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Of the Seat and Proximate Causes of Insanity.IT is only for the last few years that medical students have

had the opportunity of making themselves familiar with thephenomena of unsound mind, and that those phenomena havebeen brought before their minds, and elucidated by lectures.This boon, thus lately conferred, is owing much to the en-lightened and liberal views of Dr. CONOLLY; and THE LANCET,being impressed with the value of the lectures that ablephysician delivered at Hanwell, and being desirous of extend-ing the information conveyed in them to the profession gene-rally, wisely published them in full in its pages.

In the attention bestowed on mental diseases, a few yearsback rather than at present, the French far surpassed us, byputting before the rising generation of practitioners the meansof acquainting themselves with mental diseases, by lecturesand demonstrations. The great ESQUIROL was one of thefirst to become a teacher of mental pathology, and in this office he is now followed, at the Salpetriere, by a distinguishedpupil, M. FABRET, and also by M. BAILLARGER. The formerphysician, M. Fabret, in his recent course, has been engagedin the examination of some of the most important and obscurequestions met with in the pathology of insanity; such as itsseat, its internal causes, organic or proximate. Of the views given by M. Fabret, and as reported in the Gazette desHôpitaux, we will now offer a sketch.

Madness is essentially idiopathic or localized in the brain ain all cases, when it has not been preceded or accompanied ’by any affection foreign to the encephalon, the cure ofwhich has been sufficient to remove or put a stop tothe madness. In very many cases, the encephalic originof insanity is not called in question; but it is not so when itis undertaken to appreciate the influence of preexisting or ofconcomitant affections far removed from the principal nervouscentre. From the fact, that other lesions have preceded theappearance of madness, it does not follow that they have pro-duced it, or that their cure would have prevented its develop-ment. The problem becomes complex, and to solve it wemust establish a definition: by the words, seat of insanity,we are to understand, the point whence it sets out from therecesses of the organism-a point which may be placed inanother organ than that whose functions are disordered.From the functions of the brain, the appreciation of causeswhich may modify it, and post-mortem appearances, M. Fa-bret concludes that insanity from sympathy forms the excep-tion, although a very frequent one. Among certain women,the accession of insanity corresponds to the occurrence ofpregnancy, and then to treat the brain is vain; cure followswhen delivery occurs, and the uterus returns to its ordinarycondition. Visceral affections, which develop apyretic deli-rium, act more frequently as predisposing than as exciting causes. They determine a state of irritability, which gives tomoral causes acting, a power they would not otherwise possess;they can rarely develop insanity of themselves. But in everycase it is impossible to measure the influence of causes whichhave concurred to produce the same result.The organic causes of madness are of two kinds-encephalic

causes for idiopathic, visceral for sympathetic insanity. Ac-cording to M. Fabret, delirium is the necessary expression ofa derangement of the brain. The presence of anatomicalchanges in the brain is the rule, their absence the exception;but as to the determination of the value of these changes asproducing causes, there is much yet to be desired. Carefulinvestigations on the dead subject have detected frequent co-incidences between certain anatomical lesions and certainforms of madness; but these relations are not constant. How-ever, it is certain that insanity may exist without the co-existence of anatomical alterations in the encephalon-i. e.,so far as our senses can discover.Now, respecting the internal causes of sympathetic mad-

ness. Affections of the digestive tube are a frequent cause.M. Fabret believes, that in those predisposed to unsoundnessof mind the gastro-intestinal canal is oftener deranged in itsnervous supply and functions than it is inflamed, and that thetreatment should be directed rather to a neuralgic affectionthan to an inflammatory.

Diseases of the liver, of the urinary apparatus, and of thegenital, have each and all a real influence in the productionof insanity, and it may be remarked, that they tend to de-volop a form of madness characterized by sadness andmelancholy.Madness is most frequently idiopathic; mania and mono-

mania especially so. In melancholia, visceral affectionsand disorders of organic life are more frequent and moremanifest, whether they have preceded or followed the onsetof the melancholy condition.

