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very obscure, on the whole the view formerly advanced by us appears lately to have gained ground : that many cases, especially of so-called peripheral epilepsy are of an angio-neurotic nature, and owe their origin partly to a direct, and partly to a reflex irritation of the vaso-motor nerves. Benedikt states that the epileptic attack is primarily caused by sudden spasms or relaxation of the vessels, and presents the most complete analogy to neuralgic attacks, only that here the irritation affects chiefly the vaso-motor nerves, and so leads directly or indirectly to anæmia or hyperæmia of the brain. He also thinks himself justified in assuming that the hippocampus major indicated by Meynest as the part affected in epilepsy is a vaso-motor centre, irritation of which, whether from the cerebral hemispheres or by reflex influences from the periphery, induces the phenomena of the epileptic seizure.”

Nothnagel holds, on the strength of his formerly cited experiments, that the cervical sympathetic has a certain control over the actions of the pia mater, contraction of which is accompanied by contraction of the arteries of the brain, which have the same origin; and therefore believes that the epileptic seizure is the result of the anæmia of the brain consequent on the reflex contraction of its vessels. According to this theory the sympathetic plays a most important part in bringing on the epileptic attack, as most of the vaso-motor nerves of the pia mater are included either in the cervical part of the sympathetic or in the ganglion supremum. Other investigators (Schultz, Riegel, Jolly,) have not, however, confirmed the experimental grounds on which this doctrine rests.

When, gentlemen, we see such different opinions from the greatest physiologists and pathologists of the day, as to the cause of the epileptic seizure, we must see how uncertain is any mode of treatment. However, the deadly pallor that comes over the patient, with the cold extremities and feeble pulse just before the seizure, would lead us to believe that the sympathetic and vaso-motor nerves play an important part in the attack. My own experience of epileptic maniacs is, that they never recover ; true, that they get over the maniacal attack, but for it only to


come on again, generally with more violence. I am not even prepared to say that any medical treatment will shorten these maniacal attacks, they seem to get over them just as well without as with medicine ; putting them in the cell and leaving them alone seems to answer all purposes. But for the time being they are a most dangerous class of maniacs, and, as I stated to you in my paper on the Medical Jurisprudence of Insanity, so impulsive as never to be trusted. You must not suppose that all epileptics are maniacal, many, very many epileptics pass through life most intelligent men, and live to a good age and never show symptoms of insanity. These epileptics rarely apply for relief to medical men, and when they do they very soon get tired and give up treatment. There is a form of epilepsy, when not accompanied by mania, that you may keep in subjection by medical treatment, that is by attending to their general health, and every couple of months giving Brown Sequard's mixture for eight or ten days, changing it occasionally for atropine. I speak of that form that the French designate Petit Mal.In this form the patient never falls to the ground, never foams at the mouth. They simply get a sudden spasm as they describe it, of the heart; the face becomes deadly pale, there is slight twitching of the eyelids and corner of the mouth, the person is still for a moment of time, and the fit passes off, very frequently in less than a minute. I have a patient, at present, in the asylum who is an epileptic maniac, and always knows when his severe fits are coming on by having these slight attacks which he calls " side shows."

I do not propose to give you in this paper, all the different forms there are of insanity, and the symptoms to be found in the different forms ; to do so would take months daily lecturing. All I proposed was to give you a few general remarks applicable to nearly all cases, and that you should be guided in your treatment by general, well-understood, and recognized, medical principles, and that you should not be carried away with the idea, , that certain medicines and a certain mode of treatment cured insanity and cured epilepsy.

I will now speak of the moral treatment applicable as a general rule to all cases of insanity. A medical man or any one else whose duty it is to exert a moral influence over their insane patient, must not think he can do so by looking stern or fierce at them; that was a delusion in former days, but it is long since played out. We must begin with a feeling to our patient of pity akin to love, and the sooner we come to love our patient the better for the patient and ourselves; no action of our patient must ever shock our sensibilities, no matter how gross or unseemly that action may be. We must always remember that their whole thoughts and ideas are perverted, and that in virtue of their disease they are irresponsible beings, we must look upon all their acts and actions with a feeling as near as possible to the feelings of a mother when she looks upon the actions of her baby child. Whatever chance there is in gaining a moral influence over an insane person by kindness, there is no chance whatever by being cross and angry with them, or by punishing them. These remarks I wish to stamp deep in the memories of all those who have anything to do with the treatment or management of the insane.

