever forgot- Treatme'nt. ten his sense of visionary grievances under the stroke of poignant and tf o$orite real affliction ; and the miser, when reduced by a sudden reverse of sadd°nSr °r f°rtune to actual beggary, and thus completely disencumbered of the verses have load that has hitherto so much oppressed him, has returned to his suwecZi: sober senses, and learned a juster estimate of worldly possessions. especially The same attempt has often been recommended in disappoint- riceamT ments under the passion of love ; and, according to the concurrent grievances. rePort OI*tne poets of ancient and modern times, many of whom pro- liow far fess to be well versed in this kind of discipline, it has very generally inhopeieBs been attended with success. Where the emotion has more of a love. corporeal than a sentimental origin, this may easily be conceived; and it is possible that it may also sometimes have occurred under a purer feeling : though, for the honour of the human heart, I do not Contingent think this is much to be trusted to. Where the choice between answered8 two young persons of fair character is really imprudent, yet the affec- bottor. tjons are so rivetted as to bid defiance to all forcible attempts to un- fetter them, a promise of consent on the part of the reluctant parent at the distance of a given period of time, as a year and a half or two years, with an undertaking on the part of the lovers neither to see nor correspond with each other in the mean time, an engagement easily fallen into, has answered in many instances to which I have been privy. The ardour has gradually cooled on the one side or the other, the judgment has been more impressed with the nature of the imprudence, or a more attractive form has interposed, and settled the question irretrievably. While on the contrary, if the fidelity should hold on both sides to the end, and the passion be heightened instead of depressed, as in this case there is most reason to suppose it would be, hard, indeed, must be the heart that would extend the re- -triction farther, and that would not wish joy to so deserving a couple. SPECIES III. EMPATHEMA INANE. HARE-BRAINED PASSION. WAVWARD AND UNMEANING PASSION, URGING TO INDISCRIMINATE ACTS OF VIOLENCE : AIR HURRIED AND TUMULTUOUS : COUNTE- NANCE FLUSHED ; EYES GLARING AND PROMINENT. Gen. II. This is the manie sans delire of M. Pinel: a case of frequent oc- ivPnEoCnymL cu/rence but incorrecUy named in this manner, since, in the opinion of pinei. of all other nosolomsts-. and perhaps all other pathological writer*. cl. iv.] NERVOUS FUNCTION. [ord. i. 33 the character of delirium (that is of diseased judgment, diseased per- Gen- H. ception, or both) is essential to mania. loathe-1' M. Pinel ascribes this species principally, and with great force of ma ""un- reason, to a neglected or ill-directed education upon a mind naturally Sained perverse or unruly : and gives the following striking example: An g'mmon only son of a weak and indulgent mother, was encouraged in the origin. gratification of every caprice and passion of which an untutored and ^"31 violent temper was susceptible. The impetuosity of his disposition increased with his years. At school he was always embroiled in disputes and quarrels; and if a dog or a horse offended him he instantly put it to death. Thi3 wayward youth, however, when un- moved by passions, possessed a perfectly sound judgment. When he came of age, he proved himself fully competent to the manage- ment of his family estate as well as to the discharge of his relative duties, and even distinguished himself by acts of beneficence and compassion. But his deep-rooted propensity to quarrel still haunt- ed him, and wounds, law-suits, and pecuniary compensations were the general consequence. At last an act of notoriety put an end to his career of violence. Enraged at a woman who had used offen- sive language to him, he tumbled her into a well. A public prose- cution followed, and, on the testimony of a great many witnesses who deposed as to his furious deportment, he was condemned to perpetual confinement at the lunatic asylum of Bicetre. On the commencement of the French revolution, when the mob Further broke open the doors of the prisons and the lunatic hospitals, to libe-lUustratcd' rate all whom they thought unjustly confined and under restraint, a patient labouring under the present species in the Bicetre asylum, pleaded his own cause so rationally, and pathetically, and so artfully accused the governor of the asylum of cruelty, that the armed rabble commanded him to be instantly liberated, and scarcely suffered the governor to escape with impunity. The patient thus restored to freedom was led about in triumph amidst the reiterated shouts of 4 Vive la Republique!' The sight of so many armed men, their loud and confused noise and tumultuous conduct, soon roused the vision- ary hero to a fresh paroxysm of fury. He seized, with a vigorous grasp, the sabre of his next neighbour, brandished it about with great violence, and wounded his liberators indiscriminately. Fortunately he was soon mastered; when the savage mob thought proper to lead him back to his cell, and with shame and reluctance acknowledged their own ignorance and misconduct. The mode of treatment mav be collected from the preceding Remedial pages. proces9' !>4 cl. iv.j NEUROTICA. [oRD. i- GENUS III. ALUSIA. ILLUSION. HALLUCINATION. THE JUDGMENT PERVERTED OR OVERPOWERED BY THE FORCE OP THE IMAGINATION ; THE SFIRITS PERMANENTLY ELEVATED OR DEPRESSED ; THE FEELINGS OF THE MIND DEPICTED IN THE COUNTENANCE. Gen. III. Alusia is here derived from the Greek uXvo-m, '• aberratio,'' from generic°f *>*<», " errabunda mente afficior,"—" inquietus aberro:" whence name. the Latin term allucinatio or hallucinatio. According to the rule which renders the Greek v, by the Latin y, the name of this genus ought rather perhaps to be alysis; but as the Latins have themselves retained the v in allucinatio, it is here suffered to continue in alusia, making a similar exception to that already observed in lues. The Greek term is preferred to the Latin, as the name of the genus, for Synonyms, the sake of uniformity. Sauvages, and after him Sagar, have em- ployed hallucinatio as the name of an order ; Darwin and Crichton as that of a genus, and, consequently, running parallel with the genus before us. Wherever the genus exists, hypochondrias or hypochon- driasis is usually placed under it. It is so by Sauvages, Sagar, and Crichton; and it occupies the same place in Linneus, who has merely adopted the term imaginarii instead of hallucinationes. Alusia embraces the two following species : 1. ALUSIA ELATIO. SENTIMENTALISM. MENTAL EXTRAVAGANCE. 2.------HYPOCHONDRIAS. HYPOCHONDRISM. LOW SPIRITS. SPECIES I. ALUSIA ELATIO. SENTIMENTALISM. MENTAL EXTRAVAGANCE. ROMANTIC IDEAS OF REAL LIFE ; ARDENT AND EXALTED FANCY • PLEASURABLE FEELINGS ; FREQUENT PULSE ; GREAT ACTIVITY ; EYE KEEN AND LIGHTED UP ; COUNTENANCE CONFIDENT AND ANI MATED. Gen. III. The merit or demerit of this species, named from the rhetoricians spec. I. elatio, and with them importing " elevated, exalted, magnificent Snecies jo i i = cl.iv.1 . NERVOUS FUNCTION, [ord.i. U5 style or imagery," must, I fear, mainly rest with the author himself. Gev. III. It is, however, strictly derived from nature, and is intended to fill iw' *' up what has hitherto been left as a vacant niche by the nosologists. ?la,i.°- Alusia, or hallucination* like ecphronia or insanity, comprises a list talis™ n of affections that are characterized by two opposite states of nervous f^"^*;. action, entonic and atonic, or in the language of Dr. Cullen, excite- nosology ment and collapse; elatio is intended to include the former of these, fongdypatho" as hypochondrias, the ensuing species, is, the latter. They stand Ac"^"J^0 in the same relation to each other as elevated and dejected mad- Relation of ness or melancholy. Both are united with a peculiar modifica- spccie^to"1 tion of the digestive function, but possessing opposite bearings; theensuing. being in the former strikingly active and energetic, and in the latter strikingly sluggish and languid. Hence under the first species the . patient is able to endure enormous fastings, and to support life upon the scantiest and least nutritive diet, either of which would be de- structive under the second. This species embraces the following varieties :— « Heroica. Chivalry. Romantic gallantry. /3 Facetosa. Crack-brained wit. y Ecstatica. False Inspiration. ^ Fanatica. Fanaticism. The age of the first of these varieties, that of cnrvALRY or " a. Elatio romantic gallantry, has nearly, if not altogether, departed. It chivalry. may be regarded as a generous and high-spirited flight of the ima- ^Xntrv? gination that gives a visionary colouring to the external world, and nescrip- combines, without a due degree of discrimination, ideas of fact with ,lon" those of fancy. Like many of the varieties of empathema or ungovernable passion, it may lead to or be combined with ecphronia or insanity. I have sometimes had to- attend patients who, having spent the Senii.ueii- grcater part of their days and nights over the most captivating novels sometimes1'' of the present day, had acquired so much of this falsity of perception make rtn as to startle their friends around them, and to give evident proofs It1"0' that they were of a mind occasionally deranged, though, when the Illu3trate(''- attention could once be seriously engaged, capable of being brought down to the soberness of external objects and real life. These have commonly been ladies unmarried or without a family, about the middle or a little beyond the middle of life, of a nervous tempera- ment, fine taste and fancy, but whose education had been directed to subjects of superficial or external ornament rather than of intrinsic excellence. Their manner has been peculiarly courteous, their conversation sprightly and figurative, and their hand ready to aid the distrest. But it has been obvious that in all they were saying or doing they had some ideal character in their minds, whose supposed air, and language, and manners, they were copying ; and the dis- trest were always most sure of relief and of a relief often beyond the necessity of the case, whose story was combined with some peri- lous adventure or sentimental catastrophe. In former times, however, when the wild and daring spirit ofButfal romance formed the subject of popular study, and mon an«;m" Q\i ex. rv.j NEUROTICA. L0*D-l' Gen. III. The spinsters, and the knitters in the sun Spec. I. And the free maids that wove their threads with bones, a A. Elatio Were wont to chant it. hcroica. Romaic this bewildering triumph of the imagination.over the judgment was gallantry. far more common, and carried to a much higher pitch. The high- isUcT6'" toned and marvellous stories of La Morte d'Arthur, Guy of Warwick, former Amadis of Gaul, The Seven Champions of Christendome, and The During the Mirror of Knighthood; the splendid and agitating alternations of Sc or magicians, enchanted castles, dragons, and giants, redoubtable com- Norman batants, imprisoned damsels, melting minstrelsy, tilts and tourna- ments, and all the magnificent imagery of the same kind, that so peculiarly distinguished the reign of Elizabeth, became a very fX^c"- frequent source of permanent hallucination. The historian of tore of Don Don Quixote adhered strictly to the tenour of his times in repre- trurtothe senting the library of this most renowned knight as filled with Ihe t"me°sf: romances of this description, and himself as being permanently and hence crazed by an uninterrupted perusal of them. And that the same twVof60" morbid effect was not confined to Spain, and was, indeed, common Ascham. t0 our own country we know from the severe, but just invectives of Ascham against this class of writings, and his complaints of the proved fur- disordered turn they had given to the public mind : and still more ther from from the necessity Shakspeare felt himself under in making all hia iult\y\\\ol maniacal characters, whether really or but pretendedly so, deeply of shak-ny versed m the prose or poetical romances of the day, and throwing speare's forth fragments of exquisite force or beauty in the midst of their characters, ^^test ancj m0st discordant ravings ; Lear, Edgar, and the heart- broken Ophelia are in this respect alike gifted, and show to what sources their reading had been directed. Without an attention to these casual glances it is impossible to understand the meaning of the sentiment, and its force or feeling is lost upon us, as in the fol- lowing burst of Ophelia which consists of a string of quotations or allusions to picturesque customs : " You must sing Down a-dovon an you call him adown-a. O, how the wheel becomes it! It is the false steward that stole his master's daughter." We have not space for the explanation, but it may be found in the commentators, or in the interesting and elaborate history of " Shaks- peare's Times," by my early and valued friend Dr. Drake. f3 a. Elatio The second variety of the present species, that of crack-brained CrTck-3' wit, is derived rather from the peculiar temperament of the indivi- biained wit. dugL\^ than from anv particular habit or train of reading; for in general, few persons have given themselves less time to read, study, or even Description, think, than those who are possest by it. It is characterized by high spirits, a sportive and lampant imagination, and a flow of facetious ebullient wit incapable of restraining itself. It is hence often poured forth on most improper occasions, and hesitates not to sacrifice a friend at the shrine of a jest. jfclf.1"1'1'" There are some persons who possess by nature so perpetual a tide of excitement that their high spirits seem seldom or never to ebb, and so irresistible a propensity to this kind of verbal merriment that no change of circumstances can deprive them of it. Sir Thomas More, who perhaps overflowed with this disposition in ? cl.iv.j NERVOUS FUNCTION. [ord.i. vt»? very high degree, is well known to have been facetious on his own ^^j1, scaffold. 0 a. Eiutfo It is not always however, nor, as we have just observed, even for Af- file most part, that the man of ready wit is, like Sir Thomas More, a bminedwit. man of ready judgment, or sound learning. The apprehension not neceg. necessary to consitute the one is widely different from that necessary ^dc«1?^ to constitute the other, as we had occasion to remark under a for- abound mer genus : and hence vivacious sallies, taunts, and repartees, not ^flj™""' only may co-exist with a deranged condition of mind, but are fre- wn«J$rdis- quently a result of it. And on this account the court jester of for- it: mer times, whose office succeeded to that of minstrel, was commonly J^1^ denominated the king's fool, as uttering from the unbridled liberty in a de- of speech that was allowed him, humorous flashes of rebuke which £"$ no man in his sober senses would have ventured upon ; and which o*^,,^ seemed, to adopt the language of Jacques, who was himself not court wit unjustly accused of wearing the same livery, to show that d'enom?- in his brain natedfoo!. Which is as dry as the remainder biscuit After a voyage, he hath strange places craram'd With observations, the which he vents In mangled forms. The third variety, or ecstatic illusion, is also a pleasurable v^^iato hallucination: and consists in a sense of false inspiration, or a False'°a visionary boast of some preternatural endowment, in the course of JS^ggJ;. which the judgment is so far "perverted as to mistake the energetic notions of the imagination for realities ; so that the victim of the delusion believes in apparitions, affects an intercourse with the world of spirits, or lays claim to a power of working miracles. This morbid afflatus has often been aped by cunning impostors g^J" to serve their own interests with the multitude: and there is no great by cunning difficulty in conceiving that it is in many cases a real and serious i»po»to». hallucination, when we reflect on the ease with which such impos- tors themselves are capable of deluding the populace and working them up into false ecstasies, and especially of inveigling them into a hearty belief of their own miraculous powers. When the passions How of men are once set afloat, and the subject presented to them is full p™^"* »: of the marvellous and the terrible, they are too apt to confound the persons. false with the real, and are prepared to proceed to whatever extre- mities the magician may choose to lead them. We are told by illustrate*. Lucian that when Archelaus, a celebrated Greek actor, performed the part of Andromeda in the tragedy of Euripides, several of the spectators were seized with a delirium ; some at the time of per- formance, others a day or two afterwards ; during which they did nothing but declaim in a theatrical manner, and piteously lament the fate of the persecuted princess. Burton, therefore, has some reason for remarking that what the impostors before us, or the brain- sick enthusiasts whom they imitate, once broach and set on foot, " be it. never so absurd, false, and prodigious, the common people will follow and believe. It will run like murrain in cattle, scab in sheep. Nulla scabies superstitione scabior; as he that is bitten by a. mad dog bites others, and all in the end become mad. Either out of affection of noveltv, simplicity, blind zeal, hope, and fear, thr Vol. IV.—I* ex. tv,\ .NEUROTICA (obv. *> gem. III. giddy headed multitude will embrace it, and without farther cxami Spec. I. *• ■.. >?* -/a Eia,ionatlon approve it. * . ccstatica. The genuine enthusiast is always possest of a warm imagination, inspiration. and generally of a nervous temperament, and delicate frame ; and a ^empera- ]ong series of elevated abstraction on religious subjects, combined jTabltaD with protracted fasting, has ordinarily been the harbinger of the sectary to fancied afflatus. Such was the discipline by which the lovely, and produce it. blooming, and sincerely devout Saint Teresa was prepared for ec- fnIIaintfi°d stasies and visions, and led to impose upon herself and all that Teresa. beheld her; and seriously to believe, in the fervour of her mind, that her body was lifted from the earth: and that she heard the voice of God, saw our Lord with St. Peter and St. Paul standing on her left hand; by the first of whom the cross, which was at the end of her beads, was miraculously transformed into four largo gems, incomparably more precious than diamonds; with many other marvellous revelations which we cannot find room to detail. Though it should be noticed that devils appeared to her as well as blessed spirits, whom she always kept at a distance by sprinkling holy water ; and that she was an eye-witness to the joyful escape from the flame of purgatory of the purified souls of father Peter of Alcantara, father Ivagnez, and a Carmelite friar.t It is not necessary to produce other examples, though many <:mo might be brought from our own times. A cure is extremely difficult difficult. tQ ke 0btained; and I am afraid that even Mr. Locke's admirable Haa been chapter on Enthusiasm would be read to no purpose. In one stratagem^ instance the enthusiast seems to have been brought home to him- Example. seif by a pleasant and ingenious stratagem of his superintendant at Venice. This visionary had conceited himself to be Elias, and like the prophet, had determined upon fasting forty days. The keeper fearful that he would never hold out, and that he should lose his patient, dressed up a man in the attire of an angel, who was intro- duced to him in no ordinary manner, and informed him that he was commissioned from Heaven to bring him food. The supposititious Elias took it, was afterwards allowed to find out the trick, and thus, at the same time, found out his own imposition upon himself. 6 a. Elatio From the influence which we have seen such enthusiasts, or even Fanaticism, pretended enthusiasts, capable of producing upon the mind of the multitude when roused by the solemnity and awfulness of the reve- lations that are supposed to be disclosed to them, we can easily see how fanaticism, constituting the fourth variety of the present species, may obtain an ascendency, and even rage with all the rami- Descrip- lying power of an epidemic: consisting of religious flights of the imagination, predominant over the natural feelings as well as the judgment, excited by the calls or doctrines of those who affect to be preternaturally gifted, or who possess an equal influence over the mind by the high sanction of priesthood, profound learning, or any other respected authority: and often urging to a voluntary and in- appropriate submission to severe privations, mortifications, and tor- ♦• Anatomy of Melancholy, Part m. Sect. ir. ' Butler's Lires of the Saints, in l«c«. Gfi. iv.) NERVOUS FUNCTION &>»». i. 90 tures; or to the torture and massacre of those who profess different Gtl*. in. rrpprfa Spec. I. tf , • L , - ,,.,- 5 A. Elatio Examples, as in the last variety, may be found m every age and frnatica. religion, but chiefly in times of gross ignorance and barbarism ; where chiefly a"*' the general mind has been too little informed to distinguish between fgenoiam.of truth and sophistry, and the passions have been undisciplined to re- ™& »>«- straint. It is lience of no importance what religion or superstition time"8 is to be inculcated, for those that are true and those that are false Jy^^j have been equally laid hold of by enthusiasts and impostors to pro- of the pro- duce the same end, and effect the same triumph by means and ma- peafeVio! chinery that could only be furnished from the infernal regions. Hence of n0 im\ the blood and raving of the prophets of Baal; the Curetes or Phry- producing0 gian priests, and the delirious votaries of the Indian Juggernaut; the phrophete'o? Gruel and senseless penances and punishments sustained in many of Baal. the convents and nunneries of Lamism, and still more so in those of priesfsf" many catholic countries. Hence the terrible sufferings of the Wal- j2,di*n t denses, the furies of St. Bartholomew's day, the fires of Smithfield, Lamism. and the dark and doleful cells, the whips, and wires, and pincers, ofThe"88 and pullies, and all the infernal paraphernalia of the Inquisition, waidense?. Hence, in ancient times, the matrons of Canaan and of Carthage lomew's ° were instigated to throw their own children into the flames, and sacri- £*?■.... » 1 i » i • ■ • tii Inquisition. nee them to the gloomy deity whose anger it was held necessary to appease; and hence in more modern days, Philip II. of Spain, was Philip ii. goaded to impeach a son, of whom he was little worthy, before the of 8pai" Chamber of Inquisitors, to bespeak their condemnation of him, and to take effectual care that he should be poisoned, as soon as his sen- tence had been pronounced. The cure of these diseases belongs rather to colleges of general in- c"re.t0** struction than of medicine. Individual cases of enthusiasm and chiefly by fanaticism have existed, and will probably continue to exist, in all function ages; but when the general mind is well informed, and the social »pd a feelings and virtues, are duly estimated and widely cultivated, the genuine" ° wild-fire will burn in vain, and meet with little or no fuel to support knowledge. its rage. SPECIES II. ALUSIA HYPOCHONDRIAS. HYPOCHONDRISM. LOW SPIRITS. GLOOMY IDEAS OF REAL LIFE ; DEJECTED SPIRITS *, ANXIETY J DYS"- PEP6Y J LANGUID PULSE J INDISPOSITION TO ACTIVITY ; EYE OBLIQUE AND SCOWLING J COUNTENANeE SAD AND SULLEN. The term hypochondrias is taken from the anatomical compound ^Ec.Yr hypochondria, to which region the disease was formerly supposed to Expiana- be altogether confined. Hypochondrias is here used instead of hy- g£5ktba eochondriasis, the common name, because, as already observed en terns tut) u,. iv.] NEUROTICA. [ORD. I. Spec.1//' various occasions, iasis as a termination is limited, nearly with this Alusia Hy- single exception, to denote in the medical vocabulary a peculiar pochondh- family of cutaneous diseases, as pityriasis, psoriasis, ichthyiasis, and Hypochon- many others. The author has felt the less difficulty in proposing spirits. L°w tms change, as hypochondriasis is of comparatively modern inven- tion, and is not to be met with in the Greek or Latin writers ; by whom the complaint is usually alluded to or described as a species of melancholy, or rather as a disease of the melancholic temperament. H°Y. It constitutes the third sort or species of this malady described by by Gaien in Galen, and which he regards as connected with a peculiar state of veSrsy0wi?h tne stomach; though, from its mental symptoms, he does not in- piocies. cline to contemplate it as Diocles, a contemporary physician of repu- tation, had done in his Book on Gastric Affections, as a simple dis- comrove ease °^tms organ> ^ne controversy has been in different times con- not yet tinued to our own day ; and it does not seem to be even yet univer- 11 ca* sally settled whether hypochondrias should be regarded as a mental or a dyspeptic malady. M. Esquirol, and M. de Villermay,* con- template it in the.latter light, M. Georgetf and M. Falret, though a pupil of M. Esquirol, refer it in every instance to the brain as itspri- a*?aVngedhy *"ary seat4 in Pinel the disease seems to be included under alie- Pinei. nation mentale, and its different varieties to be distributed, though without particular remark, amidst the five species into which he has divided that genus. close re- The present species bears so near resemblance to several of the to^ome10" varieties of genuine melancholy as to be often distinguishable from gemunf °f th?m with Sf eat difficulty ; and the more so as it is no uncommon meiancho- thing for hypochondrias to terminate in melancholy, or for melan- pyri:gainateay chQty to be combined with hypochondrias.§ Both may be the re- from like suit of a predisposing constitution, or may be primarily induced by accidental causes where no such constitution exists : and the pre- disposition and the accidental causes of the one may become those of the other: fqr the temperament known by the common name of melancholic, and characterized by a lean and dry corporeal texture small and rigid muscles, a sallow skin, brownish-yellow complexion' little relieved by redness of any kind, deep-black and coarse hair' eyes sunk in hollow sockets, large prominent veins, especially in tho hands and arms, with a tendency to solitude and private musing, is a common precursor of both. And in like manner a sedentary life of any kind, and especially severe study protracted to a late hour in the night, and rarely relieved by social intercourse, exercise, or nuga- tory amusements ; a debauched and dissolute habit, or excesses in eating and drinking, may become causes of either of these maladies from accessory circumstances that cannot be traced out even where Descriptive the predisponent temperament does not seem to exist. But it is character. very jUstly observed by Sir A. Crichton that even in those, " whose health is much deranged, true melancholy seldom arises, except mental causes of grief and distress join themselves to the corporeal * Traite des Maladies, Nerreuses, &c. iSur la Folie— Physiologie du Cerveau. De-THypochondne et du Suicide, &c. 8vo. Paris 1622. § Falret, de l'Hypochondrie, &c. ut supra passim. ' ml. iv.] NERVOUS FUNCTION. [ord.i. iOl ones : and this constitutes one of the characters which distinguishes Gen. hi, melancholia vera from hypochondriasis. The former may be said ^f^'1L to be always excited by mental causes, and consists in various phae- Hypochon- nomena of grief, despondency, and despair; whereas the latter most iiypochon- commonly arises from corporeal causes, and its mental phenomena £^}.. consist of erroneous ideas entertained about the patient's own make or body."* The corporeal causes are usually a diseased condition of one or Ordinary more of the digestive organs, and especially, as we shall presently cauPse»?a have to observe, a displacement of some part of the colon. It is also not unfrequently a result of the sudden cessation of some pe- riodical or other habitual discharge, as that of an issue, or o* a hemor- rhoidal flux, a chronic ulcer, or some external eruption. The melancholy man seldom lives long, and his disorder often commences in the meridian of life. He frequently terminates his days by violence, or at tlio utmost never attains old age. The hypo- chondriac seldom becomes affected till after the meridian of life, and very generally continues to the stage of longevity. The common corporeal symptoms are a troublesome flatulency in Diagnostics, the stomach or bowels, acrid eructations, costiveness, a copious dis- charge of pale urine, spasmodic pains in the head and other parts of the body, giddiness, dimness of sight, palpitations, general sleepless- ness, and an utter inability of fixing the attention upon any subject of importance, or engaging in any thing that demands vigour or cou- rage. The mental feelings, and peculiar trains of ideas that haunt the imagination and overwhelm the judgment, exhibit an infinite diversity, and lay a foundation for the three following varieties : et Autalgica. Vapours. /3 Pertsesa. Weariness of life. y Misanthropica. Misanthropy. Spleen. In the first variety, which is commonly distinguished by the a A- Hypo- name of vapours, or low spirits, the patient is tormented with a ai'itTigica". visionary or exaggerated sense of pains or some concealed disease ; DTaspc"™rt; n a whimsical dislike of particular persons, places, or things ; or groundless apprehensions of personal danger or poverty. Greding gives an account of a medical practitioner who applied Exemplified. to him for assistance, under an impression that his stomach was fill- ed with frogs, which had been successively spawning ever since he had bathed, when a boy, in a pool in which he had perceived a few tadpoles. He had spent his life in trying to expel this imaginary evil, and had travelled to numerous places to consult the first physi- cians of the day upon his obstinate malady. It was in vain to at- tempt convincing him that the gurglings or borborygmi he heard were from extricated and erratic wind. He argued himself, says M. Gre- ding, into a great passion in my presence, and asked me if I did not hear the frogs croak. I have at this moment under my care, a hypochondriac of about Additional J Jr illustration. * Of Mental Derangement. Vol. in. p. 235. 102 ci. iv.] NEUROTICA. fonD.1. oew. in. Spec. II. a A. Hypo. chrondriai. nuialgica. Vaponr«. An injudi- cious perusal of medical books a frequent cause. Exemplified from Villermay, J. J. Roua- 95SU. fifty years of age, who affords a sufficienfproof that Moliere drew his Malade Imaginare from nature, and hardly added an exaggerating touch. His profession is that of the law ; his life has been uniformly regular, but far too sedentary and studious. Without having any one clearly marked corporeal affection, he is constantly dreading every disease in the bills of mortality, and complaining one after another of every organ in his body ; to each of which he points in succession as its seat; especially the head, the heart, and the testes. He now suspects he is going to have a cataract, and now frightens himself with an apprehension of an involuntary seminal emission. It is rarely that I have left him half an hour, but I have a note to inform me of some symptom he had forgotten to mention, and I have often five or six of these in the course of the day. The last was to state that shortly after my visit he had had a discharge of three drops of blood from the nose—a change which he thought of great importance and requiring immediate attention. His imaginary symptoms, how- ever, soon disappear, provided they are listened to with gravity and pretended to be prescribed for ; but not otherwise. Yet in disap- £ earing they merely yield to others that can only be surmounted in ke manner. His head is too much confused to allow him to en- gage in any serious study, even if it were prudent to recommend it to him: but on all common subjects he is perfectly clear, and will converse with shrewdness and a considerable extent of knowledge. His bowels are sluggish : his appetite not good though he eats suffi- ciently ; his sleep is unquiet, but he has enough of it without opiates; his pulse is variable, sometimes hurrying on abruptly, and without any obvious cause to a hundred strokes in a minute, but often very little quicker than in a state of health. His tongue varies equally, and is irregularly clean, milky, and brownish, and then sud- denly clean again. He is irritable in his temper, though he labours to be calm ; and is so rooted to his chamber that it is difficult to drag him from it. He has now been ill about ten weeks, but it is during the winter, and the season is too severe and inclement for him to ven- ture abroad. I look forward to his restoration in the spring from exercise, change of air, and a course of tonic medicines. I have not found him complain of dysphagia globosa, or that sense of suffoca- tion from the feeling of a constringing ball in the throat which is so common to hysteric patients, and which, from its being often also traced in the present disease, has been called by Pechlin suffocatio hypochondriaca ;* but his spirits are in a state of almost perpetual de- pression. A superficial and injudicious perusal of medical books, addressed to those who are not of the profession, has been a frequent source of this affection. M. Villermay distinctly states as one of its causes among his own countrymen a "lecture habituelle de Buchan." Rousseau admitted that this was a powerful cause of hypochondrias in respect to himself. " Having read,'* says he, " a little on physi- ology I set about studying anatomy ; and passing in review the num- ber and varied actions of the parts which compose my frame. I * lib. x. Obs. 31 ci. iv.] NERVOUS FUNCTION. [ord.j. 103 expected twenty times a day to feel them going wrong. Far from Gen. hi. being astonished at finding myself dying, my astonishment was that aSAf h'"". I could live at all. I did not read the description of any disease chondrias which I did not imagine myself to be affected with : and I am sure vapourf." that if I had not been ill I must have become so from this fatal study. Finding in every complaint the symptoms of my own, 1 believed I had got them all, and thereby added another still more intolerable— the fantasy of curing myself." The whims that are sometimes seriously entertained under this Fancies variety of the disease, are so truly ludicrous that " to be grave ex- Dythe™ ceeds all power of face." One thinks himself a giant, another a ^nelx_ dwarf; one is as heavy as lead, another as light as a feather. Mar- travagantiy cellus Donatus makes mention of a baker of Ferrara who thought Marcellus himself a lump of butter, and durst not sit in the sun nor come near Donatu* the fire for fear of being melted. They are all extremely timid, and their fears are exercised upon trifles, or are altogether groundless. Some suspect their nearest and dearest friends of designing to poison them : others dare not be alone in the dark lest they should be at- tacked with ghosts or hobgoblins. They dare not go over a bridge or near a pool, rock or steep hill, lest they should be tempted to hang, drown, or precipitate themselves : and if they come to a place where a robbery or murder has been committed, they instantly fear they are suspected. Trincavelfius had a patient that for three years Trincavel* together could not be persuaded but that he had killed a man, and at length sunk into a confirmed melancholy, and made away with himself for fear of the gallows.* It is a melancholy reflection that the wisest and best of mankind are as open to this affliction as the weakest, and perhaps more so. Pascal himself was at one time so hallucinated with hypochondrism, as to believe that he was always on the verge of an abyss into which he was in danger of falling. And under the influence of this terror, he would never sit down till a chair was placed on that side of him on which he thought he saw it, and thus proved the floor to be sub- stantial. It is frequently induced by too free a use of spirituous liquors, the Pj^°ed b_ stomach and other digestive organs being hereby debilitated and an excessJ almost paralysed ; and where this is the case the disease is apt to ^uquois. terminate in that exhausted state of the nervous system generally, and delirious condition of the brain, which by some writers has been Delirium called delirium tremens; in which the mind and body exhibit equal what6."6' feebleness, combined with a high degree of irritability, and the patient often falls a sacrifice in a few days: previous to which, he is worn out with convulsive struggles, succeeded by a cold and general perspiration ; the pulse increases in rapidity and becomes thready, and the twitching of the tendons subsides into a tremor that spreads over the whole body ; the countenance is pale and anxious, the patient mutters with incessant rapidity, and the delirium is constant, though easily interrupted by questions addressed to him. In one case, says Mr. Blake, who has given a good description of the complaint. * Consil. xin. Lib. 5. 104 CL. IV.J NEUROTIC-A. [oBD. I. Ge.v. in die mind was so diseased that the patient after being desired a A.EHypo- to Put out his tongue, continued.for nearly half an hour to push it out chondrias and draw it in alternately in quick succession whenever I looked Vapours!" towards him.* If before this extremity takes place a sound and re- freshing sleep creep gradually over the frame, the irritability subsides, a healthful quiescence succeeds to general commotion, and the mind and the body become by degrees re-invigorated. 0 a. Hypo- Under the second variety we meet with a totally distinct set of perts/a." morbid feelings and ideas : for the patient is here oppressed with a Weariness general listlessness and disgust; an irksomeness and weariness of Ascribed by life, often without any specific reason whatever. This is the melan- toaiEngi. x. 1.^5 now be gone ; now in bed they will rise, now up, then go to bed ; Gen. III. now pleased, and then again displeased ; now they like, by and by ?** % ll' dislike all, weary of all: sequitur nunc vivendi nunc moriendi cupido, chondri^" saith Aurelianus :* discontented, disquieted ; upon every light occa- piCsaa.nthro" sion or no occasion object; often tempted to make away with them- S.Plee°; 1 xi i- i -n " i- i i • Misanthro- seives ; they cannot die, they will not live : they complain, weep, py lament, and think they lead a most miserable life : never was any ^"'Pf"101'' man so bad. Every poor man they see is most fortunate in respect of them : every beggar that comes to the door is happier than they are : jealousy and suspicion are common symptoms in the misan- thropic variety. They are testy, pettish, peevish, distrustful, apt to mistake, and ready to snarl upon every occasion, and without any cause, with their dearest friends. If they speak in jest the hypo- chondriac takes it in good earnest; if the smallest ceremony be ac- cidentally omitted he is wounded to the quick. Every tale, dis- course, whisper, or gesture he applies to himself. Or if the conver- sation be openly addressed to him, he is ready to misconstrue every word ; and cannot endure that any man should look steadfastly at him, laugh, point the finger, cough, or sneeze^ Every question or movement works upon him, and is misinterpreted, and makes him alternately turn pale and red, and even sweat with distrust, fear, or anger." As in this species the body is more affected than in any other Remedial division of mental alienation, more may often be accomplished by pr° eB medicine ; though we must by no means be inattentive to moral dis- cipline. The skin is very frequently cold and without a free secre- Warm dm- tion, and hence, general friction with rubefacients and the warmer phoreli<;s diaphoretics have often been found serviceable. The digestive organs are almost always torpid, and several of them, especially the stomach and liver, secrete their respective fluids not only in too small a quantity, but of an unhealthy quality, so as to be too viscid, too dilute, or morbidly stimulant. Some kind of acrimony, indeed, is almost always found in the stomach, and particularly that of acidity. And Jience aperients, carminatives, and particularly the tonic plan Warm which has already been recommended under limosis Dyspepsia, are InTcarml manifestly called for, and will often be found serviceable. natives. Post-obit examinations have also frequently pointed out another singular local cause which otherwise we should little expect; and that is a ment on'he displacement of the transverse colon. M. Pinel, as we have already colon often observed, regards this as a very common cause of insanity in all its dissection. forms: but there can be no question that it is a powerful and ready cause of the present species of mental alienation. M. Esquirol, who has found it as frequently as M. Pinel, tells us that this displace- ment sometimes consists in an oblique, and sometimes in a perpen- dicular direction of the intestine, so that its sinister extremity lies behind the pubes ; whilst it has sometimes descended into the form of an inverted aorta even below the pubes and into1 the pelvis* No General^ disease of the organization has been found in any instance, and debility,0' hence the change of place must proceed from relaxation and debility 1"?^^* cBccV. * Lib, I. Cap. vi Vol. IV,—H 10b* cl. iv.) NECROTIC A. [oKH. i Gen. III. Spec. II. Alusia Hypochon- drias. , Hypochtin-j drisni. Low spirits. Modical treatment. Tight pain in the epigastrium from this cause. How to ho nalliatcd. Disease oflon re- lieved hy marisca) he morrhage, or leeches applied to the anus. Chronic discharges to he re- newed whenever suddenly obstructed. Opium doubtful. Exercise, especially on horse- back. Moral ma- nagement. alone, where the misposition is not connate ; on which account it may, in some instances, be an effect, as it is certainly a cause m others. It is under these circumstances that we chiefly meet with that pain in the epigastrium to which we have already adverted, and winch gives the feeling of a tight cord surrounding the body in the line of distress ; and when such a symptom, therefore, occurs, we have reason to suspect the cause of the disease to be produced by some derangement of the colon in respect to position. Under the operation of such a cause the art of medicine can do but little : tem- porary ease, however, may be obtained by the pressure of a belt broad enough to support the whole of the lower belly ; and it is pos- sible that the intestine may gradually right itself under a course of the warmer tonics, as columbo, canella alba, and cassummuniar, or lose its morbid irritability by habit. But these are rare terminations ; for more generally the displacement increases, and the disease itselt gains ground and becomes more incurable. Congestions from weakness of vascular action in one or more of the abdominal viscera, are a frequent result of Hie present com- plaint, and not unfrequently a primary cause : und hence we may see why the bleeding piles should be serviceable in so many in- stances as to obtain from Alberti the name of medicina hypochon- driacorum,* and why leeches repeatedly applied to the anus, as re- commended by Schoenheyder, should often have a like beneficial effect.t This is of the greatest importance where the disease has been preceded by a periodical flow of blood from the hemorrhoidal veins : and should point out to us the necessity of renewing any other discharge or external irritation to which the system may have been accustomed. Opium is a very doubtful medicine, though strongly recommended by Deidier and other respectable writers ; and readily had recourse to by hypochondriacs themselves to relieve their distressful sensa- tions. Dr. Cullen asserts peremptorily that he has always found a frequent use of opiates pernicious in hypochondriacs : J and in many instances in which I have myself been tempted to employ it, I have been compelled to withhold its further use from its doing more mis- chief than good. It has often, in such cases, been exchanged for other sedatives, but rarely with any decided advantage. Exercise of all kinds should be eneouraged in every modification of the disease, but especially exercise on horseback, though it is sel- dom in the first and third variety we can succeed in getting a patient to try it. The diet should be governed by the principles already laid down for treating indigestion. In the moral management, assiduous kindness and consoling conversation produce a deeper effect than they seem to do. Lo° quacity is always hurtful, but a talent for cheerful discourse, inter- mixed with interesting and amusing anecdotes, frequently draws away the patient's attention from himself, and becomes a most useful pal- liative. In the autalgic variety, in which he is perpetually haunted -vith a feeling of some dreadful disease which exists no where but ir. * Dissert, de HaeinoiThoidibus. Halle. 1716.- I Act. Soc. Med. Hafh. «. p. SIS. : Mat. Med. Vol. it. p. 245, Edit. 4trv , l. iv.] NERVOUS 1'UNCTION. Lord. i. 1U7 his own fancy, the hallucination, when we possess his confidence, Gen. III. should be removed by a candid statement of the fact, and, if neces- Aiumaiiy.' sary, friendly expostulation : but the moment we find the preposses- P^fJ^-. sion is too strong to be removed by argument, it is better to humour chondrism. the conceit and to pretend to prescribe for it. It is sometimes ne- Mo'rVaipuito'- cessary, indeed—for the hypochondriac is often possessed of great »rne«£ent- cunning—to drop all pretensions whatever, and to put him in good autaigic earnest upon a course of medicines for a disease we know he is as ^ftfme9 free from as ourselves. Thus a firm belief that he has an inveterate "«^sa,^° itch is a common delusion with a patient of this kind, and it will be prevailing1 often found impossible to persuade him that he is cured till his whole fancy. body has been repeatedly rubbed over with sulphur or hellebore oint- ment. I had lately under my care a special pleader of considerable Exemplified. eminence, who in the course of this affection would have it that he had the pox. I at first argued the point with him day after day, but to no purpose ; he felt certain that he should never be well till he was not only salivated, but had used tonic injections for a gleet which lie said accompanied it, though he had no discharge whatever. It was in vain to deceive him by supposititious medicines, for he was a man of considerable learning, and well acquainted with medical preparations, and I hence allowed him his heart's desire ; he rubbed in mercurial ointment every night, and for an injection used a solu- tion of zinc. In a week he persuaded himself he was well, and begged permission to desist from a farther use of the remedies ; a permission which was readily granted him. In the second variety, or tasdium vita:, where the time seems to Treatment hang intolerably heavy on the patient's hands, from his having, in second a mistaken search after happiness, relinquished a life of constant ex- JJ^JJ. ™ citement and activity for the fancied delights of rural retirement and vitas. quiet, the best and most radical cure would be a return to the situa- ^Jf^™ t0 tion that has been so unfortunately abandoned : but if this cannot be suits; accomplished the patient must be put into a train of pursuits of some ^ ™iu other kind. If he be fond of the sports of the country, he should 3^ i» ■ 11 • 1 i* Willi great weary himself in the day time with hunting or shooting, or even vigour. horse-racing rather than be hypochondriacal from idleness ; and spend JJ^1!* his evenings in the bustle of dinner-parties or cards. And if he be w»«»£ilM capacified for higher and more useful occupations, let him plunge J}utPeus,l0 headlong into the public concerns of the parish and its neighbour- hood, become a member of its select vestries, a trustee of the high- ways, or a magistrate of the district. The habit of excitement must for some time be maintained, though it be afterwards let down by degrees : and the intermediate steps are of no great importance so far°as they answer their purpose. We are not at present arguing the case upon a principle of ethics or of religion ; but merely upon a prin- ciple of moral medicine. Yet I have often known persons of the Happy above description broken in by degrees to a love of domestic quiet, abOTeV e for which they were by no means fitted when they first entered upon «»»«« it: and who, with a love of domestic quiet, have settled also, as a soberer stage of life has advanced, and reflection has gained ground upon them, into a love of strict moral order, and the higher duties of a conscientious Christian, to which at one time they seemed tfs little disposed. Kfci CL; IV.} NEUROTICA. [oRP. I- GENUS IV, APHELXIA. REVERY. GEK. IV. Origin of the generic form. » Subject almost new <-? medicine. Means of our becoming acquainted with an external world; external senses: due secre- tion of nervous fluid: exercise of the faculty of atten- tion. Power of the will in summoning ihe atten- tion : Kevery de- pends upon this power ia tensely exerted, et wanted. Distinctive characters. INACTIVITY/ OF THE ATTENTION TO THE IMPRESSIONS OF SUR- ROUNDING OBJECTS DURING WAKEFULNESS. Abheexia is derived from aQetea, " abstraho, retraho, avoco, ab- duco ;" and is in use among the Greek writers. The subject is almost if not altogether new to nosology, and has seldom been dipped into by physiologists. Dr. Darwin occasionally touches upon it in various parts of his " Zoonomia," and Dr. Crich- ton in his " Inquiry into the Nature of Mental Derangement," and it is well described and illustrated by La Bruycre in his " Charac- ters ;" but it yet remains to be analyzed and reduced to a nosolo- gical method, and examined in a pathological view. A few leading ideas upon this subject have already been thrown out by the author in his comment upon the present definition in the volume of noso- logy ; and of these he will avail himself in treating of it more at large. In order to our becoming acquainted with the exist enceof sur- rounding objects, or of an external world, as it is called by psycho- logists, three things are necessary : sound external senses ; a secre- tion of the nervous fluid, apparently under different modifications, whereby they are made capable of being roused or excited by the different objects addressed to them ; and an exercise of the faculty of attention to the impressions which are thus produced. The will has, or ought to have, a power of calling this, as well as every other faculty of the mind, into a state of exertion or of allowing it to be indolent; q.nd it is chiefly upon this want of power, or the same power intensely exerted, that the phenomenon of revery depends ; thus giving rise to the three following species of mental aberration : 3. APHELXIA SQCORS. 2. --------- INTENTA. 3. --------- OTIOSA. ABSENCE OF MIND. ABSTRACTION OF MIND. BROWN-STUDY. In the first of these the attention is truant and does not yield readily to the dictates of the will: in the second it is rivetted at the instigation of the will itself to some particular theme unconnected with surrounding objects ; and in the third it has the consent of the will to relax itself, and give play to whatever trains of ideas are up, nerrnost or most vivacious in the sensory. ol. iv.] NERVOUS FUNCTION. [ord. i. 109 SPECIES I. APHELXIA SOCORS. ABSENCE OF MIND. X RTJANT ATTENTION ; WANDERING FANCY ; VACANT OR VACILLA- TING COUNTENANCE. This is an absence or vacuity of mind too common at schools Gen. IV* and at church; over tasks and sermons; and there are few read- ^mma. ers who have not frequently been sensible of it in some degree or other. In reading books in which we are totally uninterested, composed in a tedious and repulsive style, we are almost continually immersed in this species of revery. The will does not exert its power ; the attention is suffered to wander to something of stronger attraction; or the imagination is left to the play of its own nugatory ideas ; and, though we continue to read, we have not the smallest knowledge of the argument before us ; and if the subject to which the train of our thoughts is really directed be of a strikingly ludicrous character, we may possibly burst into a laugh in the middle of a discourse of great gravity and seriousness, to the astonishment of those around us. This is a common case, and may lead to great embarrassment. Sometimes We have nevertheless thus far supposed that the will does not exert }0te7lts its power, and sufficiently rein in the attention to the subject ad- P^wei £°r dressed to it. It not unfrequently happens, however, that the will, habit. for want of a proper habit, has lost its power either wholly or in a very great degree, and cannot, with its utmost energy, exercise a due control over the attention ; and it also happens in other cases, Sometimes from a peculiarity of temperament, or morbid state of body, that the 0hfeatten-y faculty of the attention itself is so feeble, that it is incapable of being tfio" t0° steadily directed for more than a few minutes to any object of im- long exei- portance whatever, with all the effort of the will to give it such di-tIon' rection. The mind, under either of these conditions, is in a deplorable state Either case for all the higher purposes of reflection and knowledge, for which by injurious to its nature it is intended ; since it is upon the faculty of attention mRnuii i /» 1 • i !/•••• i • expansion that every other faculty is dependent for its vigour and expansion ; and invi- without it the perception exercises itself in vain ; the memory can f^ o'th"/1 lay up no store of ideas ; the judgment draw forth no comparisons ; faculties. the imagination must become blighted and barren ; and, where there is no attention whatever, the case must necessarily verge upon fatuity. In early life, the attention, like every other faculty of the mind, is Attention weak and wandering, is often caught with difficulty, and rarely fixed infancy; upon any thing. Like every other faculty, however, it is capable of other*8 ">( Mental Derangement, Vol, i. p. as*. 112 CL. XV.] NEUROTICA [ORD. I. Sp^c* lu Abstraction of mmd may be produced by various causes, but the Apheixia ' following are the chief, and form two distinct varieties: intcnta. Abstraction « 1 i of mind, a Apheixia a pathemate. I rom some overwhelming passion. (8 Apheixia a studio. Trom intense study. a a. intenta Of the first variety we have already offered abundant exam- m:'1te!he pies in the two preceding genera: and especially in the cases of un- livery governable joy or rapture, grief and despondency ; under the influ- wheiming ence of which the affected person is often as much lost to the world Thc'imii- around him, as if he were in a profound sleep and dreaming ; and viduai oniy hears, sees, and feels the vivid train of ideas that possess them- aS much selves of his mind, and rule it as a captured citadel. To these alone world0win the attention is directed ; here it exhausts all its power, and the will a profound concurs in the exhaustion ; insomuch that the patient is said in some cases to have stared at the meridian sun without pain :* and in others to have been undisturbed by the discharge of a cannon.| (i a. intenta We meet with like proofs of this variety of revery in many cases Revery0 of intense study, and especially upon abstract subjects, as those of from intense pUre mathematics, in which all the reasoning and more serious facul- ties of the mind, as the perception, the memory, and the judgment, as well as the attention, are jointly called into action, and kept equally upon the stretch. Of the power of this variety of revery in rendering an individual torpid and almost dead to all around him, we have a decided instance in Archimedes at the time of his arrest. instanced in When the Roman army had at length taken Syracuse by stratagem, Arc une es. ^j^ ^e tactics of this consummate engineer prevented them from taking by force, he was shut up in his closet, and so intent on a geo- metrical demonstration, that he was equally insensible to the shouts of the victors, and the outcries of the vanquished. He was calmly drawing the lines of a diagram when a soldier abruptly entered his room, and clapt a sword to his throat. " Hold friend," said Archi- medes, " one moment, and my demonstration will be finished." The soldier, surprised at his unconcern at a time of such extreme peril, resolved to carry him before Marcellus; but as the philosopher put under his arm a small box full of spheres, dials, and other instru- ments, the soldier, conceiving the box to be filled with gold, could not resist the temptation, and killed him on the spot. * Blumenb. Bibl. i. p. 736. f Darwin, Zoonom. m. i. ii. 2. cl. iv.f NERVOUS FUNCTION Tord. i. 113 SPECIES III. APHELXIA OTIOSA, BROWN-STUDY. LEISURELY LISTLESSNESS ; VOLUNTARY SUHRENURR OF THE AT" TENTION AND THE JUDGMENT TO THE SPORTIVE VAGARIES OF THE IMAGINATION : QUIESCENT MUSCLES ; IDLE GRAVITY OF COUNTENANCE. The attention is equally summoned into action, and dismissed at Gex. iv. the command of the will. It is summoned in the last species ; it is ?j?RCm ni- dismissed when a man voluntarily surrenders himself to ease and list- tion here lessness of mind : during which period, moreover, in consequence of {'"""jjf jjf this indulgence in general indolence, the external senses themselves bequies- unite in the mental quiescence, and a smaller portion of nervous fluid other rea- is probably secreted for the very reason that a smaller portion is de- ^g^^oi manded; and hence the active senses without are as vacant and un- senses are strung as the active senses within, and as blunted to their respective 'huVpociep stimuli. The first playful ideas that float over the fancy in this case take the lead, and the mind relaxes itself with their easy and spor- tive flow, (t is the studium inane of Darwin,* who seems, however, Studium to have in some degree misapplied the name, or to have confounded Darwin: the aberration with that of ecphronia or alusia^ Cowper has admi- admirably ,11 -. i • • i i. 11 • described by rably described it in the following verses : cowper. Laugh ye who boast your more mercurial powers, That never feel a stupor, know no pause, Nor need one ; I am conscious, and confess, Fearless a soul that does not always think. Me, oft, has fancy ludicrous and wild, Sooih'd with a waking dream of houses, towers j Trees, churches, and strange visages, express'd In the red cinders, while with poring eye I gazed, myself creating what I saw. Nor less amused hare I quiescent watch'd The sooty films that play upon the bars Pendulous, and foreboding in the view Of superstition, prophesying still, Though still deceived, some stranger's near approach-. 'Tis thus the understanding takes repose In indolent vacuity of thought, And sleeps, and is refresh'd. Meanwhile the face. Conceals the mood lethargic with a mask Of deep deliberation, as the man Were task'd to his full strengh, absorb'd, and lost. In the indolent mind such indulgence is a disease, and, if not stu- With the diously watched and opposed, will easily become a habit. In the s"chent studious and active mind it is a wholsesome relaxation ; the sensory, j^f^f with the stwlrons a * Zoohom. in. i. ii. 2. and again iv. u. iv. 2. Vol. IV.—15 1U cl.iv.] NEUROTICA. |uiu>. i. Gen. IV. Spec. III. Apheixia otiosa 15rown- study. '.vliolcsome relrtxaiion : Especially whore the attention is spurred on by a spirit uf rivalry ns well as by the will. Illustrated. Even simplo attention long directed to mental pursuits oc- casionally produces confusion. Exempli- fierL' in the correct language of the poetlk sleeps and is refreshed,' grows fertile beneath the salutary fallow and prepares itself for new harvests. This is more particularly the case where, in conjunction with an attention " screwed up to the sticking place," and long continued there, a spirit of ardent emulation is at the same time stirring, and distracted between the hope and fear of gaining or losing a distin- guished honour or reward. I have seen this repeatedly in young men who have been striving night and day, and week after week, for the first prizes of our English universities; some of whom have indeed succeeded, but with a hectic exhaustion that has been reco- vered from with great difficulty; while others, in the full prospect of success, have been compelled to relinquish the pursuit, and to de- grade. ' Yet even vyithout this conflict of feeling, where the attention alone has been too long directed to one or to a variety of recondite subjects without relaxation, the mind suffers considerably, and its powers become shaken and confused ; of which we have an interest- ing example in the case of Mr. Spalding, a scholar of considerable eminence in Germany, as drawn by himself and communicated to the editors of the Psycological Magazine.* His attention, he tells us, had been long kept upon the stretch, and had been still more dis- tracted by being continually shifted from one subject to another, when being called upon to write a receipt for money paid him on account of the poor, as soon as he had written the two first words, he found himself incapable of proceeding farther. He strove all he could, and strained his attention to the utmost, but to no purpose: he knew the characters he continued to make were not those he wished to write, but could not discover where the fault lay. He then desisted, and pflrtly by broken words and syllables, and partly by gestures, made the person who waited for the receipt, understand tfyat he should leave him. For about half an hour, a tumultuary dis- order reigned in his senses, so that he was incapable of remarking any thing very particular, except that one series of ideas of a trifling nature, and confusedly intermixed, forced themselves involuntarily on his mind. At the same time his external senses continued perfect, and he saw and knew every thing around him. His speech, how- ever, failed in the same manner as his power of writing, and he per- ceived that he spoke other words than those he intended. In less than an hour he recovered himself from this confusion, and felt no- thing but a slight head-ache. On examining the receipt on which the aberration first betrayed itself, be found that, instead of the words " fifty dollars, being one half year's rate," he had written " fifty dol- lars, through the. salvation of Bra—" the last word being left unfi- nished, and without his having the least recollection of what it wa; intended to be. * CJrichton's Inquiry into Mental DeraDgem«nt, I. 237. CL. IV.] NERVOUS FUNCTION [ord. r. 115 GENUS V. t>ARONIRIA. SLEEP-DISTURBANCE* J. HE VOLUNTARY ORGANS CONNECTED WITH THE PASSING XRAIN OF IDEAS, OVERPOWERED BY THE FORCE OF THE IMAGINATION DURING DREAMING, AND INVOLUNTARILY EXCITED TO THEIR NATURAL OR ACCUSTOMED ACTIONS ; WHILE THE OTHER ORGANS REMAIN ASLEEP. Paroniria, from vupa. and ev£/£«v, signifies, " depraved, disturbed^ ^»en. T. or morbid, dreaming." So in Dioscorides,* JW»v«£«s, signifies, the^eneric" u tumultuosis et malis somniis molestans." !orm- In treating of the genus ephialtes, or night-mare,t I endeavour- Essential ed to explain its course and nature ; and hereby pointed out the es- between™ sential distinction which exists between that disease and the present,.^jj?1^ and the impropriety of uniting the species which belong to both of maro> and them under one head, as Dr. Cullen has done in his genus oneirody- sp"^8?11 nia, since, with the exception of their occurring in the night and hence erro- during sleep, and therefore involuntarily, they have little or no con- unitedly nexion or resemblance in cause, symptoms, or even mode of cure. 0ullen- The three following species are so clearly and decidedly of one- and the same family, as to prevent all dispute in their present po- sition. They are here, however, associated for the first time in a £enus distinct from ephialtes. 1. PARONIRIA AMBULANS. SLEEP-WALKING. 2.---------■ LOQ.UENS. SLEEP-TALKING, 3.---------SALAX. NIGHT-POLLUTION. The nature of these singular affections, and the means by which ^fioni they are produced, have never yet been explained, and rarely, so far only to he as I know, has any explanation been attempted. To understand deretoodby them fully, it would be necessary for us to enter into a minute de- fjf™^",,^ vclopement of the physiology of sleep and dreaming, which the physiology limits of the present work will not allow. On some future occasion °'dsl^am. the author may, perhaps, follow it up into siicb a detail: but a few me- general remarks must suffice for the occasion before us. . j*m"gr In sleep, accompanied with dreaming, the faculties of the mind ^J™?* bear a pretty close parallel with those of the body as to the effect lopemen? produced upon them. Some of them, as the will, the perception, °tfatesSof the judgment, are in a state of general torpitude, like the voluntary the body J ° „ ' . , .. , ° , , , ...• r. • and mind.. Organs of the body ; while the ni6mory and the imagination, like Manyoftht faculties o. _ ■ „ . w the mind e: * Vol. ii. p. 127. t Vol. r. Ord. n. Gen. v, 116 CL. IV.] NEUROTICA [ORP. I- Gen. V. Paroniria. Sleep-dis- turbance. well as of the body at this time torpid : others in a slate of activity. Hence the aensory erowded with ideas wanting the control of the will. Whence the ideas preserve some Bort of catena- tion in dreaming : and are sometimes more and .sometimes less regular. Dreaming ideas sometimes so vivid and wild us to stimulate the senses and rouse them abruptly from sleep. Sometimes only a single sense thus roused, and why. Hence Bleep- talking, sleep- walking, o: somnam- bulism, and night pollution. the vital or involuntary organs of the body, arc in as high activity as ever. The sensory is hence as much crowded with ideas as at any time ; but, destitute of a controlling power, they rush forward with a very considerable degree of irregularity, and would do so with the most unshapeablc confusion, but that the habit of association still retains some degree of influence, and produces some degree of con- sonance and proportion in the midst of the wildest and most extra- vagant vagaries. And hence that infinite variety that takes place in the character of our dreams ; and the greater regularity of some. and the greater irregularity of others. Hence a combination of thoughts or ideas sometimes only in a small degree incongruous, and at other times most frantic and heterogeneous ; occasionally, indeed, so fearful and extravagant as to stimulate the external senses them- selves into a sudden renewal of their functions, and consequently to break off abruptly the sleep into which they were thrown. Now as the stimulant force of our ideas in dreaming, is often sufficient to rouse the external senses generally, and to awake us all of a sudden ; it may be of such a kind, and just of such a strength, as to excite into their accustomed action the muscles of those organs or members only which are more immediately connected with the train of our dreams or incoherent thoughts ; while every other organ may still remain torpid. And hence the muscles chiefly excited being those of speech, some persons talk, or the muscles chiefly excited being those of loco-motion, other persons walk in their sleep, without being conscious, on their waking, of any such occurrence.* And by the same means we may easily account for the third species of the genus, or that which consists in dormant and involuntary salacity. SPECIES I. PARONIRIA AMBULANS. SOMNAMBULISM. SLEEP-WALKING. THE MUsSCLES OF LOCO-MOTION EXCITED INTO THEIR ACCUSTOMED ACTION BY THE FORCE OF THE IMAGINATION DURING DREAMING. Gen. V. Spec. I. In profound sleep all the powers of the mind and body, except the involuntary organs, in a state of torpitude. In dreaming some of the mental i*culties- ouly slee>i. is the wi!i, -;'" pe:?rr^* In profound sleep all the faculties of the mind, as well as all the voluntary organs of the body, are in a state of inactivity or torpitude, and the only organs that preserve their active tenor are the involun- tary ones : so that in this state there is neither thought nor idea of any kind. In dreaming some of the mental faculties only sleep or are torpid, while the others, like the involuntary organs of the body, continue wakeful or active: the somnolent faculties, we have already observed, are the will, the perception, and the judgment : the wakeful are the memory and the imagination. * Hennings, Von den Traumera uml Nachtwandlern. Weimar 1784 L^0S'3D8-NatUra' Differentiis' et Cattsh er,ram 9ui donnientes ambulant, ft- CL. iv.] NERVOUS FUNCTION. [ord. i. 11? It would not be difficult, if we had time, to show why the invo- Gfn- v> luntary organs do not require rest, or, in other words, become torpid paroniria like the voluntary ; nor why the will and the judgment sooner asso- amouiaus. 1 11 ;. i i i "• • ■ Somnam- ciate in the general sleep of the external senses than the imagination, buiism. but this would carry us too far into the subject of animal physiology, talking. There are two physiological remarks, however, which it is necessary lj>'n> and to make in explanation of the morbid affection immediately before mem" while us. The first is, that sleep is a natural torpitude or inertness in- I^'^s1- duced upon the organs of the body (with the exception of the in- continues voluntary) and the faculties of the mind by fatigue and exhaustion. Not difficult And the next is that, in the production of sleep, it is not. necessary t".knt°hw that all these powers of body and mind should have been equally ex- invoiumary posed to exhaustion : for, such is the effect of association and habit, °^ar" qU°re that as soon as one faculty or organ feels fatigue, or becomes ex- rest, nor hausted, the rest participate in the same condition, and the sleep or wiifand torpitude becomes common to the whole. It is hence the body is Jjjg^l^, made drowsy by mental study, and the mind by corporeal labour ; i.ecome that muscular exercise wearies all the senses, and the exertion of the ^"the senses wearies the muscles : though there can be no doubt that the imagina- general tendency to sleep is also partly superinduced by the indirect sleep is a exhaustion sustained by the organs or faculties that have been less "^'"^g employed, in consequence of the share of sensorial energy which, induced by as from a common stock, they have themselves contributed towards exhlustioo. the support of the more active and hence more debilitated powers. The Now it sometimes happens, either from disease or peculiarity of 0f some of constitution, that all the external organs of sense do not associate ^["^y in the general action that has taken place, or yield alike to the ge- and mind neral torpor to which it gives rise ; and that the auditory, the optical, secondary, or some other sense, continues awake or in vigour, while all the rest or the result , .■'•.. . i-i vi of associa- are become inert; as it does also, that such particular sense, like tion with the muscles of particular members, as observed a page or two above, g^of lue is awoke or restimulated into action in the midst of the soundest external sleep by the peculiar force and bent of the dream, while the rest still sense3 ° sleep on and are unaffected. every1'" If the external organ of sense thus stimulated be that of sight, instance the dreamer may perceive objects around him, and be able to dis- ^l^llr" tinguish them : and if the tenor of the dreaming ideas should as or sleep of powerfully operate upon the muscles of loco-motion, these also may and some- be thrown into their accustomed state of action, and he may rise jjjf1^^"115 from his bed and make his way to whatever place the drift of his awake sud- dream may direct him, with perfect ease, and free from danger. He ^%^ " ° will see more or less distinctly in proportion as the organ of sight is continue to more or less awake: yet from the increased exhaustion, and of if the course, increased torpor of the other organs, in consequence of an "J^f^l increased demand of sensorial power from the common stock, to sight, the supply the action of the sense and muscles immediately engaged, mray™cr- every other sense will probably be thrown into a deeper sleep or tor- ff^^g por than if the whole had been quiescent Hence the ears may not asleep: be roused even by a sound that might otherwise awake the sleeper, j^a/of He may be insensible, not only to a slight touch, but a severe shaking the dream of the limbs : and mav even cough violently without being recalled fuiijVw^ 15b cl. iv.] NEUROTICA. [ord. 1. Gen. V. Spec. 1. I'arnniria nmbulans. Somnam- bulism. Sleep- walking. the loco- motive muscles, ho may waik, while the rest of the mind and body aro dormant. The dor- mancy of the sleeping organs hereby increased, and why Irritability of habit often a pre- disponcnt cause. Morbid state of the stomach often an exciting cause. Exempli- fied. This case produced by nervous irritability, and hence the hurry of the sleep walk: vchcte no such irrita- bility the dreamer often proceeds coolly and collectedly. The ryes are more or less open: but from their winking, have some- times been described bs closed. llemdieal - atmei t. from his dream. Having accomplished the object of his visionary pursuit, he may safely return, even over the most dangerous preci- pices, for he sees them distinctly, to his bed ; and the organ of sight being now quite exhausted, or there being no longer any occasion for its use, it may once more associate in the general inactivity, and the dream take a new turn, and consist of a new combination ol images. Somnambulism occurs in many persons without any manifest pre disponent cause, though it is generally connected with a considerable irritability of habit. A morbid state of the stomach, where this habit exists, has very frequently proved an exciting cause : of which Dr. Yeates has given us an example in the case of a young gentle- man of ten years of age related in the Medical Transactions.* lie was of a delicate frame, often troubled with sickness"; sometimes rejected his food undigested, after havinglain two days in his stomach ; his bowels were costive, and the stools were dark, offensive, and ill- formed. The sympathetic symptoms were frequent head-aches with occasional stupor, general coldness of the skin, and limpid urine. After being in bed for about two hours he was wont to start up sud- denly as in a fright, dart rapidly into the middle of the chamber, or of the room adjoining, and walk about with much agitation. Jn this state he would run over quickly, but incorrectly, the transactions of the day ; and he once attempted to spell a word which in the day time he had spelt wrong, in doing which he jumbled a number of letters together. When spoken to he would make a rational reply ; and in one of his sleeping perambulations he called for an epitome of the history of England which he was in the habit of reading : the nurse brought him a book, but not the one he called for ; on perceiving the difference, he immediately threw it froim him with great violence, and with expressions of anger and disappointment. On these occasions his eyes were wide open, though he did not seem conscious of seeing, nor of his situation at the time. It was, says Dr. Yeates, a perfect state of dream throughout, though partaking of the acts of the waking state, for he would avoid objects walking about the room. His face was quite pallid at the time. In this case much of the nervous hurry and agitation seems to have depended upon the debilitated and irritable state of the patient's frame. But where the affection proceeds from idiosyncrasy, or where there is no disturbance of the general health, the dreamer often proceeds far more coolly and collectedly ; and the eye-lids, in- stead of being wide open as though staring, arc often not more than half-unclosed, in some cases even less than this; which has given occasion to marvellous stories of somnambulists walking over dan- gerous places, or avoiding dangerous objects with their eyes Com- pletely shut all the time. The remedial treatment it may be necessary io pursue we shall defer till we have briefly noticed the succeeding species, as the same treatment will apply to the whole. * Vol. v. Art. XXvMl. p. 4i4. ^l. iv.j NERVOUS FUNCTION. [ord. i. 119 SPECIES II. PARONIRIA LOQUENS. SLEEP-TALKING. THE MUSCLES OF SPEECH F.XCITED INTO THEIR ACCUSTOMED ACTION BY THE FORCE OF THE IMAGINATION DURING DREAMING. It is not necessary to dwell upon this species, as we have already Gen. V, explained the general principles of the inordinate action in the pre- uenerai ceding pages. As the train of ideas which form the dream, when p™'^1^ pecuiiarly lively and immediately connected with the organs of loco- under the motion, may stimulate those organs into their accustomed activity, £pericds'.ns and thus give the dreamer a power of walking without conscious- ness ; in like manner if a similar train of dreaming ideas be immedi- Organs of ately connected with the organs of speech, these may also be equally muiaied by influenced, and the dreamer be able to talk without being conscious j£|!i,™i1nn,Tot of it, or having any recollection of such exertion when he awakes, ideas. And as, for reasons already specified, the organ of sight is some- times, in the same way, roused from a state of sleep or torpitude to a state of wakefulness, while all the other external senses continue somnolent, or, from idiosyncrasy or some local or accidental cause, do not join in the general repose, but continue vigilant during its dominion—the organ of hearing may be roused in the same manner P'gan of or exhibit the same anomaly ; and, in this case, the dreamer, who, someUmes under the influence of the last species of affection,is able to see as fnsst°,gate9 well as to walk, is able, under the present, to hear as well as to wakefui- speak. Examples, indeed, are given in which a by-stander obtaining whence the some clue into the train of thoughts of which the dream is composed, dreamer 11 11 -i • , ab!e t0 has been able, not only to keep up an irregular conversation, but, hear as by dexterous management and the artful assumption of a character ™e'aka310 which he finds introduced into the dream, to draw from the dreamer Possible the profoundest secrets of his bosom, the dreaming ideas generally quence of consisting of those on which the dreamer is most employed when ,hls" awake, or which lie nearest his heart. I have never met with a case of this kind in my own practice, but it is given as a fact by various physiologists from the time of the Greeks and Romans to ..)ur own day. 120 n.. iy.] MK UOTK'.A. [osn. T. SPECIES III. PARONIRIA SALAX. NIGHT-POLLUTION. THE SEXUAL ORGANS EXCITED INTO VENEREAL ACTION BY THE FORCI OF THE IMAGINATION DURING DREAMINO. Bv Sauvages this affection is absurdly placed among the species of Gen. v. gonorrhoea, which, with great looseness of generic character is dc- Spec. III. fined " passio cujus praocipuum symptoma est fluidi puriformis vel piacederro- seminiformis effluxus stillatitius ex urethra." This definition is, neousiy by intieej wide enough to embrace the affection before us ; but the ab- bauvages: . " . . ° . ' surdity consists in intermixing a natural discharge produced by the ordinary orgasm with morbid discharges, in which, in most cases, there is no orgasm whatever. Dr. Cullen, however, has continued -and by to assign the same place and the same name to the present species, c"'len' and this with still greater inconsistency ; since he has struck out of his definition of gonorrhoea the epithet seminiformis, and confined it to a u fluxus humoris ex urethra, nncter naturam.'''' r'o that he has been obliged to break his own bounds to introduce this natural flux into the place he has allotted it. And hence in his laying down the treatment of gonorrhoea in his Practice of Physic, he takes no notice of his gonorrhoea dormientium, as though feeling that it was altc- gether a different subject. Physiology. We have already observed that whatever part of the animal frame is immediately connected with the tenour of the somnolent vision. it is often roused, under particular circumstances, from the general sleep or torpitude in which it had participated, and becomes wakeful while every other part perseveres in the common repose. During ideas of sleep, moreover, our ideas are often more lively and operative than m'orTiiveiy during wakefulness, and this on two accounts ; first, because from lnan«r\ the uninterrupted activity of the involuntary organs there is a more ness, and ready secretion of sensorial, as well as of most other fluids, in a state why' of perfect tranquillity ; and next, because the ideas that predominate at the time are not broken in upon or weakened by exterior impres- sions and disturbances. It is, on this account, when the faculty of the judgment is stimulated into activity, instead of the car or eye or the motory powers, a man has sometimes been able to solve diffi- culties in dreaming which proved too hard for him when vigilant. And to this effect Dr. Spurzheim : " somnambulists," says he, " even do things of which they are not capable in a state of watching ; and some dreaming persons reason sometimes better than they do interesting when awake.* A singular and amusing instance of this occurred nation.1'8" not many years ago to a very excellent and justly celebrated friend of the author's, the Reverend William Jones of Nayland, Suffolk, * Pbysioenomical System, p. 1.75. 8vo. Lond. 1815. cl.iv.J NERVOUS FUNCTION. [ord.i. 121 who, among other branches of science, had deeply cultivated that of Gen. V. music, to which indeed he was passionately attached. He was a l^onSr"1' man of an irritable temperament, ardent mind, and most active and ^^- brilliant imagination : and was hence prepared by nature for ener- po'ilution. getic and vivid ideas in his dreams. On one occasion during his sleep, he composed a very beautiful little ode of about six stanzas, and set the same to very agreeable music : the impression of which was so firmly fixed in his memory, that on rising in the morning he set down and copied from his recollection, both the music and the poetry. It is hence not difficult to conceive that members so irritable as Hence the sexual organs, when once the imagination leads energetically to gasm from the subject of concupiscence, should occasionally participate in the &!„""* vision, and prove their sympathy by the result. In some morbid states of the body, and especially when accom- Seminal panied with local irritation, produced by inflammation, fibrous timesS°me entony, the debility of old age, or a habit of vicious indulgence, a gieeinfrom seminal flux has sometimes taken place without any connexion with various the dream, and sometimes without either erection or turgescence; thisBdoesbut but this does not constitute the affection immediately before us ; in not belong which the stimulant power lies in the sensory and is propagated from sent species. that organ to those of generation. The Roman poet who so admirably unlocked the nature of The fact things to his contemporaries, by following the footsteps of nature th^Greeks herself, into most of her deepest recesses, directed his attention to and Ro_ , 1 • • i • i • i /> ii mans, and this subject, among other physiological facts, and has elegantly ex- elegantly plained it in the above manner ; adducing, at the same time, another byPLucrc"- instance of the influence which the ideas of dreaming sometimes ex- ti,ls> ercise over the organs connected with them, derived from the evacu- ther effect ation of the bladder which frequently takes place in children whose "t[nj,simiJaT dream is directed to this natural want, and who image to themselves the ordinary vessel employed for such purpose, as at hand for their use r Purei ssepe, lacuna propter seu dolia curta, Somno devinctei, credunt se extollere vestem ; Totius humorem saccatum corporis fundunt; Quom Babylonica, magnifico splendore, rigantus. Turn, quibus astatis freta primitus insinuantur, Semen ubi ipsa dies membris matura creavit, Conveniunt simulacra foris e corpore quoque, Nuntire praclari voltus, pulchrique coloris, Qui ciet inritans loca turgida semine multo, Ut, quasi transactis srepe omnibus rebus, profundant, Fiuminis ingeiiteis fluctus, vestemque cruentent.* In the medical treatment of all these species of paroniria we must Medicai never lose sight of this principle that, although in many instances General3' their predisponent cause is a peculiar idiosyncrasy or habit, their ^'jjjfjjj?9 exciting cause, in all cases, general or local irritation ; and that this tended to, irritation is of two very opposite kinds, which it also becomes us very th" "Sg particularly to attend to, namely, that of entony or excess of power, ^a^may and that of atony or deficiency. be entomc J J or atoms. Vol. IV.—16 * De Rer. Nat. iv. 1020. (I/. IV.] NEEROTii. .a. [ord. Gen. V. Spec. III. Paroniria salax. Night- pollution. Treatment. Remedial process when from entonic irritation. \Vhen from atonic irritation. Undue ac- cumulation of power to be pre- vented. Heiice hard mattrass: and nar- cotics- Illustration. It is to the former that Lucretius alludes, and which is by far the most common exciting cause : and where this exists, our first indi- cation is to reduce the superabundant vigour by venesection, purga- tives, laborious exercise, and a limitation to a plain and spare diet. While, on the contrary, where the exciting cause is debility, our attention should be directed to a tonic course of medicines, and particularly to those tonics which prove sedative at the same time that they strengthen the system. Several of the mineral acids are entitled to this character, and especially the sulphuric : and a still greater number of the vegetable bitters, and particularly the extracts Qf hop and lettuce. Dr. Cullen, indeed, as we have already observed, supposed a sedative power to exist in all the bitters, though not equally in all. How far the Prussie acid might be employed for this purpose I cannot say from personal practice : but if it really consist, as. it is supposed to do, of the sedative principle of the laurocerasus or bitter almonds, it may possibly prove a very serviceable remedy. Our next object of attention should be to prevent all undue accu- mulation of the sensorial principle during sleep, and this may be accomplished iu two very distinct and opposite ways. The first is the use of a hard mattrass, with so small a covering of clothing that, the sleep may be somewhat less sound than ordinary, and conse- quently more easily broken off. For the force of our dreaming ideas will always be in proportion to, a certain degree of soundness in our sjeep ; I say a certain degree, because if the fatigue or exhaustion, or torpitude, be extreme, the sleep will become profound or lethar- gic, all the faculties of the mind will participate in it, and, as already observed, there will be no ideas or dreaming whatever. And hence the second mode of preventing an accumulation of sensorial, and especially of irritable power, will be the employment of narcotics till the morbid habit is destroyed ; for these, when carried to a sufficient extent, diminish vascular action, and consequently take off sense and motion so completely as to extinguish the vital principle altogether, and hence not only to suppress all power of dreaming, but even life itself. I had lately under my care for the last species, a very modest and regular young man, who was a student of Christ's College, Cam- bridge, and was alarmed at the idea of having his constitution under- mined by its continuance. He was rapidly growing of slender make, and of a relaxed habit. Nitre, which has been so often recommended as a sedative, in this case did no service: but under the use of q,pill composed of one grain of opium and five of camphor taken nightly, and draughts of myrrh, and infusion of columbo acidu- lated with sulphuric acid, he lost the tendency in a fortnight, after having been subject to the discharge for many weeks. His bowels were kept at the same time constantly stimulated by the pill of aloes and myrrh: and the cold-bath formed a part of his regimen. Pagania and De Cazelles* have recommended electricity ; but the author has never tried its effects, having uniformly succeeded without it. * Town, de Medicine. Tom. ixxiv ce.iv.} NERVOUS FUNCTION. [ord.i. 128 Where cither of these species, but particularly the two former, are Gen. V. connected with a morbid state of the stomach, the disease must be f"^,"1, attacked in this quarter, as it was with great judgment and a favour- salax- able issue in the case quoted from Dr. Yeates. Stion. Treatment. Where a secondary affection, j the primary disease must he principally GENUS VI, 8ttcmlod" MORIA. FATUITY. DEIEcT OR HEBETUDE OF THE UNDERSTANDS G. AloEiA is a Greek term from pu^oc,, " stultus, fatuus." It is here Gen. VI. limited to its proper signification. Vogel employs it, thoup-h with a 0risin. I™1 j-rr ■ . P . . , °_ , .r. • . ° use of the oinerent termination (morosis instead of moria) in the same or very generic nearly the same sense ; but he is almost the only medical writer that Employed does so. By Nenter and Sauvages moria is used to denote melan- hitherto in Cholia complacens (self-complacent melancholy), while by others it significa- is employed synonymously with ancea or idiotism. To complete the Jj.°,1f much confusion, morosis (amentia Morosis) is the name given by Sauvages confusion to mental imbecility (moria imbecillis), though, as already observed, nomencia- he had just before used moria in the sense of melancholy. It is pre-tUxe* cisely in the signification now offered that the term is employed by Erasmus, in his celebrated treatise entitled " Moria Encomium,'* or ■' The Praise of Folly," which he dedicated to Sir Thomas More. Mora, rhoror, morosus, morositas, are derived from this common Derivatives source; and uniformly import" waywardness, tardiness, dulness, im- common pediment;" though the lexicographers, not having hit upon the rightro0t- path, have wandered in different directions without being able to satisfy themselves. In Sauvages and Sagar, morositates are in fact u corporea: morid" defects or hebetudes of the bodily faculties. The preceding genera are founded upon a morbid perversion or How dis- misrule, a diminished or excessive excitement of one or more of the f[^u',sh\cd powers of the mind operating upon trie mind itself or upon the body, preceding The present is founded upon a natural or permanent dulness, or hebe- seiu tude of one or more of the same powers, producing a deficiency^ in the understanding, which, however, may be regarded as the general flame or constitution of the mind, in the same manner as the body is the general frame or constitution of the organs which form its sepa- rate parts. Moria thus explained, will be found, as a genus, to em- brace the two following species ;— 1. MORIA 1MBECILLIS. IJIBECIEITV. ?. ----> DEJIENS IRRATIONALITY- 124 CL. IV. NEUROTICA |0R1>. SPECIES I. MORIA IMBECILLIS. MENTAL IMBECILITY. Gen. VI. Spec. I. General remarks. THE DEFECT OR HEBETUDE PARTIAL, OR CONFINED TO PARTiCULAS FACULTIES OF THE UNDERSTANDING. We have already observed that all the faculties of the mind are as subject to a diseased disturbance as the organs of the body : and hence all of them are liable to be affected by the present species. The whole of the varieties, therefore, under which mental imbecility is capable of being contemplated might form an extensive list: but it will be sufficient to confine ourselves to the four following : x Stupiditas. Stupidity. $ Amnesia. Forgetfulness. 7 Credulitas. Credulity. £ Inconstantia, Fickleness. Dulness and indocility of the apprehen- sion ; torpitude and poverty of the imagination. Feebleness or failure of the memory. Weakness and undue pliancy of the judgment, with a facility of being duped. Instability and irresolution of the will. a M. iinhe- cillis Stu- piditas. Stupidity. Generally other faculties besides the imagination and appre- hension obtuse in this variety. Yet the judgment often sound though slow ; and even sounder than in facetious quickness. Explained. Apprehen- sion, its relation to the perception. Difference between stupidity and ;jnoia"o», In stupidity there is generally a dulness in several of the faculties besides the apprehension and the imagination ; and sometimes, per- haps, in all of them : but then it originates in these, and the rest are for the most part only secondarily dull, as not being furnished with a sufficient number of ideas or in sufficient rapidity for their use. Thus the judgment of a heavy or stupid man is often as sound in itself as that of a man of capacious comprehension ; and more so, perhaps, for a reason we have already observed under alusia facetosa, or crack-brained wit, than that of a man of facetious quickness of parts: but the heavy man requires time and patience to collect his ideas, and eompare them with each other ; for they are neither furnished to him in a free current from his memory or his imagination, nor does he readily apprehend or lay hold of them as they are offered from external objects to his perception, which, in effect, is little more than a synonym for the apprehension—the apprehension being the per- ception in a state of exercise, or exertion. There is hence a mate- rial difference in physiology, though, perhaps little in practice, between ignorance and stupidity. The former is want of knowledge from want of its ordinary means; and by the use of such mean* may, perhaps, soon be gotten the better of: the latter is dulness in the use of such knowledge as by ordinary means has been acquired cl.iv.J NERVOUS FUNCTION. [ord.i. 125 and exists in the sensory, though in a state of stagnation or dor- Gen- vi, mancy. Mr. Locke has made the same distinction, though he has a M^i"„be- justly enough observed that, for all practical purposes the man of "'j!8 St"- stupidity had almost as well be without his knowledge as with it. stupidity. " He," says this admirable writer, u who, through this default in his ^n\mpllfied memory, has not the ideas that are really preserved there, ready at Locke. hand when need and occasion call for them, were almost as good be without them quite, since they serve him to little purpose. The dull man, who loses the opportunity whilst he is seeking in his mind for those ideas that should serve his turn, is not much more happy in his knowledge than one that is perfectly ignorant. It is the business of the memory to furnish those ideas which it has present occasion for, and in the having them ready at hand on all occasions., consists that which we call invention, fancy, and quickness of parts.'"* Stupidity or dulness of apprehension may be idiopathic ; but it °tau???tdf may also proceed from want of education, or education irregularly soX ' conducted ; for all the faculties of the mind, like the muscles of the affection.0 body, become invigorated and are rendered more alert by a well Want of disciplined exercise. And hence stupidity is a natural result of idle- cation.6 l ness ; as it is more particularly of idleness in conjunction with an undue use of wine and fermented liquors, which have a proverbial power of besotting the understanding. It is also produced tempora- Local or rily or habitually by various corporeal diseases ; as hemicrania, disease. chronic inflammation or dropsy of the^head, gout in the head, and sometimes repelled cutaneous eruptions or habitual discharges. Stupidity, like wit, is propagable ; and hence we frequently see it is propaga* run from one generation to another ; and not unfrequently it forms ble' a distinctive mark in the mental character of districts or nations : in many cases, indeed, where they border closely on each other. The inustraterL Dutch have at least as much solid sense as their neighbours the French ; but they are certainly less quick ; or, in other words, they have a duller fancy and apprehension! Bceotia in respect to choro- graphy was merely separated from Attica by Mount Cithaeron ; but in respect to genius the two countries were as far apart as the poles. So in the Pacific Ocean, the natives of Otaheite learn every thing with facility ; the natives of New South Wales have no aptitude, and learn nothing. The residence of a few missionaries among them for a short term of years, has nearly civilized the former ; the actual possession of the country for a far longer period, by a British public and a British government, -with a perpetual intercourse, and the kindest encouragement, has made little or no impression upon the latter. A failure of memory, however, which forms the second species 0 m. imbe- of mental imbecility before us, is a far severer evil than dulness of n'es'a. m perception with poverty of imagination : for as all the sources of Foreetful- information to which we have been privy cannot be always imme- oblivion. ' diately before us to excite the perception, we must necessarily draw eviTthan upon our recollection for those which are not so, and whose ideas stupidity. or impressions we stand in need of. And hence the memory is the The me- mory in some * Essay concerninc; Ham. Underst. B. n. Ch, x. Sect. 8. strongly lib CL. 1V.J NEUROTICA. [ORD. I. cillis Am- nesia. Forgetful- 710SS. Oblivion. Newton. Pascal. Retention Examples. ^p*!' \1' great storehouse of intelligence ; and in one sense at least the Pla- ii u. imbe- tonic doctrine is universally true that " all knowledge is reminis- cence." There are some minds in whom this faculty has been peculiarly retentive, as that of Newton, who made it answer the pur- pose of intuition; and of Pascal, who is said never to have forgotten, till his health failed him, any thing he had ever done, read, of thought of. Retention of memory, however, is a different property from that howdiffers' of quickness. They may and often do co-exist; but they are also nes?.qmck f°und separate : for there are many persons who can well catch hold of an entire song, an entire sermon, or a series of speeches in parlia- ment, and can recite them almost, if not altogether, verbatim imme- diately afterwards, but who lose all recollection of them in a day or two : while there are others who are obliged to pause over the sub- ject submitted to them, or to have it repeated for several times before they can get it by heart, yet who, when they have once fixed it in the memory, retain it as long as they live. Mr. W. Woodfall, the celebrated reporter of the parliamentary debates, was an instance of the former of these talents, in regard to his powers of apprehension; the well-known Jedediah Buxton of the latter : though it should be remarked that Mr. Woodfall retained with as much ease as he first fixed speeches in his memory. Failure of Failure of memory takes place in a variety of ways. It is some- Miowsritseif times general, and extends to every subject; but it is frequently far more manifest on some subjects, than on others. Salmuth mentions a case in which the affected person had forgotten to pronounce words, but could nevertheless write them.* Mr. j. Hunter was suddenly attacked with a singular affection of this kind in December 1789, when on a visit at the house of a friend in town. " He did not know in what part of the house he was, nOr even the name of the street when told it, nor where his own house was : he had not a con- ception Of any thing existing beyond the room he was in, and yet was perfectly conscious of the loss of memory. He was sensible of impressions of all kinds from the senses, and therefore looked out of the window, although rather dark, to see if he could be made sensible of the situation of the house. The loss of memory gradually went off, and in less than half an hour his mcknory was perfectly reco- vered."! This might possibly be connected with a gouty habit to which Mr. Hunter was subject, though not at this time labouring under a paroxysm. The late Bishop of Landaff, Dr. Watson, gives a singular case df partial amnesia in his father, the result of an apo- plectic attack. " I have heard him ask twenty times a-day," says Dr. Watson, " ' what is the name of the lad that is at college V (my elder brother) ; and yet he was able to repeat, without a blun- der, hundreds of lines out of classic authors."! And hence, there is no reason for discrediting the sfory of a German statesman, a Mr. Von B. related in the seventh volume of the Psychological Maga* in various ways. In forget- fulnesss of words. Forgetful" ness of family iiames. * Cent. 11. Obs. 4l. t Sir Everard Hon c. 4to. 1794. T. Anecdotes of the Life of KicLa:*.! Watson, D.D., Bishop of Landaff t Sir Everard Home's Life prefixed to his Treatise on the Blood, Inflammation &c. 4to. 1794. I . l. iv.] NERVOUS FUNCTION. [ord.i. 12*/ zinc, who having called at a gentleman's house, the servants of Gen. VI. which did not know him, was under the necessity of giving in his ^ l*c„t,l\„ name ; but unfortunately at that moment he had forgotten it, and cii>s Am- excited no small degree of laughter by turning round to a friend who getfuiness.r accompanied him, and saying, with great earnestness, " pray tell me °jf'v,;°f"'u who I am, for I cannot recollect." nessofa From severe suffering of the head in many fevers a great inroad "^me. °" is frequently made upon the memory, and it is long before the con- j.iene™1 valescent can rightly put together all the ideas of his past life. Such nesfoften was one of the effects of the plague at Athens, as we learn from Ey'?euvcee4 Thucydides, rove, $t x«< toOy tXctufcxve ttxpuvtikx xvxftxvtxs t«v w«vt»v Example , . ^ 1 l'r>:Io Thu- afMiW nxi yyvoyrxv v(pctc, ts uvtovs, xxt tovs enriTi)6stov<; : " and many, Oil cydides. recovery, still experienced such an extraordinary oblivion of all things that they knew neither themselves nor their friends." A few Angular years ago a man with a brain-fever was taken. into St. Thomas's getfuiness" Hospital, who as he grew better spoke to his attendants, but in a 1°afn*usa,°e'cn language they did not understand. A Welsh milk-woman, going ancTreco- by accident into the ward, heard him, answered him and conversed disused?"6 with him. It was then found that the patient was by birth a Welsh- man, but had left his native land in his youth, forgotten his native dialect, and used English for the last thirty years. Yet in conse- quence of this fever he had now forgotten the English tongue, and suddenly recovered the Welsh. Boerhaave, however, gives a still more extraordinary instance of F,urtJier. iv- i r CT • . • . iit i illustration; oblivion in the case of a Spanish tragic author who had composed many excellent pieces, but so completely lost his memory in conse- quence of an acute fever, that he forgot not only the languages he had formerly learnt, but even the alphabet: and was hence under the necessity of beginning to read again. His own poems and compositions were shown to him, but he could not be persuaded that they were his productions. Afterwards, however, he began once more to compose verses ; which had so striking a resemblance to his former writings that he at length became convinced of bis being the author of them.* The memory may also be prematurely impaired (for in age it is a impaired by- natural defect) by various other causes. Idleness or inattention will do it, as in the case of stupidity, as will also an over-exertion of the faculty, injuries of the head, rheumatic, or gouty pains in it, dyspep- tic maladies, various narcotic poisons, prostrating haemorrhages, or want of food, and libidinous indulgence.! Dependent upon this last cause Sir Alexander Crichton has given singular a single example of what may be called perverse oblivion in an old from"" attorney, nearly seventy years of age, who, though married to a lady 1'b'dinous much younger than himself, kept a mistress whom he visited every night He was suddenly seized with great prostration of strength, giddiness, and forgetfulness ; but the last was of a peculiar kind and consisted in the mistaking the name of one thing for that of another ; -..o that if he wanted bread he would ask for his boots, and though * Pf;eloct. Acad, in Justit. Med. ex Edit. H alien. Tom. \v. p. 463. See also ''richt. Of Ment. Derangement, i. 370. + pi^ert. de Memorirn Lwsionp ex nimis Verier. TT«n. AH. 1695, numerous causes 125 cl. iv.J -NEUROTICA. [ord. (i M. imbe- cillis Am- nesia. For- getfulness. Oblivion. y M imhe- cillis Cre- dulitas. Credulity Found volantary evil. Gen. VI. enraged at the latter being brought to him, he would still call out for his boots or shoes. In like manner if he wanted a tumbler to drink out of, it was a thousand to one but he would call for the ordi- nary chamber utensd, or, if this were wanted, he would call for a tumbler or a dish. This gentleman, however, was cured of the complaint by large doses of valerian and other cardiacs. In credulity, constituting the third variety of the imbecility before us, the faculty of the judgment is the chief seat of disorder. It is unquestionably more generally to be found among ignorant both among people than those whose minds are well stored with the elements of and well ' knowledge ; but as we also frequently perceive among the former a Du^chiefly most obstinate and wilful incredulity, and among the latter extraor- among the dinary proofs of the present failing, it cannot be regarded as alto- Among the gether an effect of a general want of ideas : it is in reality a hebe- tude or indolence of the judgment or power of ratiocination, which induces a man to take things upon trust and allows others to think for him, not for want of ideas, but for want of comparing one idea with another, those of probability with those of improbability, and fairly striking the balance ; in consequence of which, under the in- fluence of this mental oscitancy, he readily yields himself, body and soul, to the opinions of others, and follows such opinions blindfold; as those who shut their eyes must be led by those that see, or else fall into the ditch. This is voluntary credulity ; yet many have been so long accus- tomed to it, that it has all the effect of a chronic disease, and is as difficult of cure as the most obstinate. There are some men, how- ever, whose judgment is more morbidly dull by nature, than from in- activity or a neglected education ; or may possibly have been ren- idiopathic dered so by intemperance ; who are deficient in natural skill to use the evidence they possess of probabilities ; and being incapable of carrying on a train of consequences in their heads, and of weighing exactly the preponderance of contrary proofs and testimonies, are easily misled, and rendered the dupes of every plausible sophist, and the playthings of every impostor. " There are some men," says Mr. Locke, " of one, some but of two syllogisms, and no more ; and others that can but advance one step further. These cannot always discern that side on which the strongest proofs lie ; cannot constantly follow that which in itself is the more probable opinion."* There is another imbecility we have noticed, as strangely inter- fering with the integrity of the understanding ; and that is fickle- ness, or an instability and irresolution of the will. The faculty of the will requires not only to be directed aright in infant life, but to be fortified and strengthened by a course of exercise and discipline Elucidation. as much as any faculty whatever. This we may say as physiolo- gists ; but as moralists we may speak a bolder language, and main- tain that it demands the spur and trammels of education even more than all the other faculties put together, since it is designed by nature to be the governing power and to exercise an absolute sway over the rest, even over the desire itself, by which, however, it is moved in all ordinary cases. * Human Understand. Book iv. Ch. xix. $ 5. From bein voluntary may be- come a chronic diseise. More generally tj M. imbe cillis In- constantia Inconstan- t- Ordinary cause. cl. iv.j NERVOUS FUNCTION. [ord. i. 129 A child whose inclinations have never been reined in, is perpe- Gen- VI. tually letting the will and the desire run together, and changing both o^.mbJ- every moment; and if this disposition be suffered to grow into a cilliB In*. habit, it will produce the fickleness of which we are now speaking, Licon"-" 'a and form a character on which there can be no reliance ; whose de- alancy- termination of to-morrow cannot be known from that of to-day: because the will itself, void of all firmness or resolution, is the sport of every transient incident, every interposing uneasiness or pleasure: and which, hence, becomes its own torment still more than the tor- ment of those around it; since being ever instigated by the feelings of the moment, and sacrificing the future to the present, it often purchases a fleeting gratification, and of subordinate value, at an ex- pense of permanent and substantial happiness. Upon the remedial process for the mental infirmities which ap- Remedial pertain to this species, little is to be said in a work of medical in- ^diseases struction. So far as they relate to corporeal causes, and we have ^^[j,^ pointed out various causes of this kind that apply to several of them, or imbe-' those causes should be minutely inquired into, and^ as far as possi- Medical. ble, removed or palliated ; and whatever will tend to invigorate the entire frame, as the metallic tonics,* regularity of diet, sleep, ex- ercise, and above all, cold bathingt must supply the rest. To the Moral. arms of mental and moral instruction, however, the sickly under- standing must be chiefly intrusted ; and; where these are properly applied, the mind may often be rendered sufficiently sound for all the ordinary purposes of life, and even for some of its elegancies ; though it may never be distinguished for terseness, brilliancy, or comprehension. The leading aim should be to lay hold of the strongest faculty, and to make the direct cultivation of this an indi- rect cultivation of the rest. SPECIES II. MORIA DEMENS. WITLESSNESS. IRRATIONALITY. ^ DEFECT OR HEBETUDE OF ALL THE FACULTIES OF THE UNDER- STANDING. Of this species we have three varieties that seem to require a dis- Gen. VI, tinct notice :— Spec" IL x Stultitia. Shallow knowledge, vacant coun- Silliness. Folly. tenance, light frivolous fancy : for the most part with good na- ture ; sometimes with obstinacy * Agricola, commut. in Poppium. Tr. de Argento, p. 136. t Dauter, Von Gebranche des Kalten Wassers. Vol. IV,—17 130 cl. iv.j NEUROTICA. [ORD. i Gen. VI. a Lerema. Spec, H. r Moria de- rnen6. Wit- lessness. Ir- rationality. Dotage. Superannuation. y Anaa. Idiotism Impotence of body as well as of mind from premature old age ; childish desires and pursuits; drawling speech or garrulous babble, composed of ideas for the most part associated by pre- vious habit. General obliteration of the mental powers and affections ; paucity or destitution of ideas ; obtuse sensibility; vacant countenance; imperfect or broken articulation; with occasionally transient and unmeaning gusts of passion. u U. de- mons Stul- titia. Silliness- Folly. Generally a natural infirmity: often capa- ble of palliation byjudicious manage- ment. 0 M. de. mens Lerema. Dotage. Superan- nuation. Causes. Description Further illustrated from Pinel. The difference between the understanding of some men and that of others is extreme ; yet it is not every minute variation from the standard of soundness that constitutes a disease whether in mind or body; but as soon as, in either case, such variation becomes a marked or serious evil it is entitled to this name ; and, in the sub- feet before us, falls within the range of the first of the preceding varieties. This, which is what we ordinarily denominate silliness is generally a natural infirmity, and in some families appears to be hereditary. A well directed education, however, may do much, as there is commonly some faculty that will bear cultivating better than the rest, and which points to the particular line to which the study of the individual should be especially addressed, and in which he may appear respecta- ble. He may have imitative powers, and make a good painter or engraver, though he may not have creative powers, and make a good orator or poet. He may be fond of arithmetic, and fitted for trade and accounts, though he may not possess a taste for scientific sub- tleties, or be well calculated for any one of the professions. Dotage, when a mere result of old age, is hardly to be regarded as a disease, and is rarely accompanied by any effervescence of the passions. But it often appears prematurely, and is especially acce- lerated by excessive indulgence m corporeal pleasures : sometimes %y violent mental emotion, as anger, or by long continued grief. Tfhder the two former of the causes, there is often combined with it an incessant garrulity, a very high degree of passionate, but unmeaning effervescence, and puerile mobility. M. Pinel gives a striking example of this in a person whom he had frequently an opportunity of seeing. "His motions," says he, "his ideas, his broken sentences, his confused and momentary glimpses of mental feeling appeared to present a perfect image of chaos. He came up to me, looked at me, and overwhelmed me with a torrent of words without order or connexion. In a moment he turned to another person, whom, in rotation, he deafened with his unmeaning babble, or threatened with an evanescent look of anger ; but as incapable of determined and continued excitement of the' feelings *s of ,a just connection of ideas, his emotions were the effort of a . L. iv.j NERVOUS FUNCTION. [ord. i. 131 momentary eftervescence, which was immediately succeeded by a Gen. vi. calm. If he went into a room, he quickly displaced or overturned pia^e-11' the furniture, without manifesting any direct intention. Scarcely ",ens could one look off before he would be at a considerable distance, Dotage. exercising his versatile fondness for bustle in some other way. He Nation" was quiet only when food was presented to him. Even at night he . rested but for a few moments." A strong desire of food, however, is by no means common under this species: it is perhaps most frequently met with in the dotage of old age; but in premature lerema we often find the appetite entirely banished, and a resistance fo food of all kind when offered. Idiotism, the third variety, is often the result, as we have > M- de_ already observed, of an original misformation of the cranium, some- Anofa. times in respect to thickness, more frequently in respect to shape ; o^Tom by both which the internal cavity, and consequently, the capacity of morbid the brain, is unduly diminished. K™ of The internal causes are habitual inebriety, excessive and ener- "ium; vating pleasures, violent agitation of the passions, whether pleasurable times from or painful, as overwhelming joy, startling terror, deep and protracted J."**™1 grief, or furious anger ; tumours within the cavity of the cranium ; injudicious management in ecphronia, and especially an excessive use of the lancet. To which some add suppressed discharges or eruptions, as blennorrhea,* and itch,t and the drinking of human blood .| Idiotism, however, is more frequently congenital, than accidental ; More fre> and it is melancholy to think that it is also sometimes hereditary, congenital. Of those who are idiots from birth, many, moreover, are sooner or °^^ wth later afflicted with palsy or epilepsy, or both ; a clear proof of the palsy or existence of some organic affection of the brain or nerves : the for- ejnlepsy' mer being sometimes partial, and confined to the face only or extend- ing down one of the sides. Idiots rarely attain old age ; they seldom exceed the term of thirty years ; and when paralysis or-epi- lepsy are concomitants, they usually die at a much earlier period. In idiotism the ideas of sensation and of reflection appear to be Description. equally inaccurate. There is a vague, unsteady, wandering eye, seldom fixed for any length of time upon any one object; a stupid expression of countenance in which no sign of intelligence is por- trayed ; a gaping mouth from which the saliva flows constantly : a perpetual rolling and tossing of the head ; no memory, no language, no reason. The idiot has all the animal instincts, and some of the passions. Of the last, joy, fear, and anger, are those with which he is most frequently affected, but these are of a very limited kind. His joy is unmeaning mirth; his fear, a transient calm ; his anger, a momentary fit of violence. The toys of children, and the gratification of hunger and thirst, are his only pleasures : bodily pain or fear of bodily pain his only distresses. It is said that idiots have sometimes shown a strong sexual appetite : but this is not common, for they rarely seem to attend to any distinction of sex.§ * Ehrmann, Beytrage zur anfklarung des Trippers. f Wantner. Journ. de Medicine, Tom. lvi. p. 115. } Sennert, lnstitut. cum Paralis. Vitel. 1667. 4to. Zacut. Lusit. Prax. Med. Adm. I. in. Obs. 79. § Crichton, Of Mental Derangement, i. p. 314. \3Z « L. IV.j NEUROTICA. [ord. i Spec II' The treatment' where medical assistance can be of any use, must y M?de- ' chiefly depend upon the nature of the cause. Blistering and internal mens stimulants to increase the action of the nervous system, and augment idiotism. the habitual torpitude of the abdominal viscera which are usually Treatment, aflfected in this malady, offer the fairest chance of advantage. Acci- dental commotion of the brain, an occasional cause, has occasionally also proved serviceable, as has likewise a fracture of the cranium. Hence too fevers have relieved the disease ; and active paroxysms of mania have proved a complete cure ; and I once knew a cure effected in a lad who fell from the first floor of a house into the street; the torpitude or obstruction, or whatever was the cause. being hereby removed CLASS IV. NEUROTICA. ORDER II. ^STHETICA. DISEASES AFFECTING THE SENSATION. DULNESS, DEPRAVATION, OR ABOLITION OP ONE OR MORE OP THE ORGANS OF CORPOREAL SENSE. .tEsTHETicA is derived from xtrtxwtixi, " sentio, et, proprie, sensu ClassIV. corporis." The term applies, however, to all the external senses, vfrfo^s H' and, in the language of Galen, peculiarly expresses » xiT6t}Tmn ^uv«/u/s, significa- " the power or faculty of sensation." It must, also, be admitted that ordinal ' " it is occasionally applied to mental sensation, as in Isocrates to torm an<1i,s ■ . i i_ "ii _*• j i. • compounds. Demonicus, euro/ tjjv cmmm yta^v xio-StjT^, " thus will you jeel their now used mind or inclination." bj[SSlon:. The term has hence been used in different significations by crates: different medical writers. It has seldom^ indeed, been applied to the mind, but has strangely varied between expressing sensation generally, and the sense of touch alone. In Dr. Young's excellent by Young. volume on Medical Literature it runs for the most part parallel with its meaning in the present work, and imports diseased action of all the corporeal senses ; but, with this appropriation of the term, there seems to be an incorrectness in applying it, as the same author does immediately afterwards, to defective memory, which he names dysaethesia interna, and ranks in the same list or genus with defect of the external senses. Sauvages, and after him Sagar and Cullen, Sauvages have applied dysesthesia? to a morbid state of the corporeal senses and !?asa> generally ; whence anaesthesias should in their hands have expressed atony or total inactivity of these senses generally. But while dyses- thesias extends to all the senses, anaesthesia is by the same writers limited to the single sense of touch ; with no small perplexity to the young student. In the Physiological Proem to the present class we have taken so full a survey of the connexion which exists between the brain and the corporeal senses by means of the nerves, that it is not necessary to say more upon the subject at present: and I shall only therefore where one further observe in these preliminary remarks that where one of the deficient, senses is deficient, ami especially where naturally deficient, the rest $1*™^. have very frequently been found in a more than ordinary degree of 134 cl. iv. j NEUROTICA. [ord. 11 Orde^Ii' viSour and acuteness ; as though the sensorial power were primarily jEsthetica.' derived from a common source, and the proportion belonging to the affeeun» organ, whose outlet is invalid, were distributed among the other thesens°a- organs.* enUariy The genera, under the order before us, are taken in a regular vigorous, series from the corporeal senses themselves in a state of morbid the ensuing action, and are in number six : of which the first five are derived genera. from the five external senses, and the last from a diseased state of particular branches of the nerves distributed over the frame generally for the common and pleasurable feeling of health in the different organs through which they are dispersed. I. PAROPSIS. MORBID SIGHT. II. PARACUSIS. ------- HEARINC HI. PAROSMIS. ------- SMELL. IV. PARAGUSIS. ------- TASTE. V. PAR APSIS. -------TOUCH. VI. NEURALGIA. NERVE-ACHE GENUS I. PAROPS IS. MORBID SIGHT. SENSE OF SIGHT VITIATED OR LOST. Gen. I. Paropsis is literally "diseased or depraved vision," from wupx, Segeneric tnale, and o-^/s, visus; as paracusis, " diseased or depraved hearing," term. from -ttxpx, and xkowi. Diseases of The ophthalmic monogr aphists, by making every variety of affection unneees- a distinct disease, have most unmercifully enlarged the list under sadly mui- this genus. | To say nothing of Campiana, Taylor has in this manner mustered them at two hundred and forty-three,:}: while Plenck has contrived to multiply them to nearly six hundred.^ Upon a comprehensive view of this subject, it will, I think, be found that this formidable number may be reduced to the twelve species following: * Trinckhusius, De Caecis sapientia ac eruditione, Claris mirisque caecorum quo- rundam actionibus. Gerse, 1762. Meckren. Observ. Med. Chir. cap. xx. t Campiani, Raggionamenti sopra tutti i Mali degli Occhi descritti, &c. Genoa, 1759. I Catalogue of two hundred and forty-three diseases of the Eyes. Edin. Vol- 1749. » § Doctrina de Morbis Oculorum. 8vo. Vienn. 2d Ed. 1783. cl. iv.j NERVOUS FUNCTION. [ord.ii. 135 1. PAROPSIS LUCIFUGA. NIGHT-SIGHT. 2. -------- NOCTIFUGA. DAY-SIGHT. 3.--------LONG1NQUA. LONG-SIGHT. 4.--------PROPINQUA. SHORT SIGHT. 5.--------LATERALIS. SKUE-SIGHT. 6.--------ILLUSORIA. FALSE-SIGHT. 7.--------CALIGO. OPAKE CORNEA. 8. -------- GLAUCOSIS. HUMORAL OPACITY. * 9.--------CATARRACTA. CATARACT. 10. -------- SYNIZESIS. CLOSED PUPIL. 11.--------AMAUROSIS. DROP SERENE. 12.--------STRABISMUS. SQUINTING. Most of these fall rather within the province of the ophthalmic nriefsurvey surgeon than of the physician ; but, as their general nature ought to general be known to every practitioner, we shall proceed to give a glance at j^pt?8 each of them in their order. The maladies of the eye dependent on from inflammation, and constituting ophthalmy, have been already treated practice. of in Class III, Order II, Haematic a, Phlogotica. SPECIES I. PAROPSIS LUCIFUGA. NIGHT-SIGHT. VISION PAINFULLY ACUTE IN A STRONG LIGHT ; BUT CLEAR AND PLEASANT IN A DEEP SHADE OR THE DUSK OF THE EVENING. The specific term lucifuga is so distinct as at once to point out the Gen. I. general nature of the affection whUe constituting a very prominent g^jnc *' symptom. The author, however, has found a necessity for intro- name ducing this new name, not more from its own clearness than from {""being a the confusion which has taken place among earlier writers in distin- "ew ter.m- guishing the disease by two directly opposite terms, nyctalopia and arising hemeralopia, according as these terms have been used in a literal or forme1,116 a technical and implied sense. The Greeks called it by the former names name, literally night-sight, in consequence of the person labouring and'heme^ under it being only able to see at night, or in a deep shade ; while r.?.lopi^ . nyctalopia has been used by most modern writers in the opposite sense of night-sight-acAe, agreeably to the technical or implied meaning of opia when employed pathologically ; in which case it always imports diseased vision, as though a contraction of the term paropia or paropsis : whence nyctalopia has necessarily been made to import day-sight, instead of night-sight, or that imperfection of vision in which the eye can only see in the day or whenever there is a strong light. And hence hemeralopia, the opposite to nyctalopia. has been used, with the same confusion and contradiction of signifi- cation : by the Greeks importing day-sight, being taken naturally or 18b" cl. iv.] .NEUROTICA. |oui>. 