A treatise on nervous and mental diseases, for students and practitioners of medicine

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Preface

This book is an endeavor to put a working knowledge of nervous and mental diseases into the hands of students and practitioners. A mere compilation, even of an encyclopsedia, would have been comparatively an easy task, calling only for a judicious aggregation of material. In contradistinction, the purpose and limits of a treatise require the selection and clinical verification of facts, and to this most important element of my work the leisure of seven years has been devoted, ouly two of which, however, have beeen required for the actual composition. A teacher must know what to omit, as the force and permanence of his teachings will depend upon his strict avoidance of non-essentials. Superfluous knowledge, like surplus food, may clog the activity of the mind, and in no department of medical science is the temptation to expansion and speculation more enticing than in neurology. Keenly appreciating the patient toil of the scientists, to whom we owe most of our knowledge, I have held the task of the physician in yet higher esteem, as the latter must make utilitarian application of all the facts collected by the former. There can be no loftier aim in medicine than the relief of human suffering, and to this end I have endeavored to glean from the many departments of medical science what they could contribute. Whether Americans are more prone to nervous disease than other races, or whether it is that our democratic principles set a higher value upon the individual, his comfort and health, than is customary elsewhere, it is yet certain that Europeans, in investigating disease, regard the patient simply as its vehicle, whilst Americans go one step further, and deem the cure all-essential.

Moulded by this conviction, this volume is addressed especially to the general practitioner, present or future, and its theme is rigidly iv PREFACE.

therapeutical. Medical Nihilism is an error of youth and a confession of impotence, for Nature rarely afflicts man beyond the hope of relief. The therapeutist has enormous resources. Not only does the physical world provide a great variety of medicinal substances, and transmute its forces to suit his Avill, but likewise the psychical world is bounteous in its aid. Far from spurning his inheritance, the ideal physician should gather his knowledge of disease and its antagonists from every quarter, and exert every faculty for his patient's welfare, which is his own true success.

Those who may use this work will find that it does not assume previous knowledge of its subjects on their part. The Anatomical Introduction makes plain all the facts of structure necessary to a comprehension of nervous disease. The Electrical Chapter is entirely practical, even in the details of selection and use of batteries. The space assigned to the several diseases is determined by the needs of the profession at large, a consideration which has made the chapter on Neurasthenia the largest in the book. If apparently undue space is devoted to Syringomyelia, Acromegaly, and Myxcedema, this is owing to the general interest in these new types, coupled with the lack of information apt to be shown about them even by specialists. Mental diseases are considered from the standpoint of the general physician, since the outcome will often depend on his skill in early recognition and treatment. I have endeavored to indicate what diseases of the mind may be best treated at home, what may need both home and asylum treatment, and the period of committal, and what may require seclusion from the outset. The incontrovertible fact has been generally ignored that mental diseases, like hepatitis or nephritis, are affections of a viscus, and the result has been a specialty within a specialty, and the relative disregard of the usefulness of the general practitioner. A novel feature in a work of this kind is the inclusion of the medico-legal aspects of nervous and mental diseases. I have presented this subject from the standpoint not of the lawyer but of the physician ; and furthermore, have endeavored to qualify the reader as a medical judge of both sides of the questions at issue, a faculty of much greater value than an ability limited to the mastery of only one side in the capacits^ of a medical advocate.

PREFACE. V

In carrying out the therapeutic aim of the book, each chapter has been made to contain its own section on treatment. Especial care has been taken to make the therapeutical suggestions sufficiently detailed and precise to cover the varying stages, symptoms, and complications of disease, as well as to follow the important indications afforded by differential diagnosis. In the chapters upon Mental Diseases the most approved treatment is stated, and likewise the results to be expected. Only that knowledge has been admitted to these pages which has stood the test of experience.

Students will find the terminology rendered easy of acquisition by the derivations and definitions given in the Glossary. Throughout the volume simple Anglo-Saxon terms and familiar synonyms have been preferred. The limits of the book have rendered necessary a certain degree of terseness, but those who are desirous of further investigation will find a full bibliography appended to each chapter. I have made liberal use of illustrations, deeming them essential for explanation and vividness. They are largely original, being mostly made from specimens and photographs.

