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PART III.-PSYCHOLOGICAL RETROSPECT.

French Retrospect.

621

PART IV.-NOTES AND NEWS.

Dr. Bucknill's Resignation of the Visitorship of Chancery Lunatics.- Appoint-
ments.-Notices, &c.

632-634

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The Journal of Mental Science.

Original Papers, Correspondence, &c., to be sent by Book-post direct to Dr. MAUDSLEY, 9, Hanover Square, W.

English books for review, pamphlets, exchange journals, &c., to be sent either by book.post to Dr. Maudsley, or to the care of the publishers of the Journal, Messrs. J. and A. Churchill, New Burlington Street. French, German, and American publications may be forwarded to Dr. Maudsley, by foreign book-post, or to Messrs. Williams and Norgate, Henrietta Street, Covent Garden, to the care of their German, French, and American s :- Mr. Hartmann, Leipzig ; M. Borrari, 9, Rue de St. Pères, Paris ; Messrs. Westermann and Co., Broad. way, New York,

Authors of Original Papers receire three extra copies of the Journal by Book. post. Should they wish for Reprints for private circulation they can have them on application to the Printer of the Journal, Mr. Bacon, Lewes, at a fixed charge of 30s. per sheet per 100 copies, including a coloured wrapper and titlepage.

The copies of The Journal of Mental Science are regularly sent by Book post (pre-paid) to the ordinary Members of the Association, and to our Home and Foreign Correspondents, and the Editor will be glad to be informed of any irregularity in their receipt or overcharge in the Postage.

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Annales Médico-Psychologiques ; Zeitschrift für Psychiatrie; Verhandl. lungen der Berliner Medicinischen Gesellschaft; Archiv für Psychiatriund Nervenkhrankeiten, herausgegeben von Dr. L. Meyer und Dr. C. Westphal; Correspondenz Blatt der deutschen Gesellschaft für Psychiatrie; Irren Freund ; Medizinische Jahrbücher, herausgegeben von der K. K. Gesellschaft der Aerzte, Vienna; Revue des Sciences Médicales en France et à l'Etranger, Annales et Bulletin de la Société de Médécine de Gand; Le Progrès Médical; Archivio Italiano per le Malattie Nervose e per le Alienazioni Mentali; Annali Frenopatici Italiani Giornale del R. Mani. comio di Aversa e Della Società Frenopatica Italiana Diretti dal dott. Car. B. G. Miraglia ; Medizinische Jahrbücher (Zeitschrift der K. K. Gesellschaft der Aerzte in Wien); Rirista di Discipline Carcerarie in relazione con l'Antropologia, col Diritto Penale, fc., diretta Da Martino Baltram Scalia ; Rivista Clinica Di. Bologna, Diretta Dal Professor e Larigi Concato e redatta Dai Dottore Ercole Galvani ; the American Journal of Insanity; The Chicago Journal of Nercous and Mental Disease; The British and Foreign Medico. Chirurgical Review; the Dublin Quarterly Journal ; The Lancet ; The London Medical Record; The Practitioner, a monthly Journal of Therapeutics, edited by W. L. Brunton, M.D., F.R.S.; the Medical and Surgical Reporter, a weekly Journal, by D. G. Brinton, M.D.; the Medical Times of Philadelphia. Also the Morningside Mirror ; the York Star; Excelsior, or the Murray Royal Institution Literary Gazette.

THE JOURNAL OF MENTAL SCIENCE. [Published by Authority of the Medico-Psychological Association.]

No. 93.

NEW SERIES,

NO 57.

APRIL, 1875.

Vol. XXI.

PART 1.-ORIGINAL ARTICLES. The Morisonian Lectures on Insanity for 1873. By the late

DAVID SKAE, M.D., F.R.C.S.E., Physician-Superintendent of the Royal Edinburgh Asylum, &c., &c. Edited by T. S. CLOUSTON, M.D., F.R.S.E.

(Continued from Vol. xx., p. 211.)

LECTURE V.*

Syphilitic Insanity.—This is the first of the varieties of insanity in Dr. Skae's classification that is due to the action of a poison introduced from without. As might be expected, its symptoms are much more definite than those of the more constitutional and hereditary varieties of mental alienation. Something, too, is known of its pathology, and yet it is only about twenty years since the fact was recognised that the syphilitic poison could produce mental derangement at all. It has been described by English, French, and German authors on insanity and syphilis, but Dr. Wille, the latest German writer on the subject, has given us by far the most complete account of the disease in all its forms so far as it is at present known. An excellent abstract of his paper appeared in the “Journal of Mental Science” for January last, by Dr. Addison. † It is one of the forms of insanity that must be studied in connection with the other syphilitic affections of the nervous system, if we wish to understand it. To describe its symptoms without reference to the syphilitic form of epilepsy, of paralysis, and neuralgia, would be a mistake in every respect. Dr. Reade, of Belfast, and Dr. Todd, of London, were the first in this country to direct special attention to the occurrence of mania as a direct result of syphilis.