Diagnosis of Skin Diseases.M. DBVERGIE, in order to render the diagnosis of cutaneous

affections more easy, has divided them into two classes-viz.,secreting and non-secreting, and then subdivided them accord-ing to the character of the secretion, its colour, the appear-ances, the surrounding redness, &c. The following table willgive an idea of the plan :-

I.—The secreting cutaneous diseases.a.-Serum. Eczema; pityriasis acute, (red;) eczema lichen-

oides ; herpes phlyctenoides; scabies, (the serous form;) pem-phigus ; secreting intertrigo.

b.—Sero-purulent fluid. Eczema impetiginoides; purulentintertrigo.

c.-Sero-purulentandsanious. Rupia; ecthyma, (cachectic.)d.-Pus. Impetigo ; purulent acne ; purulent scabies;

ecthyma; pustular sycosis.e.-Fatty matter. Acne sebacea; acne punctata.

II.—Non-secreting cutaneous diseases.a.-Redness, fugacious. Erythema; urticaria; roseola; in-

tertrigo, (non-secreting.)b.-Redness persistent. Purpura; scurvy.c.-Redness with papulm. Acute lichen; strophulus.d.-Redness in round patches, with scurf. Herpes circina-

tus, and nummularis.e.-Redness, diffused with scurf. Pityriasis rubra.f.—Reduess, with thickening of the skin and scales. Pso-

riasis ; lepra vulgaris.g.—Green colour. Pityriasis versicolor.h.—Black colour. Pityriasis nigra.i.-Scales or scurf, white or coloured. Ichthyosis, (white;)

ichthyosis, (brown;) chronic pityriasis.k.-Papula. Chronic lichen; prurigo.d.—Tubercles. Tubercular sycosis; lupus.m.—Vegetable productions. Favus; herpes, (decalvent;)

porrigo decalvans.n. Animal productions. Acarno, &c.

ACADEMY OF SCIENCES.

Influence of Ether on Respiration.M. V ILLE addressed an account to the Academy, of the re-

sult of the experiments he had made, in conjunction withM. Blandin, on etherization. They have confined their expe-riments to the influence of ether on respiration, and the coii-clusions at which they have arrived are just the reverse ofwhat they had supposed. In fact, in that state of completeinsensibility where the sight seems lost, where the limbs havelost heat and, often, the power of motion, respiration developsmore carbonic acid than in the opposite condition, where theplay of the organs can go on freely and naturally. In theprogress of etherization, the carbonic acid thrown off duringrespiration always augments in quantity in proportion as sen-sibility becomes enfeebled, and, on the contrary, diminishes assensibility returns and is reestablished.The following are some of the results of the experiments -Carbonic acid During the Ether con- Duration of inha-

produced during state of tained in the lation. -natnral insensihilitv_ air inhaled_

lation. .

Although the ether agitation is still very rife in France, andthe inhalation of ether is tried, and, as we would deem, veryrashly, in all kinds of diseases, yet we have lately laid but fewaccounts respecting this topic before our readers, since it hasalmost occupied sufficient space, and there has been little to addof much value. We have, however, given the above brief ab-stract, as appearing interesting, and we may hereafter give asummary of the cases in which etherization has been tried,

I with the results witnessed.

British & American Medical Journals.’ EMPLOYMENT OF SULPHURIC ETHER VAPOUR IN MONTREAL,

QUEBEC, ETC.This agent has been employed in Quebec, Montreal, and

Sherbrooke, but not with uniform success. In Quebec, Dr.James Douglass amputated the toes of a man, who had beenI previously narcotized by the inhalation of the vapour. Morei lately, in Montreal, Dr. Nelson removed a tumour from the

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thigh of a woman under similar circumstances of narcotism.The removal of a leg by Dr. Worthington, of Sherbrooke, waseffected under a like state of insensibility from the same cause.In these three instances the successful use of the ether-vapourwas complete. At the Montreal General Hospital, circum-stances lately demanded the amputation of the leg of a patient.Several protracted attempts were made, and at different in-terval?, under Dr. Campbell, to induce the narcotic effects ofthe ether, but without success; the leg was afterwards removedin the ordinary way. As the man had been of very intem-perate habits, it becomes a question how far these habits mayhave influenced the susceptibility of the patient to the in-nuence of the ether.