11. Gen. I. Spec. I. Pai ipsis lucifuga. Night- sight. Luscitas of Beer. Exposure to too strong a light a cause; and why. Perpetual nictitation. Frequent among Italian peasants. Explained. Effects. How removed. Produced by an in- tense glare. Deficiency of black pigment a cause: and why. Hence common to Albinocs. Sometimes found in #1 age. literally; by the moderns day-sight-ache, and consequently night- sight, being taken technically or by implication ; and hence Sauva- ges, " Graecis hemeralopia ; neoteiicis nyctalopia.'' It is the lus- citas of Beer.* The disease is dependent upon a peculiar irritability of the retina, produced by two very different causes : a sudden exposure to a stronger light than the eye has been wont to sustain ; and a defi- ciency ofthe black pigment which lines the choroid tunic. If the iris be weak and torpid it is enlarged ; if strong and contractile, di- minished. From the first cause this disease is common to those who live al- most constantly in dark caverns or chambers, as mines, dungeons or other prisons ; or who have recently had a cataract depressed or extracted, the growth of which has still more effectually excluded the light from falling on the retina. And in all these cases we^find it accompanied with a perpetual nictitation, from the sympathy which prevails between the retina and the orbicular muscles of the palpebral Ramazzini asserts that this complaint is common to the peasants of Italy who are employed in agriculture ; but in whom he is able to trace no other peculiarity than a considerable enlargement of the pupil.t It is not difficult perhaps to assign a reason for such an affection among these people, tMugh Ramazzini is silent upon the subject. The sky of Italy is peculiarly bright, its atmosphere pecu- liarly clear, and its temperature relaxingly warm. The peasants of Italy, therefore, are exposed to the joint operation of almost every cause that can produce habitual debility in the iris, and irritability in the retina. And we find these causes acting with renewed power at the time when the disease chiefly makes its attack, which we arc told is on the return of spring, or rather at the vernal equinox, when a double flood of day breaks on them. And such is the dimness it produces that the peasants lose their way in the fields in the glare of noon ; but on the approach of night, they are again able to see distinctly. It is hence necessary for them to keep for some weeks in the shade or in comparative darkness, till the eyes recover their proper tone : and the weakness, and consequently the disease, sub- sides. And hence Ramazzini tells us that in the course of the suc- ceeding month, or, in other words, after they have taken due care of themselves, the peasants recover their sight. The glare of the sun, in tropical regions, and especially where reflected from bright chalk- hills, has often produced the same effect. A deficiency ofthe black pigment is occasionally found in persons of a fair complexion and light hair ; and, as the retina is hereby de- prived of the natural shade that softens the light in its descent upon this very sensible membrane, its morbid irritability is not to be won- dered at. Albinoes, wdio are without the common pigment that lies between the cuticle and cutis in other persons, are always deficient in this also ; and hence are pecubarly subject to the present disease. In old persons the same deficiency is sometimes traced, but without * Lahre von tier Augenkrankheiteu, *ls Leitfaden zu seinen offeutlichen Vorles- nngen entworrfen. Qwey Bande, 8vo. Wien. 1817. t De Morbis Artificum, &c cl. iv.] NERVOUS FUNCTION. [ord. ir. 13V painful vision : for at this time of life the optic nerve is become Gen. I. more obtuse. In horses this want of pigment constitutes what is p^sis1' called a wall-eye. lucifuga. The disease is occasionally found as a symptom in ophthalmy, sight. various other irritations ofthe optic nerve, and hydrops capitis; and Se"^"!69 sometimes terminates in amaurosis.* eye in Acuteness of night-vision is natural to various animals that prowl Found os a in the dark : as cats, lynxes, lions, and perhaps, all the feline genus : ^^'^g whicli save their eyes from the pain produced by broad day-light, by diseases. a closer contraction of their irids than mankind are able to effect; ^d/upe'ds expanding them gradually as the night shuts in, till by the extent of that prowt the expansion, they are able to see much better than mankind in the a "'^ dark. Owls, bats, cockroaches, moths, sphinxes, and many other insects, have a similar power. Where the disease proceeds from an accidental irritability of the Treatment 1 • i- • i • /» i • when from retina, sedative applications, as the tincture of belladonna, and in- accidental ternal sedatives, as hyoscyamus and conium, have often proved ser- causes> viceable, and the more so when combined with the bark. In old age, when from or an early deficiency of the black pigment that covers the choroid pigment. tunic, medicine has very little chance of success, and all we can hope for is to afford occasional relief by palliatives, if the irritation br violent, or accompanied with inflammatory symptoms, SPECIES II. PAROPSIS NOCTIFUGA. DAY-SIGHT. VISION DULL AND CONFUSED IN THE DARK: BUT CLEAR AND POW* ERFUL IN BROAD DAT-LIGHT. This species, the nyctalopia of neoteric authors, is said to be en- Gen. I.. demic in Poland, the West. Indies, Brazils, and the intertropical re- Endemic in gions generally.! Its cause is precisely the reverse of that of the various preceding species; and proceeds from too great, instead of too Ordinary small, an habitual exposure to light, whence the retina becomes tor- cause' pid, and requires a strong stimulus to raise it. At noon-tide, there- fore, it is sensible to the impressions of objects; but does not clearly discern them in the shade or towards the close of day. Day-sight is also said, in a work of allowed authority,| to be en- Peculiarly demic in some parts of France ; and particularly in the neighbour- BomepartB hood of Roche Guyon on the banks of the Seine. And so ge- of France neral is its spread there, that in one village, we are told, it affects pne in twenty ofthe inhabitants, and in another, one in ten, every year. * Piso, De Med. Brasil, Lib. u. t Hantesierck, Recueil d' Observations de Medicine, i. ij. | Mem- de la Societe Roy ale de Med. 1756. VoT. IV—18 1J8 cl. iv.] NEUROTICA, [ord. a. Still more somraonly at times in Russia. At what season. Easily cured. G^n. I. jt makes its attack in the spring, and continues for three months : Paronsis ' sometimes, though in a slighter degree, returning in the autumn ; noctiiuga. an(j tnere are individuals who have had annual returns of the com- often8[o-' plaint for twenty years in succession. It passes off alter having run nodicliiy!" its course, or rather, perhaps, after having been treated with due me- Explained, dical attention, without any inconvenience, excepting a weakness in a few eyes that renders them impatient of wind and strong light. The soil is here a dazzling chalk, and the keenness ofthe first reflect- ed light, after the dreariness of the winter, is probably one cause of so general an evil. Perhaps, however, there is no part of the world in which this disease is found more commonly, or more decidedly, than in Russia : but then it is rarely found except in the Russian summer, when the eye is exposed, almost without intermission, to the constant action of light, as the sun dips but little below the ho- rizon, and there is scarcely any interval of darkness. The malady, again, mostly makes its appearance at this time among the peasants who protract their hard labour in the fields from a very early to a very late hour: and at the same time exhaust and weaken them- selves by their.daily fatigue. The sight is soon restored by rest, a proper shade, and bathing the eyes with an infusion of any bitter and instance of astringent vegetable. Dr. Guthrie, in the Memoirs ofthe Medical noariy'ied Society of London, from which this account has been taken, gives and^'ious8 a^so an examldc °f tne disease having appeared suddenly a few mischief, springs before in a detachment of Russian soldiers, who, being or- dered to attack a Swedish post, at the moment of its incursion had nearly destroyed one another by mistake. These men had been harassed by long marches, and been exposed night and day to the piercing glare of an uninterrupted scene of snowy mountains, both which causes had concurred in producing this effect. Sir Gilbert Blane has found it occasionally occur in scorbutic pa- a^anfraf"3 tier)ts 5 Dut nosucn disease appeared in the Russian soldiery. Hens are well known to labour under this defect naturally: and hence they cannot see to pick up small grains in the dusk of the evening, and so employ this time in going to roost: on which account the disease is sometimes called hen-blindness. In this species tonics and gentle stimulants offer the best means of cure. The bark may be freely employed internally, and blisters externally, with the vapour of camphor, ether, or carbonated ammo- nia ; and occasionally illining the ball of the eye with a few drops. of the tincture of opium, the citrine ointment, or a minute portion of prussiate of iron, also in the form of an ointment. In most of the endemic cases it seems to be an intermittent, as the preceding spe- cies appear to be occasionally: and in such circumstances a free use ofthe bark is the plan chiefly to be depended upon. When the sight is once stimulated by the full light of the day, it oc- casionally becomes peculiarly acute and vivid. Plenck asserts that he has known some men labouring under this disease, evince so high an excitement of vision as to be able to distinguish the stars at noon. Dr. Heberden has communicated a singular case of this species which it will be best to give in his own words * " A man, about * Medical Transactions, VoJ. t. defect ; whence called hen blindness. Curative process. When endemic mostly in- termittent. Sight some- times acute and vivid- Exempli- fied. Singular case of periodical day-sight. cl.iv. J NERVOUS FUNCTION. [ord.ii. 139 thirty years old, had in the spring a tertian fever, for which he took Gen. I. too small a quantity of bark, so that the returns of it were weakened parous without being entirely removed. He therefore went into the cold J"01^*- bath, and after bathing twice he felt no more of his fever. Three ay s's days after this last fit, being then employed on board of a ship in the river, he observed, at sun-setting, that all objects began to look blue, which blueness gradually thickened into a cloud; and not long after he became so blind as hardly to perceive the light of a candle. The next morning about sun-rising his sight was restored as perfectly as ever. When the next night came on he lost his sight again in the same manner ; and this continued for twelve days and nights. He then came ashore where the disorder of his eyes gradually abated, and in three days was entirely gone. A month after he went on board another ship, and after three days' stay in it the night blindness returned as before, and lasted all the time of his remaining in the ship, which was nine nights. He then left the ship, and his blind- ness did not return while he was upon land. Some little time after- wards he went into another ship in which he continued for ten days, during which time the blindness returned only two nights, and never afterwards.'' As this distinguished writer has not undertaken to account for c*se. this singular affection, it may seem, perhaps, presumptuous to drop esp "' a hint upon the subject. Yet it should not pass unnoticed that the man was in a state of great nervous debility, and probably irrita- bility, as its effect. He had formerly been employed, we are told, in lead-works, and had twice lost the use of his hands. And not many weeks from the time the above account closes, he complained of loss of appetite, weakness, shortness of breath, and a cough ; which, together with other complaints, gradually increased upon him, so that he died before the end of the year. I have observed that nyctalopia noctifuga is often an intermittent affection. In the present case it was distinctly of this nature, and evinced a decided quotidian type. We are not acquainted with the exciting cause of this intermittent; but we know that when once a circuit of action has been established in a weakened and irritable habit, it adheres to the system with almost invincible tenacity, and is recalled with the utmost facility upon the repetition of such a cause. And hence the uniform return of the affection on ship-board where it com- menced till a cure was obtained. 149 cl. iv.} NEUROTICA 0KU u SPECIES III PAROPSIS LONGINQUA. LONG-SIGHT. VISION ONLY ACCURATE WHEN THE OBJECT IS FAR Ol'l Gen. I. This is the dysopia p-oxmiorum of Cullen, the vue longue of th»; Spec. III. French. Seat of In both the preceding species the morbid affection seems chiefly chieflyThe to appertain to the retina ; in the present species it belongs chiefly ofthe3 that to tne *r's' w^i°h is habitually dilated, and not easily stimulated to preceding a contractile action. " For it is well known," observes Dr. Wells. retina.the " to those who are conversant with the facts relating to human vi- sion, that the eye in its relaxed state is fitted for distant objects, and that the seeing of near objects accurately is dependent upon mus- cular exertion." The species offers three varieties as follow : « Vulgaris. Iris relaxed, but moveable, cor- Common long-sight. nea mostly too flat. & Paretica. Iris incontractile, pupil unchange- Unalterable long-sight. able, from partial paralysis. y Senectutis. Cornea less convex; relaxation Long-sight of age. and hebetude common to all the powers of the eye. a P. longin- The fibst variety is common to every period of life, in which gprls!"" the iris is affected with an habitual relaxation ; and may be suffi- Common ciently understood from the remarks already offered. long-sight. _, J . . ,. J ... fi p. longin- The second variety constitutes the disease called immutability qua pare- 0F SIGHT by Dr. Young ;* and is admirably described by Dr. Wells Unalterable in the Philosophical Transactions, in an interesting case of a young Singular1' person about thirty-five years of age, whose retina was as sensible pheated"" to tne stimums of light as ever ; yet who, from a paresis, or perma- with para- nent dilatation of the pupil, saw near objects with considerable adjoining e confusion, but remote objects with perfect accuracy. The power muscles. 0f moving the upper eye-lid was also lost. It was an extreme case of the disease before us, complicated with partial paralysis of the fmitltcd adJoinmg muscles, and may be imitated by applying the tincture of How ' belladonna. It was easily remedied by the use of spectacles with remedied. convex glasses, by means of which the patient was able to read without difficulty in a printed book, whose letters he was scarcely able to distinguish from each other before the spectacles were ap- plied. * Phil. Trans. Year 1793, cl.iv.] NERVOUS FUNCTION. [ord. n. Ml The third variety or that produced by old age, constitutes the Gen< *• presbytia, and presbyopia of medical writers, from -srpitrSvs, senex; yiMo'ngin- and here the hebetude and relaxation, while short of paralysis, ex- ?"tfBsenec" tend usually through the retina, iris, and, indeed, every part of the Long-sigh; complicated organ of the eye ; on which account the cornea be- TheSpr'es- comes less convex in its form and less pellucid in its transparency. bylia of In the present, as in the other varieties of this affection of the writers. eyes, the best remedy for supplying the deficient convexity of the p^n,6*11111 cornea, as well as the deficient irritability of the iris, is convex spectacles ; adapting their power to the precise demand of the eye and increasing it as the demand grows more urgent. SPECIES IV. PAROPSIS PROPINQUA. SHORT-SIGHT. VISION ONLY ACCURATE WHEN THE OBJECT IS NEAR. This is in most respects an opposite disease to the preceding ; „Gen-/' for it not only produces an opposite effect, but proceeds, in the ^^'y an * main, from an opposite cause. In the former the iris is for the opposite most part relaxed and weakly; here it is sound, often too much the former; contracted: in the former the cornea is, in almost all cases, too much flattened, in the present it is too convex or polarized. The ™llbgenee best palliative, therefore, is spectacles of an opposite character to remedied those recommended under the preceding species ; and with these m'arS!0"10 we must satisfy ourselves till age brings us a natural relief, by taking Cw^iX by off the entony and depressing the cornea. Unfortunately, how- but often ever, this is a relief that does not always continue for many years ; "Jjjfpo^fy. since the excess of tone becomes too much lowered as the age ad- vances, and the sight grows imperfect from this cause. Mice are said to have this kind of vision naturally, and hence Called one of the technical names for it is myopia or myopiasis, literally "/nTiceare '■■- mouse-sight." Zll!ZeitQ o _ possess it In the common technical terms for the present and the preceding naturally. species, there is the same kind of confusion in respect to the collo- cJnfusion quial terms by which these diseases are distinguished as we have in the already shown to exist between the technical and colloquial names technical of the first and second species. terms" Thus paropsis longinqua, the long-sight of the common idiom, is the amblyopia, or clyopia proximorum of Sauvages and Cullen, literally " morbid sight of near objects;" while p. propinqua, the short-sight of the common idiom, is the amblyopia, or dyopia dissi- torum of the same writers ; literally " morbid sight of objects far oft'." In the terms now offered the technical and colloquial ideas run parallel 142 CL. IV NEUROTICA. [ORD. SPECIES V. PAROPSIS LATERALIS. SKEW-SIGHT. SIGHT ASKEW. Gen. I. Spec. V, Disease explained. How to be distinguish- ed from strabismus or squint- ing. Strabismus sometimes follows. VISION ONLY ACCURATE WHEN THE OBJECT IS PLACED OBLIQUELV. In this species the patient can only see in an oblique direction, in consequence of some partial obfuscation of the cornea (usually perhaps from scratches or slight scars) or of the humours through which the light is transmitted, or from a partial paralysis of the re- tina. This must not be confounded with strabismus, or squinting, as it sometimes has been, but which proceeds from a different cause, and is accompanied with different phenomena. In skew- sight or lateral vision, the axis of the eye affected usually coincides with that of the sound eye, though it runs somewhat obliquely to avoid the obstruction in the tunic. In strabismus the two axes do not coincide, and the judgment is formed from the strongest eye alone. If, however, in lateral vision, the obstruction be such as to make the optical axis of the affected eye at variance with that of the sound eye, squinting must be a necessary, consequence of uV disease. SPECIES VI. PAROPSIS ILLUSORIA. FALSE SIGHT. Gen. I. Spec. VI. IMAGINARY OBJECTS FLOATING BEFORE THE SIGHT ; OR REAL OB- JECTS APPEARING WITH IMAGINARY QUALITIES. This species, thus defined, clearly includes two varieties, as follow : x Phantasmatum. Ocular spectres. 3 Mutationis. Ocular transmutations. Appearances of objects before the sight that have no real exis- tence. Real objects apparently changed in their natural qualities. Both these varieties offer a very numerous family of distinct illu- sory perceptions, which require to be noticed in their order. « p iiiuso- Of the ocular spectres, constituting the first variety, one talmafum. of the most frequent forms is that of dark spots. These are the ?w*ls mmc&volitantes of many author-- • and " are sometimes." savs 3> ,l. iv.j .NERVOUS FUNCTION. [ord. ii. 14b" Young, " if not always occasioned by an opacity of some of the Gen- J- vessels of the vitreous humour near the retina. They are seen in a a *EuiUSo- full light, and cannot, therefore, as Sauvages has justly remarked, [^^ be caused by any thing in the anterior part of the eye ; and they ocular may often be observed to change their form with the motions of the I^k'sp'ors. eve ; which they could not do if they did not depend on some float- The muscas ■ i rin • i f • • \- a volnantes ing substance. 1 heir apparent change of position, wnen we at-0f various tempt to follow them with the eye, is a necessary consequence of £™„'g0e's- the motion of the eye itself which contains them."* AhPp!"e"V If, however, these phantasmata depended upon vascular opacity p\,^f0en° of any kind, it is difficult to account for their mobility. And hence accounted Demours is, perhaps, nearer the mark in ascribing them to small supposed portions of Morgagni s humour that have acquired an increase of *°[Jheescaled density, weight, and refractile power without losing their transpa- jjf™.0"^ rency.t And in this view of their formation Mr. Guthrie coin- by°D8em"urs cides.j r«£d Gu,h- Another form these ocular spectres exhibit is that of net-work ; oci.iar hence called suffusio recticularis by Sauvages, and visus recticularis a^mk: by Plenck. This is sometimes permanent; sometimes transitory ; or.viB™8i and is probably, as conjectured by Sauvages, produced by a morbid affection of the arteriolaa of the retina. A third form is that of sparks ; and hence called by Sauvages f£f0or suffusio scintUlans. It proceeds generally from a blow or excess of scintiiians. light. The eve is also troubled with an imaginary sense of dazzling, Dazzling . n i x-n i • t. i or myrma- constituting the myrmaryge of the Greek writers. Its usual cause ,yse. is supposed to be a plethora ofthe minute vessels ofthe eye. Sometimes from the same cause the ocular spectres assume an g"'^0"^ irridescent appearance ; or exhibit in splendid succession, all the suffusio' colours of the rainbow. This Sauvages calls suffusio coloris. It is colon3- occasionally a regularly intermittent affection, or returns at stated periods, and particularly in the evenings ; and occasionally the mor- bid appearance is confined to a single colour. Dr. Heberden has given a curious example of an affection of this kind in a lady of ad- vanced age, who took lodgings on the eastern coast of Kent in a house that looked immediately upon the sea, and was of course very much exposed to the glare of the morning sun. The curtains of the bed in which she slept, and of the windows, were of white linen, which added to the intensity of the light. When she had been there about ten days, she observed one evening at the time of sun-set that first the fringes ofthe clouds appeared red, and soon after the same colour was diffused over all the objects around her, and especially if the objects were white, as a sheet of paper, a pack of cards, or a lady's gown. This lasted the whole night; but in the morning her sight was again perfect. The same alternation of morbid and sound sight continued the whole time .the lady was on the coast, which was three weeks, and for nearly as long after she left it; at which time * Delius, Diss. Phantasmata ante oculos volitantia, effcctus oculorura singularis. Erlang. 1751. t Traite des Maladies des Yeux, p. 409. ? ijectnres on the operative Surgerr of the Eye, p. 211. 8vo. 1823. 144 cl. iv.j NEUROTICA. [ord. i< Gen. I. Spec.W a f. Illuso- ria phan- tasms turn. Ocular Bpectres. P P. illuso ria muta- tionis. Ocular transmuta- tions. Metamor- phopsia of Plenck. Error of form. Error of motion. Error of number. The diplo- pia of Sau- vages. Error of colour. Singular example; Further illustrated, in a case connected with paropsis ionjinqua. it ceased suddenly and entirely of its own accord. Excess of light upon a delicate and irritable habit, appears to have been the cause of this singular affection. The retina was too strongly excited to throw off the impression easily—and that of the red rays of the de- scending sun, constituting the last impression communicated, re- mained after the sun himself had disappeared The circle of action may be easily accounted for by an uniform return of the same cause. The second variety of false sight, or that in which real ob- jects appear changed in their natural qualities, is by Plenck denomi- nated, in consequence of such change, metamorphopsia. Sometimes the change exhibits error of form ; and the objects appear too large, too small, cut in half, or distorted. Sometimes error of motion : in consequence of which they seem to be dancing, nodding, or in rapid succession. Sometimes error of number : and then they appear double, triple, or otherwise increased or multiplied ; constituting the diplopia of Sauvages and many other writers. Sometimes error of colour, in which case one hue is mistaken for another, as red for green, or green for yellow, or every hue ap- pears alike. Examples of this imperfection are not unfrequent. Air. Scott has given a singular instance of it in one ofthe volumes ofthe Philosophical Transactions,* and Dr. Priestly in another.t The last is especially worthy of notice as in some degree a family defect; and was communicated to Dr. Priestley by Mr. Huddart of North America. Of five brothers and two sisters, all adults, three of the former were affected with it in a greater or less degree, while the re- maining two and the two sisters possessed perfect vision. Ono ofthe brothers could form no idea whatever of colours, though he judged very accurately ofthe form and other qualities of objects ; and hence he thought stockings were sufficiently distinguished by the name of stockings, and could not conceive the necessity of calling some red and others blue. He could perceive cherries on cherry-trees, but only distinguished them, even when red-ripe, from the surrounding leaves by their size and shape. One ofthe brothers appears to have had a faint sense of a few colours, but still a very imperfect notion: and upon the whole they seem to have possessed no other distin- guishing power than that of light and shade, into which they resolved all the colours presented to them : so that dove and straw-coloured were regarded as white, and green, crimson, and purple, as black or dark. On looking at a rainbow one of them could distinguish it as consisting of stripes, but nothing more. Dr. Nicholl of Ludlow has published a case in the Medico-chirur- gical Transactions,]: of the same kind, though the imperfection seems to have been confined to one or two colours alone. The pa- tient could easily distinguish the green of the grass or the leaves of the trees, but, like those in Mr. Huddart's statement, he confounded with the green the red-fruit or flowers which happened to be inter- mixed with it. The false-sight in this case was also connected with * Vol. lxviii. 1778. p. 611. t M. lxvii. 1777. p. 260. * Transact, of the Merlico-Chir. Soc. Vol. lx. cl. iv.] NERVOUS FUNCTION. [ord. n. 145 paropsis longinqua; for the patient saw objects at a greater distance **EN*r- than other people, and more distinctly in the dark. The irids were fp*m'Jo-' here, also, gray, with a yellow tinge round the pupil. riamuta- The causes of these varieties are not always assignable.: many of ocular them, however, are the same as have been pointed out under the va- {[on™"111" riety of ocular spectres. Diplopia, or errors of number, have often causes been occasioned by long exposure to severe cold, sometimes by local signabie: spasm, sometimes by hydrocephalus.* Baumer gives a case pro- th>JJJctljf t£e duced by a wrong position of the pupil.t Raghellini another caused preceding by a double pupil.J In Lentin is a singularly complicated example partlcXi of objects seen triply. § dfuTiaor The chief diagnostic of many of these illusions is their mobility,|| error of which distinguishes them very decidedly from the fixt spots perceived x"^^^ in the eye, and which depend on an opacity of the lens, or a defec- How far re- tive state of the retina. They sometimes precede amaurosis or cata- TnVchief ract, though not very often ; and when they have reached a certain ^chot^"iCr" ' point, cease to become more troublesome, or rather, from habit, mobility. to be troublesome at all, and are little attended to: for if cataract or Jease^to be amaurosis do not soon follow, there is no reason for expecting either trouhie- of them ; a consolation of no small moment, as no certain remedy and do not has hitherto been discovered. ?0reany'ose In other cases, and especially where the misaffection is not struc- worse com- tural, but dependent upon an entonic or an atonic condition, of the p aiDt" optic nerve, muscular fibres, or blood-vessels, benefit has been de- rived, in the first instance, from local bleeding, blisters, and seda- tives ; the sedatives being employed both generally and topically : and in the last instance by stimulant collyriums, and general tonics. Many of these varieties of false-sight, and especially ocular spec- tres, are also found as symptoms in several species of dinus, syspasia, syncope, plethora, cephalitis, dyspepsy, and various fevers; some few of the filaments of the great sympathetic passing off, at its origin within the cavernous sinus to the orbit, and uniting with the lenticu- lar ganghon.1T * Justi, Baldinger, N. Mag. Band. xi. p. 446. -f Art. Hafn. I. Art. xxvii. % Lettera al S. Coechi sopra l'offesa della vista in una Donna. Venet. 1748,1749. § Libr. u. Obs. 20. H Guthrie, Lectures, &c. ut supra, p. 212. H Cloquet, Traite d'Anatomie Description. Blork, Beschreisbung des fuenste" nonverpaares, &c. Leip. 1817. Vol. IV.—19 146 IV.] .NEUROTICA. ORD. il- SPECIES VII. PAROPSIS CALIGO. OPAKE CORNEA. Dimness or abolition of sight from opacity of the corne4- or spots upon its surface. Gen. I. The Latin term caligo sufficiently explains the nature ofthe dis- AnUqCu'ated' ease, by importing " dimness, darkness, cloudiness, obscurity." In colloquial old English this opacity, as well as the pterygium,* was denominated pre-., " a " web Ofthe eye," from it? apparently commencing in an obscu- rity ofthe hyaloid, or choroid membrane, and giving the idea of a film spreading across the sight; whence Shakspeare in King Lear, V" This is the foul fiend Flibbertigibbet; he gives the wkr, and the pin, squints the eye, and makes the hare-lip." The pin is a variety ofthe synezesis, " closed or contracted pupil," or of one species of amaurosis, and will be noticed in its proper place. The exciting or immediate cause of this disease is rarely discovera- ble, as for the most part it makes its approach imperceptibly ; it is often, however, a common consequence of old age. Judging from the last species, we may place the usual proximate cause in a vari- cose or congested state of the vessels ofthe cornea, or hyaloid tunic from debility, whence moreover the finer and more attenuate parts ofthe secerned fluid are alone carried off, and the denser and gross- er left behind. Hence stimulants and tonics, as blisters, weak so- lutions of brandy, camphor, alum, and nitrate of silver, are often found useful in the present day ; as the saffron-coloured, or golden acrid juice of the chelidonium majus, or greater celandine, diluted with water or milk, was formerly. The disease is often accompanied with or preceded by congestion of the vessels of the head, and consequently a stupid pain and heavi- ness : and in some cases there is reason to apprehend that this affec- |3ea^'orof tionoftheheadisitself the cause, or rather that an obstructed liver is Exciting cause rarely discovera- ble: yet a common conse quence of old age. Probable proximate cause. How far remedial. Chelidoni- um majus. Sometimes apparently caused by congestion in the the liver- Remedial process in this case. A tedious disease. Exempli- fies. the primary cause, from which the overloaded state of the bloodves- sels in the head originates. But where the pain in the head is acute, and has followed instead of preceding the obscurity, the affected membrane has probably yielded to inflammation. Leeches or cup- ping-glasses should be here freely applied in the first instance, as well as brisk cathartics and mercurial alterants, and afterwards the stimulant plan just noticed. It is, however, generally a tedious dis- ease at best, and mostly incurable : and the author has at this mo- ment a patient who has laboured under the whole of the above symp- toms for some months, though it is not long that lie has had the care of her. She has tried local bleeding, purgatives, and at night * Vol. ii. f'l. m, Ord. n. Sp. 1. cl. iv.j NERVOUS FUNCTION. [ord. ii. 147 an equal mixture of Plummer's and the mercurial pill; with the va- ~Gen- *• pour of ether applied to the eyes < :.i ee times a-day, and apparently paropsis ' with advantage. o^afe* Baron Stoerck strongly recommended an extract of the pasque- comea. flower, Pulsatilla nigricans, the anemone Pulsatilla of Linne"us, for nig^n's internal use; and from the success he ascribed to it, the plant found °r i»"que- its way into the Edinburgh pharmacopoeia. The anemonepratensis Anemone would probably answer as well. These plants in their recent state Pratensls' have very little smell; but their taste is extremely acrid, and when chewed they erode the tongue and fauces. Other German practi- tioners, however, as Schmiicker, Bergius, and Richter, have tried even the Pulsatilla without success, though they have carried their doses to a larger extent than Stoerck ventured upon. Small and antimony frequently repeated doses of tartarized antimony appear, upon so j" csma11 many testimonies, to have been successful in various cases, that it is a remedy well worth a trial. Dr. Rowley used it with success upon an extensive field of practice.* Gleize employed it with equal success alone,t and Hufeland as satisfactorily in combination with warm bathing, and, the internal use of millepedes :J the last of which, however, may be spared without any serious risk. The disease has sometimes disappeared spontaneously, or without any known cause. Where the disease has become permanent, it may be distinguished ^owd,js"M from a cataract, and hence a useless operation be avoided, by a green- from ish hue of the iris if previously blue or gray, or a reddish, if pre- catarac'- vioushy brown. The iris moreover remains immoveable, as the de- bility has now extended to itself, and from an irregular contraction of its fringe, the pupd acquires a broken, and for the most part an- gular or elliptic shape. In newly-born infants spots on the cornea are occasionally met sPots on with, which soon vanish spontaneously :§ probably the rays of light of newty" acting as a salutary stimulus upon the occasion. fam*1-11" soon van» ish, and i— why. SPECIES VIII. PAROPSIS GLAUCOSIS. HUMORAL OPACITY. DIMNESS OR ABOLITION OF SIGHT FROM OPACITY OF THE HUMOURS". Glaucosis is a Greek term from yhxv*,o<;, " blueish or greenish Gen- L tinted," from the common colour of the obscurity. It was also specific called by the Greeks glaucoma, and by the Romans glaucedo. name, its Glaucosis is here preferred to glaucoma, because the final oma im- termination ports usually, and, for the sake of simplicity and consistency, ought * On the Principal Diseases of the Eyes. . Xouvelles Observations, &c. % Yon Blathern. P. 259, 5 Farr. Med. Comiava. "■ 30- 146 cl. iv.] NEUROTICA. |ohi>. u- sGEviii' always to import, external protuberance, as in staphyloma, sarcoma, PaYopsiV and various others noticed in detail in the volume of Nosology. opacity? of action in the absorbents that carry off the waste fluid of the hu- prorimlas niours, similar to that described under the last species ; and is some- cause. ". times benefited by a like stimulant and tonic plan of treatment. Caiigo of Sennert calls it indeed a caligo, and distinguishes it by its proceed- ing from a defect of the aqueous humour—caligo a defectu humoris aquei; by which he seems to mean that the torpitude belongs rather to the excretory than the absorbent vessels ; but, in this case, the cornea would appear depressed or flattened, which is rarely if ever a symptom. of Guthrie ^r* Guthrie nas united the two diseases in the same manner as Sennert, describing both under the name of Glaucoma, which he defines " an alteration of the component parts of the vitreous hu- mour, accompanied by derangement of structure of the hyaloid membrane of the retina, and tunica choroidea, the vessels of which are always more or less in a varicose state."* carried off Both this and the preceding species have sometimes ceased spon- neousty or taneously,t without any apparent cause ; and HelwigJ gives an in- by a fever. stance in which the cessation was not only spontaneous but sudden. How.djs- They have also been carried off by fever. In the cabgo there is from caHgo. often a sense of fulness, stiffness, or other uneasiness, and occasion- ally of pain. In the present affection little disquiet of any kind is Treatment, complained of. Collyriums of the astringent minerals or metallic earths, or other stimulants are often serviceable, when persevered in.§ SPECIES IX. PAROPSIS CATARRACTA. CATARACT. DIMNESS OR ABOLITION OF SIGHT FROM OPACITY OF THE CRYSTAL- LINE LENS. Gen. I. The cataract as it is now called, was by old English writers named ThfpeaH-' pearl-eye or pearl in the eye, and is so denominated by II ol- eyeof^oid land, the faithful translator of Pliny. Catarracta, as a Greek term, writer's. is usually derived from xxTxe'pxcra, " to disturb, destroy, or abolish.'' Shfnce0111 **T*e'p*Tx.n or KxrxexKTK, however, was employed by the Greek wri- derived. ters themselves to signify a gate, door, or loop-hole, and the bar mZh'g ofwhich fastens it, and becomes the impediment to its being opened. the term. * Lectures on the operative Surgery of the Eye, p. 214. t Hagendorn, Obserr. Med. Cent. i. Obs. 56. Franc. 1698, 8vo. Eph. Nat Cur Dec. i. Art. n. Obs. 166. * ' X Obs. US. • i,CoPfZ'one d'Osservazioni e Riflessioni di Chirurgia di Giuseppe Flaiani, Doitore m Medicina e Chirurgia, &c. Tom, iv. Roma, 1803 ll. iv.] NERVOUS FUNCTION. [ord. ii. 149 And it is probably from this last sense that the term cataract was Gen- '• first applied to the disease in question, as forming a bar to the eyes p^opsis which were called the loop-holes or windows of the mind by various catanacta. philosophers, as we learn from Lucretius, who thus closes his oppo- sition to their view : Dicere porro oculos nullam rem cernere posse, Sed per eos animum utforibus spectare reclusis Difficile est.* To deem the eyes, then, of themselves surrey Naught in existence, while th' interior mind Looks at all nature through them, as alone, Through windows, is to trifle— Whence, perhaps, Shakspeare in the speech' of Richmond :— To thee I do commend my wakeful soul Ere I let fall the windowsof mine eyes. The Greeks themselves, however, called this disease indifferently bailed by hypochyma, apochysis, and hypochysis. The earlier Latins, suf- hypo^ma, fusio : whde catarracta seems first to have been made use of by the apjc^ysis.' Arabian writers, and was probably introduced into the medical no- chysu. menclature by Avicenna. Yet the more common name among the p^babiy** Arabians was gutta obscura, as that for amaurosis was gutta serena; first used °y the pupil, in this last species, being serene or transparent. thoughlne The Arabians, who had adopted generally the humoral pathology Arabia*" of Galen, conceived both these diseases to be the result of a morbid term was rheum or defluxion falling on a particular part of the visual orb, in obscura. the one case producing blindness with obscurity, whence the name °risin and of an obscure rheum or gutta; and in the other without obscurity, gutta""8 ° whence the contrary name of a transparent or serene rheum or gutta. °uttaUraand But as various other diseases, and particularly ofthe joints, were also serena. supposed to flow from a like cause, and were far more common, the terms gutta and rheuma were afterwards emphatically applied, and at length altogether limited, to these last complaints; whence the terms gout and rheumatism which have descended to the present day, as the author has already had occasion to observe under ar- throsia podagra. For gutta the Arabian writers sometimes em- ployed aqua; and hence, cataract and amaurosis are described by many of them under the names of aqua obscura, and aqua serena; and the former, by way of emphasis, sometimes under the name of aqua or arqua alone. For gutta obscura the modern Germans have revived the terms onyx and ceratonyx where the lens is peculiarly onyx and hard or horny.t SS The opacity producing a cataract may exist in the lens alone, the Germans. capsule alone, or in both ; thus laying a foundation for the three fol- lowing varieties : * De Rer. Nat. in. 360. t See Langenbeck's Prufung der Keratonvxis, einer nener Methode, &c. Got Una:- 1811, «ro 150 cl. iv.j NEUROTICA. L0RD- u' Spec'ix " Lenticularis. The opacity existing in the lens itself, Paropsis Lenticular Cataract. and confined to it. cataract*' & Capsularis. The opacity confined to the capsule, or Capsular or membra- membrane of the lens. nous Cataract. y Complicata. The opacity common to the lens and its Complicated Cataract. capsule. tiie'liumour ^e are to^ moreover by Richter* of a cataract of the humour of of Mor- Morgagni, or the interstitial fluid which lies between the capsule \3uit.' ana" the lens : whence this has also been copied by Plenck, Profes- sor Beer, and Sir WUliam Adams into the list of modifications ; but rather as a possible than an actual case; for none of these practi- tioners give a single example of such a variety ever having occurred to them with certainty, though Beer suspected it in one case.j Sometimes It is sometimes accompanied with a sac enclosing a small body of nled with a Pus or icbor, and is probably the result of the inflammation that pro- sac, con- duced it. In this case it forms the cataracta capsulo-lenticularis cum andpartPi-US' bursa ichorem continente of Schmidt.J Beer affirms that this sac named bv *s commonby seated between the lens and posterior part of the cap- Schmidt. sule, and very rarely between the former and the anterior part.§ of the sa" Professor Beer seems to have refined a little too much in his di- Muitipii- visions and subdivisions of cataract, for he not only assigns a distinct divfsions of place to the Morgagnian, and this pustular cystic, but to a cystic form Beer, without pus, to a siliquose, and a trabecular ; while he further par- titions the capsular into two separate forms, according as it is before being nine or behind in the capsular chamber ; thus giving us a catalogue of and four "or nine distinct forms of what he calls the true cataract: while he allots his spurious four 0ther subdivisions to what he denominates the spurious cataract: meaning hereby some other obstacle to vision, the seat of which is without the crystalline capsule, between its anterior hemisphere and the iris, and consequently constitutes a distinct disease, embracing several modifications of paropsis Glaucosis. cataracts Cataracts are of different colours and of different degrees ofcon- coiour'and sistency from circumstances influencing the morbid action with which consistency. we are DUt iittie aCqUainted ; and as little with the occasional causes of such action, though old age seems to be a common predisposing cause. They are, therefore, black, white, leaden-hued, ferruginous, green, amber ; as they are also fluid or milky, soft, firm, hard, horny, and even bony, for they have been sometimes found of this last tex- ture. || They are not unfrequently the result of an hereditary taint, adhering to generation after generation, and appearing either con- genitally, or by a very general predisposition afterwards. BistenCe°ynnot From the colour of the cataract no conclusion, in the opinion of t„ be that acute observer Mr. Pott, can be drawn in regard to its con- gathered ° irom the colour: * Von der Ausziehung des grauen Staars. Gott. 1773. 8vo. t Lehre von den Augenkrankheiter, Baud n. Sect. 56. I Ueber Nachstaar und Iritis, &c. Wien 1801. j Lehre von der Augenkrankheiter, Band u. p. 301. 1813. || Weuzel, Traite de la Cataracte avec des Observations. Paris. 1786. Guthrie's Lectures, &c. on the Eve, p. 2'.,H cl. iv.] NERVOUS FUNCTION, [ord. n, 151 sistence ; but he thinks that when the opake crystalline is perfectly Gem. I. dissolved so as to form a soft cataract, it is somewhat enlarged ; and § ^rops!?2' that when such dissolution does not take place, and a hard cataract <-atarracta is produced, the crystalline is in some degree lessened. The hard BOftCata- cataract has also been distinguished by the name of ripe, as the soft ^ what; by that of unripe. " But if we would think and speak of this mat- cataract. ter," observes Mr. Pott, " as it really is, we should say that a disso- lution or softening of the crystalline lens is by much the most com- mon effect; and that seven times out of nine, when it becomes opake, and tends to form a cataract, it is more or less softened : the soften- ing sometimes extending through the whole range of the lens and sometimes through only a part of it; while, however, the part that remains undissolved is rarely, if ever, so firm as the centre of the sound crystalline." Mr. Pott proposes it as a question, whether J^^ cataracts, which have been found perfectly soft, have not in general .actsof grown opake by slow degrees ? and whether those which have been *™th , discovered to be firm have not become opake hastily, and been pre- ™J*rm of ceded by, or accompanied with, severe and deep-seated pain in the growth t head, particularly in the back part of it ?* There is no ophthalmologist, however, who has paid so much attention to this subject as professor Beer;. and though his divisions f^^nl are perhaps a little too minute, yet the microscopical accuracy with remarks of which he has followed up all the modifications of the cataract are Becr- entitled to our most serious attention. He agrees with Mr. Pott that a hard cataract is always comparatively small, though he adds that every small cataract is not necessarily hard. He is peculiarly minute in examining all the qualities which the disease may exhibit of position, colour, shadow, shape, range ; together with the mobi- Tahtf0„e"ffi; lity and degree of prominence of the iris ; and till all these charac- cataract. ters have been accurately weighed, he hesitates to determine as to the variety of the cataract; or, in effect whether it be a cataract at all. The shadow cast by the iris constitutes his leading clue. If the °fhahacter lens in an opake state maintain the size it possest when transpa- shades cast rent, there is a manifest shadow thrown back upon the surface ofthe aheres sins. cataract by the iris. If the cataract be less than the natural lens, this shadow is broader than usual. If the opake lens be swollen no shadow is present, as the capsule is pushed forward into contact with the iris, and the posterior chamber is abolished. And by carefully comparing all the signs that lie before him, he is able to indicate with certaintv, in every instance, the seat, the size, and the consistence ofthe cataract. We have already observed that a cataract is occasionally the result sr°0Xcedes of an hereditary taint; in other instances it originates spontaneously, from or from causes we cannot trace. It has, however, often followed t,aYntd,{ary upon convulsions, chronic head-ache, syphilis, rheumatism, sup- Occasional pressed perspiration, and in a few instances trichosis Plica, or ca matted hair.j It has also appeared as an effect of inflammation, produced by a thunder storm.J The siliquose or bean-shaped cataract is usually the result of a ^"^ * Chirnrgical Observations relative to the Cataract, &c. 8vo. 1775. London. diameter. t De la Fontaine, Chirurg. Med, % Richter, Chir. Bibl. Band. v,. 158. l.)'i CL. IV.j NEUROTICA. [ORI>. II Gen. I. wound or rupture ofthe capsule, through which the aqueous humour p!r!£sisIX'is admitted to the lens. In children this mischief is occasionally catanacta. produced by those fits of convulsion to which they are subject as Cataract. gQon ag born^ an(J during which the muscles of Ihe eye-ball are affected with violent spasms.* At this age the opacity is a light oray, and evidently has its seat in the anterior capsule, which is shrivelled and wrinkled. In adults the opacity is chalky, when the capsule has been wounded ; otherwise it is dusky or yellowish ; and the kernel of the lens usually remains, while its surface and circum- ference are dissolved. The opacity is flat; and the shadow of the iris broad. From its occurring occasionally in infants soon after birth, it is often confounded with a genuine congenital cataract. Haredeseion- ^ike PAROpsIS Glaucosis or humoral opacity, it has sometimes taneousiy, ceased spontaneously, or without any manifest cause ;t and Helwig deniyf aSnd" &iyes an instance in which the cessation was not only spontaneous carried off birt sudden.J It has also, at times, been carried off by fever.§ HenceeTer' There is hence, specious ground for conceiving that some medi- Sight'Se cme mignt be discovered capable, by some general or specific action, supposed of producing a like change, and proving a remedy for the disease; serviceable: ane but without any certain advantage.il This is the more to be lamented, because o'f because whatever surgical operation may be determined upon as success of most adviseable, there is no guarding, on all occasions, against the many ope- mischievous effects which may result, I do not mean from the com- everTwhen plication or severity of the operation, for this, under every modi- derforrnedy ficauorb *s simpler and less formidable than the uninitiated can rea- Sauses of' dily imagine ; but from the tendency which is sometimes met with, iii-suceess. from idiosyncrasy, habit, some peculiar acrimony, or other irritable principle, to run rapidly into a state of ulcerative inflammation, and in a single night, or even a few hours, in spite of the wisest precau- tions that can be adopted, to endanger a total and permanent loss of illustrated, vision. I speak from personal knowledge, and have, in one or two instances, seen such an effect follow, after the operation had been performed with the utmost dexterity, and with every promise of suc- cess ; and where a total blindness has taken place in both eyes, the operation having been performed on both; neither of them being * Beer, ut supra. t Haggendorn, Observ. Med. Cent. i. Obs. 60. Franc. 1698, 8vo. Ludolf, Miscell. Berol. Tom. iv. 258. vValker, On the Theory and Cure of a Cataract. \ Observ. Physico-Med. 23, Aug. Vind. 1680, 4to. § Velscbius. Episagm. 20. || Beytrage zur Chirnrgie tmd Ausrenheilknnst. Von Franz Reisinsrer. &c. Got tinmen, 1814. cl. iv.] NERVOUS FUNCTION. Lom».n. 153 quite opake antecedently, and one of them in nothing more than sGem,JL an incipient state of the disease, and the patient capable of writing paropsis and reading with it. And hence it is far better, in the author's calaract'a' opinion, to have a trial made on one eye only at a time, and that Hence aii the worst, where both are affected and one is still useful, than to °ftoUid'beS subject both to the same risk ; for the sympathy between them is so bad re- considerable, that if an inflammatory process from any constitutional with or accidental cause should show itself in either, the other would be caut,on- sure to associate in the morbid action. The usual modes of operating for the cure of a cataract are three ; Us"al i-i /> iij*1 modes of that of couching or depression : that 01 extraction: and tnat ot, operating. what is called, absorption.* The first was well known to the prac- ^"de^'ef-1 titioners of Greece and Rome ; and is ably described by Celsus, sion. who advises, in cases where the lens cannot be kept down, to cut it Absorption. into pieces with the sharp-edged acus or needle, by which mean it {^^"Jf will be the more readily absorbed. And, from this last remark, we have the ureeks some reason for believing that even the third of the above methods, jj^f °" that of absorption, was also known at the same time; as it is pro- Probably V 1 1 i i -i a* absorption: babie, indeed, that the second, or the operation by extraction, was andex- likewise ; since we find Pliny recommending the process of simple lractloa- removal or depression in preference to that of extraction or drawing it forth; " squammam in oculis emovendam potius quam extrahen- dam,"t which Holland has thus honestly, though paraphrastically translated " a cataract or pearl in the eye is to be couched rather, and driven down by the needle, than quite to be plucked forth." In the East, however, both these plans appear to have been pur- De|i«»on sued through a much longer period. Both are noticed by the Arabian tion known writers in general, and especially by Avicenna and Rhazes ; and ^.™*™n°" both seem to have been practised from time immemorial in India, the East. and, according to the account of the cabirajas, with wonderful suc- cess. Dr. Scot was informed by one of the travelling operators, who, however, spoke without a register, that in the operation of depression this success was in the proportion of a hundred who were benefited to five who obtained no advantage -whatever. Upon the ordinary operation of depression M. Willburg seems to J™lbu^f have made a considerable jmprovemenjg^>y pressing the cataract reciihaUon. backwards and downwards into a particular position where it is less likely to ascend or touch the retina ; and to this mode of operation is given the name of reclination. The operation of extraction seems to have derived no small ^°tdio^f improvement from the method of Sir William Adams, who, after improved detaching the cataract, first passes it through the opening of the J£dA£0B™s: pupil into the interior chamber by means of his needle, and then ex- tracts it by an opening on the outer side of the cornea, instead of by one in its interior part. The simplest and least irritating of these operations, however, is J{£*^][ that by absorption, as it is now commonly called, as it was named most ad- nrecipitation by Maitre-jan^ on his first noticing the disappearance ™1 whey; The preci- * Guthrie, Lect. on the operative surgery of the Eye, p. 184, Svo, 1823. Maitre^jan. t Nat. Hist. Lib. xxix. Cap. i. t Traits des Maladiesdel'Oeil. Edit.aec. Troyes, 1711 Vol. TV— 20 IJ4 cl. iv.j NEUROTICA. |ord. 11. Gen. I. 0f portions ofthe opake lens ; but which in effect is neither absorp- paropsis tion nor precipitation, but solution, or dissolution, as Mr. Pott cor- Catarracta. rectly described it. But it should be known to the operator that Solvent' while the solvent power of the aqueous humour is wonderfully ac- power of tj tnat Qf ine vitreous is weak and inconsiderable : and hence the tue aqueous ^ _. , . humour solvent or absorbent plan, first practised by .Buchhorn, and since in acfiv'e; our own country by Sir William Adams, consists in dividing the that of the cataract, after its separation, into small fragments, and passing them humour with the needle by which they are thus divided, through the pupil Principle of into *ne anterior chamber, which constitutes the seat of the aqueous this moihod-humour, apparently in perfect coincidence with the method first prac- by Adams, tised by Gleize, and since recommended by Richter.* The frag- Cometimes ments thus deposited are usually dissolved in a few weeks; and veryrapidiy where the cataract* is fluid they have often been dissolved and ab- and'earried sorbed in a few seconds ; and sometimes even before the needle has off- been withdrawn. The division is here made through the cornea, previously illined with belladonna to dilate the pupd, and it is to this Cerato- method of operating that M. Buchhorn gave the name of cerato- nyxis.J The first inventor, however, of the plan in its simplest state was Conradi of Nordheim. SPECIES X. Paropsis synizesis. CLOSED PUPIL. DIMNESS OR ABOLITION OP SIGHT PROM CONTRACTION OR OBLITERATION OF THE PUPIL. Gen. I. The term synizesis is derived from o-vuga, " consido coeo, coa- Spec. X. lesco;" and was used among the Greek grammarians, before it theSspectfic obtained an introduction into the medical vocabulary, to signify the term. coalescence of two or mie syllables into one. This species ex- hibits two varieties : x Simplex. Simple closure of the pupil. Simple closed pupil. p Complicata. Closure of the pupil complicated Complicated closed pupil. with cataract, or opake cornea. zesis 8yim- The pupil becomes closed or obliterated from a gradual contrac- fee *i(ln and' at length, coalition of the muscular fibres of the iris ; from closed pu- mflamrnation of the surrounding membranes; or from protrusion of 0 P S ni ^ iriS' '? 3li theSG C£lSeS il iS a SIMI,I,E OBLITERATION OF THE zesis com- pupil. It is complicated when the obliteration is combined with SLu- an °Pacity of the cornea' or with a cataract. When the disease i« ed closed nuPn- * Chirurgische Bibliothek. Band. x. r Buchhorn de Keratonyxide. Halae, 1806. CL. lV.j \ERVOL'S FUNCTION. foun. n. 155 an effect of inflammation, it forms the atrcsia iridis of Dr. Schmidt Gen. '• of Vienna, who further subdivides it into complete, incomplete, and $ Vv.%n\. partial, according as the vision is totally destroyed, impaired, or z^"m" confined to a part ofthe pupil.* Compiicat. The natural form of the human pupil is circular, this being the pup-,1.066* natural form of the fine fringe of the iris by which it is surrounded. Atresia iri^ But in a very few instances the fringe, or rays, of the iris has evinced Schmidt. a different figure, and the pupil, in consequence, has been found ?'u5p^ofthe oblong, or heart-shaped. \ The first has occurred most frequently : changed by and according to Albums has sometimes preceded loss of vision.;£ **"*disease- Block gives an instance in which the disease was congenital and ^usndbg6". hereditary.§ genital and If the iris contract irregularly, sometimes only a few of its fibres heredltary* spread across the pupil, while others are retracted : and hence we have examples of double or more than double pupils, though ofo°uJ>iepu- smaller dimensions than the natural circle. Solinus gives an in- produced. stance of two pupils hereby produced,! and Janin of not less than ^jPilfive" five.II Dr. Plenck, who very unnecessarily multiplies diseases, con- Complicate fines the term synizesis to a total contraction of the pupil; and elupti.°°e makes its partial' contraction a distinct affection, which he calls My6sU.of . , ,. . Plenck. myosis: and the second or complicated variety, another distinct synechia, affection which he denominates synechia. But this is to perplex what' rather than to simplify the subject. Medicines in this disease are of little avail. In the first variety Medical an external application of the tincture of belladonna, or a solution tr?*[.mecnt. _ ..-I- -i ,i ■*.*. u 0l the nrst of stramonium, which is said to answer the same purpose,** has variety. occasionally effected a cure by destroying the contractile action ; and dilute solutions of brandy, camphor, or sulphate of zinc, by their tonic or stimulant power. When the disease does not yield The second to this mode of treatment, or consists of the complicated variety, it to surgery* belongs manifestly to the art of surgery, and its removal must be sought for in books on that subject: among the best of which may be mentioned, Mr. Guthrie's Lectures on the Eye lately published, and Professor Beer's Essay on Staphyloma, and artificial pupil, published in 1804,tt and his Doctrine of the Diseases of the Eye published in 1817.JJ According to the nature of the coalition, Beer employs three varieties of operation, incision, excision, and separation, which he distinguishes by the names of corotomia, Corotomia, corectomia, and corodialysis. The first is the simplest, and that Corodiaiy- most usually had recourse to. In the second, an incision being sis- made with a cataract knife, close to the edge ofthe cornea, and not larger than the third part of its circumference, the iris, if it pro- trude, is laid hold of by the hook ; or if no protrusion take place, * Ueber Nachstaar und Iritis Nachstaar operationen. 4to. Wien. 1801. t Eph. Nat. Cur. Dec. in. Ann. vii. vin. Obs. 21. % Anat. Acad. Lib. vi. cap. S. § Medicinische Bermerkungen, p. 1. || Vide Marcel. Donat. Lib. vi. cap. ii. p. 619. IT Memoires, &c. * * Annual Report of the Liverpool Institution for Diseases of the Eye. By Alex- ander Hannay, M D. 1822. ft Amicht der Staphylomatoien Metamorphosen des Anges, und der Kunstlichen Pupillen bildung. IJ Lehre von der Augenkrankheiter, &c. ut supra. Lo6 cl. iv.] NEUROTICA- iouu.u. Gen. I. Spec. X. ji P. Syni- zesis com- plicata. Complicat- ed closod ptipil. The last, Reisinger's method the hook introduced through the incision, is made to lay hold of £h<. pupillary edge of the iris, which drags it through the wound when a sufficient portion of it is removed by a pair of scissors. In the third method, which is that formerly proposed by Dr. Rcb-mger. the operation is performed by a double hook or hook forceps.-' SPECIES XI. PAROPSIS AMAUROSIS. DROP SERENE. DIMNESS OR ABOLITION OP SIGHT WITII AN UNALTERABLE PUPIL. USUALLY BLACK AND DILATED ; BUT WITHOUT AKY OTHER APPA- RENT DEFECT. Gen. I. Spec. XI. The gntta serena of the Ara- bians. Confounded by Milton with cata- ract or suf- fusion. This is the gutta serena of the Arabic writers, whence the term " Drop Serene" of our own tongue ; terms we have already ex- plained under paropsis catarracta. Milton is well known to allude to this affection in his beautiful address to light, as he does also to the cataract by him called suffusion, as the Latins call it suffusio: but it is singular that, in the course of this allusion, he seems doubtful as to which of the two diseases he ought to ascribe his own blindness: Thee I revisit safe And feel thy sovereign vital lamp ; but thou Revisit'st not these eyes, that roll in vain To find thy piercing ray, and find no dawn. So thick a drop serene has quench'd their orbf, Or dim suffusion veil'd.t Origin of The term amaurosis is derived from the Greek afutveo?, "■ obscu- hc rus, caliginosus, opacus." The most common cause is a paralysis of the retina, usually in conjunction with a paralysis and dilatation* of the iris. Occasionally, however, the iris is rigidly contracted ; its debility being accompanied with great irritability ; and hence, offering two varieties ; to which a third may be added, from the dis- ease assuming, at times, an intermittent type. term Oidinary cause. Atonica. Atonic amaurosis. Spasmodica. Spasmodic amaurosis. Intermittens. Intermittent amaurosis. With permanent atony, and dilata- tion of the pupil. With a permanent contraction of the pupil. With periodical cessations and returns. * See also D. Welter's Treatise Ueber kiinstlicne Pupillen, und eine besondere Methode, diese fertigen; pubhVhed in Langenbeck's Neue Bibliothek. B. u. St. 4. See also Dr. Schlagintweit Ueber den gagenwartigen Zustand der kunstlichen Pupil- iea bildung, &e. JYlunchen 1818. t Par. Lost. in. 21.- CL.iv.f NERVOUS FUNCTIOiV [ord. n. lb* It would be easy to adrrrit other varieties if we were to attend to Gen. I. all that has been written on the subject, and adopt all the opinions pfrop8'i3X ' that have been delivered; for we are told of cases in which the £™usr°si3- pupil has not been permanently immoveable, but has contracted rene. Other mo- on exposure to an intense light ;* and of others in which the pupil AiS^-^, instead of being black has evinced a pale or nebulous appear- noticed by ance.t In the first of these exceptions the disease has not ac- writers •, quired completion ■ and the other is allowed for occasionally in the ^L™mI definition. It will often be found nothing more than an incipient into differ- ent stages cataract. of the one Plenck makes a distinct disease of an unalterable pupil with or ™e°a^"f without injury of the vision under the name of mydriasis. When Mydriasis accompanied with injured vision, it is evidently a variety of amau- ^fna?t1.enck; rosis ; and it is questionable whether an unalterable pupd is ever to be traced without defective vision. Under the one or other of these varieties amaurosis is also found, f^f^ occasionally, as a symptom or sequel in hysteria, syspasia, lues, and some other local rheumatism. paropsis. It is probably to the spasmodic variety of^ this species, that Pin o^pm- Shakspeare chiefly alludes by the term pin or pin-eye, the pupil eye,w a" being sometimes contracted to nearly the diameter of a pin's head ; though the synizesis is equally entitled to the name. I have quoted one example already under P. Caligo, which he calls web-eye: another is contained in the following couplet: ----Wish all eyes Blind with the pin and web. The existence of an amaurosis is known by the specific symptoms Wagno.- of the pupil being peculiarly black and dilated, and the want of contractibility in the iris on exposure to a strong light. Its com- £°™^ mencement is often accompanied with pain in the head, which progress. diminishes as the disease increases. Yet it occasionally steals on without pain ; and if it be confined to one eye only, it will some- times exist for months or perhaps years, without a person's being sensible of it; as, in such cases, it is only traced by the patient's accidentally closing the sound eye alone and then finding himself in darkness, or by some other incident. The black cataract has sometimes been confounded with it, or ««»- mistaken for it, of which we have just noticed an instance in Mil- sionaiiy ton, as has also that modification of the capsular cataract, in which cvataract:" the posterior lamina of the capsule is alone opake. -&?££- The occasional cause is, therefore, for the most part incapable ot occasional being followed up.J Richter contends that it is often dependent cause. upon a dyspeptic state of the digestive organs ; and it has at times occurred suddenly upon a plethoric state of the vessels, apoplexy, cephatea, a blow on the head, or some other injury of the senso- rium. It has sometimes succeeded to paropsis lucifuga, and some- * Caldani ad Haller. v. Richter. Nov. Comm. Soc. Goett. Tom. iv. 77. Hey. Medic. Observ. and Inquir. Vol. 5. p. 1. p, 62 t Richter, Nov. Com. Soc'Goett. Tom. IV. p. 77. Goett, Case., Ed. H. p. ' Lehre von den Augenkrankheiter, &c. v0n. O. J- Beer, Pyo. Wren. toS CL. IV.j NEUROTICA. [0R1». i< Spec* xi times Purulent ophthalmy. From the stronger stimulus of the light, Paropsis ^ is more frequent among soldiers or labourers in tropical than in Amaurosis, temperate climates. It is also well,known to be temporarily pro- rene. duced by the juice of the solanum or atropa Belladonna ; and in one or two instances permanently from an accidental im mission into the eye of the poison of a serpent or spider.* It has likewise been induced by a flash of lightning, by insolation or undue expo- sure to the rays of the sun ; by a suppressed catarrh, suppressed hemorrhages, or venesection when rendered habitual;) by suppressed exanthems, and eruptions of various kinds, especially porrigo, herpes, and scabies ; by some sudden strain or other violence; or by some overwhelming passion of the mind as wrath or terror.J Sometimes It has also appeared as a sequel or metastasis upon fevers ; and metastasis succeeded to the use of poisonous cosmetics. There are a few cases dfsease" m which li has proved hereditary,§ nas proved Professor Beerii is minute in describing the modifications that R^eumSc proceed from plethora, and a morbid state of the digestive organs ; amaurosis but gives a still more copious detail of that which depends upon local rheumatism, and which he, hence, calls the rheumatic amau- rosis. In this he remarks that the pupil is perfectly clear, and the iris unalterable, slightly dilated, and thrust a little nearer the nose and the eye-brow than naturally, so as to be in a small degree dis-; placed inwards and upwards. The tears flow on sbght occasions, and the light is often troublesome, accompanied with an aching pain in the eye-ball. The movement of the eye is impeded, and more in one direction than in others. This modification rarely pro- ceeds so far as to perfect blindness. Prognostics. The prognostics are generally unfavourable, except where the disease exists as a symptomatic affection. Where we can decidedly trace its existence to plethora whether entonic or atonic, or to some Treatment, violent injury to the head, bleeding and purgatives are clearly in- Jtieedmg. dicated : and though they have frequently failed in the former, they have often proved of the utmost success in the latter, when pursued with great activity. Where however there is great weakness in the exquisitely tender organ of the eye, palsy is often induced before these evacuations can relieve the oppression, which is indeed a fre- quent cause of their failure in such cases. In the spasmodic Emetics, variety active emetics frequently repeated, and resolutely persevered in at each time till the system becomes weakened, as in the treat- ment for the epidemic ophthalmy, have certainly been at times found Blisters and successful. Blisters and sternutatories also demand attention : the Tica. first should be applied to the temples ; the second is best formed of turbeth mineral with about ten times its proportion of mild snuff, or any other light powder. The vapour of ammonia, ether, or camphor, mixed with hot water, has sometimes also afforded be- * Bosnian, Beschreibung von Guinea, p. 369. Boyle, Tract, de. Concord. Medic. Specific. t Heister, Wahrnehm. B. II. p. 441. Bresl. Samml. 1726. I. 603. I Herculanus, Coram, in Rhazis. Lib. is. Richter. L. c. p. 81. Schaarschmid Med. und Chir. Nachrickten in. n. 18. 5 Redlin, Curat. Med. Millenar. n. 822. Oeheme de Amaarosi, p. 20. 0 Lehre von den Augenkrankheit, &c. ut supr*. cl.iv.) NERVOUS FUNCTION. [6rd.ii. 159 nefit: as has probably the use of moxa frequently, repeated, so Gen. 1. warmly recommended by Baron Larrey. "By this remedy," says pfroC8'iXI" he, " not only has the progress of amaurosis been arrested, but in Amaurosis. some cases removed, even where the blindness was complete."* "reEe. The rheumatic form is frequently treated with success, and princi- ^^ment' pally by diaphoreties. Beer employs guaiacum and camphor com- niaphore- bined, during the day, and Dover's powder at night: and with these Dover's he has recourse also to blisters, placed in succession behind the ear, p,),ydff., on the temple, and over the eye-brow, so as tfl maintain a catena- ters. tion of counter-irritative actions. Both this and the plethoric mo- stimulants dification, in which local bleeding is of the utmost benefit, are fre- sTe'-'aTmo" quently hurried on to a complete development of disease, and a l'fica,ions- total insensibility of the retina by stimulants, and particularly by vapours." galvanism and el< ctrieity. Where it has followed on repelled eruptions, it has also been oc- wh°n use- casidnally found to yield to setons and blisters, or a restoration of ful- the suppressed efflorescence; and, as in other diseases, what has sionai>cca" sometimes proved the source of its production, has been found its cause in best remedy ; so that the cause has become the cure. Thus it has an occa- ' at times yielded to the violence of a fever, to that of a sudden blow ^ihers.'6, on the head, to a strong light, to a paroxysm of convulsions. Elec- Electricity. tricity, and especially voltaism, has probably been serviceable in some instances; at least the assertions to this effect are very nu- merous, though in various cases both these have sometimes been altogether unsuccessful, and, as just observed, sometimes highly mischievous. Nor is the magnet without its recommendations, Magnetism. having been applied to the upper part of the spine, while minute bags filled with iron filings were placed on the eyes ;t a~nci, in an imperfect case of the complaint, Weher conceives he derived be- nefit. The chief dependencies besides these have been on cam- internal phor, cajeput, musk, mercury, iron, bark, arnica, and externally the Stimulants. Pulsatilla nigra. Of the arnica or German leopard's bane, Pellier, as well as Collier, speaks warmly. The latter recommends it in all nervous atonies, whether general or local. He employed the flowers of the plant in decoctionj in the proportion of about half an ounce to a pint of the strained liquid, which may be taken in a day or a day and a half. Richter, Schmucker and other German writers declare it to be of no avail. The Pulsatilla is certainly Pulsatilla i • i i N /, t 11 l-n i-v entitled to better entitled to attention. " 1 would recommend it, says Dr. further Cullen with his usual liberality, " to the attention of my country- tnals" men, and particularly to a repetition of trials in that disease so fre- quently otherwise incurable, the amaurosis. The negative experi- ments of Bergius and others are not sufficient to discourage all trials, considering that the disease may depend upon different causes, , some of which may yield to remedies though others do not."§ When distilled with water it gives forth a terebinthinate substance + Recueil de Memoires de Chirurgie, &c. Paris, 8vo. 1821. t Wiirkungdes Kuntstlichen Magnets, &c. p. 24, 25. Hell. v. Nootnagel, 1. c. § 22. Eph. Nat. Cur. Dec. u. Ann. v. Obs. 247. X Prodigious Enlargement and Dropsy of the Eye. Dr. Layard. Phil. Trans. 1757-8. Vol. 50. p. 747. § Mat. Med. Vol. ii. Part n. Ch. v. p. 216, 160 cl. iv.] ^NEUROTICA. LoR»- u- Gen. I. resembling camphor, which necessarily possesses a stimulant, and Parop«s ' hence a medicinal power. Whence the euphrasia officinalis, or Amaurosis, eye-bright, obtained the character it once possest as a specific in this disease, it is difficult to say. By Hildanus and Lieutaud, how- rene Euphrasia ever'lt was chiefly confined, even in its zenith of popularity, to the little enti- amaurosis of old age. Its chief sensible quality is that of being a nrtme°tne mild astringent. Rue, which rivalled it at one time, and by Milton Rue- is put u^on a level with it, has far better pretensions when used ex- ternally in the form »f a potent infusion ; for it unites the properties of volatile pungency and bitterness : both which, as concentrated in strong chamomile tea, I have occasionally found highly service- able in an incipient state of this disease produced by weakness ; though, as already remarked, none of these should be employed in several forms of the disease. Narcotics. The narcotics, if they have ever been serviceable in any way, can only have been so in the spasmodic variety. Of these aconite has been chiefly popular in Germany: it has been strongly recommended by many writers of reputation, and has sometimes been given by gradual augmentation to the amount of a drachm daily.* Chevil- Union of lard combined the use of antimonials with blisters : but cold applied andbiutere8 externally, and cold bathing as recommended by Warner, will often be as much entitled to our attention, as any other process. instance of Dr. Powell relates a case of sudden loss of vision, preceded by scintiii'ation an acute cephalaea, in which an emetic was found, during the act of from emet- vomiting, abruptly to restore sight to the right eye (for both were affected) with a sensation as if a flash of lightning had taken place ; And of par- but the vision was soon again lost. More than a twelvemonth c^eryof afterwards the patient returned to emetics ; when, after the use of the motory the second, the pupils of the eyes recovered the power of dilating fh°eWiris?f and contracting on exposure to light, and preserved it till death, but the power of vision was not restored. During the whole of this case of blindness, the sense of hearing was peculiarly acute.| The dis- Hearing covery of Dr. Bock, that a few nervous filaments appertaining to the lcnteUm°3 great sympathetic nerve are thrown off while this nerve is within Explained, the cavernous sinus, and entering the orbit unite with the lenticular ganglion, will enable us satisfactorily to account for these remote influences ; the ear, as is frequently the case, sympathizing with the morbid state of the eye either directly or reversely.| * Beobacbtungen and Untersuchungen, he. Band n. Nuremb. 1767. X Trans. Med. Vol. v. p. 226. I Beschreibung des luensten Nerven paares und seiner Verbindungen nrit underen Nerven, &c. von D. A. Carl Bock. Leipsic, 1817. cii.iv.] NERVOUS Fr\CTIO\. fonn. ir. USl SPECIES XH. PAROPSIS STRABISMUS. SQUINTING. OPTIC AXES OP THE EYES NOT COINCIDING ON AN OBJECT. This disease, in colloquial language now called squinting, \vas Gen. l. formerly denominated goggle-eye, whence the word goggles is still £*t^\y' applied to the glasses which are used by persons affected with the »»med complaint. i'he French call these glasses masques d loiichette; wie^coThe literally squinting-guards. The technical term stabismtjs, is de- t(j™' ^°"- rived from .he Greek g-tpxZos, " tortus oculis," or " sight-twisted." French The optic axis is an imaginary line passing from the centre of questUrn- the vitreous humour, lens, and globe of the eye to the object ofchette- „ t t> , x • • ,1 .• n .1 • - • • Origin of vision. In perfect vision the optic axis of the one eye is in unison the tech- with that of the other ; ~and, consequently, they converge or coin- p^Vo'i™'. cide at the same point; and the object which would otherwise ap- Why ob°-' pear double, as being seen by each eye, is contemplated as single. iing1eapP°n' In order to this coincidence, the muscles of each eye must con- jhoughseen ■ i t • i • i /. .by both stantly assume the same direction, their position and configuration eyes. be precisely alike', and the sight be of an equal power and focus: a deviation from each of which postulates must necessarily produce squinting, or an inaccordant action of one eye with the other. From common and early habit we acquire an equal command over Bo<& eyes the muscles of both, and are able to give them any direction, or associate ir; power of direction, and to fix them upon any object we please, ^jo*!"0 d And such is the force of habit that they at length involuntarily as- hence diffi- sociate in the same action, and it is difficult for us to give to the them'a^if- one eye a different direction from that of the other; or, in other ferentdi- words, to make their optic axes diverge instead of converge. In Nu such persons born blind no benefit can be derived from this unity of ?n9SOecr^n action, and hence it is never attempted; and the muscles being hom blind: never subjected to discipline, the eye-balls roll at random, and dV^uiVof wander in every direction. In consequence of which one of (he fixi°s bo'h most difficult tasks to be acquired by such persons, after obtaining same ot>- sight, is that of keeping their eyes fixed, and giving the same bear- Jtheir°oV ing or convergent line to each. And hence, again, they see things M^s double at first, and in a state of great confusion. When one eye is naturally stronger, or of a more favourable A ''be wain focus, or more frequently employed than the other, as among watch- where one makers and jewellers, the latter, from comparative neglect, relapses *?* ig,"*,,u," into an undisciplined state, and less readily obeys the control of the or than the will. Its muscles do not assume the same direction as those ofthe JJenco a"d eye employed ; and if they do, in the two former cases, the object °h(^y("Jrst. still appears double; and hence, the neglected, or weaker eye, cdto: wanders and stares at one or at various objects, while the eye relied ^J^ '"„ upon is fixed upon some other. And it is this divergence of the wanders Vor. IV.—21 162 a. iv.j .NEUROTICA [ord. n. Gen. 1. Sp. XII. Paropsis Strabismus. Squinting. from the proper di- rection. This inac- cordance of direction constitutes snuintin^. optic axes, this inaccordance of direction, or looking at different objects at the same time, that constitutes the present disease. It is obvious, therefore, that strabismus may have three varieties : x Habitualis. Habitual squinting. (3 Atonicus. Atonic squinting. '/ Organicus. Organic squinting. From a vitiated habit ; or the custom of using one eye, and neglecting the other. From debility of the affected eye, whence the sound eye possesses a different focus and power of vision ; and is alone trusted to : in consequence of which the weak or neglected eye insensi- bly wanders as already stated. From the eye being differently constructed in form or position. n P. Stra- bismus ha- bitualis. Habitual squinting, •he nystag- mus of Tlenck. (3 P. Stra- bismus atonicus. Atonic squinting. y P. Stra- bismus or- ganicus. Organic squinting. Goggles seldom ser- viceable. A more ef- fective plan proposed. The first of these varieties constitutes the nystagmus of Dr. Plenck, and its cause is sufficiently obvious. In the second the sound eye is alone trusted to, because it is the only eye on which any dependence can be placed ; and hence the weak eye, neglected by the will, wanders insensibly, as in the preceding order we have seen that any one of the mental faculties will wander in like man- ner under the same want of discipline. In the third variety the difference of form or position respects the situation or figure of the one eye compared with the other, or of the particular parts of the one eye compared with those of the other : in consequence of which the one is favoured and the other thrown into disuse. In this last variety a complete cure is hardly to be expected. In the second it is attended with considerable difficulty ; and in the first is rather to be accomplished by what, in mania, we have called moral treatment than by medicine. A constant and resolute exer- tion on the part of the patient to obtain a command over the weak or irregular eye is of absolute necessity, while the neglected eye itself, if weak, should be strengthened by tonics and gentle stimu- lants. Goggles, though often recommended, are seldom servicea- able, and especially to children ; for although the sight must hereby be restrained in each eye to a common line, the child will still use the sound eye alone, and leave the irregular eye unemployed. It is a better plan to affix some object near the orbit of the affected eye at such a distance that it may constantly catch and draw off the pupil from the inner angle to the outer. But the method that I have myself found by far the most effectual, is to blindfold the sound eye with a blink for a considerable part of every day ; and thus force the affected eye into use, and a subserviency to the will. I recom- mend this simple plan most strongly, and especially in the case of children; and may venture to predict that it will be sure to succeed in the first variety of the disease, that of hnbit. and frequently in both tlio other5 •l.iv.J \ERVOLS FUNCTION. Lord.u. lrj.j GENUS II. PARACUSIS. MORBID HEARING. SENSE OF HEARING VITIATED OR LOST. Paracusis is a term of Hippocrates derived from nxex%ova, '■ per- Gen. II. peram, depravate, vitiose audio." The mechanism of the ear is as J"^"^"^ complicated as that of the eye, and as admirably adapted, in all its '"»'•. parts, to the perfection of the sense which constitutes its function. iysi0°s> Its lobes, its entrances, its openings, its various drums, its minute and multiplied foramina, its delicate bones, all contribute to one com- mon effect. Even the surrounding bones, and still more than this, jj°nes sur- the teeth, are, in no small degree, auxiliary to the same object: as the ear, and the experiments of M. Perolle, given in the fifth volume ofthe Turin ^th'auxi- Transactions have abundantly established : as they have, also, that hary to bone in general is a far better conductor of sound than air, alcohol, earlns• or water. We may hence learn one very important use of the four minute IIonce °"c , j • i • i -ii ^i - use of the bones deposited in the posterior chamber of the tympanum, the loss bones in of any one of which impairs the hearing, and, in some instances, 0^heVtym- has produced total deafness: of which we have a striking proof in panum. the case of a lad, described in the Philosophical Transactions, who illustration. had parted with the incus on one side, and both the incus and malleus on the other, by means of an ulcerated sore throat that opened a passage from the fauces into each ear, and through which the bones were discharged. The tympanum, on the boy's recovery, seems not to have lost its vibratory power, for he was sensible of violent or sudden sounds, but altogether insensible to conversation, and ap- parently as deaf in the ear that had only parted with the incus as in that which had parted with both bones.* From the complicated organism of the ear it follows necessarily Diseases of that, like the eye, it must be subject to a great variety of diseases ; oiun"ear while many of the diseases of the one sense must bear a striking ™ (J,™1"^ analogy to those of the other. Thus painful and> obtuse hearing the eye. and deafness may be well compared with painful and obtuse vision ustrate and blindness. As the eye is at times affected with illusory objects, so is the ear with illusory sounds ; and as, when the optic axes do not harmonize, as in strabismus, the same object may be seen double, so may the same sound be heard double when the action of the one ear is inaccordant with that of the other. And hence it is not at all to be wondered at that a peculiar degree Sympathy of sympathy should exist between these senses, and the state of the the senses of sight and hear- * Vol. U. No, 60. 1761, ing. 164 ex. iv.] NEUROTICA [ord. n. Gen. II. Paiacusis. Morbid hearing. Alternation of deafness and blind- ness. From the depth of the organ of hearing the seal of r'isease often less known than in dis- orders of vision. Whether the cochlea be the most dis- criminative part of the organ or the mem- brana tyra- j.«ani f one be frequendy affected by that of die other. Bartholine gives a case in which deafness and blindness alternated with each other, and we shall presently have to observe that a temporary affection of the eyes may sometimes be produced by particular noises. As the organ of the ear, however, is less exposed than that ofthe eye, we are far less acquainted with the immediate scat of it* dis- eases, and even with the exact bearing which every particular part sustains in the general phenomenon of hearing. It was at one time supposed that the nicest power of discriminating sounds, or, in other words, that accuracy of distinguishing which constitutes what is called a musical ear, is seated in the cochlea ; birds, however, whose perception is exquisite, have no cochlea. It has since been con- ceived by Sir Everard Home that it is the membrana tympani in which this fine feeling is peculiarly lodged,t and that it depends upon the muscularity of this membrane : yet the same feeling has re- mained, and in a high degree, in persons whose membrana tympani has been ruptured. Paracusis as a genus includes the following species : PARACUSIS ACRIS. ---------OBTUSA. TERVERSA. DUPLICATA. IDLUSORIA. SURDITAS. ACRID HEARING. HARDNESS OF HEARING. PERVERSE HEARING. DOUBLE HEARING. IMAGINARY SOUNDS. DEAFNESS. SPECIES I. PARACUSIS ACRIS. ACRID HEARING. HEARING PAINFULLY ACUTE AND INTOLERANT OF THE LOWEST SOUNDS. Gen. II. Spec. I. Occurs idiopathi- cally in nervous idiosyncra- sies. Hyperc ou- sts of Itard This occurs occasionally as an idiopathic affection in nervous and highly irritable idiosyncrasies, and bears a striking analogy to that acritude of sight which we have noticed under paropsis lucifuga. It is the hyperconsis, or, as it should rather be, the hyperacusis of M. Itard, who also regards it as an idiopathic affection in various cases.j It depends upon a morbid excitement, sometimes ofthe whole of the auditory organs, but more generally of some particular part, as the tympanum, or the labyrinth, and particularly the cochlea, or some of the internal canals. In many instances it seems confined to the branches of the nerve ; and Bonet gives an instance of it Epist. Cent. iv. No 40. | Phil. Trans. Year 1800 Traite des Maladies de l'Oreille. et de 1'Audition. 2 Tomes. 8vo. Paris. 1821 cl.iv.J NERVOUS FUNCTION. [ord. n. 165 from the very singular cause of a triple auditory nerve formed on Gen- H- cither side ;* in which case there is sufficient ground for its idiopathic parucu'sis' origin. It is found more frequently however as a symptom of ear- ^cris. ^^ ache, head-ache, epilepsy, otitis, cephalitis, and fevers of various ing. . . ' ■> f f Ji r Found as a Kinds. symptom in The sensation -is sometimes so keen as to render intolerable the various dis- . . eases. whisperings of a mere current of air in a room, or the respiration sensation of persons present, while noises before unperceived become highly j°t'„fjj™be£ distressing. keen- I have at this moment before me a most impressive description of ^u'8ti£?e5. this effect, in a letter from a young lady of about twenty-eigbt years of age, of an irritable habit, great genius, and a highly cultivated mind, who about a twelvemonth ago was attacked with a cephalitis which proved severe and alarming. The brain has hereby been weakened, but the mental powers are rendered more acute ; and the external senses, especially those of hearing and seeing, strangely sympathize with each other. " You think me," says she, in this letter, " unfit for study, but study 1 must, whether I am fit for it or not, otherwise my mind preys upon itself, and no power can prevent my thinking, which is almost as bad as reading. Last night I was kept awake for some hours by so powerful an excitement of the brain that I really thought it would have taken away my senses. The pain i3 very acute, but I do not mind that so much as the distraction which accompanies it. It usually comes on with a most painfully quick hearing. I feel as if the tympanum was stretched so tight as to make the least sound appear almost as loud as thunder; and a loud noise is just as if I received a blow quite to the centre of the brain. This really is not imagination but actual sensation. More- fy'^f^y over a noise affects my eyes so much that I am obliged to darken my with the room when at any time I am under the necessity of hearing any 1*^1° thing like a noise: a loud sound affects my eyes, and a strong light my ears. They seem to act reciprocally. My head is certainly not so bad, nor any thing like it, as it was at Clifton, but still the sudden attacks I have from over-exertion ofthe mental powers, or upon any other excitement, make me always fearful I shall lose my senses." Injections of warm water, or a few drops of almond oil dropped RreJ^a' into the ear will occasionally succeed in affording relief, by relaxing the spastic tone of the vessels. But cold water, and cold applica- tions about the ear, and even pounded ice where there is no tendency to a periodic rheumatism, by directly inducing torpitude, will at times, have a better effect: laudanum may also be introduced into the ear, and a blister be applied to its immediate vicinity. * Sepulchr. Lib. I. Sect. xix. add. Obs. 7. 166 ex. iv.j NEUROTICA. [okd. n SPECIES II. PARACUSIS OBTUSA. HARDNESS OF HEARING. HEARING DULL AND CONFUSED ; AND DEMANDING A CLEAR AND MODULATED ARTICULATION. GEM. II. Spec. II. Causes. Nervous deafness, what. Found as a symptom in various Sometimes produced by imper- foration. Sometimes by insects. Medical treatment. Hearing trumpet. Principle of its action. This may proceed from organic defect; from local debility, in which case it is called nervous deafness ; or from some accidental obstruction in the external tube or passage, as that of mucus, wax, sordes, or any other extrinsic body: or, in the internal or Eustachian tube, from mucus, inflammation, or ulceration and its consequences. It is also found occasionally as a symptom or sequel in various fevers, in hemiplegia, apoplexy, otitis, lues, and polypous caruncles or con- cretions in the passage of the ear : and has followed on drinking cold water during great heat and perspiration of the body, of which several examples are given in the Ephemerides of Natural Curiosi- ties. Among the cases of organic defect one of the least common is atresia, or imperforation : yet Albucasis* gives us an instance of this, as does Bartholinet and Henckel.J And among the more singular obstructions of an accidental kind may be mentioned insects and the grubs of insects or worms. Bartholine mentions a leech which was once found to have burrowed in the ear : and Walker a small stone which had unaccountably become lodged there and was discharged by a fit of sneezing. § The cure must depend upon the nature ofthe cause. All foreign bodies must be carefully removed or destroyed, and the cavity ofthe ear be washed by means of a syringe. Accumulations of wax may be softened by oil of almonds and alkohol, which will dissolve what- ever resinous part it possesses ; and a like inunction will be found the best means of destroying insects. Atonic or nervous deafness will often bid defiance to our utmost exertions : but it will sometimes yield to local stimulants and tonics ; of the former, are alkohol, ether, camphorated spirits, essential oil of turpentine combined with olive oil, and the tinctures of the gum-resins, as myrrh, amber, kino, balsam of Tolu, and blisters about the ear. Of the latter, cold water, and solutions of alum, white vitriol or other metallic salts. Where hardness of hearing is habitual and cannot be radically cured, we can only endeavour to diminish the evil by advising a hear- ing trumpet, which is, in fact, an instrument formed upon the prin- ciple of imitating the cavities of the labyrinth of the ear itself, and the object of which is to collect a large body of sonorous tremors, and send them to the tympanum in a concentrated state, by means * Vide Marcell. Donat. Lib. vi. Cap. 11. p. 619. f Hist. Anat. Cent. vi. n. 36. - ISAnmerk. i. 6 Obsery, Medico-Ihirurg. xx. 8vo, lllh •L.iv.j NERVOUS FUNCTION. [ord.h. 167 ed most ad- vantageous- of a convergent tube, or, in other words, to increase as much as Gen. II. possible the vibratory power of the sound. Now sound is well p™^!' known to be propagated in straight lines, and hence persons partially obtusa. deaf will always hear most* distinctly when directly opposite the hewing!8 °' speaker. For the same reason the trumpet itself should be formed as nearly as possible in a straight line ; though we are sometimes, for the sake of convenience, obliged to deviate from this direction, and to bend the tube into the segment of a circle, by which some degree of power is always lost. The metal of which the tube is How form- made should be that which is found most sonorous, or, in other words, which most completely reflects, instead of absorbing, the lv sound ; and while the funnel or larger aperture is as wide as possible, the extreme end of the pipe cannot be too small. M. Itard has found that a parabolical figure has no advantage over a conical or pyramidal tube ; but that the tube is assisted in producing distinct- ness of sounds by an insertion into it of slips of gold-beater's leaf, at proper distance, in the manner of partitions.* SPECIES III. PARACUSIS PERVERSA. PERVERSE HEARING. THE EAR ONLY SENSIBLE TO ARTICULATE SOUNDS WHEN EXCITED BY OTHER AND LOUDER SOUNDS INTERMIXED WITH THEM. This is a very extraordinary hebetude of the organ, though it has Gen. h. occasionally been met with in most countries. Where it exists, the fh^io'ioJv. ear, as in other cases of imperfect hearing, requires to be roused, in order to discriminate the articulate sounds addressed to it, but finds the best excitement to consist in a great and vehement noise of al- most any kind.j It consists, according to Sauvages, who seems to Cause ami judge rightly concerning it, in a torpitude or paresis of some parts disease. of the external organ which, in consequence of this additional stimu- lus, convey the proper sounds addressed to them beyond the mem- brane of the tympanum, in the same manner as the drowsy or those who are sluggish in waking, do not open their eyes, or admit the light to the retina unless a strong glare first stimulates the exterior tunics. It seems, however, sometimes to depend upon an obstruc- tion of the Eustachian tubes. Under the influence of this species it occasionally happens that Some particular sounds or noises prove a better stimulus than others, though t°(U"timu-" equally loud or even louder; as the music of a pipe, of a drum, or ^1"ergthan of several bells ringing at the same time. Holder relates the case illustrated. * Traite de Maladies de l'Oreille et de l'Audition. 2 Tome?, Paris, 1821. + Feiliz in Riditer Chir. Bibl. Band, ix. p. .M5, ib> CL. IV.] NEUROTICA. [ORD. li. Gen. II. Spec. HI. Paracusis perversa. perverse hearing. Mode of treatment. Stimulus of sound adapted to the exigen- cy. may prove a perfect cure. Illustrated. Voltaism. Genet h1 and loc: and tonics of a man who never heard but when he was beating a drum ;* and Sauvages a similar case of a woman who, on this account, always kept a drum in the house, which was constantly played upon while she was conversing with her husband. The latter gives another case of a person wljo was always deaf except when travelling in a by a violent fever, or a flash of lightning, so has deafness from atony, which often approaching to paralysis, been recovered by a like fever or a thun- der-clap ;§ ordinary causes being thus transferred into extraordinary modes of cure. Among the stimulants most useful, where the deafness is depen- dent upon debility of.the membrane ofthe tympanum, or the nerve of hearing, have been the aura of voltaic electricity, applied two or three times a-day for half an hour or longer each time, and persevered in for many weeks ; a series of blisters continued for a long period, and a diluted solution of nitrate of silver. Yet a chronic ulcer form- ing in the ear, and discharging plentifully, has often proved more effectual than any of these. Mr. Gordon, in the Edinburgh Medical Commentaries, relates a case of total deafness produced suddenly on a soldier in good health, by plunging overhead into the sea : which, after a long routine of medicines had been tried in vain for three months, yielded to the use of mercury as soon as the mouth began to be affected. A gentle sali- vation supervened, his hearing was gradually restored, and in six weeks from its commencement he returned to his duty perfectly cured.|| Explained. The excitement of the salivary glands seems, in this case, to have extended by sympathy to the Eustachian tubes, or whatever other parts of the organ of hearing were diseased. Uienmem-of When the Eustachian tubes are imperforate or irrecoverably branatym- closed, which may commonly be determined by an absence of that stuuteinub" sense of swelling in the ears which otherwise takes place on blowing l!oTof0the the n0Se V1°!'"nt,y' Riolanus,and afterwards Chisselden, proposed a Eustachian substitute for the canal by making a small perforation through the tube. membrane of the tympanum; and Sir Astley Cooper has boldly put their recommendation to the test. The artificial opening does not destroy the elasticity of the membrane, and it has hence been occasionally attended with success ; and perhaps would be always, * Ut supra. t Engraved Representation of the Anatomy of the Human Ear, &c. Hull 182S I kSs^'i^p.1?^-Nat-Cur-Dec- ••A- - <*-»" ' || Edin. Med. Com. Vol. in. p. 80. becjme causes. Mode of. treatment- Voltaic electricity. Blisters. Solution of nitrate of silver Chronic ulcer. Case of cure by salivation Its proper limitation, CL. IV.] NERVOUS FUNCTION. [ord. h. 173 if it were to be limited, as M. Itard* has shown it ought to be, to a Gen. II. permanent obstruction ofthe Eustachian tube, unaccompanied with ParacUSi3 " inflammation, or any other cause of deafness. And it is from a Dueradf^gs; wanton application of this remedy to other cases, that it has so often Treatment. been tried in vain since Sir Astley Cooper's successful sanction. ta* °n,pu°seed less and wanton em- ployment. GENUS III. PAROSMIS. MORBID SMELL. SENSE OF SMELL VITIATED OR LOST. This is the parosmia and anosmia of many writers ; from -tcxpu, G«j»- ™- •' male," and o£w, ^olfacio," analogous with paracusis and parop- and generic sis : anosmia, however, will not include one of its species, and the derivation. present termination is preferred on account of its analogy with that of the parallel terms. Under this genus may be arranged the three following species : 1. PAROSMIS ACRIS. ACRID SMELL. 2._________OBTUSA. OBTUSK SMELL. 3.---------EXPERS. WANT OF SMELL, SPECIES I. PAROSMIS ACRIS. ACRID SMELL. -MELL PAINFULLY ACUTE OR SENSIBLE TO ODOURS NOT GENERALLY PERCEIVED. Generally speaking, the sense of smell in all animals is in pro- Gen. III. portion to the extent of the Schneiderian or olfactory membrane pf,^,;*; with which the nostrils are lined, and over which the branches of the olfactory nerves divaricate and ramify. And hence this mem- brane is much more extensive in quadrupeds and birds, which chiefly trust to the sense of smell in selecting their food, than in man ; for it ascends considerably higher, and is, for the most part, possessed of numerous folds or duplicatures. It is hereby the hound distin- guishes the peculiar scent thrown forth from the body of the hare, * Traite do Maladies de l'Oreilles et de 1'Audition, &c. 2 Tomes. Paris- 1P2' 174 cl. rv.l NEUROTICA. [°*i>- «■ j • Gen. HI. and the domestic dog recognises and identifies his master from all Parosmia other individuals. Acris- Yet the nerves of smell are not only spread in great abundance olfactory ' over the olfactory membrane of all animals possessing such an ne^r organ, but they are distributed so near the surface as to be almost naked. naked ; and hence in every class they are easily and hourly excited easily sti-6 into action, being covered with little more than a layer of bland, mulated. insipid mucus, thin at its first separation, but gradually hardening by the access of air into viscid crusts, and which is expressly secreted by the finest for the purpose of defending them. From this nearly naked state Trnpaipabiy it is that they are stimulated by aromatics, however finely and impal- puiverized. pably divided: whence the violent sneezings that take place in many persons in an atmosphere in which only a few particles of and rapidly sternutatories or other acrid olfacients are floating : and hence also sympathy the rapidity with which a sympathetic action is excited in the neigh- fn^reftesh- houring parts or in the system at large, and the refreshment which is ment. felt on scenting the pungent vapour of carbonate of ammonia, or vinegar, or the grateful perfume of violets or lavender, in nervous Hence also head-aches or fainting-fits. The fetid odours are well known to anVexfen- affect the nostrils quite as poignantly as the pleasant; and to produce siveeffect quite as extensive a sympathy: and hence the nausea, and even odours. intestinal looseness which often follows on inhaling putrid and other offensive effluvia. Under pe- Under peculiar circumstances, however, the ordinary apparatus for cumstances smell possesses an activity, and sometimes even an intolerable keen- becomeg3 ness, which by no means belongs to it in its natural state. M. Virey, exquisitely who has written a very learned treatise upon the subject of odours, Said'to be asserts that the olfactory sense exists among savages in a far higher keener degree of activity than among civilized nations, whose faculty of smell union** sn~ • vages=than is blunted by an habitual exposure to strong odours, or an mtricate naYions*1 combination of odours, and by the use of high-flavoured foods. And and why. he might have added that this sense, like every other, is capable of cul- smeif Uke tivation, and of acquiring delicacy of discrimination by use ; that sava- ca abhfof Sesi many of whom make an approach to the life of quadrupeds, employ cultivation: it, and trust to it in a similar manner ; and that this is, perhaps, the reliedfupon chief cause of the difference he has pointed out. It is in like manner by those relied upon by persons who are deprived of one or two of the other -deprived of external senses, as those of sight or hearing, or both : not merely in hearing consequence of more frequent employment, but from the operation of the law we have already pointed out, that where one of the exter- nal senses is destroyed, or constitutionally wanting, the rest, in most cases, are endowed with an extraordinary degree of energy, as though the share of sensorial power, naturally belonging to the defective organ, were distributed among the rest and modified to their re- striking spective uses. One of the most interesting examples that I am ofathisre-n acquainted with of this transfer of sensorial power is to be found in mark- the history, first given to the public by Mr. Dugald Stuart, of James Mitchell, a boy born both blind and deaf; and who, having no other senses by which to discover and keep up a connexion with an exter- nal world than those of smell, touch, and taste, chiefly depended for information on the first, employing it on all occasions, like n cl. iv.| NERVOUS FUNCTION. [ord. n. lvo domestic dog, in distinguishing persons and things. By this sense Gen. III. he identified his friends and relatives ; and conceived a sudden paf0^mls attachment or dislike to strangers according to the nature of the ™*j* effluvium that escaped from their skin. " He appeared," says Mr. smell. Wardrop, who has also published an account of him, " to know his relations and intimate friends by smelling them very slightly, and he at once detected strangers. It was difficult, however, to ascertain at what distance he could distinguish people by this sense; but, from what I could observe, he appeared to be able to do so at a considerable distance from the object. This was particularly striking when a person entered the room, as he seemed to be aware of such entrance before he could derive information from any other sense than that of smell. When a stranger approached him he eagerly began to touch some part of the body, commonly taking hold of his arm, which he held near his nose ; and after two or three strong inspira- tions through the nostrils, he appeared to form a decided opinion concerning him. If it were favourable, he showed a disposition to become more intimate, examined more minutely his dress, and expressed, by his countenance, more or less satisfaction. But if it happened to be unfavourable, he suddenly went off to a distance with expressions of carelessness or disgust."* The Journal des Sgavdns for 1667, gives a curious history of a ^>o^ monk who pretended to be able to ascertain, by the difference of qualities odour alone, the sex and age of a person, whether he were married J^enaina- or single, and the manner of life to which he was accustomed, bieby this This, as far as the fact extended, may possibly have been the result exquisitely of observations grafted upon a stronger natural sense than belongs keen- to mankind in general; and is scarcely to be ranked in the list of diseased actions. But among persons of a highly nervous or irri- ^t"rceeS8°/t|_n table idiosyncrasy, I have met with numerous instances of an acute- iy acute, ness of smell almost intolerable and distracting to those who laboured ^Jffi^ under it; which has fairly constituted an idiopathic affection -T and persons of sometimes nearly realized the description of the poet, in making its habit: possessors ready at every moment to f^ted^e"- ..... . .. neath the Die of a rose in aromatic pain. smeI) of a Mr. Pope seems to have written this line as a play of fancy at the gcrfb'edV" lime, but the writings of various collectors of medical curiosities ^edp. abundantly show that he has here described nothing more than cription an occasional and sober fact. Thus M. Orfila gives us an account ™^™$f' of a celebrated painter of Paris of the name of Vincent, whoofitscor- cannot remain in any room where there are roses without beingrec nes|' in a short time attacked with a violent cephalasa succeeded by fainting.! And M. Marrigues informs us that he once knew a sur- geon who could not smell at a rose without a sense of suffocation, which subsided as soon as the rose was removed from him ; as he also knew a lady who lost her voice whenever an odoriferous nosegay was applied to her nostrils.J * History of James Mitchell, a boy born blind and deaf, &c. By James Wardrop, F.R.S. Ed.4to. 1813. , „, . ._„ * s,,r les Poisons, Tom. n. Cl. v. § 972. * Journ. de Physique, year 1780- 176 cl. iv.J NEUROTICA. LoKU- vu Gen. III. Spec. I. Parosmis acris. Acrid smell- Singular effect of the odour of pinks: like effect of the odour of linseed. Predispo- nent cause of the pre- sent spe- cies. Occasional causes. Sometimes a result of idiosyn- crasy. Often found as a symp- tom in va- lious dis- eases. Medical treatment. We have observed that a keen stimulation of the olfactory nerves is often productive of a very powerful sympathetic action in other organs. There are few persons who, on inhaling the fine particles of black hellebore and colocynth, while in the act of being pounded, would not feel their effect on the intestines by a copious diarrhoea ; but where the acuteness of smell exists which constitutes the present disease, whether limited to particular odours, or extending to all odours equally, the sympathetic action is sometimes of a very singu- lar description. M. Valtain gives the history of an officer who was thrown into convulsions and lost his senses by having in his room a basket of pinks, of which, nevertheless, he was very fond. The flowers were removed, and the windows opened, and in the course of half an hour the convulsions ceased, and the patient recovered his speech. Yet for twelve years afterwards he was never able to inhale the smell of pinks without fainting.* And M. Orfila relates the case of a lady of forty-six years of age, of a hale constitution, who could never be present where a decoction of linseed was pre- paring without being troubled in the course of a few minutes after- wards with a general swelling of the face, followed by fainting and a loss of the intellectual faculties ; which symptoms continued for four and twenty hours.| The predisponent cause of the species before us is a nervous 01 irritable habit. The occasional causes are local irritation from a slight cold, in which the contact ofthe air alone, as inhaled, often produces sneezing; or excoriation of the mucous membrane of the nostrils from the use of sternutatories in those not accustomed to them. It is often the result of idiosyncrasy ; and perhaps at times, as in para- cusis acris, of a superfluous distribution of olfactory nerves. As a symptom it is often found in opthalmia and rheumatic heimcrania. Where the disease is connected with the habit, the nervous excite- ment should be diminished by refrigerants and tonics, as the shower- bath, bark, acids, neutral, and several of the metallic salts. And where it is chiefly local, we may often produce a transfer of action by blisters in the vicinity of the organ : or relax the Schneiderian membrane, and moisten its surface by the vapour of warm water. The sniffing up cold water will also prove serviceable in many in- stances, by inducing torpitude at first and additional tone afterwards. Dr. Darwin advises errhines for the first of these purposes, that of exhausting the excitability and blunting the sense. * Hygiene Chirurgicale, p. 26. t Sur les Poisons, loc. citat. c iv.J NERVOUS FUNCTION joflo, 11. 17? SPECIES II. PAROSMIS OBTUSA. OBTUSE SMELL. SMELL DULL, AND IMPERFECTLY DISCRIMINATIVE. This is often a natural defect, but more frequently a consequence Gen. in. of an habitual use of sternutatories, which exhaust, weaken, and <^PE?'n" . /.hi sometimes torpify the nerves of smell, as long exposure to a strong light a natural weakens and impairs the vision, and sometimes destroys it alto- sometimes gether. To those unaccustomed to sternutatories, the mildest snuffs Produced will produce such an excitement as is marked by a long succes- free use of sion of sneezing, which is nothing more than an effort of the reme- Jie™ulat0" dial power of nature to throw off the offending material; while those illustrated. who have habituated themselves to snuff for years, can hardly be excited to sneeze by the most violent ptarmics. The evil is here so small that a remedy is seldom sought for in Remedies idiopathic cases : and in sympathetic affections, as when it proceeds sought for i from catarrhs or fevers, it usually, though not always, ceases with wh«n .svm* the cessation of the primary disease. It is found also as a symptom usually' in hysteria, syncope, and several species of cephalaea, during which temDorary- the nostrils are capable of inhaling very pungent, aromatic, and volatde errhines, with no other effect than that of a pleasing and refreshing excitement. Where the sense of smell is naturally weak, or continues so after When catarrhs or other acute diseases, many of our cephalic snuffs may "o^eumes be reasonably prescribed, and wdl often succeed in removing the.reli«v«d by hebetude. The best are those formed of the natural order verticil- snuffs.1" latae, as rosemary, lavender, and marjoram ; if a little more stimulus be wanted, these may be intermixed with a proportion of the teu- crium Marum; to which, if necessary, a small quantity of asarum may also be added ; but pungent errhines will be sure to increase instead of diminishing the defect. Vox. IV.—2b lib CL. IV.j NEUROTICA (OKI). II. SPECIES III. PAROSMIS EXPERS. WANT OF SMELL. TOTAL INABILITY OF SMELLING OR DISTINGUISHING ODOURS. Gen*. HI. Tuis species is in many instances a sequel of the preceding ; for sometimes wnatever causes operate in producing the former, when carried to an a sequel of extreme or continued for a long period, may also lay a foundation for ceding'spe-tne latter. But as it often occurs by itself, and without any such in- £ieB- . troduction, it is entitled to be treated of separately. It offers us the idiopathic two following varieties : « Organica. From natural defect, or accidental Organic want of smell. lesion, injurious to the structure of the organ. /3 Paralytica. From local palsy. Paralytic want of smell. a p. expers The first variety occurs from a connate destitution of olfac- Organic'' tory nerves, or other structural defect; or from external injuries of Ymeiu* various kinds : and is often found as a sequel in ozamas, fistula lachry- How pro- malis, syphilis, small-pox, and porphyra. The second is produced jjp?expera DF neglected and long continued coryzas, and a persevering indul- paraiytica. gence in highly acrid sternutatories. want of The author once knew a very beautiful and elegant young lady How'pro- wno nad fr°m birth so total a want of smell, as not only to be inca- duced. pabie of perceiving any difference in the odours of different per- the disease fumes or flowers, but of sweet and corrupt meats ; and who could from birth, inhale very powerful errhines without sneezing. Though this affec- tion seemed to have been connate, and dependent upon a natural destitution of the nerves of smell, the Schneiderian membrane had something of the thickening which is ordinarily produced by catarrhs, and the lady always spoke as though under the influence of a slight cold. Mode or When this affection is a sequel of local irritation, as from a corvza treatment. „ . , , . M /••/... ^V"J'"* or catarrii, warm stimulating vapours, as of vinegar or frankincense, are often useful. If produced by syphilis the fumes of cinnabar may be inhaled by the nostrds ; or a sternutatory may be used composed of turbeth mineral and ten times the quantity of any mild and light powder, as orris-root. ci. iv.j NERVOUS FUNCTION. 4oni>. ii. 179 GENUS IV. PARAGEUSIS. HORBID TASTE. SENSE OF TASTi: VITIATED OR LOST. Parageusis is derived from nxex, " male," and yevu, i: gustum Gen. IV. preebeo," whence ■xxpxytva, and consequently nxexyeva-n. The author 2o8generi<- has preferred, with Vogel, the present termination to parageusia, as term. analogous to the names ofthe preceding genera of the order before us. ynonym3' In the senses of taste-and smell there is a considerable association, Association partly perhaps resulting from the proximity of their organs and partly thVsenses from an affinity in the modification ofthe sentient fluids with which °f ,taete„ 1 • • i i an" sr^R"• they are supplied. I he young lady I have just noticed who was illustrated destitute, or nearly so, of the sense of smell, was equally destitute of that of taste, and could not distinguish by this criterion between beef, veal, and pork ; and consequently in respect to all these had no preference. The chief organ of taste is the tongue, but this is not the only Tongue no* organ, nor is it absolutely necessary for an existence of the sense. thougVthe The Philosophical Transactions give us examples of persons who of't^te'23" possessed a perfect taste after the tongue had been wholly destroyed ; as taste has and Professor Blumenbach, in his Comparative Anatomy, affords us whenthe a similar example in an adult whom he visited, and who was born tongue fias • been Jos? without a tongue. Consonant with which many insects appear to or never' have a faculty of taste, though they have no organ of a tongue : and |*'ml|dan-.. among these the gustatory function is supposed by Professor Knoch mais ap- to be performed by the posterior pair of palpi or feelers. While, on hive a the other hand, there are many animals possessing a tongue who do {*°*ecji^f, not use it as an organ of taste. All birds possess a tongue, for even have no the pelican, which has been said to be tongueless, has a rudiment of othM^ni- this member : yet there are but few birds, comparatively, that taste ma]s v>s- or are able to taste with this organ. Parrots, predaceous and swim- tonguf do ming birds are an exception to this remark ; for they possess a soft "f'T'iu, thick tongue, covered with papillae, and moistened with a salivary an organ of fluid, and select that food which is the most agreeable. Yet in by Fcw'birdc far the greater proportion of birds we do not find the tongue appro- "?us eIr- priated to this purpose. In many of them, indeed, it is stiff, horny, and destitute of nerves. The tongue of the toucan, though some- Toucan, times several inches in length, is scarcely two lines broad at its root: it has throughout the appearance of whale-bone, and its margins are fibrous. The tongues of the woodpecker and cock of the woods Wood- are equally hard and horny : in themselves they are short, and in a cocVor .th« quiescent state, lie backward in the mouth, and are covered with a wood3'- -*ort of sheath issuing from the os hyoides or the esophagus : lvi* they ISO NEUROTICA |viu>. u Chame Icon. The tongue when an organ of taste stud- ded with papillae: covered with a fine Ewreu1^' P03sess a mechanism which renders them extremely extensile, and MaorrhSidUals" capable of being thrust forward to a considerable distance. 1 hat taste. Qf tjje WOodpecker is sharp-pointed with barbed sides, and is darted with great rapidity out of the mouth to an extent of some inches ; by which means it follows up such insects as the animal is in pursuit of, through all their crannies in the bark of trees ; sticks thcin through with its apex, and in this state drags them out for food. The cha- meleon has a tongue of a somewhat similar kind, which, in like manner, answers the purpose not of taste, but of preying for food. It is contained in a sheath at the lower part of the mouth, and has its extremity covered with a glutinous secretion. It admits of being projected to the length of six inches ; and is used in this manner by the animal in catching its spoil, and especially in catching flies. It is darted from the mouth with wonderful celerity and precision ; and the viscous secretion on its extremity entangles minute animalcules, which constitute another portion of its food. The tongue, when it forms an organ of taste, as in man, is studded, and especially on its upper surface and lateral edges, with innume- rable nervous papilla? issuing from a peculiar membrane that lies beneath, and has a near resemblance to the skin in other parts, but is softer and more spongy. Its external tunic or cuticle is an exquisitely epithelium, fine epithelium, which is moistened, not by an oily fluid, like that of the surface of the body, but a peculiar mucus which proceeds from the foramen caecum of Meibomius, and the rest of the glandular expansion of Morgagni. Hence We have here, therefore, a more exquisite sense of touch than on bierofBtouch the general skin, whose papillae are not only smaller but dry. than^the There can be no question, also, that the sentient fluid with which t^skin0 they are supplied is differently modified from that of the skin ; and fluid^ffer- nence the provinces of the two senses, though they occasionally entiy mo- approach each other, are still kept distinct; and the tongue becomes a discerner of certain qualities, which the skin cannot discriminate : as sour, sweet, rough, bitter, salt, and aromatic. Thus much we know; but we do not know the cause of that different effect, or, in other words, of that variety of tastes which Tr^'sk? °f different substances produce upon the papillae of the tongue, and cannot. which constitute their respective flavours. It was supposed by the wuse'ofdi- Epicureans, and the doctrine has descended to the present day, that flavou s°f a11 tIlis l,?Pends uPon the geometrical figure of the sapid corpuscles ; unknown, arid particularly so with respect to saline bodies, which are cubic t^Epicu- in sea-salt, prismatic in nitre, and equally diversified in vitriol, sugar, reansstill and other crystals. It is sufficient, however, to annul this explana- tion" fion .to observe, that many crystals of very different forms are alike insipid ; while others of the same, or nearly the same, shape, possess very different flavours ; as also that the flavour in any of them con- tinues the same even where we are able to change the figure ; as, for example, by rendering common nitre cubical. The cause of flavours, therefore, appears to reside in the elementary principles of substances that lie beyond the reach of our senses. But the variable condition ofthe peculiar covering of the papilla: the 3tate of of the tongue, together with thr condition of the ndioinin» it!?elf but animals which are destitute of such collateral aids, and have to an agree- depend upon their instinct alone, distinguish flavours, as we have 1x^0%. already observed they do smells, with a far nicer accuracy than man- auadm- kind; and, admonished by this correct and curious test, abstain mollis-a more cautiously than man himself from eating what would be inju- criminating rious. And hence herbivorous animals, whose vegetable food grows well as often intermixed with a great diversity of noxious plants, are fur- ^an'-'and nished with much longer papilla?, and a more delicate structure of hence the tongue than mankind, as they are endowed also with a more [h??u'ish 1S* accurate sense of smell; both which, indeed, they jointly rely upon "r"^1,rive-> for the same purpose. sonous The sense of taste, therefore, which possesses so close an analogy chimin. to that of smell, is subject to a similar train of specific diseases, and termixed. consequently the genus parageusis must contain the three following species: 1. PARAGEUSIS ACRIDA. ACRID TASTE. 