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of a whim, or without any apparent motive whatever. The profession is happily now so far advanced as to know that the barbarous practices formerly in use to quiet these refractory patients were cruel and inefficacious. In most establishments at the present day, distinct wards are appropriated for their accommodation ; but I would humbly suggest the propriety of having distinct and distant buildings allocated to their use, to prevent the annoyance of the more rational patients by the incessant monotony of this melancholy sound. In connexion with such establishment, I would have some smaller cottages or residences situated near some quiet sea-port or other desirable locality, whither such patients as might be likely to derive advantage from change of scene, sea-bathing, or even the diminution of that restraint which must characterize every large and well regulated establishment, might be removed, and yet be not altogether divested of medical control. I have known occasional exercise beyond the limited precincts of an asylum, country excursions, and even extended travelling, to relax the morbid action of the intellect, give rise to a train of new thoughts, recall pleasing 'associations, and facilitate and promote recovery.
Lastly, I would advise students not to confine their attention or practice to diseases of this description, even though it be desired to make them the chief objects of study. The relatives of a patient are so fearful lest it should be supposed that any of their family or friends labour under mental derangement, and so cautious to prevent such a supposition from gaining ground, that if a person by his ability and perseverance should attain the unenviable distinction of being skilful in treating insanity, his opinion would be the last they would apply forhis carriage the only one which they would object to stopping at their door. So much is this the case, that I have known persons studiously avoid a physician of such an obnoxious reputation, lest it should be thought that their acquaintance with him originated in the melancholy manner just described. On the other hand, the friends of a patient will never object to ask the opinion and assistance of a man who has the reputation of being skilful in other classes of disease.
We have much pleasure in giving a place in our pages to the above interesting communication ; because, although Mr Duncan no where alludes to Phrenology, his remarks are in accordance with its spirit, and with the principles so zealously inculcated by Drs Spurzheim, Georget, Falret, Dr A. Combe, and other phrenological physicians, in their respective works, and in various contributions to our journal. Mr Duncan, for example, suggests that students be admitted to public asylums to study insanity in the same way as they do other diseases, by the personal examination of the patients; and he argues that .by selecting the students properly, and having a control over them, no harm will result to the patients visited. He might have added, that the experiment has been extensively made, and been attended with complete success. Dr Combe mentions in the introduction to his work on Mental Derangement, that he had the good fortune to attend the first course of clinical lectures ever given on insanity, viz. those of Esquirol at the Salpétrière, near Paris, so long ago as 1819. On that occasion stu
b dents were admitted to the patients at the time of the visits, without reserve or restriction, and although numbers availed themselves of the privilege for several months in succession, we are assured by Dr Combe, that in no one instance did any un pleasant or injurious consequences follow,' while on the contrary many of the patients were amused and gratified. M. Esquirol, of course, exercised his own discretion in passing by those cases which he considered likely to suffer from the intrusion, and his presence operated as a restraint on the evil propensities of any of the visitors who might have been inclined to provoke or ridicule the patients ; but beyond these precautions there was no other form or ceremony observed or required in the admission of students.
Since that time, now sixteen years ago, the same system has been not only continued but extended in the Parisian hospitals. At the immense asylum for male patients at Bicêtre, Dr Ferrus, the enlightened physician of the establishment, admits students to his visits, and delivers regular lectures on the more remarkable cases which present themselves to his notice ; and he also bears testimony to the double advantage to both students and patients which results from the practice.
We may even go a step farther, and say that there is more than presumptive evidence to prove, that the profession owes this important step in the study of mental diseases to the humanity and genius of the late lamented Spurzheim. In his work on insanity, published in 1816, after alluding to the obscurity in which the subject was involved, and the splendid oppor. tunities for improving our knowledge of it, possessed by men at the head of large establishments like those above named, he feelingly remarked, how painful it was that persons thus favourably situated should communicate so little of what they learned to the public. In Spurzheim this sentiment was the offspring of the purest and profoundest humanity; but it was very differently viewed by some of the friends and admirers of the justly celebrated Pinel and Esquirol. By them the sentiment
was stigmatized as a gross and almost defamatory personal attack; it was resented and repaid by virulent abuse and the most captious criticism, and a great effort was made to destroy the reputation of the best work on insanity which had till then appeared...
Strong in the simplicity of truth and innocence, Spurzheim stood unmoved. His feelings were wounded, but he knew he was in the right, and feared not for the result. The storm passed over and was apparently forgotten , but two short years after, clinical lectures on insanity were announced, and pupils regularly admitted to the visits where no such instruction was obtainable before ; and, to his honour be it said, Esquirol, who, we have been informed, really believed himself aimed at by Dr Spurzheim, was the man who led the way in this new and untried field, and he has since ably been supported it
In regard to Mr Dunean's second suggestion we may mention, that a lectureship on mental diseases was established in Edinburgh about ten years ago, by Dr Morrison, the author of some very sensible works on the subject. Dr Morrison was bound to give one course annually, which he did for several years. From some cause or other these lectures have of late been discontinued. The lectureship, however, yet stands in the Edinburgh Almanae among the existing things.
