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ner: first, he leads them to believe that they are wolves, so that, blinded by fancy, in their own proper human form they actually attack and wound men and cattle; second, while really in deep sleep, they dream that they are wandering about and injuring men and cattle, their master the devil meanwhile doing that which their disordered fancy pictures to them; third, Satan impels real wolves to do some mischief, and at the same time so affects the imagination of lycantropes, as to cause them to believe that they are the guilty parties.

Majolus (Dier Canalic, t. 2, colloq. iii.) relates that a prisoner was brought by some peasants to a Duke of Prussia, accused of wounding cattle. He was deformed, and had wounds in his face, caused by the bites of dogs. He confessed that, twice a year, about Christmas and at the feast of St. John the Baptist, he was in the habit of assuming the form of a wolf, and that it caused him much trouble and discomfort when the hairs made their appearance, and he underwent the metamorphosis. He was kept in prison for a considerable time, but, although carefully watched, no transformation was observed.

William of Brabant states that a reasonable man was so deceived by the art of the devil, that many times in the year he thought himself to be a raving wolf: without sense, he wandered about in the woods, and especially followed little boys. At last, by the grace of God, he recovered his reason.

Knights not unfrequently condemned lycantropes to the stake.

Chiefly through the exertions of Wierus of Brabant, physician to the Duke of Cleves, the true nature of lycantropy and other similar diseases was at length recognized, and the unfortunate victims of the delusion became objects of pity rather than of punishment. Considering the period at which he lived, the exhortations of Wierus are particularly strong, and his statements remarkably explicit. In his work, "De Præstigiis Dæmonum, et Incantationibus, et Veneficiis,” Wierus appeals to the emperor and the state, and implores them to spare the guiltless dæmoniacs who are, he asserts, for the most part maniacal persons, or melancholics, or poor hysterical women.

The doctrine of lycantropy probably arose from the belief in the existence of good and bad spirits, and from the intimate relation which existed between the primitive pastoral nations and their animal companions. Evil deeds, it was thought, were punished by change after death into one of the lower animals, and virtuous deeds rewarded by a progress in the scale of organization. Thus Lycaon's metamorphosis was referred to the anger of Jupiter at his crime of serving up human flesh at a banquet. It was and is still usual to represent bad spirits in the form of animals of prey, with claws; thus, in the Indian mythology we find them figured as dogs, cats, tigers, etc. The middle ages were deeply imbued with this notion ; the devil was pictured as a goat, and magicians, sorcerers, and witches, were described as assuming the form of cats,

Now the opinions and modes of thought of the age usually give the form and colouring to the delusions of the insane. The disordered mind, like a mirror, reproduces only what it has received. It may render back its impressions more or less truthfully, more or less distorted, and in an almost endless variety of recombined forms, but it does not exert any creative power. In our day, delusions take their colouring

In 1521, Peter Burgot and Michel Verdung, both lycantropes, were burned at Poligny.-(Wier de Præst Dæm, lib. 6, ch. xi.) According to Fincelius (De Mi-or of noxious or disgusting animals. rabil, lib. xi.) in 1541, a peasant of Pavia maintained that the only difference between himself and a real wolf consisted in this, that in a wolf the hairs of the skin are external, but in himself turned inwards. In order to test the truth of his story, the judges, before whom he was brought, made incisions into his legs and arms; at length, however, they declared him innocent, and delivered him over to a surgeon, but he died a few days afterwards from the wounds. A person labour-chiefly from physical science; absurd notions respecting under this delusion was brought to Pomponatius. The peasants wished to have his skin removed, to see whether the hairs were turned inwards. Pomponatius, however, refused to comply with this demand, and by suitable treatment soon cured the man of his delusion. -(Schottus' Physica Curiosa.)

ing steam, electricity, magnetism, etc., have usurped the place of those derived from the poetical religious myths of the credulous middle ages. Some delusions, indeed, being founded upon passions which always exist in the human breast, are common to every people in every age. But it is only during the middle ages that we observe numerous instances of the rapid spread of such epidemics as the St. John's and St. Vitus's dance,-as the children's crusades, as lycantropy,— and as the various delusions and irrational acts founded upon religious ideas, which abounded in cloister life, and are so ably recorded by Hecker, Calmeil, and others.

