however merely obey the impulse of false ideas, insane conceptions, of which we have a remarkable example in the case of Jonathan Martin, who fired York Minster."

6. Manie de Caractère."—Manie raisonnante of Pinel, and Moral Insanity of Pritchard. The author thus characterizes the condition.

"I think we may term manie de caractère that slight perversion of the instincts and affections which renders the individual a scourge to all around him, and which is yet unattended with mental delusion. These are turbulent, unmanageable beings, choleric in disposition, committing various censurable acts, which they are always ready to justify by plausible reasons; and who become to their friends and family a continued source of inquietude and grief. They commit mischief for amusement, malice, or wickedness, and are incapable of application or labour. They break, disarrange, and destroy everything. Individuals afflicted by this partial perversion of the disposition, commit out-ofthe-way actions, and maintain the most singular and absurd conversation, well knowing all the while what they do and what they say. The understanding suffers no lesion: the patient is enabled to justify his proceedings with a surprising connection and lucidity of ideas and expressions. There is but an instinctive perversion-a general exaltation of the bad propensities, but rarely to the extent of insanity."

Such persons often have violent outbreaks of short duration directed against a variety of subjects; and they have usually sufficient control over their violence, so as to escape from some of its consequences. There seems an innate perversion of the propensities, but not to an extent to warrant seclusion. When this perversion of the affections complicates ordinary insanity, the lunatic becomes the most insupportable of beings, creating eternal confusion and quarrels among the other inmates and their attendants, which indeed seems the chief object of their lives.

7. The propensity to thieve, so frequently exhibited in persons whose circumstances place them above the necessity, and many other perversions, all belong to the same category.

CHAP. VI. LESIONS OF VOLUNTARY MOTION.

These may exist in the condition of exaltation, of debility, and of intermittence. In the first, we have placed maniacal furor, tetanus, convulsions, and chorea; in the second, paralysis, delirium tremens, senile tremor; in the last, epilepsy and hysteria.

It is obvious we cannot pursue the author's examination of all these important diseases; and will content ourselves with an abstract of his opinions upon general paralysis or paralytic cerebritis, to which he attaches. considerable importance on the score of their originality. The Bicêtre has afforded him ample opportunities of studying these cases, two wards being expressly devoted to their reception. He believes very different pathological conditions have been confounded under one vague term, and recognises six distinct forms of the affection, differing in anatomical character, progress, and symptoms.

The first and rarest of these has not hitherto been described, and is that:

which is associated with acute inflammatory action in the periphery and central portions of the brain, and which resists all the resources of art. 2. In this we have the affection of the brain in a chronic condition, with consequent ramollissement, of the gray substance especially, the membranes and white portions of the brain being also affected. The atrophy which results is accompanied by a general sinking-in of the brain, leaving a space between its periphery and the skull-cap. M. Parchappe, after his numerous investigations, came to the conclusion, that general paralysis essentially arose from a ramollissement of the middle layer of the cortical substance of the cerebral hemispheres. 3. With all the symptoms of acute phlegmasia there is found after death a condition of hypertrophy of the white portion of the brain, its volume and density being both increased, and the augmentation proceeding from the base upwards, so that at last the convolutions become flattened by reason of pressure against the cranium. The gray substance becomes diminished, and no vascularity of the white exists. This change in structure, when chronic, has very frequently been observed by various authors in epilepsy. 4. This is exactly opposed to the last form, consisting as it does in atrophy of the white substance of the brain. The hemispheres are often reduced to one-third of their volume, leaving more than an inch interval between their surface and the interior of the cranium. In most cases there is phlegmasia of the gray substance; but, as in the case of hypertrophy, the white portion is that in which change in bulk is observed. There are often meningeal hæmorrhage and serous effusions present, arising probably from the obliterated condition of the vessels within the convolutions. 5. In this the paralysis is intermittent, returning only at intervals of six months or a year, and then again disappearing for the like, or a shorter period. 6. In this the disease is cured, either by influence of the treatment employed, or, much more probably, by reason of the favourable constitution of the patient. Such cures are rare indeed, but they are occasionally operated upon patients seemingly at the point of death.

These various forms are illustrated by means of twenty-four wellnarrated cases; so that the chapter forms a valuable monograph upon the subject well worth consulting.

"We are now in a position to observe that in general paralysis, as in all the other diseases of the nervous system, the changes of structure are very variable, and that they present very different types, each having very opposite aspect and characters, although the prominent symptom in all is paralysis, first of the organ of speech, and afterwards of the sphincters and limbs. We may see that the identity of lesion is a chimera that we must renounce, and the identity of the seat of disease is hardly more tenable."