ERYSIPELATOUS INFLAMMATION OF THE FAUCES AND THROAT.

Several cases of an acutely fatal form of inflammationaffecting the throat and fauces have recently presented them-selves in London. The same disease appeared some three orfour years ago, in the wards of one of our large hospitals,where several of the patients fell victims to it. Its extensions

at that time, to some of the officers proved its contagious cha-racter, whilst its origin and progress, as in the following case ,showed its connexion with erysipelas.The patient, aged thirty-six, robust, and temperate, exposed

himself to cold after being much heated. He complained offeverishness, and slight sore throat. His medical attendant,Dr. FRAZER, being sent for at two A.M.,found him complainingof excruciating pain,"shooting from throat to left ear. The parotid was swollen;the tonsils, velum, uvula, and pharynx, were intensely red andgreatly swollen, especially the latter, which was twice itsnatural size. He had much difficulty in swallowing andbreathing, spoke in a hoarse whisper, and was obliged to sitin an arm-chair, in consequence of the dyspnoea; pulse 132, ofgood strength. Took twenty ounces of blood from his arm;scarified tonsils and uvula. Ordered linseed poultice to throat;tartrate of antimony, four grains ; nitrate of potash, onedrachm; water, four ounces: mix. Give a tablespoonful everyhalf hour till sickness supervenes.-Eight A.M.: Respirationand deglutition still difficult; is unable to lie in bed on accountof dyspiacea; very restless; bowels moved freely by mixture;pulse still good; took sixteen ounces more blood from his arm.Ordered six leeches to be applied to his throat; mixture to becontinued every two hours; to use a sugar-of-lead and opiumgargle for throat, and an inhaler.-Seven P.M.: bowels openedfrequently; breathes and swallows rather easier. Continuemixture every fourth hour.

" Next day, I was called to him at five A.M., on account ofswelling of the nose, which prevented his breathing freely;found him much alarmed, the membrane swollen, and thecontinuous skin, for half an inch on each side of nose, havinga distinct erysipelatous appearance, evidently extending; healso complained of general headach, especially over frontalsinuses. Cleared out nostrils, and applied two leeches toSchneiderian membrane, which bled freely. Directed sugar-of-lead and opium wash to be applied warm to nose externally.- Eleven A.M.: Has found great relief from leeching andlotion; headach and difficulty of respiration much alleviated;erysipelas spreading on face. Omit mixture; continue lotion;soda-water for drink."

From thence the disease spread over the face and scalp.The treatment, successfully applied, consisted of ammonia,quinine, and general support.The reporter, Dr. Frazer, makes the following remarks :-"This case is chiefly interesting on account of the disease

originating in the throat, as it is not usual for erysipelas tooriginate in a mucous membrane; in the majority of casesaffecting the head, it first shows itself about the ears or cheeks,and thence extends over the face to the scalp, and occasion-ally over the nostrils and lips to the fauces and pharynx. Inthe above case, it, on the contrary, first declared itself in thethroat, and extended, not only through the nose to the face andscalp, but the symptoms also indicated its extension to thelarynx and oesophagus, which was the chief cause of thepatient’s distress and imminent danger. I may mention, asanother illustration, that erysipelas occasionally originates inmucous membranes; that during the whiter of 1842, an epi-demic, first affecting the throat, prevailed extensively in manyparts of this continent.

