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centres, but was seated in the peripheric nerves.—Annales de la Société de Médecine d'Anvers.
ESOPHAGEAL CATHETERISM OF THE INSANE.—The thesis of M. Emile Blanche on esophageal catheterism of the insane is reviewed in L'Union Médicale. We extract from that notice the following article :
“ Esquirol was the first who proposed introducing through the nostrils into the @sophagus a gum-elastic catheter, in order to convey liquid food into the stomach. Two surgeons, Antoine Dubois and Murat, accordingly practised the operation, without in any way modifying the instrument which was used, although the route it had to traverse was very different in its anatomical aspect. The consequence was, that it did not always succeed; sometimes it was attended with considerable danger, and followed even by death. To remedy this, certain modifications in the instrument were made. The first and most important, by Dr. Ferrus and Dr. Mitivié, was the substitution of an ordinary gum-elastic catheter for the esophageal instrument. This has been used successfully for five months together in one case by Dr. Ferrus; and for seven weeks at a time, by M. Blanche, on an insane patient at the Salpétrière. The latter states that the operation with this instrument is easily performed, and with proper care we may be sure of succeeding. There are, however, certain difficulties connected with its use : when the catheter reaches perpendicularly the posterior paries of the pharynx, it may form an arch. If it be not very flexible, it curves with difficulty; and if force be used, this part of the operation may be painful. When the lunatic has acquired by practice the art of applying the base of the tongue against the posterior paries of the pharynx, by energetically contracting the muscles of that part, the obstacle to the passage of the catheter becomes serious. In such a case it may curve on the base of the tongue, and pass into the mouth, and then, by using a little force, a false passage may be made, by perforating the pharynx. The catheter may also pass into the larynx, or it may bend at the part where its eyes are situated, and thus form an obstacle which will prevent the passage of food, even when the instrument is in the @sophagus. To remedy these inconveniences, M. Baillarger provided the catheter with two stilets, one of steel, and the other of whalebone; the first, bent to a proper angle, enabled the operator to avoid the posterior paries of the pharynx; the second, after the first had been withdrawn, straightened the catheter by its elasticity, and applied it against the pharynx, thus withdrawing it from the glottis. The double object of the operator was thus answered ; but it was attended with the difficulty of withdrawing the stilet in its curved state through the nostrils, the vertical diameter of which is not sufficient for that to be done readily ; its extraction therefore causes a dragging and a compression which is always painful. To do away with this, M. Blanche has invented an articulated stilet, the rings being thirty-one in number, and so arranged as to play freely when flexed, but when extended, which is effected by a watch-spring working inside the rings, and soldered to a stiff and moveable stem, it assumes all the rigidity of a non-articulated stilet. This instrument, then, after it has been passed in the cnrved state through the nostrils into the pharynx, can be straightened, and passed on, so as to avoid the larynx. All that is requisite is to pull upon the watch-spring, which becomes straight, drawing with it the rings of the metallic chain, and thus apply the catheter against the posterior pharyngeal paries. When it has reached the @sophagus, the stem connected with the watch-spring is let go, the articulated part resumes its flexibility, and the stilet can thus readily be withdrawn.”
This instrument appears to be a valuable modification and improvement on those previously in use.
M. Brierre de Boismont mentioned at a meeting of the Société de Médécine at Paris, reported in the Revue Médicale, that in cases of insane persons who refuse to take food, he puts on the strait-waistcoat, and then introduces, by force, a catheter through the nose into the pharynx. He does not consider it requisite to pass it into the æsophagus. Some liquid aliment is then introduced through this canal; and he asserts that the agony the proceeding causes, as well as the imminent sense of suffocation, are such that the patient never forgets it, and will afterwards take the food that is offered to him, for fear of being again subjected to the same.
