MORBID PHENOMENA OF ORGANIC LIFE.

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CHAPTER XXIV.

MORBID PHENOMENA OF ORGANIC AND NUTRITIVE LIFE.

THIS division of the subject will be briefly considered in the following manner:

DIGESTION AND ASSIMILATION.-Owing to the intimate sympathy existing between the brain and stomach, the physician is usually able to detect, in association with cerebral diseases, functional disturbances of the digestion and nutrition, often giving rise to serious complications. These symptoms, however, are often altogether overlooked, in consequence of their being masked by the more prominently developed signs of local head affection or mental disorder.1

In the early stages of insanity, the stomach exhibits evidences of great functional derangement. The appetite fails, the powers of digestion become impaired, the secretions vitiated, the liver disordered, and the bowels act with great irregularity or are obstinately costive. The gastric affection is recognized by fetid breath, coated tongue, loss of appetite, in some cases amounting to loathing of food, deficient hepatic secretion, and great depression of spirits. The patient complains of flatulence, cardialgia, and acidity of the stomach. Occasionally there is extreme nausea, and often actual vomiting. Constant sickness when it cannot be clearly traced to the influence of poison, morbid conditions of the uterus, kidney, or stomach, is significant of functional or organic disease of the brain, particularly when allied to headache, vertigo, and other indications of local cerebral dis

Willis, as quoted by Morel, says Dr. Griesinger, relates a remarkable case of a lady whose health had been injured by profound grief. One day, after having eaten a very indigestible cake, she was seized with a feeling of burning heat in the precordial region. There followed an instantaneous sensorial delirium. She imagined that the upper part of her body was on fire. She took a spring, and precipitated herself into the street, crying out that she was cursed by God, damned, and that she already was experiencing the punishments of hell. The same delirium was reproduced as soon as this lady experienced similar physical sensations.

turbance. These symptoms will be considered more in detail in the succeeding chapter.

In tumors of the brain, the patient often has, not only irritability of the stomach, but a disposition to vomit. This nausea in a remarkable manner resembles that preceding or accompanying sea-sickness. The invalid is rarely, if ever, actually sick, but he constantly feels so. This sensation is occasionally observed by the patient more prominently manifested on first rising in the morning; when washing, or shaving, he will be suddenly stopped by an inclination to vomit.

A person who was troubled by this symptom, caused by a cerebral tumor, remarked that it appeared as if he were constantly rolling about in a boat at sea, or repeatedly under the influence of small doses of tartar-emetic or ipecacuanha. This symptom is observed in some cases of abscess of the brain. A gentleman, who died suddenly of one, was annoyed for some months previously to his decease by a troublesome and depressing sensation of nausea. For some time this symptom was supposed to arise from disordered state of the stomach, and he was treated for this affection. After examining the case several times, I detected disease of the brain (tumor). There were associated with the nausea severe vertigo and paroxysmal attacks (somewhat localized) of headache. The cerebral abscess was considered to be the effect of a severe injury inflicted upon the head by a fall from a horse, whilst hunting, ten years previously.

The sensation of nausea, not amounting to actual vomiting, is occasionally symptomatic of acute and chronic softening of the brain. It often indicates the commencement of inflammatory and congested encephalic conditions. In the obscure cerebral diseases of children, the presence of irritability of the stomach, clearly not connected with gastric or intestinal derange ment, is an important symptom of mischief going on in the head.

Chronic disorders of the digestive organs frequently precede, and are associated with, if they do not operate as the direct cause of, various types of mental derangement. A morbid state of the liver, stomach, and bowels is seen prominently manifested in all forms and degrees of insanity. These gastric disturbances and visceral complications are often observed in an advanced position throughout the whole course of the malady. They give character and persistence to the mental impressions. In consequence of these physical derangements patients are often led to believe that they have been or are being poisoned, and under such hallucinations obstinately refuse to take food. In these cases there is generally serious disorder of the stomach, disease of the liver, or chronic irritation of the mucous membrane of the bowels. The breath is fetid, the tongue furred, the secre

DISEASED STATES OF THE APPETITE.

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tions vitiated, bowels inactive, and appetite either altogether lost or extremely vitiated.

"The refusal to take nourishment," says M. Morel, "often depends upon a disordered condition of the digestive organs. The truly wonderful obstinacy with which certain insane persons refuse food is, however, most commonly caused by their delirious ideas, such as a fear of poison and a desire to die of hunger in obedience to an order given them by a superior power. M. Morel relates the case of a lady whom he had to feed for several weeks by means of the stomach-pump, who refused to eat voluntarily, under the influence of an illusion that the food placed before her was composed of the flesh of her murdered children. "Some insane patients complain of a fire that devours them, and sometimes of an icy coldness which paralyzes the peristaltic action. They are subject to borborygmus and flatulence. All the phenomena which men enjoying their reason bring easily to a right interpretation, become among hypochondriacs the starting-point of the most strange illusions. They have in their intestines unclean animals who gnaw them; some even pretend to have neither stomach nor intestines. It seems to them that all they eat falls down a bottomless gulf. One patient imagines that she ought no longer to eat or speak. Her body no longer exists, it is one composed of shapeless fragments, which have no cohesion between them. Also her clothes are not attached to her person, and she constantly experiences a most painful sensation for a modest woman-she believes that she is going to be exposed naked to public view."

The presence of worms in the stomach and intestines often creates an uncontrollable indisposition for food. Chronic inflammation, and sometimes ulceration of the bowels, have been known to produce analogous symptoms.

