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case only quiet patients can escape, no great injury, M. Bouchet thinks, can accrue, if they are soon re-captured; but it is different when the escape takes place from the asylum, where the strictest precautions should be enforced, and the building be so constructed as to prevent escapes. One lunatic has escaped five times from the asylum, and four times from the Bicêtre; and another, a homicide, made his escape with the strait-waistcoat on.
The sixth mode, that of death, may be the result of violence or accident, or from the mental disease itself, or the accidental diseases by which it may be complicated. The acts of violence may be committed by the keeper in a fit of anger against the lunatic, induced by an assault against him. To avoid this as much as possible, the service is so arranged that the keepers are seldom alone, so as to have an imposing array of strength to overcome the violent lunatic. They also have an apron, which they are instructed to throw over the turbulent patient's head, so that he can no longer see where to direct his blows. The keepers are authorized to put on the strait-waistcoat; but confinement in a cell can only take place by order of the physician. Accidents occur to the insane while at work, as they do to other workmen, and from the direct violence of the patients, while labouring under delirium. Of the former only two have proved fatal in fourteen years. Suicide is rare; but attempts at self-murder are frequent. The refusal to take food is generally obviated by the use of the oesophageal sound, modified by Leuret and Baillarger. Generally speaking, this plan soon succeeds in overcoming the refusal; but one patient persisted for several months, alleging that her food was poisoned. She died of gangrene in different parts of the body. Hanging is a mode of self-destruction frequently attempted. One patient succeeded in destroying himself by tearing the strait-waistcoat, and strangling himself with one of the bands. Another patient poisoned himself with glass, which he had managed to collect and break up; and another threw himself under a cart-wheel, but without experiencing any injury.
Death, as the direct result of insanity, occurs but rarely in the asylum. M. Bouchet refers the mortality of the insane to acute or chronic cerebritis, the latter showing itself in the form of dementia, complicated with general paralysis. The mortality in 1846 was nineteen per cent. among
the women. This was owing to the greater number of cases of dementia, a disease more prevalent among men than women. Among the diseases which complicated insanity was scurvy, which showed itself in several cases of dementia; these terminated fatally. It also appeared in patients affected with other forms of insanity. Of these latter, two died, and about
from seventeen to twenty recovered. The only cause that M. Bouchet can assign for its occurrence, is the inertia which attends dementia.Annales Medico-Psychologiques.
ATTEMPT AT MURDER : INSANITY.—A man named Miguand, alias L'Oreille, alias Alexis, was, in December, 1847, tried at the Court of Assizes of the Seine, for attempting to murder the police-serjeant, who was about to arrest him for breaking his ban. Certain facts having come to the knowledge of the magistracy, they directed an inquiry to be made as to the state of his mind. Dr. Jacquemin, physician to La Force, reported that “Miguand is a complex being : in his ordinary state he is gentle, and as easy to lead as a child; but when opposed, he becomes ferocious, and resembles a brute beast. On one occasion he literally crushed a tumbler between his teeth. His excitement is such, that, in order to restrain him, it is necessary to put irons on his hands and feet.” Dr. Jacquemin's opinion, however, was, that the accused fully understood the nature of the crime he had committed. The crown eventually abandoned the prosecution on the production of a certificate from the physician to the Madelonnettes, stating that, in 1838, the prisoner was confined there for confirmed insanity. The jury returned a verdict accordingly.
A few days afterwards, Miguand was brought before the tribunal of Correctional Police in Paris, on the charge of breaking his ban. His costume on that occasion was bizarre. On his prisoner's dress he wore the grand cross of the Legion of Honour; at his button-hole there was a large pasteboard cross; from his neck there hung a myriad of amulets, &c., and his fingers were loaded with rings. The contradictory nature of the reports from La Force and the Madelonnettes induced the court to order a fresh inquiry to be made into the state of the prisoner's intellect.
INFANTICIDE.--Louis Cellier, a priest, serving the parish of St. Gall, in the diocese of Clermont, was arraigned at the Cour d'Assises du Puy de Dôme, on a charge of infanticide, the victim being his illegitimate offspring, by his servant. The plea of insanity was alleged in his defence. Several of the witnesses gave it as their opinion that s'il n'était pas fou, il était bien drôle tout le même. During the mission he himself rang the bells at all hours of the night. One day, during the procession, he got a drum, and began to beat it; he did the same on another occasion in the sacristy, while they were singing. Again, when returning from administering the viaticum, and passing through the village, he shouted out the song, " Reveillez vous, belle endormie." He used to consecrate eight hundred hosts for the spiritual wants of the inhabitants of the commune, although they were only three hundred in number. When he was the vicar at Maraingues, he used to get up at night, and go out alone, or accompanied by a man he employed, and, armed with a poniard, sword, or other weapon, give way to the most extraordinary courses in the fields; or else, suddenly seized with a panic fear, would flee until overcome with fatigue. At other times, he would turn his weapons against his companion, and even against a tree, which he would combat with, until he fell from exhaustion. His mother was insane from an early age.
Louis Cellier was found guilty of the crime of infanticide, with mitigating circumstances, and sentenced to five years' hard labour. The sentence did not change the expression of the prisoner's features in the least—they bore the same pale and suffering imprint as before, the same vague and unintelligent look.—Gazette des Tribunaux.
In this case, according to the editor of the Annales Medico-Psychologiques, the medical men who were consulted considered Cellier’s conduct to indicate great excitement and bizarrerie, but not to amount to mania. The editor of the journal observes that the court ought not to have been content with this opinion, but to have summoned medical men who have devoted themselves to psychological studies, as they alone are competent to judge of the mental state of an accused person. However enlightened and well-informed they may be, other practitioners are not able to seize the more minute indications of insanity, since even psychologists themselves in some cases require a great deal of time and attention to declare the presence or absence of insanity.
