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perated by loss of blood; and the state of debility which followed was so great as to protract his return to the degree of mental and bodily health he had always enjoyed during the intervals.

Here, inordinate vascular action annihilated for a time the nervous power, and left the patient in a perfect state of exhaustion. Generous diet, the shower-bath, and tonics, speedily restored his strength.

In tracing and exposing these various morbid conditions of the sanguiferous system, and their influence on the cerebral functions, it is by no means implied that the morbid conditions of the nervous system and their influences should be disregarded. But the latter having already been by others amply considered and discussed, I have on that account endeavoured to place the former in a more prominent point of view.

There are many other phenomena in the circulation, which, whether investigating the causes, or merely examining the symptoms of intellectual disorders, claim

attention.

Besides, there are also various diseases that originate, are complicated with, or have an immediate affinity to, insanity, and which have hitherto been slightly noticed.

Under this impression, I shall extend my observa

tions.

L

COMMENTARY VIII.

HÆMORRHAGIC DISCHARGES.

VARIOUS sanguiferous discharges, whether periodical, occasional, or accidental, greatly influence the functions of the mind. Some, by their suppression operating as exciting causes; others, by their flux proving critical. Among these are classed, 1, the menstrual-2, hæmorrhoidal-3, varicose-and, 4, nasal and other hæmorrhages. These are all complicated with the functions of the circulation, though the menstrual can scarcely be ranked with the others, since it is one of the most important natural functions, while the rest are all morbid actions of the vascular system.

1. Menstrual Discharge.

Every body of the least experience must be sensible of the influence of menstruation on the operations of the mind. In truth, it is the moral and physical barometer of the female constitution. Both the accession and subsequent regularity of the menses depend on the due equilibrium of the vascular and nervous systems. If the balance be disturbed, so likewise will be the uterine action and periodical discharge; though it does not follow that the mind always sympathises with its irregularities so as to disturb the cerebral functions. Yet the functions of the brain are so intimately connected with the uterine system, that the interruption of any one process which the latter has to perform in the human economy may implicate the former.

Whether this evacuation be delayed beyond the period when it ought to appear, or be obstructed after being once established, or a female be arrived at the critical age when it ceases entirely; or whether the state of utero-gestation, or parturition, or lactation, be going on, they are all conditions in which the vascular system is involved.

When the menses are stopped, a sudden or gradual plethora sometimes follows in a system long accustomed to the discharge, and a consecutive local determination to some other part often ensues.

Ere the system accommodates itself to this innovation, the seeds of various disorders are sown; and especially where any predisposition obtains, the hazard of insanity is imminent.

The state of utero-gestation is a state of local determination, from which the general system seeks relief by uterine hæmorrhage. Or sometimes this local determination influences the nervous system, and superinduces those phantasies called longings, which are decided perversions or aberrations of the judgment, though perhaps the simplest modifications of intellectual derangement. These anomalous feelings have been referred to uterine irritation from mere gravitation, and so they may be; but they first induce a greater determination of blood to the uterus and its contents, and then to the brain, through the reciprocal connexion and action existing between the two organs.

Amenorrhoea or obstruction of the menstrual flux is, however, by no means so frequent a cause of insanity as is supposed. I am quite convinced that amenorrhoea is oftener a consequence of cerebral disturbance; for in numerous cases, derangement of the mind precedes the menstrual obstruction, and the discharge returns as the functions of the brain and other organs return to a healthy state. Emmenagogues, therefore, and other remedies.

given in insanity (vulgarly) to force the menses, may do a great deal of mischief.

Before any remedy is prescribed with this view, it behoves us to ascertain whether the amenorrhoea should be considered as a cause or an effect of the mental derangement. That it is often a cause there can be no doubt; because terror, the sudden application of cold, &c., have occasioned the instant cessation of the menses, upon which severe cerebral affections, or instant insanity, has supervened; and the senses have been restored with the discharge.

The critical period, as it is called, when menstruation ceases, is certainly a period favourable to the development of mental aberration. The whole economy of the constitution at that epoch again undergoes a revolution. The moral character, at the age when the menses naturally cease, is much changed to what it was on their first access; and every care or anxiety produces a more depressing and permanent impression on the mind. There is neither so much vital nor mental energy to resist the effects of the various adverse circumstances which it is the lot of most to meet with in the interval between puberty and the critical period.

Besides, as an author has observed, the age of pleasing in all females is then past, though in many the desire to please is not the less lively. The exterior alone loses its attractions, but vanity preserves its pretensions. It is now especially that jealousy exerts its empire, and becomes very often a cause of delirium. Many, too, at this epoch imbibe very enthusiastic religious notions; but more have recourse to the stimulus of strong cordials to allay the uneasy and nervous sensations peculiar to this time of life, and thus produce a degree of excitation equally dangerous to the equanimity of the moral feelings and mental faculties.

2. Hæmorrhoidal Discharge.

Suppression of the discharge of blood from the hæmorrhoidal vessels is almost as detrimental to men as that of the menses is to women. At least, so says Esquirol: and he adds, that its action, exercised in a more advanced age, produces most frequently melancholy and demency.

From the age of Hippocrates to the present, physicians have attached much importance in the cure of all cephalic affections, and of melancholia particularly, to hæmorrhagic discharges from hæmorrhoids or piles.

I can easily conceive, that in a constitution subject to periodical discharges of blood from the hæmorrhoidal vessels, to suppress such discharge might sensibly affect the brain and disturb its functions; but as I have never had any direct proof of insanity being induced from this cause, though I have from suppression of the menses, I cannot coincide in Esquirol's dictum.

It is a practice almost universal among the continental physicians to apply leeches repeatedly round the anus to the hæmorrhoidal vessels as derivants, and as a substitute for this discharge. The practice may be of some benefit in cases of insanity clearly sympathetic from morbid actions seated in the abdominal viscera, but I doubt its efficacy in most cases; for, according to the evidence from anatomical investigations, diseases of the abdominal organs among the insane are by no means common.+

The opinion, that a discharge of blood from piles often proves critical and removes insanity, I have never seen confirmed. From the frequent reference to this disease by foreign writers, we may imagine that it is much more common abroad than in this country; and if so, a wider

* Dict. des Scien. Médic. tom. xvi. p. 192.
+ Compte Rendu, 1826; Tableau, No. 15. .'

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