2. -------- OBTUSA. OBTUSE TASTE. fi. ■ '■■ ■ ---- EXPERS. WANT OP TASTE. Ib2 CL. IV. j NEUROTICA [ORP. II. SPECIES I. PARAGEUSIS ACRIDA. ACRID TASTE. TASTE PAINFULLY ACUTE OR SENSIBLE TO SAVOURS NOT GENERALLY PERCEIVED. Gen. IV. Spec. I. Sense of taste im- proveahle by use: and ex- hausted by labour. Morbid acuteness of taste distinct from ac- curacy of taste. Causes, a morbid or excessive secretion of sensorial Jluid ; and .1 de- ficient se- cretion of lubricating mucus. Both causes sometimes co-exist. Mucus sometimes acrimoni- ous when secreted: The sense of taste, like that of sight, smell, or hearing, is capable of acquiring a higher degree of accuracy by use : and hence those who are in the habit of tasting wines by this organ, perceive a variety of flavours, or modifications of flavour, which another person not versed in such trials, is insensible of. We also perceive that the nerves of taste, like those of every other sense, become exhausted, and consequently torpid, by much labour and fatigue. And hence, the nicest discriminater, after having tried a variety of wines, spirits, or other pungent savours in quick succession, is far less capable of judging concerning them, and has at last little more than a confused perception of gustatory excitement. Morbid acuteness of taste, however, varies essentially from accu- racy of taste: for under particular states of irritation, pungent savours, of whatever kind, give equal pain to the tongue, which at the same time is altogether incapable of distinguishing between them. This painful acuteness may proceed from two causes : a morbid or excessive secretion of sentient fluid, or a deficient secretion of the peculiar mucus that lubricates the lingual papillae ; in consequence of which the latter are exposed in a naked state to whatever stimuli are introduced into the mouth. The former is sometimes found, though for the most part only temporarily, in highly nervous and irri- table constitutions, and especially during a state of pregnancy; the latter in an acrimonious condition of the stomach accompanied with great thirst and a parched tongue. Both these causes, however, very frequently co-exist; as in ulcerated sore throats, or other ex- coriations of the mouth, in which the papillae are in a state of the keenest excitement, while the tongue is sore either from a defective secretion of mucus, or from its being carried off by a morbid and aug- mented action of the absorbents as fast as it is formed. In this state of diseased action, moreover, it not unfrequently happens that the mucus itself is secreted in a morbid and acrimo- nious condition ; and the palate, instead of being soft and smooth, becomes harsh and rugous or furrowed, exquisitely irritable, and intolerant of the slightest touch or the mildest savours. I have sometimes met with this distressing affection, apparently as an idio- pathic ailment, or at least unconnected with any manifest disease of the stomach or any other organ; and seemingly induced by a rheu- matic pain from carious teeth. It is, however, far more frequently a symptom of acrimonious dyspepsy, porphyra, and chronic syphilid cl>iv.] NERVOUS FUNCTION. jord.ii. 183 In treating this affection we should, in the first instance, direct Gen. IV. our attention to the state of the stomach, and clear it of whatever Pafa'geus'is sordes may probably be lodged there. This may sometimes be done acrida. by aperients : but when we are sure of an acrimonious defoedation Medical8 e in this organ, it will be the shortest way to commence with an Emetics!'" emetic. The local symptoms may, in the mean while, be relieved in two Topical ap. ways. First, by changing the nature of the morbid action, or ex- phcat,0DS' hausting the accumulated sentient power by acid or astringent gar- gles, or a free use of the coldest water alone: for which purpose also sage-leaves and acrid bitters have often been employed with advantage. And next, the naked and irritable tongue may be sheathed with mucilages of various kinds, and thus a substitute be obtained for its natural defence. And in many cases both these classes of medicines may be conveniently united. When the affection is a symptom of some other disease, as in the Attention case of syphilis and scurvy, it can only be cured by curing the pri- maVdi"" mary malady. Carious teeth, if such exist, should be extracted ; ^ ™hen and if the palate be rugous or spongy, scarification should be em- tic. ployed copiously and repeatedly. SPECIES II. PARAGEUSIS OBTUSA. OBTUSE TASTE. TASTE DULL, AND IMPERFECTLY DISCRIMINATIVE. This species rarely calls for medical attention. It occurs some- Gen. iv. times idiopathically, and seems to be dependent on a defective sup- So^f'tiJJe*a ply of nerves, or nervous secretion subservient to the organ of taste, idiopathic; I have seen it under this form in various instances ; and, as already nectedwith observed, have found it connected in a few cases with obtuseness of "htuseness smell. The patient has not been altogether without taste or smell, but both have been extremely weak and incapable of discrimination. In the case alluded to at the commencement of this species, the individual could distinguish the smell of a rose from that of garlic, and the flavour of port wine from that of mountain or madeira; but she could not discriminate between the odour of a rose and that of a lily, nor between the taste of beef, veal, or pork, and conse- quently gave no preference to either of these dishes. As a symptom this affection occurs in almost all the diseases that Fom* fre- are accompanied with hebetude of smell, as catarrh, hysteria, and aUsymptom. several species of cephalaea. 104 cl. rv.] NEUROTICA. L0BD-u' SPECIES HI. PARAGEUSIS EXPERS. WANT OF TASTE, Gen. IV. Spec. III. Sometimes natural and congenital: and then immedica- ble. Sometimes the result of palsy, and may admit of palliation. A tempo- rary symp- tom in va- rious com- plaints. TOTAL INABILITY OF TASTING OR DISTINGUISHING SAVOURS. As an utter want of smell is sometimes a natural or congenital effect, so in a few instances is an utter want of taste, and unques- tionably from the same cause, an absolute destitution of nerves or nervous power subservient to the gustatory organ. This default is altogether immedicable : as is also for the most part the same when a result of palsy general or local: though here stimulant gargles or masticatories, as mustard-seeds, horse-raddish, pyrethrum, and cam- phor, have sometimes succeeded in restoring action to the torpid nerves. When, however, it occurs, as it sometimes does from a long use of tobacco, whether by smoking or chewing, or of other acrid narcotics, these stimulants will be of no use. In fevers, various exanthems, and inflammations, this species exists temporarily, partly perhaps from a diminished or morbid secretion of sensorial fluid, but chiefly from a conversion of the mucus of the tongue into a dry, hard, or tough and viscid sheath; the lingual absorbents drinking up only the finer parts of the mucus, and leaving the coarser to agglutinate upon the surface of the organ. And where there is much increased heat and action, the epithelium or cuticle of the tongue itself becomes often peculiarly thickened and coriaceous or leathery. Acids, in the form of gargles, are the plea- santest means of removing this morbid substance, but they will often succeed best if rendered viscid and converted into a soap by mixing with them a little almond oil, which may at the same time be sweet- ened with honev. cl. iv.} NERVOUS FUNCTION |wu>. n. 165 GENUS V PARAPSIS. MORBID TOUCH. SEiNSE OF TOUCH OR GENERAL FEELING VITIATED OR L0S1. Par apsis is derived from the Greek terms, -xxpx and x^rro/Mct, Gen. V. '• perperam tango." The common technical name for the genus is the'l^nenc dysesthesia but not quite correctly ; since this word, as we have term :^ already had occasion to observe, is also employed to express morbid differently external sensation of any kind, whether of touch, taste, smell, sight, cordantiy or hearing : while by Dr. Young it is equally applied to one at least applied. of the faculties of the mind, as in dysesthesia interna, which he characterizes as " a want of memory, or confusion of intellect." This genus embraces three species as follow: 1. PARAPSIS ACRIS. ACRID SENSE OF TOUCH OR GENE1 RAL FEELING. 2. ------- EXPERS. INSENSIBILITY OF TOUCH OR GENE* RAL FEELING. 3.-------ILLUSORIA. ILLUSORY SENSE OF TOUCH OR GENE- RAL FEELING SPECIES I. PARAPSIS ACRIS. ACRID SENSE OF TOUCH. I'HE SENSE OF TOUCH PAINFULLY ACUTE OR SENSIBLE TO IMPRESSIONS NOT GENERALLY PERCEIVED. This species of morbid sensibility shows itself under almost in- Jjj*^; numerable modifications : but the four following are the chief: « Teneritudo. Soreness. /3 Pruritus. Itching. y Ardor. Heat. } Algor. Coldness. . . . a P. acris In the first variety or that of soreness there is a feeling ol painful T^entud* uneasiness or tenderness, local or general, on being touched with a sense of degree of pressure that is usually unaccompanied with any trouble- *o= or Vol. IV.—24 186 cl. n-.j NEUROTICA. [ord. ii. some sensation. This is often an idiopathic affection ; but more generally a symptom or sequel of fevers in their accession or first Gen. V. Spec. I. « P. acris Teneritudo. stage, inflammations, or external or internal violence, as strains. Acrid sense . °. of soreness bruises, and spasms or tender- ness. Different circum- stances under which the affection occurs comfort, on what dependent It is not always easy to account for this feeling, and perhaps the Pathology, cause is, in every instance, more complicated than we might at nrst be induced to suppose. It occurs where there is distention of the vessels, where there is contraction of them, and where there i- neither. Wherever it exists, however, it is a concomitant of debili- ty, and may, in many instances, be regarded as the simple pain of Feeling of debility, the uneasiness of an organ thrown off from its balance of ease°and health. The general health of the body depends in a very consider- able degree upon the harmonious co-operation of its respective or- gans ; insomuch, indeed, that this harmony of action, as wc had occasion to observe in the Physiological Proem prefixed to the pre- sent class, was supposed by a distinguished school of ancient philo- sophers, and is still supposed by many physiologists of the present day, to constitute the principle of life itself. Regarded as an univer- sal principle the hypothesis is unfounded, though in many respects beautiful and plausible.* Yet notwithstanding that the life of the animal frame does not altogether depend upon an harmonious co- operation of the whole of the organs that enter into its make, much of the comfort of life has such a dependence ; and we trace the same principle in the minutest and comparatively most trivial parts of the animal functions as manifestly as in the largest and most complicated organs. Where every portion of a member, however subordinate in itself, as a toe or a finger, works well or healthily, disqu?lt°f there is a feeling of ease and comfort, but wherever it works ill or and ten- with difficulty, there is a sense of disquiet, and, under peculiar cir- cumstances, of. tenderness or soreness. A change in the diameter of a vessel whether by dilatation or contraction, provided it be moderate and gradual, is accompanied with no uneasy sensation whatever; but if either be violent or sudden, a feeling of soreness is a certain result, of which we have daily examples in strains and spasms. There may perhaps be no great difficulty in accounting The chief for this : but the more common cause of tenderness is of a different traced and kind, and a cause which often operates when neither of these are described. present though it is often combined with them. amor'bid" In order that evei7 Part of an orga« may play upon every other condition of part with a feeling of ease and comfort, it is well known that through- out the entire system, not only every surface, but every, even the minutest, interstice in the tunics of the minutest vessels, is supplied by a soft and lubricous fluid, which is poured forth by secernents of exquisite subtilty, and having executed its purpose and" become waste matter, is carried off by equally subtile absorbents, and succeeded by a fresh secretion of the same fluid. Now in all cases of external or internal violence these are the ves- of Tiotewl ?T, Cliraactencus. ' ' rL.rv/] NERVOUS FUNCTION. [<■ lines of pungent agony, while from irritation of the lachrymal gland ent branchi the eye weeps involuntarily. In this case we may reasonably suspect e-o^ ^ tfie disease to be seated in some part ofthe superior maxUlary nerve, affecte«u 196 cl. tv.] NEUROTICA. [onv.ii. Gen. VI. Spec. I. Neuralgia faciei. Nerve-ache of the face. Disease has been mis- taken for various others. How dis- tinguisha- ble Cause little known. Sometimes local Exempli- fied. Nature of the disease first pointed out by An- dre and at tacked with success. constituting the second branch of the fifth pair. And it is hence obvious that the radiation of the pain must vary according to the nerves or nervous twigs that are affected. The disease has-been occasionally mistaken for rheumatism, hc- micrania, and tooth-ache : yet the brevity ofthe paroxysm, the lan- cinating pungency of the pang, the absence of all intumescence or inflammation, the comparative shallowness, instead of depth, of its seat, and its invariable divarication in the course of the facial nerves or their offsets, will always be sufficient to distinguish it from every other kind of pain. Of its exciting causes we know but little. It seems sometimes to have been produced.by cold, and sometimes by mental agitation in persons of an irritable temperament. But it has been found in the robust as well as in the delicate, in the middle-aged as well as in the old. In a few cases the irritation has been local, of which Mr. Jeffereys has given a very striking instance in a young woman who, when only six years old, fell down with a tea-cup in her hand, which was hereby broken, one of the cheeks lacerated, and a fragment of the tea-cup imbedded under the skin. The wound healed, though slowly and with difficulty ; the buried fragment of the tea-cup was not noticed, and consequently was not extracted. From an early. period a violent nervous pain returned nightiy, and one side of the face was paralytic. These dreadful symptoms were endured for fourteen years : at the end of which time an incision was made through the cicatrix down upon what was then found to be the edge of a hard substance, and which appeared, when extracted, to be the piece of the tea-cup above noticed. From this time the neuralgia and paralysis ceased ; the affected cheek recovered its proper plumpness, and the muscles their due power.* It is possible, as suggested by M. Martinet, that, as a symptom, it may sometimes occur in what he calls, and perhaps correctly, an inflammation of the nerves, or a thickening of the neurilemma in some particular organ, of which he has given various examples, ac- companied with a reddish or even violet tinge, and studded with minute ecchymoses.t But that this is not the only, or even the ordinary, proximate cause is clear, since in the cases alluded to, pressure upon the part is intolerable, while in idiopathic neuralgia it is commonly consolatory, and considerably diminishes the agony. Andre appears to have been the earliest writer who remarked this painful affection with accuracy ; and he succeeded in removing it permanently by applying a caustic to the infra-orbitary, or maxillary branch of nerves in one case in which a previous division of the nerve by the scalpel, as practised by Marechal, had produced only a temporary cure. Andre, who resided at Versailles, published his account in 1756, whimsically enough intervening it in a treatise on diseases of the urethra. A few unsatisfactory experiments and operations were given to the public in the course of the next fifteen years, chiefly by French practitioners, from which little of real value * Lond. Med. and Phys. Journ. Mar. 1823. p. 199, Memoire surl'lnflammation dee Nerfs, &c. 1324- ul.iv.J NERVOUS FUNCTION. [ord. ii. 197 is deducible. In 1776, Dr. Fothergill, in the fifth volume of Medi- Gen. VI. cal Observations and Inquiries, communicated a very full and elabo- Nc'faigia' rate description and history of the disease : since which time M. J^ h Thouret and Pujol have each published a valuable paper on the ofthe face. same subject, in the Memoirs ofthe Society of Medicine of Paris, £,,!y7e-rds containing various cases collected and described with great minute- scribed by <= ,ii ii i_r a.- tothergill: ness ; and we have already adverted to the more recent publications Dy Thouret of Dr. Meghn and Professor Chaussier. by'sfilSl' It has of late been suspected that in some cases, at least of this dis- and chW ease, the seat of irritation might be at the origin instead of at the ex- g"'t of tremity ofthe nerve ; an idea that has arisen from the powerful sym- ^"{-^"g pathetic action manifested by the eye and the stomach forming the suspected boundaries ofthe chain, upon which subject we shall have to speak at "J^ of large when treating ofthe genus entasia in the ensuing order. " The the nerve. nerves," remarks Dr. Parr, " that supply the eye externally, and the slight connexion ofthe intercostal with the brain, are nearly from the same spot in the cerebrum, and it did not seem improbable, in the case alluded to, that the disease may have really been at the ori- gin ofthe nerve, although felt as usual at its extremity.^ Dr. Parr Hence ar- fe . ' °. , ...-'. , senic tried; was, in consequence, induced to try arsenic, and in one instance, he tells us, with a decidedly good effect. It is also said to have been since found serviceable in a few other cases. In Mr. Thomas's hands, however, we shall presently perceive that it completely failed. Mercury is also reported to have occasionally proved successful, and an^,mer- especially when carried to the extent of salivation ; though in nun e- evenro rous instances it has been tried even to this last effect without any salivat,or- benefit whatever. When about thirty years ago animal magnetism was a fashionable study in France, it was had recourse to for this disease among others, and had its day of favour as a popular remedy.* Of late, Acetje however, neuralgia has been attempted to be cured in France by an external use of acetic ether; while in Germany Dr. Meglin has em- henbane ployed pills composed of the extract of henbane, and sublimed oxyde und zins- of zinc, and according to his own statement with great success. But, beyond controversy, one of the most valuable medicines that Subcarbo-. have hitherto been tried is the subcarbonate of iron, for the first use "ra0l ° of which, so far as I know, we are indebted to Mr. Hutchinson,! who commonly employs it in doses of a drachm three times a day. The instances of success appear to be very numerous, though this also, like all other medicines, has often failed. The action of the iron seems to depend upon its tonic power, the most valuable quality we can desire. But there is another energetic medicine which has Prussic also a fair claim to attention from a very different property—that ofac subduing the sensibility, and this is prussic acid. Mr. Taylor of Cricklade, Wilts, has made repeated trials of this powerful sedative in various cases, and apparently with more rapid relief than is afford- ed by the carbonate of iron. He commenced his career with a drop of Scheele's preparation in twenty-four hours, in divided doses ; but. as he grew better acquainted with the effects of the medicine, he * Edinb. Med. and Surg. Journ. July 1823. * Oases of Neuralgia Spasmodica, Sec. By B. Hutchinson, &c. Svo. Lond. 1823, 19S cl. iv.j ^NEUROTICA. |>k»- **. Gen. VI. Spec. I. Xeuraigia faciei. Nerve- nche of the face. No medi- cine to be depended upon for a radical cure in all cases. Case from Perceval. Occasional palliativon may bo found Time alone works a natural cure if vcorkod at all. Acupunc- ture. Chief radi- cal cure to be found in a division of the af- fected nerves. Interesting case re- lated by *>arwin. gave a drop for a dose at first, and then increased the dose to two drops, repeating it three times a day. In one or two instances he has carried the quantity, by a gradual augmentation, to twenty-four drops a day, in the course of a month's use : and very often to five and six drops a day, by adding a drop to every day's account.* Time alone must determine whether the cures thus obtained will prove as permanent as those effected by the tonic power of the sub- carbonate of iron. To induce ease, however, under any circumstan- ces, and for any period of time, in the midst of so much torment, is an invaluable blessing. In effect, neither narcotics, nor tonics, nor any other class of me- dicines that has hitherto been employed, can be in every case de- pended upon for a radical cure, though some of them, and particu- larly the subcarbonate of iron, are worthy of high commendation. " My father," says Dr. Perceval of Dublin, in his manuscript com- ment on the present author's Nosology, "was subject to neuralgia faciei for several years, and used a variety of medicines without re- lief. He was worse in close damp weather, and much worse when his mind was occupied. At length he had an issue inseited in the nucha, kept his bowels free with James's analeptic pills, and ex- changed a town residence for the country. In this situation he soon throw >ff the disease, from which he was free for a considerable time before his death." Change of scene, a transfer of morbid ac- tion, and a recruited cheerfulness of spirits are valuable auxiliaries in the present as in every other nervous affection : but I much ques- tion whether these alone have ever operated a cure. A sponta- neous cure is the work of time alone ; and time, though often a long and tedious period is requisite, will generally accomplish it, and probably did so in the case before us. The fact is, that the nervous svstem in every part, and every ramification, becomes gra- dually torpefied by excess of action ; and as the eyes grow blind and the nostrils inolfacient by strong stimulants applied to them, so the nervous twigs of every kind, after a long series of irritation from the present disease, become exhausted of power and obtuse in feel- ing : and it is probably by hastening this state that the most active stimulants, and the warmer tonics, produce whatever benefit is to be ascribed to them. How far acupuncture or needle pricking, the zin-kingof the Chi- nese, which we have already described under chronic rheumatism, might be useful, has not yet been determined. It has, at least, a fair claim for experiment, before having recourse to a curative attempt by the knife. This radical cure consists in a division of the affected branches, provided they>can be followed home. Dr. Haigliton completely- succeeded, some years ago, in a case in which he divided the sub- orbital branch of the fifth pair; and Mr. Cruickshank and Mr. Thomas more recently in a case of considerable complication, and where the affection was evidently not confined to the different, branches of any single nerve. This last case is given by Dr. Dar- * Edinb. Med. and Surg. Jtfnrn. July 1823. cl.iv.] NERVOUS FUNCTION. [ord.ii. 199 win, whom the patient had intermediately consulted, in the second Gen. VI. part of his Zoonomia, and is one ofthe most interesting sections of jf^j'J' the work. The patient, a Mr. Bosworth by name, was between Jaciei thirty and forty years of age. When he first applied to Dr. Darwin oMhe'fece! he complained of much pain about the left cheek-bone. Dr. Darwin Disease at suspected the antrum maxillare might be diseased; and, as the se- taken;8" con ' eft'.e ^:i:-. 'r-g teeth had hern litely ext-a^ted, directed a per- foration into the antrum, which was done, and tne wound kept open for two or three days without advantage. Afterwards by friction about the head and neck with mercurial unguent, he was for a few days copiously salivated, and had another tooth extracted by his own desire, as also an incision made in such direction as to divide the artery near the centre of the ear next the cheek, which gave also a chance of dividing a branch of the affected nerve ; but without suc- cess. Internally opiates were administered in large quantity when and niedi- the pain was exceedingly violent: bark being used freely in the in- in vain.6 tervals, but without effect. The pain spread in various directions from a point in the left ?«>&?**of cheek a little before the ear, sometimes to the nose, and forepart of the lower jaw, and sometimes to the orbit of the eye on the same side ; the under part of the tongue being at times also affected. It returned on some days many times in an hour, and continued several minutes ; during which period, it is well worth observing, as showing the connexion between an irregular sensitive and an irregular irrita- tive power in the same muscles, the patient, says Dr. Darwin, seemed to stretch and exert his arms, and appeared to have a tendency to epileptic actions, so that his life was rendered miserable to himself to support, and to his friends to witness. The complaint gradually un'/e^ine0' grew worse, and Ur. Bosworth removed to London for the purpose care of of again putting himself under Mr. CruickshanU's care, and of sub- shank, and mitting to any operation he should recommend. The pain was now Thomas) intolerably acute, and almost unremitting: and opiates afforded him little or no relief though taken to the quantity of six tea-spoonsful of laudanum at a time. The operation of dividing the diseased nerve- was therefore determined upon. " As the pain," says Mr. Thomas in his letter to Dr. Darwin, after and ope- its completion, " was felt more a':ute in the leftala ofthe nose, and ^h partial the upper lip of the same sile, we were induced to divide the second success. branch of the fifth pair of nerves as it passes out at the infra-orbital foramen. He was instantly relieved in the nose and lip ; but to- wards night the pain from the eye to the crown of the head became more acute than ever. Two days after we were obliged to cut Farther through the first branch passing out at the supra-orbital foramen : this submitted afforded him the like relief with the first. On the same day the pain t0, attacked, with great violence, the lower lip on the left side, and the chin : this circumstance induced the necessity of dividing the third branch, passing out at the foramen mentale. During the whole pe- riod, from the first division of the nerves, he had frequent attacks of pain on the side of the tongue ; these, however, disappeared on di- vision ofthe last nerve. ,l The patient was evidently bettered by each operation ; still the 200 cl. rv.] NEUROTICA. [oni>.«. Gen. VI. Spec. I. Neuralgia faciei. Nerve-ache ofthe face. Additional division of nerves, and ulti- mate cure. General remarks. pain was very severe, passing from the ear under the zygoma to- wards the nose and mouth, and upwards round the orbit. 1 his route proved pretty clearly that the portiodura ofthe auditory nerve was also affected, at least the uppermost branch of the pes anserina. Before I proceeded, continues Mr. Thomas, to divide this—Mr. Cruickshank had operated hitherto—I was willing to try the effect of arsenic internally, and he took it in sufficient quantity to excite nau- sea and vertigo, but without perceiving any good effect. I could now trust only to the knife to alleviate his misery, as the pain round the orbit was become most violent; and therefore intercepted the nerve by an incision across the side of the nose, and also made some smaller incisions about the ala nasi. To divide the great branch lying below the zygomatic process, I found it necessary to pass the scalpel through the masseter muscle till it came in contact with the jaw-bone, and then to cut upwards ; this relieved him as usual. Then the lower branch was affected, and also divided ; then the middle branch running under the parotid gland. In cutting this, the gland was consequently divided into two equal parts, and healed tolerably well after a copious* discharge of saliva for several days. 111 hoped and expected that this last operation would have termi- nated his sufferings, and my difficulties ; but the pain still affected the lower lip and side of the nose, and upon coughing, or swallow- ing, his misery was dreadful. This pain could only arise . from branches from the second of the fifth pair passing into the cheek, and lying between the pterygoideus internus muscle and the upper part of the lower jaw. The situation of this nerve rendered the operation hazardous, but after some attempts it was accomplished." This finished the series of operations, and restored the afflicted patient to perfect health. I have dwelt the longer on this interesting case, because it seems to show, first, that there is occasionally no certain cure but in the use of the knife ; secondly, that a delay in performing the operation only affords time for the disease to spread from one branch of the affected nerve to another, and even to different branches of nerves in a state of contiguity: and thirdly, that the disease betrays the spasmodic character of the diathesis when minutely watched, even in cases in which this character is most obscure. Dr. Darwin objects properly enough to arranging this disease as a trismus, u since no fixed spasm," says he, " like the locked jaw exists in this malady." He adds, indeed, that in the few cases he has witnessed, there has not been any convulsion ofthe muscles ofthe face ; but in Mr. Bos- worth's case he has expressly noticed the morbid stretching of the arms, and the tendency to epileptic actions. Its proper place, how- <*vpr. seems to be where it is now arranged. cl. tv.\ NERVOUS FUNCTION. [ord. ii. 201 SPECIES II. NEURALGIA PEDIS. NERVE-ACHE OF THE FOOT. BACKING AND LANCINTAING PAINS RANGING ABOUT THE HEEL ; AND TREMULOUSLY SHOOTING IN IRREGULAR DIRECTIONS TOWARDS THE ANKLE AND BONES OF THE TARSUS. This is the neuralgia plantaris of Professor Chaussier: who men- Gen. VI. tions a very decided case of it, to which Dr. Marino, a physician of |pD^'mIr' Piedmont, had been long subject. It commenced, he tells us, in exemplified. early life ; was relieved by the mineral waters of Vivadio ; and still more by the pressure of a tight bandage. With advancing years it became less severe, the cause of which we have already explained in the preceding species, but never ceased altogether. It alternated with other nervous affections, and was at length complicated with convulsive asthma. In calling the attention of the medical profession to this speeies, ^hfrt°h™ by introducing it into the volume of Nosology, so long ago as the present beginning of 1817, I had my eye directed to a very marked case g^tcldeeB.waa which had then lately occurred to me in a clergyman of this metro- crioed by polis, about forty-five years of age, but otherwise in firm health and the authot' cheerful spirits. He had for many years been a victim to it. The paroxysms were short, and of uncertain recurrence, but so acute as nearly to make him faint, and at length compelled him to relinquish the duties of the pulpit, for which from his zeal and eloquence he was admirably qualified, but where he had frequently been obliged to break off with great abruptness from the unexpected incursion of a fresh paroxysm. The pain usually extended up the calf of the leg towards the knee, and ramified towards the toes in an opposite direction, and was usually compared by himself to that of scalding verjuice poured over a naked wound. The tibial branches of the popliteal nerve, and particularly the plantar twigs, seem in this spe- cies to have been the part chiefly affected, though it is probable that some of the offsets from the peroneal branch associated in some instances in the morbid action. Every therapeutic process that the art of medicine in the hands of Qjj™*™ the most experienced physicians of this metropolis could devise, was vain. in this case tried in a long and tedious succession in vain. Sometimes external and sometimes internal preparations, or a tight ligature, appeared to afford a temporary alleviation, and to protract the inter- vals : but never any thing more. It was in consequence proposed Amputatiou by a surgeon of great eminence to amputate the leg, which was at mended. one time on the point of being submitted to, though protested against °r^dcitionB by the present author, on two accounts. First, the uncertainty whether the morbid condition of the nerv« might not be seated Vn»„ IV.—26 20-2 ll.iv.) NEUROTICA. [ord. u. Gen. vi. chiefly in the origin instead of in the extremity of the nerve ; in which Newafeia case, amputation could be of no avail; and secondly, the chance pedis. that in process of time the keen sensibility of the affected branches oftto'foot! would be worn out and obtunded by the violence of the action. Such was the undecided and miserable condition of this patient at the time of noticing his case on the publication of the author's volume cureef- of Nosology. Since this period, the prediction that the disease f?me.d b7 would gradually wear itself out, has been completed: the paroxysms are now slight and tolerable, and the intervals much longer : and the patient has for nearly a twelve-month been able to resume the dutie9 of his profession without any interruption. SPECIES III NEURALGIA MAMMAE. NERVE-ACHE OF THE BREAST. SHAKP, LANCINATING TAINS DIVARICATING FROM A FIXED POINT IN THE BREAST ; AND SHOOTING EQUALLY DOWN THE COURSE OF THE RIBS AND OF THE ARM TO THE ELBOW ; THE BREAST RETAINING ITS NATURAL SIZE, COMPLEXION AND SOFTNESS. Gen. VI. About the year 1820,1 was requested by Mr. Blair, to examine wiusuation' a y°ung woman, then eighteen years of age, who, for more than two of case on years had been subject to a painful disorder of the breast that seemed "resent1 ° equally to defy all parallel and all mode of treatment. On examining founded'3 *nto *^e nature OI" tne symptoms, I found them as described in the preceding definition. The organ was full-formed, soft, and globular, without the slightest degree of inflammation, or hardness. When the paroxysm of pain was not present it would bear pressure without inconvenience, but during the pain the whole breast was acutely Description sensible. The paroxysms returned at first five or six times in the and pro- _ , , i 1 i . . eress of course of the day, and were short and transient: but as the disease Jj§ disease. became more fixed, it became also more severe and extensive : for the agonizing fits at length recurred as often as once an hour, and '-sometimes more frequently: and from being comparatively concen- trated, the lancinating shoots darted both downward in the course of the circumjacent ribs, and upwards to the axilla, whence they afterwards descended to the elbow, below which I do not know that they proceeded at any time. These fits were at length so frequent and vehement as to embitter her whole life, and incapacitate her from pursuing any employment; for it frequently happened that, if she attempted needlework, her fingers abruptly dropped the needle a few minutes after taking hold of it, from a mixture of pungent pain and tremulous twitching. The twitching or snatches in the shoul- der, for it at length reached to this height, were at one time so con- siderable as to give the patient an idea, to use her own words, that ex. rv.] NERVOUS FUNCTION. [ohd.h. 203 something was alive there ; while, though the lancinating pain did Gen« vj- not descend below the elbow, a considerable degree of trepidation Neuralgia1' reached occasionally to her fingers' ends. Her general health was n2nmmiE- in the mean time unaffected, and she was regular in menstruation. ofeihe~ac I had no hesitation in regarding this as a non-descript species of Gonial neuralgia; and as little in communicating my fears that no plan of health un- medicine we could lay down would be more than palliative, even if Progno^ it should prove thus far beneficial, and that we must trust to time ,ie3' alone for a cure, and that obtuseness of sensibility which I have already noticed as a common consequence of high nervous irritation continued till the organ becomes exhausted and torpified. Every remedial process, was nevertheless, tried in series for the ^dicli * purpose of obtaining relief, if not full success. Bleeding, local and treatm'nf. general, frequently and profusely repeated ; purgatives of all kinds ; tonics and antispasmodics of all kinds ; the hot and cold bath ; elec- tricity and galvanism in every form ; rubefacients, blisters, setons, issues, and whatever else could be suggested, were enlisted into ser- vice in succession. But every thing was equally without avail: nor in every do I know that even a temporary relief was obtained by any of these. "'availing. Narcotics of all kind%proved impotent; drowsiness, indeed, and a comatose stupor were hereby in various instances obtained, but the interval of wakefulness was as much as ever tormented with the same racking paroxysms. From the powerful influence of nux vomica in Failure ot> many cases of nervous affection, to some of which we shall have ca. occasion to advert hereafter, I had some hope of producing a slight impression on the nerves affected: but the hope proved illusory: the patient took it in infusion as far as to about eight grains at a dose three or four times a-day. till her head was intolerably con- fused and every other part became numb, but the paroxysms were intractable. The poor sufferer, whose relations were incapable of affording the resources of private practice, tried one dispensary after another, and at length one of the largest hospitals of this metropolis, without the smallest benefit, and from each was discharged as incurable. About Disease di- six months since, however, being nearly four years from the com Bpon^ane- mencement of the disease at home, and having utterly relinquished ous,y' all medical means, with the exception of a seton under the breast, which was not dried up, she began to think herself rather better, and has continued to improve ever since, till a week ago, when he? mother came to inform me she was worse again. This intelligence greatly surprised me, till I learned that the seton was now quite healed. It has since been opened and there is a hope of her again improving. Thus far was written in the first edition of this work. The Subsequent patient, under the kindness of Sir William Blizard, obtained an concerning entrance into the Margate Sea-bathing Infirmary, and after five or thiscare- six weeks use of the marine-bath returned home—not indeed entirely free from pain, but in comfortable ease, and able to resume the use of her needle. About six months afterwards, however, the complaint returned with as much violence as ever, and again the most power- ful tonics and antispasmodics were tried in vain. The sub-carbonate 201 cl. iv.] NEUROTICA [ORD. II. spec hi of iron'in tlie fuuest doses employed by Mr. Hutchinson, were had Neuralgia' recourse to and steadily persevered in, but to as little purpose as Nerve"*-he every other medicine. She has now again returned to the Margate ofthe Infirmary, where I hear she has again found benefit. In various breast* cases, however, even in this species, I have reason to believe that the iron has proved as successful as in neuralgia faciei. And Dr. Alderson has given another example, in a very striking instance of mammary neuralgia, but in an older and less irritable period of life.* * Cases of Neuralgia Snasmodica, &<*. Bv B. Hutchinson, &c. 8vo. London. ISM, " CLASS IV. NEUROTICA. ORDER III. CINETICA. DISEASES AFFECTING THE MUSCLES. IRREGULAR ACTION OF THE MUSCLES OR MUSCULAR FIBRES : COM- MONLY DENOMINATED SPASMS. Having, in the Physiological Proem to the present class, glanced, Class IV. as far as our space would allow, at the disputed question concern- Ge^ra'11' ing the nature of muscular irritability, or contractility, to adopt the character language of Dr. Bostock, and its affinity with sensorial or nervous °ar fibroin influence, it is now only necessary at present to take a very brief* massy view of the general character and mode of action of muscles as they appear to the naked eye in a massy form, or, in other words, as composed of an almost infinite variety of minute fibres. A muscle thrown into action, increases in absolute weight, in Effects of density, and in power of resistance. It is also said to increase in action'" absolute bulk: but the experiments upon this subject are contra- upon mus- dictory ; the middle or belly of the muscle, indeed, is at this time selves.6"1 evidently-enlarged, but then its length appears to be proportionally diminished. Muscles constitute the cords, as bones do the levers, constitute of the living frame; and in most cases the muscles grow tendi- {he living0 nous, as the bones do cartilaginous, towards their extremities; by ^ame-. which means the fleshy and the osseous parts of the organs of mate the motion become assimilated and fitted for that insertion of the one ^e^asf structure into the other upon which their mutual action depends; tn« latter the extent and nature of the motion being determined by the nature ci°es°at,their of the articulation, which is varied with the nicest skill to answer the extre«)ities. purpose intended. Whether, however, the substance of tendons structure consists of the same fibres as the belly of a muscle but only in a ° ,endo"s state of closer approximation and possessed of finer vessels which do not admit the introduction of red blood, or whether they form a distinct system of fibres, merely attached to those of the muscles, is at present-undecided. It is certain that tendons possess nothing of the peculiar structure of muscles, and seem to be more nearly allied to the simple solid.* ' See Dr. Bostock's Elementary System of Physiology, p. 67, 8ro. 1824, 206 cl. iv.] NEUROTICA. [ord. hi. ClassIV. Ord. III. Cinetica. Diseases affecting the mus- cles. Though more com- pact than muscles often bro- ken by their exertion. Explained Bones sometimes broken in tho same manner. Muscular action pro- duced by a principle peculiar to life : Its force enormous: but over- rated by the me- chanical physicians. Singular examples of miscal cuiation. Law of muscular contrac- tion : as exhibit- ed in the long and circular mtraclee. It appears singular, at first sight, that the tendinous fibres which thus seem to be compacted into a firmer and more substantial cord than those of the muscles, should be sometimes broken by muscular exertion, while the muscular fibres remain uninjured ; yet this un- questionably depends upon their greater rigidity, and, consequently, inability of yielding to the force by which they are opposed. And hence it is that the bones themselves are sometimes broken in the same manner, as by a violent jerk, or a sudden and spasmodic con- traction, of which we shall presently meet with examples, especially in the patella, the ribs, and the arms. The muscles themselves, however, are occasionally ruptured by a like irregular violence and excess of power, as the recti abdominis in tetanus, and the gas- trocnemii in cramps. Muscular action, then, consists in a mutual attraction and con- centration of the constituent fibres of muscles, in a manner peculiar to living matter, for we cannot imitate it by any combination or action of mechanical fibres. It is not, however, a contraction in every dimension, since in this case the muscular volume would be diminished ; but in length only, attended with a proportional in- crease of bulk, so as to preserve the absolute volume unchanged, or nearly so. It is easy to conceive, from these few remarks, that the force ex- erted by muscular contraction may be enormous ; but by the me- chanical physicians it was calculated in the most extravagant man- ner from premises in many instances wholly chimerical. Thus Borelli estimated the force with which the heart contracts, in order to carry forward the circulation of the blood, to be equal to not less than 180,000 lbs. at each contraction ; while Pitcairn, applying the same speculation to the function of digestion, conceived that this process is accomplished by a muscular exertion divided equally be- tween the stomach and the auxiliary muscles that surround it, amounting in the stomach alone to the force of 117,088 lbs. for which "had he assigned five ounces,'" says Professor Monro, "he would have been nearer the truth."* Yet we do not want these visionary calculations to prove the wonderful power possessed by muscular fibres; the facts we have already adverted to, and others we shall have to notice in the course of the present order, are suffi- cient to establish their astonishing energy, without having recourse to unfounded hypotheses, or exaggerated statements. In general, says Dr. Parr, in a very excellent article upon this subject,! it appears that the force with which a muscle contracts is in proportion to the number of its fleshy fibres, and the extent of the surface to which these fibres are attached ; but its degree of contraction or the extent of its motion is in proportion to their length. The limits of contraction differ in the long and in the circular muscles ; for the former do not contract more than one third of their length, but the circular fibres of the stomach, which in their utmost dilatation may be expanded to a foot in circumfe- rence, may, after much fasting, be reduced to the circle of an inch. • Monro, Comp. Anat. Pref. p. viii. t Med. Diet, in wrb. Musculo, cl. rv.J NERVOUS FUNCTION. [ord. m. 207 It must, however, be added that in circular muscles no fibres pass ClassIV. completely round ; bundles of fibres are collected and end at dif- cmeVica^1* ferent points, while some begin where others end. Each may, Diseases therefore, admit of only a limited contraction, while the dilatation theemu£ just mentioned may be the sum of the whole. cles- The action of muscles is never interim ..ted, and only diminished Action of in the sleeping state ; though where the sleep is profound and never in- lethargic the diminution amounts to almost a cessation, except in 5™^"^ the voluntary organs. When muscles .ire not exercised, the senso- diminished rial or irritable fluid moves forward with an easy flow ; or in the words Bleep.'" of Haller "the vis insita is very slightly exerted ;" but we can still trace its influence by the position which the limits assume and dis- cover the relative strength of the antagonising muscles. Thus we find the flexors stronger than the extensors ; for, during sleep, the head falls forward, and the body, legs, arms, and fingers are slightly bent. The cause of this additional strength is easily explained; ™*y j" ,hi3 for the flexors have stronger and more numerous fibres; their in- flexors sertion is farther from the centre of their motions, and under a ?hTe«eri"C* larger angle, which must increase when flexion has begun. This «>fa. superiority of the flexors bends the fetus in the womb into a round ball. The same superiority of power continues, though in a less degree, after birth, and hence frequent pandiculations are required to give activity and energy to the extensors, which they again lose in advanced age. On awaking from a sound sleep the same yawn- ings and stretchings occur from the same cause: and Bethel fanci- This doc- fully refers the crowing of the cock and the fluttering of his wings [""ym^o?6 to a similar purpose. It is always useful in disease to examine the matoiogy. position of the limbs during sleep, particularly the sleep of children. If they deviate from the ordinary degree of flexure to a more straight position, there is generally some irregularity in the state of tone, and of course in the vital influx. The irritability or contractility of a muscle is a very different power Contractj- from that of elasticity. The latter always depends upon simple re- d'iJtinct6 7 action, and is never a source of actual energy : it merely restores, elasticity. in a contrary direction, the force which had been impressed, and the Compared. effect which it produces can never be greater than the amount of the cause. But in muscular contraction the mechanical effect pro- duced is infinitely greater than the mechanical cause producing it, as when the organ of the heart recently detached from the body just dead is slightly scratched in its inside by a needle, it will contract so strongly as to force the point of the needle into its substance.* But the chief proof of the difference between the two is that the irritable power of a muscle is often excited without any mechanical cause at all, and from the mere influence of the wdl, which has no effect upon the simple elasticity of organs. Hence, while con- tractility belongs to the muscular structure alone, elasticity apper- tains to many other substances as well, whether animal, vegetable, or even metallic. Muscles also have their elasticity, but the prin- ciple is altogether of a different kind, though often confounded with * Fordyce, Phil. Trans. 1783, p. V 20b CL. IV.] NEUROTICA. [ord. III. ClassIV. Ord. III. Cinetica. Diseases affecting the muscles. Tonicity often used synony- mously with elas ticity. Voluntary or animal muscles as contradis- tinguished from invo- luntary or automatic. Distinctive characters. Continuity of action in the invo- luntary muscles and whence de- rived, com- pared with the supply of the vo- luntary muscles. Though more uni- form in their ac tion, still subject to abnormi- ties, espe- cially spasms. Different organs and functions the sub- jects nf dif- ferent kinds of spasmo- dic motions. A few ex- ceptions to the general rule. the preceding by modem pathologists ; and particularly in their use of the term tonicity* which is often employed with little precision, and frequently means nothing more than this common principle of elasticity, to which indeed it seems directly to be applied by Dr. Cullen. The muscles of the body may be divided into two grand classes, voluntary or animal, and involuntary or automatic. In the former we meet with some that are peculiarly remarkable for strength and continuity of contraction, as the greater part of the round muscles ; and others as remarkable for mobility and vacillation ; among which we may place most of the long muscles. These properties are strikingly exemplified in a state of disease, and call for particular attention ; the muscles characterized by mobility presenting exam- ples of atonic or agitatory spasm; while those that are conspicuous for continuity of action are chiefly subject to rigid or entastic spasm. Continuity of exertion, however, is generally less evident in the voluntary than in the involuntary muscles, of which last some organs, as the heart, continue their efforts through life without in- termission ; though all of them relax or remit occasionally or pe- riodically. For this greater permanency and regularity of- action they are indebted to the peculiar provision which has been made for their supply of nervous power ; for while the voluntary muscles are furnished in a direct line from the sensorium, whence indeed the close connexion they hold with it, the control the will exercises over them, and their catenation with the prevailing emotion of the mo- ment : the involuntary muscles are dependent chiefly on the inter- mediate or ganglionic system described in the proem to the present class, and are more remotely connected with the sensorium : they are in consequence far less influenced by the variable impulses of the mental faculties, and are placed beyond the jurisdiction of the will. And hence the tenour of their action is more equable, more permanent, more uninterrupted, and less subject to fatigue or wea- riness. But as these organs are by no means free from the power of injury, or diseased action, they are also subject at times, in common with the voluntary organs, to those abnormal motions which are ordinarily denominated spasms : and it is not a little curious to observe the uniform tendency which different spasmodic affections manifest towards some organs or functions rather than towards others. Thus the vital function, in which the heart and lungs are such prominent agents, is chiefly disturbed by palpitation and syn- cope ; the natural, or that in which the abdominal organs so gene- ral!) co-operate, by hysterics ; and the animal, extending through the range of the voluntary organs, by tetanus and epilepsy. In the prosecution of the present order, indeed, we shall see that this does not hold universally; that epilepsy, for instance, is often a disease rather of the stomach or intestines, than of any other organ, and that the heart is sometimes affected with rigid instead of with clonic * Bostock, Elem. Syst. of Physiology, p. 168, 8vo. 1824 ol.iv.) NERVOUS FUNCTION. [ord.iii. 209 spasm : but the rule holds generally and is not essentially shaken by ClassIV. these casual exceptions. cinftica. Dr. Cullen has contended that in all spasmodic affections the ^eecats£3 brain is the actual seat of disease, and that they consist in some the mus- morbid modifications of its energy. "The scope and purpose ofc'^ien.s all that he has said," he tells us, " is to establish the general propo- j1"*1™0 sition that spasmodic affections, whether they arise primarily in the gpaBnis de- brain or in particular parts, do consist chiefly, and always in part, in Pem^d" an affection and particular state of the energy of the brain : and that state of the operation of antispasmodic medicines must consist in their cor- recting this morbid or preternatural state in the energy of the brain, by their correcting either the state of preternatural excitement or collapse, or by obviating the too sudden alteration of these states." This proposition seems rather to follow from Dr. Cuiien's singular °£«j°£f doctrine concerning the mutable condition of the energy of the trine ac- brain, and the immutable nature of the nervous power which is «°«n,ed propagated from it by vibrations, than from the clear face of facts before us. Spasms, in many instances, are altogether local; they «*™°lse are confined to particular muscles, or particular sets of associate pointed out. muscles, and have no effect on the brain whatever so as to disturb its energy ; of which we have examples in hiccough, priapism, chorea, and often in palpitation. They depend upon some irritation existing not at the origin, but at the extremity of the nerves: and, where such is their source, even though the chain of morbid action should at length reach the brain and affect its energy, as in convul- sions from teething, epilepsy from worms, or some palpitations from ossific or polypous concretions, all the antispasmodics in the world will afford no relief so long as the local cause of irritation continues to operate; while the moment this is removed, where it is capable of removal, as by the use of a gum-lancet or active anthelmintics, all the powers of the brain become instantly tranquillized ; its facul- ties are rendered clear, its energy is re-invigorated, and its motive power or sensorial fluid flows forward in an uninterrupted tenour. The greater number of spasmodic affections therefore, do not so much depend upon the state of the brain as of the living fibres that issue from it, and maintain a correspondence with it; for the stream may be vitiated while the fountain is untouched. We have seen, *J*™Jent indeed, in the proem to the present class, from the concurrent re- iiTusuated. suits of various physiological experimenters, that although, while the organ of a brain exists, it exerts a certain influence over the principle of muscular motion, this principle is far less dependent upon the encephalon than that of general feeling or of the local senses : that it is found abundantly in animals totally destitute of a brain; and that hence, those possessing a brain may be excited not only into abnormal and spasmodic, but even into a continuation or re-production of regular and natural, motions of various muscular organs after the brain has been separated from the spinal chain, by stimuli applied to this chain, or even by the artificial breath of a pair of bellows. , _ ., . We have seen also that the nervous filaments of the muscles are "cand of two kinds, sensific and motific, the former proceeding from the fibres. Vol. IV.—27 210 cl. iv.] NEUROTICA. Lo»»- m- Class IV. Okd. III. Cinolica. DUeases affecting the mus- cles. Spinal chord double. Why often little pain felt during severe tits of tetanus or convul- sions. cerebellum, or the posterior trunk of the spinal chord, to which it gives rise, and the latter from the cerebrum, or anterior trunk of the same double chord : and, as these two sets of filaments do not necessarily concur in the same affection, it is obvious that the mus- cles of a limb, or of the whole body, may be thrown into the most violent agitation, or the firmest rigidity, without much, or perhaps any degree of painful emotion, or increased sensibility. And we can hence readily account for the little complaint that is made by patients upon this subject, on their being freed from a severe paroxysm of tetanus, convulsion-fit, or hysterics. The following are the genera of diseases which will be found to appertain to the present order : I. ENTASIA. II. CLONUS. III. SYNCLONUS. CONSTRICTIVE spasm. CLONIC SPASM. SYNCLONIC SPASM. GENUS I. ENTASIA. CONSTRICTIVE SPASM. IRREGULAR MUSCULAR ACTION PRODUCING CONTRACTION, RIGIDITY, OR BOTH. Gen. I. Entasia is derived from the Greek evrxo-is, " intentio," " vehemen- gen?r1c0f tW " rigor," from evrwa, "intendo." By many nosologists the name and genus is called tonos, or tonus, which is here dropped in favour of explained.y the present term, because tonus or tone is employed by physiologists and pathologists, in direct opposition to irregular vehemence or rigi- dity, to import a healthy and perfect vigour or energy of the mus- cles ; and by therapeutists to signify medicines capable of producing such or similar effects. The genus entasia includes the following species: 1. entasia priapismus. 2. ------- loxia. 2- ----- rhachybia. 4. 5. 6. 7. 3. 9. AETICCLAEIS. SYSTREMMA. TRISMUS. TETANUS. LYSSA. ACFOTis?rr« PRL4.PISM. WRY-NECK. MUSCULAR DISTORTION OF THE SPINE. MUSCULAR STIFF-JOINT. CRAMP. LOCKED-JAW. TETANUS. RABIES. CANINE-MADNESS SUPPRESSED PULSE. CL. IV.] NERVOUS FUNCTION. [ORD. III. 211 SPECIES 1. ENTASIA PRIAPISMUS. PRIAPISM. PERMANENT RIGIDITY AND ERECTION OF THE PENIS WITHOUT CON- CUPISCENCE. The specific term is derived from the name of Priapus, the son of Gen> *• Venus and Bacchus, who is usually thus represented in paintings otfgfn'J' and sculptures, but with a concupiscent feeling. Galen applies the the specific term also to females, as importing a rigid elongation of the clitoris How "used without concupiscence. by GaIen- Spasm is, in all instances, a disease not of vigour, but of debility Peculiarly with a high degree of irritabdity : and there is no case in which this of iewfity. is more striking than in the present species. It has been found oc- casionally in infancy ; but it is far more frequently an attendant upon advanced years. It has sometimes also followed upon cold, and especially local cold, clap, dysury, and the use of cantharides as a cure for seminal weakness. It has at times been a result of free living, and particularly hard drinking. The spasms consist in a stiff and permanent contraction of the erectores penis, unconnected with any stimulus arising from a fulness of the vesiculae seminales. Dr. Darwin says, he had met with two cases where the erection, Sometimes producing a horny hardness, continued two or three weeks without €hromc> any venereal desire, but not without pain. The easiest attitude was lying upon the back with the knees bent upwards. The corpus cavernosum urethras at length became soft, and in a day or two the whole rigidity subsided. One of these patients had been • a free drinker, had a gutta rosacea on his face, and died suddenly a few months after his recovery from the present complaint. It is singular that this spasm should sometimes continue after death: at least we have accounts of such cases in Marcellus Donatus and other writers. As the disease is a case of both local and general debility, its cure Cure diffi* is in most instances difficult. Antispasmodics and tonics are the cu f" only medicines that promise relief, as camphor, opium, bark, warm aromatics, warm-bathing, cold-bathing: but the whole are often tried without effect. 213 cl. iv.] MUJROTICA. iORl». "I SPECIES 11. ENTASIA LOXIA. WRY-NECK. Gen. I. Spec. II. Origin of specific term. Causes. ■PERMANENT CONTRACTION OF THE FLEXOR MUSCLES ON THE RIGHT OR LEFT SIDE OF> THE NECK. DRAWING THE HEAD OBLIQUELY IN THE SAME DIRECTION. The term loxia is derived from the Greek, Aefe?, " obliquus, tortus ;" whence loxarthrus in surgery, an obliquity of a joint of any kind, without spasm or luxation. By the Greeks, however, the term was specially applied to the joints or muscles of the neck. This disease, in its genuine form, proceeds from an excess of mus- cular action, particularly of the mastoid muscle on the contracted side. But we frequently meet with a similar effect from two other causes : one in which there is a disparity in the length of the muscles opposed to each other, and consequently a permanent contraction on the side on which they are shortest; and the other in which, from cold or a strain, there is great debility or atony on the side affected, and, consequently, an incurvation of the neck on the opposite side, not from a morbid excess, but an overbalance of action. This species, therefore, offers us the three following varieties: a E. Loxia dispars. Natural Wry-neck: mostly congenital- Occasional Causes. /3yE. Loxia irritala E. Loxia atonica. Spastic wry-neck. Atonic wrv-neck. From disparity in the length of the muscles opposed to each other. From excess of muscular action on the contracted side. From direct atony of the muscles on the yielding side. x Dispars. Natural wry-neck. 0 Irritata. Spastic wry-neck. y Atonica. Atonic wry-neck. The first variety is mostly congenital, though sometimes pro- duced by severe burns or other injuries. And a like effect occa- sionally issues from a cause that may be noticed in the present place, though not connected with a morbid state of the muscles; a dis- placement ofthe muscles from an incurvation in the vertebrae of the neck, by which, though the antagonist muscles be of equal length and power, those on the receding side of the neck are kept on a per- petual stretch, while those on the protruding side are in a state of constant relaxation. The other two varieties are commonly the result of cold, or inflammation, or a strain ; often by carrying too heavy loads on the head. M. Boyer gives instances of the disease produced by moral causes : and Wepfer relates the case of a man who had a wry-neck, occasioned by a convulsive action of the mus- cles on one side of the neck, which appeared whenever he was tor- gl. iv.J NERVOUS FUNCTION. [ord. hi, 213 mented by chagrin, but ceased as soon as he was restored to a state Gen. I. of mental tranquillity.* pyE'. toxia The cure must depend upon the nature of the cause. In colds '^ri^;a and strains, warmth, the friction of flannel, and the stimulus of vola- atonica. tile or camphor liniment combined with opium, will be found most ^pryfn'ecck. serviceable, as tending to diminish pain, and restore action to the Atonic , i -r -,. t -u i c wry-neck. weakened organ. In direct spasms the same process will also tre- Mode of quently be found useful, but the application of cold water as a tonic treatment. and antispasmodic will often answer better. Where the antagonist muscles are of unequal length, the case lies beyond the reach of me- dical practice, and, if relieved at all, can only be so by a surgical operation. If the cervical vertebras be incurvated, but the bones sound, the disease may not unfrequently be made to yield to a skilful application of machinery by the hands of an ingenious surgeon. It sometimes happens, however, that the bones in this case arc soft and occasionally carious, and the slightest motion of the head is attended with intolerable pain. Setons have here been found serviceable, with an artificial support of the head ; but this kind of affection is often connected with a constitutional softness of the bones, of which we shall have to treat in the first order of the sixth class, under the head of vxmosTixjlexilis, SPECIES III. ENTASIA RHACHYBIA. MUSCULAR DISTORTION OF THE SPINE. PERMANENT AND LATERAL CURVATURE OF THE SPINE, WITHOUT PARALYSIS OF THE LOWER LIMBS : MUSCLES OF THE BACK EMACI- ATED ; MOSTLY, WITHOUT SORENESS UPON PRESSURE. Distortion of the spine is produced in various ways ; and it is Gen. I. chiefly owing to a want of due attention to this fact, that so much ^f^;11- confusion has of late prevailed respecting the real nature of the par- kind.of ^ ticular case to be treated, and the particular treatment that ought to 3tio„.lb" be adopted. The disease, under this general name, was first introduced before Spinal dis- the public with any considerable degree of notoriety by Mr. Pott, as firrBlt10dne.as connected with a palsy of the lower extremities, and as dependent pitied by upon a scrofulous diathesis ; which at length fixed itself upon some scrofulous part of the vertebral column, softened or rendered carious the bones 11%%™' that became affected; and hereby necessarily produced crookedness, caries. and a morbid pressure upon the right line of the spinal marrow. This is a case that often happens, and a like effect occasionally Rtachetic occurs in a very early period of life, from a rhachetic, instead of a scrofulous diathesis; though from the greater facility with which the * Traite de Maladies Chirurgioalcs, &c. Tom. vn. 8vo. Paris, 1821. 214 cl. rv.j NEUROTICA. [ord. hi. Gen. I. Spec. III. Entasia Rhachybia. Muscular distortion ofthe spine In these cases the disease a primary af- fection of the hones. Producing angular distortion, as opposed to lateral. Muscular ligament- ous or car- tilaginous contortion. These organs sometimes affected singly, sometimes jointly. But most frequently the muscles. In these cases the distortion lateral alone. Distinction observed by the Greek writers- Lordosis, what. Cyrtosis, what. Hybosis, and specting distortions from every other cause have been too often for- gotten ; and the moment a young female is found to have a tendency to a vertebral distortion of any kind, it has too generally been taken for granted that the bones were in a diseased state, or on the point of becoming so ; that the patient was labouring under the influence of a strumous diathesis, which was manifesting itself in this quar- ter : and all the severe measures of caustics or setons, with an un- deviating permanent confinement to a hard mattress, or inclined plane, for many weeks or months, which a strumous affection of this kind calls for and fully justifies, has been improvidently had recourse to, with a great addition to the sufferings of the patient, and, in many instances, no small addition to the actual disease which has been so unhappily misunderstood. Mr. Baynton seems justly chargeable with having adopted this g^ewts ^ general view of the subject, and extending it indiscriminately to every case. Mr. Wilson, who though he conceived the disease to origi- of Wilson; * Tim. n. v. 740. ^16 cl. iv.] NEUROTICA. [oRD- Hi. BpiHC of Lloyd: and Jar- rold. gen. I. nate in a rachetic rather than a strumous diathesis, and had recourse, Enfas.a as we shall observe presently, to a different mode of treatment, seems Rhaehybia. to have stretched his parallel hvpothesis over the same extent ol i\Zn"n ground. And Mr. Lloyd, who has lately favoured the profession °f the wjtn a valuable work on the same subject, in like manner contem- plates every case of spinal distortion as issuing from a common and that a strumous cause ; to which cause also it has since as uniformly been assigned by Dr. Jarrold.* Mr. Lloyd, correctly indeed, distin- guishes between the angular and the lateral curvature ; and with equal correctness observes that " in the former there is always some destruction of some portion of the vertebral column, and often, for a considerable time, progressive destruction of bone, cartdage, and ligament, and the vertebrae undergo precisely the same changes as the extremities of other bones in scrofulous diseases of the joints ;" while he adds that " in the latter there is no destruction of parts, but merely an alteration of structure ;" that " a wasting of the muscles always attends it in a greater or less degree ;" and that " it has been supposed by some authors that the cause of the curvature is entirely in the action of the muscles. But although," he continues, " this may be and most probably is the immediate cause, I am much more inclined to believe that the primary cause is in the vertebrae : that scrofulous action is set up in them, which increases their vascularity, and softens their texture." Here, then, is a distinct recognition of the two forms of morbid TwoThief distortion of the spine, to which I am anxious to direct the attention SScVforms of the reader : and each of them is allotted its peculiar seat, and of spinal diacritical signs ; the bones, with manifest injury of the bones, and the muscles with manifest injury of the muscles. The rest is matter of mere hypothesis, and needs not urge us into a discussion. So obvious and so much more common indeed is muscular than osseous distortion of the spine, that other pathologists, from this fact by'some00' chiefly, have contended, that this is the only form of the disease in its commencement. Such was the opinion of the late Mr. Grant, of Bath, and such is the opinion of Dr. Dods, of the same city, in an interesting tract he has lately published on this subject :t while Dr. Harrison refers its origin to " the connecting ligaments of the vertebrae. These," he observes, "get relaxed, and suffer a single so?eiySniat8d vertebra to become slightly displaced;" in consequence of which, he adds, " the column loses its natural firmness, other bones begin to press unduly upon the surrounding ligaments ; they in turn get re- laxed and elongated, by which the dislocation is increased, and the distortion permanently established. The direction becomes lateral, anterior, or posterior, according to circumstances: but the malady has, in every instance, the same origin and requires the same mode ol cure, t There is much ingenuity in this explanation, and I have no doubt tnat it is a correct expression of various cases of vertebral distortion. General admission. distortion. The mus- cular must common said to be the only form of contortion. Opinion of Orant: of Uods: ofHarri solely in the c on- necting li- gaments. This last hypothesis like the rest too limited. 8vo.S?7 ^ thC Caa8e3 °f ** CurTature of the SP™> ^th Suggestions, &c. I ^^S^ZS^f^S^Contorted Spine>** Lon* "»■ ^l. iv.J NERVOUS FUNCTION. [ord. in. 41? It chiefly fails, like the osseous hypothesis, in too wide a spirit of Gen. I. simplification, and in allowing no other origin in any instance than ESp- .m* that which forms the key-stone of its own pretensions. Admitting Rhachybia. the disease to commence in the connecting ligaments, the asso- Suon ciating muscles must soon be involved in the mischief, while, if it of.the commence in the latter, the ligaments which unite them to the bones lHwtrataii. cannot long continue unaffected. So that the question is merely one of primogeniture, and imposes little or no difference in the mode of treatment. Nay, even the bones themselves, by being irregularly pressed upon, may at length suffer in such parts from increased absorp- tion, become thinner and more spongy, or even ulcerate and grow carious; so as, in process of time, to give a direct proof of osseous or angular contortion, though induced instead of taking the lead. One of the chief difficulties, in cases where we have no reason to Whence apprehend a morbid state of the bones, consists in accounting for that" occurs the change that seems to take place in the relative position of several j°t*| "*, of the vertebrae or their processes ; and especially in the greater tion ofva- elevation or prominence of their transverse processes on one side, br» or'theli while those on the other are scarcely perceptible. And it is in truth £rob°M8e5'f chiefly to solve this question that most of the hypotheses of the pre- ferentiy ex- sent day are started in opposition to each other. The idea of an Cy uuri- actual dislocation of the vertebral bones, which enters into that ofson"- Dr. Harrison, would sufficiently account for the fact, if such a dislo- cation could be unequivocally shown. But whde the change of position does not seem in any instance to amount to' a complete extrusion of a vertebra from its seat of articulation, the ease and quietude with which, under judicious management, it often seems to recover its proper position, and to evince its proper shapes, are inconsistent with the phenomena that accompany a reduction of luxated bones in every other part of the body. The explanation therefore has not been felt satisfactory to a numerous body of pathologists ; and Dr. Dods has hence offered b*Dode- us another solution, which is also highly ingenious, and may perhaps in the end be found correct in those cases in which the miscurvature is very considerable, and especially where it becomes double or assumes a sigmoid figure. He supposes, in the first place, that the whole disease in its origin is seated in the extensor muscles of the back, or that part of them to which it is confined : more especially in the quadratus lumborum, sacro-lumbalis, and longissimus dorsi. He supposes, next, that the right hand being habitually more exerted than the left, the effect of such surplus of force, in conse- quence of our throwing the body towards the left to preserve its centre of gravity, and hence strongly contracting the muscles of this side of the spine, must fall in a greater degree upon those muscles, and more dispose them " to suffer disorganization and become con- tracted ;" and he hence accounts for the greater frequency of con- tortion on the right side than on its opposite. He then proceeds to Double °. 11, !_• t_ i_ a* curvature account for the single or double curvature which the contortion accounted effects, by remarking that the morbidly contracted muscles of the to1' left side, in overcoming the action of the muscles of the right, do not drag the vertebra? forward towards themselves in a direct line. 218 cl. rv.J NEUROTICA. [ord. lil- Gen. I. Spec. III. Entasia Rhuchyhia. Muscular distortion ofthe spine. Rotation of tbe verte- brae. Effects of such rota- tory change. Morbid si- tuation of the scapu- la? ac- counted but rotate the vertebras to which they arc attached, because of the angles formed, relatively, between the vertebras and the pelvis (the points of origin and insertion of these muscles), and the force Ol their contraction acting upon moveable, horizontal, or transverse levers, namely, the transverse processes of the vertebras.* Morbid curvation of the spine, therefore, in the opinion of Dr. Dods, does not consist in an evulsion of separate vertebra; from their natural course and position, but in a twist of a great part or the entire column, by which means the morbid lateral flexure is nothing more than the natural sigmoid sweep ofthe vertebral chain, wrested more or less round to one side, as by the turning of a cork-screw. Whatever displacement is met with in the ribs or the other bones of the chest, is necessarily a result of this first deviation from the line of health. " All the ribs," he observes, " have a double attach- ment to the vertebrae; one, by their heads, to the bodies of them, and the other by their tubercles to the transvere processes. When the vertebrae, then, are made to rotate upon each other, in the manner described, by the permanent contraction, and this, for example, to the right side, which is the more frequent direction they take from the causes noticed, they, by this movement, push out or backwards the heads ofthe ribs ofthe left side, and force their ster- nal extremities considerably forward, because of the quick circular turn which the ribs make between their-angles and their points of attachment to the vertebras, and the very small motion, from such a formation of them, requisite here to produce them. Together with this movement of the ribs, which produces the projection of the left side of the chest in front, they are also made, from their double attachment to the vertebrae, to fall down or approximate, or, as it were, overlap each other, at their angles. This causes that hollow- ness or sinking in of the left side of the chest behind. The falling down of the ribs here described appears to me to be in part owing, also, to the permanent contraction of the sacro-lumbalis muscle, which is inserted into all their angles. While these movements take place with the ribs on the left side of the body, the very oppo- site, of necessity, happens to those on the right. By the rotatory movement of the vertebras, the ribs on the right side have their heads contrary to those on the left, drawn inwards, and their sternal extremities made to recede backward: while their double con- nexion with the vertebras causes them, contrary also to those of the left side, to be raised up and separated from each other at their angles. This rising up and separation of the ribs at their angles, is what produces the projection of the right side of the chest behind." From this general change of position, and particularly the twist of the ribs, Dr. Dods accounts for the unnatural situation of the scapulas, and in many instances of the clavicles and the sternum, with the falling down ofthe right shoulder. He observes, moreover, that though the contortion of the spine most frequently takes place to the right side, yet that it occasionally takes place to the left That the whole column is not always moved round, but only a part of it • * Ut. supra, p. f»3, •;l. iv.] NERVOUS FUNCTION. [ohd. i;r. 219 and that hence, instead of a profile of three morbid flexures brought "Gen. I. into view, which invariably follows in the former case, ve have 1^'ni" often a profile of only two : and that where the muscles of both Rhachybia. sides of the column become contracted from position, which some- distortion times takes place, the greater number of the vertebral joints acquire °f^° an ancylosis, and the body is arched backwards. There is much ingenuity through the whole of this explanation, Hypothesis which plausibly accounts for that ridgy line of projection so fre- ,nsenious: quently felt on the left side of the loins, when the morbid curvation is on the right, ascending nearly to a level with the spinous processes, while there is not only no such ridge on the opposite side, but even no appearance of the transverse processes. Upon the hypothesis before us these processes are conceived to be equally elevated on the one side and depressed on the other, which gives us the two phenomena of an unnatural and ridgy prominence in the former line, and of an unnatural disappearance in the latter. The hypo- thesis nevertheless (for at present it cannot be entitled to a higher appellation) requires further elucidation and support: and,after all, £ut^ann°|- can never altogether reach the precise object at which it aims, that exclusively. of establishing itself at the expense of every other view, and espe- cially of subverting the doctrines of a diseased action of the other moving powers or their appendages, the ligaments of the spinal muscles, or the cartilages into which they are inserted ; a morbid condition of which is often capable of proof from the very limited area of pain and tenderness to which, on pressure, the disease seems to be confined : to say nothing of the affection of the vertebral ?>ones themselves, in which, as already observed, spinous distortion sometimes commences, though from a very different source, and in which even when derived from the source now contemplated, it sometimes terminates. There can be no doubt, however, that the spinal distortion ofTliemus- the present day is a disease far more frequently of the muscles and of distor- their appendages than of the bones, and is the result of a want of tc'°^1™°I*tin equilibrium between the antagonist forces on the one side and on the the present other of the vertebral column, as well those of the trunk as of the Explained. back ; in consequence of which this column is deranged in its natural sweep, and either twisted or deflective in particular parts, or in its whole length : all the other changes in the general figure and devia- tions from the general health being dependent upon this primary aberration. It is hence a disease of muscular debility or irregular, and hence £^™yar clonic, action in the fibres of the yielding muscles, and an inability the proxi- to resist the encroachment that is made on them by their more pow- ™»^ erful antagonists. The complaint almost invariably shows itself from the age of ^;emcnt puberty to that of mature life, though sometimes later ; and is nearly ofthe dis limited to females, and among females, to those of delicate habits, ease< and who are especially disciplined in the false and foolish rules for obtaining a fine figure. It is hence a perpetual inmate in our public ™* female schools, and is by no means an unfrequent attendant upon found. domestic education. 220 Gem. I. Spec. III. Entasia Rhachybia. Muscular distortion ofthe spine. Progress. CL. IV.J NEUROTICA. [OK P. ill Sequel of general and con- ditional mifchief. Occasional Causes. Too rapid growth: drains: chlorosis; shool -dis- cipline of the day. The progress of the disease may be so easily collected fromtl physiological survey we have already taken, that a feu * onto in addition is all that is necessary to be added. The complaint first shows itself by a general listlessness and aj er sion to muscular exertion of any kind, and an unwonted desire.to lounee and loll about. No signs of constitutional disease, however, are as yet manifest; the nights are not disturbed, the appetite does not fail, the evacuations are regular, and the pulse unaffected. There is soon afterwards a sense of weariness, and even at times uneasiness. about the back and especially the loins ; and if the muscles of these parts be minutely examined, several of them will give proof of Hac^ cidity and extenuation. If no steps be taken at this time to arrest the disease in its march, or if the steps taken be injudicious or ina- dequate, the vertebral column will soon be involved m the mortnd action ; and especially, as Mr. Ward observes, " on the occurrence of-any particular disturbance to the constitution ;"* its numerous joints will lose their nicely adjusted poise ; they will in various parts be left too loose on the one side, and dragged too rigidly on the other ; and the elegant contour of the spinal chain will progressively be broken in upon. All the other changes, whether upon the general form or the general health, which progressively take place in the advance of the disease, are entirely consecutive upon the symp- toms before us, and may be anticipated by any one. From the morbid contest which is thus continually going on between the antagonist muscles, their internal organization must necessarily become greatly affected, and the growing debility which is manifest in the contractile and extensile power of their aggregate fibre, will enter into every part of every separate fibril, and affect their vis insita. The flow of nervous power, instead of being uniform, will take place in irregular jets; and, for reasons already urged in a preceding part of this work,! a clonic though occult agitation, will succeed to artenour of measured energy. The debility and irregular action of one muscle wdl spread by sympathy or association to various others ; and from the derangement of the bones of the spine and the chest, the functions of respiration and digestion, and consequently, in a greater or less degree, all the other functions of the body must be interfered with in their respective powers, so that there is scarcely any other disease but may follow : and the frame will become generally emaciated. As the proximate cause is debility of the extensor muscles of the back or loins on either side, the occasional cause will consist in whatever has a tendency to produce such debility. Too rapid growth is a frequent source of this complaint; a casual strain of the muscles on either side is a source not less common ; chlorosis or any other constitutional weakness may lead to the same effect; and assuredly the use of stiff and girding stays, or any other part of that fashionable compression which is designed in the school-discipline of the present day to mould the form into a somewhat different and * Practical Observations on Distortions'of the Spine, Chest, and Limbs, p. 36, 8vo. 1382. 1 rv«nio Spasm, infra. Cl, iv Ord. m. flen- n i.l.iv.] NERVOUS FUNCTION. [ord.hi. 221 more graceful shape than perhaps the niggard hand of nature has °ek. I. intended—such as back-boards, braces, steel-bodices, or steel- Entasia *' crutches, spiked collars, neck-swings, and even education-chairs. ^Ihi^b}'bia' The tendency of all these to produce deformity where it does not distortion exist, and to aggravate it where it does, is forcibly pointed out by "p^ Dr. Dods; who nevertheless seems to censure, with rather more acrimony than needful, the whole system of school-drilling educa- tion as practised in many of our most fashionable establishments. A course of discipline for giving grace and elegance to the growing "°^ j"ci. form, if conducted with judgment, devoid of rigorous compression pime may to the expanding organs, and allowing a sufficient alternation of relax- e Ba,utat? ation and ease, so far from being injurious to the health and strength of the general frame, has a natural tendency to invigorate it. But the greater frequency of the lateral distortion of the spine in our own day, compared with its apparent range in former times, together with the increased coercion and complication of the plan laid down in many of our fashionable schools for young ladies, seems clearly to indicate that some part at least of its increased inroad is chargeable to this source : and the following remarks of Mr. Pott upon the but appears various instruments applied to a growing girl in order to prevent a rie/tooVar crooked shape, have a wider claim to attention in the present day i"many than when they were first given to the world. " These," says he, a» justly " are used with design to prevent growing children from becoming £b8p'™|! crooked or mis-shapen ; and this they are supposed to do by sup- porting the back-bone, and by forcing the shoulders unnaturally backwards. The former they cannot do ; and 'in all cases where the spine is weak, and therefore inclined to deviate from a right figure, the latter action of these instruments must contribute to, rather than prevent, such deviations, as will appear to whoever will, with attention, examine the matter. If, instead of adding to the embarrassment of children's dress by such iron restraints, parents would throw off all of every kind, and thereby give nature an oppor- tunity of exerting her own powers ; and if, in all cases of manifest debility, recourse were had to friction, bark, and cold-bathing, with due attention to air, diet, exercise and rest; the children of the opulent would perhaps stand a chance of being as stout, as straight, and as well-shapen as those of the laborious poor." The simple fact is that the system of discipline is carried too far, Uncuiti- and rendered much too complicated ; and art, which should never pJlJod'wUh be more than the hand-maid of nature, is elevated into her tyrant, cultivated In rustic life we have health and vigour, and a pretty free use of the you limbs and the muscles, because all are left to the'impulse of the moment to be exercised without restraint; the country girl rests when she is weary, and in whatever position she chooses or finds easiest; and walks, hops, or runs as her fancy may direct when she has recovered herself; she bends her body and erects it as she lists, and the flexor and extensor muscles are called into an equal and harmonious play. There may be some degree of awkwardness, and there generally will be, in her attitudes and movements; and the great scope of female discipline should consist in correcting this. With this it. should begin, and with this it should terminate, whether 222 LL. IV.j NEtliOTIOA. |i>itn. ia. l- our object be directed to giving grace to the uncultivated human figure or the uncultivated brutr. We may modify the action of muscles Gen. Spec. III. of the spine Mus^u"'11" 'n common llseN or even cau more into P^ay than are ordinarily cxer- distortion cised, as in various kinds of dancing ; but the moment we employ one set of muscles at the expense of another ; keep the extensors on a full stretch from day to day by forbidding the head to stoop, or the back to be bent; and throw the flexors of these organs into disuse and despisal; we destroy the harmony of the frame instead of adding to its elegance ; weaken the muscles that have the disproportionate load cast upon them ; render the rejected muscles torpid and un- pliant; sap the foundation of the general health, and introduce a crookedness of the spine instead of guarding against it. The child of the opulent, while too young to be fettered with a fashionable dress, or drilled into the discipline of our female schools, has usually as much health, and as little tendency to distortion, as the child ol' the peasant; but let these two, for the ensuing eight or ten years, change places with each other ; let the young heiress of opulence be left at liberty ; and let the peasant girl be restrained from her freedom of muscular exertion in play and exercise of every kind ; and instead of this let her be compelled to sit bolt upright, in a high narrow chair with a straight back that hardly allows of any flexion to the sitting muscles, or of any recurvation to the spine ; and let the whole of her exercise, instead of irregular play and frolic gayety, bo limited to the staid and measured march of Melancholy in the Penseroso of Milton: Muscular amuse- ments not inconsis- tent with grace of figure. Such should in- termix with those in ordinary use. With eren step and musing gait; to be regularly performed for an hour or two every day, and to con- stitute the whole of her corporeal relaxation from month to month, girded, moreover, all the while, with the paraphernalia of braces, bodiced stays, and a spiked collar,—and there can be little doubt that, while the child of opulence shall be acquiring all the health and vigour her parents could wish for, though it may be with a colour somewhat too shaded with brown, and an air somewhat less elegant than might be desired, the transplanted child of the cottage will exhibit a shape as fine, and a demeanour as elegant as fashion can communicate, but at the heavy expense of a languor and relaxation of fibre that no stays or props can compensate, and no improvement of figure can atone for. Surely it is not necessary, in order to acquire all the air and grace- fulness of fashionable life, to banish from the hours of recreation the old rational amusements of battledore and shuttlecock, of tennis, trap-ball, or any other game that calls into action the bending as well as the extending muscles, gives firmness to every organ, and the glow of health to the entire surface. Such, and a thousand similar recreations, varied according to the fancy, should enter into the school-drilling of the day, and alternate with the grave procession and the measured dance, for there is no occasion to banish either ; although many of the more intricate and venturous opera dances, as the Bolero, should be but occasionally cl. iv.] NERVOUS FUNCTION. [oim. in. ZZJ and moderately indulged in ; since, as has been sufficiently shoivn Gen« '• by Mr. Shaw, " we have daily opportunities of observing, not only EntaSa"'' the good effects of well-regulated exercise, but also the actual de- Rhachybia. fortuity which arises from the disproportionate developement that is distortion of produced by the undue exertion of particular classes of muscles.* the spine" It may be observed," continues the same excellent writer," that the ligaments of the ankles of some of the most admired dancers are so unnaturally stretched that, in certain postures, as in the Bolero dance, the tibia nearly touches the floor. So bad, indeed, is the effect occasionally produced by a frequent stretching of the liga- ments, that the feet of many of them are deformed: for the ligaments which bind the tarsal and the metatarsal bones together become so much lengthened by dancing and standing on the tips of the toes, that the natural arch of the foot is at length destroyed."! Such then are the best preventive means against muscular or Such the ligamentous distortion of the young female frame, and especially of vemive3 the vertebral column, in conjunction with pure air, plain diet, and means. well-regulated hours of rest. If, notwithstanding such means, a tendency to crookedness on Remedial i-ither side should manifest itself, evidenced by the symptoms already pointed out, no time should be lost in making an accurate examina- tion of tho spinal chain : and if such tendency should be accom- panied with pains about the pelvis and lower extremities, our atten- tion should be particularly directed to the state of the vertebrae seated in the centre of the different flexures of the column, but especially of the lumbar, for it is probable, in this case, that one or more of them maybe in a state of inflammation. Where this is the case, the usual means ©f taking off inflamma- Cupping tory action, and especially depletion, by cupping-glasses, should be necessary. instantly had recourse to. But where the cause is debility alone, More com- and a want of equilibrium between antagonist sets of muscles, rest, ™nfcs. reclination, general tonics, especially myrrh, steel, and in many cases the sulphate of quinine, sea-bathing, and in effect whatever may- tend to introduce a greater firmness of fibre and general vigour of constitution, constitute the best plan of treatment. To these should be added a series of friction, and especially of F««ion shampooing or manipulation applied down the whole course of the pooing: spine, and particularly that part of it where the distortion is most evident: and it may be of advantage, as proposed by Dr. Dods, to should be direct the course of the manipulation in a particular manner to such dexterity. transverse processes of the vertebrae as appear peculiarly elevated, so as artfully, and by insinuation, to assist in restoring them to their proper position. It will also be found expedient in most cases to illine the hand with oil or some other unctuous substance, in order to prevent the friction from irritating or excoriating the skin. Those who ascribe the disease to a strumous diathesis in every How treat- instance, have of course a medical treatment of their own adapted heWaBna to this view of the case. Such is the practice of Dr. Jarrold who ^,™X"*., * On the Nature and Treatment of Distortions, &c, p. 15. Lond. 8vo. 1823. + Id. p. 17. \i± CL.IV.J NEUROTICA. OKl>. IIi< Gen. I. Spec. III. Entasia Rhachybia. Musculnr distortion ofthe spine. Plan of Jarrold; his alleged success. Probably less owing to his direct than his auxiliary means. Position. Nature of couch. Inclined plane, and inclined position. Curved po- sition pro- nosed by Dods. Either may be right or ■wrong, oc- casionally. has lately written a treatise upon this subject containing many valu- able hints, but who limits the seat of the malady to the intervertebral cartilages, as he does its cause to a strumous taint. His Materia Medica, therefore, for the present purpose, is nearly restricted to burnt sponge and carbonate of soda. " Conceiving," says he, that " there might be some relation between it and bronchocelc, I have made use of similar remedies."* To which he occasionally adds, when the debility is considerable, twenty drops of nitric acid daily. And with this simple process he tells us that he has been so suc- cessful in a restoration of health, strength, plumpness and upright- ness, that " medical treatment is seldom further required, unless the appetite and digestion be impaired." Not acceding to this causation, I have not tried the plan ; which seems here to have been far more successful than in bronchocelo itself ; even when the more powerful aid of iodine is called into co- operation, which it is singular that Dr. Jarrold does not appear to have had recourse to. To all the confederate means, however, of recumbency, friction, shampooing, pure air, and occasional exercise, he is peculiarly friendly : and as these have of themselves effected a cure in the hands of various other practitioners, it is not improbable that Dr. Jarrold is far more indebted to such confederates than he is aware of; and that his auxUiaries have been of more service to him than his main force. It has been made a question of some importance, which is the best position for a patient to rest in who is labouring under the complaint before us, or has a striking tendency to it; as also what is the best formed couch for him to recline upon? All seem to agree that the couch should be incompressible, or nearly so, in order that the weight of the body may be equally, instead of unequally sustained, and not one part elevated and another depressed : and hence a mattress is judged preferable to a bed ; and a plain board is by many esteemed preferable to a mattress. It is also very generally agreed that the board or mattress should form an inclining plane, so that the body, placed directly on the back, may be kept perpetually on the stretch; while Dr. Dods maintains in opposition to this general opinion, that the line should be horizontal, or even curved ; that a position on the back is by no means neces- sary, and that a posture of extension cannot fail of being injurious, and adding to the strength or extent ofthe disease. Either of these opinions may be right or wrong, according to the nature of the case ; and hence neither of them can be correct as an universal proposition. Ease and refreshment are the great points to be obtained, and whatever couch, or whatever position will give the largest proportion of these is the couch or the position to be re- commended : whether that of supine extension, or relaxed flexure. Dr. Dods, who refers all kinds of lateral distortion to debility of the fibres of the extensor muscles, proscribes an extended position in every instance ; and, as already observed, recommends a curved relaxing couch in its stead, so that the patient may sink into it at his * Enquiry into the Causes of the Curvature of the .'-pine, &<*, ut supra, p. 119 cl. iv.j NERVOUS FUNCTION. [okd. 111. J225 ease, instead of being put upon the stretch. The advice is good so Gen- I- far as the opinion is correct, and the disease is dependent upon Intosia111' debility of the extensor muscles alone : for here nothing can afford Rhachybia. so much ease to the patient as such an indulgence. But it is not to distortion be conceded that the fibrous structure of these muscles form the "^c° seat of the disease in every case, and consequently the recommend- ation will nojt always apply : for the flexor muscles may be affected, or the debility be seated in the extensor ligaments, or the vertebral cartilages with which they are connected. I have at this moment under my care a lady just of age, who, for four years past, has been labouring under a slight affection of natural distortion, feeling much more of it whenever she suffers fatigue, or is affected in her spirits. A position nlustrated, strictly supine, and somewhat extended, upon a hard mattress or a level floor is the only posture that affords her ease, and takes off the sense of weight on the spine, and oppression on the chest. She has often tried other positions but in vain. To this, therefore, she has uniformly recourse after dinner, and, occasionally, at other times in the day as well. Pure country air has also been of great service, but above all things sea-bathing. She has just returned from an excursion around the Devonshire coast. The first day's journey, though in a reclined position in an open landaulet, with every atten- tion that could afford ease and accommodation, proved so fatiguing, and produced so much pain in the spine, that it was doubtful whether she would be able to proceed. A better night, however, t than was expected, capacitated her for another trial, and the fatigue was considerably less : on the third or fourth day, she had an op- portunity of beginning to bathe ; and by a daily perseverance in the same was enabled, soon after reaching Teignmouth, to engage in long walks, climb the loftiest hills, and enjoy the entire scenery : her appetite became almost unbounded, and her flagging spirits were restored to vivacity. It is hence perfectly clear that while that position and that mode of dress are most to be recommended which afford the highest degree of ease and comfort; gestation, pure air, sea-bathing, and {^{on gca every other kind of tonic, whether external or internal, are also of pure air, the utmost importance ; and that perfect and continued rest, in f^ and" whatever position it be tried, is far less efficacious than when inter- general rupted by such motion as can be borne, though with some degree combine of fatigue, and the other tonic auxiliaries just adverted to. In pVecVding. extreme cases, indeed, such exercise as is here adverted to should Rest inter- be postponed till the debilitated, and, most probably, irritable organs Ihwftan" have lost some part of their disease : yet the motion of friction or °°™ptu^; manipulation by a skilful and dexterous hand, may still be adverted extreme to, and should supply its place. Vol. IV.—29 W ci,.iv.;| NEUROTICA. L'°«D' UU SPECIES IV. ENTASIA ARTICULARIS. MUSCULAR STIFF-JOINT. PERMANENT AND RIGID CONTRACTION OP ONE OR MORE ARTICULAR MtSCLES OR THEIR TENDONS. Gev I. The joints of the limbs are as subject to muscular contractions Spec. IV. ^ the neck . and, in many instances, from like causes: the following are the varieties of affection hereby produced : x Irritata. From excess of action in the ' Spastic stiff-joint. muscles contracted. 0 Atonica. From direct atony in the yield- Atonic stiff-joint. ing muscles. y Inusitata. From long confinement or neglect Chronic stiff-joint. of use. Causes. Besides the ordinary causes of cold, inflammation, and strains, by which the first and second variety are produced, the former has some- times followed upon a sudden fright,* upon drying up a cutaneous eruption, or checked perspiration.t Freind, also, mentions a case in which it has been cured by a fright;{ and Baldinger one in which it disappeared on the revival of a suppressed eruption which had given rise to it.§ Rheumatism has often produced it, and particu- larly the second variety, in the joint of the knee and thigh-bone. Treatment. In a case of the latter kind, it was successfully attacked by Richter,|| with a cautery of a cylinder of cotton. In this and the third variety much benefit is often derived from repeated and long continued friction with a warm hand, and particularly if illined with some stimulant balsam or liniment. In an obstinate contraction of the fingers succeeding to a fractured arm, Dr. Eason relates an instance in which the rigidity suddenly gave way to a pretty smart stroke of electricity after every other mean had failed ; and the patient had the use of his fingers from this time.IT Such exercise, moreover, or exertion of the limb, should be recommended as it may bear without fatigue. The cold-bath, as an antispasmodic, has sometimes been serviceable in the first variety, and more fre- quently as a tonic in the second. c!£°.ni.c Most men exhibit proofs of the third variety, or chronic often pro- stiff-joint, from a neglect of using many of their muscular powers : habiStuafirom for nearlv a fourth Part of the voluntary muscles, from seldom being neglect of called into full and active exertion, acquire a stiffness which does muscles affected. * Starke, Klin. Instit. p. 32. t Paulini Cent. i. 39. I ™G »£?ho o^v 5 N- Magazin. Band. w. 78. ! Chlr. Bibl. Band, x. 2P*. «! Edin. Me.], Comment, v. p. 84. <-L. iy.] XERVOUS EUNVTiON. [ord. m. 221 not naturally belong to them, whde many that, by exercise, might Gen. I. have been rendered perfectly pliant and obedient to the will, have f *tEC-'IV " lost all mobility, and are of no avail. Tumblers and buffoons are articuiaris. well aware of this fact, and it is principally by a cultivation of these s^jo/nu neglected muscles that they are able to assume those outrageous J^f1™6^- postures and grimaces, and exhibit those feats of agility which so often amuse and surprise us. It is a like cultivation that gives that measured grace aad firmness as well as erect position in walking, by which the soldier is distinguished from the clown ; and that enables the musician to run with rapid execution, and the most delicate touch, over keys or finger-holes that call thousands of mus- cular fibres into play, or into quick combinations of action, which in the untutored are stiff and immoveable, and cannot be forced into an imitation without the utmost awkwardness and fatigue. SPECIES V. ENTASIA SYSTREMMA CRAMP. sudden and rigid contraction and convolution op one or more muscles op the body : mostly of the stomach and extre- MITIES, vehemently; painful, but of short duration. Systremma, literally " contortio, convolutio," " globus," is derived Gen. I. from evTTPtfa, " contorqueo," " convolvo in fascem." Stremma, of^'J" the primary noun, is an established technical term for "strain, twist, specific wrench ;" and the author has hence been induced to add the present h^liea t0 term to the medical vocabulary in the sense now offered, for the ■«»*«*• purpose of superseding and getting rid of crampus, which has rous term hitherto been commonly employed, though at the same time com- ciamiius- monly reprobated, as a "term intolerably barbarous, derived from the German krampf. The proper Latin term is, perhaps, " raptus Raptus of nervorum ;" whence opisthotonia or opisthotonus is denominated by $^atin"' the Latin writers " raptus supinus." But raptus is upon the whole of too general a meaning to be employed on the present occasion, unless with the inconvenience of another term combined with it. The parts chiefly attacked with cramp are the calves of the legs, Parts the neck, and the stomach. The common causes are sudden expo- affected. sure to cold, drinking cold liquids during great heat and perspiration, c«uses' eating cold cucurbitaceous fruits when the stomach is infirm and in- capable of digesting them, the excitement of transferred gout and overstretching the muscles of the limbs, in which last case it is an excess of reaction produced by the stimulus of too great an extension. ^ Hence many persons are subject to it, and especially those of irri- Casei'eboaw table habits, during the warmth and relaxation of a bed, and particu- P£*£|J larlv towards the morning when the relaxation is greatest, the aecu- in the long muscles- 228 cl. iv.] NEUROTICA. [okd. ui. Gen. I. Spec. V. Entasia Systremma. Cramp. Other causes of cramp. How pro- duced in swimming. Symptoms when the hollow or membra- nous mus- cles are affected. When the more fleshy muscles are affected. Mode of treatment. Vulgar plan of squeezing a roll of brimstone explained. Treatment where the Btomach is affected. mulation of muscular or irritable power most considerable, and the extensor-muscles of the legs are strained to their utmost length to balance the action which the flexor-muscles have gained over them during sleep. Cold night-air is also a common cause of cramp, and it is a stdl more frequent attendant upon swimming, in which we have the two causes united of cold and great muscular extension. An uneasy position of the muscles is also in many cases a sufficient cause of irritation ; and hence we often meet with very painful cases of cramp in pregnant women down the legs, or about the sides, or the hypogastrium. When the hollow or membranous muscles are affected, they feel as though they were puckered and drawn to a point; the pain is agonizing, and generally produces a violent perspiration : and if the stomach be the affected organ the diaphragm associates in the con- striction, and the breathing is short and distressing. If the cramp be seated in the more fleshy muscles, they seem to be writhed and twisted into a hard knot, and a knotty induration is perceivable to the touch accompanied with great soreness, which continues for a long time after the balance of power has been restored. In common cases where the calves of the legs are affected, an excitement ofthe distressed muscles into their usual train of exertion is found sufficient : and hence most people cure themselves by sud- denly rising into an erect position. I have often produced the same effect and overcome the re-action without rising, by forcibly stretch- ing out the affected leg by means of other muscles, whose united power overmatches that of the muscle that is contracted. Warm friction with the naked hand, or, which is better, with the hand illined with camphorated oil or alcohol, will also generally be found to succeed. A forcible exertion of some remote muscles, which thus collects and concentrates the irritable power in another quarter, will also frequently effect a cure ; and it is to this principle alone, I suppose, we are to refer the benefit which is said to arise from squeezing strenuously a roll of brimstone, which suddenly snaps be- neath the hold. The brimstone snaps from the warmth of the hand applied to it; but its only remedial power consists in affording a something for the hand to grasp vehemently, and thus excite a sudden change of action. Where the stomach is affected, brandy, usquebaugh, ether, or laudanum afford the speediest means of cure ; and it is often neces- sary to combine the laudanum with one or the other of the preceding stimulants. Here also the external application of warmth, and dif- fusible irritants, as hot flannels moistened with the compound cam- phor liniment, are found in most cases peculiarly beneficial. Ex- citing a transfer of action to the extremities, as by bathing the feet in hot water, or applying mustard sinapisms to them, is frequently of great advantage ; as is the use of hot, emollient and anodyne injec- tions, whose palliative power reaches the seat of spasm by sympa- thetic diffusion, and often affords considerable quiet. Here, also, the patient should be particularly attentive to his diet and regimen^ confining himself to such viands as are most easy of digestion, and least disposed to rouse the stomnch to a return of these morbid and CL. IV.] NERVOUS FUNCTION. [ord. in. 229 anomalous actions ; for a habit of recurrence is soon established, Gen. i. which it is difficult to break off. ' £*■?•v- t i_ 1 • ntasia In pregnancy, where the crampy spasms are often migratory and Systremma. fugitive, the position should frequently be changed, so as to remove Treatment the stimulus of uneasiness by throwing the pressure upon some other ""jj6/ preg" set of muscles : and if the stomach be affected with gout, opium, rhubarb, chalk, or aromatics should be taken on going to rest. The best preventives when the cause is constitutional, are warm Best pre- tonics, and habituating the affected muscles to as much exercise as venUves' their strength will bear : and hence the same forcible extension used in swimming which produces cramp the first or second time of trial, will rarely do so afterwards. Cramp is also found, as a symptom, and as one of the severest Found also symptoms ofthe disease, in various species of colic and cholera ; in wm mmp" which cases it must be treated according to the methods already ^*°J.dis" pointed out under those respective heads. SPECIES VI. ENTASIA TRISMUS. LOCKED-JAW. permanent and rigid fixation of the muscles of the lower JAW. This disease is by the French writers called tic. The technical Gen- '• term is derived from the Greek tptfy, " to gnash or grind the teeth;" French ' which, like the French synonym, is supposed by the lexicographers ?yno.n),m- to be onomatopy, or a word formed from the sound that takes place th"Stechni- in the act of gnashing. caiterm. In truth it was to a disease in which morbid gnashing formed a j*oth *e symptom, that both the Greek and French term was originally ap- French plied : for the trismus of the old writers consisted, not of a rigid, but Sy a°p- a convulsive or agitatory spasm of the lower jaw ; an affection com- pHed to a paratively trifling, and rarely to be met with, and when it does occur affection; appertaining to the clonus of the present system of nosology, the clonic spasm of authors in general. And the use of trismus or tic to import a state of muscle directly opposed to that which it first indi- cated, is another striking proof of the incongruous change which is perpetually occurring in the nomenclature of medicine, for the want of established rules and principles to give fixation and a definite sense to its respective terms. Dr. Akerman is the only writer of reputation I am acquainted with and recent- in recent times, who has used trismus in its original intention; or pued by" rather who has united its original with its modern meaning. For he Akerman. employs the term generically ; and arranges under it the two species of trismus tonicus, being that now under consideration, and trismus clonicus, or the disease it originally denoted. But this arrangement 230 cl. iv.j NEUROTICA. LOR1>- ui Gen. I- Spec. VI. Entasia Trismus Locked- jaw. German synonym Variously and irregu- larly ar- ranged by Cullen; at one time a distinct genus from trismus which was also made a distinct genus; at other times both reduced to a variety of a common genus. Proper place in a middle line of arrange- ment, each forming a distinct species. Analogy. Found ge- nerally in alt ages, tempera- ments, and climates. In other animals as well as in man. Causes. is uncalled for, and inconvenient, and has not been received into general use : the term trismus being, with every writer of the present day, limited to the first of these two species alone, notwithstanding the origin of the word. And hence, as it is so generally and com- pletely understood, there would be an affectation in changing it for any other. The Germans call it kinnbakkenzwango, which is pre- cisely parallel with the locked-jaw of our own tongue. Dr. Cullen in the first edition of his Nosology, made trismus and tetanus, our next species, distinct genera, but he altered his opinion before the publication of his First Lines, and regarded them as nothing more than degrees or varieties even of the same species. " From the history ofthe disease,,' says he, " it will be evident that there is no room for distinguishing the tetanus, opisthotonos, and trismus or locked-jaw as different species of this disease ; since they all arise from the same causes, and are almost constantly conjoined in the same person."* In consequence of which, in the later editions of Dr. Cuiien's Synopsis, in which the supposed error is attempted to be corrected, the disease is introduced with a very singular de- parture from nosological method : for first, tetanus is employed as the term for a distinct genus, defined " a spastic rigidity of many muscles ;" and next under this generic division are given no species whatever but two varieties of degree alone, to the first of which is again applied the name of tetanus, defined " the half or whole of the body affected with spasms ;" and to the second that of trismus ; defined " spastic rigidity chiefly of the lower jaw." Passing by this irregularity of method, the proper view of the subject seems to lie in a middle course; in contemplating trismus and tetanus, not as distinct genera, or mere varieties of a single dis- ease, but as distinct species of a common genus ; and under this view it is contemplated in the present arrangement. Trismus bears the same relation to tetanus as synochus does to typhus ; the two former, like the two latter, may proceed from a common cause and require a similar treatment; and the first may terminate in the last. But trismus, like synochus, may run its course alone, and continue limited to its specific symptoms. And as Dr. Cullen has thought proper to make synochus and typhus distinct genera, he ought at least to have ranked trismus and tetanus as distinct species. Trismus is found in all ages, sexes, temperaments, and climates. In warm climates, however, it occurs far more frequently than in cold ; and chiefly in the hottest of warm climates. Dr. Cullen observes that the middle-aged are most susceptible of the disease, men more so than women, and the robust and vigorous than the weakly. Other animals are subject to this complaint as well as man, particularly parrots ; and from many of the causes! that affect the human race. These causes, for the most part, are chilliness and damp operating upon the body when heated, and hence sudden vicissitudes of heat and cold ; wounds, punctures, lacerations, or other irritations of nerves in any part of the body, whence it has not unfrequently fbl- * Pract. of Phys. Book in. Sect. L. Chap. I. § hcclxvii. r Baton. Abhandlungen Von Krankeit auf der Insel Cayenne, &c. i.l. iv.] NERVOUS FUNCTION, [oed. hi. 231 lowed on venesection when unskilfully performed,* and still more Gen. I. frequently on amputation, worms or other acrimony in the stomach, |nt^siaVI' and especially in those of infants. We have thus the three following Tiismus. varieties offered to us, which, however, chiefly differ in symptoms jaw.e peculiar to the period of life in which the disease is most disposed to show itself, or in the interval between the casual excitement and the spastic action : x Nascentium. Attacking infants during the first Locked-jaw of infancy. fortnight after birth. (3 Algidus. Occurring at all ages, after expo- Catarrhal locked-jaw. sure to cold and damp, espe- cially the dew of the evening, the symptoms usually appearing within two or three days. y Traumaticus. Occurring as the consequence of Traumatic locked-jaw. a wound, puncture, or ulcer ; chiefly in hot climates ; and rarely appearing till ten days or a fortnight after local affection. The pathology is highly difficult, if not mysterious, and has hence Pathoio- been purposely avoided by most preceding writers. Dr. Cullen ex- fipTe dX" presslyavows that he "cannot in any measure attempt it."| There ^t at- is one principle, however, to which I have frequently had occasion tempted to to direct the reader's attention, which will help us in a considerable edby tie"1" degree to develope something of its obscurity, and to account more auth<" >" especially for so remote a separation between the seat of primary especially irritation and that of spasmodic excitement, which constitutes, per- ^ $'"£" haps, its most embarrassing feature. The principle I allude to is mo,e action the sympathy that prevails throughout the whole of any chain ofthe™hl"f organs, whether continuous or distinct, engaged in a common func- **rRt of lhed tion, and which is particularly manifest at its extremities ; so that let that of a morbid action commence in whatever part of the chain it may, the \"™J? extremities, in many instances, become the chief seat of distress, and Analogies. even of danger. We had occasion to notice this law of the animal of "'mote economy when treating of parapsis illusoria, or that imaginary ^hen3 sense of feeling and of acute pain in a limb that has been amputated united in a and is no longer a part of the body, which we referred to the prin- chai^of ciple before us : and farther noticed, by way of illustration, the pain actIon- often suffered at the glans penis from the mechanical irritation of the neck of the bladder by a calculus. So, irritating the fauces with a feather excites the stomach, and even the diaphragm, to a spasmodic action, and the contents of the organ are rejected. Irritating the ileum, as in ileac passion, produces the same effect upon the stomach and esophagus ; at the same time that the other extremity of the canal is attacked with rigid spasm, and consequently with obstinate cos- tivcness : while in cholera both extremities are affected in a like way, and we have hence both purging and vomiting. It is to the * Delaroche, Journ. de Med. Tom. xr. p. 213. Forestus. Lib. x. Obs. 111. Schenck, Obs. l. r. N. 250. •t Pract. of Phys. Book in. Sect, i Chap. i. § mcclxix. 