Obscure diseases of the brain and mind

Front matter

ON THE OBSCUEE

DISEASES OF THE BRAIN,

AND

Preface To Foueth Edition

This, the Foivrth Edition of my work, has been carefully revised. Many of the cases related in the former issues have been removed, thus making room for important additional matter of greater practical value.

The new views of the pathology and treatment of Epilepsy, Progressive Locomotor Ataxy, Aphasia, and Glosso-Laryngeal Paralysis, will be found in this volume.

F. W.

23 Cavendish Squaee, June 1868.

PEEFACE TO THIED EDITION.

The object of this work is to briefly, clearly, and free from all unnecessary technicalities of language, point out the more important salient and characteristic symptoms that usually precede and accompany serious and often fatal attacks of disease of the brain and disorder of the mind.

This work is to be considered merely as an outline or sketch of a vast and hitherto much-neglected branch of practical medicine.

All diseases of the brain, independently of or complicated with disorders of the mental operations, are, as a general rule, very obscure in their origin, insidious in their progress, and most difficult to treat successfully, particularly when, in consequence of their being unobserved in their incipient stage, they are permitted to pass unarrested from an acute into a chronic condition.

Hence the grave significance attached to the advice so properly given to the practitioner of medicine, that he is not only to watch with the greatest vigilance for the approach of all head affections, but, if possible, to anticipate their

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Preface

stealthy advance, and prevent, by the early use of remedial measures, those organic and incurable alterations in the delicate structure of the brain, which so often follow neglected cerebral and unnoticed mental diseases.

A careful study of the premonitory signs of these affections should not, if philosophically considered, excite on the part of the patient morbid apprehension or nervous alarm.

In all the great transactions of life, the wisdom of the maxim, that prevention is better than cure, is universally admitted. Its application is general.

Admiral Fitzroy sits quietly, like a magician of old, in his London studio, and, as the result of much philosophical study and many complex calculations, based upon a large accumulation of data illustrating meteorological science, is able, with extraordinary and almost unerring precision, to detect sudden alterations of temperature and changes of weather. With wonderful sagacity he has frequently been known to predict the approach of fearful hurricanes. _

Having satisfied himself as to the accuracy of his conclusions, the Admiral touches the electric wire, and instantaneously communicates with the officials on the coast, bidding them to hoist the storm signals. By the wise and timely warning thus given, much valuable property about proceeding to sea in vessels is preserved, and many valuable lives are saved.

The skilled mariner, by his knowledge of the laws governing storms, and a careful observation of the character of the clouds and elevation or fall of the barometer, is able

PREFACE.

xi to anticipate the approach of foul weather, and thus, by the adoption of precautionary means, to avoid placing his vessel within the reach of danger.

The general in command of an army marching in time of war through an enemy's country sends out in advance his trustworthy scouts, and is thus protected from all sudden surprise. So the philosophical physician, recognising the fatally destructive character of certain diseases, considers that he is hut ill discharging the duty he owes to the public if he does not point out to the uninitiated, as well as those who are medically educated, the symptoms that, in the great majority of cases, are premonitory of serious morbid orsranie conditions.

It may be urged that it is mischievous to excite anxiety where no danger is close at hand ; but surely it is wise to be on our guard against the approach of disease, to observe its first warnings, and thus, by the use of appropriate remedies, prevent the enemy from obtaining a permanent lodgment in one of the vital tissues.

The daily records of passing events are full of sad data painfully illustrating the folly of neglecting disease of the brain and mind in its incipient stage.

Fatal attacks of apoplexy, serious cases of alarming paralysis, incurable conditions of softening of the brain, lamentable instances of insanity, suicide, homicide, and murder, are matters of daily occurrence, springing out of unobserved and neglected affections of the brain and mind.

It is with the view of exciting a deeper interest in and

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PREFACE.

of awakening a profounder and more philosophical attention to this important subject that these pages have been penned.

That this work (of which two large editions have been sold within three years) has been productive of much practical good, admits of easy and satisfactory demonstration. Cerebral symptoms that were too commonly overlooked, or, if noticed, viewed as insignificant, are now properly considered as symptomatic of threatening brain and mental disease. Thus mischievous maladies have been detected in the incipient stage and placed under arrest, whilst appropriate medical measures have been adopted for their mitigation and cure. For these known results I have every reason to be grateful.

