arteries upon the circulation-Diseased arteries a cause of apoplexy-Diagnosis
of insanity-Affections with which insanity is liable to be confounded-Distinction
between insanity and delirium-Diagnosis of cerebral congestion-Distinction
between insanity and cerebritis-Diagnosis between meningitis and inflammation
of the substance of the brain-Anæsthesia preceding cerebro-spinal disease-
Incipient symptoms of general paralysis-Diagnosis between general paralysis
and wasting palsy-Diagnosis of softening of the brain-Premonitory symptoms
of acute and chronic softening-Cerebral abscesses and tumours-Importance
of knowing the antecedents of patients-Diagnosis of cerebral cephalalgia-
Importance of cephalalgia in a diagnostic point of view-Neuralgic and Rheumatic
cephalalgia-Nervous headache, and the cephalalgia symptomatic of tumours of
the brain-Diagnosis between cerebral and idiopathic sickness of the stomach-
Treatment of incipient insanity-Duties of the physician-Depletion in insanity,
its use and abuse-Caution to be exercised in the exhibition of purgatives-Use
of hellebore by the ancients for the cure of insanity-Value of opium in the treat-
ment of incipient insanity-Use of chloroform in cases of insanity-Isolation of
the patient from his friends-Mr. Spurgeon's method of subduing evil thoughts—
Necessity of self-control-Importance of early treatment of organic disease of the
brain-Value of tonic treatment in incipient apoplexy and paralysis Treatment
of softening of the brain-Disease of the brain caused by mechanical injuries to the
head-Injurious effects of blows upon the head-Importance of watching the state
of the brain after injuries to the head-Various diseases of the brain preventible if
treated in the early stage-Abscesses from blows upon the head-Course of
treatment to be adopted after severe blows upon the head-Importance of the
early detection of head symptoms-Treatment of cases of impaired intelligence
-Importance of a cultivation of the faculty of attention-Treatment of impair-
ment and loss of memory-Treatment of the mind after an attack of insanity-
Susceptibility of the memory to improvement-Mental remedies for the improve-
ment of memory-On the cultivation of the memory-Montaigne's loss of memory
-On the advantages and disadvantages of a commonplace book-Impairment of
memory the result of undue straining in early life-Importance of the careful
cultivation of the memory-Excessive straining of the memory in schools-When
does the intellect begin to decline ?-The vital, not the intellectual, principle
affected in old age-Celebrated men who have retained their intellectual powers
to a great age, as exhibited in the lives of Cherubini, Corneille, M. des Quen-
Bounnières, M. Leroy, Fontenelle, Voltaire, Richelieu, Mr. Waller, John Maple-
toft, Titian, Benjamin West, R. Cumberland, Handel, Ben Jonson, Sir Isaac New-
ton, Locke, Dr. Johnson, Bacon, Chaucer, Sir E. Coke, Lord Eldon, Lord Kenyon,
Lord Hardwicke, Lord Stowell, Bolingbroke, and Lord Mansfield-Is great
vigour of memory allied to defect of judgment?-Great strength of memory com-
bined with intellectual vigour, illustrated in the lives of Dr. Johnson, Edmund
Burke, Clarendon, Gibbon, Locke, Archbishop Tillotson, Grotius, Pascal, Leibnitz,
Euler, Muratori, Ben Jonson, Themistocles, Cyrus, Hortensius, Niebuhr, Sir
James Mackintosh, Dugald Stewart, Dr. Gregory, and Seneca-Kind treatment of
the insane-Duties of the psychological physician

628-706

ON

OBSCURE

DISEASES OF THE BRAIN

AND

M. IN D.

CHAPTER I.

Introduction.

THERE is not in the whole range of medical literature, ancient or modern, a passage that transcends in grandeur of conception, majesty of diction, and sublimity of truth, the exordium with which Hippocrates introduces to the reader his celebrated aphorisms: 1. 'O Bios βιος Bpaxis (Life is short); 2. 'H de réxvn μaкpǹ (Art long); 3. Ο δὲ καιρὸς ὀξὺς (The occasion fleeting); 4. Ἡ δὲ πείρα σφαλερή (Experience fallacious); 5. Ἡ δὲ κρίσις χαλεπὴ (Judgment difficult).

καιρὸς

"O de kaipos c." How important it is, to fully appreciate, when considering the treatment of the diseases of all vital structures, the practical significance. of this great medical apophthegm.

