Leqons Cliniques sur les Maladies Mentales Professees the Salpetriere or leuocteur ivugustevoism, ivieaecinde the Salpetriero
These pages represent tlie different courses of lectures delivered since the year 18G7 by Dr.Voisin at the Salpetriere, which, as is well known, is the great receptacle for female lunatics in Paris. The lectures are chiefly devoted to the classification of the different forms of insanity and the description of the alterations of the cerebral cellules; to the differences
Clinical Lectures on Mental Diseases delivered at the Salpetriere. By Dr.
Auguste Voisin, Physician to the Salpetriere, pp. 196. Paris, Bailliere, 1876.
existing between the congestive form of insanity and general paralysis; and the varieties found in the chemical composition of the cerebral structure. Dr Voisin treats in succession of insanity caused by anaemia and by arterial atheroma; of a form of posterior spinal meningitis which might be mistaken for sciatica; of the influence of lesions of the senses in producing illusions and hallucinations; of madness in early life; of madness caused by the siege of Paris and by the Commune; of tuber- cular insanity ; and the final lectures are on acute and chronic alcoholism, and on the disturbances of speech observed in general paralysis. In reference to the classification of insane cases, Dr Voisin passes in review the existing systems of nosography, but only to condemn them, and he maintains that a true system of mental pathology can be con- structed only by combining together etiology, pathogeny, clinical expe- rience, and pathological anatomy. lie is the more convinced that such is the true basis of classification because he has never made an autopsy of an insane patient without finding some cerebral or extra-cerebral lesions, some visible to the naked eye and others appreciable only by the microscope. Without the aid of the last-named instrument, he states, the brains, not only of lunatics, but of idiots, might be regarded as healthy; but under the microscope the lesions are quite perceptible, for there is usually an advanced fatty state of the greater part of the cerebral capillaries, and granular and fatty and pigmentary alterations of the cerebral cellules. All the lesions he has observed in the brains of insane persons, up to the present time at least, may be thus summed up: (1) lesions of the capillaries, apoplexy and effusions of hematosin and hematine in the lymphatic sheaths, dilatations of the capillaries, infarctus, and atheroma; (2) anamiia of the capillaries, diminution of the normal quantity of phosphorus in the cerebral substance; and (3) alterations of the ganglionic corpuscles, presenting several degrees, the first and most common lesion being an infiltration of pigment and of fat in the protoplasm, and then, in a more advanced stage, the pig- ment and the fat disappear, and the circumference of the corpuscle is seen to become shrivelled and to touch the nucleus, which was at first free. Other lesions, however, giving rise to insanity and of a more easily appreciable character, are often observed, as, for instance, con- gestions, tumours, hydatids, atheroma; or the brain may be antemic ; and in certain cases insanity appears to depend upon “lesions of the organs of sense, as of sight and hearing.
As we are unable to follow Dr Voisin at length into his interesting researches, we can only refer to some of his more striking descriptions and passages, among which are his remarks on the psychical influence of the siege of Paris and the subsequent reign of the Commune, his lectures on acute and chronic alcoholism, and his observations on the disturbances of speech in general paralysis.
In reference to the first-mentioned subject, Dr Voisin remarks that, although most cases of insanity may be traced to hereditary pre- disposition or to idiosyncrasy, yet that the events of the Siege and of the Commune were so extraordinary and so dreadful as to be of them- selves sufficient to cause insanity in persons who would have otherwise escaped the malady, and he relates several instances in proof of this position. “When reading of the atrocities committed during the dread- ful period referred to, an English reader might well imagine that only insanity could explain the horrible crimes perpetrated; and Dr. Voisin, without actually admitting so much, adduces an instance of a fiend in female human shape, admitted into the Salpetriere, Avho either was insane, or had become so during the Commune, and who, under the influence of drink and fury, had committed the most horrible crimes of arson and murder, and who boasted of her deeds when in the hospital. She was (perhaps mercifully) carried off” suddenly by meningeal hemorrhage. In reference to the influence of drink in caus- ing insanity, Dr oisin draws a melancholy picture of the present condition of the Parisian population in this particular. Eighteen years ago, he tells us, the cases of insanity from drink were less than half of those known at present, and he shows, by the evidence of figures, that the number of this class of insane patients at the Bicetre in 18G0 was more than double that of the cases in the same institution in 185G. It also appears, from the documents published daily by the municipal police, that every month in Paris nearly 300 persons, on the average, are confined for their personal safety, who have been found in the public streets incapable of taking care of themselves, and among them, sixty, or nearly that number, are dead-drunk (ivres-morts). The con- sumption of alcohol in Paris has, we are also informed by Dr Voisin, more than trebled during the last five years, and the drink most com- monly consumed is absinthe. The author divides the alcoholic cases into two categories, namely, those who are not altogether sober in their habits, but are overtaken by temptation to great excess on some occa- sion ; and the habitual drunkards who have had several attacks of delirium tremens.
The last section of Dr Yoisin’s work, on the disturbances of speech in general paralysis, is exceedingly well and carefully written and will amply repay perusal. He describes, in the first place, the different conditions necessary for the production of articulate speech, the idea (elooc) being first formed in the brain, and being then conveyed, by means of the conducting nervous fibres, to the muscles and other organs by which articulation is effected. He then describes the dif- ferent morbid conditions by which speech is either abolished or imper- fectly developed ; and the conclusions at which he arrives on the sub- ject are that, in general paralysis, the morbid conditions of speech are slowness of utterance (dnonnement, for which there is no equivalent single English word), drawling, hesitation, stuttering, stammering, trembling, and mutism; that the first three are caused by cerebral lesions, and the last three are the results of alterations in the medulla ob- longata ; and that mutism may be the consequence of cerebral lesions, and of lesions of the muscles and nerves of the tongue and the lips.
We regret that our space forbids us to do more than glance at the numerous subjects treated in this very useful contribution to psycho- logical medicine, and we can only state, in conclusion, that the book shows throughout a profound knowledge of the subject of which it treats, and that the theoretical views are tested and illustrated by the practical lessons afforded by the great establishment over which Dr. Yoisin now presides, and by the Bicetre, with which he was also for- merl)- connected.
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