F. W.

October 1863.

Introduction

Important aphorism of Hippocrates in reference to the early treatment of disease — Marshall Hall on the neglect of premonitory symptoms of disease of the brain — General neglect of incipient cerebral symptoms — Attention paid to the early symptoms of disease in other organs — Cases illustrating the neglect of incipient symptoms — Insidious character of disease of the brain- Obscure cerebral symptoms — All affections of the brain have an incipient stage — Latent disease of the brain — Diseases of the brain subject to general pathological laws — Neglected affections of the brain — Cases of alterations of structure of the brain— Physiology of the brain— Necessity of watching for incipient cerebral disease — Early treatment of insanity — Unwillingness to recognise the existence of insanity — Importance of early treatment, pp. 1—21

Chapter II. Morbid Phenomena Of Intelligence

All physical alterations of the brain modify its psychical functions— Effect of cerebral disease on the mind— Emotional exaltation and excitement— Irresistible impulse to suicide — Ennui not always a condition of mental inactivity —Early symptoms of mental disorder— Disorders of the mind shown by alterations of thought and conduct, 22 27

Chapter III. Premonitory 8ymptom8 Of Insanity

Ilgnorance of the nature of insanity— What is insanity ?— Ignorance of the mental and nerve force— The extent of our knowledge of the nature of mind and matter— Impossibility of denning insanity— Study of metaphysics and logic— Suggestions for an improved analysis of morbid mind— Laws governing the operation of thought— State of the mind between sleeping and waking- Insanity and dreaming— Are intellectual problems solved during dreams ?— Insanity a waking dream— Pascal on dreams— Poetry, &c, composed during sleep— Rapidity of mental action in dreams— Curious case— Resemblance of the phenomena of dreams to insanity— In dreams the mind is often conscious of its creations— Lucid intermissions during attacks of insanity— Singular temporary restoration to reason, 28—60 xiv

Chapter IV

CONFESSIONS OF PATIENTS AFTER RECOVERING FROM INSANITY J OR THE CONDITION OF THE MIND WHEN IN A STATE OF ABERRATION.

The autobiography of the insane interesting and instructive— Indivisibility of mind— Can the insane accurately describe, after recovery, their previous condition of disordered mind ?— Shakspeare the only correct delineator of insanity— Former barbarous treatment of the insane— Pinel's efforts to ameliorate the condition of the insane— Progress in the pathology and therapeutics of insanity, 61—65

Chapter V. State Of The Mind When Recovering From An Attack Of

INSANITY.

State of the mind when passing out of an insane into a sane condition— Doubts as to the reality of delusions among the insane— The Eev. Mr Watford's account of his recovery from an attack of mental derangement, . 66 -71

Chapter VI

ANOMALOUS AND MASKED AFFECTIONS OF THE MIND. Impossibility of denning insanity— Singular case of insanity— Insanity among children— Symptoms of insanity— Undetected mental disease— Remarks by Dr Brierre de Boismont and others on the insanity of early life— Insanity in the United States of America— Statistics of insanity among children— Hereditary predisposition to insanity— Incipient symptoms of insanity— Transformations of character in the early stage of insanity— Exaggerations of natural states of mind often indicative of insanity— Delusions— Diagnosis of insanity— Obscure disease of the brain— Latent and unrecognised insanity- Serious results following a non-recognition of insanity— Pseudo forms of mental disorder— Insidious approach of insanity— Symptoms of latent insanity- Alterations of character and disposition preceding attacks of insanity— Cases of morbid paroxysms of passion— Temper disease— Curious case of disordered mind— Insanity shown in acts of brutality— Concealed monomania— Moral character changed by physical injury— Paralysis of the moral sense— Illustrations of moral idiocy— Shakspeare's description of this affection- Latent case of monomania— Transformation of character caused by physical disease— Effects of diseased brain on the character — Historical illustrations of diseased brain on the character— Caligula, Tiberius, Catherine de Medici, Frederick William of Prussia, Robespierre, Judge Jeffreys- Meteorological influence on the mind— Effect of chloroform on the mind- Resemblance of mental phenomena caused by the use of chloroform to insanity— Curious mental phenomena caused by the absorption of poison in the blood— Singular case of hydrophobia affecting the mind- Influence

CONTENTS.