The appetite is frequently seriously vitiated and depraved. The patient has a morbid craving, and never satisfied desire for food. His hunger cannot be appeased. After eating an enormous meal he will emphatically declare that he has been starved, or had either the smallest amount of nutriment, or none at all. A vitiated state of the appetite is shown by the patient eating with an apparent relish or at least indifference, the most repulsive and disgusting matters. The sense of taste in these cases occasionally appears to be completely paralyzed.

In the incipient stage of insanity the assimilative functions are often seriously disordered. Hence the emaciation so often. observed to accompany, not only the commencement of insanity, but of various organic diseases of the brain uncomplicated with aberration of mind.2

1 Morel.

All disorders of the nervous system, particularly those implicating the intelligence, have a damaging influence upon the function of nutrition. In cases

As the mental disorder advances, the function of nutrition is occasionally restored to a healthy state, and the patient not only gains flesh, but becomes embonpoint. This condition is often observed in chronic insanity, and in other cases where the patient is less sensitive to the destructive effect of his insane delusions. He ceases to be worried and vexed by his morbid ideas, and an improvement in the digestion and nutrition takes place. If the mental does not proceed pari passû with his physical restoration, an unfavorable prognosis is to be entertained. But even under these discouraging conditions patients recover.

MORBID PHENOMENA OF CIRCULATION, RESPIRATION, AND GENERATION. Considering the close organic sympathy between the heart and brain, it may, à priori, be inferred that in all affections of the great nervous centre, the cardiac functions would almost invariably exhibit marked deviations from a normal state. In the writings of Morgagni, Baglivi, Lieutaud, and Corvisart, this subject is but cursorily referred to. Although the latter authority affirms that he has never seen an instance of apoplexy that can be clearly traced to cardiac disease, he is, nevertheless, of opinion that the cases recorded by Testa, Laurent, and the other writers previously mentioned, "suffisent pour établir qu'une affection du coeur peut devenir la cause determinante de l'apoplexie." Richerand is said to be the first writer who pointed out pathologically the intimate connection between encephalic and cardiac disorders.

This distinguished physiologist says, "The dissection of patients who have died of apoplexy has proved to me that the excess of force in the left ventricle of the heart is a more powerfully predisposing cause of the disease than a large head and short neck -a state of body which is supposed by most physicians to indicate the apoplectiform conformation."

In a Mémoire read by Richerand before the Ecole de Médecine, he refers to the case of the illustrious Cabanis, who died of apoplexy, caused by or associated with disease of the heart. The autopsy of this distinguished philosopher revealed extensive cardiac disease. The left ventricle was enormously enlarged and hypertrophied. Eight ounces of blood were effused into the ventricles of the brain, and this effusion had been so violent that the septum lucidum was torn through, and the surface of the thalami and corpora striata made rough and jagged. Malpighi and Ramazzini died of apoplectic attacks connected with hypertrophy of the heart.

of anxiety of mind, how often does the general health become seriously impaired and the assimilative powers completely paralyzed. In the incipient stage of insanity the nutritive functions appear occasionally altogether suspended. The patient, long before attention is called to the state of the mind, loses flesh, and is Occasionally reduced to a dangerous state of emaciation and inanition.

1 "Nosographie Chirurgicale," vol. iii.

CEREBRAL AND HEART DISEASE.

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At a later period, Lallemand, Broussais, Andral, Bouillaud, Bertin, and Rochoux, have directed attention to this subject. MM. Bertin and Bouillaud remark, that "the majority of the patients in whom hypertrophy of the left ventricle of the heart is present will be found to exhibit symptoms of cerebral congestion, and that many of them will fall victims to disease of the brain."1

Important as this subject is to the practical physician as well as physiologist, it is not my intention to enter minutely into its analysis. It is sufficient for my purpose to call attention to the fact, reserving for the succeeding volume any detailed remarks I may have to make in reference to the influence exercised by certain affections of the heart upon various functional and organic diseases of the brain.

There can be no doubt among those whose duty it is to investigate the disorders of the mind in all their numerous phases, that cardiac disease exercises a material influence over the functions of the cerebrum. How common it is for the physician, whilst performing his autopsies in acute and particularly chronic cases of insanity, to discover apparently long-existing organic disease of the heart, especially in its valvular structure.

M. Falret, of the Hospice de la Salpêtrière, has published the results of his dissections in ninety-two cases of chronic mania. In twenty of these there were "des lésions diverses du cœur, coincidant avec des altérations chroniques du cerveau, ou des membranes cérébrales."

Morel, when referring to the connection between the central circulatory system and cerebral disease, observes, "that the affections of the heart enter largely into the etiology of mental affections." A patient under his care, subject to maniacal paroxysms, imagined that an animal was confined in his chest devouring his heart. After death, hypertrophy of this organ was discovered, with valvular disease interfering with the free passage of the blood through the auriculo-ventricular orifice. These organic changes in the substance of the heart, as well as in its valves, if associated with insanity, give rise to great difficulty of respiration, headache, restlessness, insomnia, and severe paroxysms of irritability. These symptoms are often combined with great oedema of the extremities. Morel adds, "I have observed among such patients the periodical return of strange ideas, hypochondriacal sensations, and often spectral hallucinations, which arise with the increase of the impediment to the circulation and the cerebral congestion which is the consequence of it. These hallucinations are usually of a terrifying nature." "It is known," says M. Saucerotte, "what a powerful shock the beating of the arteries occasions to the encephalic mass, and one