West Riding Lunatic Asylum Reports
291 REVIEWS. 1. , Vol. iv. :Author: J. Cwciiton Browne, M.D. The volume before us contains many articles replete witli useful information.
The first article is an address delivered at the Annual Medical Conversazione held at the West Riding Asylum. Dr Carpenter, who delivered it, drew the attention of his audience to the psychological import of Dr Ferrier’s experimental investigations into the functions of the brain, and, at the request of the editor of these reports, he con- sented to its appearance in print.
We are told that the chief experiments relating to the nervous system have been made by British investigators, and Sir Charles Bell, Dr Marshall Hall, Dr Waller, Dr Brown-Sequard, and Dr Ferrier, are here mentioned. Many more names could be added of persons equally distinguished in their investigations on the nervous system. Dr Carpenter, after carefully describing the difference between the tubular and cellular components of the nervous system, and giving a pathological description of nervous tissue, passes on to consider’ nervous force and activity, and a comparison between human and comparative pathology. Dr Carpenter has formed the following opinions relative to Dr Ferrier’s investigation into the functions of the brain :? 1st. That the cerebrum has a reflex action of its own, which mani- fests itself in the production of co-ordinated movements.
2nd. That these movements are called forth, not- by the mental states themselves, but by cerebral changes which are their physical antecedents.
3rd. That we are able to draw from these experimental researches a more definite rationale as to the automatic performance in man of movements which originally proceeded from intentional direction. 4th. That the cerebrum does not act immediately upon the motor nerves, but that it plays downwards on the motor centres contained “within the axial cord.
5th. That Dr Ferrier’s experiments throw great light on the ” cressed” action of the several ganglionic centres contained within the skull.
6th and lastly. Dr Carpenter concludes: ” I consider, therefore, that the results of Dr Ferrier’s experiments encourage the belief that by the combination of anatomical and developmental study, of experi- mental enquiry, and of pathological observation, much light may be thrown on the’functions, not merely of the several ganglionic centres “which are aggregated in the human brain, but on those of the different parts of the great 1 hemispherical ganglia’ formed by the convoluted layer of the cerebrum.”
An interesting clinical case is given by Dr Iiughlings Jackson, describing a remarkable case of recovery from ” double optic neuritis.” This is accompanied by an excellent diagram. .We quite agree with NO. II. NEW SERIES. Y 298 WEST RIDING LUNATIC ASYLUM IlErORTS. Dr Jackson tliat the ophthalmoscope is a most valuable aid in the diagnosis of nervous affections. Pathological Illustrations of Brain Function, by David Ferrier, M.D.?The author of this paper presents to us a number of cases illustrative of cerebral lesion, to which are appended many post-mortem examinations. Special attention is drawn to the average thickness and density of the skull, the adherence and nonadherence of the dura mater, and the contents of the sinuses, with reference to the fluidity or solidity of the blood contained therein, and wasting of convolutions. “We are told that it is only by accurate records and observation, which are alone arrived at by careful investigations of the cadaver in the dead- house, that any approach to the localisation of brain function can be attempted. Dr Ferrier is entitled to the warmest encomium for this careful paper and for his earnest endeavours to illustrate cerebral pathology.
The Urinology o f General Paralysis. John Merson, M.D.?After a few remarks upon the importance of a careful analysis of the urine in all diseases, a short summary is given of the excess and deficiency of the phosphates in cases of acute mania, dementia, and the third stage of general paralysis. We are told that a plus quantity of phosphate exists in a paroxysm of acute mania and a minus quantity in cases of cerebral exhaustion. These conclusions were arrived at by Dr Beale and the late Dr Sutherland, but to which the writer of this paper takes exception. He maintains that the cases from which these experiments were deduced were insufficient to justify the opinions formed.
A number of valuable tables are given, describing the specific gravity, the quantity of urine passed during the twenty-four hours, the amount of urea, NaA, H3P208, H2S03, excreted either under the administration of Calabar bean or without it. The results of the observations of Dr Merson are as follow :? 1. The quantity of urea varies above and below the average of health, being in the majority of cases considerably increased. Pro- bably also the uric acid is increased. 2. The quantities of chlorides and phosphoric acid are notably diminished; that of sulphuric acid remains about as usual. 3. The specific gravity varies within wider limits than in health, but the mean does not differ materially. 4. The absolute quantity of urine passed is slightly below the average of the healthy cases examined ; but, estimated according to weight of blood, the amount excreted by seventeen general paralytics was slightly in excess of that secreted by six healthy cases. 5. Under the influence of Calabar bean there is a considerable diminution in the quantity of all the solid constituents, especially the urea.