XV physical irritation on the mind — Morbid views of religion — Extraordinary organic change discovered after death in the membranes of the brain — Brutality and immorality— Cases of erotic monomania— Speedy cure of a case of insanity — Singular case of concealed insanity — Recklessness in monetary transactions exhibited in the incipient phase of mental disorder — Case of undetected insanity — Motiveless acts of brutality conuected with latent insanity — Homicidal insanity — The medico-legal witness — Duties of the psychological expert— Importance of the testimony of experts in subtle cases of insanity — Popular ignorance of insanity — Evidence in cases of alleged lunacy — Case of Atkinson, the homicidal idiot — Danger of lunatics being at large — Decision of juries in cases of insanity — Serious consequences of a wrong verdict in commissions de lunatico — Anomalous defective state of the law of lunacy — Justice to be tempered with mercy, . . . 72 — 140

Chapter VII. The Stage Op Consciousness

Neglect of habits of self-inspection — Innate wickedness of the human heart— Mysteries of the inner mental life — Consciousness of the approach of insanity — Foreshadowings of insanity — Struggle between reason and insanity — Morbid apprehensions of insanity — Confessions of patients — Insidioiis advances of morbid thought — Obscene and immoral ideas — Illusions premonitory of insanity — Phantasms and spectral illusions — Illusions of hearing (voices) — Incubation of insanity — Efforts made to conceal insanity — Insane impurity of thought — The insanity of Ophelia— Explanation of the causes of perverted thought — Sources of early moral deterioration — Purity of thought sometimes exhibited by the insane — Power of controlling insane ideas — Symptoms of incipient insanity —Morbid presentiment of insanity — Prediction of attacks of apoplexy— Sir W. Scott's anticipation of brain disease — Dean Swift's presentiment of his approaching imbecility — Morbid anticipation of insanity, , 141 — 163

Chapter VIII. Stage Op Exaltation

Psychical exaltation— State of mind premonitory of insanity — Morbid exaggeration of ideas —Emotional exaltation— Suicidal delirium connected with great exaltation of spirits— Wit, ingenuity, and cunning of the insane— Mental acuteness of the insane — Poetical enthusiasm in mania— Mental abilities of the insane — Symptoms of insanity in young women — Peculiar type of mental disease— Self-control and shrewdness of the insane— Art of analysing subtle cases of insanity— Feigned insanity unmasked by chloroform— Concealment of delusions by the insane— Cunning, cleverness, and subtlety of the insane — Acute instinctive manifestations of the insane— Subtlety of the insane metaphysically explained— Symptoms of insanity— The physical agitation of incipient insanity— Tortures of a wicked conscience— Happy type of insanity —Horace's description of the happy madman — Premonitory signs of apoplexy—Insidious symptoms of general paralysis, . . . 164- -189 xvi

CONTENTS.

Chapter IX. Stage Of Mental Depression

Acute morbid melancholy— Symptoms of brain disease -Concealed delusions- Subtle types of suicidal insanity— Melancholia a symptom of organic disease of the brain, 190—192

Chapter X. Stage Op Aberration

Obscure progress of aberration of mind— Exaggeration and perversion of ideas —Disorder of the perceptive faculties— Delusions, how they originate — Morbid conditions of sight— Illusions of hearing— Illusions premonitory of disease of the brain— Singular case of spectral illusions— Perversions of the moral sense— Insane pilfering and concealing— Insanity manifested by avarice and licentiousness — Softening of the brain, .... 193—208

Chapter XI. Impairment Of Mind

Insidious advances of mental imbecility— Symptoms of softening of the brain and apoplexy— Lesions of intelligence preceding disease of the brain— Impaired nutrition of the brain, 209—212

