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other functions also are deranged. M. Londe objected to the strictly physiological view of the opinion that insanity cannot exist with out organic disease. M. Londe further criticised the objection of M. Bousquet, that if insanity be analogous with dreaming, then do we lose our reason nightly, and recover it in the morning. This view, said M. Londe, is too spiritual, for that natural sleep does not overtake us without our having some idea of its approach ; but if before sleeping the brain be excited by drinking, or by emotions, or by work, it is attended with dreams more or less fatiguing. With reference to the failure of pathologists to detect any certain alteration of the brain in insanity, M. Londe observed that similar failure had occurred in other diseases. M. Londe, in concluding, stated his opinion to be that, in recent and curable cases of insanity, the causes, chagrin, &c., have acted upon only a portion of the brain ; while in more serious forms of the affection-e. 9., following violent disturbance, febrile delirium, &c.—the lesion has been general, or has become so, whence not only the intellect, but also other cerebral functions, are injured.
M. Ferrus opposed the Report, which he characterized as having for its object to exhume and diffuse exclusive doctrines.
M. Piorry combated the arguments of M. Bousquet from the difference in the permanency of insanity as compared with that of delirium. This, observed M. Piorry, cannot be regarded as a ground of distinction, since cases of delirium with fever are met with lasting ten, fifteen, twenty days, or even longer; while there are cases of delirium without fever which should be regarded as insanity, passing off within a week: the absence of fever, according to M. Bousquet, distinguishes insanity from delirium. Insanity, again, does not always develop itself slowly, but often breaks out as suddenly as delirium.
In answer to the objection urged by M. Bousquet against the analogy drawn by M. Moreau between insanity and dreaming, M. Piorry olvserved, that it is by such physiological studies that psychological science is to be advanced.
With reference to the statements of M. Bousquet that morbid anatomy has thrown but little light upon the nature and cause of insanity, M. Piorry urged that it does not follow, that because in so delicate and complex an organ as the brain many instances occur in which nothing of value has been found, therefore that those numerous instances should be lost sight of in which sufficient has been found to account for the perversion of the thinking faculties.
The Report of the discussion upon this, M. Bousquet’s paper, occupies eighty-two pages. We cannot afford space for its reproduction. It may suffice to say that it was severely criticised, and its principal positions refuted by various speakers.
Pathological Condition of the Brain in Epileptics. At the Société Medico-psychologique, January 19, 1855, M. Delasiauve observed how frequently no appreciable alteration of structure can be detected after death in epileptics; while on the other hand, the most varied post-mortem appearances are sometimes met with, in which the etiological relationship is not traceable. He had recently met with a case in which a large osseous plate, from three to four centimetres in extent (=1.181 to 1.574 English inches), was placed in the form of an arc between the two hemispheres of the brain, and appeared as if a portion of the falx were ossified. Was this growth, asked M. Delasiauve, the cause of the convulsions? It would not seem from its position, that it could have much interfered with the functions of the brain. The symptoms, moreover, seem to have coincided with an apoplectic seizure dating about four years previously, and which had left a large cell in the substance of the middle lobe of the left hemisphere, as evidence of its occurrence. There had been three or four paroxysms at monthly intervals ; during the last few months the dementia and general paralysis had made great progress.
Another patient had presented a more striking ossific deposit. This was a fragment of bone, of a cubic form, about the size of a filbert, and studded all over with needle-shaped spiculæ. This fragment was lodged in the fissure of Sylvius, adhering slightly to the pia mater. It is probable that these spiculæ irritated the otherwise healthy brain and gave rise to the attacks. The patient had frequently suffered from vomiting, both at the time of the fits, and in the intervals. It was not clear whether these attacks of vomiting were referrible to the cerebral irritation, or to onanism, to which the patient had abandoned himself.
M. Loiseau related the case of an epileptic in whom it was found that an osseous growth had caused absorption of a portion of the hemisphere.
M. Ferrus related the case of a lady of high intellectual development, who had suffered from intense pain in the anterior region of the brain, and on one occasion an epileptic seizure occurred. It was found that an osseous tuft had been formed on the orbitar plate, which had torn the membranes and injured the brain.
