breadth of thought manifested throughout-and from the extent of scientific illustration brought to bear upon many of the most important and difficult problems of our nature. If Mr. Bain has not given to the world a perfect system of descriptive and analytic psychology, he has at least done that which will enable less original minds to build upon his foundation an enduring edifice; he has boldly struck out a new path in mental science, and has rendered more service to the cause than many centuries of merely speculative metaphysicians.

ART. VII.-NERVOUSNESS.

NERVOUSNESS is one of those quasi-technical terms which are to be reprobated for their vagueness, but which cannot be got rid of. We refuse to admit them into strictly scientific nomenclature, but we are not able to ignore their existence. Nervousness is one of the most obnoxious as well as one of the most commonly used of these terms. It is most obnoxious, because in its pathological signification-the nervousness of "medical cant" as Johnson would have contemptuously characterized the word-it has a meaning the very antithesis of the one that legitimately belongs to it. Nervousness, the synonym of strength and vigour, and nervousness, the synonym of feebleness and nervelessness, clash together most disagreeably; but although we may carp at this, the word with its latter meaning has an established place. It is used popularly to convey a notion of the many functional deviations, psychical, sensory, and motor, which mark the nervous diathesis, and which do not possess a sufficiently distinct character to enable us to classify them with precision under one or other clearly defined form of disease. It serves also to express similar lesions when they occur consecutive to many acute and chronic affections. It is, indeed, a very general term proper to many symptoms arising from widely different

sources.

In systematic medicine we do not hesitate to make use of the parent-word nervous in its simplest signification, to wit, "relating to the nerves," but the phenomena included commonly under the term nervousness are scattered abroad in various groups, under the heads of the different pathological conditions in which they appear to originate or to be most immediately connected with.

The fitness of this arrangement has been recently questioned by Dr. L. Bouchut.* He holds that the various symptoms for which we have no other term of sufficiently wide scope than

*De l'Etat Nerveux aigu et chronique, ou Nervosisme. Par L. Bouchut, Professor agrégé à la Faculté de Médecine de Paris. Paris. 1860.

nervousness, in its popular acceptation, as well as sundry others significant of functional disturbance of the nervous system, appertain to a peculiar type of disease which he proposes to name nervosism, "tiré du mot latin nervosus, nerveux, pour faciliter l'adjonction souvent necessaire de la double épithète aigu ou chronique."

Dr. Bouchut tells us that he had often been surprised to hear individuals designated hypochondriacal or hysterical who were seriously indisposed: men of intelligence who did not exaggerate their sufferings, and who exhibited no signs of disorder in their hypochondria; delicate women who were tormented by the general state of their nervous system, and yet who were not erotic and had no uterine disturbance. It seemed to him, therefore, that a revision of the different groups of the neuroses, which would obviate these practical inconveniences, would be useful to medicine. He has endeavoured to effect this. 66 Guided," he writes, "by the conscientious and attentive study of the sick, I have been thus led to frame, at the expense of many affections, and especially of hysteria and hypochondriasis, a general neurosis characterized like those named by the federation of a certain number of nervous disorders of movement, sense, intelligence, and the principal functions." To his own observations Dr. Bouchut has added others furnished to him by his confrères, and many which he has culled from the works of Esquirol, Pinel, Chomel, and others; and sundry maladies described by them and still known as certain forms of dyspepsia, gastralgia, mental aberration, general paralysis, delirium, &c., on account of the principal phenomena accompanying the disorders, he finds to be but secondary symptoms of the more complex general disorder of the nervous system, which he has selected and set apart. Again: "the multiform and proteiform nervous contingencies which accompany many nosohemias or blood changes, and especially chlorosis, which Professor Bouillaud has described with rare precision; certain convalescences, some chronic maladies, and particularly chronic syphilis, which are nearly always exclusively investigated as a consequence of anæmia, without its being considered that this alteration of the blood is as often the result as the cause of the evil :" Dr. Bouchut considers these facts 66 in a different fashion, because they enter into the category of those that he proposes to study, and he is glad to profit by them."

The curious process of eclecticism here set forth, naturally provokes our curiosity to know somewhat more of the manner in which it was carried into effect. But in this respect we are in a great measure doomed to disappointment, for Dr. Bouchut deals with the subject of his treatise as a well established fact, assuming the truth of his position in the very first sentence, and thenceforth

marshalling definition, division, history, causes (predisposing and determining), symptoms, progress, duration, terminations, varieties, complications, and so forth, with charming precision, leaving the reader to discover, by his own ingenuity chiefly, the reasons why such and such results should take their place in systematic medicine.

The question is, however, one of sufficient interest to warrant us in endeavouring to ascertain if there be aught of value, and if so what, in Dr. Bouchut's generalization. In attempting this we shall adopt the order of exposition which he himself has had recourse to,

Dr. Bouchut defines nervosism in the following manner :

"Nervosism is a general neurosis, febrile, or apyretic, characterized by an association, more or less numerous, of variable functional disorders, continued or intermittent, of sensibility, intelligence, movement, and of the chief organic instruments (des principaux appareils organiques).

"These disorders are purely nervous, but they may lead to a belief in the existence of very different organic maladies in the organs of which the function is deranged."-(p. 1.)

It is not often that definitions aid us much in comprehending the nature and character of a disease, consequently, if Dr. Bouchut fails at the onset to give us any clear conception of what he means by nervosism, it is but just to him to imagine that this may possibly arise from his having trusted himself to the treacherous brevity of a definition. It is unfortunate, however, that immediately after the definition we are called upon to admit that the disease so described is found under two forms, one of which, chronic nervosism, is said to be familiar to physicians under other names; the other of which, acute nervosism, has hitherto been neglected. The acute malady is always accompanied with fever, is infinitely rarer than the chronic one, and rapidly induces the gravest disorders: the chronic malady endures months or years, and when very aggravated may give rise to marasmus and consumption.