Chapter XII. Morbid Phenomena Of Attention

Importance of the faculty of attention— Genius a continued attention— Impairment of attention— Morbid distraction and reverie— Injurious effects of protracted reverie— Resemblance of reverie to dreaming— Morbid imaginative contemplation— Hypochondriasis— Morbid concentration of attention— On the importance of controlling the imagination— Weakness of attention a symptom of cerebral disorder— Morbid effect of concentrated attention- Defect of Speech— Impairment of attention— Morbid distraction a symptom of brain disease— The cerebral disease of Oscar, King of Sweden, exhibiting itself in the early stage byidistraction of mind, j . . . 213—232

Chapter XIII. Morbid Phenomena Of Memort

What is memory?— The natural classification of ideas— Cause of decay of memory in old age— Mode of acquiring knowledge— Theory of memory- Loss of memory in apoplexy— Laws regulating the admission of ideas into the mind, 233—241

CONTENTS. xvii

Chapter XIV. Acute Disorders Of The Memory

Decay of memory in old age— Retention of early impressions in old age— Premature impairment of memory— Loss of memory in advanced life— The poet Roger's loss of memory— Importance of preserving the memory— Impairment of memory a symptom of brain disease— Loss of memory a symptom of paralysis and softening of the brain— Sudden and transient loss of memory—Symptoms of mental disorder— Causes of impaired and paralysed memory— Sir H. Holland's case of temporary loss of memory— Effect of stimulants in restoring the memory— Confused state of the memory a symptom of ramoUissement of the brain— Effect of mental emotion on the ldeas> 242—252

Chapter XV. Chronic Affections Of The Memory

Forgetfulness of names previous to an attack of brain disease— Loss of language caused by a blow on the head-Singular case of revival of a language long forgotten— Loss of language after attacks of apoplexy, &c— Effect of injury to the head on the memory— Singular case of defect of memory— Loss of memory after acute bodily disease— Effects of Paralysis on the memory- Loss of certain words, &c— Remarkable case of disordered memory— Effect of a bullet-wound on the memory— Impairment of memory after epidemics —Paralysis of the memory caused by intense cold— Effect of the Russian campaign on Bonaparte's memory— Loss of memory caused by fever— Loss of language— Singular manifestations of memory prior to death— Effect of apoplexy on the memory— Effect of a mental shock on the memory-Remarkable case of disordered niemory-Proximate cause of morbid memory- Singular case of defect of memory— Cases of impairment of memory, 253—276

Chapter XVI. Perversion And Exaltation Of Memory — Memory Of The Insane

' Curious cases of perversion of memory-Remarkable case of double per sonality-Case of double or divided consciousness-Exaltation of memory a fatal diagnostic sign-Exaltation of memory in the brain diseases of early lile-lmprovement of memory in advanced life often precursory of apoplexy -Case of exaltation of memory-Memory of the insane- Shakspeare on the memory of the insane, 277—285

Chapter XVII. Psychology And Pathology Of Memory

Destruction, a physical and moral impossibility-Indestructibility of mental impressions-Effects of organic physical changes on the mind-Inexplicable

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CONTENTS.

psychical and physical phenomena — Assimilative power of the blood — Nutrition of the brain— Is the mind situated in the brain ?— The subject of chemico-cerebral pathology ought to be more investigated — Phenomena of latent mental impressions— Curious facts relative to latent light — Indestructible character of ideas — Mental phenomena caused by drowning— Curious phenomena manifested at death — Morbid phenomena of language — Knowledge of languages revived by fever — Curious phenomena observed in somnambulism and catalepsy — Laws governing the association of ideas — Morbid and sensitive state of activity of the memory— Physical theory of latent mental impressions— Physical impediments interfering with thought — The brain compared to a galvanic battery — Sudden resuscitation of latent ideas — Rapidity of mental action — Cases of loss of memory, and its sudden restoration — Idiocy cured by blows upon the head — Connexion between wit and madness — Dormant nature of mental impressions — Latent ideas suddenly recalled to consciousness — Loss of speech and consciousness— Sudden arrest of intelligence— Garrick's accurate knowledge of insanity, how acquired — Morbid fixedness of idea, . 286—329

