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halation of hot hops-hot hops to the throat, diaphoretics and cathartics.

But the time I find when my services are most needed is between the paroxysms, by exercising the tonsil with Fahnestock's tonsilotine. Then I touch, with pointed lunar caustic, any opening that may be found on the removal of the tonsil, which I find soon makes a permanent cure.

The excising and subsequent treatment is the only cure for chronic abscesses of the tonsil. This operation (excising the tonsil) is a very small one, and not the least dangerous. My object is to place the instrument on such a level as to cut through in the middle; I do not remove the whole tonsil. After the operation is over, a gargle of tannin and staten is all that I prescribe, except I have the fistulous tuber to heal that I have separated.

When the half taken off is examined, I am able to pass the end of a probe through several openings in nearly every case. I find some persons whom I cannot induce to submit to an operation; such persons I treat by the more troublesome and tedious process

caustics.

The frequent touchings by sharp pencils of nitrate of silver, gradually get these openings so that I can find a solid base. But it is, I find, tedious and very annoying treatment for the physician to use as well as the patient to bear.

If my patient be scrofulous, I treat the case with remedies to oure that disease, in connection with the surgical treatment. I find this is one of the most frequent troubles incident to growing people who have passed the age of five years, and is so interfering often with the enjoyments of the young, while enjoying the pleasures of that age, that it becomes important I should know just how to cure them.

There are some young persons who have this disease from the slightest exposure. Sleigh riding or skating are not to be enjoyed, nor dancing parties, etc., without going through a siege of tonsilitis, followed by suppuration. But I find the excision in almost every case forever settles the disease.

No. 291 W. 7th Street, Cincinnati, O., February, 1880.

MEDICAL JURISPRUDENCE.

BY W. P. STRICKLAND, M. D., LL. D.,

Professor of Medical Literature and Forensic Medicine in the Eclectic Medical College, of the City of New York.

INSANITY.

(Continued from page 54, February, 1880.)

The brain is the seat of insanity, and to understand the pathology of the brain is of the first importance in a medical jurist. Insanity being a disease of the brain and not of the mind, for, properly speaking, there is no such thing as a disease of the mind, and disease can no more be predicated of it than corruption or derangement can be predicated of light, heat, electricity, magnetism or galvanism, different forms of the same element, being alike imperishable and incorruptible. The question as to "who can minister to a mind diseased?" is without meaning in a psychological sense. How the term insanity, the simple meaning of which is, unsoundness, came to be connected with the mind, is one we would like to have explained. The derangement about which there has been so much discussion, is cerebral and not mental. If the brain is in a sound and healthy state the mind cannot be otherwise. Could we take the mind of an idiot or a raving maniac and bring it into connection with a perfect brain, it would exercise all its faculties to perfection. The difference between an idiot and a philosopher is, not that the one has mind and the other is destitute, but one has brain in sound and healthy exercise, and the other is without that brain.

Regarding the brain as the seat and cause of derangement, all treatment of lunatics is directed to the wrong patient, and is not only as useless, but harmful as it would be to administer medicine to a well man. The mind is always in a sound, healthy condition, and never can, from its very nature, be otherwise. When the therapeutist shall make himself acquainted with brain pathology, and by skilful treatment restore its functions to health—and this ought to be done where the derangement is functional and not organic or structural-then may we dismiss our psychologists and lunatico inquirendo committees, and shut up our lunatic asylums, and cause every inmate to shout, "Othello is himself again." In fact,

all that the imbecile or idiot needs is, not mind, but a sufficiency of brain and time for its cultivation. That the brain is the organ of the mind and not its origin, secreting thought as the liver secretes bile, according to the godless and senseless philosophy of the materialist, has been fully and frequently demonstrated. The connection between the mind and the brain and the mode of mental operation is one of the unfathomable mysteries of science. The mind is the grand centre of the supreme nervous system, receiving from the sensitive columns of the spinal cord, and from the higher nerves of sense, the various impressions there created; it collects, associates, and assimilates these impressions, and excites a corresponding action of the mental system, which operates upon every motor nervous ramification, and produces the varied actions of life. How these impressions on the nerve fibres and cells can be converted into acts of consciousness is what no one, who has insight into the mechanism of the soul, can tell.

The ganglionic nerve cells of the brain are supposed to be the centres of its functional activity, as much as are the nerve cells of the motor system, and if so, mind is in a certain sense the developed energy of nerve cell, as there is nothing more certain than that its action depends on the brain and nervous system.

