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The special diseases of the nerves are thus arranged :
“I. Neuritis (inflammation of the nerve trunks).
“II. Tumours; of two kinds.

a. Painful subcutaneous tubercle.

b. Neuroma (of various kinds). “ B. Inorganic or functional. “III. Neuralgiæ, considering specially, —

a. Facial. Neuralgia of the fifth nerve. b. Ischiatic. Sciatica.

"c. Dorso-intercostal.
“IV. Hypercineses, or spasms, considering specially,-

"a. Facial-spasmodic tic.
b. Oculo-motor. Strabismus.

“c. Laryngeal. Laryngismus stridulus. “V. Anæsthesiæ, especially of the fifth nerve.

“VI, Acineses, or paralyses, and especially that of the facial nerve (portio dura of the seventh).”

Part Third.


Medico-Legal Consultation on a Case of Monomania.

By M. BAILLARGER. The parents of M. M-, who died in the Charenton, 10th Jan. 1851, consulted M. Dubois as to whether deceased was in a sound state of mind at the time of making his will, in June, 1848. The confinement in Charenton dated from Nov. 1850, when he was in a state of dementia and general paralysis. The question to be determined was, whether the mental affection was of recent origin in 1848, or was the last stage of a much older affection existing at the time of the execution of the testament. This was to be answered—1st, by certain writings of deceased ; and 2ndly, by the statements of the medical attendants of M. M—.

In July, 1846, M. M— addressed a letter to the “Constitutionnel,” giving notice that the police had directions to check the machinations of his enemies. In 1847 he also complained to the procureur du roi that he was annoyed by anonymous letters, and by the culpable designs of certain persons to terrify him, and alterer son intelligence. A note was also found, written by himself five days before the will was made, and which purported to contain a receipt for an antidote to poison, that had been, it stated, administered to him by a garde mobile. The antidote consisted of vanille and milk.

Among the papers belonging to deceased was a list of his enemies written by himself.

The medical attendant of the deceased, Dr. Delente, stated that M. M— had suffered an attack of apoplexy in 1841, the traces of which were visible after death. Dr. Delente had regarded M. M— as a monomaniac, being under the impression that his heirs had conspired to poison him.

From these and other circumstances, M. Dubois gave it as his opinion that the deceased was a monomaniac in 1846 ; that the mental affection continued; and, that at the date of the execution of the will he was not in a sound state of mind.-—“Annales Médico-Psychologiques.” Juillet.

On the Identity of Dreaming with Insanity. By M. MOREAU, of

Tours. M. MOREAU holds, as a fundamental point in the explanation of the phenomena of insanity, the essential identity of the state of dreaming with insanity. This proposition he regards as the corner-stone of the edifice of the science of psychology. This conviction M. Moreau has arrived at from researches long conducted by himself, and from the study of other writers upon psychology.

The following extracts will illustrate the principal arguments of M. Moreau on this question.

In refuting certain objections taken by M. Delasiauve, M. Moreau observes

“No dream can be called spontaneous, we do not of our own accord, and according to our own good pleasure, plunge into the state of dreaming; we may prepare all the conditions, we may drive away all the obstacles to sleep, but we cannot dream voluntarily; that is altogether another matter. At the very moment that these conditions for which we have arranged promise the desired result, at that instant we cease to be ourselves; with the inner consciousness our spontaneity of action is lost, the ego is transformed; another individuality, that of the dreamer, takes the place of the awake. We see then here that nothing takes place but that which occurs in delirium, in a dreamone is delirious. In the former it is so in obedience to a physiological cause unknown; in the second, in obedience to an unknown pathological cause in spontaneous insanity), or well known (in the madness of intoxication). The result in both cases being the extinction, the slow or sudden annihilation of intellectual spontaneity-a metamorphosis of the ego-a dream.

“The state of dreaming has in all ages attracted the attention of physiologists, but has it been sufficiently studied in itself, independently of the organic conditions in which it is produced ? Are we not too much accustomed to regard these conditions as indispensable to its development ? Has it been ascertained whether it may not be met with in very different pathological and physiological conditions? In other words, must we recognise in the dream a particular mani. festation of the thinking faculty, determinable by essentially different causes ?

a. We have elsewhere said, that what we call absence of mind, is in reality but incomplete dreaming, an intermediate state between waking and sleeping, and received more with reference to the intellectual than to the properly organic conditions of sleep. We speak indifferently of reverie and absence of mind as an intense mental pre-occupation, which absorbs our attention to things around us. Here, then, common language bears us out in our views.

