lunatics, to their mutual torment, and sometimes danger; and, I will aver, to the certain impeding of recovery. It is notorious, that nothing is more alarming to the generality of lunatics than those sudden convulsions to which the epileptic are subject; therefore, those simply maniacal, and those who have fits, by association reciprocally aggravate each other's malady. In this branch of morals England is decidedly infe rior to her continental neighbours. Almost all the public lunatic asylums in Europe receive the epileptic, fatuous, and idiotic; and if their registers be examined, we have evidence of the good effects which result, provided they are under judicious regulations. The Paris registers report only five cures out of six hundred and eighty-two old and new admissions of epileptic maniacs.* In the hospital of La Charité, Berlin, the success has been much greater; the recoveries amounting to near a fourth of the epileptics admitted.† I fear, however, that epileptic mania has been, and still is, a disease shamefully neglected in British asylums. Enough is already known, from the success resulting from greater care being taken of those afflicted with this malady in foreign and in our provincial asylums, to induce still further attempts to ameliorate their condition, if not to recover them. Recent experience has proved, that we were in the infancy of our knowledge of the treatment of the various forms and complications of insanity; and we now see the happy issue of more enlightened and scientific views. Why should not the same spirit, good feeling, and increased experience, be extended, and the condition of the poor epileptic, whether maniacal or not, be improved? Maniacal epilepsy is, as may be readily imagined, a fatal disease. In the Paris hospitals the mortality is at the rate of one in seven.* 3. Convulsions. Convulsion, which sometimes supervenes on mania, is another disorder of the circulation. In all convulsions there appears a sensible determination of blood to the brain, or an increased impetus in the cerebral vessels. The increase of mon entum is often occasioned by irritation of the nervous system, as in cases where exostosis, projecting spicula, or peculiar conformations of the cranium, exist. Children troubled with convulsions during dentition, are said to incline to insanity at an adult age. Greding remarked, that few insane people die of general convulsions; yet he admits that the proportion amounts, in maniacs, to ten in one hundred, and in melancholics, to six in twenty-four. This, surely, is proof enough of general convulsions being very frequent among the class of patients which this physician attended. Indeed, I can scarcely give credit to the statement; for, though sometimes occurring, such a proportion of this disorder among the insane is unknown in this country. This author also refers to an exciting cause of convulsions in maniacal epilepsy, and which, though irremediable, has been less regarded, in my opinion, than it deserves; that is, the exceedingly sharp and irregular shape which the processes at the base of the skull often * When I visited La Salpetrière, in October 1817, I found about 200 epileptic females sitting in one capacious apartment, heated by stoves to a most oppressive degree, and no proper ventilation. The congregation of so many persons, and especially epileptics, in such a place, must have proved exceedingly injurious to their health, and probably induced many apoplectic or sudden deaths. + Chrichton, App. vol. ii. present; and which, if they do not lacerate, at least may produce violent irritation of the brain, especially when, either from position or muscular exertion, a larger quantity of blood is suddenly propelled into the vessels at the base of that organ. These deviations from the ordinary formation of the bony bed of the brain, have been chiefly noticed near the sella turcica behind the processus clinoidei. In an hundred maniacs, the skulls of thirty-four presented a sharp pointed elongation of the posterior clinoid processes; in others there were irregularities of these bony processes. In twenty-six epileptic maniacs, there were eight in whom this process was singularly sharp and pointed. Of course, there is no means of ascertaining, in any cerebral affection, whether such organic deviation exists; and even if that were possible, human skill could avail nothing. I have lost four out of five insane patients from convulsions. I examined four of their heads; and in all of them these processes were so excessively sharp, that they attracted the particular attention of the gentlemen who performed the dissections, who were anatomical demonstrators, and of course intimate with the natural structure of the human body. In two cases of mania succeeded by convulsions, the evident cause proved to be a spiculum projecting from the inner table of the skull. One of these cases merits peculiar notice. A gentleman, aged thirty-six, had been for several years the active partner of an extensive mercantile house, and in that capacity had applied extremely close to business, and experienced great fatigue and anxiety consequent upon it. He was a man of admirable talents, possessed an uncommon facility in acquiring languages, and was of great information and fine taste. M February 8th. In the night he had a strong convulsion, which lasted an hour; and which went off without any remedy being applied. He daily grew more violent and unmanageable; and on the 18th was removed into my establishment. Here, under the influence of a regular system of diet, exercise, and medicine, he greatly improved in general health, and in his mental faculties, except that of memory, which exhibited some very curious anomalies. Early in June, when the weather was very hot, he was much affected by it; but he kept very quiet. He now complained of much pain beneath the protuberance on his head, and expressed a wish for a knife that he might cut it off. June 10th was an excessively hot day, but he felt better than for several preceding days; and in the cool of the evening he sauntered for half an hour in the garden with a book in his hand, as was his custom, though he had lost the knowledge of reading. Soon after he came in, he was seized with a violent convulsion. His face was excessively red, the carotid and temporal arteries were throbbing with great violence, and the breathing was stertorous. The temporal artery was attempted to be opened; but it was not successfully executed, and little blood followed. Cupping-glasses were applied to the head, and he was bled in the arm, and the blood suffered to flow till the arterial action was lessened. Forty ounces of blood were abstracted before any effect was produced: the beating of the arteries was then reduced, the breathing became freer, and the convulsive twitchings subsided; he swal-. lowed what was offered, and soon after was sensible of what was said to him. 11th. At 4 P. M. the convulsions returned, but with less violence. I removed the bandage from his arm, and took away about ten ounces more of blood; and various remedies were administered. In the afternoon he spoke, and distinguished all about him. 12th. He relapsed into insensibility, there was a universal tremulous motion of his limbs, alternating with slight convulsions. 13th. The violence of the convulsions increased, and he gradually sank and died. Dissection, six hours post Mortem.-On the external surface of the cranium there was a considerable protuberance, extending about two inches in length and one and a half in breadth, on the left side of the coronal suture, close to the central line. The skull was rather thin. On the inner table of the cranium, which formed the cavity of the protuberance mentioned on the exterior, there were several small spots, as if the bone were absorbed, and there it was diaphanous. The portion of the dura mater corresponding to this cavity was converted into an ossific substance, in the form of several irregular spicula projecting towards the brain, one of which, with a very sharp point, was much more elongated than the others. Opposite these spicula the substance of the brain was absorbed, and a cavity formed in it, more than half an inch broad, lined with a tuniclike, vascular, cellular membrane. The tunica arachnoidea had in most parts become consolidated with the pia mater, forming an opaque covering on the brain of a gelatinous consistency: all the vessels were much distended with blood. The substance of the brain was soft and flabby; on dividing the white portion it was thickly sprinkled with bloody points. Between the membranes, and in the ventricles, there was a large collection of water. The plexus choroides were shrunk and pale, as if macerated. The abdominal viscera were all healthy, especially the liver, the soundness of which had been much suspected during life. |