" The exciting cause was apparently cold, as erysipelas was

not epidemic at the time; the most prevailing complaint wasa species of catarrh accompanied with sore throat. This ap-peared for the first few days to be, and probably was, thepatient’s case, but owing to some predisposition, the local in-flammation assumed an erysipelatous action, which appearedto me to have propagated itself to one of the patient’s children,and to a friend living in the same house.Opposite plans of treatment have been, and still are advo-

cated by authors of the greatest respectability-depletion bythe one, and stimulants and tonics by the other. In the abovecase, owing to the intensity of the inflammation of the throatand larynx, the treatment was necessarily very active; thepatient was twice bled and once leeched, before the diseasedeclared itself on the skin. The effects of such active treat.ment in erysipelas are worthy of remark."—British AmericanJournal.

ETHER-VAPOUR USED UNSUCCESSFULLY PER ANUM.

The following case is taken from a small pamphlet (a reprintfrom the Bfadras Spectator) forwarded by Dr. J. T. JOHNSTONE.It affords little encouragement to repeat the operation:-" A. B-, European, a strong, healthy-looking man, having

hydrocele on the left side, of about one year’s standing, pre-sented himself at my house for operation, on Thursday, 1st ofApril, and wished to be put under the influence of ether pre.viously. Having on the day previous, as recommended byAssistant-surgeon Crawford, used the vapour of ether as anenema, by way of experiment, on three dogs, with the effectof producing symptoms of drunkenness, attended by vomitingand apparent diminution of sensibility in each case, I con-sidered the present a fair opportunity of trying it in this wayon the human subject. I put one ounce of ether into a com-mon bladder with an ivory pipe, placed the bladder in hotwater, and forced the vapour into the rectum as it evaporated.The patient immediately complained of much uneasiness, saidhe felt as if I were throwing boiling lead into him, wasgriped, and tasted the ether in his breath. His breath alsosmelt strongly of it. In a few minutes he felt so much dis-tended, was griped, and felt altogether so uncomfortable, thathe made me discontinue the injection, saying that he wouldrather suffer the pain of the operation than go on with it. Idid so, and performed the operation for the radical cure in theusual way. He did not feel at all affected by the ether, andthe pain of the operation seemed as much as usual. It isworthy of remark, that in the course of the first week afterthe use of the ether, he passed from fifteen to eighteen lum-brici, varying from two to six inches in length. They wereall dead when passed. He had taken no medicine exceptinga dose of castor oil."

REPORT OF THE ROYAL BDINBUBGH ASYLUM.

The following extracts, showing the great improvementwhich is daily taking place in the management of the insane,promoting the comfort, if not accomplishing the cure, of allthe members of this unhappy class, are taken from the AnnualReport (for 1846) of the Royal Edinburgh Asylum, under themanagement of Dr. Skae :-

Cures.-" There have been discharged from the institution,during the past year, 140 patients, of whom 101 were reco.vered, and 39 more or less improved. The recoveries werethus in the ratio of 24.674 to the mean number resident, and51.269 to the number of admissions. The proportion of thetotal number discharged, including those more or less im-proved, is 34.168 and 71.0659 per cent. to the mean numberresident, and the number admitted respectively."Deaths.-" During the past year, the deaths were 44, giving

a ratio of 10.738 per cent. to the mean number resident, andof 22.335 to the admissions. The mortality is somewhathigher than on former years; but it is a matter rather of sur-prise than otherwise that it should be so low as it is, consider-ing the number of incurable and protracted cases which haveaccumulated in the institution."

The frequency of tubercles." The table of deaths and morbidappearances shows how large a proportion of these cases werethe results of tubercular phthisis, or of that form of cerebraldisease, not less surely fatal, called general paralysis. Thetable also illustrates an interesting fact, referred to in lastyear’s report-namely, the frequency of tubercular depositsin the insane. Even in a large proportion of the cases inwhich phthisis was not the immediate cause of death, dissec-tion showed that the seeds of it were there, and only wantedtime for their development. Out of the nineteen dissections,in which an examination of the chest was made, tubercleswere found in the lungs in thirteen. Whether these facts

51

prove, as at first sight they appear to indicate, a close con-nexion between the tubercular diathesis and the predispositionto insanity, can only be determined by a comparison of thepost-mortem appearances in an equal number of cases takenfrom the experience of a general hospital." . .:’

When, we may add, from our own experience, it will beound not far below the numbers here indicated.

