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Note on the Nervous Disturbances After Removal and Atrophy of Testicles.*

By C. H. HUGHES, M. D., St. Louis,

President and Professor of Neurology and Psychiatry, Barnes Medical College.

M. WEISS has reported in Wein. Med. Press, 1890, the case of a man 54 years of age, in whom a series of grave nervous symptoms, occurred shortly after the removal of both testicles for tubercular disease. This condition manifested itself by great mental and physical restlessness, agitation, palpitation of the heart, gastric crises, profuse perspiration, melancholia, snycope, etc. The author noted the similarity of these symptoms to those observed in women at the menopause, or after the removal of the ovaries.

In 1880, there came to me a patient from an adjoining State who, after the removal of one testicle, had, in addition to persistent neuralgia testis, symptoms much like those described by Weiss, the melancholia being associated with hypochondriasis. After a course of treatment extending over one year, which included local galvanism for the relief of the neuralgia, the patient's nervous symptoms and pain disappeared. He improved much in general tone, but persisted in believing that his scrotum. was too long, and went East and had it shortened, which operation seemed to satisfy him, and the patient has remained well ever since, and is virile.

A patient from a neighboring State, of good physique, good mental capacity and intelligence (a professional man from Iowa), after atrophy of both testicles without scrotal pain, one testicle being the size of a lima bean, the other not larger than a small peach stone, became neurasthenic and sexually hypochondriacal (the latter a

*Read by title before the Mississippi Valley Medical Society, at Cincinnati, September, 1892.

reasonable fear, however), somewhat sleepless and mentally depressed, but has improved under treatment in all except his doubts as to his virility, which are well grounded, though he has never tested his sexual powers.

Another patient, after exsection of a tuberculous right testicle performed in Germany (a fistulous opening having been left by the surgeon, which we did not deem it prudent to disturb, but kept open and injected with bichloride solution, as it occupied and diverted the patient's mind), came under treatment for profound melancholia with associated insomnia, hypochondriasis and suicidal. impulses, December 22nd, 1891, and remained under treatment, with marked improvement, until January 7th, 1892, when he went home. Returning on the 14th of January, he continued to improve, with some exacerbations of depression, owing to the increasing complications of his neglected business, when being advised by intermeddling friends to consult a surgeon of this city, he was taken out of our hands by the surgeon whom he consulted against our protest (as it was a surgical case, he said), placed in a hospital, and died the day following the operation, of nervous shock probably. We did not see him.

A number of similar cases might be cited from our own experience had we the time to record them, in which marked nervous disturbance has followed removal of one or both testicles and atrophy, the nervous derangement being either sequent or concomitant to the condition calling for removal and to the atrophy, the cerebro-spinal system appearing, especially in the trophic centers of the gray anterior cornua of the cord, to lose some stimulating influence essential to its healthy tone and perfect integrity, in some organizations, because of the missed peripheral neural impressions through the lost or degenerate genital apparatus (just as the peripheral motor system suffers atrophy from central disease of a degenerative kind) as well as what may be lost to the organism through failure of seminal resorption. The same or similar results seem

to have followed as sequence of a number of recently reported and carefully observed cases after the performance of the operation of oophorectomy.

We have observed the same fact in acquired aspermatism. Weiss ascribes these disturbances to the absence of the normal secretions from these glands, which from the experiments of Brown-Séquard seem to have a marked tonic effect upon the nerves. The removal of this stimulant, he believes, results in a general nervous depression, as in cases where other habitual stimulants are suddenly suspended.

This is doubtless to a certain extent true, but it is not the whole truth. The causes that make the operation. necessary, that lead to the degenerative changes that call for surgical therapy, and the psychical after-effect of the surgical procedure must also be considered. Such of these cases as reach the neurologist before falling into the hands of the surgeon, generally show marked neuropathic instability, and not infrequently it is one of the hereditary factors of the case. The question as to cause and sequence, therefore, has yet to be finally settled by further clinical facts with the testimony now largely in favor of constitutional neuropathic decadence, and hereditary neural instability as the chief factors in causation.

A Contribution on Legal Medicine

Homicidal Mania.*

By DR. CAMUSET,

Director of the Asylum at Bonneval.

HOMICIDE unfortunately is not a rare thing in insan

ity, and when, if homicidal mania exists, it is not always as a special morbid entity. The insane in certain clinical circumstances are impelled to murder. We have succeeded to define and limit these circumstances. It has also been recognized that the homicidal maniac, according to the species of mental malady with which he is attacked, proceeds in a peculiar manner. Thus in certain cases we can, upon the simple, circumstanciated narration of a homicide committed by a maniac, foresee the special mental malady which will be shown to exist with him after a direct examination.

To pretend that only those maniacs attacked with certain psychoses are susceptible of becoming homicides would overreach reality. It has been justly remarked that every maniac may, at a given moment become dangerous. But in these exceptional cases the insane have sometimes not even consciousness of the gravity of the consequences of their act.

Many persons have heard the history of that aged dement who, though harmless up to the time, brained his nearest neighbor in the dormitory because this one kept him (the old dement) from sleeping, by his too loud snoring. There are many similar cases, in which chronic lunatics act in destroying life, really under the influence of a delirious conception but without realizing the bearing of their act.

* Translated by P. R. THOMBS, M. D., Superintendent State Insane Asylum, Pueblo, Colo.

All these cases constitute in reality but accidents, and they do not hinder that this principle be recognized as legitimate, whose importance in legal medicine is considerable, namely, that tendency to homicide is not a common, unimportant symptom which can be observed in all kinds of mental affection, but on the contrary, that this tendency is a symptome propre to certain psychoses, and does not manifest itself but in clinical, well-determined circumstances.

What are now the pathological circumstances in which homicide is observed? To answer this question in a complete manner, it would be necessary to expose methodically all the semeiology of homicide in mania, this would constitute a very interesting but very complex study, which I do not pretend to undertake. It may be sufficient to indicate briefly the diverse psychopathic states in which tendency to homicide figures as an element.

It is in mania of persecution that we more often meet cases of homicide. Under this name two different morbid entities are designated in France, viz., the mania of persecution of Lasegue (chronic mania, systematized psychosis with progressive evolution), and the mania of persecution of Falret, which is not accompanied with hallucinations.

We shall speak at first of the mania of persecution of Lasegue. This nosologic entity is one of the best characterized from a symptomatic point of view, in mental medicine. It comprises three periods. The second period shows itself by systematized ideas of persecution, and by hallucinations of hearing and of cénesthésie. In the third period, which is sometimes wanting, ideas of grandeur add themselves to the preceding troubles.

It is during the course of the second and third periods, especially during the second, that homicide may be observed. The patient has found the principal author of the torments he endures, and of the insults and wrongs with which he is overwhelmed. He knows his enemy, and gets rid of him by killing him. His determination is guided by logic; besides, his mental faculties are pre

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