Chapter XVIII. Morbid Phenomena Of Motion

. Diagnosis between cerebral and spinal paralysis — General muscular debility — Early signs of softening of the brain — Partial loss of motor power Incipient symptoms of apoplexy and paralysis — Insidious progress of brain disease — Case of brain disease without impairment of intellect— Muscular tremors symptomatic of brain disease — Irregular muscular action — Morbid want of muscular co-ordination — Difficulty of explaining these phenomena — Convulsive action — Obscure types of nocturnal epilepsy — Loss of memory in epilepsy — Diagnosis of epilepsy — Premonitory symptoms of epilepsy — Affections of the tongue and muscles of the mouth — Insidious symptoms of paralysis — Effects of softening of the brain on the motility— Morbid handwriting- Paralysis agitans — Premonitory symptoms "of paralysis agitans — Loss of sleep — Morbid affections of the spinal cord— Acute ramollissement of the spinal cord — Alterations in motion in cerebral Softening — Peripheral paralysis- Symptoms of progressive locomotor ataxy, .... 330—354

Chapter XIX. Morbid Phenomena Op Speech

Various forms of aphasia— Cerebral localisation of speech — Is loss of speech the result of affections of the anterior lobes of the brain ? — Loss of speech caused by cerebral paralysis — Disease of the corpora olivaria a cause of loss

of speech — Morbid impairment of speech Irregular impairment of the

articulation — Paralysis of ideas in incipient cerebral disease — Pathology of aphasia — Case of aphasia — Symptoms of glosso -laryngeal paralysis — Morbid irregularity of speech — Forgetfulness of certain words a symptom of apoplexy — Singular misplacement of words — Cases of curious defect of articulation — Morbid articulation — Loss of speech a symptom of apoplexy, congestion, and softening — Morbid misuse of words— Singular alterations of speech — Irre-

CONTENTS.

xix gularity and impairment of speech — Diagnostic value of affections of speech —Symptoms of acute softening — Loss of speech caused by mental distress — Loss of speech a symptom of epilepsy and apoplexy — Premonitory signs of paralysis — Sudden' loss of speech — Successful treatment of a case of loss of speech — Morbid speech following apoplexy— Singular case of mutism caused by ■ bullet wound — Perversion of speech the result of a wound on the head — Case of extraordinary perversion of speech — Morbid imitative movements of articulation — The " echo " symptom of softening of the brain — Involuntary articulation a symptom of brain disease — Effect of insanity upon the voice- Alterations of voice symptomatic of insanity, .... 355 — 393

CHAPTEE XX.

MORBID PHENOMENA OF SENSATION.

Exaltation of sensation— Softening of the spinal cord — Vertigo a symptom of cerebral disease — Cause of vertigo — Symptoms of epileptic vertigo — Obscure cases of epilepsy — Diagnosis of epilepsy- HyperEesthesia of the brain — Cephalalgia generally accompanying cerebral affections —Cerebral headache — Anaesthesia a symptom of brain disease — Incipient symptoms of apoplexy- Insensibility of the mucous membrane of the conjunctivae in incipient disease of the brain — Sensation of cold a symptom of apoplexy — Impairment of the sense of taste a symptom of softening — Sensation of weight and heaviness in the side a symptom of cerebral softening — Deficient sensibility of the insane — Explanation of the causes of anaesthesia — Impairment of sensibility in incipient general paralysis — Kemarks by Pinel on the insensibility of the insane — Cases of insensibility to pain among the insane — Insensibility from^pre-occupation of mind — Vitiated sensation symptomatic of cerebral disease, . 394 — 414

Chapter XXI. Morbid Phenomena Of The Special Senses

Normal acuteness of the senses — Mental distress caused by certain odours— — Mozart's acuteness of hearing — Acuteness of the sense of touch among the blind — Singular defects of vision — Inability to distinguish colours symptomatic of brain disease— Curious cases of error of colour, 415 — 418

Chapter XXII. Morbid Phenomena Of Vision, Hearing, Taste, Touch, And

SMELL.