"The other tables speak for themselves; they show thecurability of even the most hopeless forms of cerebral disease,our cases of dementia having been discharged cured, andfourteen of melancholia. They also exhibit cases of recoveryafter a protracted derangement; but, at the same time, theypointedly illustrate the important truth so often impressedupon the public by those most conversant with the statisticsof insanity-namely, the unspeakable importance of earlyseclusion in every case of mental alienation."

The non-restraint system.—Dr. Skae writes," Since thecommencement of my residence in the asylum, I have devotedmyself energetically to the furtherance of those great prin-ciples which distinguished this institution during the regimeof my esteemed predecessor—non-restraint and kindness, aidedby all those appliances which are comprehended under theterms hygiene and moral treatment."Amusements.-" The weekly concert and ball has continued

to afford its quota of amusement and interest to the patients.The routine of the evening has been varied and enlivened from time to time, as circumstances would permit, or oppor-tunity offered. Songs sung, and dances performed, in appro-priate costume by the patients or attendants, afforded onesource of variety. On other occasions, the contributions ofprofessional and amateur performers have added greatly tothe interest of the evening. On one Thursday, the usualviolin and violoncello performers, tenacious enough of theirown excellencies, of which I would not express myself dis-paragingly, gladly gave place to a band of German performers,whose brass instruments delighted every one not less withwaltzes, and airs from the most favourite operas, than withtheir performance of several of our most admired nationalmelodies. On another occasion, the accomplished author ofthe "Old Gentleman," and a distinguished comedian, madethe most melancholy faces in the whole assembly relax intosmiles at their comic songs." An attempt has been made within the last few weeks to

introduce additional means for awakening new and healthytrains of thinking among the inmates of the asylum, bycreating new sources of interest. Of these I may mention,what, I trust, is only the first of a series of lectures, a lectureon chemistry, with experiments, delivered by Mr. LNIacadamto a larare and most attentive audience."

To these sources of attraction are added, besides the numerous minor amusements, " a curling pond," country ex-cursions, a school for imbeciles; and the Morningside Mirror,issuing from the asylum press, is not the least interestingevidence of progress. Journalists can enjoy no highergratification than to record instances of human advancement,such as reports like this display.

THE ARTIFICES OF QUACKS.

The following communication, by Mr. ROW.NTREE, is takenfrom the same journal, and may convey a useful warning tosome of our readers. It is the old trick revived, of Mr. M."buying no other than Mr. D.’s blacking:"-"As it adds materially to the usefulness of your journal, to

report occasionally systems of fraud which come under ournotice, I send you the following, which is but one of severalinstances of which I am cognizant:-

" A few days ago, a respectably-dressed woman came intomy shop, and requested to be served with two two-shilling andninepenny bottles of Dr. B-’s Gout Tincture, at the sametime placing in my hands a circular letter. I replied thatI had not the medicine by me, but that I could procure it forher, from the address mentioned in the bill. She accordinglypromised to call in the evening for it; when I acquainted herthat it was always customary, in cases of this nature, to leavea deposit, especially when the parties were strangers to eachother, to which she made no objection, but placing a shillingon the counter, asked if that was sufficient, to which I repliedin the affirmative. She then left, with an injunction that thebottles should be ready when she called in the evening. Itstruck me, from the eager manner of the person, and thecurious style in which the circular was composed, that it wasbut a trick to get the medicine into my hands. I consequently

instructed my assistant to watch where the woman proceeded.He soon returned, and said that she had entered the very

i place.where the nostrum was prepared! I then very clearlydiscovered that she was herself connected with the prepara-tion, and had resorted to this expedient to enhance its sale.