Dr. Pinel thus speaks afterwards concerning the Seat of the disease. "We observe that it is especially the muscles of the tongue, larynx, œsophagus, and sphincters of the anus and bladder, which are first paralyzed; and that it is only some time after that, first the superior and then the inferior extremities become affected. We feel no doubt that the affection commences with a lesion of the olivary bodies, or some of the nervous bundles emerging from these, and afterwards propagates itself to the rest of the hemisphere; or if the affection originates in the periphery, it must involve some filaments which are in relation with the olivary body. One must believe, from their singular configuration, the kernel of gray substance forming their centre, and from their development in man alone, that the

olivary bodies, whose function is as yet problematical, must preside over some faculty peculiar to man-the articulation of laryngeal sounds. The nerves of the pharynx, larynx, and tongue spring from them, and it is the lesions of these organs which proclaim the advent of general paralysis. The facial arises in the same point, and the trembling of the lips and cheeks is very remarkable among these paralytics. Bell regards the olivary bodies as destined for respiration because the pneumogastric obtains thence parts of its origin, and the lesion of this nerve explains the inertia of diaphragm, the slow respiration, languor, torpor of the heart, and paralysis of the sphincters. * *The changes in the olivary bodies are as well characterized as those of any other of the nervous centres; but 'their examination, perhaps from difficulty of appreciating these, is completely neglected in autopsies. Nevertheless, Guislain, Esquirol, and others, have remarked their induration in epilepsy. In general paralysis their appearance and volume are in exact accordance with those of the other portions of the brain. In atrophy hardly a vestige of gray centre is discernible, while in hypertrophy they are large an projecting. We doubt not that in the stammerers and dumb these parts would present well marked changes." 396.

*

CHAP. VII.-LESIONS OF THE EXTERNAL SENSES AND OF GENERAL

SENSIBILITY.

These, as the other lesions of the nervous system, may manifest themselves by a state of exaltation of the sensibility-the hyperesthesia of Andral; a state of depression-anesthesia; and a state of perversion— illusions, painful affections.

Examples of an excessive excitability of one or more of the external senses, and especially of the general sensibility, are of common occurrence in patients who have become exhausted by excessive study, watchings, inordinate passions, and may also arise from an entirely opposite class of causes, as indolence, the privation of a customary stimulus, as tobacco, &c. A too rigorous diet maintained during convalescence may determine the same phenomena, as in fact may whatever contributes to the production of a defective or vicious hæmatosis-the nervous system being liable to inordinate excitation just in proportion as it is deprived of its due supply of highly arterialized blood. Hence the irritating effect which prolonged and chronic diseases exert upon the system. Partial or general diminution of sensibility is likewise of frequent occurrence, depending upon some more or less considerable changes in the nerves supplying the parts or in the centres whence they emanate. In considering perversions of the external senses, we must distinguish illusions from hallucinations. In the production of the latter the brain is alone concerned: while, in the former, the sensibility of the extremities of the nervous system is perverted, and conveys false impressions. A man in a healthy state of mind may be the subject of an illusion of the senses, but his reason corrects the error. This is not the case with the lunatic, and illusions of the various senses are constantly complicating their cases. The only example M. Pinel presents of a perverted condition of the general sensibility is the horrible disease hydrophobia, but his description of it is meagre, and presents no novelties. Of perversions of general sensibility accompanied by pain, the various forms of neuralgia, hemicrania, clavis hystericus, rachialgia, &c. are examples. Some of these may become epidemic.

"There prevailed in Paris fifteen years ago an epidemic of local pains in the palms of the hands and soles of the feet, to which the name of acrodynia was given. The patients compared this pain to that produced by the insertion of pins or needles. The skin became red, and insensible, and peeled off in scales. This epidemic was replaced by the influenza and cholera, and has not re-appeared

since."

CHAP. VIII.-OF THE CAUSES OF CEREBRAL DISEASES.

Dr. Pinel distinguishes these into predisposing, moral or functional, and physical causes the last comprehending all the changes occurring in the brain, and the re-actions of the various viscera upon that organ.

Predisposing Causes.