232 CL. IV. j NEUROTICA. [<)Ki>. III. Gen. I. Spec. VI. Entasia Trismus. Locked- jaw. Sympathy pervading a chain of nervous fibres; and evinced chiefly in their re- mote ex- tremities. Illustrated. This rea- soning ap- plied to trismus and dis- eases of a like kind. Illustrated in trismus. same principle we are to ascribe it that when the surface of the body is suddenly chilled, as on plunging into a cold bath, the sphincter of the bladder becomes irritated, and evacuates the contained urine : and, in treating of marasmus, we had occasion to show that while, in one of its species, the disease seems to commence in the digestive, and in another in the assimilating organs, constituting the extreme ends of a very long and complicated chain of action, it very generally happens that at which end soever the decay commences the opposite end is very soon affected equally. In a continued chain of nervous fibres, however, this principle of sympathy which induces remote parts, and particularly remote ex- tremities, to associate in the same morbid action, is peculiarly con- spicuous. Hence, if a long muscle be lacerated in any part of its belly the tendinous terminations are often the chief seat of suffering. As the ulnar nerve sends off twiggs from the elbow to supply the fore-arm and fingers, a blow on the internal condyle of the humerus gives a tremulous sensation through the fore-arm and hand : and as the ulnar nerve itself is only an offset from a plexus or commissure of the cervical nerves which also give a large branch to the scapula, a paralysis of the ring or little finger has sometimes been removed by stimulating the scapular extremity by a caustic applied at the in- ternal angle of the scapula. In inflammation of the liver, a severe pain is often felt at the top ofthe shoulder, and in palpitation of the heart, at the left orifice of the stomach. Both these are to be ac- counted for by recollecting that the radiations of the phrenic nerve extend in an upper line to the shoulder, and in a lower to the dia- phragm, which constitute its extreme points ; and that one of its branches passes over the apex of the heart. Now as the under sur- face of the diaphragm participates, from its contiguity, in an inflam- mation of the liver, the top of the shoulder suffers, as forming the extreme point of the phrenic chain by which these organs are con- nected ; and as the upper surface of the diaphragm is in direct con- tact with the left and very sensible orifice of the stomach, an uneasi- ness at the apex ofthe heart becomes the cause of irritation to this orifice in consequence of its connexion with the diaphragm, and hence, of necessity, with the lower branch of the phrenic nerve at its extreme distribution. These remarks apply with particular force to the disease before us, and many others of the same class with which it has a close analogy, as tetanus, lyssa, and hemicrania. And, although from the intricacy of the intersections and decussations with which various nerves pursue their radiating courses, it is impossible for us, in many instances, to determine why one line of connexion suffers while another remains unaffected, yet in most instances we may be able, by an accurate survey, to trace the catenation, and hence to obtain some insight into the physiology of these exquisitely curious, and complicated disorders. In mapping the nervous ramifications which give rise to trismus or locked-jaw, we must regard the ganglionic system, consisting of the various branches of the intercostal trunk, and the numerous branches which unite with it from the whole line ofthe spinal marrow* m- xv.J NERVOUS FUNCTION. [0ud. im. Z&i as constituting the centre; and as, from this centre, we perceive °en. I. ramifications radiating in every direction to the face, the entire EntasiaVI' length of the back, the upper and lower limbs, and the thoracic and Trismus. abdominal viscera, we see a foundation laid even by a continuous jaw.ked" chain, for an association of remote parts and even extreme points in morbid changes, even though we may not be able, satisfactorily per- haps, in any instance, to trace out the individual line by which the diseased action is carried forward, and to separate it from other lines with which it is inextricably interwoven. Thus, in the case of illustration trismus nascentium, forming the first variety under the present spe- frnTfirst10 cies, the irritation of the nerves of the stomach, which is very clearly varietv- the primary seat of disease in most cases, is propagated directly to the central branches of the ganglionic system, by the tributary off- sets which the stomach receives from it. But we have already ob« sarvcd, that the chief contribution to this grand junction-canal is derived from the intercostal nerve itself, in the first instance an arm from the trigeminus or fifth pair of nerves, two branches of which radiate upwards, constitute the maxillaris superior and maxUlaris inferior, and are lost in the muscles ofthe jaws ; so that the upper extremity of the nervous line distributed over the stomach is the nerves of the jaws themselves. While various branches ofthe fifth occasionally unite with the portio dura, or respiratory trunk of the seventh pair, which divaricates not only to the diaphragm, but over all the muscles that have the remotest connexion with the respiratory system. And hence, agreeably to the law of the animal economy we have just pointed out, the muscles of the jaws, forming this ex- tremity in the chain of morbid action, are the organs in which we may expect an irritation of the nerves of the stomach in various in- stances to manifest itself most strikingly. In like manner we may account for the second and third varieties illustration , . ii. i -ii 1 .... applied to of trismus, or that produced by a chilly dampness, or irritative vio- the second lence applied to the upper or lower extremities : for as these are all varieties. supplied by nerves from the vertebral source, which, as we have already remarked, gives off branches from every aperture in the spine to the ganglionic system, and as this system, at its upper end, ter- minates in the maxillary branches of the fifth pair of nerves, the muscles into which these nerves are distributed constitute one ex- treme point of a long chain of nervous action, while those of the upper and lower limbs constitute the other. And hence the same law which produces a spastic fixation of these muscles in certain ir- ritations of the ftomach, may reasonably be expected to operate with a like effect in certain irritations of the upper and lower limbs. And as the intercostal nerve, at its first rise from the common source of itself and the maxillary branches, receives also, in its progress, off- sets from the sixth, seventh, eighth, and ninth pairs of cerebral nerves, as well as from all the vertebral, and as all these, in consequence of such an interunion and decussation, are sending forth branches oyer the muscles of the back, the chest, and the thorax, there is no diffi- culty in conceiving, when a rigid spasm has once commenced in the lower jaw, why it should be propagated through any of the muscles •ippertaining to these parts of the system, or even originate in them Vol. IV.—30 231 cl. iv.J MIL RO TIC \. |ohd.iii Gen. I. Spec. VI. Entasia Trismus. Locked- jaw. Illustration equally ap- plicable to u K. Tris- mus nas- centium- Locked- jaw of infancy. Peculiarly common to tropical climates. Called vul- garly, but absurdly, Falling of the jaw.. Description. Ordinary cause. Diseaso sometimes found in cold and mountain- ous coun- tries. from any ofthe causes that excite locked-jaw, and hence lay a foun- dation for tetanus as well as trismus, both as a primary and a se- condary disease. And I have touched upon this subject now that we may not have to repeat the present explanation when treating of tetanus in its proper place.* In the simplest state of trismus, indeed, there is some degree of stiffness found at the back of the neck, and even in the sternum. The disease, in some cases, shows itself with sudden violence, but. more usually advances gradually: till at length the muscles that pull up the jaw become so rigid, and set the teeth so closely together that they do not admit of the smallest opening. In tropical climates, for Dr. Cuiien's remark that it is most com- mon to the middle-aged only applies to the temperate regions of Europe, children are particularly subject to this complaint, and with a few peculiarities which, though producing no specific difference, are sufficient to establish a variety. The disease in this case is vul- garly known by the absurd name of falling of the jaw. It occurs chiefly between the ninth and fourteenth day from birth; seldom after the latter period. Without any febrile accession, and often without any perceptible cause whatever, the infant sinks into an un- natural weariness, and drowsiness, attended with frequent yawnings, and with a difficulty, at first slight, of moving the lower jaw ; which last symptom takes place in some instances sooner, in others later. Even while the infant is yet able to open its mouth there is, occa- sionally, an inability to suck or swallow. By degrees the lower jaw becomes rigid, and totally resists the introduction of food. There is no painful sensation ; but the skin assumes a yellow hue, the eyes appear dull, the spasms often extend over the body, and in two or three days the disease proves mortal. The ordinary cause is irritation in the intestinal canal. Hence viscid and acrimonious meconium frequently produces it; as worms are said also to do, some months after birth.. It seems, moreover, in some instances, to have followed from irritation in tying the navel- string, or its not being properly attended to afterwards; in which case, though the stomach may be affected by contiguous sympathy. the disease makes a near approach to the third or traumatic variety. Yet the appearance of the epastic action is as early as where the stomach is primarily affected. In cold and even mountainous countries this variety is also some- times found. " I am informed," says Dr. Cullen, "of its frequently occurring in the Highlands of Scotland ; but I never met with any instance of it in the low country, "t Whether, according to the con- jecture of this celebrated writer, it is more common to some districts than to others, has not been sufficiently determined, " It seems," says he, "to be more frequent in Switzerland than in France." Hot climates, however, constitute its principal domain ; and hence it is not very surprising that Bajon should place one of its chief resi- * See Cloquet, Traite <1'Anatomie Descriptive. Bork Beschreibung desfuensten Nervenpaares und seiner Verbindnngen mit andean Nerven. vorzue«riiet mit der •langlienysteme. Leips. 1817. * Ijor. ci«at. 5 MrriYvxT -J-iv.] NERVOUS FUNCTION [ord.iii. 23o dences at Cayenne ;* or that Akerman should assert it to be an Gen- I< '•ndemic in Guinea. , Spec. VI; In the second variety of the disease, or that proceeding from 0E.Tris- cold or night dew. the symptoms often appear within a day or two tarrhaiis. after exposure to the exciting cause. It is not common that the i^^ spasm expends to the muscles of the chest or back, so as to produce jaw. tetanus, though there is often an uneasy sensation at the root of the eaClipt!on" tongue with some difficulty in swallowing liquids after their introduc- tion into the mouth, the disease thus making an approach towards lyssa or canine madness in its symptoms, as we have just endeavoured to show that it does in its physiology. According to the observa- tions of Baron Larrey, indeed, this approach is in many instances very considerable ; for he informs us that on post-obituary examina- tions he has often found the pharynx and esophagus much contracted, and their internal membranes red, inflamed, and covered with viscid reddish mucus. Dr. Hennen, however, does not place much de- pendence upon any such appearances; he admits, nevertheless, that they are to be traced occasionally, though he ascribes them more to an increased flow of blood consequent on increased action than to any other cause.f In this variety, from the slighter nature of its attack, the patient not unfrequently recovers by skilful medical treatment, and there are unquestionably instances of spontaneous recovery! though cases of this kind are very rare. The intellect remains unaffected, there is little quickness of the pulse, sometimes none whatever, and little or no disorder of any kind, though the bowels are usually very costive. If the patient pass the fourth or fifth day we may begin to have hopes Trognos- of him ; for the spasmodic constriction will then frequently remit, or intermit : but, as even in the last case, it is apt to return at uncertain intervals, there is still a considerable danger for many days longer. When, as in the third variety, the disease proceeds from a nerve y E. Tria- irritated by a wound or sore of any kind, the spasmodic symptoms maticus"" are much later in showing themselves; and sometimes do not make.j^eT-iaw their appearance till eight or nine days afterwards, occasionally, in- symptoms deed, not at all till the wound is healed. The disease is more dan- "JJiTtLn gerous in proportion to the delay ; the adjoining muscles of the face ™J*° p^; become more affected, and, as is already observed, the spasms often rfetief ;V'1 shoot downward into the back or chest, and trismus is complicated ™*™t°i0n. with tetanus. The breathing is nasal and abrupt, the accents are ally more interrupted and slow, and uttered by the same avenue ; the muscles iJ^cHpUon. ofthe nose, ffps, mouth, and the whole of the face are violently drag- ged and distorted, and the patient sinks from nervous exhaustion and want of nutriment, the jaw-bone being set so fast that it will often break rather than give way to mechanical force. The disease, from this cause, is generally fatal: and we are in- ™»*'a"e_ debted to the ingenuousness of Sir James M'Grigor and Dr. Hen- raiiyfttai. nen for a confession that, whatever remedies were employed in the * Bajon, Abhandlung. von Ki-ankheit. auf derlnsel Cayenne, &c. Erp. 1781. t Principles of Military Surgery, 246. ! Briot. Hist, de la Chirurgie Militaire en France, &c. Svr>. Beganson. 181? ass cl. iv.] NEUROTICA GEH. I. Spec. VI. 0 E. Tris- mus trau- matica. Traumatic locked-jaw, Treatment the same as for tetanus, and reserv- ed for the close of that sub- iocr. British army, whether in India or in Spain, the mortality was ncarh the same. But as the treatment of the present variety and the ensu- ing species should be founded on a like principle, we shall reserve this subject till we have entered upon a distinct history of the latter SPECIES VII. ENTASIA TETANUS. TETANUS. PERMANENT AND RIGID FIXATION OF MANY OR ALL THE VOLUNTARY MUSCLES ; WITH INCURVATION OF THE BODY AND DYSPNOEA. Gen. I. Tetanus is* derived from titxiw, which itself is a derivative ofi'in^f1" from rma-<" tenQ,o, extendo." Like trismus it is a term common to thejspecific the early Greek writers, among whom it was used synonymously with opisthotonus and emprosthotonus, though the two latter were afterwards employed to express two distinct modifications of the disease. From peculiarities in the seat or mode of its attack, this species offers us the four following varieties : term. Anticus. Tetanic procuration. Dorsalis. Tetanic recurvation. Lateralis. Tetanic transcurvation. Erectus. Tetanic inflexibility of the body, Tetanus of the flexor-muscles. The body rigidly bent forwards. Tetanus of the extensor-muscles. The body rigidly bent backward. Tetanus of the lateral muscles. The body rigidly bent laterally. Tetanus of both the posterior and anterior muscles. The body rigidly erect. EtoproS' tbotonus what Catochus how con- nected with these. More pro- perly a subdivision of earns. General physiology. The first of these varieties is the emprosthotonus of early writers ; the second the opisthotonus; the third the pleurostho- tonus of authors of a later date ; the fourth the proper tetanus of Dr. Lionel Clarke, and a few others. To these varieties it has been usual to add the singular disease called catochus ; which by Sau- vages, Cullen, and various other authorities is regarded as closely connected with this species. It has a near affinity to it unquestion- ably, and hence out of deference to concurrent opinions, it was suffered to stand as a variety of tetanus in the first edition of the author's Nosology, but with a note intimating that it seems rather to belong to the genus carus of the fourth order of the present class, and to be a modification of the species ecstasis, under that genus : and as this appears to be its proper place it wdl now be found arranged there accordingly. The general physiology, «o far as it seems capable of elucidation. cl. iv.J NERVOUS FUNCTION. [ord. hi. 237 has been already given under the preceding species ; the proximate Gen. I. cause being that of a peculiar irritation of a certain chain or asso- Ectasia*1' ciation of nerves, chiefly operating with the greatest violence at the Tetanus. two extremities of the morbid line. This irritation seems, in many nireaV instances, to consist in inflammation ; and hence is made a common p^xlmate cause by many ofthe most valuable writers ofthe present day. Pro- cause. fessor Frank seems first to have started the idea, and he has been followed in succession by Dr. Saunders of Edinburgh, Dr. Chisholm, Dr. James Thomson, and Dr. Abercrombie, who have been up- held in Italy by M. M. Brera, Rachetti, and Bergamaschi, and in France by M. Esquirol. Bergamaschi* advances indeed so far as Neuroste- to maintain that where wounds themselves, of whatever form, are the Berga- remote cause, a neurostenia, as he calls it, or inflammatory affection maschl- of the nerves, is still the proximate cause ; extending itself from the wounded part, by the nervous extremities, to the spinal marrow and the brain, or vice versa, from the brain to the spinal marrow and principal nerves, and thence to the parts that are subservient to loco- motion. Dissection, however, is very far from giving proofs of such inflammatory change in every instance : while in many cases the disease is of too fugitive a character, and makes its seizure or its disappearance too rapidly for the more measured progress of inflammation. The exciting causes are also for the most part those of trismus : Exciting , .. ° ..„ fi i. i i causes. though it appears in infancy far less frequently, unless as a con- comitant of that disease. Damp and cold, therefore, and simple nervous irritation from wounds or sores in hot climates and crowded hospitals, are the chief sources of its production ; and where these accessories exist, terror seems to be a powerful auxiliary, and has alone, in some instances, been sufficient for its production. " Pas- betimes sion, or terror," says Dr. Hennen, " after wounds and operations, a .powerful has been known to produce the disease in some; and sympathy, ^themf though a rare cause, in others." It is said also to have been pro- duced by insolation or exposure to the direct rays of the sun,t and has unquestionably followed, as M. Magendie, and numerous other French authors^ have abundantly shown, from various irritant nar- cotics, as strychnine, or the extractive of nux vomica, as also from galvanism, when raised to a sufficient power for the purpose. Lateral tetanus is very rarely to be met with, and seems to be j^'*] rather a chronic than an acute malady. Fernelius, who first described peculiarly it,§ gives a case in which it occurred annually, but only in the uncommo winter, during which season the patient had two or three paroxysms daily, the head was first attacked with a peculiar vibratory feeling which gradually descended to the neck with a sensation of cold, and by the time it reached the scapula, was immediately succeeded by symptoms of opisthotonus, and afterwards of lateral contraction ; during which the mind and external senses were unaffected, but the * Osservazioni Medico-pratiche sul Tetano.—Giornale di Medicina pratica del Sie. Cons. e. Prof. Cav. V. L. Brera. T Pathol. Lib. v. p. 372. \ Desportes, Raffcnean, Fonquier, Dupuy. b Medical Observations and Inquiries, Vol. vi. Zm i.l. iv.j- NEUROTICA. lultU- 1U SpE Vll' flexor"muscles were so firmly fixed that no antagonist force of the Entasia " bystanders was able to overpower the contortion. Tetanu*' ^or are eit^er of the otlier variet*esi in anv degree, so frequent Description, as trismus, except where they form a subsequent part ofthe general varietfeT chabi of morbid action. My observant friend Dr. Hennen, con- aiso less' fesses that during.the whole period of his superintending the British tha "tru- hospitals in Spain he never met with but one case of emprosthotonus, mus when an(j even this he describes as an incurvation that rather approached idrioCpayihic. it than constituted the disease itself. " It was observed," says bo, " at the same time and in the same hospital, with the various degree- of trismus : rigid spasms of almost every muscle of the body, and violent periodical convulsions, all from similar injuries to that in which it was produced."* Tetanus a From the complicated manner, indeed, in which tetanus shows compUcaud itself, and its anomalous attack upon different sets of muscles at the affection of same time, it seems in many instances to put all the subordinate emusces. j—giong Qf classification at defiance. It is, in truth, for the most part a mixed disease, affecting various and opposite sets of muscles: and this in many cases so equally that the spastic action of the flexors just balancing that of the extensors, "the patient," to adopt the language of Dr. Lionel Clarke," seems often to be braced between opposite contractions." It is to this form, indeed, that this last very intelligent writer has limited the name of tetanus as that to which it applies most emphatically. Like Dr. Hennen, he asserts that he had never seen a single case of genuine emprosthotonus ; and that of the other two varieties of which he treats, the opistho- tonus and proper tetanus, the former occurs most frequently. Tetanic jn episthotonus or tetanic recurvation the. symptoms some- SiSo": times show themselves suddenly, but more commonly advance slowly and imperceptibly : the patient mistaking the uneasy stiffness which he feels about the shoulders and cervical region for a crick in the neck, produced by cold and rheumatism. The stiffness, however, increasing, he finds it impossible to turn his head on either side without turning his body : he cannot open his jaws without pain, and he has some difficulty in swallowing. A spastic and aching traction now suddenly darts at times towards the ensiform cartilage, and thence strikes through to the back, augmenting all the previous symptoms to such a degree that the patient is no longer able to support himself, and is compelled to take to his bed. The pathognomic symptom in this variety is the spasm under the sternum which is per- petually increasing in vehemence ; and, instead of returning, as at first, once in two or three hours, returns now every ten or fifteen minutes. Immediately after which all the host of concomitant con- tractions renew their violence and with additional severity : the head is forcibly retracted, and the jaws snap with a fixation that rarely allows them to be afterwards opened wide enough to admit the little finger. This vehemence of paroxysm may not, perhaps, last longer than for a few minutes or even seconds: but the spastic action pre- vails so considerably, even through the intervals, that it is difficult * Military Surgery, p. 247. 8vo. Edinb, 1820. l. iv., NERVOUS FUNCTION. [ord. hi. 239 for an attendant to bend the contorted limbs into any thing like an GENyJj easy or reclined position. The breathing is quick and laborious, EntMia and the pulse, though calmer and less hurried, small and irregular. Teh»i». The face is sometimes pale, but oftener flushed, the tongue stiff and torpid but not much furred ; the whole countenance evinces the most marked signs of deep distress, and swallowing is pertinaciously abstained from, as accompanied with great difficulty and often pro- ducing a sudden renewal of the paroxysms. The last stage of the disease is truly pitiable. The spasms return every minute and scarcely allow a moment's remission. The anterior muscles join in the spastic action, but the power of the posterior is still dominant; and hence while every organ is literally on the rack from the severity of the antagonism, the spine is more strongly recurvatcd than ever, and forms an arch over the bed, so that the patient rests only on the back part of the head and on the heels. During the exacerbation of the spasms, the lower extremities, even while they continue rigid, are so violently jerked, that the utmost attention is necessary to prevent the patient from being projected from his bed: and Des- j^j^jgjj, portes gives a case in which both the thigh bones were broken from been broken the violent contraction of the flexor-muscles during a momentary J^nt e remission of the extensors :* similar results to which we shall have contraction ' ot the occasion to notice hereafter. tiexor- The tongue is in like manner darted spasmodically out of the muscles- mouth, and the teeth snapped suddenly and with great force ; so that unless a spoon covered with soft rags, or some other intervening substance, is introduced between the teeth at such periods, the tongue must be miserably bitten and lacerated. The exertion is so labo- rious that the patient sweats as in a hot bath : and the heat has in some instances been raised to 110° Fahrenheit. The pulse is at. this time small, and irregular : the heart throbs so violently that its palpitations may be seen ; the eyes are sometimes watery and larfc- guid ; but more commonly rigid and immoveable in their sockets : the nostrils are drawn upward, and the cheeks backward towards . the ears, so that the whole countenance assumes the air of a cynic spasm or sardonic grin, while a limpid or bloody froth bubbles from the lips. There is sometimes delirium, but this is not common : the patient is worn out under this laborious agony in a few hours ; though more usually a general convulsion comes to his relief, and he sinks suddenly under its assault. In the erect tetanus, in which there is a balance of spastic Ercct action between the anterior and posterior sets of muscles, the pro- Description. gress of the disease is not essentially different. The march of the ^cTcon-0" spastic action, however, varies in some degree, as we have already siderabiy observed, in almost every instance from trismus to tetanus, and from vanes" one modification of tetanus to another : yet the course we have now described is that which chiefly takes place where the disease advances in something of a regular and uninterrupted progress. Its ^°sn0E' danger and duration are commonly to be estimated from the degree of violence ofthe incursion. Where this is very severe the patient * Hist, dea Maladies d« St. Domingue, ii. p. 171. ^40 cl. L>.j .NEUROTICA ;.«un. i.: SpNVIl" rarety survives die third day, and is sometimes cut oil" on the second. Entasia ' or even in six and thirty or four and twenty hours. But, where the Teta"us' attack is less acute the patient may continue to suffer for a week before he reaches his tragic termination. If he have strength enough to survive the ninth day he commonly recovers, for the paroxysms diminish in violence, the intervals of remission are longer, and the muscles being generally more relaxed, he is able to take a little nour- ishment. Through the whole period there is an obstinate costivc- ness, partly from want of food in the stomach, but chiefly from an association of the mouths of the intestinal excernents in the spas- modic constriction. piinc'm/e of ^he gener£d principle of cure is far more easily expressed than cure two- carried into execution. It is that of taking off the local irritation, take'ol? lo- wherever such exists, and of tranquillizing the nervous erethism of caiirrita- the entire system. The first of these two objects is of great im- tion, and -iiii- ,-. • n /• i tranquil- portance in the locked-jaw or trismus of infants ; for by removing nera!here?e" tne viscid and acrimonious meconium, or whatever other irritant is thism of lodged in the stomach or bowels, we can sometimes effect a speedy ThoTreTof cure without any other medicine. Castor oil is by far the best lortancTin aPer*ent on this occasion, and it may be given both by the mouth the locked- and in injections. But if this do not succeed we should have mfants. recourse to powerful anodynes; and of these the best by far is opium, Modes of which should be administered from three to five drops in a dose, piuhing according to the age of the patient. Musk and the host of antispasmo- thts object. jjjcs fjave Deen trjec| so 0ften ^vith so little success that it is not worth while to put the smallest dependence upon them : nor has the warm or cold bath produced effects sufficiently general or decisive, to allow us to lose any time in trusting to their operation. They may be employed, however, as auxiliaries ; but our sheet-anchor must be opium, which if the spastic action bave made much advance when we first see the patient, should instantly be employed in conjunction with the prescribed aperient. By taking off the constriction from the intestinal canal, and thus restoring and quickening the peristaltic motion, it may even expedite the dejections. of trismus ^n trismus or tetanus from wounds or sores, the local irritation is or tetanus not so easily subdued : nor is its removal of so much importance. wounds or though in no case of small moment. But, generally speaking, the «>res'. spastic action is, in these instances, as much dependent upon con- action here stitutional, as upon topical irritability, and when it has been once dependent excited it will run through its career, whether the local cause continue upon con- or not. It is owing chiefly to this fact that the best and most active as topical plan of cure so often fails of success; and the most cautious prac- andabence titioners hesitate in their prognostications, whatever be the march of often con- symptoms, for the first four or five days. " From the state of the theUiaiterer pulse," says Dr. Hennen, " I have derived no clue to either the h* CeUk?" Pr0Per treatment or the probable event; it has, in the cases I have greatdiffi- met with, been astonishingly unaffected. From the state of the skin proenosti- * nave Deen ^ end claim to attention ; and their votaries are so equally divided that it jns, * London Med. Itepos. Vol. xx. p. 403. Case furnished by Mr. Finch. t M. Coze. Remarques Mir la Nux Vomique, &c. j Silvester, Med. Obs. and Inquir. i. Art. I. White, Med. Obs. and Inq. n. Art. xrsiv. § Thomson's Annals of Philosophy. Vol. IV —31 UJ, cl. iv.] NEUROTICA [oiiw. m Gen. I. is no easy matter to say which is most strongly recommended. The EnfasiJ"" bitter demands more general strength in the system than the former : Tetanus, hut neither of them are to be depended upon except as an auxiliary. Treatment. The cold bath has the authority of Dr. Lind in its favour,* and has in some instances been tried with success in America.! Mercury Mercury, in various forms, has been had recourse to from a very ■TatuTex- early period: and, on the authority of Dr. Stoll, has occasionally cite saliva- been used for the purpose of exciting salivation. On what ground it has been carried to this extent I do not know, except it be that a pretty free flow of saliva from the mouth spontaneously has, by many persons, been regarded as a favourable sign. The disease, however, does not seem to be accompanied with any symptom that can be called critical; and it is hence probable that this spontaneous flow of saliva is nothing more than a result of the violent action and alternating relaxation of all the parts about the fauces. Neverthe- less, salivation, where it has been accomplished, is said by many writers to have been serviceable, though I know of no practitioner who has relied on it alone. And, in reality, such is the rapidity with which both trismus and tetanus usually march forward where they have once taken a hold on the system, that we have seldom time to avail ourselves of this mode of cure, were its pretensions still more decisive than they seem to be. It is most successfully employed after copious venesection, and in conjunction with opium. opium Opium, indeed, in every stage and every variety of both tetanus wdepend- and locked-jaw, is the remedy on which we are to place our chief if ed upon in not our only dependence. But to give it a full chance of success ii and modifi- should be administered in very free doses, and it is not easy for us to tate'Vivcn De to° ""ee *n lta use- *n tne Edinburgh Medical Commentaries^ in very free we have a case in which five hundred grains were taken within Exempli- seventeen days, which is about thirty grains a-day : and in the Edin- ned. burgh Journal,§ another case, in which, after smaller doses along with calomel, the practitioner at last gave a drachm of solid opium at one time. This, however, proved too high a dose ; for the induced stupor was accompanied with very laborious respiration, and nearly an extinction of the pulse, and the patient was obliged to be roused by stimulants. He recovered ultimately. Yet in the West Indies opium is often carried with the most beneficial effect to as great an extent as this, though not at once. Thus Dr. Gloster of St. John's, Antigua, gave to a negro, labouring under tetanus from an exposure to the night air, not less than twenty grains every three hours, in conjunction with musk, cinnabar, and other medicines: and con- tinued it with but little abatement for a term of seventeen days, in the course of which the patient took five hundred grains of this nar- cotic. For the first six days little benefit seemed to be effected, but after this period the symptoms gradually declined under the same perseverance in the medicine ; and in thirteen days more they were so much diminished that no further assistance was thought necessary. °piunwilih *f tbere be any thing wbich adds to the sedative power of opium union sudorifics; * Essay on Diseases in Hot Climates, p. 257. t Tallman. Amer. Phil. Trans, i. xxi. Cochran, Edin. Med. Com. Vol. in. p. 183. ! Vol. i. p. 88. fc Edin. Med. and Sur<*. Journ. No. unci. Mr. Barrs case. cl. rv.] NERVOUS FUNCTION. [ord. hi. 243 in this disease it is sudorifics, and particularly ipecacuan. And Gen- *• upon this subject Dr. Latham has given a valuable paper in the Entasia' Medical Transactions, in which he offers examples of failure in the Tetanus. use of James's powder, when used either alone or in alternation Treatment. with opium ; but of full success by uniting the two powers of the f^acall • narcotic and the sudorific, though he afterwards preferred ipecacuan «»given by to James's powder, and prescribed it in the form of the compound powder of this name. He gives cases in which he employed this compound in very severe attacks, and sometimes in what seemed to be its last stage of the disease, with an immediate arrest of its symptoms, and progressively a perfect restoration to health. His doses consisted of ten grains repeated every three or four hours. In no instance was there any unusual inclination to sleep, how long soever this treatment was continued, which in one case was for a fortnight: nor was there any degree of sickness, nor any other inconvenience, except that of a perspiration troublesome from its excess.* It is only necessary to observe further that during the treatment Proper either of trismus or tetanus, a very particular attention should be 0f essential paid to ventilate the chamber with pure air : and especially to importance. purify the air of close and crowded hospitals, without which no plan of treatment in the world can be of any avail. We should also The bowels remove, if possible, the costiveness to which the bowels are so pe- lieved of culiarly subject, by some gentle aperient: for it sometimes happens, u^gentfe8" not only in infantile trismus or tetanus, but in that from obstructed aperients; perspiration, or cold and dampness, that the primary cause of irrita- tion is seated in the bowels : while, whatever accumulation takes place in this quarter, during the course of the disease, may add to and exacerbate the general erethism. At the same time nothing °u« drastic can be more mischievous than the drastic purges which practitioners highly mis- are apt to give at the commencement of this disease, consisting ofcmevon8- jalap, scammony, and aloes. We have already seen that the gene- Explained. ral excitement is so extreme that the slightest occasional irritation, even that of changing the position of the head, is sometimes suffi- cient to produce a return of the spasms: and hence there can be nothing more likely to do it than the griping effects of such acrimo- nious medicines. And it will be far safer to pass by the constipa- tion altogether, than to attempt to remove it by such dangerous means. The best medicine is castor oil, which may be given either by the mouth or in the form of injections : and if this do not suc- ceed, we may employ calomel. But the action of the bowels must only be solicited, and by no means violently excited. * Med. Transact. Vol. iv. Art. iv. 241 et, iv. NEUROTICA. [okd. i«- SPECIES Mil. ENTASIA LYSSA. RABIES. Gen. I. Si. VIII. Antiquity ui the spe- cific name and of the disease Itself. Noticed repeatedly in the. Iliad. Lyssa pra- farable to hydropho- bia, iu common synonym, and way. Hydropho- bia not a constaut •ymptom: being fre- quently absent in quadru- peds ; and said to be some- times ab- sent in mankind. Hydropho- bia some- times found without rabies. Exempli- fied. SPASMODIC CONSTRICTION OP THE MUSCLES OF THE CHEST ; >rJTEK' VENING TO THE BITE OP A RABID ANIMAL ; USUALLY PRECEDED BY A RETURN OF PAIN AND INFLAMMATION IN THE BITTEN PART .' GREAT RESTLESSNESS, HORROR, ARD HURRY OF MIND. The Greek term for rabies was lyssa : and the antiquity of the disease is sufficiently established from its being referred to several times under this name by Homer in his Iliad, who is perpetually making his Grecian heroes compare Hector to a mad-dog xvix Xvt- vt)T7ipx, which is the term used by Teucer ; while Ulysses, speaking of him to Achilles, says, —— Kfiartprj St I AYXXA Itivictv.* So with a furious Lyssa was he stung. The author has ventured to restore the Greek term, not only as being more classical, but as being far more correct than the tech- nical term of the present day, which is hydrophobia, or water- dread; since this is by no means a pathognomic symptom ; being sometimes found in other diseases ; occasionally ceasing in the present towards the close of the career ; and, though almost always observable among mankind, in numerous instances wanting, even from the commencement, in rabid dogs, wolves, and other animals. " Constat repetita," says Sauvages, " apud Gallo- provinciales experientia, canes luposque rabidos bibisse, mandu- casse, flumen transasse, ut olim Marologii, et bis Forolivii observa- tum, adeoque nee cibum nee poturn aversari." The same fact is affirmed of rabid wolves in a case given by Trecourt in his Chirur- gical Memoirs and Observations. Dr. James in like manner re- lates the case of a mad-dog that both drank milk and swam through a piece of water ;t and one or two similar cases are said to have occurred among mankind ;J though even here a spasmodic con- striction of the muscles of the chest, and sometimes of the throat, seems to have been present. Dr. Vaughan, indeed, gives the case of a patient who called for drink through the whole course of the disease, and only ceased to ask for it a short time before his death. I have occasionally met, on the contrary, with a few obstinate cases of hydrophobia, or water-dread, without any connexion with rabies : one especially in a young lady of nineteen years of age, of * Iliad, ix. 237. t On Canine Madness, p. 10. t Fehr. Nachricht von einer todslictaen Krankheit nach dem tollen Hundsbisie. Gett. 1790, 8vo. fL. rv.] NERVOUS FUNCTION. [ord. m. 243 h highly nervous temperament, which was preceded by a very severe Gen*t- toothache and catarrh. The muscles ofthe throat had no consfric- Entasia tion, except on the approach of liquids, and the patient through the jj£*Ba,gj whole of the disease, which lasted a week, was able to swallow solids without difficulty ; but the moment any kind of liquid was brought to her a strong spasmodic action took place, and all the muscles about the throat were violently convulsed if she attempted to swallow. Similar examples are to be found in Battini, Dumas, Alibert, and several of the medical records, and particularly one of great obstinacy in the Edinburgh Medical Essays, which was chiefly re- lieved by repeated venesections,* as the preceding case was by large doses of opium. Hydrophobia is therefore too general and indefi- nite a term to characterize the genus before us, uniess we mean to include under it diseases to which it is by no means commonly applied, and which, in truth, have little connexion with rabies. Hunauld has, indeed, employed it in this extensive signification, and has hence made it embrace no less than seven distinct species, of which two only are irremediable ;t and Svvediaur has followed his example.^ There is, even in the present day, so little satisfactorily known, ^^ and so few opportunities of acquiring any practical knowledge con- and evaded cerning the general nature and pathology of rabies, that it nrght, J^?*1 perhaps, be most prudent to imitate the modesty which Dr. Cullen ™«*w has set us upon this subject, and to let it pass without a single re- cullen. mark. Yet the following hints, derived from the only three cases A^JjJj™ in which the author has ever been consulted, compared with the ,,y the pre- larger range of observation and practice of a few other physicians,8ent auth01' and especially the valuable work of Professor Trolliet of Lyons, together with the reflections to which they have given rise in his own mind, may afford a little glimmering light into the principle of the disease, and give an opportunity to succeeding pathologists of describing it more perspicuously. The symptoms enumerated in the definition, and especially the (J^f,*;. constrictive spasm that oppresses the muscles of deglutition and of ea with the chest generally, sufficiently show that the present species of dis- ^"Sin™ ease bears a very close analogy to the two preceding, in the mis- |nit. mis- chief which it excites ; and, as by far the most frequent cause ofthe ,.nd i'n the two preceding species is the irritation of a wound or puncture on ?£™£ the surface of the body, it bears quite as close an analogy to them > in the nature of its cause as in that of its effects. We have seen it to be a law operating throughout the animal ^^hbfhe system, that if a morbid action commence in any part whatever of a extremities continuous chain of functions, or of fibres, it often produces a pecu- „uoaU80chain liar impression upon its extremities ; so that the extremities them--of functions selves form in many instances, the chief seat of distress and even of «,&* dancer: and this more especially where the one extremity of the^Jx- ° treraities, »^ » wj tut j often laid * Inflammation of the Stomach with Hydrophobia, &c. by Dr. J. Innes. Ed. Med. doWD| and Ess I p 227 nore aSa'n t biscours sur la Rage, et ses Remedes. Chateaus Gontier, 1714, 12mo, appealed to X Nov. Nosol. Meth. Syst. Vol. i. p. 511. 246 cl. iv.] NEUROTICA. Lord. nf. sGK viii cnain becomes affected in consequence of the primary affection of Ent'uia ' the other. And we have also endeavoured to show, from the gene- £**!•• ral course and intermediate connnexions ofthe nerves which supply the surface ofthe body, and particularly the extremities, that they constitute a direct fibrous chain, of which those that are, in all com- mon cases, primarily irritated by wounds or punctures in the spastic diseases before us, from the one extremity, and those which enter into the muscles of the upper regions of the chest and the cheeks the This law other.* It is not necessary, therefore, to travel over the same ground mTuus- t0 again ; the reader may turn to it at his leisure : and he will find that trUmuY^ we nave hence endeavoured to trace out something ofthe means by and teta- which trismus and tetanus are produced by simple wounds or punc- tures in the limbs, and especially in an irritable habit. and equally Now if the reasoning be sound, as applied to trismus and tetanus. ?o?yssa,8 it must be equally good as applied to lyssa; and will induce us to which, for expect a more complicated disease and a still more severe and des- vanous 1 i • i reasons, perate result; as we have, in the present instance, not merely an supposed ordinary and mechanical, but a specific and chemical source of irri- capabie of tation to encounter, and so indecomposibfe in its nature that it i> a more fa- capable of lurking in the system, and apparently in the part where tal disease, jj may chance to be deposited, for weeks or even months without losing its activity ; of continuing dormant, if there be no sufficient irritability of constitution or nervous fibre for it to operate upon, and of operating as soon as such a condition may arrive : for that some exciting cause is usually necessary to rouse it into action, will suffi- Whether ciently appear in the sequel of this inquiry. Sir Lucas Pepys, how- be ever ever, Dr. Bardsley, and various other writers have made it a ques- neousT tion whether the virus of rabies is ever originated, or produced spon- taneously, or in any other way maintained than by a direct commu- Denied by nication from one animal to another; while M. Girard, of Lyons, Gerard of nas denied that there is any such thing at all, and contended that Lyons. rabies consists in nothing more than an acute degree of local irrita- tion, and its effects on a highly mobile and excitable constitution. Proofs of a We have long, however, had various examples on record, and have n«oui recently been furnished with another by Mr. Gillman, in which a dog origin. chained up in a yard, and cut off from all medium of contamination by other animals, has occasionally been attacked with genuine lyssa, This pnn- and exhibited its most decisive characters. Professor Troiiiet, byPTro»iet. whose extensive experience I shall soon have occasion to advert to more minutely, while he has no doubt of its occasional spontaneous origin, limits its appearance in this form to the dog, the wolf, the fox, and the cat, believing that all other animals only receive it from the one or the other of these by inoculation.! Yet inmost Nevertheless, whilst we are thus establishing that the symptoms of woundUin- rabies are dependent upon a specific virus, it may not be foreign to flicted au- remark that most animals, when roused to a high degree of rage, muScha£e're inflict a wound of a much more irritable kind than when in a state liaifduring °^ tranquillity: and we have numerous examples in which such tranquillity: + See the preceding Species, ad init. t Noveau Traite de la Rage, Observations Cliniques, Recherchcs d'Anatomie Pa- bolo«ique, et Doctrine de eette Maladie. Pro. Ltoh. 1820 CL. I\.J NERVOUS FUNCTION. [okd. m. 247 wound has been very difficult of cure, and not a few in which it has Gen. i. proved fatal; as though at all times, under such a state of excite- |*'u,^IlL ment, some peculiar acrimony was secreted with the saliva. In the L>ssa- Ephemera of Natural Curiosities, is an example of symptoms of as'thou^h hydrophobia or water-dread, produced by the bite of a man worked '^l^1' up into fury ■* and in the Leipsic Acta Eruditorum is another n><>ny were instance of the same kind,t though neither of them seem to have Eputied been fatal. Meekren,| however, Wolff,§ and Zacutus Lusitanusil 'anrii^fgr have each an instance of such a bite terminating in death, yet with- out hydrophobia. Le Cat gives a case of death produced by the bite of an enraged duck ;1I and in a German miscellany of deserved repute we have another of the same kind.** The instances, indeed, are innumerable ; but it may be sufficient to observe further that in whieh Thiermayer gives us two cases, one in which the bite of a hen, and "^Jf another in which that of a goose proved fatal on or about the third ^i'*loa' day,tt without hydrophobia : and that Camerarius has an instance of bfa.r°P °* epilepsy produced by the bite of a horse. J{ Marvellous as these facts may appear, it is more consistent with Thege reason to accredit them than to impugn the host of authorities to to be ac- whose testimony they appeal. And it hence seems to follow that ^therihan the passion of rage, whose influence is always considerable on the impugned. trachea and salivary glands, has often a power of stimulating the one i. ^ecu"-8* or other of them, among most animals, to the secretion of an acri- encjn0flnu[h monious and malignant virus with which the saliva becomes tainted. salivary Rabies, however, has sufficiently shown itself to be dependent l!Tei!itcs upon a peculiar virus, and capable of producing specific effects ; to '^8' "e* be sometimes originated, and sometimes received by communication, aenmoni- Now the only animals which have hitherto been ascertained to have Bu't the"8' a power of originating it are, as just observed, several species ofthe vims ..f genus canis, as the dog, fox, and wolf, an 1 one species of the genus pecuTia'r to felis, which is the domestic cat; it is probable, however, there are £*""• others belonging to different classes endowed with a like power ; animals and some writers have attempted to bring instances from the horse, j^g^"^ it mule, ass, ox, and hog, yet they are not instances to be depended are of the upon. In like manner, Plater, Doppert, and even Sauvages him- lo'SnTkmds, self, have asserted the same of mankind, and have brought forward ,h,,ug!\ ' ' © pronably a few casual cases in support of such assertion. These, however, the power are, in every instance, modifications of empathema, and especially ..fn"!?.*'° of rage or fright, grafted on a highly irritable temperament, and M'n**■ hence associated with hysterical, or some other spasmodic motions, have a like Ofthe remote or predisposing causes of this disease we know {^theca- nothing. The excitement of vehement rage, putrid food, long con- »<* aiinded tinued thirst from a want of water to quench it, severe and pinching Jr itr.ingiy hunger, a hot and sultry state, or some other intemprrainent of t; e txfti!ed . . ° , . , J . ' , , , , , .• passions in atmosphere, have been, in turn, appealed to as probable predispo- an irritable nents, but the appeal in no instance rests on any authority. That Rac '.ote or predispos- ing causes * Ann. ix. x. App. p. 249. IF Recueil Periodique, u. p. 90. unknown. t Ann. 1702. p. 147. ** Samml. Med. Wahrnehm. B. II. p. 08. V*JE!?,. I Observ. Cap. lxvii. tt In Goekelu Consil. et Obs. N. 19. .SpecuS § Observ. Med. Chir. Lib. ii. N. 5. |j Diss, de Epileps. freq. p. 16. but without j1 Prax. Admir. Lib. m. Obs. 84.88. sufficient authority. i48 cl. iv.] NEUROTICA. |o«u. ur Sp* Vli'l tne sumu,us °f vehement rage will often produce a peculiar influ- Entasia ' ence affecting the saliva, and rendering it capable, by a bite, of ex- Rabu» cidng the most alarming symptoms of nervous irritation we have illustrated, just shown ; but these symptoms are not those of lyssa; and the virus, whatever it consists in, appears to be of a different kind. Pu- tridity is, perhaps, the ordinary state in which dogs and cats obtain the offal, on which, for the most part, they feed : they show no dis- gust to it, and it offers a cause far too general for the purpose. In long voyages, again, when a crew has been without water, and re- duced to short provisions, dogs have been, in innumerable instances, known to die both of thirst and hunger without betraying any signs of genuine rabies. That a peculiar intemperament of the atmos- Rabies less phere may at times be a cause, it is impossible to deny; but the common in V , * <. , . . » , . J ' torrid than disease, even when of spontaneous origin, has appeared under, per- rateemP.e" haps, every variety of meteorological change, and seems to be far mates. less common in hot and tropical regions than in those of a more moderate temperature : for it is not known, except by report, in South America, though it is said to have occasionally appeared in the West Indies, as I have been repeatedly informed by intelligent residents in those quarters; while M. Volney tells us that it is equally uncommon in Egypt and Syria, and Mr. Barrow, at the Cape of Good Hope and in the interior of the country, where the Caffres feed their dogs on nothing but putrid meat, and this often in the highest degree of offensiveness. Several of It is not improbable that several of these may occasionally become mayahow- exciting causes; but it is hence obvious that they are not competent Tltin8 °^ themselves to produce the disease. Some of them indeed have causes, but been put to a direct test, and have explicitly proved their incompe- fe\™"ia- tency' Thus in the wards of the Veterinary School at Alfort, three competent dogs were shut up and made the subjects of express experiments. thePd?sease. One was fed with salted meats, and totally restrained from drinking: Proofs of tjje second was allowed nothing but water ; and the third allowed this aeser- , ° . rt tion. neither food nor drink of any kind. The first died on the forty-first day of the experiment, the second on the thirty-third day ; and the third on the twenty-fifth ; not one of them evincing the slightest symptom of rabies. The speci- That the specific virus of rabies is less volatile and active than rabIe8Uiea°f many other kinds of morbid poisons is clear from the fact that it is active and never found diffused in the atmosphere, so as to produce an epide- ihan many my; that it never operates on those who are most susceptible of its poisons, influence except when accompanied with a wound or inserted into the cutis ;* and that, even in this case, it usually requires in man- kind, and probably also in other animals, some auxiliary excitement •"ha'are" *° ena^^e ** to carry forward the process of assimilation : for it rarely bitten rarely happens that all the men or quadrupeds that are bitten by a rabid dog Sometimes suffer from the inoculation. Mr. Hunter, indeed, gives an instance not more in which out of twenty persons who were bitten by the same dog thanone on^ Qne receive(j tne disease. This want of activity is a happy anrThence cu"cumstancer as it affords an important interval for medical treat- also the long inter- val that * Troiiiet, ubi supra. . m< 249 ment, if we should ever be so fortunate as to hit upon any curative Gen. I. process that may be depended upon. At the same time I cannot |p; VIIL avoid again to observe that as this virus is less volatile than most CsT others, it is perhaps less indecomposible than any of them, and hence ?««!£ is capable of remaining in a dormant and unaffected state, in any baet^e^nHCe part of the system, into which it has been received by insertion, for a the7njunry far longer period than any other known contagion whatever. It is ZV£t generally calculated, but I do not know upon what data, that ofVirusa,s° those who are exposed to the venom about one in four matures the eTpoifbto complaint, and the rest escape. than any When the disease has once fixed itself among a large establish- andTence ment of hounds, it has been said that the acrimony of the poi&on %$$£ becomes more concentrated and active ; operates through an un- mant for a broken skin, and even taints the atmosphere. There is, however, riodYhan" no solid foundation for such an opinion; and though tli3 disease whether runs rapidly from one dog to another, and it may be difficult in many the ac»- cases to trace the marks of a bite, yet considering that the smallest 2ko«. and most imperceptible scratch of a tooth may be a sufficient medium £cn»at?d of infection, and that every inoculated dog adds to the sources from bynfuiti-6 which it may be derived, there is no difficulty in accounting for such No sohd ? rapidity of spread without ascribing anomalies to the laws by which foundation it is regulated. Heister, indeed, has given a case of lyssa, in one of opinion1! a" the foreign collections, produced in a man by his having merely put c^wfc-f into his mouth the cord by which the mad dog had been confined : being re- but as in this instance there was probably some ulceration in the without a mouth at the time, there is nothing marvellous in its production. woun,d or Palmarius, in like manner, relates the case of a peasant, who, in the asserted by last stage of the disease, communicated it. to his children in kissing fni^Pai- them and taking leave of them.* Yet unless we could be certain marius. that there were no cracks or other sores on the lips, and no eruption intehts|cts on the cheeks of these children, the example affords no proof. cases. a,c", t v • 1 iti l • • counted for 1 can distinctly state that 1 have seen the same intercommuiiica- "pon the tion successively repeated between a rabid young man and a young faw ofThe woman to whom he was betrothed, and who could not be restrained £"<»«»• from sucli a token of affection, without any evil consequences; offered. notwithstanding that the patient was labouring at that time under hydrophobia and all the severest marks of the disease which de- stroyed him in'a few hours afterwards, and had also a perpetual desire to spit his saliva about the room. M. Troiiiet asserts not only that the virus will not permeate a sound skin, but that it is only con- tained in the frothy matter communicated from the lips ; and that neither the blood, nor the secretions of any kind are tainted with it, or give rise to the disease, whatever scratch or other injury may be received during dissection. It has, still farther, been doubted whether the virus itself is capa- Has been1 ,,/. • /. i i i • -i i • sometimes ble of propagation from the human subject to any animal even by in- denied that oculation : but a bold experiment of M. Magendie and M. Breschet CanVbeUpro- has completely settled this question; for on June 19,1813, having pagated in collected upon a piece of linen a portion of the saliva of a rabid from tho human subject. * Do Moib, Contagios. p. 266. Paris, 4to. 'MS Oontradict- v of |V. -3-> loQ cl. iv.] NEUROTICA. i»"t>- IiT Spf vhi man m tne last staSe of tlie discase' thc>' inserted it under the skin Entasia ' of two dogs that were in waiting, both of them in good health ; of Rabies which one became rabid on the 27th of July, and bit two others, rimentsof one of which also fell a victim to the disease just a month after- Mugendie WorrU sndBrcs- waras. diet. The general aggregate of the symptoms point forcibly to the ner- systenTthe vous system as the immediate quarter of disturbance. Such wan immediate the opinion of Morgap-ni, Cullen, Percival, and Marcet: and such quarter of . , *T . , & & .' . „ ? , t, disturb- indeed is the common opinion of the present day. By many writers, buMheef- however, the effects have been rather referred to the sanguiferous fec^ refer- system and regarded as a fever : Mangor describes it as a continued some wri- fever \* and Rush and many others as an inflammatory affection ; terstothe }}a(]er as a fever sui generis.] Nor is the difficulty in the least de- sanguifc- o . •> . rous system gree removed by dissection, for nothing can be more at variance than edas'agfe-d the appearances in different cases. Generally speaking the fauces and yeroran parts adjoining exhibit redness and inflammatory characters. But while tion. in some instances these are so considerable as to be on the point of examined gangrene, in others there is no inflammatory appearance whatever. andiuflam- Morgagni has examined and described bodies in both these states. pwances" Rolfinc gives one or two decided cases of the latter sort :\ while accounted Feriar notices examples in which the inflammation of the fauces had spread over the whole esophagus and even the stomach ;§ and another writer has recorded an instance in which it had descended to the ileus, which was in a state of gangrene.II In some cases the encephalon, and even the spinal marrow, has appeared to be as much diseased as the fauces ; the vessels turgid ; the plexus cho- Sometimes roides blackish ; the ventricles loaded with water : though in the cases ^^J;" examined by M. Magendie, which were confined to dogs, there was no appearance of inflammation either in the brain or spine. Sometimes the lungs have been inflamed, sometimes the liver, some- times the vagina ; while the blood, according to Sauvages, has been also found in a dissolved state, and, according to Morgagni, in a state highly tenacious and coagulable. From all which we can only conclude that owing to the violence of the disease, every organ is greatly disturbed, and those the most so that in particular cases Whether are most severely affected. Riedel asserts that among dogs a highly liol w?th offensive fetor of a peculiar character is thrown forth from every anoffen- part of the body :1T but I have not found this remark confirmed by Seems to' the veterinary practitioners of our own country ; and it certainly does loirf a few not aPPty to mankind, with an exception or two that seem to depend cases from upon some accidental circumstances ; for Wolf informs us, that in ■Jtyf but3 " one of his patients, and a patient that ultimately recovered, the blood rai'con-116" stunk intolerably as it was drawn from a vein ; and a patient of Dr. comitant. Vaughan's complained of a most offensive smell that issued from the original wound, but of which no one was sensible except himself. In like manner the patient, described by Dr. Marcet, towards the close of the disease, complained loudly of an intolerable stench that * Act. Ham. n. § Medic. Facts and Observations, Vol. i, t Versuch enerneuen Theorie, &c. (| N. Act. Nat. Cur. Vol. iv. Obi. 20. I Dissert. Anat. Lib. I. cap. xii. * Act. Acad. Mogunt. Erf. 1757. tL. iv.] NERVOUS FUNCTION. [ord. in. 451 issued from his body generally, but without being perceived by any Gen. I. other person.* Dissection in this case produced nothing striking. |„t*ttB1VI11' Dessault, in his treatise on rabies, tells us that he has often met Lyssa. with numerous minute worms in the heads of those who have died Hypothesis of this disease ; and he hence regards such animalcules as its cause. °auitewho But this writer was a slave to the Linnean hypothesis of invermina- derives the tion, and applied the same cause to syphilis, which he also supposed fr'omTni. to be maintained by a transfer of vermicules from one individual to 'fUcuigs, another : and hence proposed to treat syphilis, lyssa, and itch, as dis- eases of a like origin, with the common antidote of mercury ; and gives instances of success which no one has met with out of his own practice. The cases, however, which he describes haefnot advanced to the stage of water-dread ; and in all of them he thought it pru- dent to combine with his mercurial inunction cold bathing, and Pal- marius's antilyssic powder. Vander Brock and, after him, Rahn maintain that the return of pain Whether and inflammation to the bitten part, on the onset of the disease, irritation does not occur from any virus which has hitherto been lvinp- dormant proceed 1 lf> 1 • 1 • T "l 1 1 'r0m ft °0r" there, but from the universal excitement alone. It may be observed, mantsemi- however, in opposition to such an opinion, that this local affection "r'0u™'u^. is in most instances a prelude to the general disease, and forms the v.ersai ex- punctum saliens from which it issues; as though the contagious fer- Not from ment had remained dormant there, and was at length called into ^common*- action by some exciting cause. ]y precedes There seems, nevertheless, to be a slight departure from the gene- risantoft.ves ral character ofthe disease in a few cases, and particularly in those y^j-Jj™ that arc produced by the bite of a rabid cat, whether the latter have rabies from originated it, or received it from a rabid dog, as though by a passage ca"'"»> through the domestic cat the virus undergoes a similar change to that which takes place in the virus of small-pox, when passing through the system of an individual which has previously submitted to the influence of cowpox : for, upon the whole, the disease appears by ™!>ich to evince somewhat less malignity, to be more disposed to inter- seems'to be mit, and its spastic symptoms, and especially that of water-dread, to ^^what be both less frequent and less violent : so that in respect to symptoms less maiig- we may perhaps mark out the two following varieties : He'rice two distinct a Felina. The spastic symptoms less acute and frequently Feline Rabies. intermitting ; produced by the bite of a rabid cat. 3 Canina. The spastic constriction, for the most part, ex- Canine Rabies. tending to the muscles of deglutition, which are violently convulsed at the appearance or idea of liquids ; produced by the bite of a rabid dog, wolf, or fox. There is a case of ff.lixe babies, if it be rabies, in Morgagni, and J!elfnaLysSa which is copied from him into Sauvages' Nosology, in which the above gen™ distinction is so strongly marked, that the author, in the first edition of E*ftm^h from Mor- gagni. * Mrdico-Chir. Trans. I. 132. 262 CL. IV.] NEUROTICA. t<»KI>. Ill' Gen. I. Sp. VIII. a E. Lyasa felina. Feline rabies. his own Nosology, was induced to follow M. de Sauvages' mode of classifying it, and made it, after him, a distinct species, though he deviated from the name under which it occurs in this justly cele- brated writer, which is that of anxietas a Morsu.* The history of the enraged cat is not given, nor is it certain that the rage was that of rabies. The master of the animal was attacked and wounded in this case both by its teeth and claws. The symptoms took place four davs after the bite, and were confined to spasms ofthe chest without hydropho- bia ; nor do these seem to have been of great violence, for they arc described as "magna pra^cordiorum anxietas." Local and general bleedings were useless : a frequent repetition of the warm batli afforded relief; butit only yielded to an ephemera with copious sweat. The intervals were lunar : for it returned with the full moon for two years : the bitten part, as usual, first becoming highly irritable, and continuing the spasms or vehement anxiety of the prascordia supervening, which were now relieved by bleeding. After this period it returned*with every fourth full moon for two years more, and then appears to have ceased. A few instances bf intermission, with a return of periodical pa- roxysms, produced by the bite of a rabid dog, are also to be found in the medical collections : of which Dr. Peter's case, recorded in the Philosophical Transactions! affords a striking example, the pa- roxysm returning for many months afterwards, severely once a fort- night, or at every new and full moon, and slightly at the quarters, or in the intervening weeks. Selle, indeed, asserts that he has met with an instance of the same kind of intermission among dogs ; and hence where the individual recovers, both varieties seem occasionally to subside in this manner. Dr. Fothergill has given two cases of unquestionable affection from feline rabies produced by the same animal. The cat first bit ^oexlm'* ^e maid-servant, and afterwards the master of the house, about the pies of middle of February. The wound inflicted on the maid-servant from feline remained open and irritable from the first, and continued to resist in'theone everv application for many months ; it healed however, at length, the wound and no constitutional symptoms supervened. The wound inflicted heai^but0 on tne master healed easily and in a short time, but in the middle of no consti- the ensuing June, being four months afterwards, the usual symptoms of symptoms, lyssa appeared, yet with comparatively slight and occasional watcr- the' wo'u'nT dread: insomuch that the patient, far from resisting the use of the warm-bath, sometimes called for it, expressed a high sense ofthe com- fort it afforded him, and was able at times to dash the water over his head with his own hands. It terminated however, fatally, and with the general symptoms of distress which we shall give presently.\ In the Transactions of the Medical Society of London,§ we have a highly interesting case of the same kind, which proved equally fatal, in seventy-four days from the time of receiving the injury, and case in me nn • Ui L f . _ . e3. J J. Phiiosophi- fifty-eight hours from the commencement of the disease ; all the acliJns1"1*" symptoms moreover exhibiting less violence than usually occurs in * Classis vii. Old. i. v. 6. 1 Phil. Trans. 1745. No. 475. I Neue Bctrage zur Natur und Arzney-wissenschaft. B. in. 118 § Vied. Observ. and Inquir. Vol. v. no'hydro- phobia, end, on convales- cence, peri- odical le- turns; com. mencing in the bitten part, and for two years. A few in- stances of periodical returns have oc- curred among dogs. Singular instance recorded by Peters. And hence both varie- ties seem sometimes to termi- nate in this manner. healed easily, but death en- sued. Further il- lustrated from a marked case in the cy. iv.) NERVOUS FUNCTION. [ord. hi. 253 canine madness, with little or no water-dread, and consequently an Gen. I. ability to drink fluids to the close of the disease, though the muscles f g JU of deglutition, as well as those of the chest, evinced always some feiina.ysi" degree of constriction, with occasional exacerbations. The patient rabies! was a young lady of eighteen years of age ; the attack was made in the month of January, with both claws and teeth, by a domestic cat that was lurking under the bed, and, which though not known to be ill, had for some time before been observed to be wild, and had been roving in the woods. The fate of the animal is not mentioned. The lacerated parts were incised and purposely inflamed by the application of spirit of turpentine. The wounds healed, and the general health of the patient continued perfect till the begin- ning of the ensuing April, when she was suddenly frightened by looking out of a window, and seeing a mad dog pursued by a crowding populace. This proved an exciting cause. She instantly Exciting expressed alarm, anxiety, and dejection of mind. In the after- cause clew* noon she complained of an unusual stiffness in moving her left arm, and its sense of feeling was impaired ; she discovered an aver- sion to company : the irritations of noise, heat, and light, were offensive to her ; she avoided the fire, and forbade a candle to be brought near her. The rigidity and insensibility of the affected arm seemed to shoot in a line from the middle finger which had been lacerated, and was accompanied with an acute pain which terminated in the glands of the axilla, where she complained of a considerable swelling. Yet neither of the hands, (for both had been injured) were Little af- aftected with discoloration, tension, tumefaction, or any other mark tnepar£f of local injury, though a degree of lividity had been observed upon "n"^"5 the lacerated part of the finger a short time before the disease made its appearance. She had a painful constrictive sensation in her chest, and the respiration was interrupted by frequent sighings. The spasmodic symptoms increased, and at length the whole system, but especially the lungs, was affected with violent convulsions : the breathing was exquisitely laborious, but the paroxysm subsided in about two minutes. Frequent sickness and vomiting followed : the Spasms convulsive spasms about the throat obliged her to gulp what she IhroaVbut swallowed, and she showed a slight reluctance, but nothing more, to lit,Ie handling a glass goblet. The pulse was 132 strokes in a minute ; dread. the skin was cool, the tongue moist, the bowels open, the thirst urgent, without any tendency to delirium. She was worn out, how- Fatal ter- cver, by sensorial exhaustion and distress, and at last expired calmly minatlon- at the distance of time from the attack already stated. In the general progress of canine rabies, all the above indica- /? e. Lyssa tions are greatly aggravated, and the mind often participates in the Canute" disease and becomes incoherent. Whatever be the exciting cause, rabi«s- . the wounded part almost always, though not universally so, takes the signs"arid lead in the train of symptoms and becomes uneasy, the cicatrix look- fSfd^6" ing red or livid, often opening afresh, and oozing forth a little coloured serum, while the limb feels stiff and numb. The patient is next oppressed with anxiety, and depression, and sometimes sinks into a ■ Vo). i. Art. iv. p. Tft. 8vo. 1816. 254 cl. iv.] NEUROTICA. [oilD. HI- s?.tMVlii me'ancholy from which nothing can rouse him. The pulse and 0 e\ Lysaa' general temperature of the skin do not at this time vary much from Cali'in1' tne*r natural state. A stillness and painful constriction are, however. rabies. felt about the chest and throat; the breathing becomes difficult, and is interrupted by sobs and deep sighs, as the sleep is, if any be ob- tained, by starts and frightful dreams. Bright colours, a strong light, acute sounds, particularly the sound of water poured from basin to basin, even a simple agitation of the air by a movement of the bed-curtains, is a source of great disturbance, and will often bring on a paroxysm of general convulsions, or aggravate the tetanic constriction. The patient is tormented with thirst, but dares not drink ; the sjght or even idea of liquids making him shudder: his eye is haggard, glassy, fixed and turgid with blood from the violence of the struggle : his mouth filled with a tenacious saliva, in which we have already shown, lurks the secreted and poisonous miasm, and he is perpetually endeavouring to hauk it up and spit it away from him in every direction; often desiring those around him to Soarid stand aside as conscious that he might hereby injure them. Tin' ™eacheath6 sound which is thus made, from the great oppression he labours from vehe- under, and his vehement effort to excrete the tough and adhesive {""excrete phlegm, is often of a very singular kind ; and, being sometimes more Ph'e=m' acute than at others, as well as quick and sudden, and also fre- has some- » ,•• /», 11 times a re- quently repeated, like every other motion ofthe body, has occa- to?hbe bark- sionally, to a warm and prepossessed imagination, seemed to be a ing of a kind 0f barking or yelping. And hence, probably, the vulgar iden whence the that a barking like that of a dog is a common symptom of the dis- of'de'pa-* eaae* Tne restlessness is extreme, and if the patient attempt to lie tiont's real- down and compose himself, he instantly starts up again, and looks Forcible"*' wildly round him in unutterable anguish. u On going into the room," from6*1'0" says ^r* Munckley, describing the case of a patient to whom he had Munckiey. been called, and the author can bear witness to the accuracy of hi^ very forcible delineation, " we found him sitting up in his bed, with an attendant on each side of him : he was in violent agitation of body ; moving himself about with great vehemence as he sat in the bed, and tossing his arms, from side to side. On seeing us he bared one of his arms and, striking it with all his force, he cried out to us with the greatest eagerness to order him to be let blood. Ilia eyes were redder than the day before ; and there was added to die whole look an appearance of horror and despair greatly beyond what I had ever seen either in madness or in any other kind of delirium.'1 The patient was, nevertheless, " perfectly in his senses at this time ; and there was not the least appearance of danger of his bitting am person near him ; nor, among the variety of motions which he made, was there any which looked like attempting to snap or bite at any thing within his reach : and they who were about him had no appre- hension of his doing this."* The patient had at this time reached the third day of the disease, and expired about two hours after Dr. Munckiey had left him. Some of There is, however, a considerable difference in manv of the svmp- the syrup. toms much disposed to * Medical Transactions, Vol. u. Art. y. p. 53 C1. Iv.j NERVOUS FUNCTION. [ord. Hi. tbB toms which characterize the progress of this malady, derived from g^1^ difference of age, idiosyncrasy, or some other casualty, so that it is p £ Lygga' possible no two cases precisely parallel each other. The volume of «™«; the Medical Transactions from which I have just quoted, contains rabies^ three instances of lyssa communicated by different practitioners. In differe„t the first, which is Dr. Munckley's, no notice whatever is taken of g^ the original bite, which was both in the hand and cheek, from a fied.^ favourite lap-dog, and the patient does not seem to have had any re- sometimc» turn of pain or irritation in these organs. In the second case, which not affect- is that of a-lad of fifteen years of age, the bite, which was in the leg, yetsuch was so small that it was scarcely perceptible at the time, and from pj™ first to last never gave the least uneasiness.* In the third case, j,™*. which is that of an adult woman, the disease was preceded by the or- dinary prelude of torpor, stiffness, and tingling in the bitten part, shooting upwards to the trunk.t In the first case the patient s ojj-oji, mind never wandered to the last moment of life, which is a common „e™ character ofthe disease ; in the second and third, both were furiously but the • mad, bit themselves, the bed-clothes, and whatever else fell in their patient^ way In all of them, however, there was a severe hydrophobia, and furioUB ana in all of them the pulse did not essentially vary from its common ""go-m- standard. The first died on the third day ; the two last recovered ; pulse rarely the one under a treatment which consisted principally of opium, h d and the other under that of salivation ; leaving it therefore doubtful from*, how far the recovery may be ascribed to the natural powers .of the stBndard, constitption, and how far to remedies so widely different in their na- ture. Dr. Marcet's patient did not expire till the sixth day after the appearance of water-dread, and without any affection in the bit- ten part;* and towards the close of the disease he sometimes sud- denly gulped half a pint of water, or splashed it over his body. There is also, in these three cases, an equal and most singular ««*«■ discrepancy in the interval between the inclination of the wound and the utervai the incursion ofthe disease, or, in the language of Professor 1 rolliet, s ju,y and its period of incubation. The first interval was about; six weeks, tta mcu^ which may be regarded as the ordinary term : the second was only disease five days : the third is not set down with any degree of precision : interva)' the patient is only stated to have been seized « about the time that .*»..* the second horse died" that had been bitten by the same rabid dog : and hence this interval consisted probably of about a fortnight. A like variation in the course of morbid symptoms distinguishes o«™«a the series of cases published by Professor Brera, and which toolSoften dis- place in the month of November 1804, on the incursion of a Wolf sufficiently proved to be rabid. Generally the patients showed no desire to bite or otherwise injure persons about them, but in one in- stance such a desire was strikingly prominent. In one instance also, though there was a fatal water-dread, there was no flow of saliva. In some the horror extended to liquids of every kind ; m others water alone produced it, while wine was drunk with ease.§ * Id. Art. xn. p, 192. t W. Art. xv. p. 222. | StSio-SrcVperia'cura dell' Idrofobia, fcc. Mem. Soc. Ital. Scieaz, Modena Tom. xvn. 256 cl. iv. j -NEUROTICA. [oKU. II.' Gen. I. S?p. VIII. (i E. Lyssa canina. Canine rabies. This dis- crepancy This discrepancy seems to depend entirely upon the nature or presence ofthe predisponent or exciting cause that gives energy to the virus, and without which it may lie, as we have already observed, for an almost indeterminable period dormant, but undeeomposed and still, therefore as malignant as when fust generated. In the apparently three cases iust quoted from the Medical Transactions, the lad who dependent upon the predispo- nent or ex- citing cause. Sometimes this cause operates from the without an interval. A like un- certainty among quadru- peds : common interval ten or twelve days; but has been pro- longed to Hence in mankind has varied from a week or fortnight to safe. six weeks was soonest affected seems to have had a strong predisposition to the disease from the first moment, and which alone became an ex- citing cause ; in the woman, who suffered about a fortnight after- wards, there was probably some degree of predisposition, but the immediate exciting cause appears to have been over-exertion in walk- ing, for we are told that " she was seized as she was going on an whiioutai! errand on foot, and had walked about two miles."' There is a like uncertainty among quadrupeds. We have ju.-i taken the interval of ten or twelve days as the common term ; hut in the instance just referred to it may have been considerably longer. According to Meynall, the disease among dogs appears from ten days to eight months after the bite. In Earl Fitzwiliiam's hound.- which were bitten, June 8, 1791, the interval varied from six weeks to more than six months : and not much less in Mr. Floyer's hounds, as described by Dr. James. It is not therefore to be wondered at, that there should be a great uncertainty among mankind. And months6.'6 hence we find it has occurred a week or fortnight after the bite, three weeks, a month, and sometimes six weeks, and even three months : after which last period, however, notwithstanding occa- sional instances to the contrary, the patient is generally considered There are two cases published by Dr. Tracher in the Ameri- or three can Medical and Philosophical Register,* in which the injury in- afte/wiiich flicted by the same dog, August 16, 1810, did not produce hydro- the patient phobia in either instances till nearly three months afterwards, namely, considered3' November 3, and November 14, ensuing : and it is the more remark- ing d awe tnat ^ie ^rst case was tna* °^ a cn^d under four years of age ; Probable the second that of an old man of seventy-three. Both terminated fatally : the former case in six days, the latter in seven from the onset ofthe disease. Upon the whole we may calculate the interval as varying from five or six days to as many months, the usual period being about the same number of weeks. The academical journals, and monographic writers, nevertheless, have numerous instances of the malady appearing after a bite of many years' standing ; sometimes twelve, eighteen, twenty, and even many years thirty years : but the cases want authority in most instanc<$. I shall bufmost ' presently, however, have occasion to notice one in which it occurred thohty*"" and proved fatal more than nine months afterwards : and there is singular another communicated by Dr. Bardsley to the Manchester Society, tardation6" strongly entitled to credit, however difficult it may be to account for D^Bard!- the fact' in wmch t^e attack did not commence till twelve years after ley; the bite of a dog supposed to be mad. The patient died in the Man- m inwrvai Chester Infirmary with decided symptoms of the disease. He had of twelve been for some time antecedently labouring under great nervous, agi- mean in- terval. A few in- stances on record of the disease occurring Vol. i. ck. iv.j NERVOUS FUNCTION. [ord. hi. 25? tation and considerable depression of spirits : and Dr. Bardsley in- Gen- '• dined to ascribe it to this cause rather than to any specific poison fP£ ^"J" lurking in the system. But this is to suppose that lyssa is capable, canine. under particular circumstances, of being generated spontaneously in rallies? the human frame, which Dr. Bardsley, as we have already observed, contends that it cannot exist, even among dogs, except by contact. There are few physicians whose experience seems to have been so Troiiiet extensive upon this melancholy subject, and so actively followed up experience. by judicious and even original views, and post-obit examinations, as that of Professor Troiiiet, to whom I have already adverted. Inde- pendently of a variety of single and unconnected cases that had fallen under his care, he gives an account of a ravage committed on not less than twenty-three persons, besides cattle and dogs, in the department of the Isere in 1807, twelve of whom, for the most part terribly bitten in the face, were conveyed to the Hotel Dieu at Lyons, in which he was clinical professor, and, as such, were placed under his immediate care.* The general train of symptoms as the patients became successively General affected and died, after an active and judicious treatment of preven- symptom* tive as well as curative means, did not essentially vary from those just related. The local indications mostly but not always preceded. The interval between the bite inflicted by the rabid wolf, and the Ordinary access of disease, varied from a fortnight to five weeks, and the Range of patients uniformly sunk on the second or third day after a clear •h86*"- developement of the symptoms. In the preceding year, however, M. Troiiiet had a case produced by the bite of a mad dog, in which the disease did not show itself till five months and a half after the fj^f™]" infliction of the.wound. The patient was a strong, robust man, of of interval* thirty years of age, and the dog had died mad in the veterinary school at Lyons soon after the injury. The first symptoms in this case were the usual ones of pain in the bitten part, which gradually extended to the arm and neck. Two days afterwards the patient was sensible of a vapour or aura which ascended from the abdomen to the head accompanied with a general uneasiness. The symptom of hydrophobia was manifested on the day ensuing ; the depleting plan was, in this instance, followed up with a daring urgency, and the man expired on the evening of the same day. M. Trolliet's post-obit examinations are numerous, and they uni- Post-obit formly give proof, like the dissections already noticed, of extensive tions. mischief in various organs remotely situated from each other ; the chief of which, however, were the mucous membrane of the trachea and bronchia?, and the membranes of the brain, especially the pia mater ; all which, in direct repugnance to M. Magendie's observa- tions, were infiltrated with red blood, and gave evident proofs of inflammatory action ; while the mucous membrane of the bronchia? and trachea were covered over with a frothy material of a peculiar kind, which M. Troiiiet supposes to be the seat or vehicle of the specific virus, and which in his opinion is driven forward into the * Nouveaux Traite de la Rage, Observations cliniques, Recherches d'Anatomie .patbologique, et Doctrine de cetta Maladie, &c. 8vo. Lyon, 1820 Vol. TV .—*:, ■>5» cl. iv.j NEUROTICA. [ohd. m gen. I. fauces and intermixed with the saliva by each spastic expiration (? E,Ly"a' from the chest. The other organs he found affected as follows: canina. the capillary vessels of the lungs were penetrated with a larger quan- Rabies. tity of blood than ordinarily ; their substance was emphysematous, or contained an accumulation of air ; as did also the heart and large blood vessels in some instances. The blood itself was black, unco- agulating, and of an oily appearance. That taken from the veins during the disease coagulated into an entire cake without any sepa- ration of serum. The mucous membrane of the mouth and pha- rynx were of a pale gray and lubricated by a gentle moisture ; they contained no saliva nor any frothy material. The most singu- lar fact of the whole is that " the salivary glands and the cellular substance which envelopes them, afforded not the least vestige of inflammation ; nor the slightest alteration in their volume, their colour, or their texture." Troiiiet's It is this last circumstance that seems chiefly to have induced M. o?the^rox- Troiiiet to venture upon a new hypothesis, and to suppose that the imate cause actual seat of the specific virus is the mucous membrane of the bronchiae or lower part of the trachea, rather than the fauces or the salivary glands ; and had these last in every instance been discovered as clear of any manifest morbid appearance as in the dissections of this ingenious, pathologist, there would be strong ground for his conjecture : but, as we have already seen that in some cases there have been found only slight marks of inflammatory action in the bronchiae, while the fauces and esophagus, and occasionally the stomach and even the ileus have been so inflamed as to approach a state of gangrene, much further investigation is necessary before the old doctrine should fall a sacrifice to the new. The only fact we are at present able to collect from dissections, is a very exten- sive and violent disturbance throughout the entire frame ; sometimes fastening chiefly on one set of organs, and sometimes on another. Medical The mode of treatment is a field still perfectly open for trial; ofVhedfo- f°r at this moment we have no specific remedy nor any plan that ease, when can be depended upon, after the disease shows itself. altogether' Antecedently, indeed, to this period our course is obvious, and Prophylac- particularly if we should be so fortunate as to be consulted at the tic course time of the bite : and should consist in endeavouring, by the TheMtten promptest and most efficacious means, to prevent the spread of the part to be disease, by washing the part well and thoroughly at the nearest Prophyiac- spring or river at hand, and by extirpating the virus before absorp- ment?at* tion has taken place. This has been done in various ways : for the Various lacerated part has been sometimes amputated or dissected ; and at posed8 ' " other times totally destroyed by the actual or potential cautery. The actual cautery, by the means of irons heated to whiteness, was first adopted and recommended by Dioscorides,* and after- wards by Van Helmont, Morgagni,! and Stahl : the potential cau- tery seems to have been proposed as a less terrific mode of opera- tion, and has usually been accomplished by the means of lapis in- fernalis or decarbonated soda. It is recommended by Schenck. * Lib. vj. t De Sed. etCa«s. Morb. Ep. vm. Art. 2« <:L. iv.J NERVOUS FUNCTION. [ord.iii. 259 Pouteau, and Dr. Moseley. A notion, however, has obtained from J*E1UJ.'. a very early period that the irritation produced by a cautery, Entasia whether actual or potential, only increases the tendency to absorp- |^a" tion: and Trampel has endeavoured to prove this :* on which Prophyiac- account Hildanus and Morgagni have advised excision in combina- mcem^a" tion with the cautery : the former proposing to cut out the eschar as soon as it is formed, without letting it remain for a spontaneous separation ; and the latter, far more effectually, recommending that inustion should follow the application of the knife instead of pre- ceding it. Of these three modes of operating, the potential cautery is least P°^n"al entitled to be depended upon, for it is not sufficiently rapid in its not to be action. Of the other two it is, perhaps, of little consequence which „p£. fir Gen. I. Sp. VIII. Entasia Lyssa. Rabies. Remedial treatment. Summary ofthe com- mon inten- tions of cure. First inten- tion : to stimulate and support the vital power. Volatile alkali. Cordial confections and theria- cas; pun- gent aro- matics. Second intention; to take off supposed inflamma- tory action. Submersion in cold wa- ter ; recom- mended by Celsus. To be «nc- ceedrd by a bath of ■wBrrn eil. practice, as already observed, is still unfortunately all afloat, and we have neither helm to steer by, nor compass to direct our course. There is, indeed, no disease for which so many remedies have becri^ devised, and none m which the mortifying character of vanity of vanities has been so strikingly written on all of them. In the loose and heterogeneous manner in which they have descended to us, they seem indeed to have followed upon one another without rational aim or intention of any kind. Yet, if we nicely criticise and arrange them, we shall find that this is not the case. There are four principles by which physicians appear to have been guided in their respective attentions to this disease. That of stimu- lating and supporting the vital power so as to enable it to obtain a triumph in the severe conflict to which it is exposed. That of sud- denly exhausting the system by severe bleedings and purgatives, a* believing the disease to be of a highly inflammatory character. That of opposing the poison by the usual antidotes and specifics to which other animal poisons were supposed to yield. And that of regarding the disease as a nervous or spasmodic, instead of an in- flammatory, affection, and, consequently, as most successfully to be attacked by an antispasmodic course of medicines and regimen. The very popular use of volatile alkali and camphor, may, by some, be ascribed to the first of these views, as being powerful sti- mulants ; yet, in fact, they were rather employed from different motives, and fall within one or two of the principles of action which yet remain to be considered. But to this class of medicines, designed expressly to support the vital power, and enable nature herself to triumph in so severe a struggle, belong expressly the warm and cor- dial confections and theriacas that were at one time in almost uni- versal estimation ; as also various kinds of pepper given in great abundance, oil of cajeput, different preparations of tin, copper, and iron, and, in later periods, bark. In direct opposition to this stimulating and tonic plan, was that of suddenly debilitating and exhausting the system upon the hypo- thesis that the symptoms of canine rabies were those of violent and rapid inflammation. The practice of applying ice or the coldest water to the head, and of submersion in cold water, belongs mostly to this view of the subject, as used a century ago, though in the time of Celsus, it was employed in a much slighter degree to take off the spasm of hydrophobia, and to quench the thirst that accom- panied it. " Miserrimum genus morbi; in quo simul aeger, et siti et aquae, metu cruciatur : quo oppressis in angusto spes est."* In this almost hopeless state, the only remedy, (unicum remedium,) Celsus continues, is to throw the patient instantly and without warning, into a fish-pond ; alternately, if he have no knowledge of swimming, plunging him under the water that he may drink, then raising his head, or forcing him under it if he can swim, and keeping him below till he is filled with the water; so that the thirst and water-dread may be extinguished at the same time. But there is here, continues our author, another danger, lest the bodv of the * De Medicitia, Lib. v. Cap. xxvii. $ 2. cl. iv.] NERVOUS FUNCTION. [ord. hi. 261 patient, exhausted and worn out by the submersion as well as by the Gen- '• disease, be thrown into convulsions : to prevent which, as soon as int'as^IIL he is taken out of the pond, he is to be put into warm oil.* L>ssa- The bolder practitioners of subsequent times, in pursuing the re- Remedial frigerating plan, were regardless of convulsions, and persevered at JerconmeDfc all hazards in reducing the living power to its last ebb ; believing intention. that the nearer they suffocated the patient without actually killing mer.ionbfn him, the greater their chance of success. Hence Van Helmont kept Jf'^ 'j™™ the wretched sufferer under water till the Psalm "Miserere" was'"perilous sung throughout, which, under some choristers, occupied a much in^ted. longer time than under others ; and in the experiments of the Mem- bers ofthe Academie Roy ale, we meet with instances of a still more dangerous pertinacity ; though success is said to have accompanied one or two of them. Thus, M. Morin relates the case of a young woman, twenty years old, who, labouring under symptoms of hydro- phobia, was plunged into a tub of water with a bushel of salt dis- solved in it, and was harassed with repeated dippings, till she became insensible and was at the point of death, when she was still left in the tub sitting against its sides. In this state, we are told, she was at length fortunate enough to recover her senses ; when much to her own astonishment, as well as to that of the by-standers, she found herself capable of looking at the water, and even of drinking it without choking.! With respect to the warm oil-bath which Celsus recommends in Warm oii- succession to that of cold water, the present author can say that, in service. a single instance to which he was a witness when a young man, it produced no benefit whatever. It was prescribed by a physician in consequence of the recommendation of Celsus, but who certainly had not read him attentively, nor was acquainted with the scope of his reasoning. For in this case cold bathing had not been tried an- tecedently, and consequently there was no danger of those convul- sions for which alone the Roman physician enjoins the use of the oil. The experiment, however, was so far perfect, that the tub was full of oil and deep enough to reach the patient's chin. In connexion with the cold-bath thus persevered in to suffocation, Drastic the reducent or antiphlogistic plan was still farther forwarded, at purga lves' one time, by the use of strong drastic purgatives, of which colocynth was, for a long period, the favourite ; j and at other times by a very Profuse bold and perilous use of the lancet. tions! Bleeding has lately been revived and carried to the extent of deli- Revived quium by large and rapid depletions, and the operation has been re- sent day*" peated almost as long as the powers of life would allow. Dr. Nugent employed it at Bath, in 1753, in one case, and the patient was restored, but musk and other antispasmodics were largely em- ployed at the same time ; and Dr. Shoolbred of Bengal has since had two patients who recovered under this process ; but he em- ployed mercury at the same time, and it is by no means certain either from the history of the patients, or of the dog by which they were bitten, that the disease was a genuine lyssa. * Cels. loco citato. t Hist, de l'Acadamie Royale, Ann. 1709. 1 Hellot, An de Morsis a Rabido Colocynthis ? Paris, 1676, 2ii2 cl. iv.] .NEUROTICA [obd. in. sGE vih Yet whatever benefits this practice may possess, it has no pretcn- Knt'asia sions to novelty : for there is not a single course of treatment ever i.psa. invented for this intractable disease that has been for upwards of a Remedial century more extensively tried and retried, both moderately and pro- Se'cond"' fusely, or excited a warmer controversy upon its merits. Poupart, intention, in 1699, espoused the practice, and gives the case of a woman, Tn^preten- wbo perfectly recovered by bleeding her to dcliquium, and afterwards sions to confining her for a year to bread and water.* Exempli- Berger, in the same year, recommended bleeding, but advised fied- that the blood should be taken from the forehead. In the Breslaw Collections for 1719, is the case of a cow supposed to be rabid and said to be cured by profuse bleediag. And the Philosophical Trans- actions abound with similar histories, some of them purporting to have been attended with similar success, derived from human sub- jects : but most of them too loosely given or too undecided in their symptoms to be in any measure entitled to reliance. That of Dr. Hartley and Mr. Sandys was, at one time, appealed to as demon- strative. It is the case of a groom who was bitten by a dog, sup- posed to be mad, towards the end of November, and who sickened about the middle of January ensuing; he had an aversion to drink, and was conjectured to be labouring under rabies. Venesection was here trusted to almost entirely, and every repetition of the lancet seemed serviceable: in consequence of which he lost a hundred and twenty ounces of blood in the course of a week, by different deple- tions, which consisted of sixteen or twenty ounces at each time. The man recovered : but few readers will believe him to have been really rabid when they learn that although he had an aversion to drink, he swallowed liquids: that his chief symptoms were sickness, trepidation, a faltering speech and memory; and that, through the whole course of the disease, he attended, though with some difficulty. to his duty in the stable.! Additional The Edinburgh Medical Commentaries are equally replete with mBtances. cages -m wnich the same plan of evacuation had been tried, but they are also equally unsatisfactory. Thus Dr. Tilton informs us that, having heard of the recovery of a patient from the disease before us, who had bled profusely and almost to death, by an accidental fall from a high place, and the division of the temporal artery, he employed venesection freely in a case of his own, drawing off from twenty to thirty ounces at a time, and occasionally bleeding to deli- quium.J But the symptoms are here also so doubtful that the re- sult is of no importance. Failure of The practice, therefore, has been not uncommon for at least a tice proved century and a half; and had it proved as specific as some late re- from its dis-ports woui(j induce us to believe, it must have descended to us with continuance r /• i • and specific a wider and more confirmed reputation, and formed the only course to be relied on. But the misfortune is that, however salutary at times, it has often completely faded in the hands of unprejudiced and judicious practitioners ; and where it has succeeded it has generally been combined with other means that have been resorted * Hist, de PAcadamie des Sciences. An. 1709. t Phi!. Trans. Year 1737-8. I Vol. vi. p 43*2 M.iv.] NERVOUS FUNCTION. [ord. hi. 2b'3 to at the same time. There is a case of failure related by Dr. Gen. I. Plummer in the Edinburgh Medical Essays :* but it is not much to EntaJ111' be relied on, as not more than twenty ounces of blood were lost at Lyssa. a second and accidental bleeding, and only ten a day or two before Remedial by a prescribed venesection. Mr. Peters, however, who employed gecondln- profuse and repeated bleedings, sometimes even to deliquium, had, tention. in his day, so little dependence on them alone, that he uniformly combined this remedy with opium and mithridate, or other cordials, and in the case which he has introduced into the Philosophical Transactions, he ascribes the success which accompanied his plan to this combined mode of treatment.! In like manner Mauchart, Additional as quoted by Biihlmeier, while he advises bleeding, and to an extenteJ£amp e" proportioned to the length of the interval between the infliction of the wound and the attack of the paroxysm, (and where the patient is of a melancholy temperament, even to deliquium,) advises, at the same time, that the bitten part be scarified ; and when this also has bled tdl nothing but serum escapes, that the wound be dressed with mithridate, theriaca, or rue, and a defensive plaster put over it, and that the patient take pills, compounded of mithridate and other materials, to the number of nine every day for nine months, keep- ing himself in a free perspiration, and cautiously changing his linen. In the case of dogs, venesection, how liberally soever made use Failure of, does not seem to be of much benefit. It has lately been the up°n6dogs subject of a series of experiments at Paris, under the superin- dfe^nj6^ tendence of MM. Magendie, Dupuytren, and Breschet, who have others. carried it to deliquium, but without any success whatever. And hence, though it has unquestionably been serviceable, in many cases, the practice cannot be regarded as a specific. To close the whole, Professor Troiiiet has employed venesection And ahun- so extensively, and in such variable proportions, from single or proved upon double bleedings of sixteen ounces each to not less than seven g„b ect"^11 pounds, by different bleedings in the coarse of a few hours, and in Troiiiet. every instance so entirely without effect, as reasonably to put the question at rest for ever. And the more so as, in his hands, the And the bolder the practice the sooner the patient fell a sacrifice to it. We fusTthe0 have a striking example of this in the case of the patient just re- bleeding ferred to, whose interval between the infliction of the wound and the a fatal signs ofthe disease extended to upwards of five months. Early on lssue' the morning in which the hydrophobia first appeared, blood-letting to syncope was prescribed, and five pounds were drawn off before this effect was produced. The water-dread returned with the return of recollection; and at eleven o'clock on the same morning he was again blooded to the amount of eighteen ounces, when be again fainted. The spasms of the chest and throat became more perma- nent. At three o'clock fourteen ounces more were taken away when deliquium followed, succeeded by a considerable augmenta- tion of the spasms in extent as well as in violence. At seven in the evening the respiration became frothy as well as difficult, the diffi- culty increased, and the patient expired in a few minutes, about twelve hours only after the commencement ofthe hydrophobia. * Vol. »■. Part it. t Pbil. Trans. 1745. No. W 264 t'L. IV.] NEUROTICA. [oiw. !'!■ Gen. I. Sp. VIII. Entasia Lyssa. Rabies. Remedial treatment. Third in- tention ; to counteract the poison by general or specific antidotes. Radix Munjjo. Acids. Alkalies. Useful in many ani- mal poi- sons. Eau de luce. Mercury: first recom- mended by Desault, afterward freely em- ployed by James, co> externally and inter- nally, and regarded both as a prophylac- tic and an- tidote ; The poison of rabies has, by a numerous body of pathologists, been contemplated as of a nature akin to the poison of other venom- ous animals, and particularly serpents, and consequently best to be opposed by the usual remedies and specifics to which these are found most effectually to yield. And hence, in the first place, the use of the radix Mungo of Kcempfer (ophiorrhiza Mungos, Linn.) still sup- posed to be a specific for the bite of the cobra di capello and tbc rattle-snake. In India and Ceylon it is used to the present day as an antidote against the bite of the mad dog : Kcempfer highly extols it. and Gremmius, who practised with great reputation at Columbo, employed it very largely. Acids and alkalies belong to the same class of antilyssics. Of the former, Agricola, who was hostile to the depleting system, preferred the muriatic acid, and regarded this as a specific* even when re- strained to a topical application. Poppius preferred the sulphuric ; but by far the greater number of practitioners the acetous was held in most esteem. Many combined this last with butter, and used it both internally and externally: Wedel, with other materials ; " as a cure," says he, "for the bite of a mad dog, let the patient drink vinegar, theriaca, and rue."! The general suffrage, however, was far more considerable in favour ofthe alkalies, and especially of ammonia or volatile alkali. There is some reason for this preference. It is well known thai ammonia is a valuable medicine, whether applied externally or in- ternally, in a variety of animal poisons. I have successfully used it more or less diluted in various instances, as a lotion against the sting of gnats, wasps, bees, and vipers ; and I have seen it of great service in checking the poison of the rattle-snake, and restraining the extent of the inflammation. On the continent, and especially in France, the usual form in which ammonia was formerly employed in cases of lyssa, was that of the eau de luce, a caustic spirit of ammonia prepared with quick-lime combined with rectified oil of amber, rendered more easily miscible by being rubbed into half its weight of soap. This was in general employed both externally and internally,J though in the Journal de Medicine, we have several re- ports of a successful use of it when confined to an internal trial alone : especially one related by M. Hervet,§ and another by M. Rubiere.ll Mercury, from its proving a specific in syphilis, and more espe- cially from its specific action on the salivary glands, the immediate outlet of the poison of rabies, has had a strong claim to general attention ; and has been very extensively tried in various forms, and acquired a high degree of reputation. It was first recommended by Desault of Bordeaux in 1736, and afterwards very confidently by Dr. James in our own country, as a certain cure for man and other ani- mals. He used it both as a prophylactic at the time ofthe bite, and an antidote at the commencement of the disease. He em- * Chirurg. p. 391. t Exerc. Semiot. Pathol. Cap. 8. X Sage, Erfahrungen, &c. p. 49. Guettard, Memoires sur differentes Parties des Sciences et Arts. Paris. 1768. p. 122. § Journ. de Medicine. Tom. lxii. || Id. Tom. ixiv. UL-lv-1 NERVOUS FLNUTION t„KJ,. Ul. ^5 ployed it as well externally as internally ; but his favourite form was Gen. I. that of the turbeth mineral, in the shape of pills. He has published £nJ*1L in the Philosophical Transactions, a full account of his success with L*»*A this medicine on Mr. Floyer's hounds, after they had made a trial of Remedial overy other favourite and fashionable remedy in vain. These dogs, %££?£ as we have already observed, were affected with a severe hydropho- tention. bia, which has been denied by some writers to be a symptom ofthe JJiS'uweii disease as appertaining to quadrupeds. All the hounds, we are J,8 {","{£• iold, that were salivated with the mercury, in whatever stage ofthe useful malady, recovered, and the rest died.* His experiments on man- aoMt" kind arc less complete : for they amount to not more than threes j,»tion- . and in each of these the medicine was employed as a preventive, mSn" shortly after the infliction of the bite ; and hence, as the patients ™£mp,ete. never became rabid, we cannot be sure that they had received the contagion, or would have had the disease, had the mercury never been employed. The muriate of the metal was another favourite form, which by Loisy, was used together with inunction. The grand object was to excite a speedy salivation, and maintain it so long as there was supposed to be any danger ; and especially where the administration had been delayed till the paroxysm bad shown itself. Frank, Girtanner, De Moneta, Raymond and a host Den'eK1>. llj Gen. 1. sp. VIII. i-lntasia Lyssa. Rabies Medical treatment. Third intention. Cantha- rides re- employed 'iv Axtcr. AjIi-co- loured livecwort or lichon- ■aninu«. I.Inn. I'ulvis anti. IVHSttS. Kinetics. H. formerly employed hy Agri- cola : more lately by Satter- ley, witli success, but in a doubtful naso. or Hungary ; and it is a positi\e exhortation ol Awceniia, that what- ever diuretic may be employed should be carried to its utmost acri- mony, even to the discharge of bloody urine.* M. Axter of Vienna has of late revived the use of cantharides, and tells us that he has for thirty years employed this medicine with far more success than any other, after having previously made experiments with and been disap- pointed in the use of all other remedies, as musk, camphor, bella- donna, opium, or oil, used internally and externally, and water- bathing. But it does not seem that he can speak further than to it> supposed prophylactic powers, as he does not appear to have tried it in the acute stage ofthe disease.! The ash-coloured liver-wort (lichen tcrrestris cinereus Raii,) wa.<- another diuretic of great popularity, and which seems at length to" have triumphed over the stimulant insects, and to have superseded (heir use ; on which account Linneus changed its trivial name from cinereus to caninus. In our own country, this medicine was at one time peculiarly in vogue. It was given in powder, with an equal quantity of black pepper, a drachm and a half of the two forming the dose for an adult, which was taken for four mornings fasting, in half a pint of Mann cow's milk ; the patient, however, was first to lose nine or ten ounces of blood, and afterwards to be dipt in cold water for a month together, early in the morning. And such was (he general confidence in this plan, or rather in the antilyssic power of which the lichen was supposed to be the most active principle, that its virtues formed one of the most common subjects of eulogy in the Philosophical Transactions at the time when Mr. Dampier introduced it to public notice at an early period of the history of the Royal Society ;J while, at the earnest solicitation of Dr. Mead, the powder was admitted in the year 1721 into the London Pharmaco- poeia, under the title of Pulvis antilyssus ; who declares, that, " When united with the previous venesection, and subsequent cold- bathing, he had never known it fail of a cure,§ though he had used it a thousand times in the course of thirty years practice." How far emetics may be serviceable general trial has not, perhap.-. been sufficient to determine. They have often been found capable of relieving spasms of the throat, and enabling the patient to swallow liquids when every other plan has failed. They were hence recom- mended by Agricola, but only, perhaps on account of their violence upon a weakened frame, as a sort of forlorn hope, for he does not advise them till after the third day. Dr. Satterley, however, has given a case in the Medical Transactions, which he regards as rabies, in which vomiting was employed from an early period of the disease. and with very decided advantage.il But there seems to be a doubt whether the patient here referred to laboured under genuine lyssa. He had been bitten three months before by a dog, but the fate of the dog was not known: the cicatrix betrayed no uneasiness or irri- tation precursive to the disease, or during its course : the hvdrc. • Lib. iv. Fen. vi. Tr. tv. ; Nouv. Biblioth. Germ. Medic>-(_ uimrgicale. Pari' ; Mechanical Account of Poison*, Art. 3. > Chiron*, prtrv. N'uriib. &c. »vo. I'M'? !! Vol. iv. p. M> tontion: to nerv- ^•^•l .NERVOUS FIJN6S ■■!.. iv.} \KIK«>TKA. ,ouu. iu. Gem. I. effiaacy, if not in all cases ofthe disease, in certain Malts and cir- EmasTa1"' cumstances. Surlu, a man aged twenty-four, had been bitten by a Lyssa. dog sufficiently proved to be mad, had been cauterized immediately Medical afterwards, and been discharged as supposed to be cured. In about treatment- a month from the time of the bite he was attacked with rabies in its intention, severest symptoms, and conveyed to the hospital. Opium was the fnstancl of medicine determined upon, and as the constriction of the throat pre- iu effects vented it from being given by the mouth, a gummy solution was d'eSnto injected into the veins, for which the saphama and cephalic were tt!!1enCirCuln" alternately made use of. Two grains of the extract were in this manner thrown in, and the patient was in some degree tranquillized for an hour or two : the dose was doubled towards the evening of the same day. It was repeated at intervals, and at length increased to eight grains at a time. The relief it afforded, however, was never more than temporary : and he expired on the fifth day from the incursion.* M. Troiiiet used it freely in the form of pills, in com- bination with bella-donna. But in no instance had he reason to boast of his success, though he gave, in some cases, twenty-seven grains of opium, and nine of the extract of bella-donna in the course Belladonna of twenty-four hours. Professor Brera employed the bella-donna, dotcom- but united it with mercury instead of with opium : his doses were bined with carried gradually to a great extent, insomuch that the patients at cuty- length took the powdered root of the bella-donna, to the amount of three drachms a day; and in about forty-four or forty-six days, swal- lowed seven ounces and a half of this drug, and ten grains of cor- rosive sublimate, besides rubbing in some ounces of mercurial oint- ment, t The object was to keep the system, as much as possible, under the influence of mercury, evidenced by ptyalism, and of the narcotic effects of bella-donna, so long as the combination was con- Useful as a tinued. As a preventive it seems to have been successful; though preventive. severaj 0f tj,e patients appear to have advanced to the first symptoms of acute affection, having had some degree of water-dread, and re- curring irritation in the bitten parts, the disease did not proceed beyond these initiary steps. But we have no proof of success from this plan after the pathognomic signs had shown themselves. The op'iumand warm-bath was also combined with the above practice. In like musk when manner musk, opium, and belladonna, have been all united ; and combined, . ,r. , . . . \ . . ' . , and united sometimes combined with camphor, oil of amber, inunction with meant!11" olive ou>4 or bleeding. Musk was also at one time very generally combined with cinnabar, and in this form supposed to be peculiarly Tonqnin efficacious. The famous powder employed by the natives of Ton- puZhT °r quini 9-nd introduced into this country by Mr. Cobb, on which ac- cobbii. count it was called pulvis Cobbii or Tunguinensis, consisted of sixteen grains of musk with forty-eight grains of cinnabar, mixed in a gill of arrack. This, taken at a dose, is said to have thrown the patient into a sound sleep and perspiration in the course of two or three hours ; and where it did not, the dose was repeated till such effect * Orfila, Traite sur les Poisons, &c. t Mem. Soo. Ital. Scienz. Modena. Torn. xvn. t Vater, Pr. de Olei Olivarum efficacin contra morium cani* rabinsi, experiment* Presdae facto, adstructa, Viteb. 1760. Medical treatment. ■;L-IV-1 NERVOUS FUNCTION. joRo.m. 269 was produced. And this medicine also was regarded as a specific Gen. I. during the short career of its triumph, and a cure was commonly i^m' supposed to follow the administration of the medicine. L,"s"'.a The sedative power of several of the preparations of arsenic, how ever, had perhaps a fairer pretension than any of these, and espe- F?ur,'!' _* 11 ■•■ • » « J * intention. cially as, like mercury, it has for ages been employed with decided Arsenical benefit in Asia, in the case of syphilis. Agricola mentions its use X*'8' in his day,* but the forms in which it was then employed were rude and incommodious, and they do not appear to have been followed with much success. It is to be regretted, however, that even in the elegant and manageable form of Dr. Fowler's solution, it has not been found to be more efficacious. It has of late years been tried internally in various cases, and particularly with great skill, and in full doses, by Dr. Marcet, but in every trial it has disappointed our hopes. Applied externally, as a preventive, to the bitten parts, Dr. Linke, of Jena, thinks he has succeeded. But as his trials were made on dogs inoculated from the froth of rabid animals after death, no dependence can be placed on them. Under this head I may also observe that the Prussic acid has occa- Prussia sionally been had recourse to, but without any apparent benefit. In a°' ' the form of the distilled water of the prunus Lauro-cerasus, it was not long since made a subject of experiment at Paris by M. Dupuy- tren, who injected this fluid into the veins of various dogs, and ap- pears to have done so in one instance into those of a man : but in every case without effecting a cure. There are two or three other remedies which it is difficult to ar- Anomnioui range, but which have also acquired a considerable celebrity in the rel cure of lyssa; and hence it is necessary to notice them. The first is the Ormskirk medicine, so called from its preparer, Ormskirk Mr. Hill of Ormskirk, supposed, for the inventor could not be pre- me 'cme vailed upon to publish his secret, to consist ofthe following materials: powder of chalk, half an ounce ; armenian bole, three drachms ; alum, ten grains ; powder of elecampane root, one drachm ; od of anise, six drops. The single dose thus compounded, is to be taken every morning for six times in a glass of water, with a small propor- tion of fresh milk. If this be the real formula, and the analysis of Dr. Black concurred with that of Dr. Heysham, in determining it to be so, the inventor seems to have contemplated the specific virus to be an acid, for the basis of this preparation is unquestionably an alka- i»s basis line earth. And with regard to its occasional efficacy, the latter a writer, following the general current of the opinion of the day, informs us that this has been so thoroughly established by expe- rience, that there can be no room to doubt it. Dr. Heysham himself, however, admits of various cases in which it failed, while in many instances his successful ones do not afford proofs of an existence of the genuine disease.! The second of the anomalous remedies 1 have just referred to, might possibly have been introduced under the head ofthe common antidotes for the bites of venomous animals ; but as it has reputed * Comment, in Popp. p. 64. t T»is«. Mod. Rabie ClaninH. Svo. plants. ^7u .x. iv.j VKI R(>Ti< A j.<»Ki>. in. Gen. I. powers in some degree peculiar to itself, it is best to notice it scpa- ^itasTa1!" rately. This is the alyssum, or alysma Plantago (madwort plantain,} t.v^h. 0f established reputation in America as a specific lor the bite of the Mcu'icai rattlc-snakc, where it seems to rival the imprescriptible claims ofthe Uoatmcat' ophiorrhiza Mungos, though its juice is generally given in combina- intention. tion with that of the common horehound—an addition that ccrtninlv Medics.113 docs not promise much accession to its strength. Aiyaeum or This species of alyssum has for some ages been a popular remedy for canine madness, especially in the north of Europe : and m a late communication to Sir Walter Farquhar in the Russian tongue, trans- lated and published in Mr. Brande's Journal,* we arc told that it still retains its popular sway and reputation over a great part of the Russian empire : and that in the government of Isola it has never failed of effecting a cure in a single instance for the last five and twenty years. The preparation is simple: the root is reduced to a powder, and the powder is to be eaten by being spread over bread and butter. Two or three doses are said to be sufficient in the worst cases : and will be found to cure mad dogs themselves. other The butcher's broom (genista tinctoria), and side-leaved scull-cap (Scutellaria laterifolia), have however rivalled the reputation of the plantago ; and in our own day the first is powerfully recommended by M. Marochetti of Moscow, in the St. Petersburg Miscellanies of Medical Science, as employed with great success in the Ukraine ; and the second by Dr. S. Spalding of New-York, who tells us that it has been successful in America in upwards of a thousand cases, not only in men, but in dogs, swine, and oxen. The next remedy I have to notice is also of extensive use in the Woo'd present day, and comes before as with no mean authority. Whibt the medical practitioners of the East are pursuing their plan of abstracting rabid blood from the system, as the surest means of curing canine madness, the physicians of Finland have undertaken to accomplish the same effect by introducing rabid blood into the morbid frame. In the second number of the Hamburgh Medical Repository, Dr. W. Rithmeister of Powlowsk in Finland, has given an article in which he has collected a multiplicity of striking casee^ and various authorities in proof that the blood of a rabid animal, when drunk, is a specific against the canine hydrophobia, even where the symptoms are most strongly marked. The rabid wolf-dog, or other quadruped, is for this purpose, killed, and its blood drawn off and collected as an antilyssic ptisan. Dr. Rithmeister's commu- nication contains a letter to himself from Dr. Stockmann of White- Russia, confirming this account, and stating the practice to be equally common and successful in his own country. oiiiorinc I will only add, that a discussion has lately taken place'between two Italian physicians of distinguished reputation, Professor Brug- natelli of Pavia, and Professor Valetta of Milan, upon the virtues of chlorines as an antidote for the disease in question. The former ha" strongly recommended it ;t and the latter has denied that it i<^ • Journal of Sciences and the Arb, No. ix. p. 142 : fJiornMedi Fisiea. &r Psvia. Pre 1816 <-•'«•'v.j .NERVOLiS ILVJTlO.S. [ouu.ui. Z\i of any use :* m answer, however, to which denial, Professor Brug- Gen. I. natelli has adduced various authenticated facts, by which what he JJJJ11, calls the specific powers of the chlorine have been established and jV»"- verified.!. . 5tf£, I have thus endeavoured, upon a subject of so much interest and AnoSiw importance, to put the reader into possession ofthe general history remedies ofthe practice that has hitherto prevailed ; and he will at least allow that if the result be highly unsatisfactory—as most unsatisfactory it is—such conclusion does not result from idleness on the part of the medical profession. But how are we to reconcile the clashing and contradictory state- ments which the present analysis tinfolds to us ? This is a question of no easy solution, i'et there are many circumstances which ought to be borne in memoiy, and that will, in a certain degree, ac- count for such opposite views and decisions, without rudely im- peaching the veracity of any of the experimenters. In the first place, it is possible that the morbid poison itself, like Conciha- fhat of plague or intermitting fever, may vary in its degree of viru- clashing lence, in certain idiosyncrasies, certain countries, or certain seasons °JJdnion*_. ofthe year : and hence that a medicine which has proved useless in tice. general practice, may succeed in particular persons, particular places, ee°wceabie or at particular periods : or if inactive in itself, may be employed in some in so much milder a degree of the disease that the constitution though not may be able, in most or many instances, to triumph over it by its ,n otnerB- own powers alone. It is a just remark of Celsus that omnis fere morsus habet quoddam c^ea sup- virus ;| and we have already given proof that this is particularly the genuine0 case when the animal that bites is labouring under the influence of j^"* "°Jo. violent rage or other sensorial excitement: the symptoms incident upon which produce a severe effect upon the nervous system, and often stimulate those of genuine lyssa. And hence, there can be hence some little doubt that these symptoms have often been mistaken for lyssa, cetebraTed and have given a celebrity to the medicines employed for their cure f?r curef to which they were never entitled. In various cases, as we have performed! already seen, the disease commences almost coetaneously with the „a"^leb'*f external injury, or inoculation : in others, not till months or even >he symp- ycars afterwards. In some instances the first symptoms of the dis- ly^a'has case show themselves in the bitten part, and even this in a very dif- °^fn Jed "• ferent manner, for there may be a troublesome sense of numbness, or of irritation ; and this irritation may be confined to the cicatrix. or travel up the limb, and produce acute pain or spastic action : while in other instances there is no local affection whatever through the entire progress of the malady. Ordinarily speaking, hydrophobia, or water-dread, is one of the most common, as well as one of the severest symptoms of the disease; yet there are instances, even where the rabies has terminated fa- tally, in which water-dread has not been once complained of. Most commonly, again, on an early examination after death, the fauces- «*> * Hibliotcca Italiana. Gennaj. 