“It may be said that, in this case, the phenomena of dreaming are produced under normal conditions, the intellect not being vitiated by any morbid influence, which does not in the least reveal the presence of a germ that the slightest cause may suffice to germinate.

“There is a physiological axiom-no sensation, no perception of sensation, without attention. Where then, from any cause whatever, internal impressions absorb the attention, internal impressions are necessarily unheeded, and are as if they were not. The individual is entirely delivered over to his internal reflections, to his meditations; he has broken with the outer world, so far, at least, as regards his thoughts. He is in a veritable dream, always within the limits of the same thoughts.

b. The state of dreaming may be exhibited in its highest degree of development, even where the most important elements of sleep are wanting, for instance, in somnambulists.

“c. By the word sleep we understand that particular state which we can only comprehend by, so to say, decomposing and separating the physical from the psychical elements thereof."

Sleep, the author observes, is but a state of suspension, or temporary annihilation, of the thinking faculty, and between this and the state of stupor, whether produced by congestion of the brain or by the poisonous action of opium, hachisch, alcohol, or the inspiration of ether, &c., despite the differences of cause, there is absolute identity of physiological conditions. The objections urged against the identity of dreaming and delirium, M. Moreau attributes to the confusion of two essentially distinct points, the form and the basis (fond), the latter remaining uniform, however the former may vary. Apparently, the characters which most differ are, on the one hand, the duration of physiological sleep and its attendant dreams, the great number and variety of objects which constitute the latter; and on the other hand, the intermittence of phenomena of delirium proper, with the restricted limits within which, in ordinary cases, they are confined.

“But these differences are after all (M. Moreau remarks) but differences of form, which, considerable as they may be, do not destroy the identity of the nature of the phenomena themselves.

“So true is this, that one sees these very differences disappear in many acute cases of delirium, in all those caused by alcohol, opiates, &c., and in stupidity, in which the recent researches of M. Baillarger have shown that the play of the imagination is no less capricious, or less extensive, than in ordinary sleep. In many instances, indeed, it would be correct to say that physiological dreams are even more limited and restricted in their conceptions than those to which the name of delirium or insanity is exclusively applied.

" It would be sufficient to infer a greater tenacity and persistence, and the individual would be then positively and absolutely mad.

“This supposition, moreover, is borne out by more facts than generally supposed; thus there are many insane persons who trace their delirious ideas, or convictions, or hallucinations, to a dream. With many, insanity is in reality but the continuation of the dream.

* In confirmed insanity the dreams have effected such profound impressions upon the organism, that they cannot be effaced by the waking condition.”

The impressions of dreams are sometimes so vivid that it is difficult to divest oneself of the idea of their reality.

This is certainly a moment of insanity (observes M. Moreau, who adds) :In order that the insanity shall continue, we have only to imagine that the fibres of the brain have suffered too violent a shock to have recovered themselves. The same thing may occur more slowly."

M. Moreau supports his own views by quotations from Condillac, Sauvages, Virey, Spinoza, Van Helmont, and other writers.

“Insanity (the author proceeds to observe) implies a real transformation of personality. There are cases in which this transformation is so evident that the line of demarcation between the wakeful and the dreaming states could not be more clear and precise. There are among the insane, for instance, persons whose whole life previously to the delirium offers not a trace of its existence.

“Every act of the thinking faculty, performed without our free and voluntary assent, appertains to the state of dreaming.

** The mind cannot quit its ordinary wakeful condition without passing into that of dreaming; in any other state its actions must be destroyed or suspended, as in profound sleep or coma.

“Sleep may be compared to the repose of a pendulum, which is still susceptible of new oscillations under the slightest impulse, so long as the machinery by which it is set in motion retains its integrity. Death may be closely represented by this same pendulum, when the destruction of its wheels has put it for ever beyond the possibility of moving. Time exists only in relation to the succession of our thoughts.