In 1574, the parliament of Dôle, Franche Comté, sentenced Gilles Garnier, called the Hermit of the Bonnet, to be burned alive, because as a wolf he had killed several children. From 1598 to 1650, lycantropy prevailed as an epidemic malady among the inhabitants of the Jura mountains, and it has been computed that as many as six hundred persons were executed as lycantropes or demonomaniacs. Among these I may mention,-Pernette Gandillon, who be- FATAL FIRE IN A LUNATIC ASYLUM IN NORWAY.lieving herself to be a wolf was torn to pieces by an A fire broke out in the night of the 5th of January, in infuriated mob; her brother Pierre Gandillon, his son the Public Lunatic Asylum of Bergen, Norway. The George, and his daughter Antoinette, who, labouring firemen were immediately on the spot, but the conunder a similar delusion, were all condemned to be flagration spread with such extraordinary rapidity, strangled by the hangman and then burned. Ano- that all efforts to get the fire under proved unavailing. ther unfortunate, at Chalons, was condemned by the There was not even time to get all the 268 patients parliament of Paris to be burned.-(Vide Calmeil, out. Out of that number 22 were not to be found, and tom. i., p. 279.) In Prussia also, the Teutonic must have perished in the flames.-Continental Paper.

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On Bed Sores occurring in the Insane, or Asthenic
Gangrene, by J. C. BUCKNILL, M.D. Londin.

Few conditions occurring in the insane are more painful to witness, more desirable to prevent, or more difficult to remedy, than the death and separation of the skin and muscular tissues of the back, usually denominated bed sores.

to us from other asylums, reported 'violent and dirty,' sometimes remark, that they could not be otherwise than dirty, when they were chained down in a deep bed like a trough. The same patients being freed from all restraint the moment they arrive at Hanwell, seldom prove dirty, and not always violent."

With the discontinuance of such continued pressure and its resulting filthiness, a large proportion of those superficial, but ulcerated and troublesome bed sores attributable to neglect, ceased to occur. A certain All persons conversant with the ward duties of number of these, however, still took place until after asylums well know how heavy a tax upon the health the reform introduced by Mr. Gaskell at the Lanof the infirmary attendants, the care of patients suffer-cashire asylum in the management of wet patients by ing from bad bed sores is liable to become, and how night. Before this period it was generally considered difficult it is to prevent the effluvia arising from them snfficient if each patient was provided with dry bedfrom pervading and rendering insalubrious the sur-ding at the period of retiring to rest: in many asylums rounding air and although, most fortunately, the considered under excellent management, straw or coir patients do not appear to suffer pain from this compli- after being saturated with urine was again and again cation of their state, yet this is not invariably the case. used after being placed in the "drying house,” and There is, moreover, little doubt that the occurrence of the watery parts of the urinary excrement had been rethese mortifications frequently tends to abbreviate the moved by evaporation. The atmosphere of the asylum duration of life. On all these accounts their preven- wards in which such arrangements prevailed, was tion when possible, and their treatment when unavoid- very different from that commonly met with at the able, become matters of the utmost importance to the present time. A considerable proportion of idiotic medical officers of asylums. Those who have been and demented patients lay nightly with the lower conversant with the infirmary duties of asylums for portion of the back saturated with urine. When this the last ten or twelve years must have remarked, excretion was more than commonly irritating, and the among other improvements, the great diminution of skin more than usually irritable, this state of affairs frequency of these gangrenous sores; a diminution to caused erethema of the skin, followed by the formation be attributed to the more generous dietary in general of small pustules which soon became ulcers, and the use, to the physical health and sanitary condition of buttocks of the patient became covered with superthe patients being better attended to, and, above all, ficial sores, by no means creditable to those under to the increased care bestowed upon patients during whose charge he was placed. The only treatment the night, in providing them with dry and wholesome these sores required was the removal of their cause. bedding. By the removal of bedding during the night as often as it became wet; and above all, by cultivating those habits of cleanliness in idiotic and demented patients, which prevent the necessity of such changes of bedding, sores of this description are prevented, and under a better system they rapidly granulate and heal.