The soundness of Mr Duncan's remark, that the chance of cure is much greater in large asylums than in small, is not only deducible from the principles of physiology, but likewise demonstrated by experience. Even in the healthy condition, solitude, or a too limited, circle of associates, is very prejudicial to the mind, by withholding from the social feelings their appropriate stimulus and food, and by giving undue ascendancy to the selfish propensities ; and these evil consequences are greatly aggravated by the presence of disease. The success attending the mode of treatment adopted by Dr Ellis, in the large Pauper Asylum at Hanwell, (of which some account will be found in our 41st Number), shews, in a very striking man. ner, the utility of social intercourse, active employment, and a proper classification of the insane.
We repeat; that we insert Mr Duncan's paper with great satisfaction ; because, although it does not contain any thing strictly new, his views are important and well brought out; and it is only by the repeated agitation of a subject that all its bearings come to be perceived and appreciated. We think the author would derive much gratification from the careful perusal of Dr Spurzheim's treatise. -EDITOR,
MR CARMICHAEL'S EXAMINATION OF MR MACNISH'S OB
JECTIONS TO HIS THEORY OF SLEEP, IN THE PHRENOLOGICAL JOURNAL FOR DECEMBER 1834.
Mr Macnish has set me an admirable example in the good temper and kindly feeling with which he has combated my hypothesis of the proximate cause of sleep. I trust I shall be able to convince him that my views are rational and well grounded, notwithstanding his objections; and I still more anxiously hope, that, in executing my task, if I have not his abilities, I have at least a wish to imitate his courtesy in our common pursuit,--the ascertainment of a curious and interesting, even though it be an unimportant, truth.
My proposition is, that " The Process of Assimilation in the Brain is the Actual Cause of Sleep;" but Mr Macnish cannot conceive how a natural and healthy deposition of new particles should occasion a cessation in the functions of any organ: he argues, that “ before such a deposition can take place, there must be an augmented circulation of blood in the part; and that the greater the quantity of blood sent to an organ, the greater is the energy of its manifestations. During sleep," he adds, “ the blood is propelled in greater abundance into the liver and stomach than in the waking state; the consequence of which is, that these viscera act more vigorously, and that digestion is carried on with increased activity." And he asks, “Why should the brain be an exception to this general law?"* That the brain is an exception to this general law is the opinion of Blumenbach and other physiologists, including Mr Macnish himself.+ Blumenbach even considers the diminished or impeded flow of oxygenated blood to the brain as the proximate cause of sleep. I His able and learned translator observes,
Analogy renders it extremely probable that during the inactivity of sleep, the brain, having less occasion for arterial blood, has a less vigorous circulation than during the waking state; and we know that whatever diminishes the ordinary determination of blood to the brain, or impairs the movement of the blood through it, disposes to sleep. But although this be granted, it must be viewed, not as the cause, but as a circumstance, or, in fact, a consequence, of ordinary sleep.” | Ri• Phrenological Journal, No. xlii. p. 176.
+ Id. 177. #Elliotson's translation of Blumenbach's Physiology, p. 282. Lond. 1828. & Id. 285
cherand expresses the same opinion: “ During sleep the inward or assimilating functions are going on; digestion, absorption, circulation, respiration, secretion, nutrition, are carried on; some, as absorption and nutrition, with more energy than during waking, whilst others are evidently slackened. During sleep the pulse is slower and' weaker'; inspiration is less frequent; insensible perspiration, and all other humours derived from the blood, are separated in smaller quantity.”* “ While it lasts, the cerebral 'mass collapses; a sign that the floro of blood into it is remarkably lessened." +
My theory, therefore, did not, as he supposed, lead Mr Macnish to conclude that the brain is least active when the circulation is most urgently at work within its substance. On the contrary, it appears that, in accordance with my theory, while the brain is least active, so is also the circulation within its substance. He calls upon me, however, to shew “ that assimilation may proceed with increased activity, without any additional impulse being given to the circulation;" and allows that, if I shall do so, my doctrine may then acquire plausibility. I
This is easily done --for, as already noticed, Mr Macnish himself admits that. " so far from there being any increase of blood in the brain during healthy sleep, it is proved that the circulating fluid is actually lessened;" and he even goes so far as to state that sleep is the period in which the regeneration of the body chiefly takes place. || And Darwin shews the mode by which it may be rationally supposed that this is accomplished. He'argues that all the filaments composing the solid parts of the body, have possessed, or do possess, the power of contraction, and of consequent inertion or elongation; and that it seems probable that the nutritive particles are applied during their times of elongation, when their original constituent particles are removed to a greater distance from each other. « For," he continues, " each muscular or sensual fibre may be considered as a row or string of beads, which approach when in contraction, and recede during its rest or elongation ; and our daily experience shews us, that great action emaciates the system, and that it is repaired during rest." |
But, still more closely to meet Mr Macnish's challenge, is it necessary to remind him, that during the over-accelerated circulation of the blood which attends fever, the secretions of the several glands are more or less disturbed, and are sometimes even interrupted altogether; while the first effect of a return
• Richerand's Physiology, p. 344. Lond. 1815.
+ Id. 347. # Phrenological Journal, No. xlii. 176, 177.
Id. 177. || Philosophy of Sleep, 2d edition, 21.
Zoönomia, $ 37-3. Vol. i. of the Dublin edition of 1800, p. 529.