6. The results obtained in the three cases treated with alcohol are in favour of the view that both the quantity of urine and the amount of solid constituents are diminished under the influence of that substance. The next paper is one on Cerebral Anccmia from the fertile pen of Mr. Milner Fothergill. He describes anosmia to be a decrease in the amount of arterial blood circulating through an organ in a given space of time; the dilating and contracting power of the blood vessels so altering their calibre, and thus permitting a diminution in the flow of blood. The vaso-motor nerves affect the contraction of the circular mus- cular coat of the vessels, and the inhibitory nerves counteract this effect and produce dilation of the vessels and enlargement of their calibre.
The first point considered by Dr Fothergill in his paper is “the possibility of the occurrence of cerebral anaemia. lie says: 11 The circulation within the encephalon is very active, and the vascular supply is unusually profuse, so as to admit of great func- tional power on the part of the intra-cranial contents. But the encephalon is enclosed in an unyielding bony case, the skull; how then, it may be asked, can it become more vascular at one time than another?” A number of experiments are here alluded to, which prove, without doubt, that certain changes take place in the vascularity of the encephalon. The brain when in a state of excitement becomes turgid, but during sleep there is a period of temperate quiescence, and it is pale and bloodless.
Dr Fothergill informs us that these alterations within the cranium are due to the presence of the cerebral spinal fluid; the brain becoming more vascular as the amount of that fluid is diminished, and as the vascularity decreases the bulk of the fluid increases. The anatomical appearances found in cases of cerebral anaemia are mentioned, and the conditions under which cerebral anaemia is in- duced are fully discussed.
General aneemia is the first condition which is considered, and any drain to the system by which the diminution of the amount of arterial blood flowing through the brain affects it. It has been estimated by Haller that the amount of blood going to the brain is a fifth of the whole bulk of the blood ; a reduction, therefore, in the usual supply of blood would soon be apparent in the encephalic circulation. As an illustration of this we may mention constant drains on the system, such as morbid growths, imperfect nutrition, and dyspepsia. Spanajmia is also given as one of the causes of cerebral anaemia; and the way in which it so arises, such as malarial poisoning, lithiasis, prolonged administration of certain medicinal drugs, are duly de- scribed. The other conditions which Dr Fothergill mentions, and ably discusses at length, are: unfilled vessels; heart disease; pres- sure on the cerebral vessels; symbolism; venous stasis; apoplexy; gouty spasm of the cerebral vessels; organic disease, involving the cere’bral vessels; vaso-motor disturbances of the cerebral vessels; artificial production by medicinal agents.
The prognosis in cerebral anajmia is generally, we are told, favour- able, especially if no organic disease exists; but if it depends upon diseases of the blood vessels or organic changes in the heart, the prognosis is bad.
The progress of the disease, if not checked, passes on to melan- cholia and to mental deficiency, ” the precursor of psychical torpidity and intellectual decay.” We have a case of a young girl under our own immediate observation with cerebral anremia, followed by a typical cataleptic condition.
The treatment is now considered ; the two main lines of treatment being the psychical and physical. With regard to the first of these, change of scene, travelling, cheerful society, are recommended. In the physical or medicinal treatment, hematics, especially iron, is the most important, and in combination with arsenic. The following formula is given
I?). Acid. Arsenia) gr. -g-. Ferri Sulph. exsic gr. vj. Pulv. Pip. Nepaul. gr. xij. Pil. Al. et Myrrh.
Vegetable tonics, such as quinine, strychnine, or calumba, are also recommended. The treatment for each of the various conditions in which cerebral antcmia occurs is entered into at length, much stress being laid upon the administration of alcohol where there is cardiac depression and contraction of cerebral vessels, and upon the judicious use of opium as a sedative, and to the inutility of hydrate of chloral and bromide of potassium ; and we are told that these two medicinal drugs have a tendency to retard recovery, and ” transfer the condition from that of temporary melancholia into that more advanced and permanent condition, chronic dementia.”