Some have denied the essential relation between diseased brain and insanity, founding the denial upon the fact that the brains of deceased lunatics present in some instances no organic lesion, and hence that insanity, at least in those cases, is not a material disease, but an affection of an immaterial principle. To this it may be answered, that in diseases of other organs pathological changes have been found absent. It does not follow in either of these cases, though the lesion is not discovered, that, therefore, it does not exist. Serious disintegration of nerve element may occur from various causes, without any discovery of pathological changes. By excessive or prolonged mental exertion, the brain may be incapacitated for further healthy action, but without any visible change of nerve substance, though an increase of phosphates in the urine shows its disintegration. The lightning's stroke may produce instant death, or leave its indelible mark in a shattered constitution and disordered nervous system. Yet in neither case does the scalpel or the microscope reveal any pathological change.

In insanity, as in other diseases, irritation is the initial stage, and constitutes the first link in the chain of events, of which disorganization and destruction are the last. This stage of irritation, should it affect the physical forces but little, as is usually the case, may endure for years sufficiently strong to excite a morbid mental action, and still death result before any structural changes had occurred.

The more we come to know of insanity, the more it is robbed of its psychological aspects, and the more does it appear as a physical disease. It observes the same pathological laws as other diseases, both as to its inception and development; and also the same as to its termination in death or resolution. The morbid changes most frequently met with in insanity are such as affect the surface of the brain, and these changes are the most frequent in the cortical substance. When When a patient has died of acute mania, after the pia mater is stripped off, the cortical layer will exhibit unequal coloration, certain convolutions being rosy, others pale. They are the results of great congestion on commencing inflammation. After a longer duration, when dementia is thoroughly established, corresponding changes occur, the vessels are less full than natural, the pia mater may be stripped off more readily, the lining membrane, and especially the corpora striata, are more thickened. In addition to the above morbid appearances, it is said that the weight and specific gravity of the brain is increased in the insane.

There are three principal stages in the degeneration process of cerebral disease. 1. A change in the vessels, hindering nutrition. 2. Atrophy of the nerve element, either from imperfect nutrition or from the growth of connective tissue. 3. The subsequent metamorphosis of the connective tissue. Other forms of degeneration might be enumerated.

Various classifications of insanity have been made by different authors. The following strikes us as the best, because of its being more simple and less complicated. 1. Affective or Pathetic Insanity. Under this head is mania, sine delirio. Simple melancholy, moral alienation proper. 2. Ideational Insanity, general mania and melancholia, acute and chronic. Partial monomania, dementia, general paralysis, idiocy, including imbecility.

Perceptional Insanity is the most simple of all forms of insanity,

consisting only of false perceptions, usually of the sight and hearing. It is ordinarily premonitory of advancing cerebral disorder, but its illusions and hallucinations may be but the temporary result of intoxicating or narcotic substances, or indigestion, or derangement of the cerebral circulation, or it may occur during the course of various other diseases. This form of insanity is amenable to treatment, but, if not promptly arrested, may pass into a more serious type of cerebral disorder. It does not in any way lessen individual responsibility, and from a medico legal point, is only of interest in relation to other forms of insanity.

Intellectual Insanity is usually, if not invariably, preceded by perceptional insanity, for a longer or a shorter time, the illusions and hallucinations of the latter gradually becoming accepted as facts in the diseased brain. Where perceptional insanity does not precede delusions, there are usually present certain prodromata, which, if recognized, would indicate the forthcoming cerebral derangement. Intellectual insanity, so called, is often uncomplicated by any other forms of derangement. Aside from the physical symptoms which accompany this form of derangement, such as insomnia, indigestion, loss of appetite, etc., the character of the delusion forms, to a great extent, the symptomatology of the case. Delusions are, to a great extent, at the bottom of all the crimes committed by the insane. The insane may be laboring under a delusion that certain persons are seeking to defame their character or destroy their lives, and, as a matter of defence, they consider it their duty to take the lives of their traducers or would be murderers. Parents have been known, while laboring under the delusion, to feel that they must sacrifice their children to appease the wrath of an offended deity, and yet such persons may exhibit no other sign of derangement.

Emotional Insanity is that state of mind in which the emotions are so excited as to entirely overcome the intellect and will, so that the individual is incapable of restraining and governing his actions. Delusions, in such cases, are sometimes, though not always present. Crimes are often committed during an attack of emotional insanity, such as suicide and homicide. Many cases of what are called temporary insanity, mania ephemera, transitory mania and morbid impulse, are really instances of emotional in

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