CEREBRAL AND MENINGEAL PHLEBITIS IN PUERPERAL WOMEN.M. Ducrest, who has published an essay on the occurrence of cerebral and meningeal phlebitis in puerperal women, states that the disease is met with but rarely. When it is met with, however, it constitutes a very dangerous complication of the puerperal state. Encephalic phlebitis presents all the characters which belong to the anatomical lesions observed in the phlebitis of other organs, that is to say, it is adhesive or suppurative. In the first case, we find, in the calibre of the cerebral vessels, a firm clot adhering to the vascular parietes; in the second, pus is found in the veins and in the cerebral mass, either infiltrated or in the form of abscesses; the extent, seat, and number, may vary. As the result of these lesions, or occurring at the same time, we may note other secondary alterations, such as meningitis, meningo-encephalitis, hemorrhage, and ramollissement. In all cases there were purulent collections elsewhere besides the brain, that is, in the uterus, lungs, &c. It is
worthy of notice, that cerebral phlebitis principally attacks tuberculous subjects; M. Ducrest looks upon it as a secondary disease, a consecutive phlebitis.
The symptoms described by M. Ducrest are chiefly those which are indicative of cerebral mischief; they are not diagnostic of the disease in question. They are—more or less intense headache, delirium of a variable character and duration, preceded or followed in some cases by a sort of obtuseness or torpor of the intellect; convulsions, trembling of the muscles of the limbs and face; eclampsia, palsy, generally partial and incomplete ; contraction, generally backwards, even to convulsions ; numbness of the limbs; feeling of burning and weight in the eyes, irregular dilatation of the pupils, &c. These symptoms are neither constant nor diagnostic; nor are they certain data for the prognosis and treatment of the disease. M. Ducrest nevertheless concludes, that the occurrence of all or of the greater part of these symptoms indicates an organic affection of the brain, whatever it may be, which consequently ought to attract the attention of the practitioner; that it should be treated according to the strength of the patient, and the therapeutic rules which guide the treatment in acute diseases of the brain; and lastly, that, as there are stages in the progress of encephalic phlebitis, a prompt and active treatment should be adopted in the early part of the disease, to prevent its passing into the suppurative stage.--Archives Générales de Médecine.
TREATMENT OF EPILEPSY.---M. Mettais, at Montrouge, strongly recommends the employment of tartarized antimony externally in frictions on the head, in cases of epilepsy. He mentions several cases in which benefit has been derived from this plan of treatment, which is not, however, a novel one, counteraction having been employed long since, although now much neglected. --Gazette Médicale.
M. Le Breton describes, in another number of the same journal, a case in which he had recourse successfully to a much more severe treatment for the cure of this disease. He was consulted by a young man, who had epileptic fits daily, and whose countenance bore an impression of hebetude. M. Le Breton applied the actual cautery, two lines in diameter, to the sinciput, keeping the instrument applied about twentyfive seconds, and pressing so as not to affect the whole thickness of the skin. The cautery was applied once a week for about three weeks, during the whole of which time the patient did not have one fit. The cautery was not then applied until the twelfth day, and then more superficially than before. M. Le Breton saw the patient a fortnight afterwards, quite cured, his intellect and strength being fully restored.
The same state of good health persisted when the patient was seen by M. Le Breton about three months afterwards.
NOCTURNAL NEURALGIA OF THE FOREARM.—M. Gambérini, in describing this singular disease, states that it commences by a pain at the end of the fingers of one hand, generally the two last, and then extends along the forearm, to within one or two inches of the elbow. The pain has always stopped there in the cases which have fallen under M. Gambérini’s notice. The night is the time when the spasm occurs; and it becomes so severe as to prevent sleep, and draw forth the most piercing cries : nevertheless, with the daylight relief from pain occurs, and few patients then retain any feeling of the past sufferings. The part when examined, either before or during the attack, does not exhibit any visible alteration, neither tumefaction nor heat, although the patient, while the pain endures, complains of this latter sensation, and throws off the bedclothes, or anything else that may tend to increase the feeling. Cold applications, such as plunging the part into cold water, cause the most acute suffering ; which is also increased by moving the limb. An evident crepitation of the tendons is occasionally heard, resembling the sound emitted by walking on snow. One limb only is generally attacked ; and women are more liable to it than men, especially robust women, between twenty and thirty years of age, whose occupations require fatiguing motions of the upper arms.
In consequence of the regular periodicity with which the disease returned each evening, M. Gambérini was induced to exhibit the sulphate of quinine, but in vain. After trying several other remedies, he found that belladonna, made into an ointment as follows,—lard, ten drachms; extract of belladonna, four scruples, and used in frictions on the painful parts,—was possessed of the required efficacy. The general indications should be attended to at the same time : thus, in a strong, plethoric patient, in addition to the use of the belladonna, M. Gambérini employed bleeding with advantage. — Il Raccoglitore Medico.
PARALYSIS INDEPENDENT OF LESION OF THE NERVOUS CENTRES. -Dr. Luyckx records the case of a woman sixty years of age, who, having been exposed to cold and wet for a long time, gradually lost the use of her legs, and afterwards of the arms. The limbs were in an edematous state, and cold. The intellect was unaffected, and sensation in the parts continued. The patient was treated by emetics, gatives, blisters, &c. In ten days improvement commenced ; and in less than three months she was cured. M. Luyckx considers that in this case the disease was in no way connected with the nervous