1817. '. Giornale di Fisica, &c. Pavi.i, Febbrai. 1817. ' !>•• Medirinu, \/i'n. v. v IV. j .NEUROTIC A. [t)RU, (ir.N. I. i?F.VIII. KutaMd Lyssa. Rubies. Medical treatment. Where many per- sons bitten nt the same lime the poiion not equally ap- plied to all; whence some have been sup- posed to derive a prophylac- tic power from medi- ciiK-s which they do not possess. Illustration i'f several of the above re- marks. Different results of the above cases ca- pable of being dif- ferently accounted for. and parts adjoining are found red and inflamed : but we have already observed that Morgagni dissected patients in which there was no such appearance whatever. And in two bodies examined after death by Dr. Vaughan, the fauces, esophagus, stomach, dia- phragm, and intestines, were all in a natural state. There can be little or no doubt, moreover, where many persons are bitten in quick succession by the same rabid animal, that the poi- sonis not equally introduced into all of them. In some cases itmay be expended entirely upon the earlier victims, and hence the rest, though bitten, may be free from the virus ; while in others where the teeth have to pass through various foldings of clothes, it is possible that the virus which still remains may be wiped off in its passage, and the laceration be nothing more than a clean wound from the first. And in all such cases a sanguine experimenter, without allowing for these circumstances, will be apt to persuade himself, whatever medicines he makes use of, that the absence of the disease is owing to the effi- cacy ofthe plan or the medicine he has prescribed, and which he is hence tempted to hold up to the world as an antidote or specific. Some of these remarks will best explain the very different results of the same mode of treatment, in the eleven patients intrusted in 1775 to the care of M Blaise of Cluny, after having been dreadfully bitten and torn by a mad wolf. The principal remedy was mercu- rial inunction, though combined with antispasmodics. The mercury was carried on in all of them to salivation, and the treatment con- tinued for above a month in those that lived long enough for this pur- pose. One died with great horror and water-dread about the twelfth day from the injury, and after the mercury had begun to act. A second perished under hydrophobia, furious and at length comatose, just at the close of a month, his mouth and gums being slightly affected by the mercury. A third died nearly six weeks after the commence- ment of the mercurial plan, having been taken away by his friends on the eighteenth day, apparently in a state of doing well. The remaining eight, after having exhibited greater or less symptoms of spasmodic affection, but never amounting to hydrophobia, are said to have recovered, and were discharged accordingly :* but in a subsequent work M. Blaise informs us, that even one of these died in a paroxysm of hydrophobia six weeks after his dis- charge and supposed restoration to health.t In all these cases the success is ascribed to the action of the mer- cury, and the want of success to some irregularity or other committed by the patient while under medical care. The enormities, however, are in general rather far fetched, and not very convincing. Thus, in the last of the above cases, it is ingeniously observed that the man who had been so long discharged as well, four days only before the symptoms of hydrophobia appeared on him, had thrust his arm down the throat of an ox which was said to be mad ; though no proof is offered that the ox was really mad, nor is it pretended that even this reputed mad ox inflicted any bite upon the arm whatever. Who ' Methode eprouvee pour la Traitemeot de la Rape • Hist, de h Society de Medicine, Tom. if •L.i\.\ NERVOUS FUNCTION, [oku. in. 2/iJ does not see, that in all these cases the mercury may have been Gen. I. guiltless of exercising any control ? that those who died may have EmasTa1"' died in consequence of an effective lodgement of the virus in the Ly?81- wound inflicted, and that those who survived, may have survived Medical because it obtained no admission to the bitten part ? treatment. It is, moreover, highly probable that a spontaneous cure is occa- Raines sionally effected by the strength ofthe constitution, or the remedial perhaps?*' power of nature alone. The fact appears to be, that the disease taneousiy."' requires about six or seven days to run through its course, at the expiration of which period the system seems to be exonerated by the outlet of the salivary glands, of the poison with which it is in- fested. And hence, if by any means it be able to sustain and carry itself through this period, without being totally exhausted of nervous power in the course of so protracted and prostrating a conflict, it will obtain a triumph over the disease: and any prescribed medicine made use of on the occasion will seem to have effected the cure, and will run away with the credit of having done so, till subsequent instances dissolve the charm, and prove beyond contradiction the utter futility of its pretensions. I have already had to observe that the contagion of lyssa, though Tlie jn^ju highly malignant, is neither very volatile nor very active, and in poison and every instance, perhaps, requires some exciting or predisponent cause ■|;'t,frt{!a°f to enable it to take effect: but, as it seems to be more indecompo- before it sible than any other contagion we are acquainted with, it is capable "ate" °pe" of lying latent and undissolved for months, if not years, till it meets another ~ OCCQ.S1O110.1 with a cause of this kind. And hence the very long and uncertain cause of interval which sometimes occurs between the attack of the rabid deoenllon- animal and the appearance of rabid symptoms, has often proved another source of deception ; of which we have a singular example strikingly in Mr. Nourse's case, related in an early volume of the Philosophicalexemp Transactions ;* which states that a lad, who had been bitten in the thumb by a mad dog, took morning and evening for forty days a drachm ofthe pulvis antilyssus already described, and bathed in the sea for ten days in succession. He was in due time reported to be well, and the cure was altogether ascribed to the specific virtues of die antilyssic powder. He was shortly afterwards cut for the stone, from which also he recovered: nineteen months after which ope- ration, however, he was attacked with hydrophobia and the other symptoms of canine madness, and fell a victim to their violence. Had this patient died under the operation of lithotomy, or from any other circumstance in the interval, the virtues of the antilyssic pow- der would have obtained a complete, and indeed a rational triumph in this instance : and even now there may be a question whether the appearance of the disease was not retarded by the plan pursued : though its specific power can no longer be maintained for a moment. The occasional exciting cause which, in this instance, at length gave Exciting activity to the dormant virus, is not pointed out to us. But it is dif- sBmuiougi: ficult, if not impossible, to account, without such a cause, for the notmmccd. quickening ofthe lurking seminium ofthe poison at this time rather V'.r, [V._ >74 cl. iv.j S'E OROTIC A. [oun. ui. (Jen. I. Sp. VIII. I'.utasia r.vssa. !!:ibies. Medical lieatment. Analogous remarks and illus- trations by Perceval. further illustration, in which profuse bleeding and large doses of opium of no use. The influ- ence of occasional causes very considera- ble. Violence and com- plexity of the means employed have pro- bably sometimes proved mis- chievous if not fatal. Exempli- fied. than at any other. And the following valuable remarks of Dr. Per- ceval, occurring in his manuscript comment on the author's volume of Nosology in relation to this subject, are in full illustration of the same opinion. " A wine porter was attended, in Dispensary practice, for a low fever: after a time appeared symptoms of lyssa; and much inquiry elicited the recollection of his having been slightly bitten by a dog six weeks before. In the interval he was convicted of some frau- dulent practice in the cellar of his master, to whom he owed great obligation, and was dismissed with disgrace. Anxiety on this event seemed to produce the fever which terminated in lyssa. " Lately an officer in our barracks was bitten by a dog, whose madness being recognised, the bitten part was excised immediately ; after an undisturbed interval of two months he was advised to go to England to dissipate the recollection of the accident: there he exer- cised himself violently in hewing wood ; felt pain in the hand which had been bitten ; embarked for Ireland ; had symptoms of hydro- phobia on board the packet, and died soon after his arrival. " I have lately seen a case of hydrophobia treated ineffectually by most profuse bleeding and large doses of opium. Here too the bitten part was extirpated by caustic within an hour. He was a man of steady mind, nor could any occasional cause be assigned for bringing the poison into action, except that a bilious diarrhoea was suddenly checked. " From the varying period of attack we might infer that the influ- ence of occasional causes is very considerable. In the last patient hydrophobia supervened exactly five weeks from the time of the bite; he lost a hundred and eight ounces of blood in twelve hours which sunk him much; violent perspiration, and at length delirium, attended the water-dread ; during the last twenty-four hours he swallowed, and recovered his senses ; and died slightly convulsed whilst cutting an egg. These cases seem to point out agitation of mind and fe- verish excitation as powerful occasional causes." In a disease so intricate as lyssa a very complex treatment is by no means unpardonable : but it may fairly, I think, be questioned whether the complexity and the energy of the means employed to produce a cure may not, rather, in some instances, have had an oppo- site effect, and have hastened and confirmed a fatal issue. A patient bitten by a mad dog, having in vain tried and persevered in the use ofthe Ormskirk medicine, was next put under the joint care of Dr. Watson and Dr. Fothergdl. Having been bled standing, as long as he could stand, he was next immersed in a warm bath, where he was ordered to remain till he again became faint; a clyster of milk and water with a drachm of Dover's powder dissolved in it was injected as soon as he was removed from the bath ; half an ounce of mercurial ointment was at the same time rubbed into the legs and thighs, and three grains of thebaic extract given in the form of pills : two grains being ordered to be continued every hour till he became sleepy. To stand the brunt of a treatment thus vigorous would demand no • "•dinary constitution, even without ih<- co-operation of anv di>ea«« ci. rv.l NERVOUS I I NOTION [ofcn. m. 2?.') But that the wretched sufferer should sink (as he did, in a few hours) Gen« *• under the assault of such a malady and such a mode of cure, cannot Entasia be matter of surprise to anyone. nyi/a' The whole subject is afflictive, as well in respect to its treatment Treatment. as its progress. But how, after all, is a young practitioner to proceed "bjecVof when he meets with a case of rabies ? This is a most important treatment question ; and the following remarks, submitted with great deference cult and as the result of some little personal experience, and no small degree G*B°,,!1vi0' of reflection, arc meant to meet it, and to point out the path, which, result and in the present unsettled state of the subject it may, perhaps, be most ^^,0".. expedient to adopt. cess- From the whole of the preceding survey it is sufficiently clear that f°J^lct we have no direct specific for the cure ofthe disease ; and, hence, and hence whatever plan we employ must be palliative only. It appears also p^*1^" that the disease consists in a poison of a peculiar kind capable of pursued assimilating some of the animal secretions to its own nature, and that palliative the new matter, or contagion, hereby produced, continues to be elimi- £",£;,„ of nated for five or six days principally, if not entirely, from the excreto- lyssa of a ries of the salivary glands, as the inflammation of gout unloads itself {^''and on the extremities, and the specific matter of exanthems on the sur- requires face generally : and that, at the expiration of this period, or as soon daysto\>e. as such depuration has been effected, the disease abates, and the ^p",^' patient is restored. It appears, also, that the disease is one of the haps aito- most dangerous in the whole catalogue of nosology, and that few f^, searijvary patients recover from it under any plan of medicine that has ever ?'ands:,. :..... 11 .-i i a*tcr which been devised ; but that, nevertheless, some patients have recovered the disease under almost every mode of treatment, however incongruous and abale* contradictory to other modes ; and hence, that many cases of resto- ration must be rather referred to a natural, or .spontaneous cure, than to the virtue of medicines. In this state of things it seems reasonable that our first intention syttem to should consist, as in various other kinds of animal poisons communi- £« gneSv cated in the same manner, in supporting the system generally, and and espe-' the nervous part of it more particularly, so that it may not sink under J;car"*utg,e the violent excitement and augmented secretion which the organ part of it ofthe nerves has to encounter during so perilous a struggle. And it is to this principle we have to resolve all the benefit which has at any time been found to result from the use ofthe stimulant theriacas and other cordials ofthe old practitioners. On this account ether, ammonia, and camphor, have a strong claim upon our attention, and especially the two last, as they may be given in a solid form. All »y cardiacs t •> . • i ii j j j an" difiusj- the pungent spices belong to the same class, as cardamum-seeds, and bie stimu- capsicum, and may be adverted to as auxiliaries ; nor should wine or oBc"a8s:i0I)aI. even ardent spirits be refrained from, if the patient can be induced to iy by wine swallow them ; moderately through the entire course of the disease, ™\tltl en but liberally and profusely as his strength declines. Our grand ob- ject must be to keep him alive, and prevent a fatal torpitude in the sensorium for a certain number of days, at any expense of stimulants. or oC subsequent debility. Wine is profusely given with great suc- cess in the bite ofthe most venomous serpents ofthe East, and an» lop;v justifies us in proposing" it in the present instant ■i',t> rL. iv.j NEl KoTICA. [omd. m SpE VIII °Ur next intenuon should be to diminish, as much as possible, the Entasia ' spastic action of the chest and fauces, and to prevent a return of the BabT's exacerbations. And to this end as much quiet and composure as Treatment, we can possibly procure, under so restless a state of body, seems actionto''0 imperatively called for, and is far more likely to be serviceable than he diminish- the fatigue of taking the patient repeatedly out of bed for the purpose roucE quiet of plunging him either into a hot or a cold bath. And though opium as possible nas never of itself, perhaps, produced a cure, it seems adviseable to hlbition'of try it in liberal doses ; and the more so as several of the cases sarnycxer- already adverted to afford a direct proof that it is capable, occasion- Jjon- ally, of producing some degree of tranquillity for a short period. In lively and employing it, however, it seems most reasonable, from analogy, to opiuma"y combine it with some diaphoretic, and particularly with ipecacuan combined in the form of Dover's powder, since, at all times, the animal frame diaphoretic, is most disposed to be quiet and free from irregular actions, when powder?s tnere ls a general moisture upon the surface. In many cases of rabies such a state of body has been found unquestionably favourable ; and in one of the distances already quoted from the Medical Trans- actions, the benefit was so striking that the practitioner could not avoid regarding it as critical. It is possible, also, though no great stress can be laid upon this remark, that a part of the virus itself may be hereby eliminated, as in various other cases of animal poisons. The morbid To obtain and encourage such elimination should indeed be our be^i'fpos- first object, if we had any means of accomplishing it upon which we sirle' „. a could fully depend. This, however, we have not; but, as the quar- ehminated , • , r. ■ ,- , • , ,. • , /• 7 • ■ from the ter to which the virus is directed is the salivary glands, of which, chfefl'y byd indeed, we have full proof in consequence of the saliva being the means of fomes of the poison apparently as soon as it becomes elaborated ; glands by'y and as we have a medicine which possesses a specific influence on mercury°f tflis orf?ani and is capable of augmenting its secretion to almost any its apparent extent, it seems of the utmost importance that, while we endeavour iandmanySe to support the system, and to allay the nervous irritation, we should cases re- endeavour at the same time to quicken the elimination of the morbid intcMhis matter, by exciting the salivary emunctories, and thus probably also prineipie. carryU1g it off in a diluter and less irritant form. It is difficult to withhold one's assent to all the numerous instances of cure which are so confidently asserted to have followed upon the use of mercury carried to the point of free salivation. And hence, without allowing this medicine to be a specific more than any other, we may indulge a reasonable hope of its forming a good auxiliary, and should employ it freely, either externally, internally, or in both modes simulta- neously ; but with as little disturbance to the patient as possible, till a copious ptyalism is the result. Kever, or Fever, or inflammatory action, does not necessarily belong to tory action, lyssa in any stage : and the present mode of treatment is altogether has some- grounded upon this principle. Either, however, may become inci- tnnes asso- <= . x '. , . r ' ' * ... dated: dentally connected with it from the peculiar state of the habit or and hence some other cause. Hence, as a preventive, the bowels should be edbngfinastd' kept moderately open ; and wherever there is any just apprehension fn/fo"'!!, of plethora, or a turgid <=tatn of the vessels, and particularly ofthe vl. iv. j NERVOUS IT NOTION. [ouv. m. ZT> brain, blood should be drawn freely from the arm, and, if necessary, sGEIUj\r be repeated. We have already seen that such a state of congestion Entasia is sometimes produced even at the onset of the disease, and is so ^bja; forcibly felt by the patient himself, that he earnestly entreats the Treatment. medical attendant to bleed him. Such entreaty should, perhaps, ^esTTa never be urged in vain : but the bleedings to deliquium, which have tfh|ej^e°tf. of late years been so strongly recommended, are a rash and dan- especially' gerous practice, unfounded on analogy, and by no means rest on p.^nx en- any sufficient assurance. *real'? l° be Such, in the doubt and darkness that at present beset us, con- from a cerning the real physiology of lyssa, seems to be the safest and most ^nSgee°[on. promising path we can pursue, when called upon for aid in so afflic- tive a malady. Our best time for action, however, and almost the importance only time we can improve, is immediately on the infliction of the SL^p'ro-" wound : a tight ligature above which, with the double precaution of cess upon excision and cauterization, may in general be regarded as an effec- [ion'ofthe tual preventive. I do not know, indeed, that the profession is ac- wound. quainted with any other. It has, however, been proposed in France, Poison of to fight off the poison of lyssa by pre-occupying the ground with the poKTan poison of a viper, upon the principle of combating variolous with J^^6 l°d vaccine matter : and for this purpose it has been suggested that the dog. part bitten by a mad dog should be again bitten a little below the wound, as soon as may be, by a venomous serpent, whose virus, from its greater activity, will, in most cases, be certain of taking the lead, and may, it is presumed, guard the constitution against any subsequent effects from the wound of the mad dog. I have not, however, heard that this proposal has ever been carried into effect, and the claim of ingenuity is, most probably, the whole it will ever have to receive. I ought not, however, to conclude without noticing one very ex- Contagion traordinary fact in the economy of morbid poisons, and especially of catarrh"6 that before us, which I have had confirmed by the testimony of ^d to_ ^ several veterinary practitioners entitled to credit. It is, that no dog dogs from who has ever had the distemper, as it is called, which is the canine ae^"n°f catarrh or influenza, has been known to become rabid spontaneously, rabies; " though he is capable of receiving the disease by the bite of another reUce?v°ing it dog. If this be true, for which however I cannot fully vouch, we ^etobe'' have certainly another instance of morbid poisons mortally con- made of dieting with each other; and it might be worth trying how far trhuse.fact '* inoculation with the matter of canine catarrh might succeed in pro- tecting a human subject after the infliction of a rabid bite ; though in the dog, perhaps from a stronger predisposition to rabies, it seems to be impotent. In South America, rabies, as already observed, is Collateral altogether unknown, and I have hence been anxious to learn whether BUppon of the distemper be unknown there also : and, in answer to this in- '*• quiry, it has been told me, by several intelligent residents in that quarter, that this last disorder is so common and so fatal, that two thirds of the dogs littered there perish of it while pups : a remark which still further confirms the home-report concerning its influence on rabies, and sufficiently explains the non-existence ofthe latter on the shores of the Plata. 17^ CL. IV. | NEUROTICA. |om». in SPECIES IX. ENTASIA ACROTISMUS. PULSELESSNESS. FAILURE, OR CESSATION OF THE PULSE, OFTEN ACCOMPANIED WITH PAIN IN THE EPIGASTRIUM ; THE PERCEPTION AND THE VOLUN- TARY MUSCLES REMAINING UNDISTURBED. Gen. I. Spec. IX. Origin of the specific term. Asphyxia sometimes used syno- nymously. Failure of pulsation sometimes general, sometimes limited. Importing debility of the heart and arte- ries; and mostly connected with a spasmodic disposition. Exempli- fied. Other irri- tations than that of weak- ness are sometimes Cannes. Acrotismus is literally " defect of pulse," from xperog, " pulsus,'' with a privitive x prefixed : whence the technical term crotophus or crotophium, importing " painful ptdsation or throbbing in the temple." Asphyxia is the term employed for this disease by Plouc- quet, and would have been used in the present arrangement but thai it has been long appropriated to import suspended animation or ap- parent death ; a total cessation, not ofthe pulse only, but of sense and voluntary motion. This failure or cessation of pulsation sometimes extends over the whole system, and is sometimes confined to particular parts. In every case it imports an irregularity in the action of the heart, or of the vessels that issue from it, and in most cases, an irregularity pro- ceeding from local or general weakness, and dependent upon a spasmodic disposition hereby produced in the muscular tunic of the vessels. Of this last cause wc have a clear proof in the universal chill and paleness that spread over the entire surface in the act of fainting or of death, to which fainting bears so striking a resem- blance. Except, however, in the agony of dying, the spasmodic constriction for the most part soon subsides, and the arteries recover their proper freedom and diameter. Yet this is by no means the case always, for in violent hemorrhages, and especially hemorrhages of the womb, the rigidity has sometimes continued for several days. during the whole of which time the heart has seemed merely to pal- pitate, and there has been no pulse whatever. Morgagni relates, from Ramazzini, a case of this kind which extended to four days. The patient was a young man of great strength and activity even during this suppression. The arteries were as pulseless as the heart: and, through the whole period he was quite cold to the touch, and without micturition. On the fourth day he died suddenly.* Exam- ples indeed are by no means uncommon in which the spasm has existed for three,t four, or even five daysj before death. Other irritations, besides that of weakness, have occasionally led to a like spastic state of the arteries. The stimulus of an aneurism of the aorta has produced it in the brachial arteries, so that there has been no pulse in the wrists : and gout or somo acrimony in the stomach has operated in like manner on the arterial system to a * De Sedibttsct Causis Morb. Ep. XLvm. Lugd. Bat. 4to. 1767. *■ Pnfliolojry. p. 25. t PMargus, JVM. .TahnrranffP. Band. v. p. 2fl cl. iv.J \ERVOLrf FUNCTION. [ord. in. 2VJ much greater extent: as has likewise general pressure on the larger Gen. I. thoracic or abdominal organs, from water in the chest or cavity of Entijsia'1' the peritoneum. The cause, however, is not always to be traced, ^rsotis_ and hence Marcellus Donatus has given an instance which he tells pui oiess- us was unaccompanied with any disease whatever ;* the irritation som'etimsH probably having subsided. Berryatt, in the History of the Academy ^rtutale of Sciences, has furnished us with a very singular example of this irritation disease which was general as well as chronic, and continued through hiad3edlub" the whole term of life. In all which cases, however, though the Hence has heart itself should seem to participate in the pulselessness, we are trough the not to suppose that it is entirely without any alternation of systole jj£°^ a and diastole, but only that its action is indistinct from weakness or in ail irregularity. In treating of the nature of the pulse in the Physiolo- *^the gical Proem to the third class, we observed that it is in some per- heart nro-^ sons unusually slow, and has been found, as measured by the finger^ though in-' not more than ten strokes in a minute : j and that in many of these f%™£[- cases the cause of retardation seems to be a spasticity or want of tardation pliancy in the muscular fibres of the heart or arteries, or both, pU|3eenot rather than an actual torpor which is also an occasional cause. ™™n?m°sn' I have never met with any case in which the ordinary standard of amounting the pulse was not more than ten strokes in a minute ; but I have at j£™jy P\ this time a patient of about thirty-six years of age, whose pulse has i™™^. not exceeded twenty-four or twenty-six strokes, and has often been fi*d.mp l below these numbers. He is a captain in the Royal Navy, of a sal- low complexion and bilious temperament; till of late he enjoyed good health, but about three years since was attacked with a fit of atonic apoplexy from which he recovered with difficulty. At an interval of a few weeks from each other, he had several other fits : on recovering from the last of which he instantly married a young- lady to whom he had for some time been engaged. He has now been married about fifteen months, has a healthy infant just born. and has had no fit whatever. His spirits are good, and he is residing by the sea-side, which situation he finds agree with him best. Dr. Latham gives a similar example in a merchant whose pulse, though never intermissive, seldom, for ten or twelve years that he had known him, exceeded thirty-two beats in a minute; occasionally was as slow as twenty-two, and at one time only seventeen. u I once," F,u]rBttiJ«rion says Dr. Latham, " attended him through a regular fever, when his ' UB r pulse was not more than sixty, notwithstanding the disease ran on for at least a fortnight with a hot and dry skin, white and furred and parched tongue, and occasional delirium."J In many of these anomalies there is not only no perceptible pulse in these or a very retarded one, but often intermissions more or less regular, often V" and occasionally a want of harmony between the stroke in some of JJ^^ the arteries compared with that in others. Red gives a case in in the which the heart, the carotids, and the radial arteries all pulsated dif- d\ffekren° ferently:§ and Beggi another, in which the acrotism, or want of arteries. * Lib. vi. cap. n. p. 620. | Vol» «• P- l7- I Med. Trans. Vol. iv. Art. xx. § Memorabilia Clinica. Vol. n. Fasc. ' 6. Hall. 179'i. ZSV cl. iv.j NEUROTICA. |okD. "<• Sefix Pulsation, extended over the entire frame with the exception of the Entasia ' heart, which pulsated violently.* Acrotis- fjjjg Species js strikingly exemplified in the biographical sketch of PuiFeiess- Mr. J. Hunter, drawn up and prefixed to his volume on Blood and Acrotism Inflammation by Sir Everard Home. Mr. Hunter for the four pre rxemn)firiyed cedin£ years liad annually suffered from a fit of the gout in the spring. in j. Hun- In the year 1773, this did not return, and having, on a particular utedinhu occasion> been greatly affected in his mind, " he was attacked,'' jifc by says Sir Everard Home, " at ten o'clock in the forenoon, with a pain in the stomach, about the pylorus : it was the sensation peculiar to those parts, and became so violent that he tried change of position to procure ease; he sat down, then walked, laid himself down on the carpet, then upon chairs, but could find no relief: he took a spoonful of tincture of rhubarb, with thirty drops of laudanum, but without the smallest benefit. While he was walking about the room he cast his eyes on the looking-glass, and observed his countenance to be pale, and his lips white, giving the appearance of a dead man. This alarmed him, and led him to feel for his pulse, but he found none in either arm. He now thought his complaint serious. Several physicians of his acquaintance, Dr. William Hunter, Sir George Baker, Dr. Huck Saunders, and Sir William Fordyce, all came but could find no pulse : the pain still continued, and he found himself at times, not breathing. Being afraid of death soon taking place if he did not breathe, he produced the voluntary act of breathing ; his working his lungs by the power of the will, the sensitive principle with all its effects on the machine not being in the least affected by the complaint. In this state he continued for three quarters of an hour, in which time frequent attempts were made to feel the pulse but in vain. However, at last the pain lessened, and the pulse re- turned, although at first but faintly, and the involuntary breathing began to take place. While in this state he took Madeira, brandy, ginger, &c. but did not believe them of any service, as the return of health was very gradual. In two hours he was perfectly re- covered. "+ rim case This is one of the most extraordinary cases on record, considering fraordinarv tne extensive group of important functions that were jointly affected, and and the total freedom of the rest : and nothing can more strikingly elucidative prove how close is the sympathy that in many instances prevails be- Bfiif athS° tween discontinuous organs. The chief disease seems to have pre- often pro- vailed in the heart, the chief pain in the stomach on its upper side ; tweenSd^ and f°r ""s we mavi perhaps, account, from a law of the animal continuous economy we have so often of late had occasion to keep in view, by c«se which a morbid action affecting one extremity of a nervous fibre. explained. or bundle of fibres, is, under particular circumstances, most se- verely felt at the other extremity: for as one of the branches of the phrenic nerve passes over the apex of the heart, and is afterwards continued to the diaphragm which maintains so intimate an asso- ciation with the stomach, it serves as a direct line of communication between each of these organs ; and the painful impression imparted • Opp. Pacchioui. ltotn. 4to. 1741. Sir E. Home's Life of \Tr. Jlutiter prefixed to the Treatise on HI- od, &r. p. xlri ol. rv.] NERVOUS FUNCTION. [ord. hi. 281 to the end ofthe nervous twig that rests on the heart may, by this Gen. I. Jaw, be transferred to its other extremity that lies so contiguous to the En£siaIX' upper part of the stomach. Acrotis- The nature of the pain and the collateral symptoms seem suffi- FuTs'eiess- ciently to show that this disease was of a spasmodic kind : for the ness* deficiency of pulse was subsequent to, and consequent upon the pain, and ceased upon its removal, while the deadly paleness of the face gave proof of a constriction of the capillaries. So far as my own experience has extended, such failures of the A11 puc1' pulse, whether consisting in a total suspension, or a preternatural moniy con- retardation, and attended with acute or with very little pain, are de- witifa de- pendent upon a diseased state of the larger arteries, or the larger eased B'atc viscera of the thorax or abdomen, and generally lead to sudden larger arto death. The case of the captain of the navy which I have just re- ^"^L8" lated, and which was drawn up while the first edition of this work lead'to was in the press, I may now apply to, in illustration of this remark : death!" for I have since been informed by his sister that while at Swansea, ExempR- apparently in as good health as he had ordinarily enjoyed for several years, he was attacked with a fit of apoplexy which carried him off in less than an hour. Such, too, was the fate of Dr. Latham's patient, for we are told that u one day, when in complete health, as he then con- sidered himself, he dropped down in the street and expired. " And so sudden was the decease of Mr. J. Hunter, that feeling himself unwell while in the course of his professional attendance at St. George's Hospital, he went into an adjoining room, gave a deep groan, and dropped down dead. In all cases of this kind, therefore, the mode of treatment must Mode of depend upon the nature >f the exciting or predisponent cause as far as we are able to ascertain it. Where the cause is constitutional, a where the sober, quiet, and regular habit of life, with a due attention to the consutu-* ingesta and egesta, and particularly to a tranquillized state of mind, tional- will often enable the valetudinarian to reach his three-score and tenth year, with cheerfulness and comfort: but he must content himself with ——the cool sequestered vale of life, and not form a party in its contentions, and its glitter, its bustle and " busy hum." Where the affection appears to be dependent upon a particular ^h™detit state of any one ofthe larger thoracic, or abdominal organs, as the upon a dis- heart itself", the lungs, the stomach or the liver, our attention must e0}s^fe be specially directed to the nature ofthe primary disease. And in one of the these cases it is often essentially relieved by some vicarious irritation, oV/amt. as a seton or issue, a regular fit ofthe gout, a cutaneous eruption, or a painful attack of piles. During the paroxysm itself, the most pow- erful and diffusive stimulants should be had recourse to, as brandy, the aromatic spirit ofammonia, or of ether, which is still better, and opium in any of its forms. Some persons are said to possess a natural power of thus keeping j^™^™9 the heart upon a full stretch, and hereby producing an universal de- sponta- Vol. IV.—36 T,eons,y' '282 ex. rv.] . NEUROTICA. [om>. m. Gek. I. Spec.IX Entasia Acrotis- mus. Palseless- ness. ficiency of pulsation, and of simulating death. Dr. Cleghornc and Dr. Cheyne both give an instance of this. It should be observed, however, that the individual in either case died suddenly : and one of them, Co- lonel Townshend, within a few hour*, after having maintained this rigidity of heart for half an hour, at the expiration of which time he consented to resuscitate himself,and awoke from the apparent sleep of death. It should hence seem that the natural energy of the heart sinks gradually or abruptly beneath the mischievous exertion wher- ever such a power is found to exist. GENUS II. CLONUS. CLONIC SPASM. FORCIBLE AGITATION OF ONE OR MORE MUSCLES IN SUDDEN AND IRREGULAR SNATCHES. Gen. n. Origin of the generic term. Synonyms. Spasm and convulsion how dis- tinguished by Cullen. The Greek terms, xXevos and x^ovna-tg, import " agitation, commo- tion, concussion." The clonic, or agitatory spasms form two distinct orders in Sauvages, and a single genus in Parr. The first is unne- cessarily diffuse ; the second is too restricted. The two orders of Sauvages are in the present arrangement reduced to two genera, and constitute that immediately before us, and synclonus, or that which immediately follows. Dr. Cullen seems at one time to have had a desire of distinguishing the diseases of both these genera by the name of convulsions ; and of limiting the name of spasms to the perma- nent contractions or rigidities of the muscular fibres produced by spastic action, constituting the different species of the preceding genus. " I think it convenient," says he in his First Lines, " to distinguish the term of spasm and convulsion, by applying the for- mer strictly to what has been called the tonic, and the latter to what has been called the clonic spasm." Yet the whole are treated of in his nosological arrangement, under the common name of spasmi, and even in his First Lines, notwithstanding this distinction, under that of " spasmodic affections without fever." These spasmodic affec- tions are, indeed, subsequently divided into a new arrangement of " spasmodic affections ofthe animal functions ;—ofthe vital;—and of the natural:'' throughout which an attempt is still made to separate the term convulsion from that of spasm, and apply it to all clonic or agita- tory motion of the muscles, while coisvulsiojs, nevertheless, retained in the Synopsis, as the technical name of that single species of disease Tjrhich is colloquially called convulsion-fit, and not extended to any others. There is doubtless a difficulty in drawing the line between entastic and clonic spasm in many cases, from the mixed nature of ©l. rv.} NERVOUS FUNCTION. [ord. hi. 283 the symptoms ; but if it be felt of importance to take terms out of Gen.II. their general meaning, and tie them down to a stricter interpretation, clonic3' such interpretation should be rigidly adhered to, or some degree of 8Pasm' confusion must necessarily ensue. To understand the real nature ofthe spasms we are now entering Physioiogi upon, it may be expedient to recollect that the nervous power or fluid nationPof" appears to flow naturally, as indeed we have already observed in the *PaBI™- Physiological Proem to the present class, by minute jets, or in an flow of the undulatory course, like the vibrations of a musical chord. But the fa™£* movement is so uniform, and the supply so regular, in a state of jets: health, and where there is no fatigue, that we are not conscious of do not'im- any discontinuity of tenour, and can grasp as rigidly and as perma- f^1-*c°fa' nently with a muscle as if there were no relaxation in its flow of muscular power. To prove the nature ofthe influx, however, nothing more actI0n' is necessary than to reduce the muscles from a state of healthy tone to a state of languor, or to wear it down by fatigue ; for in this condi- tion all the muscles tremble, and the stoutest man is incapable of extending his arm with a small weight in his hand, or even of raising a glass of wine slowly to the mouth, without a manifest, and even a painful oscillation. The flow ofthe nervous power, in a state of health, is augmented Natural by the application of various stimulants both mental and corporeal, mented by The ordinary mental stimulus is the will, but any other mental faculty Jt*m„"antg- when violently excited will answer the same purpose, though the Mental action which takes place in consequence hereof, will, in some de-s irau an gree, be irregular, as proceeding from an irregular source, and will in consequence make an approach to the character of spasms ; of which a violent excitement of almost any of the passions affords examples sufficiently evident, and especially the passions of fear and anger, under the influence of which it is sometimes found impossible to keep a single limb still. The ordinary corporeal stimulants are the fluids which are natu- Corporeal .1 .... i i mi. i • stimulants. rally applied to the motory organs themselves. I bus the air we breathe becomes a sufficient excitement to the action of the lungs, the flow of the blood from the veins a sufficient excitement to that of the heart, while the descent of the feces maintains the peristaltic motion of the intestinal canal. Where these stimulants are regularly administered, and the organs to which they are applied are in a state of health, the alternations of jets and pauses in the flow of the nervous power, as we have already remarked, are uniform. But in a state of diseased action, Uniformity whether from a morbid secretion of the fluid, or a morbid condition 0f nerVpua of the fibres that are to be influenced by it, this uniformity is de- fn^drf^ stroyed, and in two very different ways : for first, the nervous energy with. may rush forward with a force that prohibits all pause or relaxation whatever, and this too in spite of all the power of the will; and we ^°r^icdti°n have then a production of rigid or entastic spasms, or those abnor- entastie mal contractions in different parts of the body of which the preceding BP8sm' genus furnishes us with abundant examples ; and next the pauses or relaxations may be too protracted ; and in this case every move- ment will be performed with a manifest tremor, Where this last la jj>4 cl. iv.J NEUROTICA. [okd. ui Gen. II. ClonUs. Clonic spasm. Production of con- vulsive or clonic spasm. Mixture of both kinds how pro- cluced. Further illustrated. Tendency to a repe- tition of irregular action when once produced : hence es- tablished habits of recurrence exempli- fied in hooping. cough In palpita - tion: In sneezing In hic- cough. the case, moreover, the succeeding jet from the accumulation ot nervous power Uiat necessarily follows upon such a retardation, must at length take place with an inordinate force and hurry ; and the movement in the voluntary muscles, when attempted to be con- trolled by the will, must be irregular and often strongly marked with agitation, giving us examples of convulsive or clonic spasm. And as, moreover, in such a state of the nervous system or of any part of it, Uiere will often be found a contest between the retarding and the impelling powers; the spasm will not unfrequently partake of the nature of the two, the nervous energy, after having been irregularly restrained in its course, will rush forward too impetuously, and for a few moments without any pause ; and we shall have either a suc- cession of constrictive and clonic spasms in the same muscle or sets of muscles, or a constrictive spasm in some parts, while we have a clonic spasm in others : and hence those violent and ramifying con- vulsions which we shall have more particularly to notice under the ensuing genus. A sudden and incidental application of any irritant power what- ever, to any of the muscular fibres, will throw them into an irregu- lar action not only in a morbid state, when they are most prone to such irregularities, but even in a state of health. Hence the invo- luntary jerk that takes place in all the limbs when a boat, in which we are sailing at full speed, gets a-ground without our expecting it, or we are assailed unawares with a smart stroke of electricity. Now, whenever a forcible and anomalous movement of this kind has once been excited in any chain of muscular fibres whatever, there is a strong tendency in them to repeat the same movement even from the first: and when from accident or a continuance of\ the exciting cause it has actually been repeated, it forms a habit of recurrence that is often broken off with great difficulty. Hence the convulsive spasm of the hooping cough always outlasts the disease itself for some weeks, and is best removed by the introduction of some counter-habit obtained by a change of residence, atmosphere, and even hours. A palpitation of the heart first occasioned by fright, in an irritable frame, has in some cases continued for many days afterwards, and in a few instances become chronic. A habit of sneezing has sometimes been produced in the same manner, and has followed upon an obstinate catarrh ; after which the slightest stimulants, even the sneezing of another person, has been sufficient to call up fresh paroxysms, and in some cases which I have seen, of very long and troublesome continuance. Hiccough affords us another example of the same tendency to a recurrence of muscular abnormities. This is usually produced by some irritation in the stomach, not unfrequently that of fulness alone : the irritation is by sympathy communicated to the diaphragm, which is thrown into a clonic spasm, and the spasm being a few- times repeated, the series of hiccuping becomes so established, as, in many instances, to be broken through with considerable diffi- culty. It is to these physiological laws that most of the affections we are now about to enter upon are referrible ; and the concentrated v'wrr a., rv.j NERVOUS FUNCTION. [ord. hi. 285 we have thus taken of their operation, will render it less necessary Gen. II. for us to dwell at much length upon any of them. cS' The genus clonus comprises the six following species : BPasm- 1. CLONUS SINGULTUS. HICCOUGH. 2. ------ STERNUTATIO. S>EEZING. 3.------ PALPITATIO. 4. ------ NICTITATIO. PALPITATION. TWINKLING OF THE EYE-LIDS. 5.------SUBSULTUS. TWITCHING OF THE TENDONS. fi» ------ PANDICULATIO. STRETCHINC. SPECIES I. CLONUS SINGULTUS. HICCOUGH. CONVULSIVE CATCH OF THE RESPIRATORY MUSCLES, WITH SONOROtS INSPIRATION ; ITERATED AT SHORT INTERVALS. Though the spasmodic action in this affection exists chiefly in Gen.JI. the diaphragm, the principal seat of the disease is the stomach, when Disease ' strictly idiopathic ; an observation which was long ago made by principally Hippocrates, and has in recent times been more copiously dwelt in the upon by Hoffman : but which Mr. Charles Bell has bt-en the first "ZnM* to establish by experiments on the nervous system. " Vomiting," pathic. says he, " and hiccough, are actions of the respiratory muscles ex- cited by irritation ofthe stomach."* Debility is pprhaps the ordinary remote cause, and irritability, or Remote some accidental stimulus, the exciting. Thus excess of food, and citing especially in a weak stomach, is often a sufficient stimulus: and cau8CS- hence the frequency of this complaint among infants. For the same reason it is occasionally produced by worms, acidity, or bde in the stomach. External pressure on the stomach is another ex- citing cause : and hence it has sometimes followed, on an incurvation of one or more ofthe ribs,t or ofthe ensiform cartilage J ofthe sternum produced by violence, and pressing on the coats of this organ. The Morbw stomach, however, is not at all times the only organ in which the sometimes morbid cause is seated that excites the diaphragm to this spasmodic *^a0'het action. The liver is frequently to be suspected. " I have often," organs says Dr. Perceval, in his manuscript notes on the volume of Noso- stomach. logy, " found hiccough symptomatic of an enlargement or inflam- fexdempli" mation of the liver on the upper convex side." It also frequently follows upon strangulated hernia; and, according to Mr. John Hunter, in numerous instances accompanies local irritation after * Experiments on the Structure and Function of the Nerves. Phil. Trans. 1821, p. 406. t Schenck, Lib. in. Obs. 49. ex Fernelio. I Bonet Sepulchr. Lib. m. Sect, y. Obs. 8. Appex. 28G cl. iv.] NEUROTICA. [ORD. UK gen. II. operations of various kinds. It has sometimes attended the pas- cior.us' sage of a stone in one of the ureters, and has continued through its HiccoTh entire course.* Spasm The affection is often very troublesome, but it cures itself in itsei""^8 ordinary cases, and where the exciting cause is lodged in the easily re- stomach ; for the spasmodic action very generally removes the acci- dental irritant; and if not, the disorder usually yields to very sim- ple antispasmodics, as a draught of cold water,.or a dose of camphor Uowto be or volatile spirits Where these have failed, a nervous action of a wlTr0*1 different kind, and which seems to operate by revulsion, has often common been found to succeed, such as holding the breath, and thus pro- means fad- ducing a voluntary spasm of a rigid and opposite kind in the dia- phragm ; or a violent fit of sneezing. An emetict will sometimes answer the purpose ; and still more effectually, a sudden fright, or other emotion ofthe mind.J If these do not prove sufficient, we must call in the aid of opium : and in the intervals have recourse to tonics internal and external, the warm bitters, bark, pure air, exer- cise, and cold bathing. We have already pointed out the tendency which these irregular actions have to form a habit, ami the more so in proportion to the Hiccough general weakness and irritability of the frame ; and hence, indeed, andloPthUS tne^r arising so readily in the later stages of typhus and other low low fevers, fevers, and their continuing to the last ebb ofthe living power. chronic Even where the constitution is possessed of a tolerable share of hiccough, vigour, hiccough is too apt to become a chronic and periodical affection ; and as the frequency of the spasm is also usually increased with the frequency of the series, it has sometimes become almost incessant, and defied every kind of medical treatment that could be Singular devised. As a chronic affection it has been known to return at examples, irregular periods from four§ to four and twenty years ;|| and as a permanent attack to continue without ceasing for eight," nine,** twelve days, ft and even three months.j| Dr. Parr tells us that he once knew it to continue for a month with scarcely any intermission even at night. u i he sleep," says he, " was at last so profound that the convulsion scarcely awoke the patient." In a few instances it has proved fatal. Poterius mentions one :§§ and another, pro- duced by cold beverage, occurs in the Ephemerides of Natural Curiosities.il || In the Gazette de Sante for 1817, is the case of a young girl who had been tormented for six months with an almost incessant hiccough. It ceased during deglutition, but re-appeared immediately afterwards. The sleep was frequently disturbed. M. Dupuytren, on being con- sulted, after antispasmodics and the warm-bath had failed, applied an actual cautery to the region of the diaphragm, and the hiccough immediately ceased ; but perhaps terror operated in no slight degree in this mode of cure. * Darwin, Zoonorn. iv. i. i. 7. t Rigaud, Ergo solvunt Singultwn Vomitus et Sternutatio ? Paris 1601. I Riedlin, Lin. Med. 1695. p. 276. $ Bartholin, Hist Nat. Cent.n. Hist. 4. || Alberti, Diss. Casus Singultus chronici viginti quatuor annorum. Hal. 1743. IT Riedlin, Cent. i. Obs. 15. ** Act. Nat. Cur Vol. v. Obs. 108. tt Tulpius, Lib. iv. cap. 26. Jl Schenck, Lib. in. Obs. 49. ex Fernelio $§ Cent. n. Obs, xxvii. "Ill Eph. Nat. Cur. Dec. in. An. i.Obs. 4« cj.iv.] NERVOUS FUNCTION. [ord. in. 287 SPECIES II. CLONUS STERNUTATIO. SNEEZING. IRRITATION OF THE NOSTRILS, PRODUCING SUDDEN, VIOLENT, AND SONOROUS EXPIRATION THROUGH T11E1K CHANNEL. Sneezing is a convulsive motion of the respiratory muscles, com- Gen. II. monly excited into action by some irritant applied to the inner mem- Pathology." brane of the nose ; in the course of which the air from the lungs is sonorously forced forward in this direction, as the lower jaw is closed at the time. " In sneezing," says Dr. Young, " the soft palate seems to be the valve which, like the glottis in coughing, is suddenly opened, and allows the air to rush on with a greater velocity than it could have acquired without such an obstruction."* It is a common and rarely a severe affection in its ordinary Has some. course. But from the habit which irregular actions of the irritable l™*l b&~ fibres are perpetually apt to assume, as we have already explained, *?rious and particularly in a relaxed and mobile state of them, sneezing has occasionally become a serious complaint. Forestus, Horstius, Lan- cini, and many of the German medical miscellaneous collections, give instances of its having been sometimes both permanent and violent; sometimes periodical; and a few cases wherein it proved fatal; which last termination is confirmed by Morgagni. The Ephe- merides Naturae Curiosorum contain one instance in which the sneezings continued for three hundred times in a single paroxysm. The ordinary irritants operating immediately on the Schneide- Ordinary rian membrane or that which lines the interior of the nostrils, are CHUSes sternutatories, a sharp pungent atmosphere, indurated mucus, the acrimonious fluid secreted in a catarrh or measles, or a morbid sensibdity of the Schneiderian membrane itself. But the severest But when cases have usually been produced by sympathy with some remote usua'ify organ, as an irritable state of the lungs, stomach, or bowels. For ^r0s"mpa- the same reason sneezing often accompanies pregnancy and thy with injuries on the head, and sometimes the last stages of low fevers ; ^ote and and is reported to have proved a sequel to repelled itch. The bene- diseased diction formerly bestowed with so much courtesy on the act of sneez- origin of ing, is said to have been congratulatory on account of its frequent ^j^"'^. violence : but we do not seem to be acquainted with the real origin meriy t>e- t. .1 • ' stowed on Of this CUStOm. sneezing. As sneezing is a symptom of catarrh, if it be repeated for some Tend, ncy time with quick succession in an irritable habit that has been fre- {" c"»efnto quently affected with catarrh, it will sometimes, in the most singu- ^""mor- bid move * Med. Literat. p. 107. 388 cl. iv.] NEUROTICA. Iord. ui. Gen. I. Spec. II. Clonus Sternutatio Sneezing menu for- merly as Bocmted with it. Illustrated Naturally a healthy action, but sometimes trouble- some and severe from habit, and requites removal Remedial treatment in such rases. How to be palliated when the affection is sympa- thetic. lar manner, call sympathetically into action the whole circle of symptoms with which it has formerly been associated, and the patient will seem at oner to be labouring under a very severe cold. An instance of this singular sympathy has occurred to me while writing. The patient is a lady of about fifty years of age, in good health, but of a highly nervous temperament. She began to sneeze from some trifling and transient eause, and having continued to sneeze for five or six times in rapid succession, her eye-lids became swollen, her eyes blood-shot, and full of tears, her nostrils discharged a large quantity of acrid serum, her fauces were swollen and irrita- ble, and a tickling and irrepressible cough completed the chain of morbid action. The sneezing at length ceased, and, within a quar- ter of an hour afterwards the whole tribe of sympathetic symptoms ceased also. Sneezing in its ordinary production, though a convulsive, is a natural and healthy action, intended to throw off instinctively from the delicate membrane of the nostrils, whatever irritable or offensive material may chance to be lodged there. But when it proceeds from a morbid cause, or becomes troublesome from habit, we should use our endeavours to remove it. When the complaint is idiopathic and acute, or, in other words, when the Schneiderian membrane is morbidly sensible, or stung with some irritant material, it may be relieved by copiously sniffing warm water up the nostrils, or throwing it up gently with a syringe, or forcing up pellets of lint moistened with opium dissolved in warm water, the pressure of which is sometimes of as much service as the sedative power ofthe fluid itself. If this do not succeed, leeches or cold epithems should be applied to the nose externally. But a free and spontaneous epistaxis, or herhorrhage from the nostrils, effects the best and speediest cure, of which Kiedlin has given an instruc- tive instance.* It has been prevented from returning by blisters to the temples and behind the ears, and frequently sniffing up cold water in the course of the day. ft has also been attempted to be cured by pungent sternutatories, so that the olfactory nerves may be rendered torpid and even paralyzed by over exertion ; but this has rarely answered : for when once a morbid habit is established, it does not require the primary cause or stimulus for its continuance. When the complaint proceeds from sympathy, the most effectual mean of removing it is by ascertaining the state ofthe remote organ with which it associates, and removing the stimulus that gives rise to it. This, however, cannot always be done; and in such cases camphor in free loses will often prove a good palliative, and if this do not succeed, we must have recourse to opium. * Lin. Med. 1695. p. 148, "iv.' VRRVOUS FUNCTION Lord. m. 289 SPECIES III. CLONUS PALPITATIO. PALPITATION. ^UBSULTORY VIBRATION OF THE HEART OR ARTERIES. Palmus or palpitatio is used in very different senses by differ- Gen. IF. ent writers. By Cullen and Parr it is limited to a vehement and ®"rep"t' irregular motion ofthe heart alone. By Sauvages and Sagar it is hiterpreta- applied to an irregular motion " in the region of the heart." By fe0r"nt<>nod-r> Linneus it is denominated " a subsultory motion of the heart or a "ologists, bowel—cordis viscerisve ;" and by Vogel is defined "a temporary agitation of the heart, a bowel, a muscle, a tendon, or an artery." The first of these views is too contracted, for palpitations or quick Sometimes abnormal beats are felt almost as frequently in many other organs, iwtedV and particularly those of the epigastric region. Yet as in these.it sometime* seems in every instance, however complicated with other symptoms, t0° bw**' -to depend upon a morbid state ofthe heart itself, or of the arteries which supply them, or are in their vicinity, the definitions that ex- tend palpitations to other organs than the heart and arteries, as separate from these, appear to be as much too loose and out of bounds as the first definition is too limited. The view now offered takes a middle course : it contemplates palpitation as dependent on a diseased action of the heart alone, or of the larger arteries alone, or of the one or the other associating with some organ more or less remote : and hence lays a foundation for the three following varieties: x Cordis. Palpitation of the heart. J Arteriosa. Palpitation of the arteries. y Complicata. Complicated or visceral palpi- tation. The vibratory and irregular action, which we denominate palpi- « c. Paip>- tation of the heart, is sometimes sharp and strong, in which d£°cor" case it is called a throbbing of the heart, and sometimes soft Palpitation. and feeble, when it is called a fluttering of this organ. Both may heart. possibly proceed from two distinct causes ; the one a morbid irrita- fluttering?' bility of its muscular fibres, or some sudden stimulus applied to it, Jot!. P"J" either external or internal, by which its systole becomes harsh and two'causes; unpliant, and evinces a tendency to a spastic fixation; and the other f^h'and, an irregular motion ofthe entire organ of the heart in the pericar- Jjjjj,lann,: dium, by which it literally strikes against the chest: the cause of Regular which we do not always know, though we see it very frequently oc- {"^""'f casioned by a sudden and violent emotion of the mind, and have ofthe Vot. IV.—37 ''"'''**' 290 ci. iv.] NEUROTICA. imjft. in Gen. II. Spec. III. n C Falpi- toti.) cor- dis. Palpitation of the heart the peri- cardium: as first pointed out by Or W Hunter Illustrated. Rebound sometimos so strong as to be beard, and agitate the bed clothe*. lias some- times dis- located 01 fractuied the ribs ; and rup- tured its own ven- tricles. reason to believe that it is often a result of the spastic systole or contraction of the heart which we have just noticed. When, how- ever, the substance of the heart is thus irregularly acted upon, and jerked backward and forward from a cause extrinsic to itself, the palpitation is confined to the pericardium, and the pulse does not partake ofthe abnormity. The last is, perhaps, the most common proximate cause of the palpitation of this organ, and we are indebted to Dr. W illiam Hunter for having first pointed it out to us. The heart, in its natural state lies loose and pendulous in the pericardium : and when the blood which it receives is, from an irritation of any kind, thrown with a peculiar jerk into the aorta, the moment it reaches the curvature of this trunk it encounters so strong a resistance as to produce a very powerful rebound in consequence of the aorta being the first point against the spine : the influence of the heart's own action is now, therefore, thrown back upon itself, and this organ, as a result of its being loose and pendulous, is tilted forward against the inside of the chest, between the fifth and sixth ribs on the left.* The rebound of so strong a muscle as the heart against the inside of the chest must depend for its violence upon the violence of the jerk with which the blood is spasmodically thrown into the aorta ; and this has often been so powerful as to be distinctly beard by by-standers.t Castellus has given an example of this sonorous effect: and Mr. Dundas has observed it in various cases. " The action of the heart," says the latter,u is sometimes so very strong as to be dis- tinctly heard, and to agitate the bed the patient is in so violent, that his pulse has been counted by looking at the motions ofthe curtain of the bed."J I have already observed, under the genus paropsis, that the point of a knife when introduced into the cornea, for the ex- traction of a cataract, has occasionally been broken off by a spasm ofthe muscles ofthe eye. And we shall hence hear with less won- der that the heart has sometimes palpitated with a force so violent as to dislocate§ or break the ribs,! for both are stated to have oc- curred on respectable authorities, and, in one instance, to rupture its own ventricles. H Upon the wonderful power ofthe soft parts, or rather ofthe muscles over the bones, when thrown into vehement spasmodic action, we had occasion to observe in the Physiological Proem to the present order : and it is hence that we have sometimes had examples of the humerus, and other long bones, being broken by a convulsion-fit. A contraction of the left aurico-ventricular opening is sometimes found to produce the phenomenon of a double pulse.** I have said that we are not always acquainted with the remote or exciting causes ofthe palpitation ofthe heart. Violent emotion of the mind, as already observed, is a frequent excitement, and one or * See J. Hunter on Blood, p. 146. note. t »C88teil.U!5 b Va!CU8-1 E»rcH.t. ad affectns Thoracis. Tr. ix. Toloso. 1614 4to Lettsom, Med. Soc .Lond. Vol. .. A Vega, De Art. Med. Lib. m. Cap 8 I Trans. Medico-Chirurg. Soc. 1.27. Q Horstii n 137—I'M P it Schenck, Obserr. 215. « Fernelio. 9 137-139. H Portal, Memoires de Paris, 1781. +* Hodgson on the Diseases of \rterie* and Veins. cl. iv.] NERVOUS FUNCTION. [obd.ui. 291 two others have been already indicated.* The first of these is per- sGen',iiii* haps the most frequent cause ; and hence we can readily admit with a c. p'aipi- M. Corvisart that palpitation, together with many other diseases of"*'0001" the heart, have been far more frequent in France, since the com- paipitatioo mericement of its late horrible revolution. M. Portal has, indeed, J^J? proved this fact by various interesting examples; from which the striking following may be selected as it is short. A young lady who had [he first. suddenly learned that her husband had been cruelly murdered by a band of the popular ruffians, was instantly seized with a violent pal- pitation that terminated in a syncope so extreme that she was sup- posed to be dead. This apprehension, however, was erroneous. She recovered ; but the palpitation continued for many years: and she at length died Of water in her chest.* The remote causes are rarely to be discovered till after death, and f*™l\ for the most part seem to consist in a morbid structure of the heart chiefly itself, or the pericardium, by which last the muscular walls of the a°morbid heart have either been obstructed in their play, or have had too much ^"j^,™ of liberty of action. The heart has sometimes been found ossified in Exempli- its general substance, as in the case of Pope Urban the vTHth ; and je more frequently in its valvules or its connexion with the aorta. It has sometimes been thickened and has grown to an enormous size, which change of structure has lately been distinguished by the name of hypertrophy, and has been fouad in one instance of a weight of not less than fourteen pounds.t A case occurred to the present author not long ago in a young lady of fourteen, in whom it reached half this weight, and was the cause of a most distressing palpitation, as well as of a general dropsy. By close confinement and quiet, and the use of elaterium and scarification to carry off the water, she recovered an apparently good share of health ; but the exercise of dancing, a few months afterwards, produced a recurrence of all the symptoms in a more violent and obstinate degree, and she gradually fell a sacrifice to them. In other cases the heart has been peculiarly small and contracted, °lher chiefly, perhaps, in the disease of tabes, or marasmus ; and conse- easionaiiy quently there has not been a sufficient capacity for the regular influx ^ meS of venous blood. The space of the pericardium has often been morbidly diminished by inflammation, or an undue growth of fat; and hence, again, the heart has been impeded in its proper action ; while occasionally it seems to have been filled, or nearly so, with a dropsical fluid. Organic injury from external violence is also a frequent cause of inj^°ic palpitation. Yet it is singular to observe the severity of lesion the £«»«£" heart and its appendages will sometimes yield to, when the constitu- si n wiih- tion is sound, without affecting the life. M. Latour who, during the {^.J^ French war, was first physician to the Grand Duke of Berg, attended E*emPii- a soldier who laboured under a tremendous hemorrhage from the breast, produced by a wound from a musket that had penetrated this * Meraoires sur la Nature et le Traiteraent de plusieurs Maladies. Tom. iv, 8yo. Paris 1819. t Eph. Nat. Cur. Dec. hi. Ann. in. Obs. IP' Mil cl. iv.j .NEUROTICA. [oku. i«t Gem. ii. organ. The hemorrhage, however, ceased on the third day, the ?Fc'CpaiPi- patient's strength gradually recruited, and suppuration proceeded tatiocor- kindly. It was nevertheless necessary to cut several pieces of the r'3, or. fractured rib away ; yet the wound cicatrized at the end of three "!„llt months, and the only inconvenience that remained was a very trou- blesome palpitation of the breast that annoyed him for three years. Six years after the accident he died of a complaint totally uncon- nected with the wound. His body, however, was opened by M. Mausion, chief surgeon of the hospital at Orleans : and the ball which had entered his breast was found lodging in the right ventricle of the heart, covered over in a great measure by the pericardium, and resting on the septum medium * To these causes may be added a scirrhous or other morbid struc- ture ofthe lungs, and, perhaps, of the spleen, liver, stomach, or in- testinal canal; for it is a frequent accompaniment upon most species of parabysma : and in these cases appears as a symptomatic affec- tion alone. For reasons already assigned it is also an. occasional symptom in hydrothorax : during which it shows itself in a very vio- lent degree upon mental agitation, especially that produced by fright or vehement rage. riieroai we should not, however, be hasty in deciding upon any structural misunder- affection of the heart, or of any of the larger organs that closely the°dise*se associate with it, nor in reality upon any incurable cause whatever. recovered For it has not unfrequently happened that a palpitation of long iwMedly!*" standing, and which has been regarded as of a dangerous kind, has gradually gone away of its own accord, and left us altogether in the Exempli- dark. Dr. Cullen gives a confirmation of this remark in thefollow- fui!en!m ing very instructive case : " A gentleman pretty well advanced in life, was frequently attacked with palpitations of his heart, which, by degrees, increased both in frequency and violence, and thus conti- nued for two or three years. As the patient was a man of the pro- fession he was visited by many physicians, who were very unani- mously of opinion that the disease depended upon an organic affec- tion of the heart, and considered it as absolutely incurable. The disease, however, after some years, gradually abated both in its fre- quency and violence, and at length ceased altogether ; and since that time, for the space of seven or eight years, the gentleman has remained in perfect health, without the slightest symptom of his byihe'au- ^rmer complaint"! A case precisely similar, and in a professional thor'sprac- gentleman somewhat beyond the middle of life also, has occurred to the present author, with a spontaneous termination equally as favourable. M. Laennec's ingenious method of mediate auscul- tation !y the stethoscope, as we have already explained, will often be found of great importance in the different forms of this species of disease.| :i'tio*!te-' The Same alternatm? spasmodic motion into which the muscular rfoaa.311 substance of the heart is occasionally thrown by one or other ofthe ruipitation causcs thus glanced at, seems, at times, to take place in some of lie irteri<;8. •" Diet, des Sciences Mi'dicales, Art. Rares. t Mat. Med. Fart. u. Chap. vin. p. 357. I See Vol. in. Cl. in. OH. iv. Gen. in. Si^c. * cu. iv.j NERVOUS FUNCTION. [ord. hi. 2£>3 larger arteries, and extends to a greater or less length in propor- Gen. II. tion to the nature ofthe cause or the extent ofthe morbid irritability ^tTVaipi. by winch they are affected, producing the secoxo varlkty before ""'° "- us That a morbid irritability may exist in a part of an artery while palpitation the m;3< is fee from any such coitduion is easy to be conceived, since ^'eg,ie urte* a like partial irritability is often found to exist in organs in which we Existence r , .. • ■ • : J' topical are capaUle ol tracing it m th< most manliest manner, iet even in irritability arteries themselves we can sometimes ascertain the same to the con- "ia"<"tery , ., eafay to be viction of our senses ; as for example in the case of phlegmonous ionceived inflammation ; in which, also, we find it accompanied with the throb analogous or alternating spasm and relaxation which constitutes what is meant '"cl» by palpitation. In a healthy an.l ordinary flow ofthe blood through times capa- the arteries it is very well known that there is no sensible scries of b|*"f f^\n contraction and dilatations whatever; and we have already observed phiegmo- in the Physiological Proem to he third class that there is no actual flammation. change of bulk of any kind, and that it is the pressure of the finger „^rv flow*1** or of same other substance against the side of an artery that alone oi the blood produces a feeling of pulsation. In phlegmonous inflammation, aneJilsno° however, every one is sensible of a considerable change in this «|temate respect; for there is often a very smart and vibratory pulsation while the'd.arae- the affected part is in perfect freedom, and no finger is applied to |a[t'enr.the it; and that this is a pulsation unconnected witii the regular pulsa- in phieg- tion of the heart is perfectly clear, because it is frequently less uni- n^nnTati™ form, rarely, if ever, synchronous with it, and in most instan-es, ^eh a"e'- twice as rapid. We have here, therefore, a full proof of a local ex- change cess of irritability in an arterial tube, and of a palpitation, or alter- J^he ' nating spasm and relaxation, as its effect. throbbing: Yet inflammation is but one cause of such subsultory action, or not "be da-" of the irritability which gives rise to it. With other causes we are [nve9^r°™ not much acquainted ; but we have reason to believe them very of the numerous, and wherever they exist, the artery operated upon will inflfmrna. evince the same kind of vibratory throb, though, in general, the stroke *jon only will not be found quite so smart as that which takes place in the "»■ this sub- pulse of a phlegmon. It may appear singular that this abnormality action, whether of the heart or arteries, should evince so much punc- others nU- tuality in its vibration; but there is often a wonderful tendency to ^iTaT punctuality in all intermissive affections whatever. We see it in !J,chtj)ve-unc> hemorrhoidal discharges, in gout, and above all, in intermitting tuaiity or fevers: and till the cause of such punctuality is explained in this last faction instance, it will be in vain to expect an explanation in the case whence ' ' derived. before us. In very irritable habits, or, perhaps, where there is a morbid sen- j^j^™ sibdity through the whole of the sanguiferous system, the palpitation shorns from will not unfrequently shoot from one artery to another ; and one or ""^*° two cases are given in the Ephemerides of Natural Curiosities,* in and has o r . , . , , . . been round which it appears to have been universal. It was so, indeed, in the universal. very irritable organization of that singularly constituted character "x™p"fi. .1. J. Rousseau, if we may credit the account he gives of himself in ed jn j j. •station to this subject: for he tells us that, after a peculiar paroxysm - F,ph. Nat. Cur. Dec. i. Ann. vi—vii. 2U4 cl. iv.J NEUROTICA. [ord. m Gen. II. 0f high corporeal excitement, he became, all of a sudden, sensible ?"^"!-" ofa pupation inevcrvpartof his body, which from this time accom- tatio arte- panjed him without intermission : and he adds, somewhat extra- pXitn.tor, vagantlv, that the throbbing was so distinct and strong, that he was of th? often capable of hearing as well as feeling it. MukTtio., The temporal arteries are peculiarly apt to concur in this mgra- or throb- t throbbing, and occasionally the catotid ; and the throbbing ol tonfpor.i both is sometimes synchronous with that of the heart, and sometimes '?d A? successive to it. Mr. Dundas h.is observed that tln> affection of the carotid. carotids is most common to persons in the prune of life; and that, on dissection, the heart is often found enlarged in its size, but with- out any increase of muscular power ; an assertion collaterally sup- ported by the case of the young lady described under the preceding variety. We here also, sometimes meet with polypous concretions, and very generally adhesions to the pericardium. Chain of And it is highly curious and interesting to notice the ramifying tion'of.eT chain of morbid action of which the heart sometimes forms the first singular. nnk. I had lately a lady under rav care, of delicate constitution illustrated. anJ jlig,||y |iervous habit, in the third month of pregnancy, who had for several weeks past been uniformly attacked in the evening with a violent palpitation in the heart, that continued for nearly an hour or upwards ; it was then transferred to the temples, which throbbed with as much violence and for as long a period of time ; vertigo fol- lowed with a tendency to deliqu-um, immediately after which there was a general reaction in the system ; the skin became heated and at first very dry; but the dryness at length yielded to a gentle diapho- resis, which concluded the morbid series; for the patient, at that time becoming tranquil, dropped i;.to a sound an i refreshing sleep, and woke free from all these symptoms in the morning. In this case, also, there was a considerable tendency to that uni- versal subsultus or alternating spasm ofthe arterial system to which we have just adverted : for all the arteries of the extremities pulsated or palpitated whenever accidentally pressed upon by any substance, though it required this additional stimulus to excite the spasmodic action. Palpitation Arterial palpitation, however, is to be found, though not more fre- i^yjlg' quently, still far more alarmingly in the epigastric region than in the gion. head ; and appears to proceed from some particular excitement of the aorta, the superior mesenteric, or some branch of the cceliac Sometime? artery. Its beat has here some resemblance to that of an aneurism lescmbhng Qf these vessels, and has often been pronounced to be such without lisai. the slightest foundation, to the great terror of the patient, and con- iiow dis- sequently to a considerable exacerbation ofthe disease It may, for abie"ll,h' tne most Parti he easily distinguished from an aneurism, by being des- titute of any circumscribed pulsatory tumour, that can be ascertained by a pressure of the finger ; by a smarter vibration in the arterial stroke ; and by that degree ol irregularity in the return of the stroke by which palpitation is distinguished from pulsation. In some cases, indeed, tiie line of the affected artery can be distinctly felt and fol- lowed up to a considerable length ; and the vibration has occasion- ally been so strong as to be visible to the eye, even at some distance, . x. iv.] NERVOUS FUNCTION. [ord. m. 295 when the surface of the epigastric region has been exposed to view. Gen« h« " From agood deal of experience upon this subject," says Dr Baillie, p *' Paipi- " I am enabled to say that the increased pulsation ofthe aorta in the 'a"on'- , r . r tcnosa. epigastric region, very rarely depends upon any disease ofthe aorta Palpitation itself, or of its large branches in that place; and that this occurrence "[teries. is almost constantly of very little importance."* This distinguished illustrated physiologist tells us, further, that he has had an opportunity of exa- Bmiiie. mining the state of the arteries in the epigastric region after death, ^'"icnt'of" in two persons who had this pulsation very strongly marked, and "ty disease who died from other diseases. In both cases all the arteries were ,", the perfectly free from every appearance of diseased structure. He was, aorta- also, some years ago, consulted by an old man upon a paralytic affec- tion ; who afterwards spoke to him incidentally concerning a palpi- tation of the kind before us, to which he had been subject for upwards of twenty-five years. The throb, on examination, was dis- tinctly to be felt; and on the patient's first perceiving it, and apply- ing to Sir Caesar Hawkins, Mr. Bromfield, and Dr. Hunter, the two former had declared it to be an aneurism, while the latter, more modestly, confessed that he did not know whut it was. Dr. Baillie, in the article now alluded to, has imitated the modesty of Dr. Hunter. " It is, perhaps, difficult," says he, "to ascertain, Hence the in many instances, the causes of this increased pulsation ofthe aorta Jj^'u^™ in the epigastric region: but in most cases it will be found to be be;,B'jer" connected with an imperfect digestion, and an irritable constitution." mostly con- And hence, whatever may improve the digestion, and render the dlegpCep"lth constitution less irritable, will be of use in mitigating the complaint: and, above all, it will be found highly serviceable to remove the pa- tient's anxiety on the subject, whenever it can fairly be done. It is Advantage here that M. Laennec's stethoscope may be employed as a valuable t'hoscope?" diagnostic, and will often enable us, better than any other means, to ascertain the real nature ofthe malady ; for an account of which the reader may turn to the remarks on phthisis t But the throbbing or pulsatory motion is often communicated to yo Palpi- other organs than the sanguiferous vessels, and forms that variety of p1I,c£ta!m" affection to which we have given the name of cohi'licated palpi- Cumpii- Tation. This is clearly dependent, in many cases, upon the vicinity i.n-aUon?" or cWse connexion of such organs v. »t!i the heart or arteries that j^,*^ form the seat of disease ; and it may also in other cases be produced, by the as ingeniously conjectured by Dr. Young, by an accumulation of ^h or.0 fluid in the pericardium or thorax, which transmits a pulsatory motion j.*""' ,otha /» p p • heart or from the heart itself to whatever other organ or surface of a cavity ..rge such fluid may reach : in the same manner as the fluctuation pro- "%£&£ ■duced bv a ij- muli of the external senses and of the will seemed necessary to excite ^c.^Spi- the sensorial organ to a secretion of vital fluid sufficient for the mere lfia Com- preservation of life. And hence, during sleep, or as soon as these Comph- stimuli were cut off, there was such an increase of languor, irregular pfta^ttI" action ofthe heart, and sinking, as though in the act of dying, that it was at times necessary, notwithstanding the extreme drowsiness of the patient from a previous and long continued watchfulness, to interrupt the sleep every two minutes ; since by this time or even sooner, the failure ofthe pulse and the appearance of the counte- nance indicated a supervening deliquium. The powers of the sto- mach, from the repeated paroxysms of the disease seem to have de- clined rapidly. Frequent supplies of food and cordials, as spiced wine, appeared at first serviceable in warding off the languor ; but at length nothing but fluids could be taken and retained without increasing the disturbed action of the heart. Yet so extreme was Languor the sense of sinking and immediate dissolution, that, on one occa- anbieP;Pand sion, after a quarter of an hour's sleep, air was importunately de- the most manded, and three glasses of undiluted brandy were drank in five stimulants minutes, without much relief; and afterwards ammonia and ether JJtJieV.ai1" repeated every ten minutes for two hours ; when the paroxysm ra- pidly declined after a copious discharge of limpid urine. The disease continued a twelvemonth before the patient felt, in any essential degree, amended : and little benefit was derived from medicines of any kind. It is well known, however, that this acute pathologist, and excellent man, has since fallen a sacrifice to a return of the complaint. In a disease produced by so great a diversity of causes, often ob- ^°^,ea„eof scure, and very generally complicated with other affections, it is im- treatment. possible to lay down any one plan of treatment that will apply to every case. Our first endeavour should be to ascertain, as far as ^"ation we may be able, whether the palpitation be idiopathic or symptom- where the atic ; and if the last, while we endeavour to palliate the present dis- sympto-8 tress, our attention should chiefly be directed to the primary malady. matic* If acrimony or any other morbid state of the stomach or bowels be suspected, this, as far as possible, should be removed ; and if we have reason to suppose hydrothorax or any other kind of dropsy, the means hereafter to be recommended for this tribe of complaints should be resorted to from the first. In pregnancy, the disease will most probably cease upon a cessation of this state of body, and usually, indeed, ceases during the latter months, or after the period of quick- ening. And if it seem to be chiefly dependent upon a general Treatment- irritability of the sanguiferous system, or ofthe whole constitution, the sedative antispasmodics, tonics, and especially the metallic, quiet of mind as well as of body, regular hours, light, meals, pure air, and such exercise as agrees best with the individual, will often prove of essential service and sometimes effect a radical cure. Much of this plan will also be requisite where we have reason Indication to apprehend some structural affection of the heart or larger blood- where the vessels : and when, from any incidental excitement the irritation is fji'^j" here more than ordinarily troublesome, recourse must be had to nar- or swuc- Vol. IV.-38 ^98 cl. iv.J NEUROTICA. [ord. hi. Gen. II. Spec. III. Clonus Palpitatio Palpitation. Treatment. Disease has sometimes been car- ried off by other complaints. cotics. Opium is by far the best where it agrees with the system : but its secondary effects are often very distressing, and we cannot employ it. In such cases we must find out, by trial, what is its best sticcedaneum : the hop, henbane, hemlock, and prussic acid have all been essayed in their turn, and sometimes one has succeeded where the rest have all failed. But upon the whole the henbane has answered far better and more generally under the author's own hands ; and in one or two instances of great obstinacy he has known it effect a perfect cure when all the rest had been tried in succession and had totally failed. In Dr. Bateman's case, however, which was peculiarly severe and complicated, the henbane, though it seemed serviceable at first, taken in doses of from three to five grains of the extract every night, gradually lost its effect even when repeated three times a night in doses of five grains at a time. The tincture of hop, in doses of thirty drops every six hours, was next tried, but produced no other effect than a slight drowsiness. Musk seemed most successful in draughts of ten grains each ; yet even this was of transient duration, and was abandoned as of no use. Where the palpitation is accompa- nied with a distressing tendency to deliquium I bave occasionally re- lieved it by camphor pills, with the ammoniated tincture of valerian or the aromatic spirit of ether. The disease has occasionally been carried off by a sudden attack of some other complaint, as gout, herpes, diuresis, or the formation of an asbcess ; and hence, setons and issues have been recommended, and have occasionally proved serviceable. Zacutus Lusitanus found the latter produce a radical cure in a palpitation of the heart which he ascribed to the rapid healing of some chronic ulcers.* Schenck advises the wearing a bag of aromatics at the pit of the stomach ;t and hence, perhaps, the origin of camphor-bags as a specific for irregularities ofthe heart of another kind. SPECIES IV CLONUS NICTITATIO. TWINKLING OF THE EYE-LIDS. RAPID AND VIBRATORY MOTION OP THE EYE-LIDS. GEN. n. Spec.IV. Common nictitation a natural action for useful pur poses; especially for the pur- pose of supplying the cornea with mois- ture. To a certain extent, twinkling or winking ofthe eyes is performed every minute without our thinking of it. It is a natural and instinc- tive action for the purpose of cleansing and moistening the eye-ball, and rendering it better fitted for vision. Dr. Darwin has some inge- nious remarks upon this subject. " When the cornea," says he, " becomes too dry it becomes at the same time less transparent, which is owing to the pores of it being then too large ; so that the * Prax. Hist. Lib. vm. Obs. 30. t Lib. u. Obs. 216. cL.iv.J* NERVOUS FUNCTION. [ohd.iii. 299 particles of light are refracted by the edges of each pore instead of Gen. II. passing through it; in the same manner as light is refracted by cu^mIV' passing near the edge of a knife. When these pores are filled with Nictitatio. watery the cornea becomes again transparent."* Moisture is, indeed, a ofthe 'ns frequent cause of transparency in various bodies ; and hence, in ^Vintage dying people whose eye-lids are become torpid and do not nictitate, of such the cornea is sometimes so dry that its want of transparency is visi-sur?y" ble to by-standers. So when white paper is soaked in oil, and illustrated. its pores filled with this fluid from an opake body it becomes transpa- rent, and radiates the light that is thrown upon it : air itself is most transparent when as much moisture is dissolved in it as it will hold ; when void of moisture, indeed, it forms a dry mist, which is occa- sionally met with in the morning, and through which distant objects are seen indistinctly : while, on the contrary, when distant objects are seen with perfect clearness, it is a sign of ruin. In a mist, dis- tant objects are also seen indistinctly ; yet here the moisture is not dissolved in the atmosphere but merely suspended, and formed by the attraction of cohesion into collected spherules. We may hence account for the want of transparency in the air which is seen in tremulous motions over corn-fields on hot summer-days, and over brick kilns, after the flame is extinguished, while the furnace still remains light. It is this dryness and want of transparency in the Blue shade atmosphere over the summits of hot and arid hills, in a bright un- painfinV" clouded sky, as in Italy, whichconstitutes what is called by the paint- what- ers the blue shade of light, and which is copied in most pictures of Italian scenery. The ordinary use of nictitation is therefore obvious : but there are Morbid many persons who wink or twinkle their eyes far more frequently howpro- than is necessary for the purpose of moistening the cornea, and in ^"me„{0;n|y whom it forms an unsightly habit. This has usually been produced by some ' at first by some local irritation, as inflammation or dust in the eyes, tationT which quickens the natural action, and, where the stimulus is consi- derable, renders it irregular and convulsive. If indeed the stimulus *>>" which be very vehement, the nature of the spasm is changed, and the eye- UrTdioses lids, instead of irregularly opening and shutting with great rapidity, f^6^ ri. becomes rigidly closed ; and such is the force with which the orbicu- gid instead lar muscles contract themselves on some occasions that they will sp^m"'0 snap a steel instrument that happens at the time to be introduced be- tween them ; a fact that, as we have already observed, has in one j*n<,khM ff or two instances occurred in performing the operation for extracting ,h° point of a cataract, during which the knife has been broken short off. ^force/' We have seen in many of the preceding species of diseases with Morbid what ease morbid actions are continued when once introduced into h*^11"),"" an organ: and hence when any permanent irritation of the eye has ex- £.*ruead,ha" cited and maintained for some days or weeks a quick repetition of twinkling, this iterative action will often be found to become ha- bitual, and remain after the irritation has subsided. This morbid habit has been sometimes cured by a powerful exer- Jj^^j. »lon ofthe will ; but more generally by using one eye only at a time. * Zo^uom. Cl. i. i. 4. 2. 300 CL. l\.j NEUROTICA. [ord. hi. Gen. ii. and closing the other ; the open eye being employed in examining cu^nus ' an object for a considerable period with great attention and steadiness. ^•ctitatio. a minute examination of the stars at night through a telescope has a ofThe eve- like corrective tendencv and may be employed for the same purpose. SPECIES V. CLONUS SUBSULTUfcv TWITCHES* aGDDEN ASD IRREGULAR SNATCHES OF THE TENDONS. Gen. II. Spec. V, Pathology. Affection most strik- ing in ex- treme stages of debility, affording additional proof of the secre- tion of a motific fluid by the irritative fihres themselves. Why the subsultory motions stronger a3 the frame be- comes weaker. Hence oc- casionally allayed by cordials and anti- spasmodics. These con- vulsive movements sometimes dependent on local debility, and do not interfere This affection is to the tendinous extremities of the muscles, in which the principle of irritation is often apt to accumulate, what palpitation is to the irritative fibres of the heart and arteries ; and hence, as we have already seen, it is included under the general term of palpitation by Vogel. We witness these starts or twitchings most frequently in extreme stages of debility produced by atonic fevers, and especially just be- fore the act of dying. They are, in Such cases, weak convulsions in- terruptedly undulating from one limb or part of a limb to another* too feeble to raise the limb itself, although sufficiently powerful to give slight but transient swellings to the belly of a muscle, and con- sequently a slight involuntary flickering to its tendons. In the ordi- nary close of life they are the precursors of the fatal scene, the har- bingers of the dying struggle, and generally indicate that the will has lost its hold, and the power of sensation is rapidly ceasing: thus affording another proof, if other proofs were wanting, to those adverted to in the Proem to the present Class, that the irritative fihres are ca- pable of secreting their peculiar fluid for themselves, and of main- taining their function, under particular circumstances, for a much later period than the organs of perception and sensation, occasionally, indeed, for some hours after the death of every other part of the body. And as debility and irritability often exhibit a joint march, the subsul- tory motions are apt to become stronger, as the regular motion of the pulse becomes weaker, and at length work up those agonizing convulsions under which the little and loitering flame of life is some- times extinguished instantaneously. Such twitchings of the tendons, however, do not always prove fatal: for they often show themselves where the case is not so extreme: and hence, they may occasionally be allayed by cordials, antispasmodics, and warmer sedatives, and are altogether lost in a favourable turn ofthe disease. It occasionally happens that the debility producing these weak convulsive actions is local and habitual; and in such cases they may be seen to agitate and play over a Jimb without any influence on the system generally, and without much injury to the limb itself. Such a state of nervous constitution may be produced by accident, but it is for the most part strictly idiopathic: and there are few practitioners* cl. iv. | NERVOUS FUNCTION. [ord. hi. 301 perhaps, who have not met with examples of it. Dr. Darwin gives Gen- h- us an instance in the following words : "• A young lady, about eleven e^us V* years old, had for five days had a contraction of one muscle in her :=j,ub.su'tus- fore-arm, and another in her arm, which occurred four or five times general"126' every minute ; the muscles were seen to leap but without bending the inuitrated arm. To counteract this new morbid habit, an issue was placed over the fr?m Dar- convulsed muscle of her arm, and an adhesive plaster wrapped tight like wm a bandage over the whole fore-arm, by which the new motions were im- mediately destroyed, but the means were continued some weeks to prevent a return."* The author has sometimes seen it about one of ^urther. the shoulders, but the extremities are its most usual seat; and he ' was lately consulted by a lady of a strikingly irritable habit, who was suddenly attacked with it in both her hands and feet, so as to throw her into a considerable degree of alarm. Upon inquiring into the patient's age and state of health, he was informed that she was between forty and fifty, that menstruation was on the point of leav- ing her, and had of late apppeared very irregularly, and that she had a considerable oppression in her head. The cause was therefore obvious, and the cure was not difficult: for it yielded to a moderate venesection, and an habitual attention to the state of the bowels. SPECIES VI. CLONUS PANDICULATIO. PANDICULATION. TRANSIENT ELONGATION OF THE EXTENSOR MUSCLES, USUALLY WITH DEEP INSPIRATION AND A SENSE OF LASSITUDE. This is, perhaps, the slightest modification of spasmodic actions, Gen. II. but as it often occurs, as in nausea on the first stage of a febrile v\PhyCt"0 be paroxysm, whether the will consents or not, and is frequently and regarded as irregularly repeated, it cannot but be regarded as belonging to the dic'acUon". present family on many occasions. The muscles chiefly concerned are the extensors of the lower jaw and of the limbs : the particular Oscitancy, „ .. , , ■ , , f. . ,. , . • yawning o. kind of pandiculation to which the first of these movements gives gaping. rise being called oscitancy, yawm^g, or gaping ; and that pro-sketching. duced by the second, stretching The muscles are excited to this E.-.citing peculiar action by a general feeling of restlessness or disquiet; and civuse" the spread of the action from one muscle or set Of muscles to another is from that striking sympathy or tendency to catenate in like movements which we so often behold in different parts of the body without being able to explain. It is possible, however, that the synchronous 'notion of the muscles of the lower jaw and ofthe limbs, for it is rarely that yawning and stretching do not accompany each other, may be dependent upon the same line of intercourse bv * /oonoiria, Catenation, Serf. XVII. i. 8. 302 cl. iv.] NEUROTICA. LOKD- iU Gen. II Spec. VI. Clonj* Pamlicula- tio. Pandicula- tion. Pathology. Natural preponde- rancy of the flexor over the extensor muscles. Shown in the fetus Pandicula tion here exerted to rostote the balance of powir. A like pre- ponderancy after birth. Pandicula- tion again used to restore the balance In all these cases pan- diculation a nntuial action. How far a morbid and convulsive action. which trismus so often accompanies a wound in one of the extre« mities, and which we have already attempted to illustrate ; the irri- tant power, in the one case, leading to a fixt or entastic, and in the other to a transient and clonic spasm. Pandiculation, considered physiologically, is an instinctive exer- tion to recover a balance of power between the extensor and flexor muscles, in cases in which the former have been encroached upon and held in subjection by the latter. A very slight survey of the animal frame will show us that the flexor muscles have, in every part, some preponderancy over the extensors ; and that this preponderancy is perpetually counteracted by the stimulus of the instinct or of the will. We see it, from the first stage of life to the last, and most distinctly in those states in which there is most feebleness, and consequently in which the con- trolling powers are least capable of exercising and maintaining a balance. In the fetus, therefore, in which the weakness is most pressing, the power of instinct is merely rising into cx.-tence, and no habit of counterpoise established in the nascent fabric, every limb, and part of every limb capable of bending, undergoes some degree of flexure, and the entire figure is rolled into a ball, as the hedgehog habitually rolls himself, even after birth. As the Ictus, however, increases in size and age, and the powers of instinct, sen- sation, and volition become more perfect, this general conflexure produces occasionally a sense of uneasiness ; and hence eveiy par- turient mother is sensible of frequent internal movements and stretch- ings of the little limbs of the fetus to take off the uneasiness by restoring some degree of balance to the antagonist powers. After birth, and during wakefulness, the stimulus of the will, directed rather to the extensor than the flexor muscles, renders the counterpoise complete for all the purposes for which it may be necessary. But the moment we repose ourselves in sleep, and the will becomes inac- tive and withdraws its control, the flexor muscles exercise their pre- ponderancy afresh, though in a less degree than in fetal life, since the extensors, from habitual use, have acquired a more than propor- tionate increase of power. The preponderancy, however, when long exerted, still produces some degree of disquiet, and hence, occasionally during sleep, and still more vigorously the moment we begin to awake, we instinctively rouse the extensor muscles into action ; or, in other words, yawn, stretch the limbs, and breathe deeply, to restore the equipoise that has been lost during uncon- sciousness. In all these cases, pandiculation is a natural action ; it is an effect produced by the will when it is called to the particular state «.f these two sets of muscles, or by the instinctive or remedial power of nature, which supplies its place, when it is dormant or inattentive, to restore ease to a disquieted organ. But in an infirm or debditated condition of the system it evinces a morbid and convulsive character, and takes place without our being able to prevent it even when the will uses its utmost effort to resist instead of to encourage it. How far its repetition may be of use in the shivering fit of an ague, or in a nauseating deliquium of the stomach, it is difficult fn ol. iv.] NERVOUS FUNCTION. [oRD. m. 303 say. Yet we are at no loss to account for its frequency of recur- Gen. n. rence: for as the whole system is, in such circumstances, thrown f?EC' V*' into a sudden prostration of strength, the extensor-muscles in conse- pS- quence of being naturally weaker than their antagonists, must become Pa^dicu- soonest exhausted, and give way with a more than ordinary submis- t'on- sion to their power. And hence we behold a painful retraction over oH™»? the whole system, and the preponderancy assumes a rigid and spastic 'account character ; and we may fairly conclude that much of the yawning for- and stretching that ensues is for the purpose of getting rid of the constrictive spasm, though these counteractions themselves often run, in the attempt, into a spasm of another kind, and become convulsive. Yawning and stretching, then, are among the signs of debility and Yawning lassitude. And hence every one who resigns himself ingloriously to feU"™ a life of lassitude and indolence will be sure to catch these motions fashi?n- as a part of that general idleness which he covets. And in this dnigence. manner a natural and useful action is converted into a morbid habit • and there are loungers to be found in the world, who, though in the prime of life, spend their days as well as their nights in a perpetual routine of these convulsive movements over which they have no power ; who cannot rise from the sofa without stretching their limbs, nor open their mouths to answer a plain question without gaping in one's face. The disease is here idiopathic and chronic: it may, perhaps, be cured by a permanent exertion of the will, and ridicule or hard labour wdl generally be found the best remedies for calling the will into action. 304 cl. rv.] NEUROTICA. [ord. ni. GENUS III. SYNCLONUS. SYNCLONIC SPASM. TREMULOUS, SIMULTANEOUS, AND CHBONIC AGITATION OF VARIOUS MUSCLES, ESPECIALLY WHEN EXCITED BY THE WILL. Gen. HI. We have already observed that clonus imports " agitative," or theggener.c "tremulous motion of the muscles;" and hence synclonus means term. necessarily their " multiplied, conjunctive, or compound agitation, or tremulous motion." The term is therefore intended to denote a group of diseases more complicated in form, of more extensive range, or more connected with the general state of the constitution cionici than those of the preceding genus; and it runs parallel with the of'sau- eB cionici universales of Sauvages as far as they can be said correctly vages. to belong to this family. The species included under this genus wdl be found to be the following : 1. SYNCLONUS TREMOR. TREMBLING. 2.---------CHOREA. ST. VITUS'S DANCE. 3. --------- BALLISMUS. SHAKING PALSY. 4.---------RAPHANIA. RAPHANIA. 5.---------BERIBERIA. BARBIERS. SPECIES I. SYNCLONUS TREMOR TREMBLING. SIMPLE TREMULOUS AGITATION OF THE HEAD, LIMBS, OR BOTH ; MOSTLY ON SOME VOLUNTARY EXERTION. Gen. III. The proximate cause of this disease is an irregular secretion or Proximate A°w OI" hritable power into the motory fibres of the muscles that cause. constitute its seat. It is hence strictly a disease of nervous debility, cause's"8 either general or local: debility produced by sudden exhaustion, as in the case of great muscular fatigue from violent exercise, severe cold or a vehement exertion of the passions, and particularly the passions of fear and rage ; or debility produced slowly and insensi- bly by causes of tardy operation, as an injudicious use of mercury. cL.rv.j NERVOUS FUNCTION. [onv.its. *U0 lead, opium or other mineral and narcotic poisons; an habitual Gbk. hi. excess in hard drinking or sexual commerce, and, in some idiosyn- synches' crasies, an immoderate indulgence in tea. And, as this disease is a Tremor. result of debility, it necessarily occurs as a symptom on the general w'hy'a c"fi*- spasm and prostration of strength that so peculiarly distinguish the ^"i'lue'ei! accession of an ague-fit, and the interrupted flow of sensorial power that takes place in paralysis. There are some persons, however, in whom the same convulsive IIat,itoai action exists habitually without any morbid state of any other organs, /o^timeis or any other inroad upon the general health. I once knew a lady, [cme'in- considerably beyond the middle of life, who was strikingly affected cans with- with this complaint, insomuch that the slightest voluntary exertion ""cii'nVr* of any of the muscles threw the head and arms into as great a tre- ^fn""*8' rnor as if they had been hung upon wires, but who enjoyed at the iiiastratsfi. time, and had for a long term of years continued to enjoy, as per- fect health as possible in every other respect; was lively, cheerful, animated, possessed of brilliant powers of conversation, and able to use a more than ordinary portion of exercise without fatigue. The earlier part of her life had been passed in India, but her con- stitution did not appear to have suffered from this circumstance; and so gradual was the attack of the affection, that though she had laboured under it for many years, she could not date its commence- ment from any given point of time. She at length died at the age of ^venty-two or seventy-three, her corporeal powers progressively de- clining, and laying a foundation for a general dropsy, while her mind continued firm to the last. In all cases of this kind the course of the nervous fluid in its pas- fn?*0'9*- sage through the motory fibres of the affected muscles, is morbidly interrupted at every jet, and where the organ or the constitution is in a state of debility, it flows also less abundantly as well as less uni- formly. We have already observed that this fluid, in its natural course, flows only by waves or vibrations, and consequently with an interposing pause or relaxation after every efflux : but that the pause is instantaneous, and the supply so regular as to answer the purpose of a permanent and continuous tenour. In clonic tremor the pauses are, however, prolonged, and for the most part irregular or untrue to themselves ; and the greater the retardation and irregularity the more marked and alarming the spasmodic shake. In the case just adverted to, there was no other diseased action Tremoioo* whatever ; the nervous fluid was unquestionably supplied in sufficient often re- abundance, and the pauses, though prolonged, were uniform ; and it *"!.a0rr*°d was singular to observe the influence the will possessed over the and undW affected muscles under these circumstances, and how completely oAhew'in. they were still under its control: for in consequence of the unifor- f *£mPri* rnity of the morbid interruptions, and from the force of habit, I have seen this patient, in the midst of a shaking that threatened every mo- ment to overturn whatever she took hold of, raise a cup brimful of tea, or a glass brimful of wine to her lips by way of experiment, without spilling a single drop. Where the corporeal health is so little interfered with, as in the present case, a course of medical treatment nrght, perhaps, do moi« Vol. IV.—3? 306 cl. w.] KE OROTIC A. I0**- "*■ Gen. III. Spbc. I. Rynclonus Tremor. Trembling. Where me- ilicil treat- ment may ho of ad- vantage: and of what it ■hould con- sist Balance of easy Weights. Shampoo- ing. FViotions kaphas. mischief than benefit. But where the constitution is generally affected, or the muscles that form the seat of the convulsion are ma- nifestly debilitated, general and local tonics and stimulants may some- times 'be tried with advantage, though they frequently fail of pro- ducing any good effects. Sea-bathing and horse-exercise, a generou? diet, change of air and scene, may be found useful auxiliaries in the general treatment; and long continued and daily friction by a skilful rubber, ammoniacal embrocations, blisters, setons, and a course of voltaism or electricity offer the best promise, as topical means of relief. The affected limbs may also be put into a train of gradual exertion for the purpose of obtaining both strength and steadiness: and to this end the head or shoulders may be occasionally made t« balance an easy weight for a given period of time, and the hand to suspend or carry a wine-glass or tumbler brimful of water. Here also may be recommended the kneading-friction, or sham- pooing of the Egyptians and Turks, which has of late become a fashionable refreshment in the watering-places of our own country, and there can be no question that the pungent and exhilarating essential oils which are applied to and absorbed by the skin after- wards, add considerably to the general efficacy. Something like this the French have long been in the habit of employing under the name of frictions seches* The horse-hair shirts and periodical flagellations of the old Franciscan friars would probably be found to answer the same purpose. But this is a remedy which is not likely to be revived in the present day whether from a medical or a moral call. SPECIES II. SYNCLONUS CHOREA. ST. VITUS'S DANCE. ALTERNATELY TREMULOUS AND JERKING MOTION OF THE FACE, LEGS, AND ARMS, ESPECIALLY WHEN VOLUNTARILY CALLED INTO ACTION ; RESEMBLING THE GRIMACES AND GESTURES OF BUFFOONS ; USUALLY APPEARING BEFORE PUBERTY. modern daw. G-fiti. III. The term chorea from #o?e«, "chorus," " ccetus saltantium," is Spec. II. comparatively of modern date in its application to the present disease, telm'of nor is it easy to determine satisfactorily who earliest employed it. It was first more limitedly denominated chorea sancti viti, under which limitation it occurs in Sydenham, and is still known in popular language, being called in colloquial English, St. Vitus's Dance, and in colloquial French, Dance de St. Guy. According to Horstius the name of St. Vitus's Dance was given to this disease, or, perhaps, more probably to a disease possessing some resemblance to it, in Whence nailed St. Vitus's dance or dance de i*t,Gi>7. * Ardoifin* Esskl sffirl'Usage des Frictions, SwAes, &t. ex. rv.] XRRVOUS FUNCTION. [«,*». j&. 3<3v consequence ofthe cure produced on certain women of disordered 9EW# I,r- mind, upon their paying a visit to the chapel of St. Vitus, near Ulm, syn'cio'nuV" and exercising themselves in dancing from morning to night, or till *:ho'en- . they became exhausted. He adds that the disease returned annually, dance."" and was annually cured by the same means. The marvellous accounts of this dance, as related by old writers, ^nr^t™na"f are amusing from their extravagance. The paroxysm of dancing, the reme- we are told, must be kept up whatever be the length ofthe time, till described? the patient is either cured or killed ; and this, also, whether she be young or old, in a state of virginity or of parturition ; and in the growing energy of the action we are further told that stools, forms, and tables are leape^ over without difficulty if they happen to be in the way. Felix Plater gravely tells us that he knew a woman of j^'" Basle, afflicted with this complaint, who, on one occasion danced sometime* for a month together : * and the writers add generally that it was *en?on!1nf<,r hence necessary to hire musicians to play in rotation, as well as va- without rious strong sturdy companions to dance with the patients till they ceBW"s' could stir neither hand nor foot.t The nearest approach to this kind of gymnastic medicine which I Recent ii- i • • 1 r- i ease ap- am acquainted with in modern times, is a singular case of the same prnachinz disease described by Mr. Wood in the seventh volume of the Medico-t0 "' Chirurgical Transactions. The morbid movements were in mea- sured time, and constituted a sort of regular dance as soon as music was struck up, but ceased instantly upon a change of one time to another, or upon a more rapid roll of the drum, which was the instrument employed on the occasion, than the morbid movements eould keep up with. Advantage was taken of the last part of this very singular influence, and the disease was cured by a perseverance in discordant or too rapid time. This form of the disease appears Taranti*- to have a near relation to the tarantismus of Sauvages, which is the mus" carnevaletto delle donne of Baglivi, all of them probably nothing c.iwWy calls scelotyrbe, literally, "cruris turba or perturbatio,"—"com- mom with motion ofthe leg ;" and his description, which is as follows, is ex- [yi^1"" tremely accurate. " It is a species of atony or paralysis, in which Gaien* a man is incapable of walking straight on, and is turned round to the left, when the right leg is put forward, and to the right, when the left is put forward, or alternately. Sometimes he is incapable of raising the foot, and hence drags it awkwardly as those that are climbing up steep elhTs." One of the best general descriptions which have been given us of chorea, is the following of Dr. Hamilton, contained in his valuable treatise on the utility of purgatives : " Chorea Sancti Viti attacks ^"P1'™ * De Mentis Alienat. Cap. iii. '• ■* Paracef*. PeMffH*. Artwtfittrn. Tract, r. Srttcnc1t»I>e Mtaji^t. "Lib;..-! JUS CL. iv.] NEUROTICA. 0UD. ».i-, ticulation was extreme, and so nearly approaching the antics of a dance. buffoon, that it was often difficult for a spectator to suppress laughter, fe'de#nlpl," Yet in singing and playing he had a perfect command over the mus- cles ofthe larynx and ofthe fingers ; his tones were exquisitely clear and finely modulated; but his neck and head curvetted a little occa- sionally. He died when about sixty years of age, without ever ex- hibiting any debility of intellect. There is a singular form of this disease which has been called by Maiieaiio, to ... . . _ J what. some writers malLeatio, consisting in a convulsive action of one or both hands which strike the knee like a hammer. In this case the hands are usually open, but sometimes clenched. Morgagni* re- lutes a case in which it came on even in the sound hand, if the fin- gers of the affected one were extended If the motion be forcibly stopped, the convulsion becomes afterward stdl more violent and general. Where the system is disposed to hysteria the paroxysm is some- Sometimes times extremely vehement, and partakes of the constitutional diathe- withhys- sis, making an approach to epdepsy, but distinguished from it by a teria" continuance of Consciousness and sensibility. Dr. White, of York, singular has given us a striking example of this mixed affection in a lady for- fhescmlx- ty-two years of age, who " bad always a very weak system of nerves," mJem£ve" and was rendered speechless for an hour or two upon any sudden surprise. In November, he tells us she was affected with a fresh paroxysm, which, upon being sent for, he describes as follows :— '• she complains of a violent pain in the right side of her face, and Description. of universal erratic aches and soreness. There i3 a scorching heat all over the skin, except from the feet up to the ankles, which are as cold as marble. Pulse not quickened but full; mouth dry but no great thirst; body costive, which is indeed her natural habit, so as to oblige her to the frequent use of magnesia. She is regular as to the menses, the return of which she expects in five or six days. Appetite good, rather voracious : but her spirits always low after a full meal, especially dinner. Has a violent pain in the loins, which often shifts from hip to hip: the leg of the aching side being so much affected with stupor and numbness, that she drags it after her in walking. She falters in her speech at times, but this does not continue long. All the muscles of the body evince con- vulsive motions> not simultaneously but successively : thus, her face is first violently affected, then her nose, eye-lids, and whole head, which is thrown forcibly backward, and often twitched from one side to the other with exquisite pain. From this quarter the convulsive action removes first into one arm, and then into the other: after which both legs immediately become convulsed with violent and incessant motions, and in this manner all the external parts of her body are affected by turns. She is all the time perfectly sensible, and knows what limb is going to be attacked next, by a sensation of * De Pedibi*, &e. r. 16. 310 cl. iv.] NEUROTICA. [oav. iu. Gen III. Spec. II. Syiiclniiud Choroa. St. Vitus'* dance. Predispo- nent cause chiefly de- bility of the sto much and its colbti- tious or- gans. Unkindly menstrua- tion an- other pre- disponent An irritahlo tempera- ment a prediepu nont: in which case any local excitement may pro duce the disease. Local ex- citements various. Medical treatment. "First in- tention to destroy the local irri- tation Hence a steady course of biibk r.ur^ng. something running into it from the part already convulsed, which she cannot describe in words: but the foretoken has always been found to be true, though the transition is surprisingly quick. She is easiest in a prone posture. Such, " continues Dr. White, " has been hor situation upwards of forty-eight hours, with scarce a moment's remis- sion, by which she complains of great and universal soreness. No words can convey an adequate idea of her odd appearance : and I do not in the least wonder that in the times of ignorance and superstition, such diseases were ascribed to supernatural causes and the agency of demons."* Even Dr. White himself applies to it, perhaps in imitation of Sauvages, the name of hieronosos. The predisponent cause of this disease is an irritability ofthe ner- vous system, chiefly dependent upon debility, and particularly a de- bility of the stomach and its collatitious organs. Most of the dis- eases of children are seated in this quarter ; and it is from this quar- ter, therefore, that chorea commonly takes its rise, and shows itselr* in an early period of life ; the ordinary occasional causes being bad nursing, innutritious diet, accumulated feces, wormB, or some other intestinal irritant. About the age of puberty there is another kind of general irritation that pervades the system ; and where this change does not take place kindly, which is frequently the case in weakly habits, the irritation assumes a morbid character, and is exacerbated by a congestive state of the vessels that constitute its more immediate seat: and chorea takes its rise from this cause. In effect, where the predisponent cause of an irritable state ofthe nervous system is very active and predominant, a local or temporary excitement of any organ, and almost at any period of life, by in- creasing the irregular flow or disturbed balance ofthe nervous fluid, will give rise to the convulsive movements of chorea : and hence it is that we find it so frequently united with an hysteric diathesis. On this account, it has been produced by a fright,! by a wound penetrating the brain through the orbit of the eye,t. by an improper use of lead, mercury, and some other metals,§ and by suppressed cutaneous eruptions.il From this view of the general nature and origin of the disease, we can be at no loss to account for the great benefit which has been derived from a steady course of brisk purging in recent cases or those of early life : for this, while it carries off the casual acrimony, or unloads the infarcted viscera, seems at the same time to act the part of a revellent, and to prohibit the return of the paroxysm by a new excitement It may appear perhaps strange to those who have not thought upon the subject, that where the disease has proceeded from intestinal irritation, it should be carried off by intestinal irrita- tion also. But the irritations are of very different kinds : and it is so far from following of necessity that, because one kind of irrita- * Edinb. Med. Comment. Vol. iv. p. 526. t Stoll. Rat. Med. Part ill. p. 405. I Geash, Phil. Trans. Vol. mi. 176S. § De Haen. Rat. Med. Part III. p. 202. Werxlf, Naohricbt von dem Kfankenimrtitnt m Erlsngcn, I7W* cl. iv.] NERVOUS FUNCTION. [ob». ux. 311 tion applied to a particular organ excites a particular effect in a re- Gen. HI. mote part, another will do the same, that the converse is more com- 5V**,C' n' monly true, and that any other kind of irritation applied to the same *,}>"n'».UB organ, by exciting a new action, will be the most effectual way of Hance'"88 taking off or preventing such effect. And it is upon this ground tMed'cal, 1 ,l i. c i i • . treatment alone that we often endeavour to cure rabies, trismus, and tetanus, by laying open the original wound to a considerable extent, or the application of some new stimulus that may answer the same pur- pose. The principle being a general one, it does not seem of much con- The par- sequence what purgative is employed, provided it be sufficiently gatilre'of"* powerful: though, where worms are suspected, the essential oil ofno *r*at turpentine, from its being a good anthelmintic, as well as a good taoce: knt cathartic, will be found one of the best. It seems, indeed, to have w»rms arc been occasionally serviceable where worms have not been the cause, suspected for Dr. Powell relates a case in which he completely effected a cure turpentine in a girl of seventeen by a single dose of a fluid ounce :* and hence Pre,erable- its antispasmodic power may at times co-operate with its purgative quality as well as its vermifuge power. Sydenham, who recommended an alternation of bleeding and *****&** purging, probably derived far more advantage from the latter than sued by the former part of his plan : it has been found particularly advanage- myConjunc- ous in the hands of Dr. Hamilton: and Dr. Parr, who ascribes to »'"" «aiay'.ne And on this account miners, and others exposed to the daily ex- halation of metallic vapours, and especially those of mercury, are frequent and severe sufferers ; of which Hornung has adduced many interesting examples from the quarrymen in Camiola.* It has also followed upon worms in the intestines ;t and in this case, has some- times assumed a periodical type.J seat of the The part ofthe nervous organ more immediately affected has. eontlo- a^s°i afforded some ground for controversy. Bonet ascribes it to a verted. diseased state of some portion of the cerebrum, and has given ex- as^Varded amples of its being found, on dissection, to contain, in various quar- by Bonet. ters< proofs of serum, sanies, and other morbid secretions.§ But the misfortune is here, as we have already observed in similar ap- pearances after mania, that it is impossible for us to determine whether these diseased fluids give rise to the disease or the disease • ;orvicai to them, And hence Mr. Parkinson seems to pay no attention to part of the t\iem aj |east as a cause, and fixes the seat of the affection in the apintl mar- ' * . row, as re- cervical part of the spinal marrow, from which he supposes it to l'arktnsun. shoot up by degrees to the medulla oblongata. We have already Uuestion shown sufficiently in the Physiological Proem to the present Class, that the nervous fibres which ramify over the extremities, whether sensific or morbific, originate from the chain of the spinal marrow y and we have also shown, in discussing the diseases of trismus, teta- nus, and lyssa, how acutely one extremity of a chain of any kind, and particularly of a continuous fibrous chain, sympathizes with an- other : and there can be no difficulty, therefore, in conceiving that wherever the cutaneous ends of the nerves of motion are torpified, or otherwise affected by any of the causes just adverted to, the ver- vertebrai tebral column must itself very seriously participate in the mischief, must.apar- and consequently the upper or cervical part of this column : and tkCi|Irle'" tnat norn this point the disease must ramify to the brain before the ' general functions of the system become affected, as in its latter stages. Remedial The remedial process is not very plainly indicated. Vesicatories, v'esic^io- and °ther stimulants applied to the neck or even the dorsal vertebra?, ries. have appeared useful. A seton or caustic, and especially the actual 'oa°uteary. cautery, as practised so generally in France, might possibly be of Active pur- more avad applied to different parts of the spine. Beyond this an game*. active purgative system, as strongly recommended by Riedlin, has Solution 0r certainly been found efficacious ;l! and the solution of arsenic bids irsenic. ag fajr for a favourable result here as in the preceding species. Musk. Stark tried musk, and carried it to very large doses frequently re- peated every day : If but it does not seem to have produced any de- cisive success. r cai Friction of the affected extremities resolutely persevered in by a :inu!ttQtS. * Cista, p. 280. f Commerc. Liter. Nor. 1743. p. 55. { Act. Nat. Cur. Vol. n. Obs. 143. § Sepul. Lib. i. Sect. xiv. Obs. 7. 