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solidism. The tenuity of the blood necessarily requires another condition to produce dropsy, consisting, according to the admission of Henle, in a certain relaxation of the pores of the vascular walls. Acconling to this writer, the laxity of tissue is induced by atony, arising probably from a direct paralysis of the nerves—a defect in nervous influence, from stagnation of the blood in the vessels, or from the too great pressure on the vascular walls, by which the fluid is forced through the pores.
In general paralysis of the insane, independently of a dynamic primary lesion, there is very frequently a permanent impediment of the circulation within the brain. In adopting the eclectic theory of Henle, we easily understand how it occurs that the serous effusion, instead of taking place in the cellular tissue, in the peritoneum, &c., occurs in the cavity of the arachnoid, in the pia-mater, and the lateral ventricles.
It is, therefore, very probable, from the preceding considerations, that the spontaneous diminution, and the insufficient formation of the albumen of the blood, are the immediate causes of a certain number of the cerebral dropsies which occur in the paralytic insane. However this may be, I think, with M. Bayle, that in these patients the exhalation of the serosity in the cavity of the arachnoid, the serous infiltration of the pia-mater, and, above all, the same kind of effusions in the lateral ventricles, all tend, by the pressure they exercise on the brain, to increase the paralysis, and the enfeeblement of the intellectual faculties. The following fact may be advanced in support of this opinion. I recently bled an insane paralytic patient, whose case is not included in the sixteen that I have already given. The disease had made rapid progress. The paralysis was so considerable, that walking and standing were alike impossible; so decided a degree of enfeeblement of the understanding, that there was almost entire absence of attention and memory-in fact, an actual state of stupidity. On analysing the blood, I found the number of the globules below its mean proportion (119), the fibrin in its normal quantity, and a diminution of the organic matters of the serum. After having, for about a month, taken large doses of aloes three times in the week, which were followed on each occasion by an abundant evacuation of liquid stools, the patient experienced a most marked amendment. Instead of his former stupidity, he evinced an aptitude to converse; and instead of remaining entirely motionless in his bed, he at length became able to stand upright, and walk alone. In this case, the compressure
of the brain could not have depended on a sanguineous congestion, since the fibrin of the blood was not diminished, and the globules were below their physiological mean. If, however, there was cerebral compressure, it must rather have been occasioned by an accumulation of serosity, whose removal must have been influenced by the alvine secretions occasioned by the aloes. Here a very rational therapeutic principle would seem to emanate from this pathogenic induction, for the employment, in analogous cases, of purgatives instead of venesection; for the former means have not, at any rate, the disadvantage presented by the latter, of depriving the blood of its globules (the number of which is below the mean), and consequently producing anæmia, which is almost as likely as cerebral congestion to aggravate the paralysis.
Far from proving detrimental to pathological anatomy, chemistry may alike aid and control its application. With equal claims to legitimacy, these two means of investigation may be regarded as kindred lights, which serve mutually to illuminate one another.
From this investigation we arrive at three classes of conclusions :
1. Chemical facts.
Chemical Facts. 1. In general paralysis of the insane, the quantitative analysis of the blood presents very variable results.
2. Augmentation of the globules (the venous crasis of the Germans) exists in the majority of cases. This principle of the blood only remains within its normal proportions in a very small number of cases. It falls below these limits in a still smaller number.
3. The fibrin remains within its physiological limits in the greater number of cases. It exhibits an absolute diminution in a certain minority. It rises above those limits (the fibrinous crasis, the hyperinosis of the Germans) in a still smaller minority of cases.
4. The solid matters of the serum, both organic and inorganic, remain within their normal proportions in the majority of cases. It is only in a very small number that they rise perceptibly above their physiological mean.
5. The organic matters of the serum, of which albumen constitutes so large a proportion, diminish appreciably in rather less than one-third of the cases.
6. The water only exceeds its mean proportion in a very small majority. It falls below it in a considerable minority of cases.
Pathogenic Inductions. 1. The augmentation of the globules (venous crasis,) and the absolute diminution of the fibrin (hypinosis), are either, independently of one another, or simultaneously and conjointly, the cause of cerebral congestion, which plays so important a part in the etiology of the general paralysis of the insane.
2. Cerebral congestion is a principal condition, but not the controlling cause of the origin of general paralysis. It is, on the contrary, the proximate or direct cause of the secondary phenomena of this disease.
3. The augmentation of the globules, instead of being inherent in the nature of general paralysis, depends on several purely contingent conditions, such as the male sex, a sanguineous temperament, the strength of the constitution, age, mode of life, voracity, and activity of digestion and assimilation.
4. The diminution of the globules occasionally gives rise to convulsive movements and attacks of catalepsy.
5. The augmentation of the fibrin is frequently associated with epileptic attacks, and several other symptoms of acute inflammation of the brain or its membranes.
6. The false arachnoidal membranes are the result of a coagulation of plastic lymph, secreted by an inflamed surface, and not of the transformation, or the pure and simple organization, of fibrin contained in the blood effused amongst the meninges.
7. The spontaneous diminution of albumen has probably some share in the formation of the more or less considerable serous effusions, which so frequently compress the brain in the last periods of general paralysis.
