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not confined to the friends of the patient. There have been instances of the magistrates themselves, from the kindest motives, refusing to grant warrants for the admission of a patient, even after he has been examined by a medical gentleman, who has given a certificate of his insanity, because when brought before them he has been able to answer certain questions correctly. The consequence is, that from this delay, instead of returning to his friends in a few weeks, which, in all probability, would have been the case if proper medical and moral remedies had at once been applied, he becomes incurable, and remains in the Asylum for life, a burden to the parish. In some instances similar delay has been attended with fatal consequences.

“It is sincerely hoped that the knowledge of these circumstances will induce an early application to be made for the admission of patients; as, even if the neglect does not prove fatal, it is contrary to every principle of justice and humanity that a fellow-creature deranged, perhaps only on one point, should, from the want of the early attention of those whose duty it is to watch over him, linger out his existence separated from all who are dear to him, and condemned, without any crime, to be a prisoner for life.”

In the premonitory stage of insanity, the grey portion of the hemispherical ganglia, is frequently in a state of capillary congestion. This pathological condition I may remark, without anticipating what I have to say on the subject of the medical treatment of the incipient symptoms of cerebral and mental affections, is easily dealt with, and the further progress of the disease arrested by therapeutic measures. A few leeches and cold applications to the head, particularly in young persons of plethoric habit, active purgation, quietude, and freedom from all excitement, physical and mental; counter-irritation to the head, the administration of the tartrate of antimony, and

IMPORTANCE OF EARLY TREATMENT.

21

the judicious exhibition of opium after the local congestion has been relieved, and the secretions brought into a healthy condition, will, in eighty per cent. of cases, cure the patient, and arrest the further progress of the mischief.

In a certain type of case, the brain, in the early stages of insanity, is in an anæmic condition, and the vital and nerve force but feebly manifested. In these cases, our

, sheet-anchor is undoubtedly opium in its various formulæ, generous diet, and blood tonics. But I must not anticipate what I have to advise in its proper place for the medical treatment of insanity.

“The importance or rather necessity of recognising disorders of the head in their early stage,” says Dr. F. Hawkins, “is obvious from the consideration that they can then alone be attacked with any chance of success. In acute cases, the period is brief indeed in which the power

of art is available. But whether the case be acute or chronic, it is only in the early stage that its precise nature admits of being distinguished with accuracy. In its further progress, from the extensive sympathies of the brain with all parts of the body, so many functions become implicated, and so various are the symptoms which arise, as to preclude arrangement or classification, and defy the art of diagnosis. The aid which in most other cases the sensations of the patient are capable of affording us is lost to us too soon in disorders of the head, until in their advanced state they all resemble one another, and present alike a dreary abolition of the powers of animal life. The period therefore is highly precious in which these affections admit of being distinguished with precision or treated with any hope of advantage.

* Croomian Lectures, delivered before the College of Physicians, May, 1829, by Francis Hawkins, M.D.

Let the physician then estimate, in all its vital importance, the grave necessity for prompt treatment and decisive remedial measures, when satisfied that the enemy is at the gates, and has attacked, or, is on the eve of assaulting, the citadel! Under these circumstances, hesitation, delay, or procrastination in bringing the patient within the range of curative measures, is fraught with the direst results, and with the saddest consequences. Let us not wilfully close our eyes to the premonitory signs, however apparently insignificant, slight, transient, and fugitive they may appear, of actual mental disorder and brain disease, for it is in this early stage when so much may be effected by judicious medical treatment to obstruct the advance of the fatal cerebral mischief.

Having dwelt at some length on the existence of a precursory stage in all affections of the brain, and on the importance of watching for the first threatenings of incipient cerebral disorder, I propose to investigate, in detail, the general character of the premonitory symptoms of encephalic, and mental disease. It will be well, However, to premise, that I cannot, in this work, do more than generalize on this wide and expansive subject.