9. fl Lin. Med. 4695, p. 101. *! Klinieche und Anatomische Bemerknn^r ej.. iv.} NERVOUS FUNCTION, [ord. in. 317 skilful rubber, with stimulant embrocations of camphor or ammonia, Gkn. in. should also be tried in an early stage of the disease, and be alter- f^fon"1' nated with the use of the voltaic trough. Here, too, we may expect B«'iismus. to derive advantage from a free use ol diaphoretic and alterant apo- lS'ns~ zems, as the decoction of the woods, and especially where the dis- ^0'utanc ease is suspected to be of a rheumatic origin :—to which may be Bath added a regular course of bathing in the Bath springs. wa,en SPECIES IV. RAPHANIA. RAPHANIA. SPASTIC CONTRACTION OP THE JOINTS ; WITH TREMBLING AND PERI- ODICAL PAINS. Of this species we know little or nothing in our own country. Gen. ill. It was first described by Linneus, who called it Kaphania, from his ofigm' of ' supposing it fo be produced by eating the seeds of the raphania Ra- *i»ecific phanistrum, a wild raddish or sharlock that grows indigenously in our cause'ofthe native corn-fields as well as in the corn-fields in most parts of Europe. '^4™?™ By other writers, as Hermann and Camerarius, it has been ascribed L-.iii.eM. to the use of darnel or rye* infested with the spur, or ergot, or some s„'ureces other parasitic plant, which we have already observed, is a frequent ursed by cause of other very severe complaints, as mlldew mortification (gan- writers, graena ustalaginea)] and erythematous plague (pestis erythemati- asm^cd'to ca.)| All these diseases, however, are so distinct from each other, the use of that though there can be little doubt of their being severally pro- grain°of duced by some poisonous material contained in the patient's food, the 60Uie kiD'1 poison must be of different kinds, and we do not seem to be acquaint- ed with the cause of this difference ; and hence the question has given rise to much controversy, and been discussed with some warmth on the continent; for, while the greater number of the wri- ters refer the disease to the raphania, or spurred rye (secale cornu- turn,) many deny that it is produced by either of these,§ and Lentin ascribes it to the honey-dew of various plants,!! concerning which we shall have to speak in the fifth volume, under parukia mellita. That it is a vegetable poison, however, seems to be admitted by common consent, and it is possible that the poison is not confined to a single plant. That many poisonous plants have a direct tendency to affect the illustrated. nervous system and excite entastic or clonic spasm, or a mixture of the two according to the peculiarity of the poison itself, or of the * Abhandlung von der Kriebelkrankheit, &c. Cassell, 1775—8. E)e Lall. Lolio temulento. Tubing. 1710. t Vol. in. in loc. X Id- IU Ioc- $ Wichman, Beytrag. zur Geschichte der Kriebelkrankheit. Leips. 1771—?. ' Beobachtungeu einiger Krankheiten, &c. 318 cl. iv.] .NEUROTICA. [olu>. in Gen. III. habit into which it is introduced we have frequently had occasion to Rapha'nia. notice already, and particularly under the head of eruptive sur- Raphania. feit, (colica cibaria efflorescens.)* This is particularly the case with several of the deleterious agarics or funguses, some of which seem to operate chiefly on the sensific nerves, and produce a general stupor ; and others on the motory, and produce palpitations, cramps, or convulsions over the whole system.! It is very probable, there- fore, that the ordinary cause assigned for the present species of dis- ease is the true one. Rothman's There is an excellent paper upon this subject in the Amoenitates inAnttem- AcademicaeJ furnished by Dr. Rothman, a pupil of Linneus, from demic*0*" *vmch ^e disease seems to be not unfrequently epidemical, and always to commence in the autumn. It is found, however, only among the lower orders of people, and in the epidemic referred to, is sufficiently traced to impure admixtures with their grain, and the Supposed employment of this vitiated grain in too new a state. Dr. Rothman early date, delineates the disease from actual observation, and does not believe it to be a new malady, as generally supposed, but thinks he has traced it in the writings of various authors from the year 1596 to 1727; which would establish, moreover, that it has been common to other parts of Europe as well as to Sweden. And in confirmation of this we may observe, that Dr. Mercard§ describes a disease very much resembling raphania that appeared at Stade in the winters of 1771, 177CJ, which was evidently epidemic, and accompanied with symptoms of fatuity, or that narcotic effect which many deleterious plants are sure to produce. Regarded Dr. Cullen who has generalized far too much his description of asa^s'iicdes chorea, in his Practice of Physic, seems to have embodied this spe- of chorea cjes as well as the preceding in the common delineation, and hence, when he tells us that" there have been instances of this disease (cho- rea) appearing as an epidemic in a certain corner of the country,"|| there can be little doubt that he alludes to the species before us origi- nating from the cause now assigned, although, without some such in- terpretation as the present, the passage is not very intelligible. Origin and The disease commences with cold chills and lassitude, pain in the The^f/ease. head, and anxiety about the prascordia. These symptoms are fol- lowed by spasmodic twitchings and afterwards rigid contractions of the limbs or joints, with excruciating pains, often accompanied with fever, coma or delirium, sense of suffocation, and difficulty of articu- Close. lating distinctly. It continues from eleven days to three or four weeks; and those who die generally sink under a diarrhoea or a pa- roxysm of convulsions. Remedial The warm antispasmodics, as valerian, castor, and camphor, ap- pear to have been employed with decisive success. An emetic, however, given at the onset of the symptoms, as recommended by Henman, would probably cut short the course of the disease, and mitigate its violence. This writer advises also blistering or bathing * Vol. i. p-171. t See Heberden, Med. Trans, u. 218 X Tom. vi. Art. cxxui. 1763. o Medicinische Versnche. Zweyter Theile, 8vo. Leipzig. n Part u. Book in. Chap. iii. mcccuii. cl. rv.] NERVOUS FUNCTION. [ord. m. 319 with Dippell's Animal Oil.* Camphorated vinegar, as employed Gen- ra> by other practitioners, would probably be found a more useful em- IX'ni^" brOCatlOn.f Raphaniai Towards the close of the disease purple exanthems or vesications are said to be sometimes thrown out, which approximate it to mil- dew-mortification, and the erythematic pestis, both which, as we have already observed, have been traced to a similar cause. SPECIES V. SYNCLONUS BERIBERIA. BERIBERY. BARBIERS. SPASMODIC RIGIDITY OF THE LOWER LIMBS IMPEDING LOCOMOTION ; OFTEN SHOOTING TO THE CHEST, AND OBSTRUCTING THE RESPIRA- TION AND THE VOICE : TREMBLING AND PAINFUL STUPOR OF THE EXTREMITIES ; GENERAL EDEMATOUS INTUMESCENCE. Bontius seems first to have introduced the term beribebi or be- <*en. ™« riberia into medical nomenclature, and tells us it is of oriental origin: J origin 'of and Sauvages has hence copied it. into his list of " nomina barbara, seneric seu nee Graeca, nee Latina." Mangetus affirms that the disease HowV was known to Erasistratus, but certainly not under this name. Eus- §"ud™geb* < tathius, however, has freGtet, but in the sense of "concha or ostre- Siid t0 urn," "conch or shell,"—and tells us that it is a term of Indian JISownT origin. He might have said, with more propriety, of oriental origin, bbnet ^***' for it is common both in its primary and duplicate form, -12 or joj, under"this •Wia or er-u-o to the Hebrew, Chaldee, Syriac, and Arabic, in tnhae7UBae8d which last h is (berabir,) and in all of them is a nomadic term, import- Ae.word in ing tillage and its production which is grain, or pasturage, and its "ense"6"1 production which is sheep, or other cattle ; and hence, probably, the T^}y of origin of brebis or sheep in the French tongue. The term is said to oriental be applied to this disease in India from the patient's exhibiting, in anfeora- walking, the weak and tottering step of a sheep that has been over- n,onto j • * most orten* uriven. tal tongues. This disease, though common to various parts of India, is chiefly KJmon met with on the Malabar coast and in Ceylon: and seems to be oT the produced by sudden transitions of the atmosphere from dry to damp, brebis!1 and from sultry calms to chilling breezes, by which the nervous and JJj?^se absorbent systems are peculiarly debilitated and torpified. In this ft>uody0n region it attacks both natives and strangers, but particularly the latter Dar wait" during the rainy season, which commences in November and termi- "nd.in nates in March ; through a great part of which, also, the land-winds cll°e"i blow from the neighbouring mountains every morning about sun-rise * Abhandl. von der Kriebelkrankheit. t Nachricht. von der Kriebelkrankheit. t De Medicina Indonrai. Cap. i. 320 cl. iv.] NEUROTICA. l0BD- Spec.1"' with ?reat c°o1ness ; and hence those who sleep abroad, or without Byncioiius' sufficient shelter, are equally exposed to the influence of a penetrating Bribery*" chi11 and damP« Barbiera.' Fresh troops, partly from their being new to the climate, but Soo8phs chiefly from their want of a sufficient degree of caution, very fre- principaiiy quently suffer severely from this complaint so long as the rainy season Exempli- continues. Thus we learn from Mr. Christie that the 72d regiment fled- was severely attarked with it in the autumn of 1797, not many months after its arrival, and continued to suffer from it till the en- suing spring; and that the 80th regiment, which relieved the 72d in March 1797, was equally attacked with it in the ensuing Novem- nentB.8P° Der- ^ 'si however, in all such cases most frequently to be found among those who have previously weakened their constitutions by sedentary habits or a li'e of debauchery • and particularly where too free an indulgence in spirits has co-operated with sedentary habits, as among the tailors and shoemakers of a battalion : who, in order to give them time to work at their respective trades, are often ex- cused from the duties ofthe field, and by their double earnings, are enabled to procure a larger quantity of spirits than other men. And we may he-i^e in souk degree account for Mr. Christie's remark that, during his stay at Ceylon, he never met with an instance of this complaint in a woman, an officer, or a boy under twenty. History The disease commences with a lassitude and painful numbness of greasiif the the whole body, the pain sometimes resembling that of formication. disease. The legs and thighs become stiff, the knees are spasmodically re- tracted, so that the legs are straightened with great difficulty and instantly relapse into the retracted state, whence the patient is apt to fall if he attempt to walk. In some cases, indeed, the motory and sensific power, instead of flowing through the muscles of loco- motion irregularly, does not flow at all, and the limbs become para- lytic. And even where the spasmodic action exists, it often travels or extends to other parts of the body, and particularly to the chest and the larynx, so that speaking and respiration are conducted with great difficulty. At the same time the whole of the absorbent system exhibits equal proofs of torpitude, the legs first, and afterwards the entire surface of the body becomes bloated and edematous, and all the cavities, particularly those of the chest, are progressively loaded with fluid: and hence towards the close of the disease, where it terminates fatally, the dyspncea is extreme, and accompanied with an intolerable restlessness and anxiety, and constant vomiting ; the muscles are convulsed generally ; while the pulse gradually sinks, the counte- nance becomes livid, and the extremities cold. Sometimes Such is the course of the disease as it shows itself at Ceylon, BevereUanu where it seems to rage more severely than on the Malabar coast, »pid. and where we are told by Mr. Christie, inspector-general of the hospitals at this station, whose account is confirmed by Mr. Colhoun,* that its progress is so rapid that the patient is often carried off in six, * Essay on the Diseases incident to Indian Seamen or Lascars on lona Vovases * hyW. Hunter, A. M. &c. * j-w ' Lord Valentia's Travels, Vol. i. p. 31». cl. iv.] NERVOUS FUNCTION. [ord. hi. 321 twelve, twenty-four, or thirty-six hours from its onset, though it gen. III. ordinarily runs on for several weeks. s^nfion V" Since the first edition of the present work, various important Ser.^e'ia- communications have been made to the Army Medical Board upon Barbie's." the subject before us. These, by the kindness of my eminent friend £3^. the Director-General, I have been enabled to examine, and they cations concur in supporting the general character of the disorder as given A°myMe- above ; as they do also in affirming that neither women, officers, nor B*™' persons under twenty years of age become the subjects of beribery ; confirming evidently because such individuals are rarely called upon to expose J^ngac- themselves at night, or to sleep in the open air. count. From the complicated nature of the disease however, and the Bribery variety of organs that are linked in the general chain of morbid action, sC^cted8 suggestions have often occurred, whether beribery be not rather a^cea£0m°"t- modification of some other malady than an idiopathic affection ; and -ome other especially whether it be not. a peculiar form of anasarca deflected especially from its common course by accidental circumstances. The last is ol ana- more especially the opinion of Mr. C.ollier, a staff-surgeon of consi Collier's derable talents and authority ; and to the same opinion I find Dr. Dp^ye0„'B, Dwyer inclining, physician to the forces at Kandyin Ceylon. Yet, after having, in his manuscript report, which is a very valuable docu ment, called it incidentally by the name of acute anasarca, he tells us that from the great diversity of its symptoms, many cases have been referred to apoplexy, carditis, aneurism, gastritis, which were purely examples of beribery. And he then proceeds as follows : " although allied in many of the symptoms to dropsical affections IT IS TO BE CONSIDERED DISTINCT ROTH IN SYMPTOMS AND TREAT- MENT." And to the same effect, a very able inspector of hospitals Farreiiv, in the same quarter, Dr. Farrell, who observes as follows: " I cannot help thinking still, notwithstanding the weight of his (Mr. Collier's) authority, that the affection commonly called beri-beri is a disease of exhaustion and debility, occurring chiefly in persons of intemperate habits, and labouring under other maladies." In effect it is not only a disease of exhaustion and debility, but of these properties pe- culiarly applied to the nervous system ; the dropsical and apoplectic symptoms only taking place secondarily, and as a result of the gene- ral weakness. "The more prominent symptoms," observes Dr. Description DvVyer, in the manuscript report just alluded to, " were numbness by Dwyer- ofthe extremities, muscular power greatly impaired, walking attended with a considerable degree of unsteadiness, pain, tottering and weak- ness of the joints ; such instability of gait as resembles a person Walking on his heels ; sometimes paralysis. In the latter stages of the disease, when the thorax becomes affected, increased uneasiness of the epigastrium and vomiting succeed; dyspnoea and all the symptoms of hydrothorax." At times the spasmodic action spreads, even from the first to spasmodic other organs than the limbs, and produces a very striking effect. A times very sergeant of the 45th regiment, of sober habits, who seems to have ^kingi* nearly recovered from two previous attacks at Kandy about a year illustrate?, before, and had left the hospital, was suddenly seized, April I, 1822, with " an extreme difficulty of breathing-, inabilitv to walk or speak Vol. IV—11 remurks on the case tf:W ll, i\.j NEUROTICA. juuo. i«- gen. III. ,nach. The muscles of the forehead, face and nose wore in motion synfionul' at the exertion made to speak or breathe. The corrugations of the Boriberia. jitter gave a sharpness of countenance very peculiar, but indicative Bate.' of great distress and anxiety. The countenance soon became livid; the pulsations of the heart were loud and fluttering; its strokes against the side could not be distinctly counted. He was bled two pounds without much relief. The appearance of this poor man was very affecting. The blood drawn was sizy ; and, upon re-opening a vein from a large orifice, he again bled freely ; but becoming ex- hausted, it was thought prudent to stop it again. His legs were much swelled, and pitted on pressure. They were covered with small livid spots, as well as other parts of his body, like flea-bites, but much larger. He died in half an hour afterwards. The thigha and abdomen were but little swelled in proportion to his legs, but evidently larger than natural. His arms were emaciated, and no part edematous. He appeared of stout make." Gmcrai The intumescence of the legs seems to have been a result of debi- lity from the two prior attacks : but it was nevertheless expected that most of the cavities of the body would have given proof of an hydropic affection ; and 1 have selected this case as one of the strongest in support of such an opinion; for, in general, though water is traced, sometimes in one cavity and sometimes in another, yet there is seldom much accumulation, and still more seldom such as to produce oppression. Dr. Dwyer took a minute of sixteen cases, and his remark upon the whole of these is " water is usually found in some of the cavities, but the organs vary:" and such an observation is alone sufficient to take beribery out of the list of proper dropsies, whatever other place we may assign to it. iw-obit An early post-obit examination, however, of the case before us examina- s]lovvCH( as follows : " About an ounce of serous straw-coloured fluid escaped in various ways, on opening the dura mater. Filling up the gyri on the surface of the brain, we observed a gelatinous trans- parent matter of some tenacity and consistence : it looked like a coat- ing of isinglass. In the ventricles there was but very little fluid: in no other part of the cranium were indications of pre-existing disease observed/' In the thorax there were various adhesions, especially within the pericardium ; on opening which seven ounces of a straw- coloured serum was found in it, yet warm. No fluid in the thoracic cavity.—In the abdomen there were few morbid appearances, ex- cept in regard to the spleen, which was as large as an ordinary sized liver, and weighed three pounds ten ounces. The liver of its usual «ize, but had a mottled appearance. Only eleven ounces of serous or dropsical fluid were found in this cavity. curative The curative intention is to re-excite the absorbent system and I't^phoi"'- tl,e afibcted branches of the nerves to" a discharge of their propel 'wrnu. iullctions hy a process of diaphoretics and stimulants. Squill pill* and calomel are chiefly depended on for the latter, and James'ti powder for the former, though the compound powder of ipecacuan Seems better calculated for the purpose, as containing a sedative admirably adapted for allaying nervous irregularities. *:*mi-i.ath. On the Malabar coa.-t. it is no uncommon practice to excite per- I *• ofthe present class, but the subject is of great extent and complexity, and cannot be followed up into any detailed explanation in a work on pathology. At present, therefore, I can only observe that Natural natural sleep is a natural torpitude of the voluntary organs ofandho^*1' the animal frame, produced by a general exhaustion of sensorial Produc°d. power in consequence of an exposure to the common stimulants or exertions of the day. And hence, if such exhaustion do not take place, natural sleep cannot possibly ensue, though morbid sleep undoubtedly may as produced by other causes. Now it often happens that, from an energetic bent of the mind to How pre- a particular subject, the sensorial power continues to be secreted vcnted" not only in a more than usual quantity, but for a more than usual term of time ; and, in consequence of this additional supply, there iJ26 cl. iv.] NEUROTICA. [oRD, IV. Gem. I. Spec. I. Agrypnia excitata. Irritative wakeful- ness. Singular examples of protract- ed sleep- lessness. Occasional approxima- tion to apheixia intenta, or mental ab- straction. Medical treatment. is no exhaustion at the ordinary period, and therefore no sic p. Severe grief is often a stimulus of this kind ; during which a morbid redundancy of sensorial power continues to be secreted, followed by a morbid excitement of the system generally from day to day, and from night to night, till the frame is worn out by the protracted watchfulness or sensorial erethism. And it is astonishing to witness in various instances how long the frame will support itself before it is worn out, or the irritation that prevents sleep sufficiently subsides for its return, and particularly where the mind is labouring under the influence of the depressing passions, or of depressing pain. A hemicrania has kept a person awake for three months;* and a melancholy or gloom on the spirits, for fourteen months. Overwhelm- ing joy has often a similar effect though seldom in an equal degree, or for so long a period of time. The mind may also be intensely directed to some peculiar object of study, and the energy of the will becomes in this case a like stimulus to the secretion of a fresh or protracted tide of sensorial power, so that the usual exhaustion of the nervous system does not take place at the accustomed period. This is peculiarly the case in a pursuit of the abstract sciences, Or those of a more strictly intellectual nature, as the higher branches of the mathematics. Where the determination of the mind to a particular subject is exquisitely intense, whether that subject be a passion or a problem, by far the greater part of the sensorial secretion is expended at this particular outlet; and, consequently, the frame at large, with the exception of those organs to which such outlet peculiarly appertains, is so far drawn upon, as a common bank, for a contribution of sen- sorial power, that it labours under a certain degree of deficiency, and hence a certain degree of torpitude, so as to become insensible to the world around it; making, in this respect, an approach to the state of mind we have already described under the name of aphelxia intenta, or mental abstraction. The cure of this species of sleeplessness is to be accomplished by allaying the mental excitement by which it is produced. This is best done hy recalling the mind from the pursuit that leads it astray, and a free surrender of the will to listlessness and quiet. The per- turbation will then subside; the sensorial organs become tranquil- lized and inactive ; the secreted tide of sensorial power will be at its ebb, and the habit of refreshing slumber resume its influence. But where, this cannot be obtained by the mere exercise of the will, we must call opium or some other narcotic to our aid, which, by its revellent stimulus, may coincide with the consent of the will, and produce the exhaustion, and, consequently, the quiet that is requisite for sleep. *■ Bartholin. Hist. Anat. Cent. i. Hist. 64. Schenck. J Ah. I. Obs. 256. cl. iv.J NERVOUS FUNCTION, [ord. iv. 327 SPECIES II. AGRYPNIA PERTHES A. CHRONIC WAKEFULNESS. ■VLEEP RETARDED BY BODILY DISQUIET ; ATTENTION ALIVE TO SUR- ROUNDING OBJECTS. The exhaustion in which the very essence of natural sleep con- Gen. L sists supposes a perfect quiescence and inactivity of the sensorial closes. powers. Uneasiness of any kind will become an obstacle ; and hence, an aching coldness of the extremities or of any other part will prevent it; an uneasy sensation at the stomach or any other part will prevent it; an absence of the common pleasurable feeling with which we ordinarily prepare ourselves for sleep will prevent it: "And, on this account,1' as Darwin observes, "if those, who are accustomed to wine at night, take tea instead, they cannot sleep." And the same evil happens from a want of solid food for supper to those who are accustomed to use it; as, in these cases, there is an irksome or dissatisfied feeling in the stomach. And hence, also, too great an anxiety or desire to sleep, is another cause of its suspen- sion ; for this as a mental disquiet will only add to the corporeal dis- quiet which has produced it; and, as already observed, the emotions of the mind must be as quiescent as those of the body, and the will, instead of commanding or interfering, must tranquilly resign itself to the general intention. Where uneasiness of this kind has been permitted to continue for How con- several nights in succession, the sleeplessness it apt to become chronic chronic and to be converted into a habit. We have hence had ex- ^"f"'" amples, as noticed with their appropriate references in the volume of very' ]ov> Nosology, in which vigilance or sleeplessness has continued for a month peno s' without intermission ;* for six months ;] and even for three years.J Mr. Gooch gives us a singular case of a man who never slept, and foJ" t^ yet enjoyed a very good state of health till his death, which happened in the seventy-third year of his age. He had a kind of dozing for about a quarter of an hour once a day, but even that was not sound, though it was all the slumber he was ever known to take.§ The cure of this disease demands a particular attention to its Medical cause ; for if we can get rid of the organic disquiet on which ittieatmcnt depends, we shall be pretty sure to succeed in obtaining our object. All irksome chills, and especially those of the feet, should be taken off by a sufficient warmth of clothing; and the habitual supper, or Habitun; other indulgence which has hitherto preceded and introduced sleep, j."^"'^. should be freely allowed. + Grilling, Cent. iv. Obs. 90. | Panarol, Pentecost, v. Obs. 4. I Plinii Lib. v. vii. Cap. 51. § Medical and Chirurgical Observations, &c. 8vo. I ^ 31b Gen. I. Spec. II. Agrypnia jiertaesa. Chronic wakeful- ness. Treatment Soothing music, and agreeable reading. Hop-bags Pedilu- vium. Gentle friction. CL. IV.j NEUROTICA. [ORD. IV The lulling sounds of soft and agreeable music, or agreeable reading, have been tried as concomitants, and not unfrequently witn success. And narcotic aromas have at time^ been had recourse to, especially that of the hop, heaped into pillows ; but so far as 1 have seen, and I have once or twice witnessed the experiment, with as little efficacy, as the pillows of the male fern in casta of rickets, which were once, according to Van Swieten,in equal estimation for this last complaint. A pediluvium as recommended by Lang,* will often be found a much better prescription, or any means which will excite that breathing moisture, which is indicative of general ease. Soft, gentle, and general friction, and especially where there is any chill or rigidity upon the limbs, will frequently produce the same effect in a very agreeable way : and this, too, without combining it with the external use of opiates as proposed by De la Prada,t and Mosch. Mosch was the favourite medicine of Thilenius,§ and hyoscyamus mus. of Stoerck.ii But a free and exhilarating glass of wine, as proposed Hypnotic DV Fordyce, will often answer much better than either of them. In powers of many cases of disquiet, and particularly in the stomach and prae- sneg. cordia, it might be well to try the hypnotic powers of the nut- meg, as warmly recommended by Dr. Cullen. We have already noticed this reputed effect in the East Indies which Bontius confirm- ed from his own experience, and which has since been confirmed by practitioners in Fnrope. And when taken in a large dose there can be little doubt of its somnolent vn iiu In the case recited by Dr. Cullen in proof of this, the person had swallowed more than two drachms by mistake, and the effect was a drowsiness com- mencing an hour afterwards which gradually increased to a complete stupor and insensibility. After this he was delirious, and continued to be alternately stupid and delirious for several hours : but in six hours from the attack he was pretty well recovered from every symptom.1T Where, however, the morbid habit is too rigidly established to give way to any of these means, we must forcibly break through it by the use of opium, till the habit itself be overcome, when all nar- cotics should be gradually omitted. The wakefulness so common to old people is hardly a disease. They use but little exertion, and hence require but little sleep ; and the internal inactivity is upon a par with the external.. A third part of the vessels perhaps that took a share in the general energy in the middle of life is obliterated, and -the wear and tear of those that re- main are much less. The pulse beats feebiy ; the muscles of respi- ration are less forcibly distended ; the stomach digests a smaller portion of food, for only a smaller portion is required ; the in- tellect is less active ; the corporeal senses less lively, and a minuter quantity of nervous fluid secreted by the brain "and its depen- * Epist xlv. f Journ. de Medicine, Tom. xxxvi. J Ansert. Abhandl. B. i. iv. St. 45. § Medicinische und Chiiurgischc Bemerkungen, &c- [i l.ibellulus quo continuantnr Experimenta, &c, ^ Mat. Med. Part n, Ch. v. Opium. Wakeful- ness of old people not strictly a disease. cl. iv.] NEKVOUS FUNCTION. |ord. iv. 329 dencies. And hence, though there is far more weakness than in Gen> !• earlier life there is a less proportionate demand for exertion, and Agrypnia11' consequently a far smaller necessity for sleep. pertaesa. From such a line of reasoning we may see why sleeplessness wakXi- should be found as a symptom in excessive fatigue, violent pain of rhysioioffy any kind, inflammation, fevers, and various affections of the brain, of this stale. Sympto- matic _^________ wakeful- GENUS II DYSPHORIA. RESTLESSNESS. TROUBLESOME AND RESTLESS UNEASINESS OFTHE MUSCLES ; INCREASE!* SENSIBILITY ; INABILITY OF FIXING THE ATTENTION. This is the inquietudo of many authors, which the Greeks express- Gen. II. ed by the generic term now chosen, importing, literally, " tolerandi synonyms- difficultas," u a difficulty of enduring oneself." It does not expressly enter into the classification of Sauvages or that of Cullen, but is nearly synonymous with the anxietas of the former, which in the pre- sent system becomes a species of this genus. "Molesta sensatio," says Sauvages, " quae ad jactitationem cogit, sed quomodo ab affinibus morbis discrepet, dicant qui experti sunt." The genus embraces two species, as exhibiting restlessness or in- quietude chiefly confined to the sensific or the irritable fibres ; or as dependent upon the state ofthe mind. 1. DYSPHORIA SIMPLEX. FIDGETS. 2.---------ANXIETAS. ANXIETY. SPECIES I. DYSPHORIA SIMPLEX FIDGETS. RESTLESSNESS GENERAL, AND ACCOMPANIED WITH A PERPETUAL DE- SIRE OF CHANGING THE POSITION. This is what we mean by the English colloquial term Fidgets, **E£# H- from fidgety, most probably a corruption offugitive, though the lexi- origin of" cographers have given us no origin of the term. Both import ^^^ restlessness, unsteadiness, and perpetual change of place. The synonym* proper Latin term is titubatio; and, indeed, most languages have some peculiar term to express this troublesome and irritable sensa- Voi. IV.— 42 330 cl. iv. j NEUROTICA [OKD- IV. Gen. H. Spec. I. Dysphoria simplex. Fidgets. Cause. Illustration. ('ori firmed from Dar- win. Further illustrated How far morbid affection. Exciting jttuses. Remedial treatment. tion, though it has been rarely introduced a» a disease into the noso- logical catalogue. , . <• Tlic actual cause seems to consist in an undue accumulation sensorial power, which seeks an outlet, so to speak, at every pore, for want ol a proper channel of expenditure. Thus every one becomes fido-ety who is obliged to sit motionless beneath a long-drawn and tedious story of common-place facts totally destitute of interest : and still more so when he is eagerly waiting, and fully bottled up, as it were, to reply to an argument loaded with sophisms, absurdities, or untruths, and over which he feels to have a complete mastery.— So the high-mettled horse is fidgety that, called out, in full capari- son, and still restrained in his career, is panting for the race or the battle. " So the squirrel, when confined in a cage, feels," as Dr. Darwin has ingeniously observed on this disease, which he calls jac- titatio," a restless uneasiness from the accumulation of irritative povyer in his muscles, which were before in continual and violent exertion from his habit of life, and in this situation finds relief by perpetually jumping about his cage to expend a part of his redundant energy. For the same reason children that are constrained to sit in the same place at school for hours together, are liable to acquire a habit of play- ing with some of the muscles of their face, or hands, or feet in irrc gular movements which are called tricks, to exhaust a part of the accumulated irritability by which they are goaded." In the two last instances this irritability is simply accumulated for want of a proper outlet, and not from inordinate secretion. In the two preceding cases of the restrained horse and the restrained ora- tor, there is added to this simple accumulation, for want of disburse- ment, an accumulation also from inordinate excitement. i It is this last source alone that can give the present affection any thing of a morbid character : and in irritable temperaments this if. often the case: for there is a diseased excess of sensorial power se- creted constitutionally, which is apt, on various occasions, to show itself by a perpetual restlessness or jactitation as troublesome to those who are ofthe company, as to those who are afflicted with it. Paulini* observes that worms, and Lentinj that atony alone, is a cause ; and hundreds of other sources of irksome irritation may be added to these ; one of the most common of which is an obstinate and unconquerable itching like that of prurigo senilis, and especially in a part of the body that we cannot conveniently get at to scratch : and hence ascarides in the rectum or pudendum, into which last organ they have sometimes been found to creep, is a most distressing, and, in some cases, a maddening cause. A course of cooling purgatives, warm bathing, or increased exer- cise, will probably be found most serviceable in this harassing com- plaint,- with an attention to the primary disease where it is sympathetic * Lanx. Sat. Dec. n. Obs. 10. + lleobacht. der Epidemischen Krankheiten. (•. 47. cl. iv.] NERVOUS FUNCTION, [OR1>. n-. ^j SPECIES II. DYSPHORIA ANXIETAS. ANXIETY. THE RESTLESSNESS CHIEFLY AFFECTING THE PR^ECORDIA ; WITH DEPRESSION OF SPIRITS AND A PERPETUAL DESIRE OF LOCOMOTION. This species, in persons of an irritable or highly nervous tempera- Gen. II., ment. and especially among those inclined to hysteria or hypochon- ®^r0, IL driacal symptoms, is occasionally to be met with as an idiopathic WiopaThte affection, to which such a temperament gives a peculiar predisposition. SfK^Sip- But we see it more frequently as a feature in the first attack of fevers, u'm~^- in nausea, in various affections of the prsecordia, and most powerfully and most distressingly in lyssa or canine madness. It has been ascribed Cause*. to the want of a free passage for the blood through the heart, in con- sequence of a polypous concretion or some other obstruction; to a simi- lar difficulty of its passage through the lungs ; and to a constriction ofthe vena porta?, producing a like impediment in the lower belly : and the anxiety has been denominated praecordial, pulmonary, or epigastric, according to the part affected, which, however, we cannot always trace out. The complaint is particularly noticed by Hip- Aiysmus oi pocrates, who distinguishes it by the name of aiysmus (*Av«-^?0 Iite" craPteT rally restlessness or inquietude. It has sometimes, and especially in persons of an acutely irritable Sometimes habit, been accompanied with great excitement of the nervous sys- nie^with tem generally, and spasmodic action of some or even all the mus- sreat ex- cles, displaying, according to the idiosyncrasy, the symptoms of chorea, the^rvou" hypochondrias, or lyssa: and has occasionally, as I have reason to I^Siy. believe, been mistaken for lyssa, where the morbid mind has pored incessantly on the recollection of some former scratch or bite of a dog or cat: and, like lyssa, it has sometimes terminated fatally, though by no means with a like rapidity. Where the affection is idiopathic, an emetic will be generally found to Medical produce the readiest assistance: after this, the warmer antispasmodics,treatmen, and, if necessary, narcotics may be successfully employed, with gentle exercise and a light diet. 332 cl. iv. | NEUROTICA. ^0Rl>• rr' GENUS III. ANTIPATHIA. ANTIPATHY. INTERNAL HORROR AT THE PRESENCE OF PARTICULAR OBJECTS OR SUBJECTS ; WITH GREAT RESTLESSNESS OR DELiaUIUM. Gen. III. Antipathia {xtrmxfag, from xvriwxieu, " naturalem repugnantiam gelfe'rlc0' habeo,") does not occur in Swediaur or in Dr. Cuiien's classifica- How far ^on' ^ut enters ^nto his supplementary catalogue, " Morborum a noticed by nobis omissorum quos omisisse fortassis non oportebat;" or, as he u en: expresses it, in another place, of diseases which were either forgotten when the arrangement was settled, or for which no fit place could and other De found within its limits. It occurs, however, in Sauvages, Lin- neus, Vogel, and Ploucquet: and seems to comprise two species : ANTIPATHIA SENSILIS. -----------INSENSILIS. SENSILE ANTIPATHY. INSENSILE ANTIPATHY. SPECIES I. ANTIPATHIA SENSILIS. SENSIT.E ANTIPATHY. ANTIPATHY PRODUCED THROUGH THE MEDIUM OF THE EXTERNAL SENSES. ©EN. Ill Spec. I. Common origin and frequent appear- ance. Singular •samples. James I. Peter the Great of Russia. Very singular examples of both species belonging to this genus are recorded by the collectors of medical curiosities ; while others are of every-day occurrence. Some may be accounted for from early fright, stories told in the nursery, or that incongruous associa- tion of ideas in early life, which we had occasion to notice in the Proem to the present class. But many are of difficult solution, and others altogether inexplicable. Under the species before us, we may mention an antipathy pro- duced by the smell of roses ; of strawberries ; of mint and some other herbs • by the sound of music : or the sight of a drawn sword, which is said to have existed in King James I.: or the rattling of a carriage over a bridge, which continued for some years after mature life in Peter the Great of Russia, who was frightened, while an infant, by a fall from a bridge into the water ; and who only over- cl.iv.] NERVOUS FUNCTION. [ord.iv. 333 came the antipathy by resolutely accustoming himself to the object Gen. Hi. 0f^sgus\ , u <5E*fc Ihe sight of crabs and lobsters, and, still more frequently, of"eD8i!js- toads and vipers, has produced the same effect. And we have a few antipathy. instances of its being occasioned hy what we should much less ex- Sancesl" pect as a cause, the appearance of bread and cheese, or even bread alone.* The object itself, however, seems to be of little or no im- portance ; the feeling in mo3t of these cases results from an associa- Common tion of such object, whatever it may be, with some painful occurrence progress in early life, of which it continues to be as much the symbol or ex- f ,,.he pression as letters are of ideas. In many instances the original Sometimes occurrence is forgotten, but the impression indelibly remains, and the fdlopa^hic. object recalls the mind to its influence. There is reason to believe, however, that the antipathy is often the result of idiosyncrasy, or something peculiar in the frame-work ofthe individual constitution. SPECIES II. ANTIPATHIA INSENSILIS. INSENSIT.E ANTIPATHY. THE ANTIPATHY PRODUCED THROUGH AN UNKNOWN MEDIUM. In the preceding species the feeling of antipathy is excited through Gen. m. the medium of one of the external senses, to which the object of anti- 0^3'^ pathy presents itself, or with which it is associated on recollection ; with the for it is the sight, or taste, or smell, or touch, or hearing of such species?5 object, or the idea of such sensible impression, that alone calls the antipathy into action. There are some persons, however, that are struck with a peculiar illustration and indescribable kind of horror at the presence of an object which cies.e spe is unperceived by any of these senses, as soon as it comes within the atmosphere of some unknown influence. The presence of a cat has Produced been often known to produce this effect, under the circumstances cases'bythe now adverted to, or when the animal though present has been con- presence of cealed, and not one of the senses has been alive to its presence, though con- Instances of this kind are to be found in most of the collections of Examples medical curiosities, as well as in various other works ;t and I have «f Mb fre- met with several decided instances in the course of my own practice. ^11 8uP. The affection, in this case, depends unquestionably upon an extraor- p°^Je dinary idiosyncrasy ; but by what means such an idiosyncrasy is in- dependent fluenced we know not. Sanvag-p.s inquire whether the effluvium crasy°Syn" thrown from the object of aversion into the atmosphere may not, in How ex- combining with the fluids of the affected person, produce an irritating sauvages3! * Ephem. Nat. Cur. Dec. 1. Ann. i. Obs. 144. et in Schol. Dec. Hi. Ann. in. Obs. 149. t Eph. Nat. Cur. Dec. n. Ann. ii. Obs. 60. Borelli, Cent. it. Obe. 61. Emer- cetanus, Diietet. Polyhistor. p. 82. 334 ci. iv.] NEUROTICA. [ord. rv. Gen. Hi. and distressing tertium quid, as corrosive sublimate is produced Antljathia by a combination of mercury with oxymuriatic acid. The tact,, at insensiiis. present, appears inexplicable : but it is not more singular than tne antipathy, wonderful power so well known to be possessed by the viverra Vi'erra noctula (common or great bat), which renders it conscious of the common0' presence and position of objects, when all its senses are muffled, and bat# which enables it, when flying in this state, to avoid them. This ex- traordinary faculty, to which we adverted in the Proem to the present class, has been called a sixth sense by several naturalists. Remedial In all these cases, whether ofthe preceding or ofthe present spe- cies, the only' means in our power of destroying the anomalous or morbid impression is by introducing a counter-habit; or, in other words, by gradually inuring the sensorium to the influence of the disgustful object. By being familiarized with what at first we most shrunk from, our courage becomes hardened and the gainful impres- sion blunted; and sights, and sounds, and smells, and the most im- minent dangers that could not at one time be encountered, or even contemplated without fainting, in process of time no more affect us than the roar of cannon affects the war-horse, or the mountain-tempest the mariner. treatment. GENUS IV. CEPHAI.^A. HEAD-ACHE. ACHING PAIN IN THE HEAD ; INTOLERANCE OP LIGHT AND SOUND j DIFFICULTY OF BENDING THE MIND TO MENTAL .OPERATIONS. Gen. IV. Cephal^a {xtQxhuix from %tx>*, "caput") is employed by thegeneric Galen, chiefly, in the sense of chronic head-ache ; whence the term term. cephalalgia has been invented in later times to express affections of synonyms. gj,orter duration. Head-aches of all kinds, however, form a natural group, and should be described under a common genus, which is here named after the oldest and most authorized term. Sauvages has particularly remarked the symptom of disability of the mental powers in the first species we are about to notice, and the remark may be applied to all the others : " difficultas cogitandi, distincte ratiocinandi, reminiscendi." The species which may be enumerated Under this gfinns arp the following' : 1. CEPHALGIA GRAVANS. STUPID HEAD-ACHE. 2.--------INTENSA. CHRONIC HEAD-ACHE. 3.-------- HEMICRANIA. MEGRIM. 4.--------PULSATILIS. THROBBING HEAD-ACHE 5.--------NAUSEOM. SICK HEAD-ACRE. i cl. iv.j NERVOUS FUNCTION. [ord. IV. 335 SPECIES 1. CEPHAL^A GRAVANS. STUPID HEAD-ACHE. PAIN OBTUSE J WITH A SENSE OF HEAVINESS EXTENDING OVER TH£ WHOLE HEAD ; SOMETIMES INTERMITTENT. The remote causes of head-ache are so numerous and so compli- Gen. IV. cated that it is difficult to catch or arrange them; and many of them Spec- L are so completely concealed from view, by a confinement to the ca^es^of brain itself, that we vainly endeavour to discover and analyze them. he*eraiC|he Repelled discharges from the hemorrhoidal vessels, repelled or re- RepeHe/" tarded catamenia, repelled fluids from the surface, are very frequent .ndo'tlEi8 causes of one or other of the species of cephalaea now enumerated. fluids- Whatever retards the current ofthe blood in the sinuses ofthe brain, or the veins which convey the blood from the head, will produce it. Of this kind are various tumours, particularly of the conglobate obstruc- glands, polypi, exostoses, or bony fragments separated by some vio- }n0{nsewith" lence from the internal table of the skull, not producing irritation, cranium. perhaps, tdl the accident that gave rise to them has long passed by and been forgotten. Hence some part of the brain has often, on dissection, been found diseased in its structure, producing, occasion- ally, an abscess with a considerable lodgment of pus. And, in some cases, the disease has been cured by the pus making its way through the frontal sinuses,* or through the ears,! and escaping externally. It has, in every age, been produced by a decayed tooth, and has Decayed ceased on its removal; a profusion of hair on the head has been also Profusion an occasional cause, in which case it has yielded to shaving or of hair- merely thinning the hair. It has often followed upon a neglected Neglected catarrh or neglected rheumatism, and still oftener has resulted from Acrimony some morbid irritation of the stomach, and especially from worms.J in the st°- So again, whatever prevents a free evacuation of the right auricle SbsVuc- and ventricle of the heart, and contributes to retard the motion of Jj°.nst'n the the blood in the veins which discharge their contents on this side of the heart, has a tendency to lay a foundation for this complaint. Under these circumstances nothing is more difficult than to deter- Difficult mine, in many instances, whether a head-ache of any kind be an jj^"_l°ia. idiopathic or a symptomatic affection, and on this account Dr. Cullen, between an deviating from the general opinion of the nosologists who preceded and a^syroi*- him, has regarded it as a symptom in every instance. This, how- tomatic ever, is to suppose that the encephalon which, from its magnitude and hence and complexify, seems to open a theatre for more intrinsic dis- [ySouHen as always * Nicolai, Decad. Observationum Itlustr. Anat. Schrader. Observ. Anat. Med. ^raPtomR Lentilius. Miscel. 1. 599. t Gockell, Gallicin. Med. Prat. Trecourt, Mem. et Observ. de Chirurgie, N. 5. + Walther, Thes. Obs. 17. Blumenbacb, Med. Bibl. B. 11. p. 434. 336 iv.j ^NEUROTICA [ord. IV. Gen. IV. Spec. I. Cephalaea- gravnns Stupid head-ache Pathology of the pre- sent spe cies. Diagnos- tics. In certain cases whence derived, and how best re- lieved. Iu other cases whence derived. General remedial process. quietudes than all other organs whatever, is exempted beyond any of them. ,, The species immediately before us, emphatically distinguished by the name of stupid iu.ad-ache, seems, when idiopathic, to be strictly a nervous affection ofthe organ, originating from nervous debility or exhaustion ; or, in other words, from the want of a proper supply ot that kind of sensorial fluid on which the organic feeling of comfort and refreshment depends. It is hence peculiarly marked by a gene- ral disquiet and confusion, rather than by acute pain ; by a general hebetude of sensorial power which disqualifies the person labouring under it for a continuance of mental labour ; and in which the sight is dim, and the hearing dull, and the memory vacant. On which account it is frequently experienced by hard students, who have sat up through the whole of the night in pursuit of some abstruse and difficult subject, or who have laboured upon the same from week to week with too small an allowance of time for sleep or exercise. In all which cases it is often relieved by surrounding the temples with a bandage steeped in cold water, which acts as a tonic upon the spent and enfeebled brain, and once more excites it to a little tem- porary energy. A sudden blow of severe grief often produces the same kind of exhaustion, and is accompanied with the same symp- toms, during which the sufferer is equally incapable of thinking, sleeping, or attending to external objects. A similar effect is produced by whatever else has a tendency to induce debility and torpitude in the nervous structure of the brain, as a profuse diarrhoea, repeated and immoderate venesections, and particularly any sudden faintness, or debility of the stomach. The last acts, indeed, in a double way; directly, as withholding the means of sensorial recruit; and, indirectly, from the close sympathy that, on all occasions, exists between the two organs. And hence, wherever we meet with cephalaea gravans as a sympathetic affection, and are doubtful to what particular organ to ascribe it, we shall, in most cases, find the stomach affected, and may venture to treat it accordingly. As much of the remedial process, however, which may be ser- viceable in any one of the species of head-ache before us, may be useful in the rest, it will be most expedient to. reserve this subject for the close of the entire genus. OL-lvvI NERVOUS FUNCTION [ord.iv. 337 SPECIES II. CEPHALAEA INTENSA. CHRONIC HEAD-ACHE. PAIN VEHEMENT, WITH A SENSE OP TENSION OVER THE WHOLE HEAD : PERIODIC ; OFTEN CHRONIC. This species is, perhaps, always dependent upon some local Gen.IV. irritation ; and may be produced by many, prohably most, of the offe^i-**' irritants noticed at the opening of the preceding species: and as internal not a few of these have a seat in the brain itself, and must remain defiefaif"1 concealed till disclosed to us by dissection, and would be still be- medicai yond our reach if we could ascertain them from the first attack, why.an there is no difficulty in conceiving why this form of head-ache should often defy all medical aid whatever, and run parallel with the life itself. Among the external causes, those productive of rheumatism are, Externa! perhaps, the most frequent, as exposing the feet for a long time to causes' cold and damp, or lying in a damp bed with a small quantity of covering. And as all rheumatic affections, when they become chronic, have a tendency to intermit, and return periodically, we may easily see why the disease before us should do so in many instances. This species may therefore be distinguished by its being rather present spe- limited to some particular part of the head than extending over the distinguish- whole organ ; by its remissions or intermissions ; by the acuteness aD'e «om of the pain during the return of the paroxysm ; by an intolerance of ° all motion of the head, far more than of light or sound, both of which, however, are sometimes highly irksome ; and by a peculiar feeling of tenseness or constriction over the encephalon, as though its membranes were muscles and spasmodically contracted. This last symptom rarely takes place till the disease has esta- other dis- blished itself for some time, and seems to indicate a thickening of symptoms. one or more of the tunics of the brain from increased action, produced by a long course of irritation ; a result which has fre- quently been discovered on dissection. Where the affection is entirely rheumatic, the local pain of the head ceases as soon as a rheumatic pain takes place in any other part of the body. There is, indeed, no great difficulty in accounting for a cessation of pain in this case upon the principle of a transfer of action. But we find it cease also, or very much remit, not unfrequently in other cases, in which post-obit examinations have proved the disease to be de- pendent on local irritation, as some bony protuberance from the interior of the skull, ossification, or calcareous concretions in some part of the substance of the brain, a tumour in the pineal gland, or Vol. IV,—43 .338 cl. iv .j NEUROTICA. [ord. i' Gen. iv. some other ganglion or commissure, or an aneurism of the carotid CeXi*"' artery ; the two last of which arc particularly described by feir uu- intensa. bert Blane, as having been detected after death, in persons who natt hehaTache. been long and severely troubled with this modification of cephalaea. intervals of To account for the intervals of ease that occur und.r these circum- oases'pro- stances in which the cause of irritation is permanent and perpetu- riuced by anv acting, we must call to our recollection that most organs, when causes, they have been long exposed to a more than ordinary stimulus, be- accounted i'c.r. come gradually exhausted and blunted in their sensibility in conse- quence of such exposure. And hence the pain they are occasion- ally sensible of, and which returns in regular paroxysms, is produced by fresh causes of excitement, periodical or incidental, or a serious aggravation ofthe disease itself. j'iieob- In a few instances, an obstructing material, forming the exciting sometimes cause, appears to have been carried off, and in one or two very rare "'uiarfcar- casesi hy channels, whose communication it is peculiarly difficult to* ijed off account for. A caries, or some other disease, affecting a small other" °r Part °f the bony substance of one of the sutures, is a cause noticed structural by many pathologists ; and this cause has, in some instances, been the sutures, so obvious, that while the patient has been able to point out the precise spot of pain with his finger, the practitioner has been able to discover a considerable indentation or vacuity, proving that a illustrated part of the suture had been absorbed or detached.* In a case of larcase.5™" this kind, related by Mr. Henry of Manchester, the immediate seat of distress was in the lower part of the coronal suture about an inch above the sphenoides. The pain was excessively acute and lanci- nating, the integuments directly over it, to the extent of a half-crown piece, were puffed up like an inflated bladder, and the temporal artery appeared tense like a chord on its full stretch. Upon the subsidence of the tumour, a chasm of about an inch long, and a sixth part of an inch broad, was felt in its late course. With the disappearance of the tumour the pain was transferred a little lower to the processus condyloides, and afterwards to a situation about an kich and a half below the angle of the lower jaw-bone Shortly after this it ceased altogether ; but the patient's- breath, from this time, evinced an earthy and disagreeable smell; and within a few days, without any previous fit of coughing or retching, he was sud- denly seized with a feeling of suffocation from something that had dropped into the esophagus and stuck there ; but which he threw up after great exertion, and found to be an angular solid substance, about the size of the last joint of the thumb, consisting, as he de- scribed it, for, unfortunately, he did not preserve it, of a hard, brown and white matter, the latter of which on being pressed fell into a dry powder. The whole was covered with a greenish mucus, and re- sembled exactly in smell the fetor which had antecedently affected his breath and had now subsided. About six weeks afterwards he had a slight return of the pain in the same part of the head, vvhicli lasted about two minutes, when he again became sensible of some- * Bonet, Sepnlchr. Lib. i. Sect. t. Obs. 92. Morgagni, De Sed. et Caus Moih Epjst. in. Art. 8. Stalpart van der Weil, Cent. i. N. 1 i »;l.!v.} NERVOUS FUNCTION [ord.iv. 339 thing falling into his throat which he soon hawked up, and which Gen. IV. proved to be similar to what he had brought up before, though in c$l%It smaller quantity, and broken into fragments. This was examined »>ten8tt. a by Mr. Henry, and was found to be calcareous matter covered with SKi*. a layer of brown tenacious mucus. 4 The vacuity in the cranium filled up from this period, and the patient could bear the integuments to be pressed upon without pain.* That the calcareous substance thus ejected from the esophagus Remarks had travelled there from the coronal suture, where before its sepa- above3™™. ration, probably in the form of a caries, it had for so long a time been the cause of cephalaea, is sufficiently clear from the course it seems to have taken and the symptoms that accompanied that course ; and a passage having been once formed, probably through the nasal sinus, we can readily account for the more easy and rapid descent of the second separation than of the first, and particu- larly as it was so much smaller in quantity. And although the nature of the passage it thus opened for itself cannot but be a matter of astonishment, it is not more mysterious than the migration of needles, and even small bullets, which have sometimes travelled almost over the whole body with little inconvenience to any part. Thus a fish- bone, after having long fixed itself in the esophagus, has worked its way into its substance, and been at length thrown out at the skin :| and the point of a sword, buried thirty years before in the eye, has at last been ejected by the palate. J Why, under this slow course of migration, inflammation is not produced has been ingeniously shown by Mr. J. Hunter ;§ but the general progress is still wonderful and unaccountable. For the few remarks we shall have to make under the head of Medical medical treatment, it will be most convenient, as already observed under the preceding species, to refer the reader to the close of the genus, in order that the plan proper to be pursued under one species may be compared with that under another. At present it is only necessary to add further, that the irritating causes of chronic head- ache we have thus noticed, excite, occasionally, other symptoms than acute pain, and particularly clonic agitations of the muscular fibres adjoining the seat of pain, not unlike those of neuralgia, and sever*3 and irremediable hemiplegia. * Mem. Med. Soc. Lond. Vol. I. t Articulari, Practica. X Hoecbstetter, Observ. Medic. Dec. vi. Cas, 9. Francf. 1679. S On Blood and Inflammation, p. 239. 340 cl. iv.] \EUROTICA. [ORD. IV SPECIES III. OEPHALiEA HEMICRANIA. Gen. IV. Spec. III. Chiefly sealed in tho integu- ments. Symptoms. Predispo- ncnts- Often peri- odical. Periods sometimes perfectly regular. more com- monly of uncertain recurrence. Yet more frequent in the after- noon than in the morning Illustrated. Occasion- ally take place in the morning. MEGRIM- PAIN VEHEMENT : CONFINED TO THE FOREHEAD, OR ONE SIDE OF THE HEAD : OFTEN FEKIOOICAL. This is, in most cases, a disease of far less importance than the preceding. Tts seat seems to be chiefly in the integuments of the head, and its principal symptoms are tenderness on pressure, an ob- scure redness of the skin, and a suffusion of the eyes. And with these there is frequently a nauseating uneasiness at the stomach, but whether as a cause or a consequence of hemicrania, it is not easy to determine ; it is most probable, indeed, that in some instances it is the one, and in others the other. The disease is most common to persons of delicate health or re- laxed habits and an irritable temperament, and particularly when subject to dyspepsy and hypochondrism. In such persons all the causes of catarrh and rheumatism are sufficient for its production, as is any thing that disturbs the balance ofthe circulation. And hence it is often a result of cold feet, or the chill that follows on a dinner not comfortably digested. Hemicrania frequently assumes a periodical character, in which case the pain mostly fixes itself on the same side, or the same part of the head, in some cases being limited to a small disk of the integu- ments, with little affection of the encephalon, and in others striking deeply into the interior ofthe head, and down towards the eye, which cannot endure the least glimmer of light. In many instances, its in- termissions are perfectly regular, and the paroxysm returns daily at the hour of noon :* but more commonly its attacks are produced by some incidental excitement, and are consequently of uncertain recur- rence. Yet it is more frequently found in the afternoon than in the morning. So far as I have observed, indeed, it usually takes place in the evening during, or soon after, the digestion ofthe dinner, and in persons of the middle age of life who live temperately. In one in- stance, in which the disease is still very obstinate, it returns at this hour after an interval of two or three weeks, continues through the whole of the night and the ensuing day, and subsides towards the evening; the paroxysm thus lasting about twenty-four hours. In a very active and otherwise healthy man, however, about thirty years of age, who has no apparent disorder of the stomach or bowels, it commences uniformly before breakfast, continues with great vio- lence about six hours, and then subsides ; leaving intervals of about six weeks or a month. * Schenck, Libr. Obs. 78, 79. Zecchii, Consult. Med. 90, 98. Franc. 1650 " tv/J NERVOUS FUNCTION. [ord. rv. 341 SPECIES IV. CEPHAL^A PULSATILIS. THROBBING HEAD-ACHE. PAIN PULSATORY, CHIEFLY AT THE TEMPLES ; OFTEN WITH SLEEP- LESSNESS AND A SENSE OF DRUMMING IN THE EARS. In discussing the genus palpitation (clonus palpitatio) we GeN. IV. entered into an explanation ofthe very curious phenomenon ofthe p^hoiogy.' throbbing or beating of the heart, or of a particular artery, or part of an artery, which frequently takes place without any connexion with the regular systole of the circulation, often, indeed, discord- antly with it both in time and force ; and we endeavoured to show that these anomalies, for the most part, depend upon a peculiarly nervous irritability, and spastic tendency of the muscular fibres of the arterial fabric, sometimes limited to the artery, or portion of an artery, in which the palpitation occurs, and sometimes common to the whole arterial system. Whenever any of the preceding species of the present genus are 0»6'n' grafted upon a constitution of this kind, or at least upon an idiosyn- crasy in which one or both the temporal arteries are possessed of this spastic tendency, and are consequently disposed to run into this anomalous contraction and relaxation, we shall have an instance of the species before us which commonly originates in this manner. The consequence of which is, that a regular arterial stroke, as oft'8^" though influenced by the systole and diastole of the heart, is often eordant feigned, which has no existence; and a pulsation is produced which ,"'tnehat is in no respect synchronous with the movements of the heart, and heart- is often half as rapid again. It occurs, not unfrequently, however, Sometimes that the morbid beat is in perfect accordance with that of the heart; but still a' but it is not less a spasmodic action on this account, for in the dis- action!*1 cussion already adverted to, as well as in the Proem to the third class, we have observed that the arteries, when in a state of health, suffer no alteration in their diameter during the passage ofthe blood through them, and ( .at their ordinary pulsation is only produced by the pressure of the finger or of some other hard substance against their sides. The species of head-ache before us, therefore, is to be regarded Disease i • o , i • , ■ , • more com" as something of a more compound kind than the rest, m conse- plicated quence of the peculiarity of the constitution in which it occurs : {henres7 °' with the exception of which its causes, and history, and, as we shall presently show, mode of treatment do not essentially differ. .142 cl. iv.] NEUROTICA [ORD. IV SPECIES V. CEPHALJEA NAUSEOSA. Gen. IV. Spec. V. Spasmodic head-ache of Fother. gill. Pathology- Descrip- tion. Seat of pain va- riable. Duration of the pain variable. Returns often iire- rular. SICK HEAD-ACHE. This is the spasmodic affection of Dr. Fothergdl, who has de- scribed it at great length and with much accuracy. As the last species consists of almost any of the preceding set down upon a con- stitution peculiarly predisposed to irregularity of arterial action, the present consists of the same set down upon a constitution peculiarly predisposed to irregular action ofthe intestinal canal. In its gene- ral symptoms, however, it is chiefly related to the stupid head-ache, and the hemicrania, particularly to the last; only that, while proper hemicrania most frequendy makes its attack in the afternoon, sick- head-ache usually shows itself in the morning ; though the latter, like the former, occasionally varies its hour, as it does also its length of intermission. The patient, observes Dr. Fothergdl,* commonly awakes early in the morning with a head-ache that rarely affects the whole head, but only some particular part of it, most frequently the forehead, extend- ing over one or both eyes. Sometimes it is fixed about the upper part of the parietal bone of one side only; sometimes the occiput is the part affected ; or it darts from one place to another; and equally varies during its continuance in its degree of intensity. There is some degree of sickness usually connected with it, mostly limited to nausea, but occasionally amounting to vomiting. If the pain commence in the morning before any meal is taken, phlegm only is thrown up, unless the straining be severe, in which case bile is inter- mixed with it. After this the pain soon begins to abate, leaving a soreness about the head, a squeamishness at the stomach, and a gene- ral uneasiness which induces the patient to wish for repose. Per- haps after a short sleep he recovers perfectly, only a little weakened by his sufferings. The duration of this species of head-ache differs, however, in different persons : in some it subsides in two or three hours ; in others it extends to twenty-four hours or longer, and with a violence scarcely to be endured, the smallest light or noise render- ing the pain intolerable. In young persons the paroxysm goes off soon ; but, after the disease has been a companion for years, it is of longer duration, and the system becomes extremely debilitated. Its returns are very irregular : some persons suffer from it every two or three days ; some every two or three weeks; and others have still longer intervals. Those who use but little exercise, and are inatten- tive to their diet, are afflicted most severely: costiveness, when habitual, is a frequent predisposing cause ; and hence a protracted * FotbergiU's Works, p. 697,4to. Medical Observ. and Inquir. Vol. ti. p. 10* cl. iv.j NERVOUS FUNCTION. [ord. rv. 343 laxity of the bowels, supervening on habitual constipation, has re- Gen. IV. moved the complaint altogether. ctThai"^' Dr. P. Warren, in a very valuable paper on this subject, seems to nauseo8a. think that a line of distinction may be drawn between the disease aChe! as produced by a morbid state of the stomach, and of the collatitious J?™^ viscera, or, in other words, as it makes an approach to the first, or from the to the third species before us. " Upon the whole,"' says Dr. War- cies.8pe" ren, " that form of head-ache, which is attended more with confu- sion than pain, and in which there is a temporary dimness of sight, appears to depend chiefly upon a defective action or secretion of the stomach ; the other (that in which the pain is acute or exceeds the confusion) which is the most prevalent form, more particularly upon inactivity ofthe upper bowels, from whatever cause it may he produced, and an imperfection of that part of digestion in which the bile is concerned."* The connexion between all these species of head-ache is so General close, and several of them are so apt to run into the others, that the treatment author has reserved the few remarks he will have to make upon the remedial treatment till the whole have, as now, passed under re- view, and have furnished us with an opportunity of concluding how far any thing like a common plan of treatment may be advantageous, and upon what points it ought to vary. A very slight recurrence to the preceding history will show us Leading that the chief causes of head-ache are local irritations, suddenly principle* checked perspiration, or exposure to cold and damps ; a peculiar irritability ofthe nervous system, and particularly a spastic idiosyn- crasy of the temporal arteries, and a morbid condition of the chylo- poetic viscera. The last is, perhaps, the most common cause ; and hence, where- a disease ever there is any doubt as to the specific character of the disease, fhVsto- we can never do better than treat it as chiefly appertaining to the mach m°st - i • i. ■ 1- 1-il u commonly fifth species, and implicated with a diseased action ot the stomach implicated, or its collatitious organs. quiring nt- It is on this account that emetics, with an anodyne given after- tention. wards, have been so generally found serviceable, and have often emetics so effected a cure in a few hours. And hence also the great advantage "[^abuT of keeping the bowels not only free from costiveness, but with some with an kind of warm irritant slightly, though constantly, acting upon them, X?-y"e of which one of the best is aloes, where there is no tendency to *^dtHh:eas piles, and copaiba, or the exlracts of rhubarb and colocynth where advantage there is. Piles, however, are not an affection to be much regarded in ents.pe"" cephalaea,for it is probable that they may often become a useful revel- Viiesocca- lent: and Dr. Arbuthnot was so firmly of this opinion that he was in the remedial. constant habit of employing suppositories of aloes, rock-salt, and honey, and asserted that nothing relieved the head so much as piles. When the disease is evidently of a rheumatic character, an open When of a state ofthe bowels should be combined with mild sudorifics, and if character necessary, narcotics. And hence the benefit that is so often found j££B££e * On Head-aches which arise from a Defective Action of the Digestive Organ? "Med. Trans, iv. Art. xvm. 344 cl. iv.J \ELROTICA. [ord. i< Gen. IV. from adding four or five grains of antimonial powder to an aloetic pill ' given at night, which rarely disturbs the paucnt before the morning . and, where this does not answer alone, or we have reason to tear, from a constitutional debility of the bowels, that the aperient may act in the night, we should unite a grain of opium with the other in- gredients, or employ Dover's powder instead. Such a plan, will, indeed, often be found to succeed even in the pulsatory head-ache or hemicrania ; though here we may frequently employ such sedatives as hyoscyamus, conium, aconite, and flam- mula Jovis, or the antispasmodics of musk, camphor, valerian, es- pecially its essential oil, and ammonia, with somewhat more benefit during the paroxysm ; and epithems of cold salt water, or a diluted solution of acetate of ammonia, applied round the head every morning. I cannot, however, avoid thinking, that in many cases of this disease, and especially where we have a clear proof of great irritability ofthe nervous system, that the prussic or hydrocyanic acid may be had recourse to with considerable advantage in moderate doses of a crop or two three times a day, in a little cinnamon water, gradually increasing the power, and uniting the acid with full doses of subcarbonate of iron, as in the case of neuralgia. In some instances, thinning the hair, where it is profuse, has also been found serviceable ; but in others it has failed, and the follow- ing remarks ofthe author's late valued friend, Dr. Parr, upon the subject of shaving, are well entitled to attention. " This practice," says he, " has not the sanction of long experience, nor is it support- ed by reason. Each hair is a vegetable nourished by a bulbous root, supplied by numerous blood-vessels. These, though small from their number, convey no inconsiderable quantity of fluids ; and as the external and internal carotids arise from a common trunk, and anastomose in some of theit branches, whatever cause increases the circulation in the former, must lessen it in the latter." He adds, that he himself was for many years a sufferer from an irregularly re- turning paroxysm of head-ache for which he could assign no cause, but at last discovered that it frequently returned after shaving the head : he consequently suffered his hair to grow, and from that time the disease gradually lessened in violence, in duration, and in frequency of its recurrence. " From being a complaint," says he, " highly serious, and beginning to affect the memory, its returns are now rare, and never so violent as to unfit the frame for any exertion of body or mind." Temporary relief has also, in many cases, been obtained by the external application of volatiles and aromatics, as ammonia, cam- phor, oil of cajeput, and ether; and where the disease has been produced by cold or rheumatism, from blisters, burning moxa,* or the actual cautery,! an issue or a seton.J In the Transactions of Natural Curiosities, is a case often years'duration completely cured by the last application.§ So the use of errhines has also been found serviceable, and particularly in chronic hemicrania, by stimulating Cephalsea nauseosa Sick-head ache. Treatment. Treatment of pulsa- tory head- ache and hemicrania Prussic acid: with iron. Thinning tho hair sometimes useful; but if used indiscrimi- nately may produce mischief- Exempli- fied. External stimulants. Errhines serviceable * Wepfer, Observ. p. 81. I Ruysch, Observ. 40. t Velshius, Episagm. 11, § Vol. ix. Obs. 91. cl. iv.j NERVOUS FUNCTION. [ord. iv. 345 the mucous membrane of the nostrils, and exciting a considerable Gen. IV. discharge : but as we have already observed that taking snuff is c^pEuiT' injurious in cases of indigestion, where head-ache is connected "auseosa. with the chylopoetic organs, sternutatories should be avoided. ache". ea In the interval of most ofthe cases thus far adverted to, tonics, ^SiT and especially the metallic, should be employed with steadiness. It »he inter- is here the nitrate of silver has been found eminently useful, when cfa'iV'hT every other remedy has antecedently failed : and perhaps large nietallic- doses of the sub-carbonate of iron, as already recommended, but without the prussic acid, may prove a valuable prophylactic. A tonic regimen, however, of exercise and early hours should combine, or little advantage will be gained by any plan. Linneus is said to Plan pur- have cured himself of a severe and obstinate hemicrania which re- Lhmeiis turned at the interval of a week, and continued for twenty-four hours, ui>on his „ « i ■ ■ ■ • i /. i 1 i-i • own person- by merely drinking a draught of cold water early in the morning, and then walking himself into a glowing heat : and in many cases no plan can offer a better promise. Verticil- The verticillated stimulant plants have, in many instances also, lant plants. been found serviceable in most of the species thus far considered, whether the disease originate in the head or in the stomach, and of these the most active as well as the most pleasant, are lavender, rose- Arum a fe- mary, and marjoram. How far the arum may answer the same pur- withDer- pose the author cannot say from his own practice, but it is very glus" strongly recommended by Bergius, who tells us, that when taken in doses of half a scruple of the compound powder, he never knew it fail of giving relief, even after the most celebrated remedies had proved useless or even added to the distress. It is certainly a very acrid stimu- lant, and seems to have been dropped from the Materia Medica too precipitately. Treatment There is one species of head-ache, however, to which but little of headache what we have thus far recommended will in all cases apply, and shou!d that is the second or chronic cephalaea : and on this account it is of vary from great importance that we endeavour to distinguish it from the rest ; BndfeSt: or rather that we endeavour to distinguish those causes of it under the operation of which it is necessary to pursue a different plan : for in many instances even here the cause of irritation may be palliated, or even destroyed, by some part ofthe process already recommended. But we have stated that this form of the disease is often depend- ent upon some structural irritation within the cavity ofthe skull, such as a node or toph, or caries of the interior table of the cranium, a scirrhous or other tumour in some part ofthe brain, or a thickening ofthe membranes that surround it. a morere- And here, in conjunction with the aperient plan, or even a brisker pi^n wbe plan of this kind than has yet been recommended, local bleediner bv Iiad re" ■ it 111111 ■ ■ , . £ J course to. cupping or leeches should be had recourse to without delay. Free venesection, indeed, has often been of great service in diminishing the inflammatory action, and taking off the topical irritability for many weeks or even months. And hence, the temporal artery has vicarious often been opened on the continent, and with very good effect: and tions often we may see why a vicarious hemorrhage from the nose, the mouth, usefu1' the liver, or some other organ. ha3 been followed, in various rase?. Vol. IV.—4-1 346 cl. iv.] NEUROTICA Louv.i* Gen. IV. by a perfect cure.* And, where some other obstruction has been t^phahJ' the cause, it has occasionally yielded to a severe fright,! or a fortu- nau»eosa nate concussion of the brain,:}: or a wound on the head.§ Hildanus acche:head" refers to several inveterate cases effectually overcome by accidents of o,7Mm°(n.t this kind.|| dent"/" Here, also, if any where, we may possibly expect advantage from J1*of a long continued use of mercury as an alterant and absorbent, in Mercury as connexion with apozems of sarsa, bardana, or some other warm with waann diluent. In organic enlargements and obstructions in other parts of diluents. t}ie bocjy sucjj a p|an j,as often answered, and analogy will therefore lead us to expect some benefit in the present disease. Velschius describes a case of a most obstinate cephalaea in which it completely succeeded. IT tseot the But where every other mean has failed, and the symptoms are S^adw violent, and the painful spot is clearly definable, and we have strong able. reason to apprehend some local organic irritation, it may become a Effects question how far the use ofthe trepan has a chance of being service- "ary"''8 '" able. Vogel gives a case in which the pain was hereby considera- bly mitigated,** and Baglivi another, in which a radical cure was effected.tt But in this instance, a portion of the brain was found in a state of suppuration, and the confined pus hereby obtained a way of escape. Marchetti gives an example of a temporary cure, the head-ache being suspended so long as the wound was open, but uut u.e ope- returning after it was healed.JJ And hence, even where no structu- quentiyfoT ra' cause of irritation has been reached, this operation has sometimes no avail, proved serviceable as a revellent. It must, however, be admitted that it has often been performed without any benefit whatever. Treatment It is hardly needful to observe that where cephalaea is evidently a condary80 secondary disease, as in plethora, chlorosis, gout, or neuralgia, our iiiease. attention must be chiefly directed to the malady on which it is depend- ent. Where it appears as a sequel upon any suppressed and habi- tual evacuation, or repelled eruption, the best means of obtaining relief will always be found in restoring the system to its former state ; and where this cannot be done we must furnish the best substitute we can by some temporary irritation or drain. L'oiiee As a general palliative, strong coffee has often proved serviceable ; viewable hi and, where its own sedative virtue is not sufficient, it forms one of the various best vehicles for the administration of laudanum in doses of eighteen a^excoi- or twenty drops. It diminishes, in some degree, the hypnotic power i'.a"iaVu-h'cte °** t'18 ^atter' Dut lt counteracts its distressing secondary effects. ,ianum: When laudanum is intermixed with strong coffee for the cure of "i'mmg0" manv modifications of heah-ache, tranquillity anu ease are produced, [''.'nd-cIT1 tnouSn there may be no sleep : when laudanum, on the contrary, is taken alone, sleep will, perhaps, follow, but is mostly succeeded by * Heister, Wahrnemungen, I. p. 70. Abhandl. der Konial. Schwed. Acad, der Wifseuchaft. xih. 39. s t Reidlin, Cent. II. Obs. 55. J Ephem. Nat. Cur. Cent. ix. Obs. 6. § Desgranges, Journ. de Med. Tom. ljt.ii. p. 360. || Cent. u. Obs. 8. «T Hecatost. n. 67. ** Chirurgiscbe und Medic. Beobaehtungen, p. 410. ■ * Speqim. Quatuor Librorura de fibr.i raotrice et roovbosH. ?: Observ. 36. Sff * l. iv.] NERVOUS FUNCTION. [ord. iv. 347 nausea and a return of the pain. Hence, the Turks and Arabians Gen- re- make strong coffee their common vehicle for opium, from its ten- cephahe!' dencv to counteract the narcotic principle of the latter.* "au,s*l03a: r r Sick head- ache. Treatment. GENUS V. DINUS. DIZZINESS. ILLUSORY GYRATION OP THE PERSON WHILE AT REST, OR OP OB- JECTS AROUND THE PERSON, WITH HEBETUDE OF THE SENSORIAL POWERS. The distressing sensation of dinus, a strictly Greek term, occurs Gen. V. in different persons and different circumstances, under very different modifications, or is connected with very different symptoms. It is Dy some often united with cephalaea, and hence, by some Jiosologists, it is m°aBde°f18t8 made a mere species of this last genus, but there are few practi- *Pe^,sffi°f tioners who have not witnessed instances of both that have com- hut imprc- menced, continued, and terminated their career without any inter- perly' ference with each other : arid hence, Linneus has not only separated them from each other and regarded them as distinct genera, but has even made scotoma, or dizziness with blindness and a tendency to swoon, a distinct genus also. In the author's volume of Nosology, scotoma, with two other forms of dinus, were regarded as separate species But as, on a ^p^eci fuller consideration of the subject, I am induced to think that all n* ™ning often an effect, and why. Predispo- nent cause of vertigo as of clo- nus, nervous debility, or exhaus- tion. Who chiefly sub- ject to these af- fections. single, and otherwise almost imperceptible sounds; and especially where the auditory nerve is itself in a state of high morbid acute- ness, during which we have already had occasion to remark that the gentlest and lightest tones, even the whisperings of a mere current of air in a room, or the breathing of persons present, is intolerable, while sounds before unperceived become highly distressing.* And in like manner by an equal irregularity in the flow of the nervous fluids subservient to the perceptiohs of smell and taste, we may account for similar illusions upon these faculties. In many instances, we find the vertigo equally present whether the patient be in the dark or light, whether the eyes be closed or open; and we have hence a full proof that it is not dependent, as Dr. Dar- win conceives, upon an increased energy in the irritative motions of the organs of vision. In some cases the representations of ob- jects are very numerous and rapid, but in others far less so, and par- ticularly where the affection is severe from the first, or the patient is in a state of constitutional debility; under which circumstances we may conceive the pauses in the flow of the nervous fluid to be more irregular or of longer duration than they otherwise would be. In many cases, indeed, the only sensation is that of a buoyant undula- tion or swimming without any succession of representations what- ever ; affording us a proof that the rapid succession of representa- tions described by Dr. Herz, is not more essential to vertigo than the increased energy of Dr. Darwin. But as the disease advances, or, in other words, as the flow or secretion of the nervous fluid becomes still more interrupted, the representations are confused, indistinct, and rapid in succession, often conjoined with a sense of dimness or darkness, existing equally whether the eyes be shut or open, forming a state \>y Hippocrates and the Greek writers generally called scotoma or scotodinus : and as the disease makes a further progress by a further interruption in the flow of the sensorial fluid, every power of body and mind aug- ments in languor, till at length sensation both external and internal fails altogether, the action of the heart, and the other involuntary organs is enfeebled, and the patient swoons away, or sinks into a fainting fit, constituting the morbid condition we shall have to de- scribe under the next genus. The great predisponent cause in all these cases, whether of mus- cular agitation or of vertigo, is nervous debility or exhaustion : the exciting causes are whatever has a tendency to disturb the unifor- mity with which the nervous power is supplied through the whole of its fibres, and from one fibre to another. And hence those persons are most subject to both kinds of affection whose nervous system is constitutionally weak and mobile, or has become debditated by dis- ease or accident. Hence dyspeptic patients are peculiarly subject to both these affections ; as are those who are faint from sudden and violent evacuations, want of food, or a long course of labour. Hence we meet with it as a frequent and distressing attendant upon those who have too freely indulged in the pleasures of the table, in those * See Paracusis acris, Vol. m. Cl. it. Ord. n. Gen. n. Spec, t VL. IV. J NERVOUS FUNCTION. [ord. iv. 351 of sexual intercourse, and particularly the gross gratification of self- Gen.V. pollution. And hence, too, we may see why it is so often an accom- {?**c- L paniment of cephalaea, as the nervous fibres subservient to the organs v'Jrtjgo. of perception are here influenced from contiguous, in some cases Vert's°- from continuous, sympathy. The exciting causes we have stated to be whatever has a tendency Exciting to disturb the uniformity with which the nervous power is supplied Causes' through the whole line of its fibres. Of these the chief ..are motion chiefly of or exertion to which the strength is not equal, motion to which the tbree *"** system has not been accustomed, or hurried motion whether exter- nal or internal. In a state of great weakness, whether from hunger, hard labour, First kind, hemorrhage, or a protracted fever, even the ordinary motion of gentle SS?5Sn°to walking is more than the little remaining strength can support: and whicn *« the man who tries it trembles in every limb and becomes imme- noTeqfia!.8 diately vertiginous. In like manner whatever be his degree of strength Second, he will feel vertiginous by exchanging the motion to which he has XTtn° been uniformly accustomed for one of a different kind, and which "*«*<"" h*s he has seldom or never engaged in ; and hence, the reason of the "ccusTom- vertigo that accompanies swinging, sailing in a ship, walking in a ed# circle, sitting backward in a carriage, or standing on one's head ; for the uniformity of the external habit has by length of time associated itself with the uniform flow or secretion of the sensorial fluid, and the one cannot be interfered with without interfering with the other. And that this is the cause of the dizziness hereby pro- duced is obvious, since as soon as the old habit is overpowered by a new one, or, in other WGrds, as soon as the man has accus- tomed himself to the new action, it may be persevered in with- out any vertiginous sensation whatever. In some persons this sym- pathy of association is not so strong as in others, and hence, they are not so soon affected : in infants and young children such a kind of sympathy has rarely commenced, for while their age has not given time for it, they have had so little walking in a straight line, and been accustomed to so much swinging and tossing about in the arms, in every direction, that they are equally prepared for all; and hence can run round a circle, or even circumvolve on their feet, without any feeling of giddiness whatever. For the same reason hurried, tumultuous, or confused motion of Third irimi, any kind, whether external or internal, has a tendency to produce i^ttuous the same effect; for the current of the nervous supply will partake 'n"t'°n ex- of the agitation, and dizziness be a necessary result. Hence the internal' vertigo that accompanies intoxication, in which, from the inordinate excitement that prevails throughout the system, the regular and uni- form stream of the sensorial fluid is quickened into a confused and disorderly rush. And hence the same effect from congestion, or compression of any kind, as also from a sudden influence of mental emotion, and particularly of the depressing passions: though in such cases the uniformity of the sensorial stream is interfered with by a check, instead of by a rapidity of action : and where the check is considerable, as in cases of sudden fright or apprehension, a faint ing* fit is at once produced without the preceding stages. 352 cl. iv.j NEUROTICA. [OUD. IV. Gen. V. Spec. I. Dinus. Vertigo. Vortigo. Whence vertigo on looking down a precipice or climbing a ladder. It is to this cause, exercised indeed in a less degree, that we are to ascribe the dizziness which is felt on looking down a precipice, climbing a tall ladder, or walking over a very narrow bridge, with a roaring torrent below ; for in all these cases we are conscious of dan- ger, and lose our firmness in our fear. And that such is the real cause is quite obvious from the fact that those who possess their firmness, and have no apprehension or trembling whatever, have no dizziness : and that we ourselves are able to endure an exposure to the same scenes and the same motion with as great a freedom from it, when habit has given us calmness, and we have no longer any apprehension. So the sleep-walker has been known to tread firmly and fearlessly over planks and precipices, the sight of which has whirled all his brains when awake. Vertigo, then, as thus explained, consists in a clonic action of the nervous fibres, subservient to the faculty of perception ; and lays open to us the three following varieties : k Undulans. Swimming of the head. ,3 Illusoria. Illusory vertigo. y Scotoma. Blind head-ache. Nervous fainting-fit. Dizziness with a sense of swim- ming or undulatory motion. Dizziness with dimness of sight, and imaginary objects before the external senses. Dizziness with blindness and ten- dency to swoon ; often succeed- ed by head-ache. ing affec tion. Mode of treatment under dif- ferent causes and oircum- stances. Vertigo not Vertigo is not generally an alarming affection, but it is only to be nefarm- remedied by a particular attention to its cause, and especially the predisposition of the system to a relapse. If we have reason to suspect congestion or extravasation in the head, bleeding, and especially from the temporal artery, will often afford effectual relief. I have seen a very severe attack of vertigo cease instantly, as by magic, on opening this artery, although not more than a tea-cup full of blood was drawn from it. Where the stomach has been gorged, an emetic, and afterwards a purgative will prove most effectual; where the cause, on the contrary, is debility or exhaustion, it is best relieved by cordials and a generous diet, and where it is an idiopathic affection of the nervous system, the warm antispasmodics and tonics, with a tonic regimen, will bid fairest to succeed. Such persons will derive great benefit by a change of air, of scene, and of company; by visiting the most quiet of our watering- places, cold bathing, and a cold ablution of the head, or of the whole body every morning. Here also a particular attention should be paid to the state of the bowels, as costiveness is always an exciting cause. During the paroxysm, perfect rest, and a reclined position will be always found necessary ; and, where there is a tendency to fainting, stimulant odours may be applied to the nostrils, and ether, ammonia, and the volatile fetids to the stomach in draughts of cold spring water. <•''. iv.) NERVOUS FUNCTION roR». rv. 3/J3 GENUS VI. SYNCOPE. SYNCOPE. MOTION OF THE HEART AND LUNGS FEEBLE OR IMPERFECT ; DIMIN- ISHED SENSIBILITY : INABILITY OF UTTERANCE. Syncope, from vJ- gar, or any other pungent odours, to the nostrils. A recumbent po- sy^op'c1' sition is always adviseable, as most favourable to an equable circu- B.jmP|e*- lation of the blood ; and irritating and warming the extremities by lWmeTt. the friction of the hand or the application of rubefacients will com- monly be found to expedite the recovery, upon the principle we often had occasion to advert to, that, in a chain of organs united by sympathy or continuity, an impression produced on the one extre- mity is sure to operate on the other. A s soon as the patient is ca- pable of swallowing, some spirituous cordial, as a glass of wine, brandy and water, fetid tincture, or the aromatic spirit of ammonia or of ether, should be administered ; and the occasional cause should be sedulously avoided in future. SPECIES II. SYNCOPE RECURRENT FAINTING-FIT. RECURRING AT PERIODS MORE OR LESS REGULAR ; OCCASIONAL PAL PIT ATION OF THE HEART DURING THE INTERVALS : AND UNQUIET RESPIRATION DURING THE PAROXYSM. This is, in most cases, a far more serious form of syncope than Gen. vi, the preceding, and is commonly ascribed to some structural disease tf0p,^on{y of the heart or the large arteries that immediately issue from it, as amnrese- an ossification of the valves, polypous concretions, an enlargement """disease or thickening of the substance of the heart, an accumulation of water jh*n _Jhe in the pericardium, or an aneurism. usually de- Each of these may possibly be a cause in some instance or other; {jp^^m,, and where, during the paroxysm, the breathing, though feeble, is Btmcturai anxious and obstructed, the face livid, and the patient in the midst u„naofCthe ofthe swoon shows a tendency to jactitation, or an uneasiness on J1®"'0' one side or on the other ; and, more especially still, where no ordi- arteries nary exciting cause can be assigned, and it has commonly followed upon some unusual exertion, or hurry of the blood through the lungs. it would be imprudent not to suspect some such lurking mischief. But there are causes of a different and much slighter kind that I ^ n°l cannot avoid believing frequently operate in the production of re- many current syncope, and that, too, with many ofthe peculiar symptoms fra0smssi^h"! just enumerated. And I now allude to any of the ordinary causes ercauses. of syncope, as set down under the first species, or any other inci- dental irritation whatever, occurring in a constitution of great mo- bility and excitability, or where the heart alone, or in conjunction with the whole arterial system, is peculiarly disposed to that irre- gular and clonic action which we have noticed under the species palpitation, and particularly under the first and second varieties 358 cl. iv.j NEUROTICA. [ord. iv. Gen. VI Spec. II Syncope recurrens. Fainting- fit. How such causes operate. Periodical swoonings. Patient's idiosyncra- sy to be studied. Remedial treatment. In such a frame of body any sudden alarm, a longer abstinence than usual, a fidler dinner than usual, unwonted exercise, and a thousand minute excitements of daily occurrence will often succeed in producing a fainting-fit: and especially where a morbid habit of recurrence has been once established, and there is a predisposition to return. Atonic plethora is another frequent cause in the peculiar constitution we are now considering, and a cause far too liable of itself to establish a circle of recurrence, and consequently to give a recurrence to the form of syncope before us. There is a singular example of periodic swooning in the Ephemera of Natural Curiosi- ties,* which seems to have been dependent upon this state of body : and another example in which it was evidently produced by a return of the term of menstruation, and became its regular harbinger.! In all cases of this kind, therefore, it is of the utmost importance to study minutely the character of the patient's idiosyncrasy and habit, and not to excite any alarm concerning organic mischief, and thus add another excitement to those which already exist, while there is a probability that the affection may be owing to one or other of these lighter and more manageable causes. In the latter case tonics, cold bathing, equitation, regular hours and light meals will form the Ijest prescription we can lay down. Where we are compelled to suspect some organic impediment or other mischief about the heart, small bleedings that may anticipate the usual time ofthe return, camphor, nitre, hyoscyamus, and what- ever other sedative may be found best to agree with the patient and diminish the rapidity of the circulation, will form the most rational medical plan we can devise ; while tranquillity of body and mind, an abstinence from all stimulant foods, and a regular attention to the state of the bowels should form a standard rule for the whole tenour of his life. * Dec. H. Ann. i. Obs. 10. t Id. Dec. ii. Ann. v. Obs. 53. «*. iv.] NERVOUS FUNCTION, Ford. rv. 359 GENUS VII. SYSPASIA. COMATOSE SPASM. CLONIC SPASM ; DIMINISHED SENSIBILITY ; INABILITY OF UTTERANCE. Syspasia, or syspasis from t?vmrxa, " contra ho, convello," lite-Gen. VII. rally imports convulsion in the popular sense ofthe term, or, in other J^"^'",^^ words, clonus or agitatory spasm, in combination with a greater or term. less degree of failure ofthe sensation and the understanding. The term seems wanted as a generic name for the three following dis- eases, whose symptoms, and, for the most part, mode of treatment, are so accordant, as to establish the propriety of linking them under a common division: 1. SYSPASIA CONVULSIO. CONVULSION. 2.-------HYSTERIA. HYSTERICS. 3.-------EPILEPSIA. EPILEPSY. The author has entered so fully into the nature and principle of o^fae °f J the patho- clonic or agitatory spasm under the genus clonus, that a very few logy given under clonus. * remarks will be necessary in explaining the pathology of these three un species. They are all of them clonic spasms, as expressed in the definition, but complicated with other morbid affections, and parti- cularly with those of the two preceding genera : for if we combine clonic or synclonic spasm with different modifications of vertigo or syncope we shall produce the three species that are now before us. In explaining the nature of clonic spasm we noticed the tendency there frequently exists when the uniformity of the flow or secretion of the sensorial power is once interfered with, to alternations of a hurried and excessive, as well as of a restrained and deficient supply, and consequently to an intermixture of constrictive or en- tastic spasm with clonic or agitatory, of which palpitation, and various other affections of this kind afford perspicuous examples. In the diseases immediately before us the proofs of such an inter- Distinctive mixture are still more striking ; for there is not one of them but of the spe- evinces an union of both descriptions of spasmodic action in a high, "p^Hata though not an equal degree of vehemence. In convulsion-fit the to the two kinds of spasm are nearly upon a balance, commonly with a geDU retention of some share of both sentient and percipient power. In hysteria the spastic or entastic action, in its sudden and transient irruptions, is more violent than the clonic, the force exercised at this time is enormous, and there is also, in many cases, a small retention of sensation and understanding. In epilepsy the clonic action is most conspicuous, and the failure of the mental and sentient faculties generally complete. 360 cl. tv.] NEUROTICA. [oh». *'■ Gen. VII. Of the essence of the nervous power we have repeatedly stated Comatose that we know nothing, for we can trace it only by its effects : but y)a!m' . we are compelled to conceive of it as a fine volatile and energetic cai prinfi- fluid, not existing out of the animal system, and, therefore formed, w?vaanctdd"v and consequently secreted, by some particular organ within it; which applied to organ there can be no difficulty in contemplating as the brain singly, geniis"86^ or the brain and nerves jointly, which constitute only different parts 'ower"" of one common apparatus. Admitting, then, the nervous power to how far be a secreted fluid, like all other secretions, this may be produced in quauitedC" excess or in deficiency, or be imperfectly elaborated, and, however AUn '*■ d produced, it may be irregularly communicated in its flow, as well fluid: and hy precipitation as by interruption. The means by which these dis- dncibiePin" eased actions take place, we have already touched upon ; and have exc^s md shown that the common causes are sometimes mental, sometimes Cy; mechanical, sometimes sympathetic, and sometimes chemical, as mechaiu*'' narc°ties and other poisons, and particularly those of repellefl cai, sym- eruptious. and che'mi- Now it is in persons of relaxed or debilitated fibres that we find cai causes, these exciting causes chiefly operative. For in those of high health, causes, full vessels, and a firm constitution, however the circulation may be chUsfly ope- accelerated, or the nervous power excited, it is rarely that we meet rative. with clonic spasms, or indeed, spasms of any kind : or, at least, we meet with a far less tendency to such abnormities, than in persons of lax and debilitated fibres, possessing, necessarily, more mobility, or facility of being put into new actions from the very quality of de- bility itself. Hence the The common predisponent, then, is weakness, particularly of the predispo nervous system ; and the common excitement, irritation. The pecu- ness',' espek ^ar effect must, however, be modified by the idiosyncrasy or pecu- ciaiiyof ^ liarity ofthe constitution, or of collateral circumstances, by which it Bystem but' may be influenced at the time. And hence the very exciting cause effect m'o- tnat 'n one '"dividual may produce hysteria, in another may produce dined by epilepsy, and in a third the more fugitive and less impressive attack "umsunces. of syspasia, as convulsion.* indifferent Tlle nature of tne idiosyncrasy, or, more particularly, ofthe indi- specie-ere vidual constitution, is rarely within our control; but the collateral inedXrent circumstances are often before us: they constitute the occasional individuals cause of the disease, and should form a prominent point in our atten- "asjrareiy tion to its progress. metdicnai There are, perhaps, few more common causes of weakness than control •. over-distended vessels ; and hence plethora is a frequent occasional tto^iLte- cause OI"each of the diseases belonging to the genus before us, the raicircum- species actually produced depending, as just observed, upon the in- Overdis'- fluence of other circumstances. Thus, if such plethora take place seufcom3; ™ a YounS woman of eighteen or nineteen, whose menstrual flux mon cause has been accidentally suppressed or retarded, it is most probable, if nossTak an irregularity in the nervous system be hereby excited, that such an ^efhora a irregularity wm ^ea(^to a nt °^ hysterics rather than to one of con- sequent vulsion or epilepsy* since we shall find, as we proceed, that this spe- ciccasional ■ause: * Pritcbard on Nervous Diseases, p. 13° ■*. Jv.j NERVOUS FUNCTION, [ord. iv. SHI cies of spasm is peculiarly connected with an irritable and especially Gen. VII. an orgastic state ofthe genital organs. Syspasia. On the contrary, if the plethora produce chiefly a distention of sPa,sm- the vessels of the brain, epilepsy is more likely to be the result; in ?enad St other words, that form of spasmodic action in which the sensation tuZT and the intellect suffer more severely than in either of the others. stance8l° While, if the plethora be general, we have reason to suspect that hysUL: the spasmodic effect will be general also, or, in other words, take ,°er °f.Cf[' the form of convulsion in which no single organ is tried more than oTof'con- another. Yet plethora, in a firm and vigorous frame, is seldom whTpic- found to produce either of these affections, for the resistance ofthe }^tin . coats of the blood-vessels is here sufficient to counter-balance the sousVes1^'" impetus of the sanguineous fluid, and, consequently, to prevent an J^Cl* over-distention. And hence, again, we see in what manner debility these becomes a remote or predisponent cause of the diseases under our effec,b' consideration. Plethora thus acting by over-distention may be regarded as a Plethora mechanical stimulus, upon the removal of which, as upon the re- *"°s"ea moval of other mechanical stimuli, the disease will cease. Vene- mechani- section is the most direct means of such removal; but it labours "m.81"11"" under the inconvenience of being only a temporary remedy. It takes off the occasional cause, but by adding to the general debility it gives strength to the predisposing cause. The more direct mechanical stimulants are sharp-pointed ossifica- More direc- tions formed in the membranes of the brain, or arising from the in- TtimaUnl^ ternal surface of the cranium; splinters of a fractured cranium, or the introduction of some wounding instrument. The occasional Mental causes resulting from mental emotions, we have already been called canseF to notice more than once; as also to show that while some of these appear to act by instantaneously exhausting the sensorial organ of its living principle, others operate by giving a check to the sensorial secretion. These modes of action are indeed opposite, but the result, which is a depletion of the nervous apparatus, is the same. And as in weakly or relaxed habits there is in every organ a greater Why in mobility, or facility of passing from one state of action to another, "nd motile than in the firm and robust, we see also why the former should be not habits the only more subject to spasmodic actions from mental emotion, but to fickflfass sudden changes of mental emotion, and, consequently, to caprice the fibreSl and fickleness of temper. Vol. IV.—-46 cl. iv. i NEUROTICA f0RD. 1\ SPECIES 1. SYSPASIA CONVULSIO. CONVULSION. i.fXJSCULAR AGITATION VIOLENT ; TEETH GNASHING : HANDS FORCIBLY. CLENCHED : TRANSIENT. In defining convulsion, most of the nosologists represent the fa- culties of the mind and the external senses as still sound and un- affected. Sauvagessays," superstite in paroxysmis animae functionem exercitio." Vogel distinguishes it, "cum integritate sensuum.'' Whether Dr. Cullen is more exact than either of these. His words are, exisuptIon "musculorum contractio clonica abnormis, citra soporem;" "an during the irregular clonic contraction of the muscles, bordering on but short of lethargy." The influence of the disease on the sensation and perception vary considerably in different cases, but so far as I have seen, the sensibility is always in some degree diminished, and I have hence ventured to introduce this feature into the generic definition as a pathognomic symptom. There are also some other differences that occur in the character of the disease in its different attacks, and which have been laid hold of as the ground-work of very numerous subdivisions by many noso- logists. For these differences we cannot always account: but in general they will be found to depend upon the idiosyncrasy, habit, or stage of life in which the disease makes its appearance, and to give rise to the following varieties : x Erratica. Migratory convulsion. /S Universalis. General convulsion. y Recurrens. Recurrent convulsion. P Ejulans. Shrieking convulsion. e Puerperalis. Puerperal convulsion. £ Infantilis. Infantile convulsion. The convulsion shifting irregu- larly from one part to another. The convulsion attacking every part simultaneously; occa- sionally protracted in its stay. The convulsive paroxysm re- turning after intervals more or less regular. The convulsion accompanied with shrieks or yells, but without pain. Occurring during pregnancy or labour, usually with coma, and stertorous breathing. Occurring during infancy ; pre- ceded by twitchings or start- ings, and accompanied with a blueness about the eves and upper lip CL. iv.] NERVOUS FUNCTION. [ord. iv. c)G3 In the first or migratory variety, the convulsion travels, in Gen. VII. some instances, so completely from organ to organ, and from one a sun- set of muscles to another, as to make an entire circle. ™'.sio e» In the second or universal variety, the convulsion is often ac- Migratory companied with a peculiar kind of percussion or hammering of one pX^""' limb against another, or against some other part of the body, resem- vuisio um- bling the malleation we have already had occasion to describe, and General constituting the malleatio of some authors. convulsion. In the recurrent variety, the intervals are often very irregular ; y s. Con- but the ordinary return, where any thing like a regular period is esta- currens?' Wished, is menstrual or lunary. To this, as also to the preceding, ^"^n many writers have applied the name of hieronosus or morbus merono- sacer ; which by others, as we have observed above, has been ^rb°urs limited to some modifications of chorea. sacer« In the fourth or shrieking variety, the muscles of respiration, 5 s. Con- and especially those of the larynx, appear to be chiefly affected; ejuians. and the shrill sounds or yelling to which it gives rise, proceed ^"vui^on. rather from an involuntary motion of these organs than from any greater degree Of pain that is suffered under this form than under any other. In puerperal convulsion, the irritation is supposed by Dr. «s.Con- Bland to derive no peculiar character from the state of the body at ^pe'ralts! the time. But it is impossible to shut our eyes to the close and ac- ^^V tive sympathy which exists between the sexual organs and the sen- sorium, and which is peculiarly striking in hysteria ; nor to the dis- tinctive symptoms which take place in convulsion from this cause ; in which there is a greater tendency to oppression in the head than in any other modification whatever, the breathing is stertorous, and the spastic action peculiarly violent; insomuch, that were it not that the head seemed first affected, we might resolve the oppression into the vehemence and duration of the entastic struggle. Convulsions of this kind occur during pregnancy, in the midst of labour, or imme- diately afterwards : they rarely, however, take place before the sixth month. Yet, if the irritation were not of a particular kind, we might rather expect it on the first turgescence of the uterus. But we shall have occasion to recur to this subject under the ensuing Class. In infantile convulsion, the mobility of the frame is impres- ^Con- sively conspicuous. The clonic motions are exquisitely rapid, and funtiiis. the fingers work and the eye-lids nictitate with a quiver that it is often [Ssion difficult to follow up. This constitutes the ecclampsia of Sauvages. In the subsequent stage of teething, as the irritative fibre is some- what firmer, the clonic vibration is rarely so rapid. Antecedently to the time of teething, the usual causes of excitement are retained meconium, flatulency, and acrimonious food.* The ordinary excitements of convulsion, however, operate at all Ordinary periods of life. They are often concealed, but are those of clonic menls, spasm generally. They consist not unfrequently, as we have already * Baumes.—Des Convulsions de 1' Enfance, de leur Cause, et de leur Traitemenr Stc, 8vo. Paris, 1789. $64 Gen. VII. Spec. L £ S. Con- vulsio iu- fantilis. Infantile convulsion. structural irritations: mental emotions : suppressed evacua- tions or exanthems. CL. IV.j NEUROTICA. ORD'. H Narcotic poisons. us Liruntis Lauro- ■erasus?; upas tiento. A parox- ysm some- rimes sud- observed, in pressure or other irritation, from a defonnity or some spicular node within the cranium ; and are said by Desessarts to occur most frequently in those whose sculls arc peculiarly large, or, in the language of Morgagni,! are nearly cubical in the occipital region. Pressure, however, or congestion in the brain from whatever cause, is an occasional source of this complaint. And hence con- vulsion is a frequent result of severe fright, or any other violent agi- tation of the mind. And, like several of the species we have just noticed, it is a frequent result of some suddenly suppressed natural or morbid discharge, or suddenly repelled complaint affecting a remote organ. It has hence appeared on suppressed menstruation, suppressed flow of milk, leucorrhcea or lochia; on suppressed dysen- tery,! or *he suppressed discharge from an old ulcer.§ And it has followed, in like manner, on repelled gout, exanthems, and cutaneous eruptions; even on a sudden cure of the itch, where it has been of long standing and has formed a chronic irritation. The usual causes in pregnancy and infancy we have noticed above. Convulsions are also frequently produced by many of the narcotic poisons in a certain degree of strength or activity, and a certain state of the constitution. For if the dose be very large, or the system much de- bilitated at the time, the irritability will be entirely destroyed, and death will often ensue instantaneously, without any struggle whatever. Thus the distilled water ofthe leaves or kernels of the prunus Lauro* cerasus, under different circumstances, will produce both these effects; as will also the distilled water of the kernels of various other fruits possessing prussic acid, as those of the black cherry and bitter almond tree ; and hence the prussic acid itself. And we may hereby under- stand the remark of Sir Hercules Langrishe* that one ounce of laurel- water will occasion more violent and stronger convulsions than five or six ounces. The dose of this water, given, by way of poison, to Sir Theodosius Boughton, was a draught phial full, and, conse- quently, about an ounce and a half. The struggling fit, in this case, began in a minute and a half, or two minutes, after it was swal- lowed ;|| it continued for about ten minutes, when he expired. The spasmodic action produced by these plants is chiefly clonic, which, in effect, is the ordinary action with which life ceases ; but there are others that render it of a mixed character, the entastic alternating with the clonic ; and some in which the rigid or entas- tic power considerably predominates, as in the poisonous juice of the upas tiente, which, though with occasional relaxations, fixes the muscles as rigidly as in tetanus, and continues the rigidity till the patient dies. In ordinary cases, however, the mode of attack and the progress of the paroxysm exhibit a considerable variation. Sometimes the * Journ. de Med. javii. 114. f De Sed. et Caws. Morb. Ep. ix. 9. X Hoefner, Baldinger N. Mag. B. vi. p. 323. § Gruellmann, Diss. Obserr. de usu cicuta? Goett. 1782. Ephem. Nat. Cur. Dct ^i^^^^i^x^'Esq"for the wilful murder of T-K-A CL. iv.] NERVOUS FUNCTION. [ord. iv. 365 assault is sudden and without any warning, but more generally there Gen> vn- are a few precursive indications, and especially in patients who are > |.Econ- subject to returns of it; such as a coldness in the extremities with a *uls.'? in- dizziness in the head, and floating spectra before the eyes, or a flatu- infantile lent uneasiness in the bowels, and a tenseness in the left hypochon- d°n,*Ug01m'e: drium. In other cases the patient complains of tremours in differ- time's ush- cnt muscles, and a cold aura creeping up the back which makes him precursive shiver. sisn3- The struggle itself I have already said, varies equally in its extent Diagnos- and violence, and I may add in its duration. The muscles are alter- description, nately rigid and relaxed, the teeth gnash and often bite the tongue* the mouth foams, the eye-lids open and shut in perpetual motion, or are stretched upon a full stare, while the protuberant balls roll rapidly in every direction : the whole face is hideously distorted. The force exerted is enormous, so as frequently to shake the entire room, and overpower the-strength of six or eight attendants. In some in- stances it has been so violent as to break a tooth, and even fracture a bone.* When the lungs are much oppressed in the course of the contest, the lips, cheeks, and indeed the entire .surface, is dyed with a dark or purple hue. The paroxysm will sometimes cease in a few minutes, but occa- Ceases sionally lasts for hours, and, after a short and uncertain period of 0" con-y rest, returns again with as much violence as before ; a fact peculiarly {j"^|.for. common to puerperal and infantile convulsions. Great languor returns at commonly succeeds; sometimes head-ache, vertigo, and vomiting, periods.'11 occasionally delirium : but not unfrequently, and especially in infants, there are no secondary symptoms whatever. The treatment of convulsion must apply to the paroxysm itself, Medicai and to the state ofthe constitution which gives a tendency to its re- of two"'' currence. kinds'as . , . . respecting If it proceed from a narcotic or any other poison introduced into the parox- the stomach, much benefit may often be obtained from the stomach thTintcrva'. syringe, employed by Mr. Jukes, of which we have given a brief description in a preceding volume.t If the poison be in a liquid form, it may hereby be considerably pumped up in its essential state, while the remainder, or the whole, if it be a powder, may be diluted and pumped up afterwards. As there is danger from congestion in the brain, venesection is, ycllPbK. in most cases, a good measure of caution, and, in many instances, t>°n gene- ts absolutely necessary : and hence, where plethora has preceded,' i "* and has threatened to become a cause, the disease has often been prevented, and sometimes effectually cured by a spontaneous hemorrhage from the nose, the ears, or some other organ. But b.ut jQ Per~ we have often had occasion to observe that, in weak and relaxed bits to be liabits, bleeding, if frequently repealed, increases the tendency to ^'great plethora; and, on this account, how necessary soever at the time, it caution. should be employed with caution, and persevered in with reluctance. Brisk cathartics introduced into the stomach, if possible, and where ^Jj"1*8 diis cannot be accomplished, in the form of an injection, lower the u.sp"»-" Gem.VII. may co-exist in the same individual : but so also m;\ vertigo or ce- sSa11' phalrca with either of them ; which would nevertheless continue to Hysteria, be regarded as distinct diseases, notwithstanding such an incidental ni*c7Z conjunction. And hence Mieg,* and various other established wn- hy,tor\* terst upon the subject have not incorrectly, though perhaps unnc- Tm&Z cessarily, treated of the disorder before us under th« two divisions cdto^'h1" of male and female hysteria, hysteria virorum, or masculma, and faminina. hysteria/Bminina. Swediaur, who affirms that man m ay labour under "ifiof the hysteric passion as well as women, arranges this and hypo- rfwediaur. chonc|risrn ag di3tinct species of a common genus, to which, with his extravagant fondness for long Greek terms, he has given the name of hyperkinesia. hferiand°f * Hysteria, like all other clonic affections, shows itself most frequently tempera- in mobile and iiritable temperaments, and particularly during that 'vhichhys- period of life in which irritability is at its highest tide, as from the «*p|le»»0.,ay aSe of Puberty to that of thirty-five years, seldom appearing before occasional the former, and rarely after the latter of tliese terms. The common 3es' occasional causes of convulsion, which we have already described, are also those of hysteria ; and hence, acrimonies of the stomach, or other abdominal organs, mental emotions, plethora, and particu- larly turgescence ofthe sexual region, are among the most frequent; on which account, we are told by Forestus,| and Zacutus Lusitanus,§ that one of the most common causes of hysteria in males is a reten- tion of semen, as one of its surest cures is an excretion. As every thing, moreover, that disturbs the uniform current of the nervous fluid, or the ordinary diameter of the blood-vessels or cavity of the heart, becomes a powerful irritant, we may also see why this dis- ease should occur on debilitating, and especially sudden evacuations, and be at no loss to account for its appearing on excessive as well as on suppressed menstruation, and consequently in leucorrhoea. And as the sexual organs lose much of their orgasm during the period of parturition, we may also see why the disease should attack barren rather than breeding women, particularly young widows, who are cut off from the means of exhaustion they formerly enjoyed ; and, more especially still, those who are constitutionally inclined to that morbid salacity, which has often been called nymphomania, and, in the present work, will be found under the genus lagnesis. Pathology. i nave already endeavoured to show by what means, in a habit of great nervous irritability, both clonic and entastic or rigid spasms are produced, and the disposition there frequently exists for them to pass into each other, or to alternate in rapid succession. And we have also seen that the former is most predominant in laxer, and more mo- bile, and the latter in firmer and more vigorous constitutions. There is no frame, however, that may not become a prey to spasmodic action of some kind or other, and hence there is no frame that may not become a prey, under particular circumstances, to this species of * Epistolse ad Hallerum scripts, No. v. r * Ep,h,:J?at- Cur* Dec- "• Ann- ,v* °bs- 18- 6L Tra»te Nouveau de Medicine Lions, 1684. I Observ. et Curat. Medic. Libr. xxvm. Obs. 29. 33. i DePraxi Admiranda. Libr. n. Obs. 85. ..l. iv.] NERVOUS FUNCTION. [ord. iv. 371 spasmodic action we are now describing. These circumstances are Gen. VII. very generally conealed from us: but we uniformly perceive that the sys^sia rule we have now adverted to holds true ; and that the hysteric spasms jjy*{jjj!