A Peculiar Form of Insanity in Children. M. DELASIAUVE brought this subject under the notice of the Société Médico-psychologique, February 26th. This affection M. Delasiauve described as having for its fundamental character a disturbance of the intellectual faculties, manifested more or less confusion of ideas, but was always complicated with ecstatic phenomena, the paroxysms of which varied in duration, and in some cases returned at short intervals. The patients remained several hours of the day as if wrapt in a sort of mystical contemplation. Often the attention was fixedly directed to one spot from which not even the most vivid impressions could arouse them. In other cases the attention was alternately directed to different points. The limbs and body were placed in the most grotesque attitudes and positions ; sometimes the head was bent in forced directions, sometimes the arms and legs remained elevated and extended. In some of these cases there was seen slow and measured jactitation, after the fashion of Punchinello. Of the eight or nine cases seen by M. Delasiauve almost all were cured within a limited period, in some cases with relapse. Bathing, sulphate of quinine, and attention to hygiene, were followed by successful results.
Although these cases were important, they did not, in the opinion of M. Delasiauve, deserve a special nomenclature as a new form of mental disease. The phenomena of these cases do not belong to mania, nor specially to early age. They are met with in those forms of partial insanity attended with convulsions, such as catalepsy and epilepsy. The ecstatic state corresponds to a slight degree of cerebral erethism, whereby the intellect, acting through volition, is subordinated to the automatic organic system. Hence, if this view be correct, ecstasy may take place whenever from moral or physical causes the normal activity of the nervous centres is increased, and favours the production of spasm. The preference of these attacks shown towards early age may be explained by the greater impressionability of that time of life. In some instances this special predisposition is referable to onanism, or intimidation, which either depress or concentrate the nervous sensibility. Several of the patients were addicted to the solitary vice, nearly all had been the subject of cruelty or unjust rigour, or had been frightened by exaggerated representations of their offences, and by fear of the wrath of God.
M. Moreau had met with instances of this form of affection, and regarded them as cases of epilepsy, attended with a degree of stupor, offering some resemblance to ecstasy.
M. Belhomme inquired if M. Delasiauve considered that an analogy existed between ecstasy and catalepsy ?
M. Delasiauve in reply, stated that he recognised in ecstasy a state of muscular immobility without contraction, accompanying a particular cerebral disorder, while in catalepsy there was abolition of feeling with tetanic rigidity. The difference is one rather of degree than of kind. Ecstasy seems to be a slighter degree of this cataleptic state.
M. Alfred Maury, mentioned an epidemic melancholy which had prevailed among the inhabitants of a district in Siberia, some years ago, under the influence of a Buddhist prediction. In this disorder the sufferers uttered a sad monotonous chant, concluding with a paroxysm of excitement, which was followed by insanity or restoration. The moral and physical condition of this people resembled that of childhood.
M. Buchez did not consider that either of the speakers had elucidated the phenomena related by M. Delasiauve. He would ask whether ecstasy occurring in the insane and epileptic is of the same nature as ecstasy occurring in the previously healthy and in those persons who can induce the ecstatic condition by profound meditation ? He further asked, whether ecstasy and catalepsy are physiologically the same? whether they might exist separately? whether they have the same organic seal?
M. Baillarger had seen cases of melancholy stupor pass into ecstasy. He objected to the use of the word “physiological” to express conditions referred to in this discussion, and which he considered as strictly pathological. For instance, if ecstasy be a suspension of the intellectual powers, how can it be said to be a physiological state ?
M. Alfred Maury compared the state of ecstasy to the passing delirium of fever, which, frequently recurring, may pass into insanity.
M. Buchez considered that there was a great analogy, but not an identity, between the ecstasy occurring in health and that occurring in disease. M. Buchez further illustrated his opinions by reference to the state of internal abstraction or contemplation under which musical composers, without the presence of a musical instrument, veritably hear the pieces they compose; and a painter sees in imagination the persons he transfers to his canvas.
M. Ferrus asked if a person in a state of ecstasy was, medico-legally speaking, responsible for his acts; M. Ferrus promised to lay before the Society the particulars of some cases bearing upon this point.