Therapeutic Inductions. 1. Venesection and a moderate vegetable diet are the most rational and efficacious means of preventing the development of cerebral congestion in the paralytic insane, and of combating it when once established.
2. In those cases in which it is supposed that pressure on the brain has been occasioned by an accumulation of serosity, and where an analysis of the blood manifests a tendency towards the diminution of the globules, purgatives and not venesection must be employed.
A BRIEF NOTICE OF THE MOST IMPORTANT WORKS AND MEMOIRS ON PSYCHOLOGY PUBLISHED ABROAD DURING THE YEARS 1846 AND 1847.
(Condensed, for the most part, from AMELUNG'S REPORTS.)
Our object in the following pages is to give our readers a succinct report of some of the most practically useful works on psychology that have appeared on the Continent during the years 1845 and 1816; and to afford those who have not the time or opportunity of examining the great mass of French and German psychological literature, some idea of its general character. We have purposely omitted all reference to works already noticed in our Journal, and to such as treat of the condition of the insane in this country, since the purpose we have in view, as we have already implied, is, if possible, rather to guide the English reader towards new sources of knowledge, than to refer to those with which he is already familiar. By excluding all notices of the French, and, more especially, German memoirs that treat of the psychological literature of Great Britain, our task has been considerably lightened, for the management of the insane adopted in the best of our public and private asylums continues to serve as a model for the institutions of other countries, and constitutes a very considerable portion of the subjects treated of in the numerous works on psychology with which the Continental press is continually teeming.
The first work to which we would refer is “A Manual of the Pathology and Therapeutics of Mental Diseases, by Dr. Schnitzer," * in which the author gives a general summary of the opinions and observations of a very large number of ancient and modern writers on psychology, and as such it constitutes a very useful compendium for the student or practical physician, who would acquaint himself with the works that have from time to time appeared in relation to mental diseases. The author does not, however, furnish us with any new facts or original views; and the value of his work is simply, as we have already remarked, that of being a practical compendium of the labours of others.
The next work on our list,t by Dr. L. F. Calmeil, physician to the
* Handbuch der Pathologie und Therapie der Geisteskrankheiten. Für praktische Aerzte und Studirende bearbeitet von Dr. A. Schnitzer. Leipzig.
+ De la folie, considérée sous le point de vue pathologique, philosophique, historique et judiciaire, depuis la renaissance des sciences en Europe jusqu'au dixneuvième siècle; descriptions des grandes épidémies de delire simple ou compliqué qui ont atteint les populations d'autrefois, et regné dans les monastères. Exposé Charenton, is a most interesting historical and judicial report of the facts recorded in various public archives, and in authentic private documents, from the fifteenth to the close of the eighteenth century, in relation to dæmonomania, lycanthropia, chorea epidemica, monomania religiosa, &c. On reading these curious records of the benighted condition of former ages, we scarcely know whether we should be more astonished at the superstition and fanaticism which proved such constant and fruitful sources of a disordered imagination (closely akin to actual insanity, and based probably on a tendency to convulsive and epileptic attacks, or on chronic affections of the whole nervous system); or at the ignorance and bigotry of physicians and judges, who suffered those afflicted with such diseases to expiate their miseries at the gibbet or the stake. In looking back with honest pride at the advance we have made over former times in the treatment of mental diseases, we must not, however, forget that it behoves us to be moderate in our rejoicings, as long as the history of psychology continues to record such instances of fanaticism as those which occurred some years since in Switzerland, those of the incubus disease in France, the epidemic dæmonomania which prevailed a short time since in Sweden and Russia
- besides many others witnessed even occasionally in this country, no less than elsewhere.
M. Pidoux, in a review of M. Brierre de Boismont's work, “On the Acute Delirium of the Insane,"* expresses the opinion that delirium may be associated (as a nervous cerebral affection) with chronic insanity, no less than with other diseases; as, for instance, meningitis, typhus, &c. M. Pidoux, in the first place, regards delirium as a peculiar affection of the brain, more especially of the organs by which thought is regulated, and does not consider it identical with, or dependent upon, inflammation, loss of blood, or any other known cerebral diseases. He, however, looks upon delirium more as a symptom than an actual disease.
In the “ Annales med. psychol.,” tom. vi., Nov. 1845,+ we find an useful report, by Morel, of the psychological journal literature of Germany, from the older journals of Moritz, Reil, Kaissler, and Hoffbauer, to the latest psychological periodicals.
des condemnations auxquelles la folie meconnue a souvent donné lieu. Par L. F. Calmeil, Docteur en Médecine de la Faculté de Paris, Médecin de la Maison de Charenton, &c. T. 2. Paris, 1845.
De la folie, considérée comme maladie à l'occasion de l'ouvrage suivant: “Du delire aigu observé dans les établissements d'aliénés, par M. Brièrre de Boismont, &e." Par Pidoux. Journal de Méd., par Trousseau. 1845. Dec.
+ La Pathologie mentale en Belgique, en Hollande, et en Allemagne. Des Journaux de Psychiatrie en Allemagne. (An. med. psych., t. vi. Nov. 1845.)