" The woman certainly returned according to promise, sheknowing very well that the medicine was not fetched fromthe establishment, and that she would, doubtless, get theshilling again. I at once accused her of the attempted fraud,threatened to retain the shilling for my trouble, and said thatI should expose the party through the medium of the press.She answered me nothing, but instantly decamped.

" On a further inquiry, I found that the preparation was oneof the numerous empirical nostrums that are being con-tinually thrust upon us, and that the circumstances, asdetailed by the circular, are only such as would be used by aneedy and daring adventurer. Should this, if inserted, havethe effect of putting the members of our body on their guardagainst the like, I shall consider that I have but performedmy duty in exposing this disreputable system."

A PHYSICIAN’S DUTY TO HIS BRETHREN.There is much truthful advice in the following paragraph,

well put and well contrasted with that contained in the

second :-

" Physicians are aware of the great difficulties and uncer-tainties in their art; they must be sensible of frequent errorson their own parts; how indulgent, then, should they be to-wards the mistakes of others. If there is a sight calculated toexcite pity mingled with disgust, it is tosee medical men judg-ing of each other with harshness and severity; thinking, that bydepressing others they do so much to elevate themselves.Avoid, especially, such a course as this; respect the opinionsof those who have at least had as good opportunities of ac-quiring medical knowledge as yourselves ; cultivate their friend-ship ; draw closer the bonds of catholic brotherhood: so willyou be spared the miseries and vexations of petty warfare,and enjoy self respect and the respect of others.

" By these remarks, I do not wish to be understood that youare to deal tenderly with quacks and quackery. As woe wasonce denounced against scribes and Pharisees—hypocrites, so.must woe be now proclaimed against empirics-the basest ofhypocrites and impostors. Our duty to the commnnity, a re-gard to the greatest good of the greatest number, demands

’ the exposure and denunciation of medical imposture and de-’

ception, whatever garb they may assume, or livery they may, put on."

We must not omit the following bit of characteristic elo-quence:—" Take, pay for, and peruse, the best medical periodicals ofthe day:’-Professor Lee’s (Bufalo University) Address.

MYSTERIES OF THE DRUG TRADE.

The Pharmaceutical Journal thus exposes the evil deeds ofsome unworthy members of the fraternity:-"The article to which we allude is a series of extracts (duly

authenticated) from the’ private pharmacoœeia’ of a chemist.A few specimens will suffice:—Opium—R Turkey opium, onepound; pea-meal beat into a mass, with honey, haif a pound;mix.—Laudanum—R Opium, one pound; boiling water, ninepints; spirit of wine, six pints; spruce beer, one pint; digestand filter.— White wax—R White wax, stearine, eclual parts,melt together and run into moulds.—Fœnugreek.; powder—R Linseed cake, ground with a little of the genuine powderto flavour it--Liquorice powder—Ditto, flavoured with a littleliquorice. —Nux voniica powder—R Oatmeal, twelve ounces;

arsenic, four ounces; umber enough to colour it!—Sweet spiritof nitre_diluted with twenty-five percent. of water.-Sp. ant-monice comp.—R Sp. ammon. co., liq. ammoniæ, p. æq., sp, vinirect. q. s., (to clear it,) &c."Neither is this an isolated case; we have received similar

documents from other correspondents, and have been offered,on several recent occasions, other evidence of the same naturefor publication. This, however, is not the kind of informationwhich we are desirous of furnishing. The above specimensare merely given as an illustration of a system of businesspractised by a class of persons whom it is the interest, as wellas the duty, of our body to expose and repudiate. Such per-sons are not entitled to the name of chemists, and they onlyexist by virtue of the depraved state of the law in this country,which allows every person, however ignorant and disreputable,to exhibit the coloured show-bottles, act as a chemist anddruggist, and bring disgrace and injury on the body with whichhe claims connexion."