|£ will assume more or less of a clonic, or of a spastic character, in pro- why some. portion as the individual is of a more relaxed or a more vigorous ei™nic°cha- make. And hence the most violent, though the least common, racier and instances of hysteric struggle that occur to us, are in young women 0c aspas- of the most robust and masculine constitution. |',ce-nce the The paroxysm often takes place without any previous warning or last most manifest excitement whatever, and especially where it has establish- r„Dlu™on° ed itself by a frequency of recurrence. Occasionally, however, we stitutions. have a few precursive signs which rarely show themselves in vain : generally as a sense of nausea or sickness, flatulency, palpitation ofthe heart, gnl'hp"tvj. depression of spirits, and sudden bursts of tears without any assigna- ous wam- ble cause, showing a disturbance in the secretion, or distribution of sometimes the nervous power. The fit soon succeeds with a coldness and shiver- precursive ing over the whole body, a quick fluttering pulse, and an acute feel- S'gn8 de- ing of pain in the head as though a nail were driven into it. The c"m!d' flatulency from the stomach or colon rises in the sensation of asuffo- mencement eating ball into the throat, and forms what is known by the name of |rnessp0f" globus hystericus. The convulsive struggle now commences, which Pur0*ysm in women of very mobile fibres is sometimes very feeble, the relaxant alternations prevailing over the contractile : but in other cases is prodigiously violent, evincing during the contractions a rigidity as firm as in tetanus, and a force that overcomes all opposition. The trunk of the body i3 twisted backward and forward, the limbs are variously agitated, and the fists are closed so firmly that it is difficult, if not impossible, to open the fingers ; and the breast is violently and spasmodically beaten. An equal spasm takes place in the sphincter Sphincter • . ■ • r. r. . • • i i .•, i i / • am often am ; so that it is often found impracticable to introduce a clyster pipe; jmpcrvi- and the urine discharged, though copious, is colourless. The mus- °^srltyedcon* clesof the chest and trachea are-agitated in every way, and hence, Whence there is an involuntary utterance of shrieks, screams, laughing, and ee'eams, crvinsr, according to the direction the spasm takes, sometimes ac- and fits of J o" o .ii I*. jj'i.* laughing. companied with, or succeeded by a most obstinate and distressing Hiccough. fit of hiccough. When the fit ceases the patient appears to be quite spent, and lies stupid and apparently lifeless. Yet in an hour or two, Jermina- or often much less, she perfectly recovers her strength, and has no p™0ljl*. other feeling than that of a general soreness, and perhaps some degree of pain in the head. It is rarely, indeed, that an hysteric fit becomes dangerous ; though it has in a few instances terminated in epilepsy or insanity. The definition asserts that the temper is fickle ; this is not to be ^ckieness wondered at ; for, in the hysteric temperament, the irregular and howTe15-" clonic flow of the irritative fluid is communicated, by sympathy, to counted all the sensorial fluids : and in consequence the mind is as unsteady as the muscles : " and from hence," observes the sagacious Burton, ^^p"0" who has painted strongly, but from the life, " proceeds a brutish kind hysteric of dotage, troublesome sleep, terrible dreams, a foolish kind of bash- £■£"" fulness in some, perverse conceits and opinions, dejection of mind, much discontent, preposterous judgment. They are apt to loathe, dislike, disdain, to be weary of every object. Each thing almost i* 72 cl. iv.j NEUROTICA. [OKD. U Gen. VII, Spec. II. Syspasia Hysteria. Hysterics. liloue of treatmonl. Chiefly to be directed to the in- tervals. M is-men- struation to be cor rected Plethora. Tonics, aromatics, and anti- spasmodics. tedious to them. They pine away, void of counsel, apt to weep, and tremble, timorous, fearful, sad, and out of all hopes of better fortunes. They take delight in doing nothing for the time, but love to be alone and solitary, though that does them more harm. And thus they are affected so long as this vapour lasteth; but by and by they are as pleasant and merry as ever they were in their lives ; they sing, discourse, and laugh in any good company, upon all occasions. And so by fits it takes them now and then, except the malady be inveterate, and then it is more frequent, vehement, and continuate. Many of them cannot tell how to express themselves in words, how it holds them, what ails them. You cannot understand them, or well tell what to make of their sayings."* The mode of treatment bears so close a resemblance to that for the preceding species that it will be unnecessary to enlarge upon it. Pungent applications may be applied to the nostrils, or round the temples, or the face and neck may be sprinkled or dashed with cold water during the paroxysm, and warmth and the friction ofthe hand be applied to the feet. The peristaltic action of the bowels should be increased, which can only be done by stimulant and cathartic injec- tions, if the contraction of the sphincter ani will allow them to pass. Our chief attention, however, should be directed to the intervals. And here the first recommendation is, sedulously to avoid every re- mote or exciting cause. If the menstruation be in a morbid state, this must be corrected as soon as may be, concerning which, how- ever, we shall have to speak in the ensuing class. If plethora be a striking symptom, the lancet should be applied to. In robust and vigorous habits we may bleed freely and have nothing to feaj, but in loose and relaxed constitutions far more caution is necessary, as has been already explained under convulsio. In this last state of body tonics should also be had recourse to, and many of the warmer sedatives and antispasmodics as assafcetida, camphor, most of the verticillate plants, and cajeput, which was a favourite remedy with Mieg.t Valerian has often proved servicea- ble, but is rarely prescribed in sufficient quantity to produce any good effect. " It seems," says Dr. Cullen, " to be most useful when given in substance and in larger doses. I have never found much benefit from the infusion in water. "| The ammoniated tinc- ture of the London College, however, is an excellent form : but even here the quantity of the root employed should be double what is prescribed. The cinchona may be usefully united with valerian, but does not seem to be of much benefit in this disease by itself. Opium is a doubtful remedy : where the precursive signs are clear it will often allay the irritation, and thus prove of great value. But it so frequently produces head-ache, and adds to the constipation, that it is rarely trusted to in the present day. When resorted to, it is best combined with camphor. Where the disease occurs in the bloom of life, and there is reason to apprehend the ordinary orgasm of this age to be in excess, the surest remedy is a happy marriage. * Anat. of Melancholy. Part i. Sec. in. 2. 4 t Epist. ltd Haller. ut. supra No. v. J Mat. Med. Part II. Ch. Vili. ct. rv.] NERVOUS FUNCTION. [ord. iv. 373 SPECIES HI. SYSPASIA EPILEPSIA. EPILEPSY. FALLING-SICKNESS. SPASMODIC AGITATION AND DISTORTION, CHIEFLY OF THE MUSCLES OF THE FACE, WITHOUT SENSATION OR CONSCIOUSNESS; RECUR- RING AT PERIODS MORE OR LESS REGULAR. The Greek physicians gave the name of epilepsy, from en-itM/u.- Gen,X}{" Savofcxi, to the present disease from its " sudden seizure or inva- ofmn of" sion," which is its direct import: and as the violence of passion or 'he generic mental emotion, to which the Roman people were accustomed to By the La- be worked up in their comitia, or popular assemblies, from the ha- ^bua'co- rangues of their demagogues, was one of the most common exciting mitiaiis, causes, it was among the latter denominated morbus comitialis ; an w r' in the popular language of our own day " Electioneering disease," in reference to the time and occasion in which it most frequently occurred ; or, according to Seneca, because whenever the disease appeared the comitia were instantly broken up.* There are many. other names, also, by which epilepsy was distinguished in former times, but it is unnecessary to recount them. The general pathology of the two preceding species, and which Pathology has been given at some length under the genus clonus, will apply to lected from the present: but it is obvious from the symptoms that the muscular fjj,*'°g„the power, commonly speaking, though not always, is affected to a less ce ing extent, and the sentient and intellectual to a much greater ; and s|,ect consequently that the irritative fibres suffer in a smaller degree than the sensific and percipient. Before we enter upon the history of the disease it will be conve- nient to remark that, from the different modifications under which it shows itself, it has been subdivided by many nosologists into very numerous varieties, but that the whole may be reduced to the following: a* Cerebralis. Attacking abruptly without any evi- Cerebral Epilepsy. dent excitement, except in a few instances, a slight giddiness. In this case the predisposing cause is external violence or some in- ternal injury, misformation or disease of the head. 0 Comitata. Catenating with some morbid ac- Catenating Epilepsy. tion of a remote part, with the sense of a cold vapour ascending from it to the head, or some other precursive sisrn. * Delra. 111. 7. 374 cl. iv.] NEUROTICA. [ord. iv. Gen. VII. Spec. III. Syspasia Epilepsia. Epilepsy. Falling- sickness. Causes mental and corpo- real. y Complicata. Complicate Epilepsy. The limbs fixed and rigid with clo- nic agitation of particular organs. Like hys- teria often produced hy a mor- bid state of (he uterus in an epi- leptic dia- thesis. Whether such a diathesis exist 1 The causes of epilepsy, like those of the two preceding species, may be mental or corporeal: but to produce this rather than either of the others there must be a peculiar diathesis, which seems to de- pend upon the state ofthe nervous organ. Where this exists almost any of the passions or mental emotions, when violently agitated, have been found sufficient to occasion a paroxysm, as anger, grief, fright, consternation : of all which the records of medicine afford abundant examples. In a like diathesis any kind of corporeal irri- tability will often become an exciting cause, whether more or less remote from the head itself; and particularly where it is productive of a preternatural flow of blood into the vessels of the brain. Thus an irritability in the ear from an inflammation, abscess, or some insect or other foreign substance that has accidentally entered into it, or the sudden suppression of a discharge to which it has been sub- ject, has in various instances produced epilepsy.* Hildanust men- tions a case in which it followed upon a considerable degree of irri- tation excited in the same organ by the accidental introduction of a small piece of glass. In like manner, an irritable state of the sto- mach, or intestines, or the liver, from chronic inflammation, debility, worms, or the presence of substances that do not naturally belong to it, has proved a frequent origin. Bartholine gives an instance in which it supervened upon swallowing pieces of glass; J and Widen- field another upon swallowing a needle.§ Confirmed drunkards are peculiarly subject to this complaint. Particular affections of the uterus are, in like manner, an occa- sional source of epilepsy, as well as of hysteria : and sometimes the latter has run into the former, where the epileptic diathesis has predominated. What this diathesis consists in it is difficult to de- termine, for it gives no external signs: and hence Dr. Pritchard seems to doubt its existence :|| but it is otherwise no easy matter to determine why a like irritation in the uterus should in one woman produce hysteria or convulsions, and in another epilepsy ; examples of which last occur very numerously in all the medical collections of cases. IT Menostation or a suppression or retention of the men- strual flux is, perhaps, the most common of this class of causes : and we may hence see, why it should occasionally be excited by a sup- pression of the lochial discharge. A sudden suppression, indeed, of discharges of almost every kind natural or morbid, of long con- tinuance in an irritable habit, has occasionally proved a sufficient source of excitement. And hence, it has followed upon restraining Demerehene, De la Conseillere in Diss, de Audita. * Hnrnung, Cista. p. 394. Ultraj. 1710. t Fabr. Hildan. Cent. i. Obs. 4. J Hist. Anat. Cent. v. Hist. 66. § Diss Ohs. Med. Triga. Goett. 1768. || On Nervous Diseases, p. 95. 1822. IT Moranus, Apologia de Epilepsia Hysterica, Orthes 1626. 4to. Schulze Diss Casus Hysterico-epileptici Resolutio. Hal. 1736. Eickmeyer Diss, d Epilepsia" Uterina. Ultraj. 1638. r <-'*■• iv.J NERVOUS FUNCTION. [ord. iv. 375 too abruptly a chronic diarrhoea,* or an habitual hemorrhage from Gen. VII. the nostrils,! or the hemorrhoidal vessels.:£ fPsEC,IW' Hence, also, repelled gout has been a cause, and still more gene- Epilepsia. rally repelled eruptions, and exanthems, as itch, various species of FaTmg-y" ecpyesis, small-pox, and in one instance miliaria. § Sometimes its,ekness- has occurred with the regular flow of the menses, and been re- excited by every periodical return . for where the peculiar diathesis exists, the slightest stimulus is often sufficient to call forth the dis- ease. In the case before us, however, the periodical discharge is usually accompanied with pain in the loins, or other local distress, as has been justly observed by Professor Osiander.ll Yet the most frequent cause of epilepsy is seated in the head Predispo- itself: and has been found on post-obit examinations to consist in mostCfre-e some morbid structure or secretion in the bones, tunics, or substance S cl. iv.j NEUROTICA lord. i%. Gen. VII. simiiar cause of irritation and mode of cure in a case of neuralgia ps%™'faciei; and it is highly probable that under a slight variation of the lepsiaco- nervous erethism in either instance, the one disease would have Cat'ennting been substituted for the other. ?PsTnie»- Under the third or complicated variety, while many of the siacumph limbs are rigidly fixed, almost without relaxation, the muscles of Compii- other parts are thrown into the most grotesque and ludicrous gesti- cawdepi- cuiations of chorea: and, if the muscles of the chest be affected in Sometimes this way, the patient appears in some cases to burst into involuntary pan'seT fits of laughter from their i- regular and clonic action.* At the same with lndi- time such has been the force of the spastic muscles as to break one or crous gi-s- * . . . . ticuiatic.ns: more teeth, to rupture an artery, or render a vein varicose ; and in Ipastic0'1' one case at 'east to burst the left ventricle of the heart itself.t violence It has been observed that the epdeptic paroxysm occurs chiefly at any^uciT irregular periods, and is for the most part of short duration. There one°6rbreak arei nowever^ some instances on record of a singular exception to more teeth this rule in both cases. For it has occasionally lasted for two or Habs°occa three flays with little or no remission. It has also returned at stated been*1!™- tmies^ and w*tn g>'eat frequency ; with the revolution of the morning, tracteu for or even of the night ; in one instance six times in a single day ;J three°duya anomPli" account for an adequate cause of this very singular phenomenon. dompii- The general mode of treatment proposed for the last two diseases °*^ ep'~ will apply to the present. The two-fold intention is to remove,"as Mocieof far as we are able, the exciting cause, and to allay the habitual iXn" ntion irritation ofthe nervous system. two-ioU: ,_T J ... to remove Where plethora manifestly exists, we may use venesection with the exciting great hopes of success, and, generally speaking, more freely than in °"iaye'an hysteria. But here also cathartics will be of considerable avail, and, the habitual in the hands of Dr. Hamilton, have been found sufficient alone to First in- produce a cure. To effect this, they should be used freely and Genesee. maintained steadily, so as to keep up a perpetual counter-irritation tion when in the bowels ; which may act as a revellent against the morbid irri- cathar- tation in any other part, and directly carry off whatever acrimony Jj^g^l1' may exist in the bowels themselves. opeiation Provided this be accomplished, the particular medicine employed &°°ounted does not appear to be a matter of great moment. Colocynth, gam- boge, sulphate of magnesia, and calomel seem to have been used with almost equally good effects ; though in visceral congestion the last should never be omitted. If worms be suspected, and especially on of tur- the vermicular ascaris, the rectified oil of turpentine should undoubt- pen edly be allowed a preference. Even where worms are not found to exist, this has often proved highly successful, apparently by the re- vulsive action it excites. As a purgative it should be given in ounce or ounce and half doses to an adult: but as an alterant in smaller doses repeated dady.* Cold affusion, whether general or confined to the head, has been cold affu- rarely tried in our own country, but is strenuously recommended by many foreign authorities, as well during the paroxysm as in the in- tervals ; particularly by Dr. Lobenstein-Ldbel. He employs it, in- how to be ". • . . ; i- „i c i • .1 adminis- deed, both in an entonic and atonic state of the frame, only in the tered uniet former case premising venesection. Under particular circumstances '^°™} it may be useful, but it requires great caution ; for even this writer stances. prohibits it where the patient is subject to gout, rheumatism, diar- rhoea, or nervous trepidations ; at the period of menstruation, or any other expected discharge, or on repelled eruptions.t It was probably from its stimulant and cathartic effects alone, that "^J^ the muscus Agaricus was ever in a high degree of popularity. It is a reddish mushroom, with a white, thick, and hollow pillar, and a reddish or crimson cup, nearly flat, about six inches in diameter. The dose was from ten to thirty grains of the powder to be taken in vinegar. Its effects, however, are sudorific as well as purgative, and, as°the last are not wanted, it has been judiciously relinquished for other medicines of the same class. It may be useful, neverthe- More use- less, to observe, whilst upon this article, that it is employed success- J^e^'pur- fully in destroying both flies and bugs, on which last account it has poses. * See Dr. Latham, Med. Trans. Vol. v. Art. xxm. and compare with his Treati?" on Diabetes. * Wasen and Heilnng der Epilepsie, &c. 8yo. 1818, 3«U cl. lr.j .NEUROTICA. [0R1>. IV. Gen. VII. Spec. III. Syspasia Epilepsia. Epilepsy. Falling- sickness. Treatment. Fiist in- tention Emetics often in- convenient, sometimes injurious. External stimulants. Accidental burn of service. Ligature round the limb yield- ing an epileptic mm. Second intention. Sedatives and tonics Popular use of stra- munium at one time; especially iti Sweden. been called bug-agaric. The former are killed instantly on their sipping milk in which the plant has been infused ; and the latter by rubbino- the juice over the holes and other places to which they re- treat in the day-time. De Haen often employed emetics, and chiefly for the purpose of exciting and maintaining a new action, for which purpose he con- tinued them daily for a week or two. His example wis followed at one time, but has long been relinquished as highly inconvenient, and in some cases injurious.* Externally, stimulants have also been tried, and in various instances seem to have been attended with good success. The spine has been rubbed night and morning with different preparations of am- monia, camphor, or cantharides ; and setons and issues have been applied to different parts of the body, as have also both the actual and potential cautery.t Where the cause of the disease has been suspected to be seated in the head, they have been chiefly confined to this organ, but where there has been a manifest aura epileptica, to the limb or other part of the body from which the vapour has seemed to ascend. And there can be no question that these also have frequently proved serviceable, especially in preventing the recurrence of subsequent fits, where a habit of return has been estab- lished. The practice is of considerable antiquity, for, under some modification or other it is recommended by Galen and many other Greek writers. In later times it has been chiefly employed by Baron Percy| an^ hy M. Gondret. Schenck has examined, at considerable length, the successful and unsuccessful cases which, in his day, had been published upon the use of cauteries.§ In several instances an accidental burn has answered the purpose of a surgical escharotic, and fortunately proved a radical cure.ll Professor Zoeffler of Al- tona, instead of cauterizing the limb from which the epileptic halitus seems to ascend, has ingeniously tied a tight ligature above the part whence the vapour issues, probably upon the ground of the success with which it is often attended in the bite of the rattle-snake, and other venomous animals, and in one or two cases the ligature seems to have proved quite as favourable in the present disease. The general irritability ofthe nervous system has been attempted to be overcome by sedatives and tonics. Of the former the chief have been camphor, cajeput, valerian, hyoscyamus, stramonium, and opium. The peculiar powers of all these we have so often had oc- casion to examine, and particularly under the preceding two species. that it is only necessary to offer a few words on the datura Stramo- nium. This medicine, like many others, has had a strange alterna- tion of fortune. About a century ago it was esteemed every thing, half a century ago it declined greatly in its reputation, and has of late been once more rising into esteem. Fourteen epileptic patients in the royal hospital at Stockholm, were, many years since, treated with * Rat. Med. Part v. Cap. iv. § 1. Eph. Nat. Cur. Cent. vi. Obs. 58. t Ab. Heers, Observ. Var. Lochcr, Observ. Pract. lioekard. Journ. de Med. Tom. xxv. p. 46. I Pyrotechnic, passim. § Observ. Lib. I. No. 233. ,!. Eph. Nat. Cur. Dec. I. Ann. n. Obs. 9. «i. iv.] NERVOUS FUNCTION. [ord. iv. 3b 1 pills of stramonium.* Of these, eight are declared by Dr. Odhelius, Gfn- vi1, in the official report upon this subject, to have been entirely cured, stasia11' five had their symptoms mitigated, and only one received no relief. Epilepsia. The greater number on first using this remedy were affected with Faiimg?" confusion in their heads, dimness in their eyes, and thirst; but these ™ek°"s;it symptoms gradually diminished. Second Where hyoscyamus has been given it has been employed both in i^iYnme- the leaves and seeds : Dr. Parr preferred the latter, and usually com- *"£ bined the seeds with some aromatics, commencing with doses of a Hyoscya- grain, and advancing them to four or five grains. m"s" The tonics employed have been both vegetable and metallic. vjnfestable Among the former the missletoe of the oak stood at one time at the Missiitoe, head ofthe remedies for epilepsy. It was regarded as a specific by lavp00uprular Colbatsch,| and most warmly recommended by Haller and De Haen.J formeriy; It appears, however, of no importance from what tree it is taken, for, as a parasite, it flourishes equally on many, and preserves its own peculiarities on all; and from every tree, so far as late experi- yet with- ments have been made, it is equally inefficacious and futile. It is ou reaso: difficult, indeed, to conceive what property could ever recommend this plant to therapeutic notice, for its sensible qualities are few and slight, both the leaves and roots having little smell, and only a weak, bitterish, nauseating taste. Bark, and the leaves of the orange tree, both of which have been FoIi.a au- very strongly recommended by many writers as powerful remedies for epilepsy, are almost as little worth a trial. The leaves of the iess power- orange, popular as they were at one time for the cure of this dis- [{Jg"1™ ease,§ have less sensible virtues than the peel ; while it is only in a Bark sei- very lew instances that we can indulge a reasonable hope of any dom ° UEC" degree of benefit from cinchona. In plethoric habits it will gene- rally do mischief, in the cerebral variety it can do little or no good; and it is only in a relaxed and mobile state of the animal frame in which we can expect the slightest success. The metallic tonics, however, offer a very different and more ah the cheering prospect: and all of them seem to have given proofs of a (onics'use salutary result. Ihe metals chiefly trusted to have been mercury, fu1, arsenic, zinc, silver, copper, and iron. Mercury has been tried in almost every form and to almost every Mercury. extent ; sometimes, indeed, to that of salivation, in which state some practitioners pretend to have found it highly useful. As a general plan, however, this can never be adviseable: and Muralt admits that in most cases where it has seemed to answer, it has only restrained the disease, or prolonged the interval, but not effected a radical cure.|| * Mem. del'Acad. Royale des-Sciences de Stockholm* traduit par M. Keralio, Tom. in. Razoux, Diss. Epist de Stramonio, &c. f See also Abhandiung von dem Missel, und dessen kraft wieoer die Epilepsie, Altenb. 1776. X hat. Med. Pract. Part vi. p. 317. § Hannes (Christ. Rud.) Epist. dePueroepileptico Foliis Aurantiorum recentibus servato. Leips 1766. Gesner, Beobachtungen, i. No. 19. The epilepsy wa- here an effect of terror. !i Hippocr. Helvet. p. 247. 382 cl. iv.j NEUROTICA. L«"u- 1V Gen. VII. Qf the preparations of zinc we took notice under convulsion, and syspasia the remarks there offered are equally applicable to epilepsy. Such, BPUeTa' noweveri has been the state ot exhausted irritability produced by Failing-' this disease in some instances, that the patient would bear almost tw™„. any quantity of them. Mr. Johnson of Lancaster gave the sulphate L 1e.ir.iLl6Di. * * •* • ■ /* l * J a. 1 Secona of zinc in doses of five grains twice a-day at first, and increased tlic intention. doge gra(juai]y to twelve grains. Thelemus had previously given ah its pre- eigjlt giains 0f the same daily.* Arsenic has of late been chiefly gWeTi"8 employed in the form of the common solution, and, as united with Entities, nickel, in the compound of an arseniate.j But the preparations of Arsenic: copper and silver have met with mo-e success than any of the pre- cow.er!*el' ceding. The best form of the first is thatof the cuprum ammoni- atum ; and the Edinburgh Medical Commentaries are full of cases cr^Tee that afford proof of its remedial power. The simplest mode of exhi- Edin.e ' biting this medicine is that of pills, as the pilula cwrulea of the Edin- burgh Pharmacopoeia, which is nothing more than ammoniated copper made into a pilular consistence by means of crumbs of bread. The patient should begin with half a grain of the metallic salt every night, and increase it to double the quantity if his stomach will bear it. Silver. The best, and indeed the common preparation of silver for the in T'ru'der purpose before us, is its nitrate. Under a more operose and unsci- fonn of entific form, it was employed as early as the beginning of the seven- Dark co°. teenth century by Angelus Sala, and afterwards by Boyle and Geof- Bkin °"omhe ^Y •> though for other complaints rather than the present. Dr. the use of Albers of Bremen has observed, and the remark has since been con- of6siiver.te firmed by Dr. Roget,| Dr. Badeley,§ and numerous other practi- tioners, that the use of this medicine, if persevered in, gives a peculiar darkness to the colour of the skin, which remains for many months after its discontinuance, and in some cases for upwards of two years. || Employed ^ Dr. Powel has tried the nitrate of silver in St. Bartholomew's in solution. Hospital upon a large scale, and in two forms, that of pills and that of solution, the solvent being mint-water which seems best to cover its unpleasant taste. Many of the cases seem to have been strongly marked, and they are given in a communication to the London h-°niraodeB College, ii They relate chiefly to young persons of both sexes, from viceaoie?r nine to fifteen years of age ; in all of whom the medicine proved Ehrempiu SUCCessful, and is said to have operated a perfect cure. The dose at first consisted of not more than half a grain or a grain of the me- tallic salt whether in the form of pill or of solution, given usually every four hours, but this was gradually increased to doses of three or four grains taken at the same distance of time ; and the increase was still continued till sickness or some other inconvenience forbad. It is singular that while the earlier writers complain very generally * Mediciniche und Chirurgische Bcroerkungen. Franc. 1789. t See a valuable article on this and similar medicines in the Edinb. Med. and Surg. Journ. No. xix. p. 374. \ Trans. Medico-Chir. Soc. Vol. vn. p. 290. | See Epichro-is Poecilia of this Work, Vol. v. Cl. vi. Ord. in. Gen. x. Spec. vi. [I On the Effect of Nitrate of Silver, Trans. Medico-Chir. Soc. Vol. ix. p. 234. *T Med. Trans. Vol. iv. Art. vm. '•l. iv.j NERVOUS FUNCTION. [o*d. iv. 383 ofthe purgative powers of this medicine, and the griping it produces, Gen. VII. the modem preparation excites no such effects; not even when it stasia11" has been carried, as it occasionally has been, to the amount of fifteen Epilepsia. grains to a single dose in the shape of pills ; though it should be Failing-7' remembered that few stomachs will bear more than five grains in a T^afment. dissolved state. Dr. M'Ginnis of Portsmouth affirms that he has Second employed it repeatedly both in recent and chronic cases, without,ntentI0n any perceptible effect, in doses of twelve grains : and M. Georget, who, however, does not seem to be much acquainted with its use, has condemned it, as a medicine dangerous to the coats of the stomach.* Iron, in all its preparations, offers a far less hazardous remedy, Iton- and in some instances appears to have been attended with consider- able success. The best form perhaps is that of the subcarbonate, in the proportion of a drachm three times a-day, as already recom- mended in the case of Neuralgia : and thus administered it has occasionally produced a radical cure. All these tonics seem to operate by taking off the tendency to irre- Mode by gular nervous action, and, consequently, the tendency to a return of ^iC'8cpro°" the paroxysm, where a habit of recurrence has once been estab- j!"?6 bene" lished : for in many instances such habit alone appears to be as epileptic much an adequate stimulus as a similar habit in intermittents : and m™n^fra" hence, whatever has a tendency to break through such a habit must have a beneficial effect; fevers themselves of various kinds have often done this ;t and especially quartans, the most obstinate ofthe whole tribe of fevers ; and the above remark explains their mode of Operation in this respect: it is that of introducing a new circle of actions. But the exciting causes of epilepsy are so numerous, and the dis- Causes and ease itself so complicated, that it would be in vain to expect success disease so* in every instance from metallic tonics, or any one description of ^"J}1'" medicines whatever. The remedies must often be varied to meet the reme- the varying case. And on this account it is by no means uncom- b^aried mon to find epilepsy removed by oil of turpentine or some other '<> meet purgative, that had obstinately resisted the most powerful doses of the metallic salts : while in some instances the disease is altogether The dis- i> • i ease some- irremediable. times irre- _ mediable. * Phys. de Syst. Nerv. Tom. n. p. 401. t Hornnng, Cista Medica. Norib. 1625, 4to. Augziige aus dem Tagebuche eines ausubenden arztes, &c. 1 Samml. Berl. 1791. 384 cl.iv.] NEUROTICA foiti.. in GENUS VIII. CARUS. TORPOR. MUSCULAR IMMOBILITY ; MENTAL OR CORPOREAL TORPITUDE OR BOTH. Gen vm. Cakus or xxpa, " sopor cum gravedine," is derived from xxpx, Origm of ll tjie head," being the organ in which the disease is chiefly seated. the generic => ° , --cjUiU' term. As employed in the present arrangement, the genus signified by this term will readily include the following species:— 1. CARUS ASPHYXIA. 3. 4. 5. 6. ---ECSTASIS. ---CATALEPSIA, ---LETH.4RGUS. --- APOPLEXIA. ---PARALYSIS. ASPHYXY. SUSPENDED ANIMATION. ECSTASY. CATALEPSY. LETHARGY. APOPLEXY. PALSY, Torpor preferred to stupor Carus, therefore, will be found to embrace under the present arrangement, a field somewhat more extensive than that allotted to it by most other writers, so as to include several of the species arranged by Sauvages under his two orders Leipopsychia?, and Co- Synonyms. mata ; to be nearly synonymous with the Defectivi and. Soporosi of Linneus ; and still more so with the Adynamia? of Macbride. As a generic sign the author has preferred the term torpor or torpitude to stupor or sopor, which have hitherto been chiefly made and sopor, use Qf for the same purpose; and ihis on two accounts First, as being of wider signification, since it includes the general idea fur- nished by both the others ; and, secondly, because neither stupor nor sopor has been uniformly employed in a determinate sense of any kind. Thus stupor is often, perhaps usually, restrained to mental insensibility or morbid sleep ; while Sauvages has explained it as meaning hebetude of the sense of touch, " molestia quae sensum tac- tfis obscurat;" and Linneus, transient sleep of any part, with a sense of formication, " sopor transitorius partis alicujus cum sensu formi- cationis." In this place, and indeed, generally, Linneus makes sopor combine the two ideas of a cessatipn of motivity and of feel- ing ; or of irritability and sensibility ; while Cullen objects, and cor- rectly, to this strained extent of the term, and limits it to the ordi- nary signification of" sleep, or a sleep-like state." Torpor, or tor- pitude, in the definition of carus now offered, imports insensibility mental or corporeal, in a frame still alive, and actuated, though often imperceptibly, by the vital principle, The term insensibility cl. iv.] NERVOUS FUNCTION. [ord.'iv. 385 would not so well answer the purpose ; it is of too wide a range, 9EN VI1L and too loose a meaning, being often predicated of insentient, unor- TwfSr. ganized matter, that never possessed the principle of life. Preferred r* ,1 i-i -n .. r. . to insensi- Uarus or torpor thus explained, will equally apply to all the species *>iiiiy, and we have just enumerated, some of which are very uncommon, and E&ntof a few of which have been supposed doubtful ; though, upon the l.he teim* whole, the authorities are in their favour, and they ought neither to "rpoVa" be omitted nor merged, as they seem to be by Cullen, in the sweep- f^K- ing name of apoplexy ; constituting in his hands a genus that includes sem ar" a variety of distinct, and in some instances, very different diseases ; rangement" but which, under his own classification, Dr. Cullen found it difficult to distinguish, or place separately. SPECIES i. CARUS ASPHYXIA. ASPHYXY. SUSPENDED ANIMATION. TOTAL SUSPENSION OF ALL THE MENTAL AND CORPOREAL FUNCTIONS! Asphyxy, from x privative, and w both distinguish- t-A from r,(jO|)ijxy- Produced by inhaling carbonic acid or some other irrespirable exhalation : countenance pallid. Produced by a stroke of lightning or electricity. Limbs flexible : countenance pale : blood unco- agulable. Produced by intense cold. Limbs rigid: countenance pale and shrivelled. In the first variety or asphyxy from hanging, or drowning, the immediate cause is suffocation, or a total obstruction to the respira- tion, and is so explained by Bonet, Haller, Lancisi, Pettit, and De Haen. The face, as we have just noticed, is turgid and suffused with livid blood : and the general symptoms are given with so much truth and emphasis by Shakspeare, in Suffolk's description of the body of Henry VI. that I copy them as a guide to the medical student: See how the blood is settled in his face ! Oft have I seen a timely parted ghost Of ashy semblance, meagre, pale, and bloodless; Being all descended to the labouring heart: Who in the conflict that it holds with death, Attracts the same for aidance 'gainst the enemy, Which, with the heart, there cools, and ne'er rcturneth To blush and beautify the cheek again. But see ! his face is black and full of blood.; His eye-balls further out than when he lived, Staring full ghastly, like a strangled man. His hair up-rear'd, his nostrils stretched with struggling , His hands abroad display'd as one that grasp'd And tugg'd for life, and was by strength subdued.4. This description, however, applies more fully to asphyxy frour hanging than to that from drowning, in which last there is more flaccidity in the limbs, and consequently less of" struggle and grasp, and tug for life." In both cases, nevertheless, the countenance has a semblance of apoplexy, as though there was a congestion of blood in the head, to which the application of the rope to theneck,inthe case of hanging, affords some countenance. And hence, many eminent writers of earlier times, as Boerhaave, Wapfer, and Alberti, referred suffocation from both the causes before us to apoplexy; while Cullen made it a subdivision of this last disease : and M. Portal has, still more lately, entered into the same view.j But in apoplexy there is always oppressive, generally stertorous sleep, which never exists in asphyxy, unless, indeed, the exciting cause has only partially operated, and produced a different disease, or apoplexy instead of asphyxy ; afford- ing us a proof of what in fact we have noticed in a thousand instances already, that different maladies may issue from the same cause, according to the degree of its violence, or perhaps the acci * Henry VI. Second Part, Act. lit. * Observations sur les Effets des Vapeurs Mephyhques. Nouv. Edit. Paris. n""t vl. iv.] NERVOUS FUNCTION. [ord. Iv. 387 dental condition or constitution of the patient. In asphyxy, GenVIH, wherever we can trace any sign of diseased action, the lungs are aC*A- ' chiefly affected ; in apoplexy, the brain. In the first the irritability sphyxm of the system is sudden and total, in the second it is progressive and tion?s.a" partial. In the former the patient is often restored after all the com- ^mSg- mon symptoms of death have, for some minutes, perhaps for nearly '"g «>\ an hour, fixed upon him : in genuine apoplexy this is never the cafje. The appearances on the dissection of drowned animals are very accurately given by Dr. Curry and precisely coincide with the dis- tinction here offered The vessels of the brain were found, in every instance, free from" distention, or any other morbid condition, while the lungs were overloaded. The author has observed that the immediate cause of asphyxy, or Where the m other words, an occlusion of the larynx, may be partial, and in of the'0" such case give a tendency to apoplectic symptoms. And in effect, Jmry"rxfg"; wherever the larynx or glottis is only imperfectly closed we meet theie m a' with such a tendency; and it is on this account that the face of to'upopiec- those who die by hanging is more generally turgid, and the muscles tic */."'"* give proof of more convulsive action than the face of those who die why. by drowning ; for in the former case, either from the rigidity in the mofelo'iT coats of the larynx, or from the rope not being properly applied, a hanging, small current of air is often capable of moving backward and for- drowning. ward for some time, and particularly in suicides, many of whom ^"j'^'d suffer much before they die in consequence of applying the rope very bunglingly, and whose cheeks, lips, eyes and tongue are pecu- liarly turgid and prominent. The reason of this may be partly col- lected from the history already given, in the Physiological Proem to the third class, of the state of the heart in the act of dying. The immediate cause of the contraction or systole of the heart, we observed, has not been satisfactorily settled : but we may safely affirm that a part of this cause, if not the whole, depends on the change,.whatever that change consists in, which takes place in the blood during its ventilation in the lungs, by which it is rendered mare active and stimulant; for as this change gradually subsides in those who are in the act or dying, the heart contracts more feebly ; and when, with the last expiration of air, it ceases altogether, the heart as instantly contracts no more : the consequence of which it that the lungs, the heart, and the larger vessels in the vicinity ofthe heart, are usually found filled with blood, the smaller vessels empty, and the general surface of the body pale. Now whatever has a power of instantaneously cutting off inspiration, must necessarily produce the same effect: and hence, as we have already observed, the gorged state of the lungs and the livid hue of the countenance in most cases of suffocation by drowning: and consequently the only reason why the lungs are not quite so full, and the countenance more turgid in most cases of suffocation by hanging, is that, from the inexpert manner in which the rope is usually applied, and the necessary admission of a certain portion of air to the lungs, the heart is, for some time, able to contract feebly, and to keep up a feeble circulation, while the pressure of the rope on the jugulars nrevents a readv return of the blood from the head, and conse 3St> cl. iv.'; NEUROTICA. [ord.iv Gen.viii. quently accumulates it in all the vessels of the face ; and hence, the „Sc?a- L more inexpertly this operation is performed, the more turgid these sphyna vessels must become, and the more apoplectic the general appear- SUToCU- tioms ance. {omhang- [t is t,ie sane' as we sha11 Prescntlv havn OCRas>on *° notice more ing'V ful|y, with persons who are exposed to the action of carbonic acid S'"m "apL gas or other mephytic vapours, so far lowered or intermixed with piectic -ip- respirable air as to render them incapable of destroying life instantly ; wmetimes in which cases there has not only been sometimes a feeble prolonga- STch'il tion of the circul ition. but even a stertorous breathing, and many r*amP- other symptoms of apoplexy, of which we shall have to speak fur- ther under the next variety. Ar.i under There are some of the narcotic poisons that seem to act in the ence'.'.^va. same manner. Given in a full dose they destroy the life instantly, colic""." Dut m an under-dose the circulation is continued feebly, and apo- sons. piectic symptoms ensue. Thus, according to Mr. Brodie's experi- ments, infusion of tobacco when injected into the intestines, and the upas antiar, when applied to a wound, have a power of rendering the heart insensible to the stimulus of the blood, and thus Suddenly stopping the circulation : while alcohol, the juice of the leaves of aconite, the woorara, essential oil of almonds, whether applied to wounded surfaces or taken internally, produce death by destroying the functions of the br in, while they act only indirectly on the cir- culation. illustrated In like manner, De Haen gives one instance of apopletic signs Haen. discovered on the dissection of a criminal who had been publicly executed by hanging ; in which the pia mater was found unusually florid, the vessels of the brain turgid, and some degree of serous effusion had taken place under the tunica arachnoides : but in this case he found, also, that the lungs were equally overloaded, and that the rope had not pressed upon the trachea, but upon the part lying between the scutiform cartilage and the os hyoides, and conse- quently that the compression had been imperfect.* Where the But, except in cases where the occlusion of the trachea has not occlusion , ' of the tra been entire, the patient who suffers from asphyxy produced by hang- tfe'thV"" ing' is as voi(l °f apoplectic symptoms as he who suffers the same ai'wa seflfbi- d*sease from drowning. In the dogs hanged by way of experiment lowsywhat by De Haen,t and cut down as soon as they were dead, and in those •verb, the drowned by Dr. Goodwin,* there was an equal absence of apoplec- tic signs : and, in truth, wherever an executioner does his duty com- pletely, the death is too sudden to allow of accumulation as its cause. JJhSo'dSx- By tIle double effect however, of sto »ping the circulation, and ob- terousiy ef- striding the passage of the air, the public punishment of hanging, combed when dexterously conducted, is probably attended with very little mtiepam, pam- ? ,,ias been said of late, that another, and indeed a chief and why.' cause of the suddenness of the death hereby produced is to be found Wh-'her J l theifi be a , n luxation of Rat. Med. contmuat. Tom. 1. part n. 8ro. uppefve'r! w!en\b|77*!,I,lg ^ ** "*" *" T°de9 ^ Ertrunkenen» Ernhenkten und Erstikten. fJ,CfneeKi0n °f Lic.with, ResPira*ion, or an Experimental Inquiry into the Ef- fects of Submersion, Strangling, &c. Lond. 1788. *«HU» J »»»« me r.i cl.iv.J NERVOUS FUNCTION. [oed.iv. 389 in a luxation of one of the upper vertebrae. Such an effect may Gen Yin. take place at times upon our public scaffolds, on which the hardened aS,TEAl l' criminal jumps from the gallows to-produce a rapid result, but it is si'hvxia rarely met wiih in the private retreat of the more timid suicide. tion?a.a" That a total obstruction to the respiration, moreover, is the chief £(sm^** m cause of death on hanging, is clear from the cases in which the ing or asphyxy has been cured by inflation of the lungs after the unhappy victim" of wretch has been cut down ; and from one o: two instances in which thj-law the individual has escaped death from an ossification of the trachea ; tTmes'Tco" of which we have a few curious examples in Bonet, and Fallopius ;* rrer1 uffc j -iir-i r being cut and more particularly from the case of uietta de Balsham, stated by 'i..wn. Dr. Plott in his Natural History of Staffordshire : who having been ExampleSl hung, in the reign of Henry VI., according to the due fyrm of law, was cut down alive, after suspension from nine o'clock on Monday til! later than sunrise on the ensuing Tuesday ; in consequence of which she received the king's pardon. Dr. Plott ascribes thi> extra- ordinary escape, and with great reason, to an ossification of the larynx : " She could not,'' says he, u be hanged, unon account that the larynx or upper part of her wind-pipe was turned to bone, 't It has hence been occasionally proposed to save a criminal con- Whether demned to the gallows by introducing a silver canula into the trachea, save life by It is commonlv reported that such an attempt was in agitation among * 8llYer . y. • ' canula. the friends of the unfortunate Dr. Dodd, but we have no reason to believe that it was then, or ever has been actually tried. The following experiment, however, as related by Dr. Curry, is Oecisjve almost demonstrative as to the immediate organ through which the mwitsof attack ■•'* death is received in hanging. It was performed at Edin- Monr0' burgh, many years ago, by the senior Dr. Munro, and in the lan- guage of Dr. Curry " clearly proves that the exclusion of air from the lungs is the immediate cause of death. A dog was suspended by the neck with a cord, an opening having been previously made in the wind-pipe, below the place where the cord was applied, so as to admit air into the lungs. In tins state he was allowed to hang for three quarters of an hour, during which time both the circulation and breathing went on. He was then taken down without appearing to have suffered much from the experiment. The -ord was now shifted from above to below the opening made into the wind-pipe, so as to prevent the ingress of air into the lungs, and the animal being again suspended, he was com dete'v lead in a fcw minutes."f Asphyxy from submersion has been very gener^'ly accounted for, Whether in even by manv who have regarded it as an effect of suffocation, by aro,nysxuyb. supposing the suffocation produced by a rush of the water into the ™'™'D cavity of the lungs which prevents the access of air. and conse- tubhes into quently of respiration. This idea, first, perhaps, advanced by Galen, „„";, ""P' has been in modern times adopted by Haller, Ooodwm, Pontfau, ^rreuacl'1*i*® and indeed most physiologists, and attempted to be supported by" various experiments on drowned cats It is now well ascertained, however, that in many cases of death from drowning not a drop of * Bonet. Lib. vii. Sect. xn. Obs. ii. Fallop. Tom. i. Obs. vi. f Hi»t. p. 292. t Observations, p. 71. 390 cl. iv.] NEUROTICA. [orp. rv. Gkn VIII. Sl'EC. I. «C A- sphyxia sunoca- tionis. Asphyxy from hang- ing ..r drowning. GIjIus how neces- sarily closed in sub iiei sion Further illustrated How long life may bo restored after hanging or drowning; during si.f- foCHtion dependent on various circum- stances. Submersion generally recovered from if not more than five mi- nutes. Sometimes if a quarter of an hour: rarely if half an hour or twenty minutes. Illustrated. water enters into the lungs ; that where it does enter, the quantity is, for the most part, ve«y small; and that, whether small or large, it passes the trachea after death instead of before it, and conse- quently cannot be a cause of death. The immediate cause, as in the case of suspension, is suffocation. The glottis is extremely irritable ; the access of the surrounding water produces a rigid or entastic spasm upon its muscles ; and the rima is as completely closed against the entrance of air, as in the case of a cord round the throat. And hence, tht suffocation often produced by a very small substance of any other kind accidentally thrust into or stimulating its aperture, as a minute crust of bread, a hair or blade of grass, a peach or even a grape stone; to which lagt Anacieon is well known to have fallen a victim. How long the living principle may, under these circumstances, remain attached to the animal frame, and afford a chance of reco- very, is not ascertained, with any degree of accuracy, even in the present day : and the answer to the question must, in a considerable measure, depend upon the degree of irritability, or perhaps the idio- syncrasy, of the individual. Mr. Brodie is reported to have asserted in his Lectures before the College of Surgeons that " when the action of the heart has ceased after the suspension of the breathing, or even has become so feeble as no longer to be able to maintain the circulation, it can never be restored by artificially inflating the lungs." This maybe true: but we have innumerable proofs of a natural restoration of both these organs to healthy action after such action has ceased for many minutes ; perhaps for many hours in Catalepsia or Trance, as we shall have occasion to observe presently. It has been known, however, from a very early age, that torpitude from drowning may be induced and continue for some minutes, with- out much danger : since this as we have already observed, was a common practice among the Greeks and Romans for the cure of lyssa ;* and was carried by Van Helmont so far that he would not suffer the individual to be raised from under the water till the psalm Miserere had been solemnly chaunted, which was the measure of time he allowed. If the submersion have not exceeded five minutes, and no blow against a stone, or other violence have coincided, per- sons will usually be found to recover without much difficulty. After a quarter of an hour, recovery is not common, and after twenty minutes or half an hour, it is nearly hopeless. Divers, from habit, are able to remain under water for three minutes ; but, according to Dr. Edwards of Paris, this is the longest period.! Young animals require less change of respirable air than those that are old. Dr. Edwards has known puppies live under water fifty-four minutes, though their voluntary motions had ceased in four minutes alone. The first report of the establishment for the recovery of drowned persons, at Paris, divides the cases that had occurred to it into three classes, the first of which includes those that were restored to life, and comprehends twenty-three instances. Of these one recovered * Vol. in. Cl. iv. Ord. in. Gen. i. Sp. viii. t De l'lnfluence des Agens Physiques sur la Vie, &c. Paris, 8vo. 1824. ci-iv.] iNERVOUS FUNCTION. [ord.iv. 391 after having been three quarters of an hour under water ; four after Gen VIII. having been half an hour, and three after a quarter of an hour ; the /a*!-1' rest after a still shorter period.* Of twelve dogs, drowned by De "phy*'* Haen for the purpose of experiment, not a single one was recovered tionis.a though only confined under water for a few minutes. It is very pos- £*'*^*ay sible, however, that in these cases the force necessary to keep them ing or submerged, may have considerably added to the extent of the mor- d,own,Dfr tality. Among mankind, where no such force is applied, this emi- About one nent physiologist conceives that one in sixteen is no unfavourable lecdve^of average of the proportion that recover.! those that There are cases, indeed, on record, of recovery from drowning ed acciden- after a submersion of some hours ; but these are rare and wonder- g,^ re]a, ful, and some of them altogether incredible : for we have histories »'■ns of of recovery after eighteen hours,J four and twenty hours,§ and even wonderful three days,|| while some ofthe retailers ofthe marvellous have stated cr^bnitr intervals of fifteen days, and in one instance, related with much gravity, not less than seven weeks. If From all which, however, we may at least learn the useful lesson of the necessity of redoubling our exertions when called upon for medical aid, and of not despair- ing very early. Dr. Edwards of Paris has lately been instituting some singular Experi- . ~ merits of experiments on the Batrachian amphibials (reptiles of the Linnean Edwards system,) and especially on frogs and salamanders, to determine how £" fr ^Wiained. t Brukser von den ungewissheit der Kennzeichen des T0de< piectic symptoms, and why. ft.'eiining nf choke- damp. By what CL- *v.] NERVOUS FUNCTION. [ord. iv. 39j they have penetrated the lungs, become so rapidly communicated to Gen.VIII. the nervous system as to prove instantly destructive, we do not seem ^^." L to be very well informed. Absorption would be the most ready way sphyxia of accounting for it, but till the objections thrown out by Mr. Ellis choke-'™' against an absorption of oxygene or any other gas by the lungs, and oSities which we have noticed in the Physiological Proem to our second attending Class, are more satisfactorily replied to than they appear to have been, IhLhfof" it is a hypothesis that can hardly be allowed. In the case of hanging absorption. or drowning it does not seem to be owing to a direct want of irritability that the heart ceases instantly to contract, but, as we have already- remarked, to its being deprived ofthe necessary stimulus which is no longer afforded by the lungs, however they may act in providing it. Yet in the present case there seems to be not only a cessation of A|Jp,aar,en[),.y action, for want of a proper stimulus, but a total abstraction of both stracthm sensific and motific power ; and this as completely in one part ofthe °ensific and frame as in another. motific The gases of the description before us that are found the most Games' fatal, are the carbonic acid, hydrogene, nitrogene, and several of a ^oUgele" more compound kind which are thrown forth from putrefying animal and vegetable, substances, and especially from cemeteries, on opening ^d/ryoma fresh graves, in which the process of decomposition is proceeding putrefying rapidly, and the concentrated effluvium bursts forth with an intole- sravcc: rable stench. Ofthe powerful effects of this last exhalation, Four- croy has furnished us with a very particidar and striking account from the narration of grave-diggers examined for the purpose ; from its instant which it appears that those who are immediately hanging over a 0|>eru corpse, whose abdomen is accidentally struck into by a pick-axe, often fall down instantly in a state of senselessness and apparent death, while persons who happen to be at a little distance, and receive the exhalation in a form diluted with atmospheric air, are attacked with nausea, vertigo, faintness, and tremors, which continue for some hours. The most common of these gases is the carbonic acid, which is Carbonic chiefly found in the guise of a torpefying vapour in close rooms where ^t8ca0'„. charcoal has been burnt, at the bottom of large beer-casks, or of ™^ wells, and in many natural caverns in the earth's surface. Its weight chiefly {>revents it from escaping readily, even where there is an accession p^"^^ of atmospheric air; and its want of smell, when pure, prevents byjts it from being detected otherwise than by its effects. As it will ftomcl- not support flame, the common and easiest test, where it is sus- capmg ^ pected to exist, is that of a lighted candle, which is well known to-undisceitu- be extinguished immediately, if this gas be present in a quantity ^ee|',y sufficient to be injurious to respiration. wheth^'it" Nitrogene and hydrogene, when pure, have probably as little smell Win sup-1 as carbonic acid gas ; but they are generally combined with other fi°rgtu-srIlcx- gases, sulphur, carbone, or phosphorus. The first, formerly deno- flame.^ minated phlogistic air, and sometimes mofette, is thrown forth foJSy8 largely during the decomposition of animal matter, and in a small phlogistic degree during that of vegetable matter. Combined with hydrogene it forms ammonia; with oxygene, nitric acid. Fourcroy asserts that JJ^sl11 it possesses a peculiar and distinct odour resembling that of fishes specific 396 et.iv.] NEUROTICA. [ord. iv. Gen.VIII Spec. I. 0C. A- sphyxia mephitica. Choke- damp. Hydrogene its offen- sive odour in combine tion with other ma- terials. How far ^nirable. Metallic fumes. 3rumes of charcoal operate differently according to their degree of concentra- tion or other cir- cum- stances. Illustrated. treatment of this mo- dification of asphyxy V"oltaic electricity, how to be applied. just beginning to putrefy; but this is probably at all times produced by its combination with other materials. It seems chiefly concerned in giving the greenish colour to parts, and especially muscular parts, in a putrd state. In some gases of this kind a candle will burn freely. Hydrogene issues also from fecal matter, and, in combination with sulphur, phosphorus, and carbone, produces the chief part of the nauseating and putrid stench thrown forth from decomposing animal and vegetable substances. It is emitted in a much purer state from the sides of coal and metallic mines, and often exists in considerable aburtdance without being perceived by the nostrils. If mixed with an equal proportion of oxygene, it may be breathed for about an hour without any great inconvenience. If inhaled beyond this time, or in a more concentrated form, it has a great tendency to occasion the effects we have just noticed, lower the irritability of the animal frame, and induce stupor or an inclination to sleep. The fumes of mercury, lead, and some other metallic substances, when highly concentrated, seem to operate not very dissimilarly to those of charcoal, and give a check to the mobility of the nervous power at once. The fumes of charcoal are generally inhaled in a diluted form, but they are still highly deleterious and produce asphyxy more or less complete, according to their degree of concentration, and in some cases according to the strength or weakness of frame of those who are exposed to them. We have a striking illustration of this in the case of two persons communicated by Dr. Babington to the Medico-Chirurgical Society, who had gone to bed in a room in which a charcoal fire was kept up through the whole of the night, with whose gas the surrounding atmosphere was strongly impreg- nated. According to the principle we have endeavoured to establish, we ought here, from the dilution of the vapour, to expect that what- ever tendency there might be to asphyxy would be united with a tendency to apoplexy. And such we find to have been the fact: for, of these two persons, the younger and less vigorous, a boy of thirteen, died apparently during his sleep, and without commotion : while the elder and more robust, a man of thirty-eight, was found, upon being called in the morning between six and seven, in an apo- plectic state, with a swollen, projecting tongue, suffused and promi- nent eyes, and laborious breathing. The patient, if any degree of sensibility remain, should in this va- riety be freely exposed to the open air, instead of to a heated atmos- phere as in the preceding: and, if he can swallow, acidulated liquids should be given him. If insensible, cold water should be dashed on his face; strong vinegar, and especially aromatic vinegar, be rubbed about his nostrils, and held under them, and stimulating clysters be injected, as recommended under the first variety. The lungs should be inflated with the warm breath of a healthy man, or, which is better, with oxygene gas. A proper use of voltaic electricity is also in many instances found highly serviceable as a nervous stimulant. No advantage, however, is likely to accrue from passing the electric aura across the chest, di CL-iv-J NERVOUS FUNCTION. [ord.iv. 397 rectly through the heart and lungs which is a common practice. The Gen Yia- fluid should be transmitted along the channel of the nerves, from /f cEa- '' the seat of the phrenic nerve in the neck, to the seat of the dia- sphyxje phragm, or that of the par vagum and great sympathetic nerve im- c'hokel'ca' mediately under the sterno-mastoid muscle, where they lie in acorn- Treatment. mon sheath, and send forth branches to the heart.* In Dr. Babing- ton's case, the application of voltaic electricity surprisingly increased the power of the muscles of respiration, but appeared rather to di- minish the action of the heart. It was hence used alternately with a forcible inhalation of oxygene gas, and various external stimulants. Venesection was tried, but does not seem to have been beneficial. The man recovered in a few days. M. Portal recommends a division of the jugular vein, but the blood Pivisi°n °f will rarely flow from any vein, and is still more rarely succeeded by h^w faV6"1 any advantage even where it is obtained. And if every other remedy 1$,™?' fail, he advises bronchotomy, and a scarification of the feet and bronchoto- hanrh t m3> and nanas.l scarifica- The sprinkling or dashing of water upon the body seems to be ^°n". useful on two accounts ; first, from having a tendency to rouse the of cold vessels on the surface to contract; and next as affording an oppor- water" tunity for a disengagement of oxygene. In the thikd, or electiuc variety, the whole system appears to y° A- be not so much rendered inirritable to stimulants, as to be suddenly piectri'ca. exhausted of its entire stock of nervous power, like a Leyden phial fje"^cal upon an application of the discharging rod : in consequence of which How the limbs are flexible, the countenance pale, and the blood uncoa- "perate8, gulable. The mode in which the electricity is communicated is of Effects little importance ; for, if sufficiently powerful for the purpose, real animate or apparent death is instantaneously produced, whether the stroke ""ererlik flow from lightning, an electric battery, or a voltaic trough; and degree of every organ is equally affected and emptied. whatever Upon plants, on the contrary, we often find a stroke of lightning ,he fornl ofthe same intensity occasion very different effects in different kinds operates' or branches of the same plant, in consequence of the variety they en't^ffeei"" exhibit as conducting powers. Upon some, it descends without in different mischief; in others, it exhausts itself on particular parts, which are pants- withered, as though attacked by a hemiplegia. In the betula alba or common birch, it never runs along the stem, but confines its stroke to the top alone, beatbig off the boughs in every direction. In animal life, however, there is also a difference of effect, but if etat" Med. Havniensis Collectanea, &c. Vol. n. Art. Tentamina Electrics in Ammalibus. t Rhazes ad. Almans. Tract, vi. Cap. v. vii. Cl. iv.j NERVOUS FUNCTION. [oun. iv. 399 ever, by the exertion of Mr. Banks, he was awakened. Several GenVIH. others of the party very narrowly escaped ; and two of them slept, s oPEAC-' '" and perished from the cold."* ephyxiaai- For these symptoms, and their effects, it is easy to account. Frostbitten Cold, so long as the living power is capable of producing a reaction, EB£eCytXex- is one of the most strenuous tonics we are possessed of, and the plained.' glow that accompanies the reaction, is felt to be peculiarly vigorous and elastic. But if it exceed this proportion and no reaction ensue, the contraction of the vessels on the surface is converted into a rigid spasm, the blood is driven into the interior, and the surface must necessarily be pale. In this extremity of temperature, moreover, cold, instead of being a tonic, is one of the most formidable sedatives in animal chemistry : it carries off the heat of the body far more rapidly than it can be recruited, and as effectually exhausts it of all its irritable and sensible power. But such exhaustion, as we have already shown under the genus paroniria, is a cause of stupor or sleep, and a cause so cogent that the will is, in many cases, inca- pable of resisting it, and falis a prey to its power. In applying remedial means to this modification of asphyxy, great Medicai caution is necessary respecting the employment of warmth; and particularly where the limbs are peculiarly rigid, and under the in- fluence of frost. In this last case it will be generally found most advisable, in the first instance, as in frost-bitten limbs, to plunge the body for a few minutes into a bath of cold sea-water or salted water, at the same time that warm air may be breathed into the lungs, and the stomach and rectum gently excited by moderate stimulants : for it does not follow that, because the limbs and surface of the body are frozen from frost-bite, the central parts have suffered to the same extent. After a short emersion in sea-water the body should be taken out, wiped perfectly dry, laid in flannel in a moderately warm room, and submitted to the friction of warm hands, several persons Keing engaged in this process simultaneously. SPECIES II. CARUS ECSTASIS. ECSTASY. TOTAL SUSPENSION OF SENSIBILITY AND VOLUNTARY MOTION ; MOS1 LY OF MKNTAL POWER : PULSATION ANP BREATHING CONTINUING : MUSCLES RIGID : BODY ERECT AND INFLEXIBLE. There is so close a connexion between the present and the ensu- gEN,v?j- ing, and, in truth, most of the ensuing species of the order before Many of us, that they are occasionally apt to run into each other, or to exhi- *h*ses,pecies bit a few aggregate symptoms. And on this account they have been connected and apt to run into * Hawkesworth's Account of Voyages, Vol. ii. p. 4R. ^ach other, iOtj cl. iv.j NEUROTICA. [ord. iv- Gen VIII very differently arranged by different writers. Sauvages, and most cSafuEsC^cIL ofthe continental nosologists, have regarded them as distinct genera, stasis! JJr Mead, and Dr. Cullen, as species or subdivisions of apoplexy, o'to'ex- and Dr. Clieyne, as the same of lethargy. Dr. Cooke has treated h.uii «gSre- Qf triem m0re cursorily than those who are acquainted with his foams8ymp" talents and learning could wish : and has so far followed Dr. Cullen ferenu dL'r- as to Place them conjointly in a chapter under the head of apoplexy: "ngVby whUe Dr. Young, coinciding with the view taken in the present Melid?68' work, has arranged the whole as a species under the generic name Chevne'!"11 ofCAKt'S. Cooke =* To understand the nature of their distinctive symptoms, and the General reason of their occasional combination, it is necessary to bear in SenS»or'uuy mind tne re'nark3 offered in the Physiological Proem to the present powe°r"dif class respecting the natural division of the nervous ramifications into different fibres of different sets and powers, and the different kinds of fluids disturbed: which these several sorts are capable of secreting or conveying, as sensific and motific fibres, and sensific and motific fluids ; since it happens that some of these diseases are confined to one set, and others to another, while other diseases, again, extend equally to both. And hence we are able to account for disorders in which the perception or sensibility is abolished, while the irritability continues witiiout much interference : or in which there is a disturbed flow or total cessation ofthe irritable power, with little interference with the percipient, and sometimes also with the sentient, as in some cases of paralysis : or in which there is a disturbance or cessation of all these, with the exception of a partial supply of irritative power to the involuntary organs. It will also be necessary to recollect, as we have endeavoured to show in many of the preceding pages, and par- ticularly under the genus clonus, that where there is a disturbance in the How ofthe motific or irritative power, this disturbance is of two oiueflyfrom kinds, one from excess, and one from deficiency ; and that in both FroiiTde*" cases there is a great irregularity of action, and consequently entastic ficiency. or rigid, and clonic or aguatory spasms, exhibiting by their continua- tion, innumerable modifications. General All the divisions ofthe nervous system, moreover, have a natural to syoipa: tendency to sympathize in the same action, however combined or dinVrent interchanging: and hence in whatever division of it a disease corn- divisions of mences, one or more of the other divisions are peculiarly ant to par- the nervoun .• «. ■ i_ jj> •■ 1.1 •• ?ystem. ticipate in tne anection : and the more so as it is not very common for abnormal actions, when once communicated, to proceed with much order or regularity : for if trismus and tremor give us exam- ples of such order, tetanus very generally, convulsion-fit, epilepsy^ and hysteria furnish proofs of the most capricious alternations of spastic and clonic action, or of their existing in different trains of muscles simultaneously. These re- These remarks peculiarly apply to ecstasy, the species imme SSiuriy6" diately before us, compared with catalepsy or trance, the species taoPecsCta8y that immediately follows. In both-, the nervous fluids contributory to compared sensibdity and irritability are disturbed in their flow or regularity of }TpshyCata' action' but not equally, nor in the same manner : for while the SSTJo1 flow of the former seems to be totally suspended, that of the latter **•• »v.j NERVOUS FUNCTION, [ohd. iv. 401 continues, though with a striking deviation from the uniform tenour GenVIH. of health. Thus far the two diseases agree. They differ in the cZub'eI-' nature ofthe disturbance ofthe motific fluid. In ecstasy, thisseems *£«• to be secreted in excess and irregularly accumulated ; in conse- Wherein quence of which the muscles are thrown into a rigid and permanentthey diffe" spasm, not incurvating the body, as in the different modifications of tetanus, but maintaining it erect from an equal excess of supply to the extensor and flexor muscles. In catalepsy, on the contrary, the motific fluid seems to be secreted in deficiency rather than ip excess, though it is often irregularly distributed ; and hence, while some muscles appear sufficiently supplied, the action of others, even the involuntary ones, is often peculiarly weak. Whence, also, the limbs, instead of resisting external force, yield to it with readiness, and assume any position that may be given to them. In both cases the torpitude of the external senses, appears to in both ihe extend to those of the mind ; for the patient, on returning to himself, Eternal has no recollection of any train of ideas that occurred to him during arises ■ . *5 equally the fit. Yet, we shall find presently that in a few instances, the torpid in power of sight and of judging, and perhaps some other powers, do ?e"""t' not seem completely to have failed. always. It deserves, however, to be specially remarked, that both these B°'h dis- diseases are most common to persons constitutionally disposed to common to some mental estrangement, as melancholy or revery, hypochondrism, [^d°"pOSe(i or morbid elevation of mind ; thus pointing out to us the outlet at to mental which the sensorial power is often carried off: for we have already menu86" seen that, under intense revery, the external senses are, for the most conclusion part, inactive or torpid to the impression of surrounding objects drawn from during wakefulness : while the mind is alike dead to every thing but w"^^*!. the train of ideas which immediately constitute the subject ofthe revery. The same tendency to abstraction, though not carried so completely into effect, is often to be found in melancholy, and still more so in that species of alusia which, in the present work, is denominated elatio, mental elevation or extravagance, and particu- larly the variety called elvtio ecstatica4 false inspiration, vision- ary conceits. If the person labouring under any of these be attacked at the same time with a general entasia, or rigid tetanus, erecting instead of incurvating the body, he will be thrown into an ecstasy, constituting the present species. And if, instead of an excessive there be a deficient supply of irritable power, and consequently a flaccidity or flexibility of the muscles instead of a rigidity, his dis- ease will be a catalepsy, constituting the ensuing species, with this difference alone, that in most cases of the two diseases before us, the faculties of the mind unite in the torpitude of the senses, instead of giving rise to it. I say, in most cases, and have kept'to the same limitation in the specific definition : for if it be true that one of the causes of both these affections is profound contemplation or attention of mind, or some overwhelming passion, as we are told by many writers, the mind does not seem, in such cases, to be without ideas, nor without them in a very energetic degree. And it is to ecstasis under this modification that I am inclined to think we should refer the cato- catochuc Vol, IV.—51 '^ 402 NEUROTICA. [ukd. n GenVIH Spec. II. Carus Ec- stasis. Ecstasy. Predispo- nent cause of ec-st-isis Exciting ™use. Ilemedial intention. Where connected with a morbid state of the liver, mercury useful. Interesting rase from i;iiisholm. cuts of most of Ihe nosologists, which they arrange in the same order as, and next to tetanus, and define a " general spastic rigidity without sensibility." Ecstasis is of rare occurrence, its predisponent cause is unques- tionably a highly nervous or irritable temperament: the exciting or occasional causes it is not easy, at all times, to determine. For the greater part they seem to be of a mental character, as profound and long continued meditation upon subjects of great interest and excite- ment ; and terror or other violent emotions of the mind. It seems also to have proceeded, like most ofthe spasmodic affections already treated of, from various corporeal irritations, and particularly those ofthe stomach and liver, suppressed menstruation, repelled chronic eruptions, and plethora : and perhaps occasionally, as hinted by the younger M. Pinel, from an inflammation ofthe spinal marrow.* The duration ofthe fit varies, from a few hours to two or three days. The patient rouses as from a sleep, seems languid, and complains of nau- sea and vertigo :—evidently showing that the morbid supply of senso- rial power is exhausted, and that the spasm has ceased in conse- quence of such exhaustion. As the disease evidently consists in a disturbance ofthe balance of the sensorial power, or in an excessive secretion of irritable, but a deficient or suspended secretion of sensific fluid, the curative inten- tion should lead us to aim at a restoration of this balance ; and hence the remedial process will run so nearly parallel with that for tetanus that it is only necessary to refer the reader to the treatment already laid down for that disease. Where catalepsy is connected with a morbid state of the livers mercury given to ptyalism has often proved highly successful. Dr. Chisholm has given a very interesting case of this kind in a young lady of eighteen of an hysterical diathesis, and in whom the ecstasy or paroxysm of rigidity was alternated with paroxysms of mania. " At the end of ten minutes the patient suddenly started up in bed, the muscles became at once relaxed, but maniacal distraction of mind instantly succeeded. During the maniacal state, now, it was particularly singular that, although she could not articulate a single word, and was evidently unconscious of what she did, yet she sun^ some very beautiful airs with a sweetness of tone and correctness of measure extremely interesting and affecting; at the end of ten minutes her head suddenly and unexpectedly dropped, and she fell back into the state of rigidity."! She finally recovered by the usr of mercury employed as above. * Journal de Physiologie Experimentale, par F. Magendie, D.M. &c. Tom. i. t Of the Climate and Diseases of Tropical Countries, p. 160. 8vo. Lond. 1822 or" TV-i NERVOUS FUNCTION. Iord. iv. 403 SPECIES III. CARUS CATALEPSIA, CATALEPSY. TRANCE. total suspension op sensibility and voluntary motion ; MOSTLV of mental power ; pulsation and breathing continuing ; MUS- CLES FLEXIBLE : BODY YIELDING TO, AND RETAINING ANY GIVEN- POSITION. This species is chiefly distinguished from the preceding by the Gen VHi, flexibility instead of inflexibility of the muscles. The cause of this HowCd'i3-1L difference has been explained under the preceding species, and needs tinguished not be repeated in the present place. The specific term common priding to the Creek writers is derived from xxrx^u^xvefMtt, " deprehendor," ^'rf ^s'of " to be seized or laid hold of," and alludes to the suddenness of its thelpecific attack. name- The predisponent and exciting causes are the same as those of J^f1fspo,° ecstasis ; and the state of the habit or idiosyncrasy alone produces exciting the difference of effect. The countenance is commonly florid, and Description. the eyes open, and apparently fixed intently upon an object, but in most cases without perception. Yet here, as in ecstasis, we some* times meet with examples in which one or more of the senses, mental as well as corporeal, do not associate in the general torpitude. So, in paroniria, the sight or hearing continues awake, while the other external senses are plunged into a deep sleep, and, in some cases of paralysis, the sentient fibres retain their activity while those of motion are torpid. The paroxysm commonly attacks without any previous warning, Progress <>f and closes with sighing or a clonic effort of the nervous power to yBmP r< re-establish its regular flow. Its duration is from a few hours or Duration. minutes, to two or three days ; and according to well established authorities, sometimes for a much longer period. And so com- Wonderful pletely exhausted of irritable power are some ofthe organs, and even Hr irritable those of involuntary action, that we have one example in a foreign p°w«- journal of forty grains of emetic tartar having been given without any effect.* The disease, like the last, is not common. Dr. Cullen, affirms Disease of that he never saw an instance of it, except where it was altogether currence; counterfeited, and asserts the same of other practitioners : which, in j^p^"^6 fact, he offers as an apology for not knowing exactly where to arrange misar. it. " Therefore," says he, " from the disease being seldom differ- cuuen; y ently described, and almost always feigned, I can scarcely tell where to place it with certainty ; but I am well persuaded that it does not who re- it all differ from the genus apoplexy, and I have hence arranged it lB a sub'. division of apoplej^ * Behrends, Baldingers, N. Magazine, B. ix. 199. 404 cl. iv.j NEUROTICA. [oud. iv. Gen.vih. ag a species of this division." Plethora or pressure of the brain may, c«rEuCs'c"' perhaps, be an occasional cause of this, as of most other nervous taiepsia. diseases, in some habits ; but the greater number of cases that have TrancePSy occurred show very clearly that this disease, in its genuine form, is as distinct from apoplexy as from epilepsy. Mostly We have sai t that both catalepsy and ecstasy are most frequently ecstuly'in9 found in constitutions disposed to mental estrangements. Dr. (Jooch constitu- [ja3 g[ven a very interesting case in illustration of this remaik in his posed to paper on puerperal insanity published in the Medical Transactions. wtrnange- The patient was twenty-nine years of age, and had been often preg- "e"'-. nant, but had only borne one living child ; and was now confined iiiusirution after, delivery of a dead child in her seventh month of gestation. " A few days after our first visit,'! says Dr. Gooch, " we were sum- xnoned to observe a remarkable change in her symptoms. The attend- ants said she was dying or in a trance. She was lying in bed motionless, and apparently senseless. It has been said that the pupils were dilated and motionless, and some apprehensions of effusion ofthe brain had been entertained. But, on coining to exa- mine them closely, it was found that they readily contracted when the light fell upon them ; her eyes were open, but no rising of the chest, no movement of the nostrils, no appearance of respiration could be seen ; the only signs of life were her warmth and pulse; the latter was, as we had hitherto observed it, weak, and about 1^:0; her feces and urine were voided in bed. " The trunk of the body was now lifted so as to form rather an obtuse angle with the limbs (a most uncomfortable posture), and there left with nothing to support it. Thus she continued sitting while we were asking questions and conversing, so that many minutes must have passed. u One arm was now raised, then the other, and where they were left, there they remained ; it was now a curious sight to see her sitting up in bed, her eyes open, staring lifelessly, her arms out- stretched, yet without aiy visible sign of animation ; she was very thin and pallid, and looked like a corpse that had been propped up, and had stiffened in this attitude. We now took her out of bed, placed her upright, and endeavoured to rouse her by calling loudly in her ears, but in vain ; she stood up, but as inanimate as a statue • the slightest push put her off her balance ; no exertion was made to regain it; she would have fallen if I had not caught her. " She went into this state three several times, the first time it lasted fourteen hours, the second time twelve hours, and the third time nine hours, with waking intervals of two days after the first fit, and one day after the second. After this, the disease assumed the ordi- nary form of melancholia, and three months from the time of her delivery, she was well enough to resume her domestic duties." S^v JSZ, 'T* °.f the comP1rt «>d the singularity of many of its offUmp. symptoms, many physicians who have never witnessed an example ^rdf/as of rt* are to° muth dlsP°s^ like Dr. Oullen, to regard it in evl J ?uDre: Py°eV ftT ".I? 'T^' 71° l^™* ^ P™ * SUffici^ to dear someti^, J from this charge ; yet the following from Bonet is added in con *«*%. urination. George Grokatski, a Polish soldier, deserted from h" re™ cl. iv.] NERVOUS FUNCTION. [ord. rv. 405 ment in the harvest of the year 1677. He was discovered a few days Gen-VIII. afterwards, drinking and making merry in a common ale-house. The ctuus'ca-' moment he was apprehended he was so much terrified that he gave ^®^a- a loud shriek and was immediately deprived ofthe power of speech. T>ance. When brought to a court-martial, it was impossible to make him ^traiion. articulate a word ; he was as immoveable as a statue, and appeared not to be conscious of any thing that was going forward, in the prison to which he was conducted, he neither ate nor drank, nor emptied the bowels or the bladder. 'Ihe officers and the priest at first threatened him, but afterwards endeavoured to soothe and calm him ; but all their efforts were in vain. He remained senseless and immoveable. His irons were struck off, and he was taken out of the prison, but he did not move. Twenty days and nights were passed in this way, during which he took no kind of nourishment, nor had any natural evacuation. He then gradually sunk and died.* The pliability of the muscles to any stimulus that acts upon them ®i,n|ul" is sufficiently evident from both these cases : but it has not been the muscles generally observed by pathologists that the force of the stimulus '£'*lg™ln which is acting upon them at the time ofthe attack, continues after- position wards, so that the same state of motion or rest is still maintained, "'ate of In the case of a school-boy, aged eleven years, related by Mr. Stearns ^^"'tetl. in the American Medical Register,! the paroxysms returned ten times in twenty-four hours, and never exceeded three minutes at a time. And if it commenced while the patient was walking, the same pace was maintained, though without the direction of the mind. The present author was consulted a few years ago on a simi- ^"^[jon lar case, by a student of Gray's Inn, about nineteen years of age. Having been attacked with a fit of catalepsy while walking, within a few minutes after having left his chambers, he continued his pace insensibly, and without the slightest knowledge of the course he took. As far as he could judge, the paroxysm continued for nearly an hour, through the whole of which time his involuntary walking Continued ; at the end of this period he began a little to recover his recollection and the general use of his external senses. He then found himself in a large street, but did not know how he got there, nor what was its name. Upon inquiry he learned that he was at the further end of Piccadilly near Hyde Park corner, to which, when he left his chambers, he had no intention of going. He was extremely frightened, very much exhausted, and returned home in a coach He was not conscious of any particular train of ideas that had passed in his mind during the fit; but if such there had been, there can be little doubt that, like the visions of a dream, the reminiscence of them would have been completely banished by the terror he felt on first recovering his recollection and finding himself in a strange place, to which he had been irregularly wandering through a great number of streets without consciousness. He had several slighter attacks ante- cedently, shorter in duration, and, from his being at rest at the time, unaccompanied with a tendency to perambulate. In this case, and in all of a similar kind, from the power which J^g^,, cases the * Medic. Septentrion. Lib. i. Sect. xvi. Cap. 6. t Vol. i. Art. vm. 10G cl. iv.J NEUROTICA. [<>*»• 1V Gen.VIII. Spec. III. Cuius Ca- talepsia Catalepsy Trance faculty of the will and the Bense of sight must be in some d* gree ol' activity. Some pow- er oi'deglu titiou Bomet lines preserved. Catoche, what. In other oases an utter inac tivity in all the invo- luntary organs. Hence the disease has been mis- taken for real death, and the un- fortunate sufferer been some- times inter- red alive. Singular example of escape. Additional illustra- tions. Hence the necessity of great caution in obtaining signs of putrefac- tion before closing the coffin. Predis- posing and exciting causes those of ecstasy ; the differ- ence of ef- fect pro- duced by the habit or idiosyn- crasy. the patient seems to possess of avoiding danger, the faculty of the will and of sight must be in some degree of activity, however ob- tunded; bearing a near resemblance to paroniria ambulans, or sleep- walking with tiie exception ofthe suddenness of the attack. Some pathologists, indeed, have noticed a modification in which the powers of deglutition and digestion continue, as well as those of pulsation and breathing, provided the food be thrust into the mouth If we were right in ascribing the catochus of the ancients to that form of ecstasy in which the nimd retains some train of ideas, we sh dl pro- bably be right also in referring their catoche to this modification of catalepsy ; though Galen seems to have regarded the term as a mere synonym of catalepsy, and .Etius alopted his opinion. Instead, however, of most of the involu itary organs being in a joint state of activity, instances have occasionally occurred of an ap- parent cessation of activity in all of them, from the scanty as well as irregular flow of the sensorial current. A critical examination of the region ofthe heart will mostly, indeed, give proof of a very feeble flutter, and if a clear mirror be applied to the mouth and nostrils it will generally be found to have a tbin vapour on its face. But even these signs have not always been given : insomuch that the disease has been mistaken for real death : and, in countries where the rite of sepulture takes place speedily, it is much to be feared that the unfortunate sufferer has, in a few instances, been buried alive.* In a case of asphyxy of a singular kind, related by M. Pew, the patient, a female, w:is peculiarly fortunate in having had her interment post- poned for the purpose of ascertaining the cause of her supposed death by dissection : for on being submitted to the scalpel, its first touch brought her to her senses, and threw her into a state of violent agitation, the anatomists being almost as much frightened as herself.t So Diemerbroeck relates the case of a rustic, who was supposed to be dead of the plague, and was laid out for interment. It was by accident three days before he could be carried to the grave, when, in the act of being buried, he showed signs of life, recovered, and lived many years.f Mathaeus, Hildanus, and the collectors of me- dical curiosities are full of stories of this kind: many of them, indeed, loosely related ; but many also possessing every requisite authority for belief: and urging the necessity of waiting for signs of putrefac- tion before the lid of the coffin is screwed down, or, I should rather say, before the body is removed from its death-bed. We have already observed, that the predisposing and exciting causes are the same as those of ecstasy, and that the state of the habit or idiosyncrasy alone produces the difference of effect. This dis- tinction has not been sufficiently attended to by pathologists in their mode of treatment: and hence one common plan has been too gene- rally laid down and pursued in ecstasy, catalepsy, lethargy, and even * Pinean, Sur le Danger des Inhumations precipitees, Paris, 1776. t Pratique des Accouchemens, &c. Tozzet's Raccolta de lYone, Osservazioni e ^ZJF*™l^'Vr0akpt*ata**iuipm leA»Physsie, a ftforte apparent 1 Tractat. de Peste. Lib. iv. Hist. 85 cl. iv.] NERVOUS FUNCTION. [okd. iv. 407 apoplexy, the general treatment being as much confounded as the Gen vW. diseases themselves. carus'oa-' Commonly speaking, copious bleedings and purgings have been l1^'3' chiefly trusted to in all of them : and as the present disease, in some Tiance. cases, arises from plethora, or obstruction, or some irritation of the ^ffiBci"njly sto ria:;h, it is not to be wondered at that this process should some- attended times succeed here also. But, if we have been correct in our pa- iheiapia. thology, if catalepsy be not only a nervous disease, but a disease of ^eatment- nervous debility, in which the sensorial power flows with enfeebled and clonic irregularity, and consequently with a necessary disturbance of the balance of the nervous system, it is perfectly clear that a re- ducent treatment, however serviceable in a few cases, cannot be laid A. '«d»«snt i . , , . . . plan not al- down as the proper plan to be pursued in general, nor even in any ways to be case as an adviseable practice, further than it may be called for by Puvsued- the contingency of the exciting cause. Stimulants of most kinds will usually be found far more serviceable, particularly in the form of blisters to the head and heart, sinapisms and other rubefacients to the extremities, and injections to the rectum. It is now well known that the simplest substances, as a solution injection of of gum arabic, or merely warm water infused, to the amount of not snbs'tances more than an ounce or two, into the current ofthe blood by opening j,"^^6 a vein, will not only excite the heart to a more violent action, but affect the stomach and intestinal canal with a like increased action by sympathy, producing sickness in the former, and looseness in the latter : and hence Dr. Regnaudot, in an ingenious inaugural disser- tation, has thrown out a hint,'well worthy of being followed up, that such a stimulus may probably succeed in rousing the system gene- rally in the present and most ofthe preceding species. Electricity or voltaism, in the manner already recommended, may vlmaism* also be tried with a hope of success: and if it be possible to intro- Diffusible duce any thing into the stomach by means of a syringe, brandy, ether, S^™"'£"", ammonia, camphor or even phosphorus, in the form and dose already &*&* into recommended, may be attempted in rotation. The body in the mean maeh. while should be kept warm, with a free influx, of pure air, and general and persevering friction should often be had recourse to. A steady JJe|*|,ie use of the metallic tonics should be chiefly confided in after the pa- roxysm is over SPECIES IV. CARUS LETHARGUS, LETHARGY. 'IENTAL AND CORPOREAL TORPITUDE WITH DEEP QUIET SLEEP. Lethargy, from the Greek terms Xk6h and xeyag" oblivio pigra," 9EN,VJ?- !* distinguished from all the preceding species of the present genus, ofig^'of 408 cl. iv. j NEUROTICA. [ord. x^. Gen.VIII. Spec. IV. Carus Le- thargus.' Lethargy the generic term. Distinctive marks Occasional causes. Proximate cause not sufficiently pointed :iut by the writers- Pathology Real dif- ference bo- tween genuine lethargy and sound healthy sleep. Occasion- ally broken in upon by short re- turns of sensation or of speech Explained. by the apparent ease and quietism of the entire system : the limbs retaining that gentle and placid flexion which they are wont to ex- hibit in natural sleep, and the eye-lids being consequently closed : by both which signs it is also distinguished from apoplexy. Lethargy is sometimes produced by congestion or effusion in the brain, by violent mental commotion, as that of fright or furious anger; by retrocedent gout, or repelled exanthems; but more generally by long-continued labour of body, or severe exertion of mind. The common causes of sleep, therefore, whether natural or mor- bid, are in many cases causes of lethargy. The proximate cause, however, of idiopathic lethargy does not seem to have been suf- ficiently pointed out, and on this account it is that it has too fre- quently, like the preceding species, been confounded with apoplexy, and regarded as a mere modification of it. We had occasion to take a glance at the general physiology of sleep, under the genus ephialtes, or night-mare, and observed that its proximate cause is to be sought for in a torpitude or exhaustion of sensorial power from the ordinary stimulants ofthe day. Now it is possible that the same effect may be produced by a defective supply of sensorial power as well as by its exhaustion; and, conse* quently, that the torpitude of sleep may ensue whenever such de- ficient action or energy exists, even where there is no exposure to its ordinary exciting causes. And this it is, as it appears to me, which constitutes the real difference between genuine lethargy and sound healthy sleep : in which sense the former becomes a strictly nervous affection dependent upon a weak and irregular action of the senso- rial organ, accompanied with a diminished secretion of sensorial power, and this power, so diminished, irregularly distributed over its different departments or ramifications; being altogether withheld from the external senses and the voluntary organs, while the current to the involuntary organs is little interfered with, as in the case of common sleep. The faculties ofthe mind seem also, in most cases, to partake of the torpitude of the external senses : though, as the whole is a disease of debility, and consequently of irregular action, we can readily account for a few singular cases that have been met with, in which the lethargy has been broken in upon by short returns of sensation, or even of speech, or by an irregular flow of ideas, which the patient is sometimes apt to mistake for sensations. And hence, lethargy has been observed under the following varieties: x Absolutus. Genuine Lethargy. (3 Cataphora. Remissive Lethargy. y Vigil. Imperfect Lethargy. Without intervals of sensation, waking or consciousness. With short remissions or intervals of imperfect waking, sensation and speech. Perfect lethargy of body, but im- perfect lethargy of mind : wan- dering ideas, and belief of wake- fulness during sleep. SiS^ The fihst variety has, in some instances, been considerably absolotug. cl. rv.] NERVOUS FUNCTION. [ord. iv. 409 protracted. We have examples of its continuance for forty days,* |^;v{y and even for seven weeks.t In one instance it is said to have resulted a cELe. from insolation, or exposure to the direct rays of the sun; and at ^'jj^' length, with great singularity, to have yielded to a large flow of Genuine urine loaded with pus that fell to the bottom.^ In this case, the |urparr^fDg cause must have been congestion, and the inflammation have passed samples off by a secretion of pus, probably without any abscess whatever, tent. The second variety, or cataphoka, is the coma somnolentum jj^Lo- of many writers : and is also a frequent accompaniment of many cataphora. fevers and other diseases of great debility. It occurs at times, how- ^h~v0 ever, as an idiopathic affection ; and 1 was some years ago ac- quainted with a very singular example that continued for five years. The patient was a young lady of delicate constitution, in her eight- Singular eenth year at the time of the attack: her mind had been previously in a state of great anxiety : the remissions recurred irregularly twice or three times a week, and rarely exceeded an hour or two : during these periods she sighed, ate reluctantly what was offered to her, had occasional egestions, and instantly relapsed into sleep. Her reco- very was sudden, for she seemed to awake as from a night's rest, by a more perfect termination of the paroxysm, not followed by a relapse. A less fortunate case ofthe same kind is related by Mr. Brewster, Additional in the Edinburgh Philosophical Transactions, and was connected with a less with depressed animal spirits, and probably congestion or plethora. 'r^ato The patient was a female servant about the middle of life. The first paroxysm was preceded by a hemorrhage from the nose, and lasted three days : the next continued six weeks; during which she occa- sionally swallowed food and had alvine evacuations. She had two subsequent fits, neither of which lasted above a few days. Not long- afterwards she hung herself. § The THIRD VARIETY, or IMPERFECT LETHARGY, IS the TYPHOMA- y^Le. nia of the Greek writers ; the coma vigil of many later patholo- vigi]. gists. It is a frequent sequel upon fevers, or other causes of great \^y nervous debility, in circumstances in which the sensorial power has Thecoma not recovered its regularity of current, or stability of balance: during m|nypa. which the patient uniformly assures his physician and his friends, thoiogists. morning after morning, that he has passed a restless and hurried night, without a moment's sleep, while the nurse has been a witness to his having been asleep the whole night long. The mode of treatment must depend upon the nature of the cause, Modeof ^ as far as we are able to ascertain it. If this have consisted in any ^vary suppressed discharge or eruption, we should endeavour to reproduce tothe it by all possible means. If we have reason to suspect compression cause ^ on the brain, copious bleedings, purgatives, and other reducents are eab, t0 imperative. And if, as is more commonly the case, it be a strictly —*»* nervous affection, and depend on atony, and a disturbed secretion or balance ofthe sensorial power, the warm nervine irritants, as musx, * Plott, Natural Hist, of Staffordshire. t Banff. Colleet. Soc. Med. Havn. u. 17. I Mmlajrni, de Scd. et Caus. Morb. Ed. r. 13, 14. Albertmo. § Edin. Phil. Trans, 1817. Vol, IV.—52 M CL. IV. j NEUROTICA. [ord. 2V Cen.VJII. Spec. IV. y C. Le- thargus vigil. Imperfect lethargy. Treatment. The treat- ment hith- erto too in- discrimi natc Plan of Foreslus compared with that of Celsus. Both plans consistent with the explana- tion of the authors, but both cannot be right as a general principle. Hence some prac- titioners have in- congmously mixed the two. Where the lethargy is a disease of nervous and espe- cially of general de- bility, a re- ducent plan wrong. Illustrated. camphor, valerian, with blisters, sternutatories, and other stimulants- arc the means we should have recourse to. These different processes have been pursued in most ages, but unfortunately they have been pursued indiscriminately : and bleed- ing, purgatives, and ethers and other diffusible excitants have been employed on like occasions, or even at the same time. Foreslus and Dr. Cheyne, who regarded lethargy as chiefly dependent upon ple- thora or congestion, seem uniformly to have adhered to a reducent plan; and Celsus who contemplated it as a nervous affection, equally confines himself to external and internal puugents, and advises pepper, euphorbium, castor, and vinegar, with the fumes of burning galbanum or hartshorn applied to the nostrils: as also shaving the head, fomenting it with a decoction of laurel leaves, or rue, and afterwards applying sinapisms or some other rubefacient epithem. All these are consistent with themselves, how much soever the writers may differ in their view ofthe proximate cause. Yet neither line of conduct can be right as a general practice; and hence it is that other practitioners have occasionally intermixed the two, some- times incongruously so ; and consequently have done less mischief, as at other times they have done less good. That genuine lethargy is, not unfrequently, a strictly nervous affec- tion, and even closely connected with an irregular or debilitated state of the mind ; and that a reducent plan is not always calculated to afford it radical relief, however it may give a temporary promise, must, I apprehend, be obvious to most practitioners who have paid a due attention to their own circle of cases ; but the following exam- ple from Dr. Cooke, bearing a close resemblance in its termination to that already quoted from Mr. Brewster, is peculiarly in point, and ought not to be omitted on the present occasion : UA lady about twenty years of age, who had usually enjoyed very good health, was one morning found in a state of profound but quiet sleep, from which she could not be awakened, although the preceding evening she had gone to bed apparently quite well. Various means had been tried with a view of exciting her from this state, but in vain. Under .these circumstances I recommended cupping in the neck ; and after she had lost a few ounces of blood in this way, she opened her eyes per- fectly recovered, and remained through the day quite free from all symptoms of disorder. The next morning, and for several successive mornings, she was found in a similar state, from which she was re- covered by the same remedy, no stimulating external applications producing any good effect. As she was considerably weakened by repeated depletions, it was determined that, on the next recurrence ofthe paroxysm, the case should be left to the effects of nature, as long as was consistent with safety. The experiment was tried; and at the end of about thirty hours she spontaneously awoke, apparently refreshed, and wholly unconscious of her protracted sleep. On th*> future returns of these paroxysms, w\iich were frequent, the same plan was adopted, and she awoke after intervals of thirty-six forty eight, and, on one occasion, sixty-three hours, without seeming to have suffered from want of food, or otherwise. In the early part of ol. rv.] NERVOUS FUNCTION. [ord. iv. 411 the disease, various means were employed without the smallest ad- Gen.VIII- vantage except that, while under the influence of mercury which vlw°s' ' produced a very severe salivation that lasted more than a month, she £e|£arfUB' was free from the complaint. For a considerable length of time Treatincn-, these paroxysms recurred : but at length they gradually left her; and soon afterwards she became deranged in mind, in which state I believe she still remains.1'* When, therefore, there are no symptoms leading to a peculiar Treatment • •'i o i whore do cause, it will be adviseable to bleed by cupping, once or twice, but symptoms not oftener, to open the bowels and keep them in a state of slight a ptculiac irritation ; to employ blisters or other external stimulants occasion- cause. ally, and to have recourse to a repeated use of the voltaic trough, sending the line of action from the occiput down the spine, and varying it to the extremities. In the mean time, if the patient can be made to swallow, we should try the effect of musk, or camphor. with free doses ofthe metallic tonics, of which the sulphate of zinc, in doses of a grain, three or four times a-day, offers the best prospect of succes?. SPECIES V. CARUS APOPLEXIA. APOPLEXY. 3IENTAL AND CORPOREAL TORPITUDE WITH PULSATION AN» OPPRESSIVE, MOSTLY STERTOROUS, SLEEP. There is a considerable difference of opinion among pathologists Gen.VIII, Whether stertor is a necessary and invariable, or only an occasional Whether sign of apoplexy. Sauvages, Linneus, Vogel, Sagar, Forestus,| »*«'<« be a Kirkland,J Young, and by far the greater number of writers have or°oniyroc- arranged it as an essential symptom ; and, hence, the present author ^°D£m> was induced to view it in the same light when he published his volume The first of Nosology. He has since, however, met with one or two cases fuj^"?, of atonic apoplexy, in which, although the disease proved fatal, the 2nd^?bed breathing was at ho time noisy or stertorous, though uniformly labo- The disease rious or oppressive : and he has hence been induced to modify the had3 f0occt{£ specific character in the manner it stands at the head ofthe present author r , . . , . . f n , without it: division: and thus to approximate it to the opinion ot X orestus, and hence Cullen, and Portal, who do not regard stertor as a necessary index. ^ecsae.nt Dr. Cullen is generally conceived to have omitted this peculiar mark, tion in the in consequence of~his having included asphyxy and catalepsy under ^king0™ the genus apoplexia, which have no pretensions to stertor. But, as »ro™a*. we shall have to return to this subject when discussing the different nion of ae, forms or varieties under which apoplexy shows itself, I shall only fur- J*™1™- thorities. * Treatise i nNeryous Diseases, Vol. I. p. 372. >?? tdhe t J,ib, y_( !•= ,73. 1 Comment, p. 16. 412 cl. iv.] NEUROTICA [ORD. IV. Gen viii. ther observe at present, that Dr. Cooke has, with great judgment OwmAm- steered a middle course in laying down his own definition, which plexia. characterizes apoplexy as " a disease in which the animal functions resuraedy" arc suspended, while the vital and natural functions continue ; hereafter. respiration being generally laborious and frequently attended with Judicious ,,i definition Stertor. * a o "lex"' Apoplexy is strictly a disease of the nervous system, dependent strictly a upon a suspension of the sensorial power in almost all its inodifica- ofethe tions, sentient, percipient, and motory, with the exception of a cer- Tltcm- tain Portion which still continues to be supplied to the involuntary organs ; the faculties of the mind participating in the torpitude of and hence the body. In these respects it bears a very near approach to the neareap- preceding species of carus ; it chiefly differs in its being generally proach to connected with an oppressed state of the vessels of the brain from ceding" overdistention or effusion•: so generally, indeed, that apoplexy is, by cam's88 °f almost all the writers on the subject, regarded rather as a disease of Distinctive the sanguineous than of the nervous system ; the morbid action of teeing "to : the latter being supposed to be entirely dependent on that of the a general former, and consequently only a secondary affection. opinion . . that it is a This view of the subject, however, is by far too limited: for ?heesan-°f although m most cases the more prominent symptoms concur with guineous the appearances on dissection in leading us to compression of the of" the a brain as the primary cause ofthe disease, yet we shall find presently 110stem.s *hat ^ nas sometimes taken place where no such compression seems This view to have existed, whilst we have already had occasion to notice a jocttoo8" " variety of affections of the head attended with forcible and severe E™T^' d comPressi°ni as inflammation and dropsy ofthe brain, that have run their entire course without any mark of apoplexy whatever : to which should be added that, while in most other diseases or lesions accom- panied with compression of the brain, and a suspension of sentient and motory power as a consequence hereof, such suspension ceases almost the moment the compression is removed, when the nerves of feeling and motion, together with the faculties ofthe mind, resume their wonted activity, and evince no tendency to a relapse ; in apo- plexy, on the contrary, the result is always doubtful; for a palsy of some part or other is a frequent and permanent effect, or the mind suffers in some of its faculties, and a relapse is generally to be appre- hended. So that though compression of the brain, and particularly from a morbid state of the sanguineous and respiratory functions, may be justly regarded as the ordinary efficient cause, there seems to be at the same time some peculiar debility or other diseased con- dition of the sensorial system to which apoplexy is primarily to be referred, and without which it might not take place ; and which has not been sufficiently adverted to by practitioners. Though there can be no difficulty in our affirming that wherever such a morbid condition exists, compression, from whatever cause, will be sure to produce the disease. "r8ew0hy" We ma-vJience see whY advancing age should prove a predisposing advancing cause : and account for the statement of Morgagni, who tells that, * On Nervous Diseases. Vol. i. p. 166. cl. rv.l x^ERVOUS FUNCTION. L0K»-iv- 413 of thirty cases of apoplectic patients that fell within the reach of his Gen.VIII. observation, seventeen were above the age of sixty, and only five cn^us°Apo- below that of forty. Hippocrates, on a more general estimate, calcu- piexia. lated that apoplexies are chiefly ((lxXiftx) produced between the for- age should tieth and sixtieth year.* This, indeed, is somewhat earlier than we poSin^reil,s" should expect on the ground of advancing age ; but when we take ciusc° into consideration that it is the precise period in which the mind is onvio"." most agitated and exhausted with the violent and contending pas- Ra5n»- sions of interest, and ambition, and worldly honours, and the blood tion of Hip- must frequently determined to the head by this impulse of sudden i'ocrutes- and irresistible emotions, we shall, perhaps, readily accede to the Hippocratic aphorism as a general rule. How far apoplexy is occasionally the result of an hereditary influ- "flr1?t,itcary ence on the frame, it is not easy to ascertain. Forestus, Portal, whether a and Wepffer refer to decided instances of such facts within their own J^*" knowledge ; the first, indeed, relates the history of a father and cause! his three sons, all of whom died in succession of this disease; but as the chronology drops with the second generation, it does not de- scend quite far enough for the purpose. There is great reason, however, for believing that an hereditary tendency does sometimes show itself; and, as this exists without external or manifest signs, it is probably seated in the sensorial system, and constitutes another of the morbid conditions of this system, to which we have referred above, as often giving effect to subordinate causes. There is no difficulty in conceiving how heat may become a pre- Heat a pre- disponent cause, since nothing tends more effectually to quicken the cause en- action of the heart, drive the blood forcibly into the ascending trunk p1*""**. of the aorta, and, consequently overload the vessels of the brain. ^ *bo B But cold is said to be a predisponent cause as well, and one that poling operates quite as extensively, while the reason of this has not been at all J;™*,;^ times very clearly explained. Now as a hot temperature acts chiefly very dif? upon the sanguiferous system, extreme cold acts chiefly upon the sen- ^"chiefly sorial, benumbs the feeling, weakens the muscular fibres, diminishes ^"^ the sensorial secretion, and consequently induces, as we have already system." seen under one of the varieties of asphyxy, an unconquerable pro- pensity to sleep. And hence again, in apoplexies produced by severe cold, the primary or predisponent cause is to be sought for in a debilitated state of the nervous system. The Greek physicians comp- are perpetually alluding to this cause as one of great frequency, and {he Greek the explanation now given, does not essentially vary from that offered f^6™ by Galen.| If, indeed, the cold be exquisitely intense, carus cause of Asphyxia is more likely to be produced than carus Apoplexia; for j^y.6" we have already observed under the preceding species that the very ^tne]ex- same cause which, operating in a more vehement degree, excites intense yu the former, operating less powerfully has often a tendency to J^g™ excite the latter. Zint\ The other predisponent causes, so far as they have been traced out, )eBS degre0 are more obvious to the senses, and, for the most part, more directly ^'re^d referrible to the state of the sanguineous function ; as plethora, cor- more mani- pulency, and grossness of habit, a short thick neck, and an inordinate p^g0*118" onuses. * Aph. Sect. vi. 57. f r>e Jj0r- Aff- 1Ah' '"• caP- vi- 414 cl. iv. j NEUROTICA. [ORD. IV Gen VIII. Spec. V. Carus Apo- plc.tia. Apoplexy. How fai a daily use ot wine in mo- deration may pre- dispose. The com- mon effi- cient cause compres- sion of the brain. How far there may be any other ex- citing cause, as determina- ble by dis- sections. The ordi- nary mor- bid appear- ances most Iy ineffec- tive other- wise than as conco- mitants ; though they may be suffi- cient where a strong predisposi- tion exists. Hence the apoplexy of infants from teeth- ing or ven- tricular acrimony. As also apoplexy from other remote ir- ritations. Most of these mor- bid actions and ap- pearances as common to other af- fections of the sensori- al system as to apo- plexy : and 1'fnce, indulgence in wines and heavy fermented liquors. Dr. Cheyne, in- deed, believes the last to be so common a cause, as even to produce the disease when employed without any inordinate indulgence what- ever : " the daily use,'" says he, "■ of wine or spirits will lead a man of a certain age ant! constitution to apoplexy, as certainly as habitual intoxication."* This may be true as here limited, but then the limitation must be attended to ; in which case we are only told in other words, than wherever such a kind of sensorial debility exists as that which we have already adverted to, the result of age, or habit, or constitution, one man will be as readily led to apoplexy under a moderate use of wine, as another man destitute of such predispo- sition will be u der a state of habitual intoxication. With this ex- planation, however, a moderate use of wine becomes only an acces- sory, and not a primary cause. How far there may be any other efficient or exciting causes of apoplexy than compression of some kind or other, it is difficult to determine, though various cases on record should induce us to sup- pose there are. Hydatids, tumours of almost every consistency, ge- latinous, steatomatous and bony, pus, and polypous caruncles and indurations of the membranes, have in various cases, been discovered on dissection, and are generally supposed to operate by compression, in the same manner as an accumulation of blood or serum. But in many instances these appearances seem to have been too minute for any such effect; and, if causes of any kind, can only fairly be regard- ed as concomitants or allied powers—as local irritants, stimulating and exhausting the sensorium, and preparing it for attacks of apo- plexy against,the accession of some superinduced and occasional cause. Though where there exists already a strong predisposition to the disease from hereditary or any other affection, it is not im- probable that such local irritants may alone be sufficient to perfect the complaint. And we may hence account for that form of apo- plexy which is said to proceed from intestinal worms, or some other acrimony of the stomach, or from teething ; and which, conse- quently, occurs at an early instead of at a late period of life, and has been specially denominated apoplexia infantum. Other organs, however, besides the teeth and the stomach, seem not unfrequendy to have given occasion to apoplectic attacks from irritation, disten- tion, or organic lesion. Thus, according to M. Portal, superindu- cing tumours and congestions have been found in the neck, in the breast, or in the abdomen ; ossifications in the thoracic and ventral aorta, as well as in the arteries of the upper and lower extremities, in the superior vena cava, and in the right ventricle and valves of the heart, which has also indicated various other changes.! Most of these morbid actions and appearances, however, are as common to various other affections of the sensorial system as to apoplexy. We have already noticed them in lethargy, convulsion, epi- lepsy, various species of cephalaea, and some forms of insanity : and hence, wherever they become causes at all, it is most probable that the disease they immediately produce, is regulated by the predispo- sition of the individual to one rather than to any other of the above * Cheyne, p. 146. t Portal, Ch. Rrsnltats de l'Overture des Corps, j>. 329. cl. iv.j NERVOUS FUNCTION. [ord.iv. 415 sensorial affections, resulting from family taint, idiosyncrasy, habit, Gen.VIII. or period of life; and, consequently, that the same exciting or oc- c.truaCApo"- casional cause, which, in one person, would produce apoplexy, in a A'^"}ex second, would form epilepsy, in a third, convulsion, and in a fourth, wheiever' madness. *&"- It is highly singular that this view of the subject should scarcely causey the ever have been attended to by physicians ; and that, whilst all the mediately " writers have pretended to regard apoplexy as a disorder ofthe ner- ^'"^ vous system, none of them have suffered such ideas to enter fairly determined into their pathology, or in any way whatever into their practice : existing" the nervous organ being supposed by all of them to be in a state of \c^^l[t0 soundness at the time of the attack ; and whatever mischief it suffers e.se rather to be merely secondary and consequent upon a morbid state of the f^0 *** blood-vessels, or of some other cause that as suddenly and effectu- singular ally interrupts the secretion or flow ofthe sensorial power, as retro- view of the cedent gout, mephitic vapours, or narcotic poisons. should Now all these accidental or effective causes of apoplexy are well scarcely known to be causes, also, of the other nervous affections we have just attended" referred to. But if this be the case, how comes it that they should -°:tLitJder. thus vary in their result, and that what in one person, and at one scription period of life, should produce apoplexy, should in another person, °f the'dJs! and in another period of life, produce lethargy, palsy, convulsions, ease. or epilepsy ? or that some of them should exist without producing farTovcsti- any of these diseases or any other disease whatever ? It is not, per- sated- haps, possible for us to develope the precise condition of the sen- sorium that leads to any one of these effects, rather than to any other : but that there is such a condition forming a predisponent or remote cause of the specific disease that shows itself, must, I think, be allowed by every one who seriously considers the subject. Nor is there, in effect, any other means of reconciling the dis- No other crepant and opposite opinions that have been held concerning the theVesent proximate cause of the disease. This we have stated to be, for capable of r_ ■ j • n reconciling the most part, compression, and especially sanguineous compres- various sion. Mr. John Hunter was so strenuously attached to this cause dlscrePant that he would allow of no other ; M. Rochoux has followed his concerning footsteps ;* and if a man died of apoplexy from atonic gout, and matecause, without effusion, the former distinguished it as a disease similar to apoplexy. He regarded apoplexy and palsy as one and the same disease, merely differing in degree : and he gives us his sentiments very forcibly, in the following words : "For many years," says he, Opinion " I have been particularly attentive to those who have been attacked Hunur" with a paralytic stroke forming a hemiplegia. I have watched them while alive that I might have an opportunity to open them when dead : and in all I found an injury done to the brain in consequence compres- of the extravasation of blood.—I must own I never saw one of te?mi°a-e" them which had not an extravasation of blood in the brain, ex- *>on to the cept in one who died of a gouty affection in the broin with symptoms every in- similar to apoplexy." j -^ £°; travasatiorc. * Diet, de Medicine, Tom. n. Paris, 1822. t Treatise on Blood, &c. p. 213. iio cl. iv.J i\EUROTlCA. [oiio.iv. Gen.VIII Spec. V. Catus Apo ploxia Apoplexy. Compres- sion no cause whatever in the opi nion of other au- thorities, and no such thing ns deter- mination to the head. Abercrom- bie. Experi- ments and hypothesis of Serres. Reconcilia- tion of these oppo- site facts. Experi- ments of Serres in- decisive, however correctly stated, and ■ In direct hostility to this hypothesis, many other writers of great . eminence and experience have contended that compression is no cause whatever, and that an accumulation of blood in the head, as a prominent symptom in apoplexy, is a doctrine rather than a fact. Of this sentiment is Dr. Abercrombie, who, after examining the question with much ingenuity, brings himself to the following con- clusion : "Upon all these grounds," says he, "I think we must admit that the doctrine of determination to the head is not supported by the principles of pathology, and does not accord with the phe- nomena of apoplexy."