Many willing hands of kind friends have aided me in the great often harassing labor of this book. To Dr. R. S. Newton I am indebted for several sections and brain specimens, and a photograph of a case of acromegaly. Dr. W. B. Pritchard assisted in the preparation of a tabulated statement of clinic cases. Dr. R. C. F. Coombes kindly furnished me with photographic portraits of typical cases of insanity.

6 East Forty-ninth Street, New York.

November, 1892.

Chapter I

Anatomicax, Introduction. Anatomy of the Cerebrum, Cerebellum, Pons, Medulla Oblongata, Spinal Cord, and Peripheral Nerves — The Bloodvessels of the Cerebrum, Cerebellum, Pons, and Medulla Oblongata — Cranial Topography — Heat Centres ...... 17-85

CHAPTER 11.

Electricity. The Galvanic Current — The Faradic or Induction Current — Static Electricity — Galvanic Batteries— Faradic Batteries — Stationary Batteries — Milliamperemeters and Rheostats — Wires and Electrodes of Galvanic and Faradic Batteries — The Method of Applying the Batteries— The Diagnostic Uses of Electricity — Charts of the Motor Points of the Different Regions of the Body . . . . ' . 86-117

PAET II.

NERVOUS DISEASES.

CHAPTER I.

Localization of Lesions in the Cerebrum, Cerebellum, and Spinal Cord. Localization of Cortical Lesions — The Motor Area — Cortical Centre of Vision —Cortical Centre of Woi-d-Blindness — Centre of Word-Deafness— Centre of Agraphia — Cortical Centre of Aphasia — ^The Centres of Mind Alone — Lesions of the Centrum Ovale — Lesions of the Internal Capsule — Lesions of the Corpus Striatum and Optic Thalamus — Lesions of the Quadrigeminal Bodies — Lesions of the Pons — Lesions of the Medulla Oblongata — Lesions of the Cerebellum and its Peduncles — Lesions of the Spinal Cord — Lesions of the Peripheral Nerves — Hemianopsia ..... 119-133

Vlll CONTENTS.

Chapter II

Tests of the General Motor and Sensory Symptoms of the Nervous System. Sight — Hearing — Smell — Taste— Touch, or Tact — Pain — Muscular Sense — Temperature-Sense — Weight — The Tendon-Eeflexes —Cutaneous Reflexes — Contracture —Paradoxical Muscular Contraction — Muscular Incoordination — Muscular Strength — Cerebral Thermometry 134-157

Chapter III

Diseases of the Peripheral Nerves. Neuralgia — Neuralgia of the Head — Neuralgias of the Trunk and Neck — Neuralgias of the Upper Extremities — Neuralgias of the Lower Extremities — Visceral Neuralgias—Simple Neuritis — Multiple Neuritis — Facial Paralysis — Neuroma 158-193

Chapter IV

Diseases of the Spinal Cord and Medulla Oblongata. Myelitis — Myelitis of the Anterior Horns — Landry's Paralysis — Spinal Hemorrhage— Divers' Paralysis, or Caisson Disease — Progressive Muscular Atrojahy — Locomotor Ataxia — Primary Lateral Sclerosis — Amyotrophic Lateral Sclerosis — The Combined Scleroses of the Cord — Syringo-myelitis — Mor van's Disease — Tumors of the Spinal Cord — Traumata of the Cord — Glosso-labio-laryngeal Paralysis — Progressive Ophthalmoplegia 194-283

Chapter V

Neuro-musculab or Muscular Disease. Pseudo-muscular Hypertrophy

— Thomsen's Disease 284-291

CHAPTEK VI.

Intra-cranial Hemorrhage, Embolism, and Thrombosis . . 292-300

Chapter VII

Diseases of the Cerebrum. Cerebral Palsies of Childhood— Intra-cranial

Growths — Hydrocephalus — Huntington's Chorea — Athetosis . 301-341

Chapter VIII

Diseases of the Cerebro-spinal Nervous System and its Membranes. Hypertemia and Anaemia of the Brain and Cord — Suppurarative Meningitis — Cerebro-spinal Meningitis — Tubercular Meningitis — Cerebral Abscess — Syphilis of the Nervous System — Disseminated Sclerosis— Lead-poisoning 342-382

CONTENTS. ix