When I address myself, in the succeeding volume, to the consideration of specific types of brain disease, it will be my object to enter more elaborately into detail, and to point out, as far as practicable, the diagnostic premonitory signs of the various organic affections of the encephalon. Many of the symptoms to which I shall refer as valid evidences of incipient brain disorder will be found common to several lesions of this organ, each presenting an essentially different aggregate group of symptoms, as well as distinctive anatomical, and pathological phenomena.

Nevertheless, I am of opinion, that a general description or resumé of the incipient signs of morbid conditions

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of the brain, before considering individual forms of cerebral disease, will not be without its practical value and importance. Agreeably to this arrangement, I propose to analyse the subject in the following order :

1. Morbid Phenomena of Intelligence. 2. Morbid States of Motion. 3. Morbid Conditions of Sensation.

Let the physician then estimate, in all its vital impor. tance, the grave necessity for prompt treatment and decisive remedial measures, when satisfied that the enemy is at the gates, and has attacked, or, is on the eve of assaulting, the citadel! Under these circumstances, hesitation, delay, or procrastination in bringing the patient within the range of curative measures, is fraught with the direst results, and with the saddest consequences. Let us not wilfully close our eyes to the

premonitory signs, however apparently insignificant, slight, transient, and fugitive they may appear, of actual mental disorder and brain disease, for it is in this early stage when so much may be effected by judicious medical treatment to obstruct the advance of the fatal cerebral mischief.

Having dwelt at some length on the existence of a recursory stage in all affections of the brain, and on the - portance of watching for the first threatenings of cipient cerebral disorder, I propose to investigate

, in tail, the general character of the premonitory sympns of encephalic, and mental disease. It will be well

,

This classification of the subject fully recognises the three physiological functions of the cerebro-spinal system, viz.: a. Thought. B. Motion. 7. Sensation. 4. Morbid Phenomena of the Special

Senses. Viz.: 8. Sight.

n. Touch. . Hearing.

0. Smell. 7. Taste.

wever, to premise, that I cannot, in this work, do more
n generalize on this wide and expansive subject.
Then I address myself

, in the succeeding volume, to
consideration of specific types of brain disease, it will
ny object to enter more elaborately into detail

, and to tout, as far as practicable, the diagnostic premonitory 3 of the various organic affections of the encephalon. y of the symptoms to which I shall refer as valid nces of incipient brain disorder will be found comto several lesions of this organ, each presenting an tially different aggregate group of symptoms, as well tinctive anatomical, and pathological phenomena.

5. Morbid Phenomena of Sleep, and

Dreaming.
6. Morbid Phenomena of Organic,

or Nutritive Life, Viz.: a. Digestion and y. Respiration.

Assimilation. 8. Generation. B. Circulation.

7. General Principles of Pathology, Treat

ment, and Prophylaxis.

vertheless, I am of opinion, that a general descripresumé of the incipient signs of morbid conditions

CHAPTER II.

Morbid Phenomena of Intelligence.

The brain, being the material instrument of the intelligence, the physical media through which the mind manifests its varied powers, it is in conformity with the rules of logic, and, in obedience to the laws of inductive reasoning, to infer, that no changes in its structure or investing membranes can take place, no alteration in the quality of the vital fluid, or anatomical character or calibre of the numerous bloodvessels that circulate and ramify through its substance can exist, without, to some extent, interfering with, or modifying its psychical functions. Cases, however, are on record, in which serious injury has been done to the brain during life without damaging the intelligence, and considerable encephalic disorganization (as the result of disease) has taken place, no aberration, exaltation, depression, or impairment of the mind, having been observed, previously to death. If such cases have occurred, they must be considered either of a rare and exceptional character, or, as pathological curiosities, unless, in every instance, the alteration of structure is strictly confined to one hemisphere, or restricted to the fibrous, or conducting part of the nervous structure, the vesicular matter, and its minute vessels remaining intact, and entirely free from all morbid change, or abnormal modification. Is it possible to conceive any great extent of disorganization, even in the medullary portion of the cerebral mass, to exist, without impli

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