Ten years ago it was not uncommon for idiots and others liable to wet their beds, to suffer from excoriations and ulcerations of the back; and looking back to the commencement of a still previous decade, yet another class of the insane, namely, acute maniacs, were liable to excoriations and ulcerations of the back from the irritation of urinous beds, and to gangrenous destruction of the same part from the continuous pressure exercised thereupon during the imposition of mechanical restraint. The abolition of restraint, has among other things rendered it impossible to produce a bed sore in a patient with a tolerable amount of physical energy, and whose sensorium remains impressible by painful sensations. The main cause of avoidable bed sores were formerly attributable to so-called dirty habits, and the injurious pressure arising from the impossibility of changing the supine position often for many weeks at a time. That the use of mechanical restraint was a necessary and fertile source of dirty habits, the following passage from the physician's report for Hanwell, 1840, clearly proves.

Although sores of this description seldom implicate the subcutaneous tissues, such is not universally the case, and I have admitted some patients in whom the ulceration thus produced was at the same time deep and extensive. In such patients the general health was bad, and it was necessary to recruit the constitutional powers with extra diet, bark and wine, and similar means, before the local affections could be successfully treated: when this had been done. attention to dryness and cleanliness, occasionally a little stimulation, as by diluted Elemi ointment, and protecting the parts by soap plaster spread on chamois leather, effects a cure in a reasonable space of time. I am, however, at a loss to conceive how bed sores and many other evils are prevented in those asylums, where a strict system of night attendance is not carried out.

Having sufficiently noticed this preventable and easily remediable form of bed sore, I proceed to consider the more formidable affection occurring in persons suffering under great deterioration of the nervous system.

"The arms or the hands of the patients were closely confined to the body; or the arms or the legs were chained or strapped to the bedsteads; or the head was confined by a strap round the neck. In this state they were left for days or for weeks in the most miserable condition in which a human being could be placed; and often to the total ruin of all habits of That urinary irritation may cause abrasions and cleanliness. The patients themselves who now come sores in paralytic and demented persons, as well as

in idiots, and that such irritation may aggravate sphacelating sores otherwise produced is no doubt correct: but the true bed sore of the paralytic is widely different from that of the neglected idiot, and arises neither from irritation, abrasion, nor primary ulceration. On the contrary, it is a true mortification, with symptoms resembling those of the dry gangrene of the aged, the bed sores of typhoid patients, and more closely still, mortifications following injuries of the spinal chord.

This form of mortification occurs most commonly in patients suffering from general paralysis; it also occasionally complicates the last stages of dementia, and is now and then seen in patients who have undergone repeated attacks of apoplexy, the effects of which have been great deterioration of the whole cerebro-spinal axis.

the dorsal region, and sometimes with minor degrees of the same condition affecting various parts of the limbs, is truly surprising. It is probable that the state of the nervous system which has caused the local affection prevents the latter from exercising in its turn a prejudicial reaction. The functions of the nervous system are almost in abeyance; mortification results; but the latter cannot produce its usual effects upon the constitution because the nervous system is not in a condition to respond to any amount of irritation. This at least appears a reasonable explanation of the fact, that general paralytics will live for weeks with an amount of sphacelating tissue which, had it occurred from mechanical injury, would have destroyed a healthy person in a few days with delirium, hiccup, and collapse.

This rapid progress and extension of gangrene is indeed a somewhat rare form, being, as I have above mentioned, coincident with a rapid loss of the power of the nerves, while the body is still bulky, heavy, and full of fluid.

To this form of injury the term of bed sore is not strictly appropriate, since it is dependent upon constitutional causes, and would take place should eircumstances prevent the patient from making use of the recumbent posture;* nor does its position correspond invariably with those parts which are subjected to pressure. The appearances presented vary consider-mortification from pressure, as they are more or less ably under different circumstances.

