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on the sensorium, * in which he treats especially of the good effects produced by agaricus muscarius, anacardium orientale, assafoetida, and belladonna.
Osiandert gives several cases of cure of nymphomania by means of tartar-emetic ointment, and the internal employment of camphor. The latter remedy, given in clysters, was also found highly serviceable in puerperal mania.
Gizzi, as we learn from the Gazette Médicale de Paris, has employed helleborus niger with success in mania and melancholia. The remedy was gradually increased from small doses, and in all cases, although slow, the effect terminated in a perfect cure.
Professor Rech, while he endeavours to establish the efficacy of cold-water affusions, applied to the head, in cases of insanity, admits, however, that these means ought to be practised with much caution, and that they are counter-indicated in acute mania, hallucinations, and other active affections of the brain. The author is opposed to Leured's theory, which ascribes a moral influence to these means; and inclines to the belief that they exercise an undoubted dynamic and material effect.
We find that Aubanel, physician to the Insane Asylum at Marseilles, has invented a bed for uncleanly insane patients, which practical experience has shown to be admirably adapted to the purposes for which it is designed. It consists of a bedstead with high sides, forming a species of trough, having a stout oak bottom, supplied with a grating in the middle, somewhat hollowed out. Below the bottom there is a zinc vessel, which pulls out like a drawer, and may be removed as often as necessary, without in any way disturbing the patient. The bedding consists of finely chopped straw, covered with a sheet. This bedstead is also furnished with a concave cover, having a grating and air-holes, which may be fastened on at will, by means of hinges attached to the sides of the bed.
The general statistical reports of the insane, in Germany and France, afford ample evidence of the improvements, both in public and private asylums, by which the last few years have been characterized in those countries. Among the numerous works, memoirs, and reports that
* Bermerkungen über die Wirkungen einiger Arzneimittel auf das Gemüth und Sensorium. Von Dr. Weber, in Hannover. (Zeitschrift für die gesammte Medicin. herausg. von F. W. Oppenheim.)
+ Glossen und Marginalien. (Zeitsch. für die gesam. Med.) Von Oppenheim.
| De la douche et des affusions d'eau froide sur la tête dans le traitement des aliénations mentales. Par le Professeur H. Rech, Médecin en chef de l'asile public des aliénés à Montpellier.
have been published in such rapid succession on this subject, we may instance that of M. Cazenave,* which gives a general and comprehensive view of the progress made in France, in the treatment of the insane, since the publication of the well-known edict of the 30th of June, 1838.
We gather from an epistolary communication of Dr. Flemming, that the asylum for the insane at Copenhagent is still in a very imperfect condition, and that the care and proper treatment of the insane are much neglected throughout the whole of the Danish dominions.
Among the mass of statistical reports before us, referring simply to some circumscribed locality, we would call attention to the admirable memoir of Dr. G. H. Bergmann,# which besides the customary statistical tables of the condition of the asylum for the insane at Hildesheim, in the year 1845, enters into the general psychological consideration of the nature of mental diseases generally, of the pathology of the cerebral organs, with observations on epilepsy and phrenology, and on the influence of the weather on the insane.
Dr. Bergmann found that where there had existed a tendency to suicide, a decidedly abnormal condition of the brain was made manifest on dissection. In like manner, there were always morbid changes in incurable cases of imbecility.
The author's definitions of the conjectured seat of the various species of mental disease, although perhaps occasionally somewhat too fanciful for our English mode of reasoning, are nevertheless extremely interesting, and well worthy attentive consideration.
From a notice in the Annales Méd. Psych.s of the statistics of insanity in Canada, we learn the curious fact, that in Lower Canada the number of idiots exceeds that of the insane threefold, whilst in Upper Canada the numbers of the insane are considerably higher than those of idiots. Can this preponderance of idiotcy, among the Lower Canadians, arise from their Celt-like practice of subdividing the land, and the consequent stationary habits of the people, and their constant intermarriages amongst their own kindred ?
Rapport sur l'asile public des aliénés de Basse-Pyrenées, par M. le Dr. Cazenave, Médecin Directeur. Pau, 1845.
+ Zeitschrift für Psychiatrie, iii. Bd. 1, H. s. 181.
# Charakteristische Uebersicht der im Jahre, 1845, in die Heil-und Pflegeanstalt zu Hildesheim aufgenommenen Seelengestörten, nebst soustigen die Psychopathologie betreffenden Erörterungen. Von Medicinalrath Dr. G. H. Bergmano. (Hann. Ann. f. d. ges. Heilkunde, vi. J. vi. H.)
§ De la folie en Canada (Annales en Canada, Ann. Méd. Psych. Juillet, 1846.)
It appears from the report of Lillybridge,* that in a population of 20,000 Cherokees, there was not one affected by insanity.
In a statistical report of insanity in Norway, by Dr. Holst, we find that in 1835, the whole number of the insane was 3576, of which no fewer than 1698 were idiots. In the year 1845, the census showed that the whole number had increased 1667, or about 64:8 per cent., so that while, at the first-named census, there was 1 insane person to 550-7 inhabitants, at the present time there is 1 to 334:1; an increase that is mainly ascribed to the increased consumption of brandy.