Having premised thus much, Dr. Bouchut proceeds to write the history of the disorder, and here we first begin to gain some feeble light as to what he actually aims to teach us.

He tells us that all nervous individuals are not necessarily hysterical or hypochondriacal, as there is too great a tendency to believe from certain writings of Galen, Sydenham, Sprengk, Pomme, &c. The authorities named are a little ancient, certainly, but let this pass. There is another morbid state, we learn, "in which the nervous element plays equally the principal part under a different form, and which can be clearly distinguished by a greater or less number of disorders of intelligence, sensibility,

movement, and the chief organic functions, without any appreciable structural alteration of the tissues." (p. 3.) This is the neurosis that Dr. Bouchut desires to signalize, and which merits to be the subject of special study.

Its existence has been recognised by previous writers, under various names, as for example, nervous cachexy, marasmus, nervous state, nervous fever, and vapours. It has been confounded with hysteria and hypochondriasis, after the manner of Sydenham, and it constitutes the nevropathy of Malcom Fleming; the hystericisme of Louyer Villermay; the névropathie aiguë cérébro-pneumogastrique of Girard; the névrospasme of Brachet; the névropathie proteiforme of Cerise; the nervous diathesis of many writers, &c. All these terms Dr. Bouchut regards as being objectionable from their tendency to localize the affection, and incommodious from their length; hence he substitutes the solitary word nervosism.

Nervosism, however, expresses something more than any of the terms given, taken singly. These are synonyms of different forms of the disorder, rather than of the disorder itself. For this is now seen as an acute affection running a rapid course, and having a serious ending; now it is most justly designated as a diathesis; while anon the proposition of Mead with regard to hypochondriasis aptly fits it: Non unam sedem habet, sed morbus totius corporis est. "It is," writes Dr. Bouchut, "the most complex nervous malady that can be produced, and it is not surprising that, in its numerous forms, it has escaped the synthesis of pathologists." (p. 4.)

Dr. Bouchut conceives that he has fettered this Proteus Morbidus, and that to his questioning unobscure answers have been returned. And truly, if this should prove to be the case, he will have achieved no mean feat; but we fear that the fetters are of sand, and that the oracular responses of the changeable deity are themselves but illusions. Let us glance at the disease as Dr. Bouchut depicts it:

"Confounded even now with hysteria or with hypochondriasis by all those who systematically term thus the nervous ills observed in woman, man, and even the infant, often with chronic gastritis, and with gastralgia, with epilepsy, mental alienation, dyspepsia, organic maladies of the brain, of the spinal marrow, of the heart, &c., &c.; nevertheless it is very different from these maladies. It approaches to and removes afar off from at one and the same time the neuroses and certain organic diseases. We encounter there paralysis, contractions, tonic and clonic convulsions, tremblings, spasms, fainting-fits, syncope, neuralgias, visceralgias, disorders of the intelligence and the organs of sense, such as sensorial illusions or hallucinations, simple or hectic fever; and it is but the mode of apparition, development, and succession of these morbid phenomena which reveals to us their true nature. In this

respect they merit the attention of physicians, who will doubtless recognise a very common malady, which is often a source of the greatest embarrassment to them in practice."-(p. 5.)

We have every respect for Dr. Bouchut, but does not this last sentence give to nervosism the character of being a word, and nothing more, provoking us to exclaim, with M. Jourdain, "Par ma foi, il y a plus de quarante ans que je dis de la prose, sans que j'en susse rien; et je vous suis le plus obligé du monde de m'avoir appris cela?"

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Among ancient writers no one appears, to Dr. Bouchut, to have described clearly and precisely nervosism, except Hippocrates. He touched upon the subject incidentally, but unfortunately this earliest recognition of the affection was étouffées" by the chimerical hypotheses of Galen upon hypochondriasis. Dr. Bouchut recognises nervosism in the description which Hippocrates gives of the nervous disorders accompanying inanition, seminal emissions, and gastralgia. Notwithstanding, however, Dr. Bouchut's dictum, that nervosism was seen imperfectly and summarily described by Hippocrates," we cannot say, with Géronte, in Le Médecin malgré lui, “Puisque Hippocrate le dit, il le faut faire;" neither can we admit that since Hippocrates' time the nervous ailments he described under the circumstances named, have been "confounded with different morbid, and, according to some symptoms, nearly similar states."

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"His numerous examples," writes Dr. Bouchut, "have always been classed in a vicious fashion, and designated by inappropriate names in relation with certain reigning ideas. It would be a curious study to make, that of the influence of words upon the things that they represent, and of the evil effects of a bad denomination upon the progress of science. There is not a physician who has not observed examples of a general nervous malady, entirely distinct from hypochondriasis and from hysteria; but for want of a word, every one confounds the first of these morbid states with the two following, or still more wrongly, with gastritis, gastralgia, chlorosis, anæmia, diseases of the heart, or spinal marrow, according to the ideas in vogue at the moment.”(p. 10.)

We shall presently see how Dr. Bouchut's suggestive remarks on vicious designations and their influence, may usefully be brought to bear in testing the merits of his present work.

Robert Whytt was, according to Dr. Bouchut, the first person who attempted to separate nervousness from hysteria and hypochondriasis. Whytt wrote:

"Persons liable to perturbations of the nerves, some of which deserve the name of nervous much better than others, may be distinguished into three classes."