Sometimes the march of general paralysis is very rapid, and the functions of the nervous system are brought to the lowest ebb under which a brief duration of life is possible, before emaciation has taken place. The patient is fat and heavy, the animal juices are abundant, the vessels are full, the mass of blood to be moved is undiminished, while the heart pulsates with feeble languor, and the vitalizing power exercised by the nerves over the tissues is reduced to a minimum. Under these circumstances the existence of extensive gangrene is inevitable, the decomposition of the body commences before death. The patient is too feeble to be supported in the best constructed easy chair, therefore the recumbent position is unavoidable, and mortification is most active in the dorsal region, The relief found in other cases by water cushions and water beds is unattainable, the slightest pressure de termines the occurrence of mortification: the weight of one leg upon another causes mortification of the knees and ancles, or the weight of the legs in the supine posture, sphacelus of the heels. I have seen the weight of the hand and forearm resting upon the abdomen cause the commencement of mortification of the soft tissues so pressed upon. In two instances of this kind I have seen the cuticle peel from the whole of the body in the moist state observed in a rapidly decomposing corpse. Final eremacausis had become active while some vital functions were still languidly performed. In these fortunately rare cases the mortification is what surgeons call moist, bullæ occur, the soft tissues are full of their juices, and probably the blood suffers a contemporaneous death with the parts containing it.

The length of time which some patients will continue to exist with the most frightful mortification of

* The Commissioners in Lunacy have recently obtained the conviction and punishment of an attendant for concealing gan

grenous bed sores on the gluteal region of a patient, produced by

pressure on a hard seat.

Sir Benjamin Brodie, who is, so far as I know, the only English surgeon who has written on bed sores, states that "patients are more or less disposed to

emaciated. A man with a cushion of fat between the skin and the sacrum, or the skin and the great trochanter, is in less danger from such mischief than another person."

However true this may be concerning the class of persons of whom it was written, of patients undergoing long continued confinement to bed on account of severe surgical diseases, it is the reverse of correct in general paralysis; it is doubtful to what extent it is correct of persons suffering bed sores after attacks of typhus fever, such disease being a most certain and effective cause of emaciation, which is therefore always a concomitant of nervous exhaustion. But in the worst cases the gangrene of paralytics does not originate or confine itself to the parts over the bony prominences above mentioned. It often attacks those parts where the fleshy cushion is the thickest, as the gluteal and lumbar regions, and its severity bears an inverse ratio to the amount of emaciation.

These early and severe cases bear a strong resemblance in the appearance of the parts to traumatic gangrené, and mortifications of the moist kind. The skin becomes dusky red, then brownish and mottled, and eventually black. Bulla often at the same time form on the fingers and feet, and the parts not subjected to pressure. In these cases a line of demarcation is seldom formed, the granulating process is not established, and no sloughs, properly so called, are separated. Such is the kind of mortification observable in those rare cases of general paralysis, wherein the degradation of the nervous system is rapid in its progress. Patients thus afflicted seldom survive more than three weeks or a month.

A less formidable variety of gangrene is observable in the last stages of general paralysis whose march has been more gradual, in patients who have been shattered by attacks of apoplexy invading both sides of the cerebrum, and in extreme degrees of dementia. Patients in these conditions are for the most part This variety of gangrene

emaciated to some extent.

So long as this was done, the ulcers became and remained well, but as soon as the man was allowed to use his hand, the pressure on the nerve was renewed, and the ulceration of the parts supplied by them returned."

differs from the one above sketched in being dry ulceration of the back of the hand, from injury of the rather than moist. It resembles gangrena senilis median nerve; another, of ulceration of the thumb, rather than traumatic gangrene. It is moreover less middle, and fore finger, from compression of the deep and more chronic than the former. A portion of median nerve, from pressure of a hypertrophy of bone the skin from two or three to six or eight superficial following fracture of the radius. "This ulceration inches in extent becomes reddish, mottled brown, resisted various treatment, and was cured only by so and then black. After a time a narrow line of demar-binding the wrist, that the parts on the palmar aspect cation is formed, and a thin dry slough is separated. being relaxed, the pressure on the nerve was removed. Very often this form of gangrene does not penetrate through the true skin; after separation of the slough, healthy granulations form, and the sore frequently heals in a short time. The healing process in such cases of general paralysis is not uncommonly observed to be remarkably rapid. I have observed that scarifications for erysipelas and other incisions made for surgical purposes, generally heal in such patients by adhesion: even when mortification is taking place on the dorsal and other regions, old sores will granulate and heal with rapidity, presenting the simultaneous occurrence of the destruction and reparation of neighbouring parts.