* M. Serres, however, a physician of con- siderable distinction in France, and who followed up this subject for many years by a careful examination of the bodies of persons who died of apoplexy and paralysis, both at the Hotel Dieu, and the Hopital de la Pitie, has carried his inroad upon the popular doctrine of the day still farther ; for he has not only, in his own opinion, completely subverted it, but has endeavoured to establish another doctrine, of a very different character upon its ruins."t To determine the question, he has gone through a long series of experi- ments upon the brains of dogs, pigeons, rabbits, and other animals, whose crania were trepanned, their lateral, or longitudinal sinuses laid open, and their brains lacerated and excavated in various ways, so as to be gorged with effused blood, yet in none of them did somnolency or any other apoplectic symptom take place. And he hence triumphantly concludes that extravasation of blood does not produce apoplexy, whether lodged between the cranium and the dura mater or between the dura mater and the brain : whether the blood occupy the great interlobular scissure, and thus lies upon the corpus callosum ; whether cavities be made in the fore, the back, or the middle part of the hemispheres, or run from the one into the other ; or, lastly, whether piercing through the corpus callosum we reach and fill up the ventricles ofthe brain. " On whatever ani- mal," says he, " we try these experiments, whether on birds, rab- bits, or dogs, the result is the same, and hence apoplexy in man ought not to be ascribed to such effusions." How are these discrepancies to be reconciled? by what means are we to account for it, that pressure may be a cause, and may not be a cause ? and that apoplexy is sometimes found with it, and some- times without it 1 It is the peculiar state of the sensorium or nervous system at the time that makes all the difference—it is the morbid predisposition or debility, or whatever other deviation from perfect health it may labour under at the moment of the application of the exciting cause, that gives an effect which would not other- wise take place : and something of which, in many cases, often dis- covers itself by precursive signs for a considerable period before the apoplectic incursion. The facts stated by Mr. John Hunter no one can call in question : and we have as little right to question the ex- periments of M. Serres: the error consists in taking an unsound and a sound state of brain for like premises, and reasoning from the * Treatise on Apoplexy, &c. p. 19. * Annuaire Medico-Chirurgicale, AvriJ, 1820. ™- iv.j .NERVOUS FUNCTION. [ord. rv. 417 effects produced on the one, to those that are found to follow on the Gen.VIII. other. This, in truth, is an error too often committed ; and heca- c™°'y' tombs of quadrupeds and other animals in a condition of perfect Apopiexia. health, are tortured in a thousand ways for the purpose of determin- Apoplexy- ing what they never could determine, though the trials were to be repeated to the end of time ; I mean the effects of certain causes on a diseased state of body in man, from their influence on a sound state of body in brutes. M. Serres's actual examinations of apoplectic patients after death, Hence however, though conducted also upon a large scale, do not seem to s«res°not afford much countenance to his hypothesis, nor in effect, to offer supported any thing out of the common way. In a considerable number of mmationV subjects there was serous effusion, sanguineous effusion, or both ; patients1'0 sometimes in the circumvolutions of the brain, sometimes in the *•""* death. ventricles, sometimes in all these ; and not unfrequently the vessels ofthe meninges appeared distended with blood, and the membranes themselves thickened. Such appearances seem to furnish something of a stumbling-block to M. Serres's new doctrine, yet he readily gets over the difficulty by satisfying himself that, in all these cases, the effusion did not produce the apoplexy, but the apoplexy the effusion. In other dissections he found some material alterations in the struc- ture of the brain, but without effusion ; and, as the last class of in- dividuals had evinced palsy rather than apoplexy, he is inclined to think that apoplexy, or that state of the disease in which the stupor is greater and more general, is occasioned by a morbid irritation of the membranes of the brain ; and palsy, or that state in which the stupor is less, by a morbid change in its substance; in consequence of which he proposes to call the first meningic, and the second cere- bral apoplexy. In this conclusion, however, there seems to be a His subdi- striking mistake ; and the very reverse is what we should have ex- Ihedisease pected ; for if there be one pathological principle more established at variance than another, it is that stupor and dulness of pain appertain to the besteeta- parenchymatous irritation or inflammation of an organ, and rousing, ^oiogtcaf" restless, and acute pain to its membranous irritation ; a principle facts. we have already explained at some length; and whence, indeed, the lancinating pain of pleuritis compared with pneumonitis, and of meningic or brain-fever, compared with acute dropsy of the head.* There is far more dependence to be placed upon the painful and unjustifiable series of experiments performed several years since by M. Rolando upon the brain of animals of almost all kinds ; and which seem to show, as we have already observed, that animals which possess a perfect brain derive their sensific power and motific power not jointly from the cerebrum and cerebellum, but separately, the one affording the one power, and the other the other.t Stupor and apoplexy were in all these cases produced, not by a morbid irri- tation of the membranes of the brain, as conjectured by M. Serres, but by a morbid irritation of the substance, while irritation of the membrane took away neither the sensific nor the motific power. * See Vol. ii. Empresma Cephalitis, Cl. ill. Ord. II. Gen. vn. Spec. I. | Saggio sopra la vera Struttura del Ceryello, &c. e sopra le Fanzioni de Sistenu Nervosa. Sassari, 1809. Vol. IV.—53 4lb NEUROTICA. {onv. iv. Gen VIII, Spec. V. Cams Apoplcxia. Apoplexy. Hence compres- sion must stiii be al- lowed the grand ex- citing cause of apoplexy. By what mea^s it operates. Disorgani- zation of the brain, sometimes pulpy or <'iffluent. Mollilies cerebri or Ramollis- ?ement de cerveau Regarded is idiopa- thic by some writers. Actual cause doubtful. Disease sometimes rapid and accompa- nied with inllammii- -ion. The brain therefore may be rendered comatose by various causes: but we hold, after all, that the grand exciting cause of apoplexy, is compression ; and this shows itself in various ways, which are well enumerated by Dr. Cheyne in the following passage : "I mention first," says he, " the remains of an excited state of the minute arte- ries of the brain and its membranes, this probably being the most important, as it is the most unvarying appearance ; then the extra-^ vasation of blood, probably the consequence of the excited state of the vessels ; the turgescence of the venous system ; the enlargement of the ventricles, partial or general;. and lastly, the serous effusion which is generally found in various parts of the brain, and which would seem to imply previous absorption ofthe brain."*' The concluding sentence in this passage appears to indicate that this correct and discriminating pathologist was by no means inatten- tive to that extraordinary change which is not unfrequently produced in the structure and tenacity of the brain by various causes of excite- ment ; and consists in a more or less extensive demolition of its substance, so" that it is sometimes found to be pulpy or pasty, and at others the disorganization having proceeded further, to be as liquescent or diffluent as soup. Morgagni has collected various ex- amples of these and other modes of disintegration ; Dr. Baillie has occasionally adverted to them ;t and Dr. Abercrombie has brought them into a still more prominent notice by an ingenious pathological explanation of their cause.J But, in France, the subject has been pursued with peculiar activity, since the publication of the first edition of the present work, and has excited an interest of no ordi- nary standard. To this change, M. Rochoux has given the name of Ramollissement de Cerveau, or Mollities Cerebri,§ and its nature and varieties have since been followed up, and systematically ar- ranged with considerable nicety and precision, by M. Rostan,!! and M. Lallemand,1T who have regarded it as an idiopathic affection, and, attempted a developement of its entire pathology and mode of treatment. Its actual cause is often doubtful ; and still more doubt- ful is it whether it ever exists as a primary disease. That inflam- mation consequent on congestion or rupture of the blood-vessels of the brain is a frequent cause is clear, because the minute and colourless arteries of the part affected are often found striated or infiltrated, as the French call it, with red blood, and a clot of effused blood is traced in the centre. The inflammatory process hereby produced is sometimes violent and passes rapidly into the suppura- tive stage, accompanied with severe lancinating pains, and a feel- ing of constriction round the head, and even delirium ; and, hence, this condition is as common a result of cephalitis as of what we diall presently have occasion to call entonic apoplexy. The soft, * Cheyne, p. 24. t S??-^™ °f °m? £a8cic; x- PL "»• P- 213> a«d PI. vm. 227, 223. *J2S& ot'LtJ^ J°Um- VOU Xly' *• 265' °—tions « Chronic In- § Rechercbes stirl'Apoplexie, 8vo. 1814 JJsioSzr^mtencore peu connue qui a re9a le nom de Ramoiissfc- - Rechercbes Anatomico-pathologiques sur 1'Encephale et ses dependaaces. IS-?! CL. IV.] NERVOUS FUNCTION. [ord. iv. 419 pulpy disorganization of the brain is in this case often intermixed Cen.Viii. with masses of pus, while the general hue of the diseased part is cvrus3' V brown or reddish from a diffusion of the red particles of the blood ^'^pj^io- that have been let loose ; and as the extravasated blood becomes more or less decomposed and intermixed with the white or gray matter of the brain, and with effused serum, the colour is found to vary considerably through all the diversities of white, gray, yellow, rosy, amaranthine, deep red, brown, chocolate, and greenish. The gray substance of the brain, however, as less tenacious, is found more generally diffluent and more completely decomposed than the white. More usually, however, the inflammation is far less violent and ^m^'cmes chronic; and the symptoms are those of an obtuse pain in the head, and inflam- general oppression,'occasional vertigo, with indistinctness of me- ™^,, mory, and confusion of thought, the pulse evincing but little if any change from a state of health. But as these symptoms are common to various other diseases, their pathognomic value is small. There are two other signs, however, pointed out by the French ^pp08'^ monographists as more ensentially distinctive, but which the present mic symp writer has never had an opportunity of noticing : these are a mouse-torr"i- smell, or odour issuing from the body of the patient like that which is exhaled from the bodies of mice ; and a movement of the lips on one side, accompanied with a rushing or whizzing sound like what is often exhibited by smokers in the act of smoking tobacco. For the production of these last symptoms, however, it is necessary that the disease should be accompanied with hemiplegia, so that one side of the mouth only is capable of motion. By far the greater number of these symptoms, however, indicate i"o? jenerr.] atony indi- atony rather than entony of action ; and hence, though inflamma- catco' tion is not unfrequently a proximate cause, debility whether conse- J^*™ quent upon inflammation, or any other morbid change, is, perhaps, a more common cause. Hence in our own country this organic mollescence has usually been regarded as a gangrene of the brain, and many of the French pathologists, and especially M. Recamier, incline to interpret it as a result of low atonic or malignant fevers, rather than of phlogotic action. With M. Rostan and M. Lalle- mand, however, if is ranked as a direct phlogosis, or phlegmasia, not resulting from apoplexy, but necessarily conducting to it and producing it. Yet, as, according to their own showing, the leading symptoms are those of turgescence and oppression, with little in- crease of pulse or other excitement, it should seem to follow that they have in a considerable degree mistaken the cause for the effect, even where inflammation is co-existent. In reality, though there is no difficulty in accounting for the ex- travasated blood, or the vascular infiltration, or the depraved colours which are found in this state of the brain upon the principle ot inflammation, there is a considerable difficulty in explaining upon the same principle the mollifaction of the diseased area : and it is upon this point that the pathology of the French writers seems chiefly to fail. 420 cl. iv.] NEUROTICA. [obd. iv- Gen-VIII. Spec. V, Carus Apnplexia. Apoplexy. Morbid action explained. Hardness and soft- ness of the brain ac- counted for. Both may proceed from the same cause. Pulpy brain chiefly found in the weak ness of ad- vanced age. The real mode of action, as it appears to the present writer, is the same as that whir.h takes place in mollifaction of the bones, which we shall explain in a subsequent part of this system ; but which, as well as its opposite, fragility ofthe bones, is always a dis- ease of weakness, local or general. Now we meet with a like devia- tion from a healthy tenacity of the brain in both these ways ; for we find it sometimes to > tough, and indeed almost horny ;* as well in the gray as in the white compartments, occasionally indeed inter- spersed with masses of bony matter ;t and at other times, as in the disease before us, too, soft and unresisting ; and in both these cases also, if I mistake not, debility will be found the immediate cause even where inflammation has preceded. The firm and tenacious material which enters so largely into the substance of the brain, and particularly into the white part, is a secretion sui generis, and so long as the secernents and absorbents of this organ main- tain a heajthy antion, and precisely counterbalance each other, this material will be duly supplied, and in a healthy state, as it is wanted, and duly removed to make way for a fresh recruit as it be- comes worn out. But if the organ from any cause becomes weak- ened in its vascular powers, that weakness will extend to one or both the sets of vessels we are now considering, and the result will necessarily be the existence of brainy matter of a depraved and untempered tenacity. The secernents may not pour it forth in a sufficient abundance to supply the waste, or they may pour it forth in a dilute and unelaborated crasis, whence the general tissue must be soft and pulpy : or if the material be duly attempered as furnished by the secernents, the absorbents may be too debilitated to imbibe more than the thinner and attenuate parts ofthe texture when worn out by use, and leave the grosser behind; in which case the matter of the brain, at least in the regions thus affected, must necessarily be rendered morbidly tough or even horny. And hence both ex- tremes may proceed from the same cause operating in a different way or upon different sets of vessels. And there can be no ques- tion that in proportion as the compages of the brain becomes looser and less resistible, effusions of serum and red-blood, ulceration, gangrene, and a total dissolution of the entire substance, must in many cases follow as a natural result, and in the order here stated. And hence in cancer of the brain the substance of the organ is always found in a soft or mollescent state. As a further proof that this pe- culiar change is for the most part a result of debility, it is admitted by both M. Rostan and M. Lallemand that it is by far most fre- quently met with in persons of advanced age ; the former indeed asserts roundly that in the whole extent of his practice he has never met with more than one instance in which he was suspicious of it at or under the age of thirty, and as examination after death was not here allowed him, he does not regard even this case as of any moment. J * Morgagni, passim. •l^A H^l,fe5WW^Jr* ^ andMwe8chi« •*«"* ta Gazette de cl. iv.] NERVOUS FUNCTION. [ord. iv. 421 It is singular that the congestive fluid, instead of proving a mate- Gen.VIII. rial elaborated by the animal frame itself, should sometimes consist oJ"'V' of a foreign material recently received into the stomach. Dr. Apopiexia. Cooke has given a case strikingly in proof of this, which I shall offer N«£r£if in his own words: "I am informed by Mr. Carlisle that, a few !he c"nf?es- tiv© fluid years ago, a man was brought dead into the Westminster Hospital, sometimes who had just drank a quart of gin for a wager. The evidences of Z?*^8"' death being quite conclusive, he was immediately examined ; and has-been within the lateral ventricles of the brain was found a considerable spirits1. quantity of a limpid fluid distinctly impregnated with gin, both to Berated. the sense of smell and taste, and even to the test of inflammability. ' The liquid,' says Mr. Carlisle, 'appeared to the senses of the ex- amining students as strong as one third gin to two-thirds water.' "* It is curious, and seems to baffle all explanation, to see how readily Parallel in- substances foreign to the blood, when they once enter into its cur- ^"transfer rent, are often carried from one organ to another, undiluted and JJ,d?xotic undissolved, and deposited in an entire, or nearly an entire state, in substances a remote quarter. Absorbed pus affords us frequent examples of (j,"™ ™£a" this, and morbid poisons, as they are called, still more frequent. It is hence that various medicines are enabled to act by a specific power ; that mercury travels chiefly to the salivary glands, and per- haps several of the demulcents to the lungs. On examining the different sources of a compressed brain, as we These dif- have just enumerated them, it will be obvious that they bespeak a sources very different, and, indeed, opposite state of vascular action in differ- oT1e^?m" ent case's ; and that while some of them necessarily imply a vehe- brain be- ment and entonic power, others as necessarily imply an infirm and opposite" atonic condition. The external symptoms, from the first, speak to 8,ate °f the same effect; and hence, from an early period of time,—as early action: at least as that of La Riviere or Riveriusj—apoplexy has been con- apoplexy6 templated under two distinct forms or varieties, which have com- has long monly been denominated sanguineous, and pituitous or serous ; as templated though the former proceeded from an overflow of blood highly "nder tw° elaborated by a vigorous and robust constitution, and rushing for- forms: ward with great impetuosity ; and the latter from thin dilute blood, nPs0aun/fr„m or a leucophlegmatic habit, from the relaxed mouths of whose ves- excess of sels a serous effusion is perpetually flowing forth. Morgagni has alxrous11"1 endeavoured to show, but without success, that this distinction was ?om.defi* , -. , . ¥ . .... , cientener- in existence among the Greek writers. It is a distinction, however, gy. that runs, not only through his own works, but through those of Boerhaave, Sennert, Mead, Sauvages, and Cullen, and is acknow- ledged by most practitioners ofthe present day. The term pituitous or serous, however, has been objected to as The term not always expressing the actual state of the brain in atonic apo- pituitous plexy ; since no serum has been found at times in cases where the °^noteai-° symptoms of debility have peculiarly led those pathologists to expect ways ex- it who have employed the distinctive term ; whde the cavities and {he^ctoai state of the brain in * On Nervous Diseases, Vol. i. p. 221. Schrader has a similar case, Observ. Anat. atonic Med. Decad. iv. Amst. 1674. As also Wepffer, Observ. Medico.-Pract. p. 7. Scaph. ca9es' 1722. t Praxis Medica. 8vo. Lngd. 1670. 4iJjJ ct.iv.J NEUROTICA. [okd. iv. Gen VIII Spec. V. Carus Apo plana- Apoplexy. and hence by Nome writers the terms strong and weak apo- plexy have been used in their stead, dis- tinctly alluding to an entonic and atonic action, and laying a foundation for two va- rieties with these names. interstitial parts ofthe brain, have, on the contrary, been sometimes found as much loaded with blood, as in what they denominate san- guineous apoplexy. And hence, Forestus and a few other writers have been disposed to exchange the terms sanguineous and serous, for strong or perfect, and weak or imperfect apoplexy. How far a modification of this disease, strictly serous, may be said to exist, we shall examine presently; but that apoplexy is continually showing itself under the two forms of entonic, and atonic action, seems to be admitted My all. And, as the terms sanguineous and serous do not sufficiently express this change of condition in every instance, the author, in proceeding to treat of these two varieties, will, for the future, distinguish them as follows : x Entonica. Entonic apoplexy. /3 Atonica. Atonic apoplexy. With a hard full pulse, flushed countenance, and stertorous breathing. With a feeble pulse, and pale countenance. a C Apo- plexia en- tonica. Entonic apoplexy. Approach of the dis- ease "• occasional precursive signs. Incursion. Stertorous breathing almost al- ways pre- sent in this form of the disease. Accounted for. Further illustrated. In entonic apoplexy the fit is, for the most part, sudden and without warning ; though a dull pain in the head occasionally pre- cedes the attack, accompanied with a sense of weight or heaviness, somnolency and vertigo. The inspirations are deeper than natural; the face and eyes are red and turgid, and blood bursts from the nostrils. On the incursion ofthe paroxysm, the patient falls to the ground, and lies as in a heavy sleep from which he cannot be "roused. The breathing is strikingly oppressive: though at first, perhaps, slow and irregular, increasing in frequency, weakness, and irregu- larity with the progress of the fit, till at length it becomes, in many cases, intermitting and convulsive. It is in this form ofthe disease that we chiefly meet with, and are almost always sure to find, a snoring or stertorous breathing ; nor is this difficult to be accounted for, since the vessels ofthe trachea, and particularly those of the larynx and fauces, labouring under the same augmented action as those of the head, a larger portion of mucus is secreted by their excretories, than is carried off by the cor- responding absorbents ; in consequence of which it accumulates, and impedes the free flux and reflux ofthe air in respiration. And hence, stertor, though not a symptom essential to apoplexy, as a species, may be ranked as a pathognomic character of the particular form before us. And to the same effect Dr. Cooke and the most celebrated pathologists who have preceded him. "Boerhaave," says he, " measures the strength of the disease by the degree of stertor ; and Portal agrees with him in opinion on this subject; ob- serving that respiration in apoplexy is greatly impeded and the motions of the breast are very apparent. We hear a noise of snoring or stertor," he says, " which is great in proportion as the apoplexy is strong. In all the cases of strong apoplexy which I have seen, the respiration in the beginning of the paroxysm was laborious, slow, and stertorous; and in those which proved fatal, this symptom, as far cL.iv.j NERVOUS FUNCTION. [ord.iv. 423 as I can recollect, remained, even when the breathing had become Gen.VIII. weak and irregular."* «ScEAPo- The author has witnessed it in the same manner continuing to p|exi» the last gasp of life : the reason of which is, that, although in con- Entonic" sequence of the debility which has now, perhaps, succeeded to mor- |p°n0erXy' bid strength of action, there is less mucus secreted in the larynx and continues fauces than on the commencement of the disease, the absorbents of weakness these organs, participating in the growing weakness, are only capable "j^6 la6t of carrying off the finer and more attenuate part of the fluid, and Explained. thus leave the more viscid in a state of accumulation. And it is Hence ,0_° for the same reason that from first to last there is often, also, an aecu- muistion mulation of frothy saliva or foam, which, as it becomes troublesome aa]fVathy by its increase, is occasionally blown away from the lips with consi- about the derable force. ip8' The skin is about the ordinary temperature, and covered with a Further ■ . .1 i ■ c n + u j description. copious perspiration, or a clammy sweat: the pulse is full and hard, the face flushed, the eyes blood-shot and prominent, and generally closed. The cornea is dull and glassy, and the pupil for the most ^or.nea .. part dilated. In a few cases, however, there is a tendency to either dilated" ' spastic or convulsive action, spreading sometimes over the limbs, but fp^,"™®8 more generally confined to the muscles of the face : insomuch that, convulsive under the first, the teeth are firmly closed, and deglutition is impeded. actlon" And where this state exists, the pupil is contracted, as in a synizesis, f^1,;^ sometimes, indeed, almost to a point. This last feature has been contracted, rarely dwelt upon by pathologists, whether of ancient or modern pDseV7edby times : but it has not escaped the observant eye of my accurate and Cooke. learned friend Dr. Cooke : "In some instances," says he, " I have seen the pupil contracted almost to a point, and a physician of emi- nence of my acquaintance has likewise observed this appearance of the eyes in apoplexy: yet although all writers on the subject mention the dilated pupils, I do not find any one, Aretaeus among the ancients, and Dr. Cheyne among the moderns excepted, who has noticed the contracted pupil in these cases.-,t The paroxysm varies in its duration, from eight to eight and forty Duration of hours, and sometimes exceeds this period. Dr. Cooke quotes from ysni.pa,t Forestus the case of a woman, who being seized with an apoplexy, ""^"^ which he caMsfortissima, lay in the fit for three days, and afterwards three days recovered. We have already observed that where it does not prove £!'er™' fatal, it predisposes to a relapse, and often terminates in a lesion of Sequel some ofthe mental faculties, or in a paralysis more or less general; di8ease. commonly, indeed, in a hemiplegia, which usually takes place on the ^p,*"^* opposite side of the body from that of the brain in which the conges- usually on tion or effusion is found, on examination, to have taken place. Bites?Je°of: ;t This," says Dr. Baillie, " would seem to show that the right side of £oemb°£>[t the body derives its nervous influence from the left side of the brain, ofthe brain and the left side ofthe body its nervous influence from the right side ^effj^a8 of the brain. It is rarely indeed, if ever, that some of the turgid Wood. vessels ofthe brain are not ruptured in this form ofthe disease, and consequently produce an effusion of blood into some part of the * On Nervous Diseases, Vol. t. p. 171. t Id. p. 174. i;>4 cl.iv.j NEUROTICA. [o*i>. i*.. Gen-viii organ of the brain." And, according to the same distinguished fc'w' writer, the part where the rupture most commonly takes place is its piexia medullary substance near the lateral ventricles, some portion of the Emonic** extravasated fluid often escaping into these cavities.* apoplexy. Atonic apoplexy is the disease of a constitution infirm by nature Jim« P°" or enfeebled by age, intemperance, or over-exertion of body or mind. Aton'fc1' It has more of a purely nervous character, as we have alreadv ob- apopiexy. served, than the preceding variety, and is more a result of vascular vascular0 debility than of vascular surcharge, and consequently where effusion ratherythan of blood is found, as it often is, in the present form, the vessels have r0af vlscuiar been ruptured, not from habitual distention or vigorous plethora, but andh2E.: from accidental, often, indeed, slight causes, that have produced, a hhrevelsois sudden excitement and determination to the head beyond what the ofVeTraiti vascular walls are capable of sustaining. Hence, a sudden fit of foaundbrup- coughing or vomiting, a sudden fright, or fit of joy, an immoderate tured, from fit 0f laughter,! the jar occasioned by a stumble in walking, or a weakness, severe jolt in riding, have brought on the present form of apoplexy, and with so much the more danger as the system possesses less of a remedial or rallying power in itself. And hence In most of the eases the effusion detected after death has, there- Uon°toThe fore, been as truly sanguineous as in entonic apoplexy ; and hence a term san- valid objection to the use of the term sanguineous as descriptive of apoplexy the entonic form alone. " It is," says M. Portal, " an error to tive o7 the believe that the apoplexy to which old men are so much subject is entonic not sanguineous." Daubenton and Le Roy, Members of the Insti- i°iu?trated. tute, died of this precise kind of the disease at an advanced age : and Zulianus describes a case marked by a pale countenance, and a pulse so weak as scarcely to be felt, which, on examination after death, was found to be an apoplexia vere sanguinea: and another in which, after all the symptoms of what is ordinarily called serous apo- plexy had shown themselves, extravasated blood was discovered in the brain without any effusion of serum, or the smallest moisture in the ventricles.| \et this It is nevertheless true that atonic apoplexy is often found with an found°with effusion of serum instead of an effusion of blood, and apparently an effusion produced by such serous effusion ; and hence, notwithstanding the of serum, , . .. /• tv a 1 1- i • i i /• i • • and appa objections ot Dr. Abercrombie, and, in the latter years of his practice, ^"ced'by" OI* M. Portal, to serous effusion as a cause at all, the experience and •l ctu9red°b" reasonmg °f Boerhaave and Hoffman, and Mead, and Sauvages, and very high Cullen, must not be abruptly relinquished without far graver proofs authorities than have hitherto been offered : for if it be a question, as Stoll has made it, whether effused serum, when discovered in the brain of those who have died of apoplexy, be a cause of the disease or an s^unTLy effec.t>§ vv.e may appty the same question to effusion of blood. It is become, possible, indeed, for effused serum to become occasionally a cause rareil"! a even of entonic apoplexy, or that which, from its symptoms is ordi- cau»e of narily denominated sanguineous apoplexy ; for it is possible for the apo°p"wy. exhalants of the brain to participate so largely in the high vascular T3vplained. * Morbid Anat. p. 227. t Aretaeus de Sign, et Caus. Diut. Morb. Lib. i. Cap. 7. * Se» aiso Burser. de Apoplex. p. 82. Cooke, ut sup. § Pnelect. p. yfc: cl. iv.] NERVOUS FUNCTION. [6iw. iv. 425 excitement by which this form of the disease is characterized, as to GenVIH. secrete an undue proportion of effused fluid into any of its cavities, 0Sc.EApoV and thus become as direct a cause of apoplexy as extravasated P|exia at°- . i ., * J nica. DlOOd. Atonic This, however, is not what is generally understood by the term H°l^y' serous apoplexy as distinguished from sanguineous, and, indeed, apoplexy ought only to be regarded as an effect of sanguineous distention, mnniy™" Serous apoplexy, properly so called, is strictly the result of a debi- "hn^ersstaJ1td litated constitution, and especially of debility existing in the excer- of a debiii- nent vessels of the brain, whether exhalants or absorbents. 1 say g^io""' absorbents, because although lymphatics have not yet been disco- vered in this organ, there must be vessels of some kind or other to answer their purpose, and the extremities of the veins have been supposed thus to act; a supposition which has derived countenance from various experiments of M. Magendie, to which we shall have to advert in the Proem to the sixth class, and which may at least stand as an hypothesis till the proper system of vessels is detected. A serous effusion, under these circumstances, may take place and may from three causes. The mouths of the exhalants may be relaxed, \tom Aitt and consequently let loose a larger portion of fluid than they are ac- causes. customed to do in a state of health, and a larger portion than can be carried off by the absorbents. Or the extremities of the absorbents may be torpid and inactive, and not imbibe the fluid that is thus thrown forth, and the balance may be disturbed in this as well as in the preceding way. Or the blood itself, may be of too watery a crasis, and too large an effusion take place from this cause; whence, indeed, we frequently meet with apoplexy as the result of general dropsy. Hence, atonic apoplexy rarely makes its attack altogether so in- Hence continently as entonic ; and is commonly preceded by a few warning apopici cxy symptoms. These are often, however, nothing more than the ordi- commonly J r /., - r' Gen.VIII SrEc.V. fi C. Apo- plexia ato- nica. Atonio apoplexy. and tbo rich. Illustrated from Blane's tables. exercise, and a diet below what is called for, will often be found to produce the same debilitating effects as case, indolence, luxury, and indulgence at too sumptuous a table. And hence, contrary to wha» many0 would expect, Sir Gilbert Blane has observed from accurate tables kept with minute attention and derived from a practice of ten years in St. Thomas's Hospital, and his private consultations, that " there is a considerably greater proportion of apoplexies and palsies among the former than among the latter :" or, in other words, that these disorders bear a larger proportion to other diseases among the lower classes than among those in high life. " Some cases of hemi- plegia," says he, "occur in full habits ; some in spare and exhausted habits. The former, being most incident to the luxurious and indo- lent, most frequently occur in private practice, and among the upper ranks of life. The latter occur more among the laborious classes, and among such of the rich as are addicted to exhausting plea- Prognostic. Atonic apoplexy more dan- gerous than en- tonic, and why. in other respects the danger parallel with the violence ofthe symptoms. Favoura- ble si case the brain is in a morbid and in the other in a sound state ; whence the premises on which the reasoning is founded are not parallel. In the treatment of apoplexy, if we be timely consulted during Medical the existence of the precursive signs which have been noticed as impoT-6"1' occasionally taking place, we shall often find it in our power com- {*m®fj0aft.a pletely to ward off a paroxysm by bleeding, purgatives, perfect quiet, tention to and, in the entonic variety, a reducent regimen. Where, however, l^VsT/nT the pulse, and other symptoms give proof of weak vascular action, JMfeding. and nervous debility, the depleting plan should be pursued with eau- pursued tion, and it will be better to employ cupping-glasses than venesec- ^ cau" tion, and, in some instances, to limit ourselves to purgatives alone. Yet, whatever be the degree of general debility, if the proofs of com- When ab- pression or distention be clear, as those of drowsiness, vertigo, and nectary a dull pain in the head, it will be as necessary to have recourse to even in bleeding either locally or generally, as in entonic apoplexy ; for such plexy? ap° symptoms will assuredly lead to a fit, unless timely counteracted and subdued. " In the actual paroxysm of apoplexy," says Dr. Cooke, and I General quote his words because it is impossible to exchange them for better, " the patient should, if possible, be immediately carried into a spa- cious apartment, into which cool air may be freely admitted. He should be placed in a posture which the least favours determination of blood to the head: all ligatures, especially those about the neck, should be speedily removed, and the legs and feet should be placed in warm water, or rubbed with stimulating applications. These means may be employed in all cases of apoplexy;"* and are consequently equally applicable to both the forms under which we have contem- plated the disease. The collateral means to be had recourse to require discrimination, and it will be most convenient to consider them in relation to the actual form under which the apoplexy pre- sents itself. In entomc apoplexy, copious and repeated bleeding seems, prima t^tmentl facie, to offer the most rapid and effectual remedy we can have of entonic recourse to : yet the opinions of the best practitioners, as well in copious^' ancient as in modern times, have been strangely at variance upon and ru- tins subject. Hippocrates, who regarded apoplexy as chiefly depend- bleeding. ent upon a weak and pituitous habit, discountenanced the use of J™jfce of the lancet, as adding to the general debility: and even where it is Hippo- accompanied with symptoms of strong vascular action, he discounte-cri nanced it equally, from an idea that the case was utterly hopeless when it assumed this form, and that to have recourse to bleeding would only bring a reproach upon the art of medicine. The autho- rity of Hippocrates has had too much influence with physicians in * Burser, p. 288. r2b cl. iv.j NEUROTICA. iOKD- gen.viii Spec. V. Carus Apopiexia. Apoplexy. Treatment. Mischie- vous influ- ence on later phy- sicians: as Forestus: Heberden: Fothergiii. Salutary effects of spontane- ous hemor- rhages. Bolder practice of other writers an- cient and modern: Ualen, Aretaeus, Paulus ^"ineta. all ages, and has extended its baneful effects to recent times, and in some instances even to our own day. Hence Forestus tells us, that in strong or entonic apoplexy, no courageous plan ought to be attempted, no venesection, no pills : we may, indeed, to please the bystanders, have recourse to the remedia leviora of frictions, and injections, and ligatures round the arms and thighs : " and where," says he, " we have not found these suceeed—in rationem sacerdo- tibus commiserimus." In our own country, the same timid feeling has been particularly manifested by Dr. Heberden and Dr. Fothergiii, but on grounds somewhat different. These excellent pathologists have chiefly regarded apoplexy as a disease of nervous rather than of general debility, and have been fearful of adding to this debility by abstracting blood, and hereby of almost ensuring hemiplegia, or some other form of paralysis. Hence Dr. Heberden speaks with great hesitation concerning the practice rather than with an absolute and general condemnation of it: he observes, which is true enough, that many persons have been injured by large and repeated bleedings, and then lays down his rule, not to bleed either in an attack of apoplexy or palsy, if there would have been just objections to taking away blood before the incursion of either.* Dr. Fothergiii, however, expresses himself still more decidedly against bleeding than Dr. Heberden. He suspects that the weak- ness it occasions checks the natural effort to produce absorption; and that even the hard and full and irregular pulse, which seems imperatively to call for a very free use of the lancet, " is often an insufficient guide ;" since " it may be that struggle which arises from an exeriion of the vires vita, to restore health." And hence, he adds in another place, " I am of opinion that bleeding in apoplexy is, for the most part, injurious, and that we should probably render the most effectual aid by endeavouring, in all cases, to procure a plentiful discharge from the bowels : as by these revulsions, the head is, perhaps, much more effectually relieved from plenitude, and that without weakening or interrupting any other effort of nature to relieve herself than by venesection."! It is singular that in drawing such conclusions from the instinctive efforts or remedial power of nature, where a cure has been effected spontaneously, these distinguished writers have not felt more deeply impressed by the salutary efforts of spontaneous and copious hemor- rhages, as from the nose, the lungs, and the hemorrhoidal vessels, which have never perhaps poured forth blood freely without operating a cure ; and that they have not endeavoured to follow these footsteps. as far as they might have done, by substituting an artificial discharge ot blood where a natural discharge has not taken place. Utner physicians, however, both in ancient and modern times. have not been equally insensible to this important fact. Galen, though he always hesitated in departing from the practice of Hipno- crates, ventured to deviate from him upon the point before us Aretaeus, Paulus of ^g,na, and Ccelius Aurelianus carried the remedy * Medical Transactions, i. p. 472. Works, Vol. m. p. 208. cl. xv.] NERVOUS FUNCTION. [ord. iv. 4^9 of bleeding to a still further extent, and Celsus regarded it as the fp^y"1' only mean of effecting a cure.* carus' " The Arabians adopted the practice of the ancients, as far as ££{j££ relates to the employment of blood-letting in the strong apoplexy, Raiment. and by far the greater number of modern physicians have, in this practice. respect, followed their example. In support of this practice we might adduce the opinion, of all who have written on the disease : we°might quote from the works of Sydenham, Wepffer, Boerhaave, fowhawe, Van Swieten, Morgagni, Eaglivi, Sauvages, Tissot, Mead, Freind, HoffiUn,' Pitcairn, Hoffman, Cullen, Portal, Cheyne, and many other eminent <£»™« modern writers."! As this paragraph is quoted from Dr. Cooke, it gheyM, is almost superfluous to add his own name to the list of those who strenuously recommend blood-letting. A question has been made as to the side from which it may be gO"e**j* most advantageous to take blood. Aretaeus drew it from the sound may be side, wherever this could be distinguished. Valsalva and Morgagni mr™'nad recommend the same ; as does also Cullen, observing that " dissec- yantage- tions show that congestions producing apoplexy are always on the Mosti'y re side not affected. "J Baglivi recommends bleeding from the diseased ';°dm™f' side, except where blood is abstracted locally. The question appears ^sound to be of no great importance : the grand object in general bleeding ByVgiivi is to diminish the quantity and momentum of the circulating fluid, f'-mthe to enable the ruptured vessels to contract with greater facility, and 81de. to afford time for an absorption of whatever may have been effused. In entonic apoplexy, general and local bleeding should go hand Locai^ ^ ■in hand ; and the quantity drawn should in every instance depend accompany upon the urgency of the symptoms. Dr. Cheyne advises us to %™*t begin with abstracting two pounds, and tells us that it will often extent. require a loss of six or eight pounds before the disease will give way, .-.tii j m , Dr. Cullen, and many other writers, as Morgagni, Valsalva, and Temporal Portal, have recommended that the opening should be made in the jugufai temporal artery or the jugular veins. " In all cases of a full habit,' vein- says Dr. Cullen, " and where the disease has been preceded by marks of a plethoric state, blood-letting is to be immediately employed, and very largely. In my opinion it will be most effectual when the blood is taken from the jugular vein ; but if that cannot be done, it may be taken from the arm. The opening of the temporal artery, when a large branch can be opened so as suddenly to pour out a considerable quantity of blood, may also be an effectual remedy ; but, in execution it is more uncertain, and may be inconvenient. It may in some measure be supplied by cupping and scarifying on the temples or hind-head. This, indeed, should seldom be omitted, and these scarifications are always preferable to the appli- cation of leeches.§ In bleeding from the temporal artery we may safely let the stream flow as long as it will, for in common it will cease before we have obtained enough, and all tight ligatures about the head, or indeed * De Medicin. Lib. in. cap. xxvii. I Pract. of Pliys. Vol. in. p. 184. t Cooke, ut supra, 292. § Id. p. 182. 430 cl.iv.j NEUROTICA. [okd.iv- Geh.VIH. any other part ofthe body should be avoided as much as possible. §axEus* V* For the same reason Heister advises that, on opening the jugular vein, Apopiexia. no ligature should be made use of, as the smallest pressure on the Tttent. part may do harm by interrupting the circulation of the blood on the external veins ofthe neck. opening of M. Dejean, of Caen, proposed, not long ago, to the Academy of riorioiigi'- Sciences, to open the superior longitudinal sinus after raising the tudinai" bone which covers it, and asserted that he had employed this mode posUedbPyr° with great success on strangled dogs. M. Portal, and M. Tenon, butdis- however, who were appointed commissioners to report on M. De- commend- jean's memoir, agreed that bleeding from the jugular vein is prefera- taibaynd°r ble to that from the sinus, as producing the same effect more speed- Tenon, jjy^ an(j wjtn more facility of restraint when a sufficiency of blood has been taken away. General What seems to be the fair result the author will give in the words of Dr. Cooke. " General opinion, then, as well as reasoning, ap- pears to be very much in favour of free and repeated evacuations of blood, both general and topical, in the strong apoplexy ; and I am persuaded that greater advantage may be reasonably expected from this than from any other practice ; yet I am very much inclined to think that it may be, and actually sometimes has been, carried too far. I have seen several cases, and heard of many others, in which very large quantities of blood have been drawn without the smallest perceptible advantage, and with an evident and considerable dimi- nution ofthe strength of the patient."* Purgatives. The next important means to be pursued is that of exciting the bowels by active purgatives, and thus endeavouring to lessen the pressure on the brain by revulsion. The particular purgative is of no importance : whatever will operate most speedily and most effec- tively is what should be preferred in the first instance : and hence a combination of calomel and extract of jalap will be found among the best ; though a free action may afterwards be more conveniently maintained by colocynth or sulphate of magnesia. Dola?us employed calomel so as to excite salivation, from an opinion that all evacua- tions are useful ; and he gives an account of several cures he was hereby enabled to effect, and particularly relates the case of a woman who was in this manner considerably relieved, and died on the ces- sation ofthe ptyalism.t fn^nic9'in The collateral remedies are of less importance though some of apoplexy, them may add to the general effect. Emetics are of a very doubt- fuiacharabc- ful character in the form ofthe disease before us, though often highly useful m atonic apoplexy. They have been given upon the princi- ple of their producing a sudden prostration of strength, and faintness : but this is a result of nausea rather than of vomiting : and the lan- guor heteby occasioned is not exactly of the kind we stand in need of ; regard being had to the disease as a nervous affection, and the danger of inducing hemiplegia. Full vomiting may, indeed, deter- mine from the head to the surface of the body, but we cannot an- swer that the straining will not renew the extravasation, or even nip- ter: ' Vi suPra> P- 311. + T)ol*us, p. 149. ' *> iv.J NERVOUS FUNCTION. [ord. iv. 481 ture a vessel where no rupture has existed. It is true the same plan Gen VIII. has at times been employed in haemoptysis, apparently with success ; cards' V* but it has in other instances been so decidedly productive of mis- Apopiexia. chief, as to urge those who have made choice of it to abandon it i&Mment. abruptly, with a determination never to return to it in any other S"^"^ case, as we have already observed when treating of haemoptysis under Class in. Order iv. in the preceding volume. The only instance in which it may be prudent to prescribe an emetic, is where the disease has evidently proceeded from a surcharged stomach. Blisters and sinapisms promise but little in this form of the disease ; Blisters they tease and irritate to no purpose when applied to the extremi- p"^"11*" ties, and are still more injurious when they are made to cover the scalp ; for they effectually prevent the use of epithems of cold water, or vinegar, or pounded ice, which afford a rational chance of pro- ducing benefit. Cordials were in high reputation among the Greek practitioners, Cordials from a belief that apoplexy is in almost every case the result of a muiants"'" debilitated and pituitous habit : and the custom has too generally rnischi leeches whose operation is far too slow for the urgency of the occa- ,eedPto g„" sion. The last, however, are recommended by Burserius, and Fo- nerai. " restus quotes an instance in which they succeeded by a formidable application over the entire body. * Aretaeus, after abstracting blood by cupping-glasses, recommends also the use of dry-cupping between the shoulders, and the recommendation is highly ingenious and worth attending to.t Purgatives, though less violent than in atonic apoplexy, should in muars^ve6 used with *■ Lib. x. Obs. 76. + Pc Cur. Morb. Actit. i. 4, Jsss doubt. 132 cl. iv.J .NEUROTICA. LoKU- Gen.VIII. Spec. V. Carus Apopiexia. Apoplexy. Treatment As may external and inter- nal stimu- lants. like manner be had recourse to : and as we have less danger to ap- prehend from the use of emetics, they may be given more treety* They are strongly recommended by Sauvages, and were regarded by Grubelius almost as a specific. They have the triple advantage of freeing the stomach from morbid acrimony, rousing the system gene- rally, and determining from the head to the surface of the body. Here also We may use both external and internal stimulants in many cases with considerable success. Of the former, volatile alkali, rubefacients, and blisters may be made choice of in succession, and applied alternately to different parts of the body. Of the latter we should chiefly confine ourselves to the warmer verticillate plants, as lavender, marjoram, and peppermint, or the warmer siliquose, as horse-radish and mustard, or the different forms of ammonia : yet even of these we are debarred by Dr. Cullen, at least, in that parti- cular modification of atonic apoplexy, which we have described under the name of serous, though he does not enter into a consider- ation of any other. Treatment In that peculiar kind of apoplexy which is sometimes produced fromexcifss by taking immoderate doses of spirits or some narcotic, and especially ofdrmkmg, opium, in which we meet with an almost instantaneous exhaustion or of nar- £ i cotics. of the nervous power, or an instantaneous stop put to its secretion *** or flow, making a near approach to asphyxy, though with a heavy drowsiness and stertorous breathing, the patient should first have his stomach thoroughly emptied by an emetic of sulphate of copper; he should be generally stimulated by blisters, and kept in a state of perpetual motion by walking or other exercise, so as to prevent sleep till the narcotic effect is over. An interesting case of this kind will be found related by Dr. Marcet in the Medico-Chirurgical Trans- actions.* vaiVt"1"" t After all it should not be forgotten that apoplexy is in most, per- importfnce, haps in all cases, not secondarily alone, but primarily a nervous affec- tion, and dependent upon a predisposition to this disorder in the sen- sorium itself, if not upon a morbid condition of it: and that hence the patient, though we should recover him from the actual fit, will be subject to a recurrence of it. In this view the interval becomes a period of great importance, and should be as much submitted to a course of remedial treatment as the paroxysm itself. After entonic apoplexy, ,the patient should habitually accustom himself to plain diet, regular exercise, early hours of meals and retire- ment, and uniform tranquillity of mind: and the state of his bowels should particularly claim his attention. After the atonic variety the same general plan may be followed with a like good effect, but the diet may be upon a more liberal allowance ; and a course of tonic medicines should form a part of the remedial system. If it were true, as suspected by Dr Cullen, that all bitters contain in the bitter principle itself a narcotic and mischievous power, these ought to be carefully abstained from, but we have already observed that this does not seem to be the fact. And hence much of the treatment laid down under limosis Dyspepsiat may be pursued here: together with 'he use ofthe waters of Bath, Buxton, and Leamington. mands minute at attention. Interme- diate treat' ment of entonic apoplexy ; of atonic apoplexy. Vol. I. p, t Vol. i. p. 164. * r.. xv.J NERVOUS.FUNCTION [ok». i,. 4^ SPECIES VI. CARUS PARALYSIS. PALSY. CORPOREAL TORPITUOE AND MUSCULAR IMMOBILITY MORE OR LEcfc GENERAL, BUT WITHOUT SOMNOLENCY. Palsy is a disease which makes a near approach to apoplexy in Gen-VIII. its general nature and symptoms, and is very frequently a result of |^;nvfo it. It is, however, still more strictly a nervous affection, and less apoplexy. connected with a morbid state of the sanguiferous or the respiratory gtrictiya5 organs. In examining it more in detad, we shall find that some- nervous times the motory fibres alone are affected in any considerable Sometimes degree, while the sentient are only rendered a little more obtuse ; cfpl'iiy'in"3" sometimes both kinds are equally torpid, and sometimes several of the motory the faculties of the mind participate in the debility, though they are sometimes never so completely lost as in apoplexy. toryhand° The Greek writers contemplated the two diseases under the same sentient: view, considering them as closely related to each other, or, in ames°influ- other words, as species of the same genus. " The ancients," says ^,e®sf^e" Dr. Cooke, who has accurately gone over the entire ground and mental taken nothing upon trust, " very generally considered apoplexy and ^"p^fy palsy as diseases of the same nature, but different in degree ; apo- and palsy plexy being an universal palsy, and palsy a partial apoplexy. Aretaeus p^Tas says, apoplexy, paraplegia, paresis, and paralysis, are all ofthe same dj^e"f ^e" kind ; consisting in a loss of sensation, of mind, and of motion, common Apoplexy is a palsy ofthe whole body, of sensation, of mind, and of ^Greeks. motion. And on this subject Galen, Alexander, Trallianus, iEtius, and Paulus ^Egineta, agree in opinion with Aretaeus. Hippocrates who, in various parts of his works, speaks of apoplexy, no where, as far as I know, mentions paralysis ; and when he refers to this disease he employs the term apopiexia. Both Aretaeus and Paulus iEgineta represent him as speaking of apoplexy in the leg. Celsus describes palsy and apoplexy by the general terms besolutio nervorum."* It is only necessary to add that paresis and palsy were used some- £a/|^°nvt times synonymously; and that, when a distinction was made between from palsy. them, paresis was regarded as only a very slight or imperfect palsy. Palsy and apoplexy, however, are something more than the same ^ysn^](] disease merely varied in degree ; the one, indeed, may lead to and be regarded terminate in the other, but they very often exist separately and with- ^as""** out any interference; and, notwithstanding their general resem- ^"^go blance, are distinguishable by clear and specific symptoms. But if great adis- the Greeks approximated them too closely, the greater part of the [nn^enaasve nosologists of modern times, as Sauvages, Linneus, Vogel, Sagar, been by many mo- „ , , dern wri- * Treatise on Nervous Diseases, Vol. n. p. l, -e-». Vol. IV.—55 434 cl. iv.] NEUROTICA. [oRI>. IV. Gen.VIII. Spec. VI, Carus Pa- ralysis. Palsy. Proper sta- tion appa- rently that uf the pre- sent work. Common causes of apoplexy very fre- quently those of palsy, espe- cially com- pression. Yet the dis- ease often produced from other causes, and especially those of nervous debility. Often intro- duced by precursive sisns. Nerves chiefly af- fected those of volunta- ry motion; but the accompa- nying nerves of feeling commonly participate in a greater or less degree- Action of the heart and lungs little inter- fered with ; and hence a material difference between palsy and apoplexy. The mind, and espe- cially the memory, rarely es- capes in- jury- Qeneral pathologi- cal re- mark ex- planatory of many symptoms •f pal=y. Cullen, and Young, have placed them too remotely, by regarding each as a distinct genus: the proper nosological arrangement seems to be that of co-species, as they are ranked by Dr. Parr, as welt as under the system before us. The common causes of apoplexy are usually asserted to be those ot palsy : and considering how frequently palsy occurs as a sequel of apoplexy, the assertion has much to support it; for compression is here also as well as in apoplexy a very frequent cause. Yet as com- pression does not seem to be the only cause of apoplexy, it is still less so of palsy in all its modifications, and we shall stdl more fre- quently have to resolve the disease into some of those causes of general, and especially of nervous, debility, which we have already noticed as occasionally giving rise to apoplexy, and which we have more particularly illustrated under the genus clonus ofthe preceding order. Palsy is often preceded by many of the precursive signs we have already noticed as forewarning us of apoplexy; and it commonly commences slowly and insidiously ; a single limb, or a part of the body being at first troubled with an occasional sense of weakness or numbness, which continues for a short time and then disappears. A single finger is often subject to this token, as is one of the eyes, the tongue, or one side of the face. The nerves chiefly affected are those subservient to voluntary motion, but the accompanying nerves of feeling in most cases par- ticipate in the torpitude though not in an equal degree, and some- times not at all. " I never," says Dr. Cooke, " saw a case of palsy in which sensation was entirely lost:" though such cases seem sometimes to have occurred. The action of the involuntary organs, and especially of the heart and lungs, are but little interfered with, though in a few instances something more languid than in a state of ordinary health. And in this respect we perceive a considerable dif- ference between paralysis and apoplexy, in which last the heart appears to be always oppressed, and the breathing laborious. The faculties of the mind, however, rarely escape without injury, and especially the memory ; insomuch that not only half the vocabulary the patient has been in the habit of using is sometimes forgotten, but the exact meaning of those terms that are remembered; so that a senseless succession of words is made use of instead of intelligible speech, the patient perpetually misusing one word for another, of which we have given various examples under moria imbecillis, or mental imbecility.* And it is hence not to be wondered at that palsy should occasionally impair all the mental faculties by degrees. and terminate in fatuity or childishness. We have frequently had occasion to observe and to prove by examples, that where any one of the external senses is peculiarly obtuse or deficient, the rest are often found in a more than ordinary degree of vigour and acuteness, " as though the sensorial power were primarily derived from a common source, and the proportions belonging to the organ whose outlet is invalid, were distributed * See Vol. in. Cl. in. Ord. iv. Gen. it. Spec. < ol. rv.J NERVOUS FUNCTION. [ord. iv. 435 among the other organs."* Something of this law seems to operate Gen.VIII. in many cases of palsy, and is more and more conspicuous in pro- c^'pT-' portion to the extent of the disease : for in hemiplegia and paraple- pjjfsi9< gia, the half of the body that is unaffected has not unfrequently Hence the evinced a morbid increase of feeling. Dr. Heberden attended a pa- Zfnmt ralytic person whose sense of smell became so exquisite as to furnish timGS perpetual occasions of disgust and uneasiness : and he mentions one SSdin- case in which all the senses were exceedingly acute. foX* °f It is to this principle we are to resolve it that where the disease illustrated. confines itself to the motory nerves of an organ alone, and the sen- "o"^ sific are not interfered with, the feeling of the palsied limb itself is £cb™fjjf sometimes greatly increased, and sometimes exacerbated into a sense the affected of formication, or some other troublesome itching. " I have seen "mes"^-" several instances," says Dr. Cooke, " in which paralytic persons have sess excess felt very violent pain in the parts affected, particularly in the shoulder ° and arm ;"j and the remark, if necessary, might be confirmed from numerous authorities. Palsy, however, is strictly a disease of nervous debility, and where Sometimes it shows itself extensively, the whole nervous system is affected by it. nervouse The consequence of which is, as we have already shown in treating ^ntfestiy of entastic, and particularly clonic spasm, that the sensorial fluid in affected; all its modifications is secreted or communicated irregularly, and its sensorial balance perpetually disturbed, so as to operate upon the mind as well jfglaunrbgd as upon the body : whence some parts are too hot and others too in various cold, and even the affected limb itself, according to the nature ofthe Hence the affection, and its limitation or extension to different sets of nerves, affected will be warmer or colder than in its natural temperature, and will times80 waste away, or retain its ordinary bulk ; while the passions of the go"etfnies mind will participate in the same morbid irritability, and evince a colder than change from their constitutional tenour. Persons ofthe mildest and j^ajns its most placid tempers will often discover gusts of peevishness and bu,*°Br irascibility; and men of the strongest mental powers have been away. known to weep like children on the slightest occasions. In a few t^e8m°nd °f instances, however, an opposite and far more desirable alteration has affected. been effected. " I had several years ago," says Dr. Cooke, " an illustrated. opportunity of seeing an illustration of this remark in the case of a much respected friend. The person to whom I allude had always, up to an advanced age, shown an irascible and irritable disposition : but after an attack of palsy his temper became perfectly placid and remained so until his death about two years afterwards."! It is the general opinion that paralytic limbs are uniformly colder £*{£'** than in a state of health : and Mr. Henry Earle has ably supported moniysup- this opinion upon an extensive scale of examination, in an article cofder'than introduced into the Transactions of the Medico-Chirurgical Society.§ jj^'!""* Dr. Abercrombie, on the contrary, in a correspondence upon this especially subject with Dr. Cooke, gives it as his opinion that paralytic parts £* ^be£ do not become colder than natural; and adds, " that he had long «omobj«d ago observed that they are sometimes warmer than sound limbs, but not lo De colder. + See Vol. hi. Cl. in. Ord. 11. Gen. in. Spec. v. t Ut supra, p. 6. X See Vol. in. Cl. m. Ord. in. Gen. I. Spec. i. } Medico-Chirur. Trans. Vol. v". 436 cl. iv.] .NEUROTICA. [ow>. »* - r.EN-.vill. without being able to account for it." The present author has fre- rafus'pl-1' quently made the same remark, though he has more commonly found raivsis. them below the ordinary temperature. The facts, therefore, on both Diversity sides are correctly stated ; and the discrepancy is to be resolved into of opinion the nature and extent of the sets of nerves that are immediately reconc.ied. affecte(^ whether sensific, motific, or both, and into the disturbed and irregular, the hurried or interrupted tenour with which the nervous fluid is secreted or supplied. subdivision The learned Pereboom, who has followed Boerhaave and Heister Soo^'6" in attaching himself to the apparently correct doctrine of the Galenic founded on school, that the nerves issuing from the sensorium are of two distinct saiot|roUgey[,hy" sorts, one subservient to sensation, and the other to muscular motion, and has so far accorded with the physiology attempted to be estab- lished in the commencement of the present volume, has divided palsy, buiw °or- w^ich he describes as a genus, into three species ; a nervous, mus- rectty ex- cular, and nerveo-muscular ; by the first meaning that form of the pressed, disease in which there is a deprivation of sense without loss of motion; by the second, loss of motion while the sensibility remains; and by the third, loss both of sense and motion.* The specific and unne- names are here, at variance with the physiology; for if it be true that compii-' muscular motion is as dependent upon the nerves as sensation, then, rued. palsy affecting the moving fibres, is as much entitled to be called nervous as palsy affecting the sentient. Nor are the few cases to be met with of privation of feeling without loss of motion, strictly speaking, to be regarded as palsies. They are rather, as Aretaeus has correctly observed, examples of anocsthesia, or morbid want of the sense of feeling, and as such will be found described in the pre- sent system under the name of parapsis expers.j Hence a On this account the present author, in his volume of nosology, piitied sub- thought it better to follow up, though with a considerable degree of fered°in the simplification, the subdivisions of Sauvages and Cullen, and to dis- ptetem of tmgu*shthe disease under the three following varieties founded upon nosology, the line or locality of affection : x Hemiplegia. The disease affecting and confined Hemiplegic Palsy. to one side of the body. p Paraplegia. The disease affecting and confined Paraplegic Palsy. to the lower part of the body on both sides, or any part below the head. y Particularis. The disease affecting and confined Local Palsy. to particular limbs. m0s'eansibi-al .,S°me nosologists have transferred to this division the local insen- externd U,e s*blhties and atonies of the external senses or parts of them, as though senses not tnev were idiopathic affections. It is rarely, however, or never, as JeTeS Aretaeus has Just1/ remarked, that they are not connected with other s°elcies- symPtoms and other derangements of such organs and their respec- species and wh * Acad. Nat. Cur. Soc. De Paralysi. 8vo. Horn*. t Class iv. Ord. n. Gen. y. vl.iv.] NERVOUS FUNCTION. [ord. iv. 437 tive functions: and hence, they rather belong to the second order of Gen.VIII. the present class, than to paralysis in the strict sense of the term. carus'pT- They are anaesthesiae,—loo-ct ttxpxXvtikoi, or vxPirixoi, rather than raiysis. •rrxexXvreti; and in the system before us are arranged accordingly. asy' Hemiplegia, the first of the above varieties of palsy, is far more a c- Pata- frequently met with as a sequel of apoplexy, and especially of atonic miplegia" apoplexy, or that in which the energy of the nervous system is pecu- pX|plesic liarly diminished, and irregular. The usual exciting causes of apo- Mostly a plexy are in consequence those of palsy, and need not be enumerated apoplexy; in the present place. In a few instances, however, hemiplegia but some- occurs without preceding apoplexy; and hence, distinctly proves found that pressure, or at least such a pressure as is demanded to produce p^edLg somnolency, is not essentially necessary. Mr. John Hunter, as we apoplexy; have already observed, was inclined to think that pressure from effused blood, was, in every instance, the cause both of this disease and of apoplexy ; but in allowing, as he has done, that on one occa- evidenced sion at least he was called to a patient who died of a gouty affection admission of the brain '■'■with symptoms similar to apoplexy,'''' and wilhout any tefrJ'Hun" extravasation whatever, he directly yields the point of compression as an universal cause : for if atonic or retrocedent gout may produce apoplexy or palsy without pressure on the brain, so may many other atonic powers, operating as effectively on the sensorium. One of A/ebiiita- * " r © J te(j and pa- the most frequent of these powers is a debilitated and paretic state retic state of the liver ; and hence those persons are peculiarly subject to this sometimes'' variety of palsy, who have spent the earlier part of their lives in an * ^a»se. habitual course of intemperance. Hoffman has particularly noticed this cause ; and Morgagni describes the case of a man advanced in illustrated. years who was attacked with jaundice and hemiplegia simulta- neously ; the jaundice affecting the hemiplegic side alone, which was At times the right, and that with so much precision, that the nose was of a pan?ed deep yellow on the one side, and of its proper colour on the other, with a which were divided from each other as by a ruled line. Other of the he- causes are exposure to the rays of the sun, drinking cold water and ™^'Xne. bathing- in it when heated, repelled eruptions, and chronic rheu- other . causes. matism. As apoplexy has its precursive symptoms occasionally, so also has Precursive hemiplegia, and particularly when it is connected with a plethoric ot™emi-B habit: for in this case, the veins of the neck and face often appear i>les»a- turgid, there is an obtuse pain in the head, the tongue moves with some difficulty, and particularly on one side, the perception and memory become impaired, and the patient feels a tendency to drivel at one corner of the mouth rather than at the other. The onset, like Attack. that of apoplexy, is at last sudden ; and if the patient be standing he drops down abruptly on the affected side. The progress of the disease is uncertain ; and depends very much ^°di^°J upon the state of the nervous system at the time of the attack. If Duration. there be no chronic debility, or other morbid condition of the sen- sorium, the patient will sometimes recover entirely in a week or even less ; but if his system, or some particular part of it, be in an infirm state, he recovers only imperfectly ; and obtains, perhaps, a thorough or a limited use of the lower limb, while the upper remains 438 cl.iv.] NEUROTICA. [«»•»*• Gen VIII. immoveable ; or he is compelled to pass through the re5na;nIder,0^ acEpar?- wretched and precarious existence with only one half of his body lysis' Hemi- suhserrient to his will, the other half being more dead than alive, ana feegic withering, perhaps, with a mildew-mortification.* palsy. we have stated that in this disease, as, indeed, in all otners, irreguia? accompanied with an atonic disturbance of the nervous energy, there drsuibutlo,, is not only a great irregularity in its flow, but a great and confused oi the sen- disproportion in its distribution to different parts of the body ; so fl°u"d that the stock, whether of sensific or motific fluid, which is altogether deficient in some parts, seems to be sent in a hurried and tumul- tuous accumulation to others, which are in consequence irritated with an undue degree of sensation or motivity, in the most capri- cious manner. Dr. Cooket and Dr. Abercrombiej. have collected numerous and highly interesting examples of these curious anoma- lies, and may be consulted with great advantage by those who are desirous of following up the subject more minutely. Transverse Sauvages gives a case from Conrad Fabricius, of what he calls ofSau-eia transverse hemiplegia, in which the disease was confined to the arm vages on one side, and the foot on the other :§ and Ramazzini speaks of other sin- a patient whose leg, on one side, had lost its feeling, but retained lmaiesX *ts Power OI* motion, while the other leg had lost its power of motion but retained its feeling, i! In some instances, indeed, the entire feeling of one side is said to have been lost, and the entire motivity on the Sense of other side ;1I and in a few rare examples persons during the pa- heaffrom r°xysms, and even for some time afterwards, have felt, on the affected cold bodies side, a sensation of pungent heat from cold, and especially polished fectedsido; bodies, and of painful cold from an application of hot bodies. cold °f ^ *s not' Perbaps, very difficult to account for this last singularity. from hot Where the sensibility is morbidly accumulated in a weak limb, as it Thufsingu- often is in hemiplegia, sometimes so much as to give a painful sense lar feeling 0f formication, cold not only excites action but becomes almost as explained. .7 J . , , „ pungent an irritant as an actual cautery; in the correct language ot the poet —Bores penetrabile frigus adurat.** And hence in climbing lofty mountains, as the Alps and the Andes, the traveller frequently finds his skin more completely blistered from the sharp cold by which he is surrounded than by an exposure to an equinoctial sun. On the contrary, the morbid halitus or perspiration into which the application of hot bodies often throws a limb, in the same relaxed and debilitated state, produces an unusual sense of fiait" coldness in consequence of the evaporation. And we may hence explain the singular case recorded by Dr. Falconer, of a gentleman who after a paralytic attack, felt his shoes very hot when he first put them on, and gradually become cool as they acquired the warmth of * See Vol. ii. Cl. m. Ord. iv. Gen. xii. Spec n. t On Nervous Diseases, Vol. ii. Part I. J Treatise on Apoplexy and Palsy. § Spec. Gen. xix. Ord. m. Cl. vi. il De Morb. Artif. 286. See also Helster, Wahrnemnngen. l. 205. 7 Eph. Nat. Car. passim. ** Virg. Georg. i. 98. ^ *v.j NERVOUS FUNCTION. [ord. iv. 43$ his feet; the re-action, and consequent increase of moisture thrown Gen VIII. forth from the surface of the feet producing the difference of f e^p;,!.1' sensation. iy«is Hemi- In the Transactions of the Medico-Chirurgical Society* there is a ulmfpiegic very singular case of Dr. Viesseux, who was gradually attacked with pA*d%ion&l an imperfect hemiplegia which at first showed its approach by per- illustration. turbed sensations, and vertigo, with a feeling of sea-sickness, a sight of objects reversed, a difficulty in swallowing liquids, and a total loss of voice, while the powers ofthe mind remained unimpaired, so that he could watch all his symptoms. Shortly after this the whole of the right side became utterly insensible, the insensible part being divided from the sensible by a geometrical line running down the body in a vertical direction : and in about three months more the insensibility of the right side of the head, accompanied with a debility of all the voluntary muscles was transferred to the left, the right re-acquiring its antecedent powers ; but all the right side below the head still continuing to possess its former torpitude. Here, also, there was a very different sense of heat and cold on the opposite sides; for whilst the left was influenced naturally, the right had the falsified sensation just noticed in Dr. Falconer's case, so that in getting into a cold bath or a cold bed, the right side had a feeling of heat, while the left side felt cold, as it should do. Hot bodies, in like manner, felt cold to the diseased side, apparently from the cause just stated. And that this was the real cause seems manifest from the patient's having often a feeling of a cold dew, or of cold water on the surface, and especially over his face, which induced him to wipe himself as if he had been wet. It is, perhaps, more singular that, though plunging his right or affected hand into cold water gave him a sense of luke- warmness, plunging it into boiling water gave him a disagreeable sensation, but very different from that of either heat or cold. This sensation seems to have been that of numbness, and was probably produced in consequence of the accumulated sensibility being rapidly carried off by the extreme heat of the water, as a like torpitude is produced by the opposite effect of extreme cold, and the rapid ex- haustion of sensibility which is so well known to follow on its appli- cation. This morbid disturbance and irregular distribution of sensorial ^j^ power is sometimes productive of the most alarming consequence ; distribution for in a hemiplegic state of the bowels some parts are, in certain p0werSOna1 cases, so acutely sensible, and others so utterly insensible, that while df™e^mes ordinary purgatives are incapable of exciting evacuations from the Explained! torpitude and irresponsibility of the palsied parts, they are sufficient to occasion inflammation, and have actually occasioned it in the parts exacerbated by accumulated sensibility, as certain experiments of M. Magendie have sufficiently established. It is owing to the same irregular distribution of sensorial power, "|™^; where every department of the nervous system participates in the sometimes diseased state of the sensorium, that we sometimes behold hemi- hyjSrhon? plegia, and particularly imperfect hemiplegia united with other affec- jjrism an<^ tions of the * vol. tii. P. tie. ™8 l-10 CL. I\.j NEUROTICA. [ORD. IV lysis Hemi plegia. Hemiplegic palsy. Exempli- fied in Saussure. The hemi plegia be but some symptoms of chorea- Gen.VIII. tions of the same system. The symptoms of hypochondrism are s"£- VL peculiarly apt to associate with it, in which case the bravest hero ' will often lose all his magnanimity and sit down and weep like a child : and in the celebrated geologist M. de Saussure, we find a still more complicated instance of hemiplegia, hypochondrism, and chorea. The disorder crept on by imperceptible degrees, and was accompanied with various anomalies. Both sides were weakened, but the left suffered chiefly ; yet, by the aid of a stick he could still drag forward the left leg. By some unknown means he had taken 3t up a morbid notion, very common to hypochondriac patients, of the oniy'hypo- difficulty of passing through a door-way when wide open without chondrism, being SqUeezed to death ; and hence, at the very time in which he could cross his room with a tolerably firm step, the moment he reached the door, which was of capacious breadth and thrown open for his passage, he tottered and precipitated his motions with the jerk of a St. Vitus's dance, as though he were preparing for the most perilous leap : yet as soon as he had accomplished the arduous un- dertaking, he again became collected, and passed on with compa- rative ease till he had to encounter another adventure of the same Sometimes kind which was sure to try him in the same manner.* Tulpius gives beriberyTUh a somewhat similar case in which hemiplegia was united with beribery.j 0 c Para- Paraplegia or the second variety of palsy, has generally been piegiaPara conceived to depend altogether upon a diseased affection of the Paraplegic spine in its bones, ligaments, or interior, most frequently in the cfueflV de- region of the loins ; in consequence of which the spinal marrow pendent becomes pressed upon, or otherwise injured, independently of any complaint of the brain. That this is a common cause is unques- tionable, and a cause that often operates long without external signs: for the vertebral extension of the dura mater maybe thickened, or a serous fluid effused, or blood be extravasated within the vertebral cavity ; or a tumour may be formed in some part of it, or the spinal but oftenest marrow itself may undergo some morbid change. But the best operating practical observers of the present day concur in opinion that para- on the plegia, like hemiplegia, is produced still more frequently by causes as affirmed operating on the brain than confined to the spine. Of this opinion thVfirsty °f *3 Dr. Baillie, who ascribes it chiefly to pressure on the brain,| Sir authorities Henry Halford, Sir James Karle, and Mr. Copeland.§ Some kind Precursive of affection of the head, indeed, will commonly be discoverable from Sl^8- the first, if we accurately attend to all the symptoms; some degree of pain, or giddiness, or sense of weight or undue drowsiness, or the"cyau°ses imP®rfection in tiie sight. And hence, many of the causes of para- ofhemipie- plegia are evidently those of hemiplegia, operating probably upon a May occur This form of paralysis may take place at any age, but it is more butachiefy' frequent as we advance beyond the middle of life; and Dr. Baillie has observed that it occurs oftener in men than in women ;* for which it is by no means difficult to account, considering the greater hurry upon a diseased spine. Produced in various tvays; after the middle of t Lib. iv. Cap. 5. * Medico-Chir. Trans. Vol. Vii. p. 214. X Trans. Med. Vol. vi. Art. n. § Treatise upon the Symptoms and Treatment of the diseased Spine ^. iv.j NERVOUS FUNCTION. [ord. iv. 441 and activity of life pursued by the former. The disease, in many Gen.VIII. instances, makes an insidious approach. There is at first nothing/fop'arl-' more than a slight numbness in the lower limbs with an appearance 'ysis.Para" of stiffness or awkwardness in the motion of the muscles: these p^piegic symptoms increase by degrees; there is great difficulty in walking, ^lln and an inability in preserving a balance ; the aid of a staff or the arm often insi- of an assistant is next demanded: and the urine is found to flow in progress of a feeble stream, or perhaps involuntarily. The bowels are at first ^e disease. always costive ; but as the sphincter loses its power of constriction, the motions at length pass off involuntarily. The disease may con- Terminft- tinue for years, and the patient at last sink from general exhaustion. It sometimes, but rarely, terminates in a recovery.* When an injured or diseased state of the spine is the origin of Origin and paraplegia, the complaint shows itself suddenly, or makes its ad- ^hfnepro- vances insidiously according to the nature of the cause: and for abjured a knowledge of this form of the malady we are chiefly indebted to or diseased Mr. Pott,t who, however, does not think that it properly belongs to sptne^as the species paralysis, though there seems no sufficient reason why it ?0BJ,ri^d should not be so arranged, as in truth it has been by most patholo- y gists from the time of Galen, who seems not only to have under- stood its nature, but to have contemplated it in this view.j The disease, however, must not be confounded with rhachybia, or dis- tortion of the spine, from debility of muscular power, of which we have already§ treated in the present volume. It sometimes happens in hemiplegia, that one or more vertebras have been pushed, by sudden force, a little way out of their proper position ; and in this case a considerable degree of numbness, to- gether with less motion in one or both the lower limbs, is almost sure to follow, too often succeeded by a paralysis of the sphincters of the rectum and bladder, and consequently art involuntary discharge of feces and urine ; and if the luxations should take place in the dorsal or cervical vertebrae, the organs of digestion may all, more or less, suffer, the respiration become affected, and the spine itself ex- £furtn^ture hibit a considerable degree of curvature. And the same effects are spine. still more likely to follow, and even to a greater extent and with still more serious mischief, from an idiopathic affection of some part of the spinal chain, arising from inflammation, scrophula, rickets, molli- faction, or caries ; from compression by some effused fluid, or a thickening of its external tunic, or even of the substance of the spine itself; of which last M. Portal has given a singular example. II In the last case the disease, for the most part, makes its approach often ^ blowly, and is often found in weakly and ill-nursed infants. Its pre- iii.nurse.i cursive symptoms are commonly languor, listlessness, weakness in ,nfat,,s- the knees, and a pale and shrivelled skin. As it advances, there is a difficulty in directing the feet aright when walking, the legs invo- * Practical Essay on the Diseases and Injuries of the Bladder. By Robert Bing- ham. 1822. xl , w t Remarks on that kind of Palsy of the lower limbs which is frequently found to accompany a curvature of the spine, 8vo. 1788. % De Locis affectis, Lib. iv. cap. vi. § Cl. iv. Ord. hi. Gen. I. Sp. 3. II Anatomie Medicale, p. 11/. Vol. IV.—56 •1-lii CL. 1V.J .\EURUIri -a. [ORD. 1<-' Gen VIII. Spec. VI. 0 C Para- lysis Para- plegia- Paraplegic palsy. Connected like hemi- plegia oc- casionally with a morbid. state of the mental powers, and even where the spine is primarily affected. Instructive illustration from Cooke. Sensibility ;iud mo- bility most injured where the upper part of the spine is affected. Singular case from Rullier. luntarily cross each other, and the little patient is perpetually stumbling upon level ground, till at length he is incapable ol walk- ing at all. In adults the progress of the disease is more rapid than in childhood. Like hemiplegia, this variety is sometimes connected with a morbid state of the mental powers, and particularly with hypochondrism, and this too where the disease proceeds from an organic lesion of the spine. Dr. Cooke has an instructive case in illustration of this, in an officer ofthe army, aged forty-five, who had for many years been exposed to the hardships of a military life, particularly to extremes of heat and cold in various climates. " For two or three years pre- vious to the paralytic attack, he had complained that his state of health was deteriorated, although no precise symptoms of disease could be pointed out either by himself or by his medical friends. His appetite was good, his bowels regular, though inclined to costive- ness, and his usual robust appearance was not diminished. He entertained some fanciful notions respecting the state of his health : and from some uneasy sensations about the sacrum he supposed that he had internal hemorrhoids, though no evidence of their existence could be perceived by his physicians, by whom he was considered as hypochondriacal." After having suffered for two or three years he gradually lost the power of walking without some support for one of his hands. He went to Bath and had hot water pumped upon his loins : soon after which he complained of pain in the lum- bar region, which was followed by a collection of fluid behind the great trochanter of the left side, which burst externally, and was dis- charged daily, in considerable quantity. The paraplegia was now complete : the lower extremities being quite useless : the feces and urine, which, for a considerable time, the patient had with some dif- ficulty retained, came' away involuntarily : his strength rapidly wasted ; he became much emaciated ; and, at the end of three months after his return from Bath he died ; retaining the use of his senses and his intellectual faculties to almost the last instant of his life* Where the upper part of the spine is affected, the superior limb- are usually divested of mobility or sensibility, or both, while but little disturbance, in a few rare instances, takes place in the inferior. The most singular example of this sort that has occurred to the present writer, is contained in a case related by M. Rullier, of Paris.t The subject was forty-five years of age, and had evinced a slight rhachetic tendency from infancy, accompanied, as is often the case, with a considerable precocity of intellectual powers : the dorsal portion of the vertebral column evincing a little distortion, so as to give some degree of elevation to the right shoulder ; but which did not proceed further. The patient, from early youth, had indulged himself in every concupiscent indiscretion, and especially in an unbounded and extravagant intercourse with females, which frequently reduced him t<> ii state of exhaustion almost amounting to deliquium. It was not. * On Nervous Diseases, Vol. n. Part i. p. 43. * London Medical and Physical Journal. July, 1822. p. 80= ol.iv.] NERVOUS FUNCTION. (ori>. iv. 443 however, till the age of thirty-four, that he first began to perceive Gen.VIII. any serious difficulty in the movement of his arms, which was soon p 0. p"ara- connected with some degree of pain and swelling in the distorted ly,*isj^ara" part of the vertebral chain. The complaint made a rapid progress, Parapiegi- and the patient in a short time lost the entire use of these limbs, p"8y' though their sensibility continued to the last, and appeared to grow morbidly acute, as he would not suffer any one to touch them, on account of the pain produced by such contact. He became indeed highly irritable in his temper, but could walk to a considerable dis- tance, enjoyed company and his usual meals, and still retained an immoderate appetency for venereal pleasures, with the fullest means of indulging it. Hectic fever, however, now attacked him with phthisis, and he at length fell a sacrifice to such a host of marshalled evils. On a post-obit examination, the chief organs found to be ^/^ affected were the lungs, and the spinal marrow at the seat of distor- dissection. tion. The last indeed presented a very singular appearance. From its origin to the fourth pair of cervical nerves, it was quite natural; but from this point, through an extent of six or seven inches in ^'jjj^ length, the whole substance ofthe column was reduced to the most spinal diffluent state of mollifaction, like what we have already noticed as marr(,vv sometimes found in mollifaction of the brain ; while below this length, the cord appeared again to be firm and uninjured ; a few flakes of medullary matter were alone found in the morbid fluid which had usurped its place, but altogether disorganized and uncon- nected. And we here therefore, behold, to adopt M. Magendie's remarks upon this very marvellous affection, a man enjoying, almost to his last hour, great moral activity, powerful generative faculties, a free movement of his inferior extremities, and a keen sensibility of the superior ; who nevertheless, for an uncertain, but probably a very considerable period, had been destitute of one third part ofthe substance of the spinal marrow ; and possessed no kind of con> munication between the cervical and dorsal portions of this cord, unless we suppose something of the sort to have been maintained by means ofthe surrounding membranes ; a supposition, however, which is entirely gratuitous, and at most capable of throwing but little light upon the subject. Locax palsv is often produced by the general causes of the other y 9- Pa,'a- ... • • i -i A- n ii. 'ysxa parti- varieties, probably operating in a less degree or more partially on tne cuiaris. brain. We have already seen that it frequently takes the lead of ^J the p-eneral affection, and appears for some days or weeks antece- often pro- & * /• i . n c duced by dently, in an imperfect movement of the tongue, or of one eye, or of the pre . sometimes occasionally necessary ; and it may be equally necessary in atonic necessary paralysis ; for here also effusion may take place both of blood and atonic"pai- serum : of serum, indeed, more frequently from deficiency than from sy as well excess of vigour ; and of blood, from a debilitated state of the vessels, apoplexy. and their greater facility to be ruptured from slight causes, as a vio- lent fit of coughing or sneezing, of joy or terror. Absorption may not easily take place in this state of constitution, but emptying the vessels alone will gain space by stimulating them to contract their diameter. I cannot better illustrate this, than by the following case from Dr. strikingly Abercrombie : " An old and very poor woman, aged about seventy, thin, pale, and withered, having gone out to bring water from one of the public wells, on the morning of the second of July, 1818, fell down in the street speechless, and completely paralytic on the right side. Nothing was done till about two p. m. when she was found stupid, but not comatose, yet completely speechless and para- lytic : her pulse of good strength, and about ninety-six. She was bled to fifteen ounces. Purgative medicine was ordered, and cold *■ On Blood and Inflammation, p. 213. t Thomson's Annals of Philosophy, No. xliv. p. 121. 446 cl. iv.] NEUROTICA. [ord. IV Gen VIII Spec. VI. Carus Pa- ralysis. Palsy. Treatment Case, and its for- tunate issui? ex- plained. When bleeding mary be improper and mis- chievous. Excellent ■liscrimi na- tion of Cooke. Purging may be in- dulged with less restraint. Its general utility ex- plained. The purga- tives should be of the warmer rather than of the cold- pt tribes. applications to the head : on the third she was considerably improved both in speech and motion ; but having become rather vyorse at. night, the bleeding was repeated, and the purgative medicine con- tinued. From this time she improved gradually : at the end of a week she was able to walk with a little assistance, and speak pretty distinctly, and by the end of another week she had entirely recovered her former health."* Nothing could be more judicious than this treatment, and the result corresponded with the views of the enlightened practitioner. There can be no doubt that in this case a vessel had suddenly been ruptured : the labour in which the patient was occupied was violent, the season was that of the summer, and the temperature probably very hot: the .stupor and state of the pulse equally indicated compression of the brain. Thus far bleeding may be allowed, and indeed, ought to be imperatively enjoined. But there are some cases in which it is alto- gether a venture, and others in which it is considered on all hands to be injurious. Even Mr. Hunter himself recoils from the practice where hemiplegia is apparently a result of retrocedent gout ; and if we follow up the spirit of this forbearance, we shall be induced to abstain equally in all instances where there is a like diminution of sensorial power—in all instances of atonic paralysis, let the exciting cause be what it may, where there is no stertor, no stupor, or vertigo, no convulsion or other irregular nervous action, and the pulse, instead of being firm, is feeble and intermittent For it should never-be for- gotten that, if many patients have recovered after bleeding, in sus- picious circumstances, others have died after it, and probably in con- sequence of it, while great numbers have derived no benefit what- ever. The advice of Dr. Cooke upon this subject is therefore founded in the truest wisdom, and cannot be too extensively com- mitted to memory : " Each individual case must be viewed in all its circumstances, and by a careful consideration of them our practice should be regulated. Before we prescribe blood-letting in hemiplegia we must investigate the age, strength, general constitution and habits of the patient, and above all the actual symptoms of the disease. In early or even in somewhat advanced life, if plethora and the various symptoms tending to apoplexy be present, I should not scruple to bleed freely both generally and topically. On the contrary, in great age, debilitated, leucophlegmatic habit, dropsical tendency, &c, I should think it right to abstain altogether from this and from every other powerful mode of depletion, unless there be an evident deter- mination to the head, marked by flushing in the countenance, throb- bing of the arteries, redness of the eyes."j In purging we may proceed with less restraint; for even in debi- litated and dropsical habits, stimulating the bowels is almost uni- formly found useful : should there be serous, or even sanguineous effusion, absorption is hereby powerfully promoted ; and if there be none, a beneficial revulsion will often be produced, and the stimulus will always be one of the most useful we can adopt. In a very debilitated state of the constitution, however, we should choose the * Treatise, &c. p. 15. J On Nervous Diseases, Vol. n. Part i. p. 141. <-l. iv.j NERVOUS FUNCTION. [ord. iv. 441' warmer in preference to the colder purgatives; and hence jalap, GenVIIL colocynth, or even aloes in preference to neutral salts : and it will Ss'pT10 also be serviceable to combine them with some distilled water im- '**&*• * pregnated with an essential oil, as mint, penny-royal, juniper, or rose- Treatment. mary. The next reducent remedy, worthy of notice, is emetics. If we Emetics have strong reason to apprehend a sanguineous effusion, this class of employed medicines ought not to be employed for a few days, and will hence iD ?an- always be doubtful in the first attack of entonic hemiplegia, as we IZslon' or have already observed they are in entonic apoplexy. But if we have T^Talyl. no ground of such suspicion, they cannot be had recourse to too but cannot soon. In a certain sense they weaken, but they are at the same time ed to^loon among the most powerful indirect tonics that can enter into our prac- E,Ih1ee^t^se■ tice. They rouse the system generally, solicit the torpid fibres to a powerful resumption of activity, stimulate all the excretories, and especially ||£j™ct those of the surface of the body, and thus promote absorption in every quarter and in every way. In low or atonic hemiplegia the practice of Stoll was founded on Practice of the most rational principles. He first checked the hemiplegia by fat°ionhahhIy emetics, and then carried it off by external and local stimulants, as cantharides, in conjunction with pills of gum ammonia, myrrh, and aloes.* Such, under different modifications, is the reducent course it seems proper to pursue in the general train of paralytic attacks when they first make their appearance. If this course succeed, the patient will soon recover, and, with a view of preventing a relapse, an exten- sion of the reducent or tonic regimen, according to the nature ofthe * case, as we have aneady noticed in the treatment of apoplexy, is all that we shall have further to prescribe. But this course may not succeed : the disease may prove obstinate and become confirmed ; and the practitioner be called upon to pro- ceed further. Having removed, as far as we may be able, all pressure upon the Subsequent sensorium, and so far given an opportunity of healthful play to its whence* function, our next business is to reinvigorate its general energy, and a"ove does extend it to the parts which it has ceased in a greater or less degree ceed?0" to actuate. prSl to Stimulants external or internal, or both, have been almost uni- invigorate forrnly had recourse to for this purpose : but I cannot avoid think- gently™ ing that the practice has been too indiscriminate, and, in many *hnd(Text^nd cases, far too precipitate. We have observed that in many cases of ing energy he'iniplegia there is not only great local inactivity, but great irregu- eased*or'-" larity of action ; a tumultuous hurry of sensorial power to some gans- parts, with an equal withdrawment of it from others. In all such have been cases we should proceed gently and palliatively rather than rapidly ^j^f/ and forcibly: and to do nothing is better than to do too much, criminateiy We should endeavour to allay the nervous commotion, and restore p"ecip° the agitated system to order by internal and external quiet of every |£j*iy. kind. The patient should be kept as still as possible in a warm mark ex- plained * Rat. Med. Part u. p. 92. iAfy CL. IV.j NEUROTICA. [OKI). IV. Gin.vhi. commodious bed and a well ventilated room. His diet should be plain with the allowance of a moderate quantity of wine, or wine and water. Camphor, musk, valerian, and other warm sedatives, as ammonia neutralized with citric acid, are here to be chiefly re- sorted to, if, indeed, wc resort to medicines of any kind, and to these may be added the less stimulant metallic salts, and especially affi^'and those of zinc and bismuth. The warm bath may be allowed two or three times a week, and if the nights be restless the inquietude may be subdued by hyoscyamus. And as this form of the disease is often connected with great general debility and a tendency to hypo- ■iPEC. VI O'arus Pa- ralysis Palsy. Treatment. A gentle und pallia- five plan why Warm well ventilated room, tem perate al wine Camphor and other warm sedatives. Metallic tonics. Warm bath Occasion- ally hyos- cyamus. Chee-ful and exhila Jowanceof chondrism or lowness of spirits, cheerful and exhilarating conversa- tion, and such occasional exercise in a carriage as may be indulged in without fatigue, will form very serviceable auxiliaries. In Pechlin* is to be found the case of a person called Peyreske, who is said to have been cured of a palsy accompanied with aphonia, by reading some favourite and agreeable authors. This may be an overstate- ment, or too much stress may be laid on this particular part of the general plan of treatment: but there can be no doubt that, in the form of the disease we are now contemplating, a gentle and a'tTng"c'on- insinuating amusement of this kind will not be without its effect. This tranquillizing and unostentatious plan I have found to an- swer wonderfully in many cases of that tumultuous and irregular action described in the preceding history of the disease before us. But where the case seems altogether confirmed and chronic, and an entire side, or some other extensive part of the body, shows a fixed loss of sense and voluntary motion, while every other part has Where3'this resumed ds healthy function, we may then, with safety, have recourse to the stimulant practice. This will consist of external and internal irritants, and Dr. Cullen has given a long and useful table of both. Ofthe former, the chief pia'n"tobe are friction by the hand or a flesh brush ; stimulating liniments pre- pared of the concentrated acids, or the caustic alkalies inviscated in oil or lard to render them less acrid and corrosive ; brine or a strong solution of sea-salt; the essential oils of turpentine, or other terebinthiuate substances ; and various vegetable acrids as mustard, garlic, and cantharides or other blistering insects. The object of all these is the same : it is that of acting upon the origin of the nervous chain by stimulating it at its extreme end, and as we have numerous instances of the production of such an effect in a great variety of cases, particularly in those of trismus and lyssa, or canine mad- ness, the principles of which we have endeavoured to elucidate under tliese diseases, we have reason to expect a like influence, and of a beneficial instead of a morbid kind, in the applications before us. Generally speaking, however, the irritation produced by aiiiaceons a use °f many of the siliquose and alliaceous or alkalescent plants, enu mte as mustardi horse-radish, and garlic, is more uniformly efficacious useful than than that of cantharides ; as the irritation excited is more consider- ed' able a«d of longer duration. " Dr. Cullen tells us that he has rea- ktrrax. son to believe the use of liquid styrax in the proportion of one part versation easy extr- cise- Singular case of cure from perusing agreeable and amusing does not succeed, a aore ac- tive and Siimulant pursued. External and inter- nal irri- tants. External stimulants. Their in- tention ind effect. The sili- quose and * Lib. hi. Obs. 27. 'u-lvi NERVOUS FUNCTION. [oko.iv. 449 to two of the old black basilicon, a favourite empirical composition, Gen.VIII. *' has been of remarkable service in paralytic cases, and particu- cm^'pI71, larly m a debility of the limbs following rickets."* raiysis. Many practitioners have, for the same purpose, been in the habit Treatment. of burning moxa, or cotton alone, on different parts of the affected ^r side. Dupuytren employed the former, and Pascal! the latter; c^ton!" and both, as they tell us, with great advantage. Baron Larrey striking speaks in terms of high commendation ofthe first, and especially in S"" spine-cases, or paraplegia. One of his examples is worth relating. The patient had been a sufferer for three years, and had violent and almost permanent pain in the extremities, tremor, emaciation, and sleeplessness ; the spinous processes of the dorsal vertebrae projected, and were painful on pressure. The moxas were applied in pairs beginning from the tenth and eleventh dorsal vertebrae. On the first application all pain was removed, on the second, spon- taneous motion was restored; and after the use of thirty moxas the patient walked without support.]: Others have thought they derived more service from a repeated use of sting-nettles. Some again issues, have employed issues, others setons, and others the potential or CauteneSs, even the actual cautery. This last mode of treatment, however, is best calculated for that form of hemiplegia produced by a diseased spine. Mr. Pott found the use of caustics applied on each side of caustics the spine peculiarly serviceable, and they have been in common B°in'c? employment ever since. In the rank of external stimulants we are to arrange electricity Electricity and voltaism. From the approach which these subtile fluids seem t^J,01" to make to the nature of the nervous power, as we have already ob- served in the Physiological Proem to the present class, and more particularly from their well known and extraordinary power of re- exciting irritability in the muscular fibres of animals that have been for some time dead, it was very reasonable to suppose that either of these stimuli might be employed with very great advantage: and accordingly we meet with them in very extensive and popular use from the earliest periods of their having been, if not discovered, at least reduced to scientific management; and have numerous reports Variously of cases in which the former was tried, and in many instances with [^ f°rrigd advantage, rather before the middle of the last century.§ In vari- wiii va- ous experiments there can be no doubt that both have been found "°g"! su° highly beneficial, but, in various cases also, both have been made ^a™"* use of in vain, and in a few instances, with apparent disadvantage, ably been To run over the list of those who have chiefly espoused, and those fuiTtut8 who have chiefly opposed their employment, would be useless. It sometimes • disservice- is of more importance to know that a very great number of physi- able: ologists and pathologists who employed them most extensively, and ^Xt" particularly in the form of electricity, for the fluids are most proba- rather dia- bly one and the same, and who were at first most sanguine of success, nanced" by gradually lost their confidence as they proceeded, and confessed their nha°vseeJj£° ployed * Mat. Med. Vol. u. Part n. Cap. v. t Journ. de Med. Tom. Lxvi. th«m rao'»l X Rectteil de Memoires de Chirurgie, &c. 8vo. Paris, 1821. extensively, $ Memoires de FAcaderaie des Sciences, L749, p. 40. Jallabert, Experience sur ' K lectricitS. Genev. 1749. Vol iv.—57 uu cl. iv.j AERVOCS FU-\CT10:\. l«>«"- ' (Jen.vih. general failure; and candidly owned that where for a time they spec. VI. pronusec[ fair and seemed to be of use, the benefit was delusive and rltysTs. merely temporary. And the author now allndes to the distinguish- Treayimen.. ed names of Franklin, Percival, Cavallo, Falconer, Quarin, Stoll, *ndat.. and Saus. sang'^e' The fact seems to be that, even at this late period ot trial, we are t1ons?ta* greatly in the dark upon the subject, and have not learned to dis- Aproper criminate the exact modifications of the disease, or the exact modifi- discrimma- cations 0f0iectric power in which alone this active stimulus may be ulectriCand employed with advantage: for that in both forms it has been occa- uf the state sionally of very high benefit is by no means to be disputed : and °Lehseems even at times when communicated by the gymnotus electrictts or wantui»e electric eel itself, of which a singular example is given in the Haer- cure"fl lem Transactions,* the patient having recovered the use of the [hetCgymno- affected side after a hundred strokes from the fish. Upon the tus el ec- whole, as it is a direct stimulus, it appears better adapted to the More up- atonic than the entonic character of paralysis. atoniclethan ^ot ana< co^ bathing are the next external stimulants we are to entonic notice as applicable to the disease before us. The stimulus of hot lfdty' water alone is often serviceable in local palsy, and especially when serviceable Pr°duced by cold or damp ; and in conjunction with the rubefacients aion« in and vesicatories we have just enumerated, or with friction to the part and'in'con- effected by means of the hand or a flesh brush, and particularly 3u."ot'on when aided by terebinthinate or other essential oils, will usually suc- facieuts ceed in restoring to the affected muscles their wonted power. But a^curef5"' where the palsy is more extensive, as in hemiplegia and many cases But in he- of paraplegia, it has been more usual to recommend the stimulus and often of hot water in conjunction with various active mineral corpuscles "i'aplhotle ne^ *n s°Iuti°n °Y i* I and hence the common resort of paralytic laths pre- patients in our own country to the waters of Bath, Buxton, and oreaimpreg- Leamington. Hot baths of this kind are also a direct stimulus; and, mainedraTith as such, are found more efficacious in paralytics of atonic or dilapi- sTimuiants dated constitutions, than in those who have suffered from plethoric tsdthoseiCof or entoruc fulness, or at least till they have been lowered to the Bath, Bux- proper standard by a long course of some reducent regimen. Learning- Cold bathing is also a stimulant as well as hot bathing, but a cold bath- stimulant of a different kind, for it acts indirectly instead of directly. ing: an in- The intention with which it is used is that of forcibly urging the mifiant.11" mouths of the cutaneous vessels into a general entastic or rigid *a ntlon sPasm m orQ,er hereby to excite a general re-action, as in the case of the first and second stages of an ague-fit, and thus to draw the tor- mented* by P^ muscles into the common range of association. Dr. Cullen cuiien seems favourable to this practice under a prudent management "ieu?a7mo- " Cold," says he, " applied to the body for any length of time is d.ncations. always hurtful to paralytic persons : but if it be not very intense, nor the application long continued, and if at the same time the body be capable of a brisk re-action, such an application of cold is a power- ful stimulant to the whole system, and has often been used in curing » Abhandlungen aus den Scriftea der Harlemer und anderer Hollaadischen Geiell- schaften. Band, j. p. 109. 0L-^1 -NERVOUS FUNCTION [ord.iv. 451 palsy But if the power of re-action in the body be weak, any ap- Gen.VIII. plication of cold may prove hurtful."* It is hence only necessary to caTus fI-1' add that while the hot mineral baths appear best adapted to cases of ra'yBis- atonic paralysis, cold affusion or the cold bath may be employed Treatment with most promise of success in accidental palsy of the plethoric and mH"ecrealhot the vigorous. baths best The ordinary internal stimulants are the mineral waters we have afoTcfcou just adverted to, camphor and other terebinthinate substances, many j^?" ,0 of the siliquose and alliaceous plants as mustard, horse-radish, gar- paralysis. lie, and onions, and a temperate use of wine : the whole of which, 'SaU however, are proscribed in all cases by many writers of great end- proscribed nence, and particularly Dr. Cullen and Mr. John Hunter : and f.yT™iien which, if allowed at all, should be confined to the atonic form of h^;. paralysis, or never be commenced in any instance of entonic palsy, but useful till the system has been sufficiently reduced for the purpose. nVform°".f And where this has been accomplished, such a class of remedies has lb" di3Case- often been found of essential service. Independently of these there is a tribe of medicines entitled also Acrid to the name of stimulants, though operating in a very different man- poi3on'' ner, which have long been boldly ventured upon by some physicians; and, after having for many years sunk into disrepute, have again been brought into favour, and are now in a pretty extensive scale of employment. I mean several of the acrid poisons, as arnica monta- as arnica na, or leopard's bane, rhus Vernix varnish-sumach, and strychnos Jhu" ver- Nux vomica. nU-Nux a 11 i i • ■ i vomica. All these excite the nervous system to great agitation and spas- Mode of modic action ; and if the dose be increased, violent convulsions, proposed alternating with tetanus, are sure to ensue : and hence it has been °^Ject in supposed that they may be rendered effectual in a restoration of mo- tivity to paralytic limbs. The flowers of the arnica, or doronicum, Arnica or as it was once called, were chiefly employed, though sometimes the first largely leaves were preferred. Dr. Collin was much attached to the former [^^"d by in palsies of all kinds, and affirms that he has found them very gene- Collin; rally successful. He gave them in an infusion or decoction, in the proportion of from a drachm to half an ounce, to a pint of the liquid :t and, from his recommendation they were, at one time, very generally adopted, were countenanced by Plenck, and Quarin, and j^™^3 experimented upon by Dr. Home.]: The last tried them in six cases, and ciua- but without much success; and they have not been able to maintain Tried win, their reputation: nor, from the violence and uncertainty of their Jjaie suc- effects, is it worth while to revive them. tiome. The rhus Vernix, or varnish-sumach, is chiefly indebted for what- Rhus Vcr- ever degree of fame it has acquired in paralysis to the experiments varnish- and recommendation of Dr. Fresnoi. Much milky juice of this £«»;£■ plant is so acrid as to blister the hands of those who gather its mended by leaves, so that they are obliged to wear gloves. The leaves are Itseeffecu. employed in decoction, and in extract: and appear not only to act powerfully upon the nervous system, but by urine and perspiration : * Pract. of Phyg. Vol. iv. mclxvi. p. 190. t Observ. circa Morbos Acutos et Chronicos. Tom. v. p. 103. * Clinical Experiments, Histories, &c. Edin. 8vo. 1780. [0Z cl. iv. j Mil UOTK'A join., iv. f.F.N.vill. and bcnco the plant has a claim to be considered as an active pro- c™'rV' moter of absorption as well as a revellent, which may, perhaps, ron- raiysis. der it serviceable in some cases of paralysis from serous compression Treatment, of the brain. Of its benefit in some other diseases of a spasmodic or nervous character, and especially in hooping cough, we have already spoken.* other sPe- Most of the species of the rhus or sumach, contain a like pungent c.osS8cssraUS acridity in their milky juices, and hence several others of them have hke power: occasionally been employed for the same purpose. Dr. Alderson, of iS?" Hull, has of late preferred the leaves of the rhus Toxicodendrum, ,lendtusmn- poison-sumach, or poison-oak, as it is sometimes, but improperly ousPsu-° called : and, in many cases of trial, he has thought it of considerable anBdChrecom- benefit. He commences with half a grain of the powdered leaves mended by which he gives three times a-day, and gradually increases the dose to four or five grains, till he finds a sense of tingling produced in the paralytic part, accompanied with some degree of subsultus, or a twitching or convulsive motion. The effett The effect, therefore, produced on the nervous system by the poison Cy^iiisU sumach is weak or clonic spasm : but there are other acrid poisons clonic which have a tendency to produce strong, entastic, or rigid spasm, other'acrid most of which possess an intensely bitter principle, and, perhaps, poisons derive this difference of effect from the tonic power of this very tend to . r _ . , i.roduccri- quality. Of these the chief are the stychnos Aux vomica, and aSdnuTlo-tne ignatia amara. Both have hence been employed in paralysis, mica and aiKi the virtues of both seem to be nearly alike ; the former, how- amara; ever, has of late taken the lead upon the recommendation of Dr. Im° account Fouquier, of the Hospital de la Charity at Paris, who has tried it upon (.f their bit- a very extensive scale, and apparently with a perfect restoration of tVpie!"1" health in many cases; and whose success has been authenticated by oi'iniew' s'ra''ar experiments, under the superintendence of MM. Magendie, tensiveiy Husson, Asselin, and other pathologists. He gives it in the form of oy i'ou-d powder, or alcoholic extract: four grains at the first, and two of the .[uiet; last are a dose, and may be taken from two to six times a-day. He instances also employs it in injections. In half an hour after administration "vPhhrpcr-v tue Parab'zcd muscles have, in various cases, begun to evince con- mancut traction : and, what is peculiarly singular, while a spastic contrac- picpara- tt0n is determined to these* the sound parts remain unimplicated in rTfrJcts ^ie act'on> -A- frequent effect, unquestionably dependent on the bitter principle of the plant, is that of increasing the appetite, and dimin- ishing the number of the alvine evacuations when in excess. Some- times it produces a temulent effect, and occasions stupor and a sense of intoxication, and, when rashly administered, general tetanus with strych- all its train of distressing and frightful symptoms. The most pow- erful form of this medicine is its alkaline basis, to which the French chemists have lately given the name of strychnine. It has hitherto been chiefly used through the agency of clysters.! Variable Like all other powerful medicines in their first and indiscriminate use, the nux vomica appears sometimes to have been highly bencfi- + Vol. i. p. 396. t Remarque* sur la Nux Vomique consideree comme Medicament. Par F M. coze. &c. Journal Universal des Sci r.ce« Medioales. Nov. 1RJ9. nine. results. Li-Ivvl NERVOUS FUNCTION. [okd.iv. 453 cial, sometimes mischievous, and sometimes to have produced violent Gen.VIII. effects on the nervous system, without an important change of any §"spI-' kind. Dr. Cooke has collected a variety of cases in which it has been raiysis. tried in our own country as well- as in France, and this seems to be Treatment. the general result. The present author has tried it in various instances, but has never been able, from its tendency to temulency, to proceed much more than half as far as some practitioners have cone, who have gradually advanced it from four grains of the pow- *- ity-four, three or four times a-day. In the case of the illustration. field, Esq.^ of the Polygon, Somers-Town, Mineralogist ? of the Duke of Devonshire, and who is well known to nave been one of the best practical geologists of his day, the author commenced with two grains alone of the powder given three times daily, as this was a hemiplegia following upon a second fit of atonic apoplexy, with a general debility both of the mental and corporeal powers, the patient being, at the time, rather upwards of sixty years of age. This dose occasioned no manifest effect, and on the third day, August 21, 1819, it was gradually increased to six grains. It now produced a powerful sense of intoxication, but with clonic agitation instead of a tetanic spasm, of the paralyzed leg and arm, and great heat down the whole of the affected side. The powder was continued in this proportion for three or four days, but the stu- por and vertigo were so considerable and afflictive that the patient could not be persuaded to proceed with it any longer, and it was in consequence suspended. On the ensuing September 1, he was evidently getting weaker, and recommenced the medicine at his own desire ; the dose was gradually raised from four to six grains three times a-day ; the same clonic effect was produced with the same sensation of heat through the whole of the affected side, but without a sense of intoxication. The dose was advanced to eight grains, when the head again became affected, but without any per- manent return of muscular power or sensation in the palsied limbs, or any other effect than a few occasional twitches and involuntary movements. Mr. Sheffield could not be persuaded to persevere any farther, and the medicine was abandoned. He continued in the same feeble state for about three months, when he fell a sacrifice to a third apoplectic attack apparently of a much slighter kind. I have stated that this was a case of atonic affection, and hence, %**£?£„ there was no opportunity of giving full play to the power of the nux to be de^ vomica. But so far as I have seen, I think we may come to the fol- thB ordi. lowing conclusions : First, that when only small doses can be given nary ef-^ without seriously affecting the head, as in cases of great general, or vomica. nervous debility, the effect is a clonic instead of an entastic or tetanic spasm. Secondly, that under this effect it is not calculated to do any permanent good, and often produces mischief. And thirdly, that it is most serviceable in entonic hemiplegia, after the patient has been sufficiently reduced from a state of high energetic health, and especially energetic plethora, to a subdued and temperate state of nulse • in which state it may very frequently be employed in doses sufficient to excite strong or entonic instead of weak or clonic spasm; -,nd wc may hence account for its opposite effects in producing and carrvino- off tetanus, as already observed under that head. i 454 cl. iv.J NEUROTICA. [OKD. IV Gen.VIII. Spec. VI. Carus Pa- ralalia. Palsy. Treatment. Hence ob- vious that nervous agitation in due pro- portion is often of peculiar advantage; whence the disease has been car- ried off spontane- ously by various kinds of mental emotion; a stroke of lightning and fever. On this ac- count a tertian ague might probably firovo high- y effica- cious, and a journey to the Hun- dreds of Essex ef- fect a cure. Collateral opinion of Fordyce in confirma- tion of this hint. Hemiple- gia has sometimes Ceased spontane- ously, and after many years' standing. Paraplegia has some- times re- ceived a natural cure. Treatment where pal- sy is local and pro- duced by fumes or other mi- nute divi- sions of metallic particles From this history of treatment, it is obvious that nervous agitation, proportioned to the mode of the disease and the strength of the patient, has often been of peculiar advantage; and hence, we are the more easily prepared for hearing that palsy has occasionally been carried off suddenly and spontaneously by a violent fit of mental emotion, as of anger* or fright,! of both which the examples are very numerous ; by a stroke of lightning ;J and by fevers.§ Nor can I do otherwise than think that one of the most rational and erF- cacious means of cure in many instances of paralysis, am""'" • '" where no great inroad has been made upon the genera? the constitution, would be a journey into the Hundred*-4 ^ : some other marshy district, for the purpose of 6btaining a sharp attack of a tertian ague, which would most effectually, and I appre- hend at the least expense, give us all the advantage of entastic_ spasm and re-action in regular and repeated tides, that we could wish for, and which have already appeared to be so desirable. In treating ot the tertian intermittent, we observed from Dr. Fordyce, that it has often a tendency to carry off a variety of obstinate and chronic dis- eases to which the constitution has been long subject, and to restore it to the possession of a better and firmer degree of health. And where paralysis is capable of removal, there seems to be few com- plaints on which it is likely to operate with a more favourable issue. The author has for some time been waiting for an oppor- tunity of making the experiment, and at present merely throws out the hint with much deference to the medical world at large. In a few cases hemiplegia is said to have ceased spontaneously by the mere remedial energy of nature, and without any apparent cause of cure ; in one instance after ten years' standing, and accompanied with loss of voice.|| And in a few cases of paraplegia from external injury to the spine, where only one or two vertebrae have in a small degree been displaced from their proper position, the same instinctive or remedial power has alone produced a cure or greatly alleviated the mischief by so far thickening the growth of the bones imme- diately above and below that the chasm has been filled up, and a line of support restored. The best artificial means of obtaining so salu- tary an action is by a free and laborious process of friction, vellica- tion, or shampooing, with such intermediate exertion or exercise as the patient may be able to take.H It is only necessary to add further, that where local palsy has been produced by the fumes or minute divisions of lead or other noxious metals, it is almost always accompanied with symptoms of colica Rhachialgia, or Painter's colic, and is to be remedied by the treat- ment already laid down under that disease.** * Camei-ar. Memorab. Cent. v. No. 30. Paulini, Cent. in. Obs: 89. Schenck, Observ. Lib. i. No. 182. t Diemerbroeck, Observ. et Cur. Med. Locffter, Beytrage zur Wundarzneykunst. i » V ie , n •& ,W,ik"!8o«»,8 Case of Mrs. Winder, 8vo. 1765. § Act. Nat. Cur. Vol. v. Obs. 64. Samml. Medicinischen Wahrnemungen. Band. vi. p. 152. || Bresl. Sainral. 1721. p. 406. 503. B T See especially, Shaw on the Nature and Treatment of Distortions to which the Spine and the Bones of the Chest are subject. 8yo. 1823. ** Vol. i. p. 164. FXD OF VOL IV. 2:01 ® NATIONAL LIBRARY OF MEDICINE NLM Q3E77T37 b NLM032779376