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horror of the word should be dissipated, and that the fact should be recognized and acted upon, that a disordered mind is just as surely the result of a disordered brain as dyspepsia is of a deranged stomach; that a scarcely appreciable increase or diminution of the blood-supply to the brain will lead as surely to mental derangement of some kind as an apparently insignificant change of the muscular tissue of the heart to fat, will lead to a derangement of the circulation, and that in the one case there may be a hallucination, a delusion, a morbid impulse, or a paralysis of the will, just as in the other there may be an intermittent pulse, a vertigo, or a fainting-fit. There is no more disgrace to be attached to the one condition than to the other.

To some of the states of mental aberration which are thus, I think, properly to be classed as insanities, I have endeavored to draw attention, to point out their clinical features, and to indicate the treatment proper for them. So far as I know, this is the first systematic attempt in this direction, and some of the forms—though many physicians will recognize them as old acquaintances they have met with in their practice--are now described for the first time.

Again, the alienistic physician, whose practice is not restricted to a lunatic asylum, has peculiar facilities for study. ing insanity in its first and most curable stages. There are many varieties of mental derangement of which asylum physicians never see the beginning; and there are others, not requiring the restraint of an institution of the kind, which they never see at all. The day has gone by when they were looked upon as the sole exponents of psychological medicine, and in all parts of the civilized world the greatest advances in that division of the healing science and art are made by physicians who are unconnected with asylums.

I have devoted a whole section of this work to the consideration of sleep and some of its derangements, and am indebted to Messrs. J. B. Lippincott & Co., of Philadelphia, the publishers of a little book of mine on the subject,' for per

“On Sleep and its Derangements,” Philadelphia, J. B. Lippincott & Co.

mission to incorporate some of its chapters into the present volume. I think that a knowledge of the physiology and pathology of this function should form the groundwork of the study of insanity. It is in aberrations of sleep that we often find the first indications of aberrations of mind.

I am also greatly indebted to Dr. R. L. Parsons, late the Medical Superintendent of the New York City Lunatic Asylum, for the use of his voluminous case-books of patients in that institution while it was under his charge. The perusal of these records has been of great assistance to me in my descriptions of several of the forms of insanity.

Again, a word in regard to the classification adopted. In the present state of the patho-anatomy of insanity, a classification, based, as it should be, on the essential morbid conditions giving rise to the symptoms, cannot be made. There are indications, however, that vaso-motor disturbances, by which the amount of intracranial blood is altered either by increase or diminution, are the starting-point at least of almost every known form of mental derangement. In his recent work on Insanity, Luys'adopts this view—a view which, I may say, has long been held, though not so thoroughly worked out, by the author of the present volume, and which he has enunciated in several monographs and treatises. It is in this direction that we are to look for the data on which to found a correct system of psychological pathology and a true classification.

In the mean time every author arranges the varieties which he differentiates, to suit himself, and at once with entire consistency proceeds to point out the fallacies and shortcomings of other systems. A classification such as can be made at

1 “Traité clinique et pratique des maladies mentales,” Paris, 1881.
?“On Wakefulness," New York Medical Journal, 1865.
“Sleep and its Derangements,” Philadelphia, 1869.

“On some of the Effects of Excessive Intellectual Exertion,” Bellevue and Charity Hospital Reports, New York, 1870.

“A Treatise on the Diseases of the Nervous System," New York, 1871, and subsequent editions to seventh, 1881.

“Cerebral Hyperæmia, the Result of Mental Strain and Emotional Disturbance," New York, 1879.

“On Certain Conditions of Nervous Derangement,” New York, 1881.

present can pretend to no more than to arrange the several forms of mental derangement into groups, possessing some one prominent feature in common. Whatever may be the objections to the system I have proposed in this work—and that they are many, no one knows better than I do myself, I hope and believe that it will prove of assistance to the student desirous of investigating the phenomena of insanity. If this expectation is only partially fulfilled, I shall be amply satisfied.

Finally, the objection may be made that, not being the superintendent of a lunatic asylum, I have no business to set up as an authority on insanity, much less to write a book on the subject. To any raising that point I would say that for the last seventeen years I have been a teacher on the subject of “Diseases of the Mind and Nervous System” in four medical colleges of the city of New York, three of them among the largest in the United States, and one the course of instruction in which is given to physicians only. The first professorship of that branch of medical science in this country was held by me; and, furthermore, that, though I cannot claim to have seen so many cases of insanity as the average superintendent of an asylum with its thousand inmates, I do claim that a single case thoroughly studied is worth more as a lesson than a hundred that are simply looked at, and often from afar off. The medical student who dissects one human body is likely to learn more of anatomy than the janitor who sees hundreds of corpses brought to the dissecting-room.


New York, May 1, 1883.


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