Such, however, is not always the case, especially in the instances of rapid decay referred to above. In these the small amount of vital power remaining appears unable to institute the slightest animal reparation. In these, whatever decomposed tissue separates, it does not form a slough in the true sense of the term; it loses consistence and tenacity, and separates by decomposition alone, no granulation process being set up.

In his lecture on mortification, Mr. Paget observes, "Lastly, we may enumerate among the causes of death of parts the defect of nervous force." "When a part is severely injured its nerves suffer proportionate violence, and their defective force may add to the danger of mortification in the old; not the blood alone or the tissues are degenerate, but the nervous structures also; and defective nervous force may be in them counted among the many conditions favourable to senile gangrene, and so yet more evidently the sloughing of compressed parts is peculiarly rapid and severe, when those parts are deprived of nervous force, by injury of the spinal cord or otherwise."—p. 463.

Sir B. Brodie, in his first lecture on mortification, observes, "This kind of mortification from pressure takes place under certain circumstances more comPathology of the Gangrene of Paralytics. monly than under others. A patient is weakened by There can be no doubt that the cause of this af- continued fever and from the state of debility in which fliction is the defect of nervous influence. From the he then is, pressure on the skin over the os sacrum, similarity of some of the symptoms presented in these the great trochanter, or other projecting parts of bone, cases to those observable in scurvy, the facile pro- will produce mortification, while it would not produce duction of bruises, the not unfrequent occurrence of it if he were in a state of health. After injuries of the petechial spots, and vesciations containing bloody spinal chord, mortification from pressure is very readiserum; it might indeed be supposed that some generally induced. In a case in which the spinal chord is dyscrasia of the blood was a main cause of these local deaths. It may indeed occasionally happen that a scorbutic condition of the blood is superadded to other elements of disease. Such patients are often fed for long periods of time with spoon meat, and if beef tea, arrowroot, and similar articles of diet, are used exclusively, the true symptoms of scurvy may be induced. I have on more than one occasion seen patients kept for a long time on a strict sick diet suffer in this manner from the inadvertence of the medical attendant.

injured in the middle of the back, you may find almost before you suspect that there is anything wrong, a great slough over the sacrum, nay, the pressure of the mattrass on the ankles, will in such cases produce the same mischief. I have known mortification begin in the ankles within twenty-four hours after injury of the spine; and a remarkable circumstance it seems, that injuries of the spinal chord should thus lessen the vital powers, so as to make the patient liable to mortification, when we consider how many circumstances there are, which would lead us to doubt whether the nerves have any influence over the capillary circulation.”— Lectures on Surgical Pathology, p. 308.

The affection, however, now under consideration has no immediate relation with the general condition of the blood. It depends upon the cessation of nutri- This appears to be one of the many instances in tion and the consequent death of the tissues and the which, reversing the natural course, pathology throws blood contained in them, from the abstraction of ner- light upon physiology: the above facts prove, that vous force. The manner in which the nervous force whatever may be the case in lower organizations, in affects the nutritive process is by no means well the higher animals at least, the nutrition of parts is understood. That it does however exercise "a direct dependent upon the integrity of the nervous system; influence," ," "the facts bearing upon the question seem and that mortification or local death results from absufficient for the proof."-Paget on Surgical Patho-straction of the nervous influence. In the report on logy, p. 41.

The cases adduced by Mr. Paget to illustrate the results of abstraction of nervous force are; one, of destructive inflammation of the tunics of the eye and ulceration of the cornea, &c., arising from destruction of the trunk of the trigeminal nerve; another of

the Devon asylum for the year 1851, I expressed my opinion, that the pathology of general paralysis consisted in an atrophy of the whole nervous system; and I based that opinion, as far as the cerebral centres are concerned, upon observations shewing the constant existence of positive and appreciable atrophy. These obser

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