"The occasion fleeting!" Let this profoundly wise axiom ever be present to the mind, and engraven in imperishable materials, and in indestructible characters, upon the memory.

If these "fleeting" moments of inestimable, incalculable, and precious value, are neglected or trifled with; if serious morbid states of brain are overlooked, or, if

B

recognised, not immediately subjected to proper treatment, chronic, irreparable, and incurable organic alterations in its structure may be the result, succeeded, when it is too late to remedy the mischief, by the bitterness of self-accusation, or the unceasing lamentations and regrets of those who ought to have been the first to observe and attack the fatal disease!

How often is the physician called upon to witness the melancholy consequences, to health of body and mind, life and reason, of a neglect of well-marked premonitory symptoms of cerebral disease! It is frequently his painful duty to hear both relatives and friends reproach themselves, when the time for action has, alas! passed away, for their criminal negligence in wilfully closing their eyes to the long-existing evidence of positive disease of the brain.

The late Dr. Marshall Hall, when addressing himself to the consideration of head affections, remarks-" A useful work might be written on the subject of insidious and impending diseases, with the view of making their first or antecedent symptoms known to the public, and of thus suggesting the care and means necessary for their prevention."*

No one was better qualified, by habits of thought, educational attainments, practical sagacity, and enlarged experience, to form a right estimate of the importance of an accurate acquaintance with the incipient symptoms of the diseases of the brain, and nervous system, than this justly distinguished and accomplished physician.

It was his painful province, in the course of a long and brilliant career, to witness the sad consequences of the non-recognition of the precursory or premonitory symptoms of those organic affections of the brain, for the

* "On Diagnosis," sect. iv. "Diseases of the Head." By Marshall Hall, M.D., F.R.S. 1817.

relief of which his great skill and extensive knowledge was so often called into requisition.

This able physiologist fully appreciated, that many of the fatal cases of brain disease with which he had to grapple formed so many sad illustrations of the neglect of premonitory symptoms.

Upon investigating the history of the diseases of the encephalon, how frequently does the medical man discover that positive and unequivocal symptoms of brain affection have existed, and perhaps, during the early stage, been observed for months, and in some cases for years, without exciting any apprehension on the part of the patient, his family, or his friends!

In the majority of these instances, clearly manifested head symptoms were entirely overlooked, and, if noticed, no right estimation was made of their value. My attention has been called to cases, in which serious mischief to the delicate structure of the brain and its investing membranes, has been thus allowed by the patient's friends to proceed uninterruptedly for years, no treatment being adopted to arrest the progress of the fatal disorganization!

The brain, the most important, and exquisitely organized, of all the structures of the human body,

"The Dome of Thought; the Palace of the Soul,"

the material instrument of the intelligence, the centre of sensation, the source of volition, is permitted to be in a state of positive disorder, in fact disease, without exciting any attention, until some frightfully urgent, alarming, and dangerous symptoms have been manifested, and then, and not till then, has the actual extent of the mischief been appreciated, the condition of the patient recognised, and advice obtained for his relief!

Other deviations from organic conditions do not, as a general rule, meet with similar systematic neglect. In affections of the stomach, liver, bowels, lungs, and skin, &c., the first symptoms of approaching disease, or departure from a healthy condition of those organs, are observed, and the patient, without loss of time, seeks the aid of his physician.

Under such circumstances, he does not hesitate to place himself under curative treatment; he feels no delicacy in describing his physical sensations; is not ashamed at being thought ill, and readily adopts the treatment suggested for his recovery. But when the brain is affected, and the patient is troubled with persistent headache, associated with some slight derangement of the intelligence, disorder of the sensibility,. illusions of the senses, depression of spirits, loss of mental power, or modification of motility, his condition is, in many cases, entirely overlooked, or studiously ignored, as if such abnormal symptoms were signs of robust health, instead of being, as they undoubtedly are, indications of cerebral disorder requiring the most grave and serious attention, prompt, energetic, and skilful treatment!

It will be well to consider, briefly, the cause of the neglect to which the brain is subjected when under the influence of disease. It is a notion too commonly entertained, that many fatal cerebral diseases are suddenly developed affections, presenting no evidence of any antecedent encephalic organic change, and unaccompanied by a premonitory stage, or incipient symptoms.

It is indeed natural that such an idea should be entertained, even by educated professional men, whose attention has not been specially directed to a study of this class of disease, or whose opportunities of watching the