When any organism is deranged from any cause, whether it be organic or functional, the first thing we must do is to try and procure rest for that organ. Therefore, the first thing we have to do in all cases of insanity is to procure rest for the brain, and this I believe is best accomplished, as a general rule, by removing the patient as speedily as possible from friends and from all their surroundings, and placing them in a well-directed and well-managed insane asylum, where they will meet with no contradiction to their insane views; where they will have no one to dispute with, or enter into discussions to try and convince them that they are talking folly, yet where they will at once feel that they are under both moral and physical control, the former always, the latter if necessary. It is astonishing how soon an insane person yields himself to the moral condition that pervades a well-managed insane asylum, and how seldom it is found necessary, even with the worst cases, to have resort to physical restraint. I would not have you to suppose that I am opposed to physical restraint, because sometimes it is actually necessary, not only for the safety of others but for the safety of the patients themselves ; but I would have you to believe that I would have such restraint the exception, not the rule. A3 such restraint very frequently, particularly if long-continued, only makes the patient more excited, the best restraint to an excited patient is to place him in a cell and leave him alone ; understand, I do not mean a dark cell, for darkness is as pernicious to the insane as to the sane brain. In a paper I read at one time before this society, I said the best means to develop the youthful brain was by good feeding, good clothing, good air, and healthy exercise, in fact that you developed the brain as you did the bone and muscle of the body; now if this be the best means to develop the youthful brain, you can easily understand how it must be the very best means to re-create the diseased or disordered brain. Remember that suffering of one sort or other is the great exciting cause of a sane man becoming insane, and do not let your patient have any suffering that you can relieve him of. Give him all the amusement you possibly can to divert his thoughts from himself; whether that amusement be playing cards, or working in a garden, but let there be no compulsory labour. With regard to giving patients enough of good wholesome food, you may be sure as long as an insane person does not put up flesh, but daily diminishes in weight, he is not improving mentally ; if you will have a strong mind you must have a strong body

I hope, gentlemen, from anything I have said you would not be led to suppose that I have given up my theory of heredity, on the contrary, the greater my experience, and the more I study the opinions of others, the more am I convinced of the truth of this theory, and in conclusion I will quote on this point some statements from very high authorities.

In the January number of the Journal of Mental Science (for 1879), there is an article headed “ Researches in Idiocy, by J. MIERZEJEWSKI, Professor in the Medico-Chirurgical Academy of St. Petersburgh, translated by Dr. D. Hack TUKE," in which he makes the following statement : “ The study of the anatomy of the brains of Idiots is a vast field accessible to research, which may serve to throw light upon some questions of psychiatry hitherto obscure, but which possesses an undeniably practical value. It ought to enable us to comprehend better the questions which relate to hereditary insanity. It is undeniable that the vices of physical conformation of ancestors are transmitted to their descendants, and that this phenomenon is the point de depart of pathological varieties.

There are not only physical malformations, but also moral perversions, which are subject to the laws of hereditary transmission. We understand, in short, that moral perversions in the ancestors accompanying malformations of the brain are susceptible of being transmitted from one generation to another. We are disposed to admit equally the existence of anomalies of the brain in those individuals who present a predisposition to hereditary insanity."

I should have told you, gentlemen, that this is from the summary of a paper read by the Professor at the Paris International Congress of Mental Medicine, August, 1878.

In the first number of Brain for April, 1878, there is a splendid article on “Brain Forcing," by T. Clifford Allbutt, M.A., M.D., Physician to the Leeds Infirmary. I wish it could be placed in the hands of every school teacher in the world, and indeed in the hands of every parent. He makes the following statement, speaking of the brain ; “ Quality as I have said, cannot be had for the asking, it is fitful in its growth and often born out of due time. It should be favoured by the continuous inheritance of culture, but the mode of its epiphany lies in the same darkness with that developmental nisus which lies behind the advance of life upon the globe. Inherited, as it doubtless must be, yet its arising cannot be foreseen in the span of human generation.” You see that I have not given you my belief in heredity any more than I have my belief that mind and body are one, on the contrary I have shown you strong reasons why I should adhere to these, which have been called by some of my opponents, “ Dr. Howard's pet theories."

You will naturally say what benefit do you derive from my remarks, if all the insane are to be sent into the luratic asylums.

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