In the third report of the [[anwell County Lunatic Asylum for 1833, Sir William Ellis, the then resident Superintending Physician of the Institution, thus speaks of the sad consequences that result from the neglect of recognising and treating insanity in its early stage :—

“ It is a. melancholy fact, that, on a most careful personal examination of each of the 558. cases now in the house, there do not appear more than 50. who, under the most favourable point of view, can be considered curable. 771119 is to be atlriaulezl almost entirely to llee neylect ofproper remedies in Me early stayes of tlze disease. To become acquainted with the symptoms first indicating it not only requires much care and attention, but much experience; for a diseased action of the brain or some part of the nervous system may be gradually undermining the health, and still be scarcely suspected by common observers to exist, from the insidious manner in which it steals upon the constitution at first : it manifests itself by some trifling aberration of intellect, and that very generally on one point only; such aberration, if unaccompanied by bodily pain, is not only neglected by the sufferers, but disregarded by those around them. This, however, is precisely the time when medical aid is the most capable of being beneficial; and could the patients butbe placed under proper care then, certainly three-fourths of them would be cured. But, unfortunately, the golden opportunity is too ofien neglected. DISEASED ACTION is allowed lo proceed unchecked unlll DISEASED ORGANIZATION lzas taken place, and tlzepalienl llas become incuralle; and it is only in consequence of the commission of some violent outrage that he is at last sent to an asylum. Until something serious has occurred, the friends hope in a few days the mind will recover its tone.

“ Unfortunately, this unwillingness to consider the patient sufficiently insane to be sent to an Asylum is not confined to the friends of the patient. There have been instances of the magistrates themselves, from the kindest motives, refusing to grant warrants for the admission of a patient, even after he has been examined by a medical gentleman, who has given a certificate of his insanity, because when brought before them he has been able to answer certain questions correctly. The consequence is, that from this delay, instead of returning to his friends in a few weeks, which, in all probability, would have been the case if proper medical and moral remedies had at once been applied, he becomes incurable, and remains in the Asylum for life, a burden to the parish. In some instances similar delay has been attended with fatal consequences.

“It is sincerely hoped that the knowledge of these circumstances will induce an early application to be made for the admission of patients ; as, even if the neglect does not prove fatal, it is contrary to every principle of justice and humanity that a fellow-creature deranged, perhaps only on one point, should, from the want of the early attention of those whose duty it is to watch over him, linger out his existence separated from allwho are dear to him, and condemned, without any crime, to be a prisoner for life.”

In the premonitory stage of insanity, the grey portion of the hemispherical ganglia, is frequently in a. state of capillary congestion. This pathological condition I may remark, without anticipating what I have to say on the subject of the medical treatment of the incipient symptoms of cerebral and mental affections, is easily dealt with, and the further progress of the disease arrested by therapeutic measures. A few leeches and cold applications to the head, particularly in young persons of plethoric habit, active purgation, quietude, and freedom from all excitement, physical and mental ; counter-irritation to the head, the administration of the tartrate of antimony, and


the judicious exhibition of opium after the local congestion has been relieved, and the secretions brought into a healthy condition, will, in eighty per cent. of cases, cure the patient, and arrest the further progress of the mischief.

In a certain type of case, the brain, in the early stages of insanity, is in an amemz'c condition, and the vital and nerve force but feebly manifested. In these cases, our sheet-anchor is undoubtedly opium in its various formulae, generous diet, and blood tonics. But I must not anti_ cipate what I have to advise in its proper place for the medical treatment of insanity.

“ The importance or rather necessity of recognising disorders of the head in their early stage,” says Dr. F. Hawkins, “is obvious from the consideration that they can then alone be attacked with any chance of success. In acute cases, the period is brief indeed in which the power of art is available. But whether the case be acute or chronic, it is only in the early stage that its precise nature admits of being distinguished with accuracy. In its further progress, from the extensive sympathies of the brain with all parts of the body, so many functions become implicated, and so various are the symptoms which arise, as to preclude arrangement or classification, and defy the art of diagnosis. The aid which in most other cases the sensations of the patient are capable of affording us is lost to us too soon in disorders of the head, until in their advanced state they all resemble one another, and present alike a dreary abolition of the powers of animal life. The period therefore is highly precious in which these affections admit of being distinguished with precision or treated with any hope of advantage.“l

° Croomian Lectures, delivered before the College of Physicians, May, 1‘29, by Francis Hawkins, .\I.D.

Let the physician then estimate, in all its vital importance, the grave necessity for prompt treatment and decisive remedial measures, when satisfied that the enemy is at the gates, and has attacked, or, is on the eve of assaulting, the citadel! Under these circumstances, hesitation, delay, or procrastination in bringing the patient within the range of curative measures, is fraught with the direst results, and with the saddest consequences. Let us not wilfully close our eyes to the premonitory signs, however apparently insignificant, slight, transient, and fugitive they may appear, of actual mental disorder and brain disease, for it is in this early stage when so much may be effected by judicious medical treatment to obstruct the advance of the fatal cerebral mischief.

Having dwelt at some length on the existence of a precursory stage in all affections of the brain, and on the importance of watching for the first threatenings of incipient cerebral disorder, I propose to investigate, in detail, the general character of the premonitory symptoms of encephalic, and mental disease. It will be well, however, to premise, that I cannot, in this work, do more than generalize on this wide and expansive subject.

When I address myself, in the succeeding volume, to the consideration of specific Iypes of brain disease, it will be my object to enter more elaborately into detail, and to point out, as far as practicable, the diagnostic premonitory signs of the various organic affections of the encephalon. Many of the symptoms to which I shall refer as valid evidences of incipient brain disorder will be found common to several lesions of this organ, each presenting an essentially different aggregate group of symptoms, as well as distinctive anatomical, and pathological phenomena.

Nevertheless, I am of opinion, that a general description or resumé of the incipient signs of morbid conditions


of the brain,before considering individual forms of cerebral disease, will not be without its practical value and importance. Agreeably to this arrangement, I propose to analyse the subject in the following order :—

1. lllorbid Phenomena of Intelligence.
2. flIorbid States of Motion.
3. lllorbid Conditions of Sensation.

This classification of the subject fully recognises the three physiological functions of the cerebro-spinal system, via:

a. Thought. B. illotion. 7. Sensation. 4. Morbid Phenomena of the Special

Senses.Viz.: 8. Sight. '1. Touch. 6. Hearing. 6. Smell. {. Taste.

5. JIorbid Phenomena of Sleep, and

6. llIorbid Phenomena of Organic,
or Nutritive Life,

Viz.: a, Digestion and 'y. Respiration. Assimilation. 8. Generation. 19. Circulation.

7- General Principles of Pathology, Treatment, and Prophylaxis.

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