MEDICO-LEGAL REPORT ON THE STATE OF MIND OF MARIE MADELEINE DROIN.-M. Girard has published in the last number of the Annales Médico-Psychologiques, a medico-legal report on the state of mind of a woman named Marie Madeleine Droin, accused of attempting to poison the daughter of a neighbour with whom she had been previously on good terms. It appeared that prior to this event she had manifested unequivocal signs of mental derangement, dating from the loss of an only child, about six years previously, to whom she was greatly attached.
Her character changed; she became ill-tempered and malicious, rejoicing when any ill befel her neighbours; and instead of living comfortably with her husband, she made his life unhappy. Her mind was said to be constantly occupied and disturbed, without however being regarded as insane. Her whole pleasure seemed to consist of speaking of her lost child, except when she alluded to the misfortunes of others. The reason assigned for the attempt at poisoning the child was, that she might cause great grief to the mother, with whom she had had a quarrel. The witness by whom this opinion was advanced, stated that she had heard several persons ask if the prisoner's troubles had not affected her intellect, since she was continually speaking on that subject, prior to the attempt at poisoning.
It is further stated, that the prisoner scarcely ever is the first to speak; that she replies only when spoken to; that she is habitually sad, and very silent, remaining seated with her eyes cast down, passing ber hand over her forehead; and not paying any attention to that which is going on around her, and that her appetite is disordered, she scarcely ever eating anything.–M. Girard asks, are not these the characteristic signs of melancholy insanity?
Other extravagant actions, committed before the crime of poisoning was attempted, are also brought forward, as for instance, the attempting to pull down the bed-curtains when in bed, cutting her own clothes and those of her deceased child to pieces, and making up her bed in the granary, &c. These attacks came on at the time when the catamenia were present. Some of the witnesses deposed to incoherence of speech on the part of the prisoner; and after she was confined in prison a short time, she complained of there being black cats in her room; she was constantly speaking of self-destruction. Her symptoms are thus summed up by the reporter, as indicative of melancholic insanity:“Nothing is wanting," he says: “the attitude, gestures, physiognomy, want of sleep, loss of appetite, love of solitude; the delirium of the passion which is the strongest in women, the love of offspring; hallucinations, convulsive movements, extravagant ideas, represented by equally extravagant actions, having the character of melancholy, and extending as far as the manifestation of the desire for death, and finally, the predominance of a fixed idea, impressing its seal in the whole moral and physical being. The correctness of her memory as to dates, coherence in her conversation, reason in her actions, and the regularity of her vital functions, are not,” says M. Girard, “incompatible with insanity.”
The personal examination of the prisoner, by the reporter, confirmed these views. A well-marked expression of wandering and sadness was evident in the attitude and physiognomy; she appeared agitated and oppressed, complaining of want of appetite, thirst, headache, heat in the bowels, and constipation; this latter lasting for a week at a time. She thinks she sees her daughter, hears her voice; perceives flames; is insomnolent, and goes so far sometimes as to suppose that she embraces and touches her daughter, who suddenly disappears, so that she only seizes a shadow. She denies obstinately having given poison to her neighbour's child, but manifests great hatred against the father, who, she says, has several times attempted to seduce her. Her conversation does not betray any sign of general insanity, except when on the subject of her daughter, to which she constantly and irresistibly led it. The remembrance of her child caused her tears to flow, and gave a very singular convulsive expression to her face.
M. Girard drew the conclusions from the preceding facts, and from others which are detailed in his report, that the prisoner laboured under partial melancholic insanity, characterized further by a marked general disorder of the intellect at intervals only, and especially at the menstrual periods. He considered, therefore, that the attempt at poisoning was the result of feelings of hatred and vengeance, out of proportion to the causes which gave birth to them, caused by a perversion of the moral sensibility and of the intellect from partial melancholia.
The woman was acquitted on the ground of insanity.
