Billeder på siden
PDF
ePub

M. Delasiauve, in an address replete with critical acumen, combats the opinions of his able and philosophical antagonist, M. Baillarger, that there are two classes of hallucinations, psychical and psycho-sensorial; and he concludes that no precise and useful demarcation can be traced between the infinitely varying phenomena of hallucination. Each case must be studied by itself in its origin, its symptoms, and its progress.

The conclusions of M. Bourdin are, that hallucination is a conception of the mind, mistaken and accepted for a veritable sensation; that it is a pathological and never a physiological operation; that it is compatible with the normal exercise of most of the cerebral functions; but that it is incompatible with the integrity of the reason.

M. Parchappe finally expresses his opinion on the several propositions of this discussion as follows:-Hallucination is not a simple modification or exaggeration of a normal state of the psychical activity; it cannot be considered a physiological phenomena, but that it is compatible with integrity of the reason in those numerous and authentic instances in which it has not occasioned any error of judgment but has been recognised as an illusion by the individual. As to whether the simultaneous action of the organs of sense and the brain is an indispensible condition to hallucination; this cannot be denied in illusions of of the senses, but in true hallucinations it is not so. The hallucination of sight and hearing in the blind and the deaf, demonstrate that hallucinations is independent of the organs of sense. The action of the organs of sense, however, does not go for nothing in the phenomena of hallucination, since there are incontestible examples of hallucination, associated with sensations, or connected with an actual condition of the sensorial organs.

The Report upon the Foundation, Construction, and Orginization of the French Asylums, by Dr. Van Leeuwen, of Jersey, is reviewed by M. Billod. He repeats all the French objections to the non-restraint system, especially the one that solitary confinement in a padded room is a mode of repression more painful, restrictive to the liberty, and injurious to the health than the use of the strait waistcoat. We observe that Dr. Van Leeuwen has taken up the pen in defence of his opinion that_the_non-restraint system practised in England, and now (owing to Dr. Van Leeuwen's exertions) making rapid progress in Holland, is far preferable to the system of treatment practised in France. His able replies are being published in the Chronicle de Jersey. We trust that when complete they will appear in the Psychological Journals.

THE ASYLUM

ASYLUM JOURNAL

OF

MENTAL SCIENCE.

The Diagnosis of Insanity, by JOHN CHARLES BUCKNILL, M.D. Concluded from page 445, vol. ii.

The Diagnosis of Mania - Melancholia - Monomania — Moral Insanity-General Paralysis—Feigned Insanity -Concealed Insanity.

Mania is the term applied to that large class of mental disorders in which the functions are in a state of excitement, and their mutual dependence and proportion disturbed. It embraces forms of disease so widely apart from each other, that in treating practically of its diagnosis it will be essential to make some classification. For practical purposes it will be sufficient to distinguish its forms into those of acute mania, comprising cases which present recent and active symptoms; chronic mania, in which acute symptoms have given way to others of a more tranquil and permanent kind; and incomplete mania, corresponding to the "mania raisonante" of the French, and embracing those anomalous and undeveloped forms of mental disorder in which defective power of volition and morbid propensities are prominent symptoms.

The term diagnosis is generally understood to mean the distinguishing one disease from another, but it is also applied to the act of distinguishing a state of disease from a state of health. Practically, it must be held to include not only the discrimination of diseases, but also their recognition. The recognition of acute mania is as easy as that of imperfect mania is frequently difficult. Few diseases have their. character so legibly stamped as that of raving madness.

VOL. III. NO. 20.

M

The physiognomy of mania has already been commented upon at sufficient length. The expression of wildness, distraction, or anger, is often varied with that of mischief, lasciviousness, or fear, and strong emotional excitement of some kind or other is rarely absent from the facial expression of the maniac.

The physical symptoms are by no means constant, and are of little value diagnostically; the face is pale or flushed, the skin dry and harsh, the bowels constipated, the pulse accelerated, the tongue bearing a whitish fur, the breath offensive, saliva increased and frequently spit out, the urine loaded with phosphates, &c. But any or all of these symptoms may be reversed, and any or all of them may and often do occur in numerous diseased conditions where there is no affection of the mental faculties. In the treatment of insanity all the signs of physical disturbance merit careful attention, but in the diagnosis their value is exceedingly small. Almost invariably in acute mania there is loss of sleep, a diagnostic symptom of the utmost value between the real and the feigned disorder. The acute maniac will often pass five or six days without any sleep, and five or six weeks with only three or four hours of sleep at intervals of several days. An impostor, feigning the violent form of madness, cannot refrain from deep and regular slumber, which falls upon him with the more certainty as he exhausts himself in his efforts of spurious fury. The impostor, moreover, cannot feign the physiognomical expression of acute mania, or at all events, he cannot maintain it for more than a few minutes. A man may imitate frantic gestures or shout gibberish without difficulty so long as his physical strength enables him, but he cannot maintain any look expressive of strong emotion unless he has practised the histrionic art with great care and success. The voice muscles, and those of the limbs, are constantly exercised in obedience to the will, but those of the countenance are the involuntary exponents of emotion. Conversation, properly so called, is always difficult, and often impossible with an acute maniac. In many cases the mind is so much occupied by delusive ideas, that only a few disconnected words can be elicited; more frequently, however, acute mania is accompanied by garrulity; this is especially the case when the exaggerated emotions are cheerful and expansive. This form of mania often exists without prevailing delusion, and the patient rambles on in his talk through a strange medley of boasts, promises and threats, oaths and obscene remarks, in a manner which renders it easy to understand why M. Falret supposes it possible that in this condition there is a spontaneous creation of ideas.