Impaired and paralysed sight — Defect of vision symptomatic of disease of the brain— Early signs of cerebral amaurosis — Cephalalgia a symptom of centric cerebral amaurosis — Value of the ophthalmoscope in detecting obscure diseases of the eye — Doable vision a symptom of disease of the brain— Case of sudden restoration of sight — Loss of sight caused by tumours in the brain— Causes of amaurosis — Loss of sight premonitory of apoplexy — Singular case of

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CONTENTS.

sudden recovery of the sense of vision— Importance of the early detection of cerebral disease— Symptoms of amaurosis dependent upon vascular congestion— Singular case of morbid derangement of sight— Exaltation of vision premonitory of brain disease— Cases of morbid exaltation of vision— Spectral illusions— Goethe's power of producing phantasms —Cases of hyperaesthesia of vision connected with disease of the optic thalamus— Perversion and aberration of sight — Peculiar expression of the eyes in some forms of brain disease— Incipient symptoms of apoplexy — Derangement of sight premonitory of meningitis, congestion, and hyperemia— Vitiated perception a symptom of apoplexy— Symptoms of cerebral hemorrhage— Morbid luminous phenomena — Photopsia a symptom of disease of the brain — Singular phantasmal phenomena— Illusions of sight — Morbid phenomena of sight— Strabismus symptomatic of disease of the brain— Double vision an important symptom of cerebral disease— Double vision symptomatic of apoplexy, paralysis, cerebritis, and meningitis— Morbid phenomena of hearing— Acuteness of hearing in incipient cerebral affections — Hyperaesthesia of hearing a symptom of insanity — Illusions of the sense of hearing— Murder and suicide caused by illusions of hearing — Morbid phenomena of taste, touch, and smell — Disordered state of the taste and smell in incipient insanity — Disordered condition of the tactile sensibility in incipient paralysis — Exalted tactile sensibility, 419—450

CHAPTEE XXIII.

MORBID PHENOMENA OF SLEEP AND DREAMING.

Sleeplessness of incipient insanity — Heavy and drowsy sensation a symptom of cerebral disorder — Insomnia caused by a severe mental shock— Death from want of sleep— Pathology of sleeplessness — Case of long-continued sleeplessness — Sleeplessness in insanity often caused by spectral illusions — Singular illusions causing sleeplessness— The poet Southey's insanity caused by loss of sleep- Morbid disposition to excess of sleep— Drowsiness a symptom of apoplexy — Lethargy a symptom of cerebral disorder induced by renal disorder causing a retention of urea in the blood — Morbid drowsiness and excess of sleep— Morbid phenomena of dreaming — Dreams often symptomatic of disease of the brain— Hallucinations between sleeping and waking— Morbid dreaming preceding insanity— Insanity commencing in a dream — Murder committed during'sleep, 451 — 465

Chapter XXIV. Morbid Phenomena Of Organic And Nutritive Life

Sympathy between the brain and digestive organs— Case of delirium caused by indigestion — Derangement of the' stomach in incipient insanity — Nausea resembling sea-sickness symptomatic of cerebral tumours and softening of the brain— Influence of chronic disorders of the digestive organs on the mental impressions during insanity— Eefusal of food by the insane, causes of— Vitiated and depraved appetite of the insane— Embonpoint in chronic insanity— Influence of disorders of the nervous system upon the functions of

CONTENTS.

xxi nutrition— Morbid phenomena of circulation, respiration, and generation- Connexion between apoplexy and cardiac disease — Influence of cardiac disease on the psychical functions of the cerebrum— Hallucinations caused by disease of the heart— State of the pulse in incipient insanity— Sympathy between the lungs and brain— Post-mortem examination of the lungs of the insane— Exaltation and impairment of the reproductive organs, 466 — 474

Chapter XXV. General Principles Of Pathology, Diagnosis, Treatment, And

PROPHYLAXIS.

■ Obscurity of the pathology of the brain — Opinions of celebrated authorities as to the proximate cause of insanity— Capillary congestion a cause of insanity —Apparently normal condition of the brain often observed after death from acute insanity— Disordered condition of the psychical co-ordinating principle a cause of insanity— Pathological phenomena of general paralysis— Softening of the brain and hemiplegia— Idiopathic ramollissement of the brain— Influence of deposits in the arteries upon the circulation— Diseased arteries a cause of apoplexy— Pathology of epilepsy— Pathology of progressive locomotor ataxy— Pathology of glosso-laryngeal paralysis, . . 475—487

