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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
place nor changes his posture; if he be seated he never stands up ; MuT U-
if standing he never sits ; if lying he never rises. He never moves f^jjjs m&-
his feet unless they are pushed aside by a by-stander : but he does Extreme'
not shun the presence of man; if asked a question he does not sauvS.
answer, and yet appears to understand what is said. He does not
yield to admonition nor pay any attention to objects of sight or
touch: he seems immersed in profound thought, and totally occu-
pied by foreign matters. Yet at times he is more awake : if food
be put to his mouth he eats, and if liquor be presented he drinks."
M. de Sauvages then adds, that this rare modification of the disease
occurred once to Dr. James, physician to the elector of Saxony,
in a man about thirty years old, who was terrified with the thought
that the Deity had condemned him. It continued for four months
during the autumn and winter; but the patient was at length restored
to his right understanding.*
Grief, and particularly for the loss of friends, discontent, severe Exciting
disappointment, the dread of some real or imaginary evil, a violent °a
and long continued exertion of any of the passions, and deep un-
interrupted study, have frequently proved accidental causes or ac-
cessories of this variety of melancholy, where the peculiarity of
the constitution has formed a predisposition, and have sometimes
produced it even where no such predisposition can be traced. M.
Magendie met with a singular exemplification of this from a cause striking
few would expect, though not difficult of solution. The patient, cation'ffom
an intelligent and agreeable man, though of a highly nervous tern- Magendie
perament, had the misfortune, at the age of thirty-six, to meet with
various crosses in business, and to have his wife become deranged
in her confinement with her first child. All his energies were de-
voted to the recovery of his wife, whom he accompanied in travel-
ling, which was recommended to her; he nursed her with tender
assiduity, and was a witness to all her sufferings of body and mind.
In time she recovered ; but he himself, instead of giving way to joy.
fell into a state of the most distressing melancholy—believed him-
self ruined, pursued by the officers of the police, and about to take
his trial for some heinous offence. Upon every other subject his
mind was sound. We have already observed, that the sudden ces- Explained*
sation of any habitual drain, or other corporeal irritation, has occa-
sionally proved a cause of melancholy; and we here find, that there
is at times as much danger in a sudden cessation of mental as of
corporeal irritation, the excited mind being as little capable of
bearing the change in the one instance as in the other. And hence
whenever such an effect occurs in an irritable frame, the individual
should be instantly roused to some new pursuit that may swallow up.
though more agreeably, the whole of the surplus of sensorial power
he has been in the habit of secreting. In the state above described,
M. Mageudie's patient continued for many months when, from some
* Nos©]. M«,i. CJa:= vin, Orf] m
GO cl. iv. j
.NRUROTICA.
[oR1>- 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 Burton
finest humour, should only have exasperated the disease and urged himBelf-
the pitiable patient, as there is too much reason to fear, to an un-
timely end ! " He composed his book," says Mr. Granger, " with
a view of relieving his own melancholy, but increased it to such a
degree, that nothing could make him laugh but going to the bridge-
foot, and hearing the ribaldry of the bargemen, which rarely failed to
* Frambes. Consult. Lib, i. 1".
&Z
CL. IV.j
NEUROTICA.
[ORI>.
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 b employ-
organs must be watched, and such relief be afforded as they may tageousiy".
stand in need of. Where aperients are required the warm and bitter
resins will generally answer the purpose best, alone or combined
with rhubarb. Where love is the cause of disease, and the fair pa-
tient is young and delicate, suppressed menstruation, or even chloro-
sis is by no means unfrequent, followed by hysteria and other nervous
affections that produce considerable trouble.
In all cases of mental dejection, however, a kind and judicious Moral re-
friend is by far the best physician : medicines may do a little, change
of scene and country, of custom and manners, a little also : but the
soothing of tenderness and indulgence, and the voice of that friend-
ship which knows how to discriminate opportunities, and seasonably
to alternate admonition with consolation will accomplish more in the
way of cure than all the rest put together. The despondency pro-
duced by the real sense of a guilty conscience or the visionary belief
of eternal reprobation, may derive important and most salutary ad-
vantage from religious instruction when conducted with a judicious
attention to the exigency of the case. But much circumspection
and adroitness are requisite upon this point, for so rooted is the feel-
ing to be extirpated that no ordinary means will suffice for its eradi-
* Falret, de l'Hypochondrie et du Suicide. 8yo. Paris', 132?.
>H 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.
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