The restless and ever changing condition of the mind, expresses itself as strongly in action as in vociferation and wild words. The patient is always in movement, running, dancing, gesticulating, embracing, or fighting with those around him, displacing or sometimes breaking furniture, thumping with fists on the door of his room, and evincing in manifold ways the restless activity of the muscular system. It is probable that this impulse to action is not entirely dependent upon the condition of the brain. The nervous system generally, is in a state of excitement, causing an incontrollable desire to expend its energies in excessive muscular action. This restlesness, however, is not met with in all cases. In gay mania, in mania with fear and anxiety it is common; but in morose and sullen mania the patient will often retain one position for a considerable time. But even under such circumstances the clenching of teeth and hands, the half involuntary movement of the limbs, evidently restrained by the will, indicates strong impulse to action.

The condition of the mental faculties in acute mania presents the widest differences. In many instances no trace of delusion can be discovered in a patient who is vociferating, swearing, laughing, reproaching, in constant movement, and without sleep. All the observations and the remarks are sometimes found to have a certain kind of cleverness and shrewd appreciation of all that is taking place. The attention skips from object to object with choreic rapidity and abruptness, causing exaggerated and absurd emotional states, but in many instances not falsifying the judgment. In most instances, however, delusions and hallucinations exist, and the task of detecting them is not difficult, for in this form of disease the patient is so demonstrable that he usually dins his delusion into your ears.

Hallucinations appear to be more frequent in acute mania than delusions proper, and also more frequent than they are in any other form of insanity. Hallucinations of sight are very common. In acute mania, patients see the Deity, and angels, and devils, hear music and voices, believe their food to be human flesh or poison, and a hundred hallucinations of the same sort, far more frequently than in other forms of insanity.

Little address is required on the part of the physician to make himself acquainted with the intellectual and emotional perversions of these demonstrable patients, or to decide as to the existence of disease. The conditions with which it is possible that acute mania may be confounded, are drunken

The physiognomy of mania has already been commented upon at sufficient length. The expression of wildness, distraction, or anger, is often varied with that of mischief, lasciviousness, or fear, and strong emotional excitement of some kind or other is rarely absent from the facial expression of the maniac.

The physical symptoms are by no means constant, and are of little value diagnostically; the face is pale or flushed, the skin dry and harsh, the bowels constipated, the pulse accelerated, the tongue bearing a whitish fur, the breath offensive, saliva increased and frequently spit out, the urine loaded with phosphates, &c. But any or all of these symptoms may be reversed, and any or all of them may and often do occur in numerous diseased conditions where there is no affection of the mental faculties. In the treatment of insanity all the signs of physical disturbance merit careful attention, but in the diagnosis their value is exceedingly small. Almost invariably in acute mania there is loss of sleep, a diagnostic symptom of the utmost value between the real and the feigned disorder. The acute maniac will often pass five or six days without any sleep, and five or six weeks with only three or four hours of sleep at intervals of several days. An impostor, feigning the violent form of madness, cannot refrain from deep and regular slumber, which falls upon him with the more certainty as he exhausts himself in his efforts of spurious fury. The impostor, moreover, cannot feign the physiognomical expression of acute mania, or at all events, he cannot maintain it for more than a few minutes. A man may imitate frantic gestures or shout gibberish without difficulty so long as his physical strength enables him, but he cannot maintain any look expressive of strong emotion unless he has practised the histrionic art with great care and success. The voice muscles, and those of the limbs, are constantly exercised in obedience to the will, but those of the countenance are the involuntary exponents of emotion. Conversation, properly so called, is always difficult, and often impossible with an acute maniac. In many cases the mind is so much occupied by delusive ideas, that only a few disconnected words can be elicited; more frequently, however, acute mania is accompanied by garrulity; this is especially the case when the exaggerated emotions are cheerful and expansive. This form of mania often exists without prevailing delusion, and the patient rambles on in his talk through a strange medley of boasts, promises and threats, oaths and obscene remarks, in a manner which renders it easy to understand why M. Falret supposes it possible that in this condition there is a spontaneous creation of ideas.

« ForrigeFortsæt »