heaviness in the side a symptom of cerebral softening-Deficient sensibility of the in- sane-Explanation of the causes of anesthesia-Impairment of sensibility in incipient general paralysis-Remarks by Pinel on the insensibility of the insane-Cases of in- sensibility to pain among the insane-Insensibility from preoccupation of mind— Normal acuteness of the senses-Mental distress caused by certain odors-Mozart's acute- ness of hearing-Acuteness of the sense of touch among the blind-Singular defects of vision-Inability to distinguish colors symptomatic of brain disease-Curious cases MORBID PHENOMENA OF VISION, HEARING, TASTE, TOUCH, AND SMELL. Impaired and paralyzed sight-Defect of vision symptomatic of disease of the brain-Early signs of cerebral amaurosis-Cephalalgia a symptom of centric cerebral amaurosis- Value of the ophthalmoscope in detecting obscure diseases of the eye-Double vision a symptom of disease of the brain-Case of sudden restoration of sight-Loss of sight caused by tumors in the brain-Causes of amaurosis-Loss of sight premonitory of apoplexy-Singular case of sudden recovery of the sense of vision-Importance of the early detection of cerebral disease-Symptoms of amaurosis dependent upon vascular congestion Singular case of morbid derangement of sight-Exaltation of vision pre- monitory of brain disease-Cases of morbid exaltation of vision-Spectral illusions- Goethe's power of producing phantasms-Cases of hyperæsthesia of vision connected with disease of the optic thalamus-Perversion and aberration of sight-Peculiar ex- pression of the eyes in some forms of brain disease-Incipient symptoms of apoplexy -Derangement of sight premonitory of meningitis, congestion, and cerebral hyperæ- mia-Vitiated perception a symptom of apoplexy-Symptoms of cerebral hemorrhage -Morbid luminous phenomena-Photopsia a symptom of disease of the brain-Singu lar phantasmal phenomena-Illusions of sight-Morbid phenomena of sight-Strabis- mus symptomatic of disease of the brain-Double vision an important symptom of cerebral disease-Double vision symptomatic of apoplexy, paralysis, cerebritis, and meningitis-Morbid phenomena of hearing-Acuteness of hearing in incipient cere- bral affections-Hyperæsthesia of hearing a symptom of insanity-Illusions of the sense of hearing-Murder and suicide caused by illusions of hearing-Morbid pheno- mena of taste, touch, and smell-Disordered state of the taste and smell in incipient insanity-Disordered condition of the tactile sensibility in incipient paralysis- Sleeplessness of incipient insanity-Heavy and drowsy sensation a symptom of cerebral disorder-Insomnia caused by a severe mental shock-Death from want of sleep- Pathology of sleeplessness-Case of long-continued sleeplessness-Sleeplessness in in- sanity often caused by spectral illusions-Singular illusions causing sleeplessness-The poet Southey's insanity caused by loss of sleep-Morbid disposition to excess of sleep -Drowsiness a symptom of apoplexy-Lethargy a symptom of cerebral disorder in- duced by renal disorder causing a retention of urea in the blood-Method of detecting urea in the blood and brain after death-Morbid drowsiness and excess of sleep- Morbid phenomena of dreaming-Dreams often symptomatic of disease of the brain- Hallucinations between sleeping and waking-Morbid dreaming preceding insanity- Insanity commencing in a dream-Murder committed during sleep, . 387-398 CONTENTS. XV CHAPTER XXIV. MORBID PHENOMENA OF ORGANIC AND NUTRITIVE LIFE. Sympathy between the brain and digestive organs-Case of delirium caused by indiges- CHAPTER XXV. GENERAL PRINCIPLES OF PATHOLOGY, DIAGNOSIS, TREATMENT, AND PROPHYLAXIS. Obscurity of the pathology of the brain-Cases illustrating the difficulties attending 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 Quensounnières, M. Leroy, Fontenelle, Voltaire, Richelieu, Mr. Waller, John Mapletoft, Titian, Benjamin West, R. Cumberland, Handel, Ben Jonson, Sir Isaac Newton, Locke, Dr. Johnson, Bacon, Chaucer, Sir E. Coke, Lord Eldon, Lord Kenyon, Lord Hardwicke, Lord Stowell, Bolingbroke, and Lord Mansfield-Is great vigor of memory allied to defect of judgment?-The memory of idiots-Great strength of memory combined with intellectual vigor, 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-The effect of lite- rary pursuits upon longevity-Dr. Caldwell's remarks on this subject-Kind treat- ment of the insane-Duties of the psychological physician, ON OBSCURE DISEASES OF THE BRAIN AND MIND. CHAPTER I. INTRODUCTORY OBSERVATIONS. How important it is fully to appreciate, when considering the treatment of all diseases of vital structures, the practical significance of the celebrated apophthegm of Hippocrates, "O dè καιρὸς ὀξὺς.” "The occasion fleeting!" Let this profoundly wise axiom be ever present to the mind and engraven in imperishable characters upon the memory, for if these "fleeting" moments of incalculable value are trifled with and serious morbid states of brain are overlooked, or if recognized not immediately subjected to proper treatment, chronic irreparable and incurable organic alterations in the material instrument of thought may be the result, succeeded, when it is too late to remedy the mischief, by the bitterness of self-accusation, and the unceasing lamentations of those who ought to have been the first to observe and attack the fatal lesion. How often does the physician 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 relatives and friends reproach themselves when the time for action has, alas! passed away, for their criminal negligence in closing their eyes to the long-existing evidence of serious disease of the brain. The late Dr. Marshall Hall, who was admirably qualified by habits of thought, education, 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 nervous system, 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." It was the painful province of this distinguished physician, in the course of a long and brilliant career, to witness the sad consequences of the neglect of the precursory or premonitory symptoms of those organic affections of the brain, for the relief of which his great skill and extensive knowledge were so often called into requisition. He fully appreciated the importance of accurate diagnosis, and the necessity of prompt action and treatment in these cases. Upon investigating the history of the diseases of the brain, how frequently does the medical man discover that unequivocal cerebral symptoms 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 friends! In many of such instances, clearly manifested head symptoms were entirely overlooked. 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 permitted to proceed uninterruptedly for years, no treatment having been 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 physical instrument of intelligence, centre of sensation, and source of volition, is permitted, in many cases, to be in a state of undoubted disorder, 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 recognized, and advice obtained for his relief! Other deviations from health do not, as a general rule, meet with similar neglect. In affections of the stomach, liver, bowels, lungs, and skin, &c., the first symptoms of approaching disease are in most cases immediately observed, and the patient, without loss of time, seeks the aid of his physician. But when the brain is affected, and the patient 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 symptoms were signs of robust health, instead of being, as they frequently are, indications of cerebral disorder reqiring the most grave and serious attention, prompt, energetic, and skilful treatment! One reason of the neglect to which the brain is subjected when under the influence of disease, is a notion, too generally |