Chapter XXVI. General Principle Of Diagnosis

Diagnosis of insanity— Affections with which insanity is liable to be confounded —Distinction between insanity and delirium— Differential diagnosis between eclampsia, hysteria, and epilepsy— Diagnosis of cerebral congestion— Distinction between insanity and cerebritis— Diagnosis between meningitis and inflammation of the substance of the brain— Anaisthesia preceding cerebro-spinal disease— Incipient symptoms of general paralysis— Diagnosis between general paralysis and wasting palsy— Diagnosis of softening of the brain- Premonitory symptoms of acute and chronic softening— Cerebral abscesses and tumours— Importance of knowing the antecedents of patients— Diagnosis of cerebral cephalalgia— Importance of cephalalgia in a diagnostic point of view— Neuralgic and rheumatic cephalalgia— Nervous headache and cephalalgia symptomatic of tumours of the brain— Diagnosis between cerebral and idiopathic sickness of the stomach-Use of ophthalmoscope in diagnosis of cerebral disease, 488 _5Q4

Chapter XXVII

GENERAL TREATMENT OF PRINCIPLES AND PREVENTION. Treatment of incipient insanity-Duties of the physician-Depletion in insanity, its use and abuse— Caution to be exercised in the exhibition of purgatives-Use of hellebore by the ancients for the cure of insanity-The use Of prolonged hot baths in the treatment of acute mania-Value of opium in the treatment of incipient insanity-The beneficial result of sedatives in cases xxn

CONTENTS.

of melancholia— Use of chloroform in cases of insanity— Value of hypodermic injections of morphia— Isolation of the patient from his friends— Mr Spurgeon's method of subduing evil thoughts — Necessity of self-control- Baxter on the sinless character of involuntary evil thoughts — Archbishop Seeker on "Sin against the Holy Ghost" — Emerson on religious sentiment induced by bodily disease — Importance of early treatment of organic disease of the brain— Value of tonic treatment in incipient apoplexy and paralysis - Treatment of softening of the brain— Disease of the brain caused by mechanical injuries to the head — Injurious effects of blows upon the head — Importance of watching the state of the brain after injuries to the head- Various diseases of the brain preventible if treated in the early stage- Abscesses from blows upon the head — Course of treatment to be adopted after severe blows upon the head — Importance of the early detection of head symptoms— Value of bromide of potassium in epilepsy — Treatment of cases of impaired intelligence — Importance of the cultivation of the faculty of attention — Treatment of impairment and loss of memory — The decay of memory illustrated in the case of Themistocles— Sophocles' refutation of imbecility in his old age — Treatment of the mind after an attack of insanity — Susceptibility of the memory to improvement — Mental remedies for the improvement of memory— On the cultivation of the memory — Montaigne's loss of memory — On the advantages and disadvantages of a commonplace book — Impairment of memory the result of undue straining in early life— Importance of the careful cultivation of the memory— Excessive straining of the memory in schools — When does the intellect begin to decline ? — The vital, not the intellectual, principle affected in old age — Celebrated men who have retained their intellectual powers to a great age, as exhibited in the lives of Cherubini, Corneille, M. des Quensounnieres, M. Leroy, Fontenelle, Voltaire, Richelieu, Mr Waller, John Mapletoft, Titian, Benjamin West, R. Cumberland, Handel, Ben Jonson, Sir Isaac Newton, Locke, Dr Johnson. Bacon, Chaucer, Sir E. Coke, Lord Eldon, Lord Kenyon, Lord Hardwicke. Lord Stowell, Bolingbroke, and Lord Mansfield — Is great vigour of memory allied to defect of judgment? — The memory of idiots — Great strength of memory combined with intellectual vigour, illustrated in the lives of Dr Johnson, Edmund Burke, Clarendon, Gibbon, Locke, Archbishop Tillotson, Grotius, Pascal, Leibnitz, Euler, Muratori, Ben J onson, Themistocles, Cyrus, Hortensius, Niebuhr, Sir James Macintosh, Dugald Stewart, Dr Gregory, and Seneca — The effect of literary pursuits upon longevity — Dr Caldwell's remarks on this subject — Kind treatment of the insane— Duties of the psychological physician, 505—57-