To prevent mistakes, it may be mentioned that this lecture was written entirely by Dr. Clouston.-T. S. C. + Jo. Ment. Sci., Jan., 1873.

They both showed that it was one of a train of symptoms that had the specific infection for its starting point; that those symptoms proved clearly that the nervous system, both spinal cord and brain, as well as their membranes, were involved in such cases, and that whatever cured the syphilis cured the neuroses. Dr. Duncan published three very interesting cases of syphilitic insanity in 1863.* Dr. Hugh Grainger Stewart published three cases in 1870.1 Dr. Wille has collated the symptoms of 77 cases of syphilis, in which there were mental symptoms of one kind or other. Many of Lancereaux's cases, given in his work on syphilis, have mental impairment or disturbance as a part of their history.

Those cases vary much in their history and symptoms, but they have certain points in common that enable us to form a picture of a typical case of syphilitic insanity.

Such a patient has had constitutional syphilis, and has suffered more severely than usual from the headaches, aggravated at night, that characterise the disease. Those headaches are increased by pressure, are deeply seated, and may be felt either in the frontal or occipital regions. He usually has pains in the neck, and a general hyperæsthetic condition of the nerves. Sleeplessness then occurs, sometimes from the severe pains, sometimes as an independent symptom. At this stage there are often motor and sensory disturbances, such as slight paralysis of the face, eye, or extremities, spasmodic disturbances, epileptiform attacks, giddiness, local anæsthesia, disturbances of co-ordination, and loss of sight or hearing. The first purely mental symptom that makes its appearance, and it is almost invariable in all the cases of syphilitic insanity- is depression of mind, and hypochondriacal fears. The patient has a morbid fear as to the effects of the syphilitic infection; he thinks he is going to die, and there is a loss of energy and originating power of mind. Lancereaux calls this a syphilitic neurosis of the intelligence. This depression of mind may continue for some time, and then pass away, having been the only mental symptom present, especially if the syphilisis cured; in other cases it remains, and other psychical affections appear. The patient begins to lose his memory, and his mind gets impaired generally, the mental condition gradually getting worse, and passing into a deep dementia, without the occurrence of any other symptom. This was the course of the disease in 34 of Dr. Wille's 77 cases. In other six this steady downward course of the patient was broken by attacks of maniacal, melancholic, or delirious violence. The rapidly progressive mental weakening is very often associated with progressive motor paralysis of the extremities. Some such cases in their physical and mental symptoms simulate general paralysis very closely, but the previous occurrence of the constitutional symptoms of syphilis, the absence of delusions of grandeur, the usual youth of the patient, and, above all, to the practised eye, the absence of the true general paralytic want of co-ordination of the muscles, sufficiently distinguish the two diseases. After the dementia has existed for some time the case may be regarded as hopeless, and the prospects of the patient's living long are fortunately small.

* Brit. Med. Jo.

+ Dublin Qu. Jo. of Med. Sci., 1863.

Such is a typical form of the malady, but who that knows the protean symptoms of constitutional syphilis would expect all the cases of syphilitic insanity to be alike? Before they reach the goal of confirmed dementia, whither they all strongly tend, and where nine out of ten that have not been cured in the early stage terminate very quickly, the minority, as they run their course, exhibit a wondrous variety of symptoms.

In certain cases, as pointed out by Griesinger, where there is pre-existing disease of the brain, where there have been previous attacks of insanity, or where there is a strong hereditary predisposition to nervous diseases, an attack of syphilitic insanity may break out within two weeks after infection, being contemporaneous with the first secondary symptoms, or it may even precede them. In such cases the preliminary hypochondriacal mental symptoms scarely appear at all, but the patient at once passes into a state of acute delirium or maniacal fury. Such cases are not so uniform as the others, sometimes the mania alternating with melancholia, sometimes disappearing for a time, the patient appearing to be quite well, or lastly, assuming the type of ordinary idiopathic insanity. Dr. Hugh Grainger Stewart's cases were of this kind, and he points out that they all had the following points in common-1. The character of their delusions (that they are the victims of conspiracy, persecution, and spiritual influence). One of them imagined that he underwent a kind of nightly torture called by him the “ Cylinder finish; that most ingenious machines were introduced into her brain to torture her; the third that people shot vitriol, ammonia, and “black poison” at him all night, to avoid which he

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