The paper is of a highly scientific and practical nature, and is one of the most valuable contributions in the Reports, and Ave look forward with pleasure to that on Cerebral Hypertemia, which Dr Fothergill contributes to the next number.
On the Therapeutic Value of Cold to the Head. Dr Benliam, M.D. ?A number of interesting and original experiments are given to indicate the therapeutic value of the application of cold to the head. The instrument used by Dr Benham to elucidate his subject is one in- vented by Ludwig, and called Ludwig’s Strom-uhr. It enables us to estimate by volume the amount of fluid which passes through the vessel to which it is applied in a given time, and has been tised exten- sively for experimenting by Dr Lander Brunton. Dr Benham does not attach much importance to the application of the icebag as a remedial agent in a direct way, as producing any action in reducing the temperature or lessening the blood supply of the vessels within the cranium, or by a sedative action upon the nervous centres. He is of opinion, however, that some reflex action may temporarily result from the application of cold thus employed.
The first question under consideration is whether cold applied to the scalp has any direct action in abstracting heat from the intra- cranial tissues. After a few experiments on this subject the following observations are made : that the temporary reduction of temperature obtained was not due to a mechanical abstraction of heat by the cold applied, but rather to some reflex action on the vessels, or a general lowering of the blood temperature.
Dr Benham then considers whether the application of cold to the scalp can induce any indirect or reflex action in lowering the temperature of the intra-cranial tissues. Eleven experiments are here carefully cited, but no accurate observations have been deduced.
The third and last theory is whether the application of cold to the head can produce in the intra-cranial tissues any appreciable action in lessening their blood supply. Experiments are also given, and the con- clusion arrived at is, that the difference in the quantity of blood flowing through the common carotid artery is not appreciably lessened from the application of intense cold to the head for thirty minutes. The writer concludes an interesting and original paper by in- forming ns that cold when applied to the scalp causes a slight lower- ing of the temperature of the intra-cranial tissues, by reflex action, a slight diminution of the temperature of the body generally in conse- quence of the direct action induced by cold in lowering the temperature of the stream of blood passing through the capillaries in direct contact with it, and a slight decrease in the frequency of the heart’s action. The next paper is by Dr Lauder Brunton, on Inhibition, Peripheral and Central.
The paper is of a highly scientific character. Inhibition is described in its various physiological characters, and we are told that it is not only in the restraint of passions and emotions that it is observed, but it occurs in all parts of the body, and it would appear that every motor centre has a corresponding inhibitory one.
The experiments of Weber, illustrative of the power of inhibition in producing restraint instead of excitement, are alluded to and described. Careful diagrams are given showing the physiological actions of various nerves under inhibitory action. The paper is so exhaustive that we cannot do justice to it in a short notice; the ideas are original, but based on a thoroughly practical and physiological footing, and are the result of sound careful research.
A paper by Dr Major, on Observations on the Histology of the Morbid Brain, is now given.
The observations are chiefly confined to the consideration of the cortical substance in senile atrophy of the brain. The paper is illus- trated with carefully executed diagrams of healthy brain-cells and those found in senile atrophy. Dr Major has come to the conclu- sion that, in senile atrophy, the cells through the entire depth of the cortical layer are morbidly affected, and that in the large nerve-cells the morbid process is one of granular degeneration, but in the smaller cells there is simple atrophy without granular degeneration. The nuclei of the cells are degenerated and ultimately become destroyed, also the branches of the large cells at an early period.
The large vessels and capillaries are dilated, and the vascular .canals are enlarged and the surx’ounding cerebral substance is indurated. The fibres are abnormally coarse and tortuous and in some parts broken down.
The Neurolgia, which includes the delicate, almost homogeneous matrix supporting the nerve elements, is in a state of atrophy and degeneration, and the corpuscles increased in number, but eventually shrivel and atrophy. The paper is a highly scientific one and deserving careful study.
An interesting and clever paper is given by Dr Lawson on The Hourly Distribution of Mortality in relation to Recurrent Changes in the Activity of Vital Functions.