DECREASE OF THE BRAIN IN INSANITY.–From a paper read by M. Parchappe, before the Academy of Sciences, “ On the gradual decrease of the brain, in proportion to the successive degradation of the intellect in simple mania," we learn that since the publication of his treatise on insanity in 1811, in which he brought forward the preceding pathological law, the author has continued his researches, and has obtained a collection of 498 additional microscopic observations, confirming all the anatomicopathological conclusions he had advanced. The existence of this pathological law of the gradual decrease of the brain in proportion to the successive degradation of the intellect springs from the comparison of the two categories, acute and chronic insanity, the medium of which differs in a quantity equal to eighty-nine scruples (grammes) in men, and eighty-five in women, in a proportion equal to 77.1000 in man, and 67.1000 in woman. It becomes still more evident, by the comparison of the medium in the four categories of chronic insanity, where we see the weight of the brain diminish at the same time with the intellectual power, and where the difference between the medium of acute insanity, and the last degree of chronic insanity, is as high as 152 scruples in man, and 135 scruples in women.—Archives Générales de Médécine.
Ox CEREBRAL CONGESTION, CONSIDERED IN RELATION TO HEMORRHAGE AND SOFTENING OF THE BRAIN. - Dr. Durand-Fardel read a memoir on this subject, some months since, before the Academy of Medicine, an abstract of which is inserted in the Archives Générales de Médécine. The two most common affections of the brain in the adult and in old age, hemorrhage and softening, cause, he says, organic lesions in the cure of which the vis medicatrix Naturæ plays the principal, if not the only part. Medicine can only be useful in seeking to prevent these diseases. With that object in view, we must become acquainted with the premonitory symptoms, and subject them to treatment as they occur. The precursory phenomena of hemorrhage and softening of the brain, when they exist and can be observed, are those indicative of cerebral congestion, such as headache, giddiness, numbness, and formication of the limbs, determination of blood to the head (coup de sang), &c. The different forms that acute softening may assume at the commencement—such as an attack of apoplexy, delirium, convulsions, and gradual and rapid abolition of the functions of relation-are identical with those which most frequently characterize cerebral congestion. In the body, the nearer the commencement of the disease, acute softening, is observed, the more certainly are traces discovered of general or partial hypertrophy of the substance of the brain. The more ordinary commencement of softening by an apoplectiform attack announces that the brain has been suddenly invaded by general hyperemia, to which succeeds the partial softening which is discovered at the autopsy, or which becomes chronic. With respect to hemorrhage, whatever part be ascribed to the alteration of the parietes of the vessels of the brain, which is common in old people, or to that lesion of the nervous pulp, called by M. Rochoux, "hémorrhagic ramolissement," the existence of which cannot be contested, at least in the greater number of cases, it is not possible to account for the hemorrhage itself, except by the existence of a determination of blood to the brain. We often find traces of this determination of blood in the bodies of persons deceased from hemorrhage, although the time that has elapsed, the treatment that has been adopted, and the unloading afforded by the rupture of the vessels appear sufficient to cause it to disappear. En resumé: if we ought not to award to cerebral congestion, or even to fluxion of blood, so direct a part in the preparation and production of these two diseases, it is impossible not to recognise a striking relation between them; whether the question be studied on the body, or during life. The disposition of the system of the encephalic circulation, the extreme vascularity of the brain, the size of its arteries, the extreme division of their branches, the obstacle to the return of the venous blood by the narrow and difficult openings in the cranium, explain the complicated rôle that cerebral congestion plays in the pathology of the brain. We may also readily find in it the explanation of a great number of cases of serous infiltration, so often met with in the subarachnoid cellular tissue.
EPILEPTIFORM HYSTERIA.—In La Verdad, a Spanish medical journal, we find the details of a case of epileptiform hysteria. The patient was a female servant, twenty years of age, unmarried, and of rather weak intellect. Epileptic symptoms first showed themselves during infancy, in consequence of blows on her head. They re-appeared at puberty, accompanied by cerebral inflammation, the result of injuries and attempts on her chastity. While residing in the house of Dr. Arguinosa, she complained one day of fatigue, and pain in the loins. The precursory