" It follows from what has been said, that the impression made upon the thinking faculty by loss of consciousness is the same, whatever may be its duration. Every person can recal that of which he is sensible at the moment of waking; whatever may be the length of time that has lapsed during sleep, the state of the mind is the same; there is a feeling of a new existence, the primary elements of which are supplied by the memory. It is perfectly true that in this state there is no difference between a moment and an age, so that if an individual were to wake at the end of many thousand years, his first impressions would not differ from what he would have experienced had he slept only a few hours.

* What occurs when an individual who has been transformed by delirium, and coming to himself with his inner consciousness annihilated, recovers his reason after ten, fifteen, or thirty years of mental disease? Exactly what would have occurred had he woke from several hours' sleep. He is surprised that he does not find everything in the same state as at the moment that he was struck by insanity. His eyes seek the old objects, his affections look for the same persons; every person and object around him, and among which he has passed so many years, he sees now for the first time, or has but a confused recollection of having seen them. He cannot recognise in the grown-up persons around him his own children; he is not sure of his own identity, -whence these wrinkles, these grey hairs, these indications of advanced age ?”

M. Moreau concludes his paper in the following resumé :

“It is not easy to allow that a body can be propelled simultaneously in two opposite directions.

“Morally, likewise, whether it affirm or deny, the mind is in either the affirmation or negation entirely one and the same, successively or alternatelybut never simultaneously.

“Now, that which the delirious individual denies, he would in the normal state have affirmed. Moreover, since delirium, as we have described it, does not affect the essence of the intellectual powers, or if one may so speak, the internal economy of those faculties, but with an uniform relation to certain objects on which their action is directed, these faculties remain intact, even amidst their false and extravagant perceptions ; so that we may say, without transgressing psychological truth, that the insane are such as they are according to the point of view from which they are regarded. It follows that not to admit the absolute transformation of the ego in the state of delirium, is to declare that the soul may deny without ceasing to affirm, or in other words, may simultaneously undergo two modifications — two modes of existence which destroy one another.

As naturally connected with the preceding notice of M. Moreau's paper in the “ Annales Psychologiques,” we append an abstract of the Report of the Commission of the Imperial Academy of Medicine, by M. Bousquet, May 1855, upon a memoir of M. Moreau, on the pathological anatomy of delirium; and a brief notice of the discussion thereon.

The Report takes exception to the views of M. Moreau, who, it observes, regards insanity, like other diseases, as an organic disease. The reporter charges M. Moreau with having confusedly used the words delirium and insanity, not regarding the distinction between the two: the one being a temporary condition, they remark, the other more durable, often lasting for life, and transmitted hereditarily; the one generally combined with fever and constitutional disturbance, the other compatible with perfect bodily health. M. Moreau, remarks M. Bousquet, considers that insanity has been viewed too much as independent of organization, and the dominant idea of his memoir is to restore it to its proper place. The reporter, as opposed to M. Moreau, holds that that source of the mental disorder is to be sought sometimes in the brain, sometimes elsewhere. The exclusive theory of either one or the other opinion they look upon as erroneous.

The most opposite condition of the nervous centres may influence and implicate the brain; in these cases, insanity may be an eventual contingent effect. Reasoning from physiological analogy, it is urged that as impressions are conveyed from the periphery to the nervous centres, and vice versa, so a similar relation of causation may occur in insanity. Besides which, those who attribute mental disease in all cases to structural change in the brain, contravene their own fundamental doctrine, which is not to admit anything of which they have not the evidence of their senses. The reporter further urges the difference between the temporary condition of the brain during sleep, and the permanent state of insanity transmissible hereditarily. The views of M. Moreau they consider to be the misapprehension of resemblance for identity.

M. Baillarger criticised and opposed the Report, which, he observed, contained only negative propositions; the general conclusion of which was to the effect, that as we are not able to unravel the mysteries of the subject, we should therefore expose all our doubts and conceal our hopes. The study of mental diseases, observed M. Baillarger, would not present the attractions it does, or be followed with so much ardour, if it were as fruitless as indicated in the Report. M. Baillarger defended M. Moreau, on the ground that his object was not to affirm the exclusively material nature of insanity, but to endeavour to counteract extreme spiritualistic notions, which to a too great extent influence practice. M. Baillarger further urged in defence of M. Moreau's opinions, that the author had enforced only a strong analogy between insanity and sleep.

M. Londe drew a distinction between delirium and insanity ; in the former, he recognised only a disorder of the intellect; in the latter,

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