The PULSE OF THE INSANE.—M. Jacobi has instituted experiments on the pulse in a great many cases of the different forms of insanity, and also on persons in good health, in the hope of being able to draw conclusions with reference to the relation of the circulation with the different pathological states of the intellect and the feelings. The experiments were performed on upwards of 350 persons. Three times a day, at six, A.M., at two, P.m., and at eight, P.M., the number of pulsations was ascertained, and a vast number of meteorological and physiological observations noticed. He was not contented, however, with merely ascertaining the frequency of the pulse, but he took an exact note of its greater or less degree of strength, of fulness, of slowness, or of tension, in the insane patients who were under observation. He indicated, besides, the relative pulsations of the different arteries, auscultated the heart, and counted the number of inspirations and expirations; the state of the iris even was examined, with reference to the general circulation; nevertheless, he remarks, “I had the vexation to see that my researches, so conscientiously made, did not fulfil the end I had proposed; and I saw that it was impossible to establish the necessary connexion between the different pathological states of the intellect and feelings, and the observations I had collected on the state of the circulation, the respiration, and the temperature of the skin, in the insane.”—Annales MedicoPsychologiques.
Du peu de fréquence de l'aliénation mentale chez les Indiens Cherokee et les Africains. (Ann. Méd. Psych. Juillet. 1846.)
+ Ueber die Anzahl der Geisteskranken, Blinden und Taubstummen in Norwegen, im Jahre, 1835. Von Dr. F. Holst. (Allg. Zeitch. f. Psychiatrie, iv. Bd. 3, H.)
COMPRESSION OF THE CAROTIDS IN INSANITY.—The phenomena noticed by M. Jacobi, as resulting from this operation, were very variable; the principal were, a sensation of burning heat, which extended over the whole head and neck, and even to the chest. Others complained of the same sensation inside the head. The sight was affected in many persons, and brilliant substances seemed to pass before the eyes. It was not uncommon for them to complain of great difficulty of breathing, amounting even to agony. This was accompanied by a sensation of weight in the head, giddiness, and a tendency to sleep, which, in some cases, really occurred, the breathing being stertorous. It is probable that in these cases sensation was lost, although it is not mentioned by Jacobi. Syncope was of common occurrence; and when not complete, the patients complained of a difficulty in moving the lower extremities. One person, during the compression of the carotids, fell as if struck by lightning; but he soon got up again, and did not experience any further ill consequence. In another person, the syncope was of considerable duration.
M. Jacobi mentions a phenomenon which has not been described by Burrows or Parry, namely, the sudden diminution in the beats of the radial artery, in consequence of compression of the carotids. eighths of his patients, the pulse fell from 100 to 66—from 72 to 48. In three instances only the frequency of the pulse was increased.
Those persons are more readily affected by carotid compression, in whose temperament the venous circulatory system predominates, or whose cerebral activity has been increased by immoderate indulgence in sexual gratification, or alcoholic drinks. Adults in the prime of life are more easily brought under the influence of this operation than women, children, or old men. It appears to be injurious in cases of cerebral congestion, probably owing to the then existing greater preponderance of the venous circulation. It is, therefore, an operation requiring peculiar precautions, and one that it would be dangerous to employ indiscriminately.-Ibid.
TREATMENT OF EPILEPSY.-M. Delasiauve, in the concluding portion of his essay on the treatment of epilepsy, directs especial attention to the importance of hygiene, which he considers to equal, if not surpass, that of medicine in the disease. There are some practitioners, even, who look upon
medicine as utterly useless in such cases, and place their sole reliance on such measures as serve to guard the patients against the causes which induce the fits, and favour the action of such natural agents as are capable of changing the constitution. Hippocrates recommended a change of climate; and Van Swieten mentions several instances in which epileptic patients were freed from their fits all the
while they remained in the East Indies. M. Delasiauve advises, when a change of climate is practicable, that a gentle, temperate climate should be selected—one but little subject to atmospheric changes; because experience has shown, in those asyla where epileptic patients are admitted, that the fits are much more frequent during extreme cold or extreme heat, and especially during continued variations of temperature. With respect to diet, the temperament, idiosyncrasy of the patient, state of the constitution, and his usual habits of living, will more or less modify it; but nevertheless it may be stated, that excess in quantity or quality, of either food or drink, will prove injurious. Every infraction of the rules of temperance will induce a relapse. More vegetable than animal food should be taken, and cooling fruits may also be used. Complete abstinence from wine is perhaps hardly necessary; but if it be drank, the wine selected should be the least stimulant, and even then only taken in moderation. Those patients who are liable to be attacked during the night, should make but a light supper, to avoid increasing the cerebral plethora, which is always greater during sleep. The necessity of maintaining the excretions must be self-evident. With respect to the insensible perspiration, cleanliness, baths, pediluvia, frictions, and warm clothing are requisite. Hard cravats and stays are decidedly injurious; and straw hats are better than the hats and caps which are in common use.
The hair should be cut short; in bed, the patient should lie with his head high, to assist the circulation of the blood through the brain. Constipation should be avoided; when it occurs, it must be treated by injections and laxatives; the digestive organs should be especially attended to.
A disordered condition of the menstrual secretion is generally the cause of increased severity of the fits. The ordinary recurrence of the discharge is frequently sufficient to induce a fit, so that the attention of the practitioner should be directed to this secretion, to maintain it in a healthy state.
Continence is essentially the virtue of the epileptic; sexual intercourse produces a nervous shock, which too closely resembles the emotion which occasions the epileptic attacks, not to be attended with great danger. Those who practise onanism have, in general, the greatest number of fits. A peaceable and quiet life suits the epileptics best. Everything that tends to excite their feelings, to rouse their passionsthe strong feelings of love, contradiction, and grief, inevitably add to the intensity of the disease. Their situation demands the greatest management, as they are in general very susceptible and irritable, especially just before and after a fit. Exercise is very salutary; an inactive, sedentary life, increases the morbid predisposition, and renders the consequences of the fits more deplorable. Hippocrates and Galen lay great