Hereditariness.-The author observes that the brain is one of the organs in which hereditary predisposition exhibits its most fatal influence, and that this is much more marked among the higher than among the lower classes. The highest families of France, obliged by their position in society to confine their alliances within a narrow sphere, have become extinct; or, where this is not the case, the intellectual powers of their representatives have much degenerated. The tables conjoined to the Reports before us attribute the occurrence of Insanity to hereditary predisposition in a much less proportionate number of cases than it is usually believed to exist in; but it is often very difficult to ascertain how far this is the case in the poor and ignorant classes to which they relate. Amid the large assemblage of insane at the Salpêtrière, it is not uncommon to see two sisters, the mother and daughter, and sometimes the grandmother. Many members of the same family become mad under the same circumstances, or at the same age. If we could obtain exacter statements, we should doubtless find, that not only insanity, but all the acute and chronic affections of the brain, as apoplexy, epilepsy, &c. are often to be traced to hereditary origin. Great as is the influence of this predisposition, it would be very rash to suppose that children born of parents who have been insane must necessarily become so, especially if only one parent has so suffered. Education and the avoidance of the exciting causes which have proved to be mischievous, may do much in modifying the predisposition. Nevertheless, often it is so strong, that no care will avert the occurrence of the disease, even under the most favourable circumstances.

2. Various other causes predispose, as the puerperal state especially. It is not uncommon to see women in the Salpêtrière who have become insane after five or six confinements. The critical age is a powerful predisposer to cerebral affections.

"There are also certain dispositions of the mind and character to which the ready development of many cerebral affections must be attributed. Such are the natural infirmities of a weak intellect subjected to the domination of evil propensities, impetuous passions, a direction of the attention to a limited number of speculative religious or political ideas, the anxieties attendant upon most extensive enterprises, the events which fix public attention, and which influence or change the popular ideas. It would not be difficult to retrace, among the admissions into our various establishments, from the period of the Revolution of 1789 to the present time, the form of insanity especially appropriate to the exaltation of ideas prevalent at each epoch." 450.

3. An anormal predominance of certain parts of the brain may give rise to a perversion or exaltation of certain of its propensities, and thus lead to some form of insanity. In acknowledging, in spite of many exceptions, as a general rule, that marked predominance of various regions of the brain is accompanied by corresponding manifestation of certain faculties and propensities, M. Pinel objects to the localization of Gall as too minute, while the relations of the bony vault with the convolutions are too remote and too variable for any practical purposes.

Moral or Functional Causes.

Causes operating by the exercise of the brain's own functions are those which produce its most serious maladies. All writers upon insanity place the operation of moral causes in the very first rank; and thus it is not in the extremes of life, but at those periods when the intellect and passions possess all their activity, that we find the most important diseases of the nervous system develop themselves. Moral causes are as various as the functions of the brain itself, of which, indeed, they are but exaggerations. The great influence of moral causes explains in part the greater prevalence of insanity among women. Even in the Hanwell Asylum, where various circumstances may influence the parishes in sending male rather than female paupers, of the 2,588 admitted between 1831-43, 1279 were males and 1309 females; but in Bethlem, where unrestricted admission prevails, the females have predominated 47 per cent., and in St. Luke's 33 per cent. Among the admissions, moral causes are also found to be much more proportionately prevalent in the one sex than in the other. This is a reason too for the greater curability of insanity among women.

"Among the various causes, some act instantly, producing at once delirium, convulsions, or paralysis, such as sudden terror, paroxysms of rage, sudden loss of wealth, &c.; while others produce their effects more imperceptibly and slowly. Grief, jealousy, religious creeds, political ideas, only produce an alteration in the cerebral functions by their long-repeated action. In insanity the delirium establishes itself thus gradually, becomes concentrated, and at last only explodes, when reason has lost all mastery over it." 456.

Physical Causes.

M. Pinel describes as the Physical Causes of the Diseases of the Brain, certain changes in its circulation or structure which in ordinary language are represented as the substantive diseases themselves. In fact, it matters little whether we describe, as he has done, first the aberrations of the various functions of the brain, and then refer back to the various changes in the anatomical conditions of the organ as the causes of such; or whether, as is usually done, we term the proximate cause the disease itself, and then describe the different functional derangements it gives rise to. He enumerates as physical causes, Congestion, Inflammation, Ramolissement, Induration, Cerebral Hæmorrhage, Cerebral Edema, acute and chronic Hydrocephalus, and organic degenerations of the brain, as Tuberco and Cancer. All these are well described at length, but not in a manner to call for farther notice from us. We may, however, transcribe one or two of the author's general observations.

"In diseases of the brain, we may repeat with confidence, the pathological