On the Organic Cause of Mental Alienation, accompanied by General
Paralysis. By M. BAYLE, who lays down the following as the chief points of his paper :
1. There is a particular species of mental affection, of a symptomatic character, perfectly distinct from the essential forms of alienation, and forming a malady by itself, an individual malady, having its own causes, with symptoms and anatomical characters too distinct to permit of their being confounded with any other affection.
2. Its causes have one common effect in producing slow or sudden congestion of the vessels of the pia mater and brain.
3. The symptoms may be reduced to two, which commence and progress concurrently-viz., paralysis general and incomplete, and nonfebrile delirium with great feebleness of the faculties. The paralysis makes constant progress in the course of disease, and terminates in almost entire privation of voluntary movements. The delirium has the peculiar feature of being characterized by ambition, and passing successively through the forms of monomania, mania, and dementia. Frequently, mania is wanting.
4. The anatomical characters are those of chronic inflammation of the membranes of the convexity of the cerebral hemispheres, often extending to the subjacent surface of the substance of the brain itself.
The proofs of these positions are deduced from the post-mortem examination of the brains of insane paralytics compared with the brains of sane individuals, and from the analogy of this disease with other inflammations of serous membranes.
Among the lesions discovered in the examination of one hundred bodies, and which were characteristic of chronic inflammation of the membranes of the brain, some were met with in all cases, while others were absent in a certain number. The changes constantly met with were opacity, thickening, increased toughness of the arachnoid to such an extent that sometimes it was possible to suspend a slice of brain by its means without tearing it; extreme congestion of the pia mater; thickening of the arachnoid of the ventricles, which also was covered with granulations; considerable effusion of serum into the cavities of the ventricles and into the network of vessels of the pia mater.
The morbid appearances less frequently met with were adhesions of the membrane, and the softening of the surface of the convolutions ; false membranes, or extravasated blood. The substance of the brain was softer in a few cases ; in some it was firmer ; in the majority it retained its natural consistence.
These post-mortem appearances are not met with in other diseases than chronic meningitis; the slight opacities, &c., occurring towards the close of life in other forms of cerebral disease, do not offer even an analogy. They have always been found by M. Bayle after death from general paralysis, and never in the case of patients who have died from other maladies ; hence it is inferred that chronic meningitis is the organic cause of insanity with general paralysis.
Structure of the Cortical Layer of the Convolutions of the Brain. M. BAILLARGER refers to his previous discovery of six alternate layers of grey and white matter in the cortical layer of the brain, and states that MM. Foville and Gratiolet, in confirming his results, have added the existence of another layer of white matter. This last layer follows internally all the folds of the cortical layer, as the pia mater follows them externally. The cortical layer of the convolutions separates itself distinctly from the white substance, especially at the depths of the anfractuosities; it remains, in effect, as if doubled by a very thin layer of this substance. This is a fact which, observes M. Baillarger, he had himself more than once observed, but to which he had not attached the importance it merits. M. Baillarger does not, in the present communication, examine the structure of this white layer, nor the nature of its connexion with the grey substance and the radiating fibres. The present notice records a fact in pathological anatomy, the separation of a group of convolutions from the white substance, and lined by this seventh lamina, such as he has often met with in the sheep.
A female, thirty-seven years of age, was admitted into the Salpêtrière, suffering from symptoms of general paralysis ; at the end of eighteen months she died. The left hemisphere of the brain was found softened throughout its whole extent. The attempt to raise the thickened membrane brought with it the entire cortical layer and a portion of the white substance of the brain. At the anterior and superior part it was possible thus to raise and separate an entire group of convolutions. On examining these convolutions in their then reversed position, their summits were smooth and of a bluish-white colour. On cutting into the summit it was observed that the white layer which covered the cortical substance was grey and very thin, of a uniform consistence, and tolerably adherent. This white lamina is the layer described by MM. Foville and Gratiolet as the seventh layer of the cortical substance of the brain.—"Annales Médico-Psychologiques.” Janvier.
“ The American Journal of Insanity,” July 1855, contains a history of the several attacks of insanity under which his Majesty King