We are told that in chronic diseases the chief hours of depression and exhaustion occur between the hours of 3 and 6 a.m., and that it is necessary between these hours to take the greatest care of our invalid by careful nursing, attention, and feeding. The paper does not bear directly on our subject; but we do not care to pass it by, it being evidently the result of careful experiments and research. Dr Cricliton Browne, the able editor of these Reports and Superin- tendent of the West Riding Asylum, gives us a paper on Acute Dementia.
Dr Browne commences by describing the various forms of dementia ?primary dementia, senile organic dementia. The first of these varieties has been called apathetic dementia, in allusion to the complete torpor of feeling by which it is marked; the term stupiditc is applied to it by Georget. Females are attacked more than males, but it is rarely seen in persons over thirty years, and we are told it depends ” upon exhausting influences operating at a period of rapid growth.” The chief moral cause of acute or primary dementia is mental inanition or monotony of thought and feeling.
Dr Browne says: ” Man does not live by bread alone?his dietary must be varied, and if it is not varied he is starved as effectually as if he were kept on short commons. And the same is true of his mental food; that, too, must be varied, and if it is not varied it ceases to nourish him, and he pines into dementia.” No doubt solitary confine- ment, living a monotonous life, and residing for a length of time in the same place are all predisposing causes to mental aberration. We are told that anaemia and spancemia are sometimes prominent causes of dementia. Acute dementia frequently follows exhaustive diseases, and universal mental inertia frequently continues for some time after typhoid fever ; this is an undisputed fact.
Acute dementia begins in one of two ways, either gradual and at first by imperceptible encroachments or by maniacal excitement. Dr Browne now accurately and graphically describes the ingress of dementia, and mentions a few cases to bear out his remarks. The acme of dementia is a mental state of profound stupidity. This stage is now described, the mental condition as well as bodily being given. Dr Browne, having thus sketched the indications of dementia, gives some most interesting and diagnostic cases to illustrate his remarks. The pathological changes are now stated. Venous congestion affects the whole encephalon; but the frontal and parietal lobes are chiefly implicated. The vessels become edematous from the accustomed want of tone; this causes pressure on the brain, and if of long con- tinuance atrophy follows. Acute dementia may, then, be stated to be a disease of venous congestion.
The paper concludes with the various remedial agents which have been tried by Dr Browne in the treatment of dementia. Quinine appears to have been tried with great success in large doses, under its influence the atonic vessels become invigorated. Guaiacum also appears to have the same result. If anajmia is present iron may at once be prescribed. Dr Browne has found the mineral acids useful if much prostration is present.
Among the prophylactic remedies are mentioned moderate exercise, application of cold to the head, and electricity to the brain; and this latter can be commended.
The paper is a very practical and instructive one, and should be care- fully read and studied, as it contains original opinion founded on great experience, skill, and care in the treatment of the insane. Dr Crichton Browne’s paper is followed by one by Dr Charles Aldridge upon Ophthalmoscopic Observations in Acute Dementia. Sixteen cases are quoted, from which deductions are drawn. The condition of the retina in acute dementia and atonic melancholia is that of ancemia, the optic discs are pale, the tint of the choroid is lowered, but not resembling atrophy, there being a want of the sharpness and brilliancy of pallor found in atrophy. The retinal vessels are small and shrunken, but no trace of previous tortuosity is apparent as is often seen in atrophy. Our attention is drawn to many points of resemblance between acute dementia and catalepsy. Re- ference is made to the investigations of Hammond and others with the ophthalmoscope in mental disorders, and the subject is most carefully and clearly discussed by Dr Aldridge.
The volume concludes with a paper by Dr Benham, Pathologist and Assistant Medical Officer at the Asylum, upon The Actions of Nicotine.
A great deal of care and trouble has evidently been taken by the author to investigate clearly the action of nicotine; and by a careful perusal of his paper we see that in man as well as animals the temperature is diminished under its administration, and the pulse is quickened under the effect of small doses. This increase in the number of the heart’s pulsations is not accompanied by a diminution in its vigour; this is demonstrated by the sphygmograph ; and from this we may conclude that small doses of nicotine do not, as is supposed, act as powerful depressants, but as stimulants and invigorators. The experiments from Avhich these deductions are drawn are fully and carefully described, and the paper concludes a most interesting and valuable volume of psychological articles, all of which are the result of scientific and practical research and reflect great credit upon the editor.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.