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MORBID PHENOMENA OF CIRCULATION, RESPIRATION, AND GENERATION.-Considering the close organic sympathy between the heart and brain, we should, à priori, infer that in all affections of the great nervous centre, the cardiac functions would almost invariably exhibit marked deviations from a normal state. In the writings of Morgagni, Baglivi, Lieutaud, and Corvisart, this subject is but cursorily referred to. Although the latter authority affirms that he has never seen an instance of apoplexy that can be clearly traced to cardiac disease, he is, nevertheless, of opinion that the cases recorded by Testa, Laurent, and the other writers previously mentioned, "suffisent pour établir qu'une affection du cœur peut devenir la cause determinante de l'apoplexie." Richerand is said to be the first writer who pointed out pathologically the intimate connexion between encephalic and cardiac disorders."

This distinguished physiologist says, "the dissection of patients who have died of apoplexy has proved to me that the excess of force in the left ventricle of the heart is a more powerfully predisposing cause of the disease than a large head and short neck—a state of body which is supposed by most physicians to indicate the apoplectiform conformation.

In a Mémoire read by Richerand before the Ecole de Médecine, he refers to the case of the illustrious Cabanis, who died of apoplexy caused by, or associated with, disease of the heart. The autopsy of this distinguished philosopher revealed extensive cardiac disease. The left ventricle was enormously enlarged and hypertrophied. Eight ounces of blood were effused into the ventricles of the brain, and this effusion had been so violent, that the septum lucidum was torn through, and the surface of the thalami and corpora striata found rough and jagged.

"Nosographie Chirurgicale," vol. iii.

Malpighi and Ramazzini died of apoplectic attacks connected with hypertrophy of the heart.

More recently Lallemand, Broussais, Andral, Bouillaud, Bertin and Rochoux have directed attention to this subject. MM. Bertin and Bouillaud remark that, "the majority of the patients in whom hypertrophy of the left ventricle of the heart is present, will be found to exhibit symptoms of cerebral congestion, and that many of them will fall victims of disease of the brain.' In our own country Drs. Hope, Copland, Watson, Wardrop, Bright, Burrows, and Bennett, have considered this subject at some length.†

Important as this subject is to the practical physician as well as physiologist, it is not my intention to go minutely into its analysis. It is sufficient for my purpose to call attention to the fact, reserving for the succeeding volume any detailed remarks I may have to make in reference to the influence exercised by certain affections of the heart upon various functional and organic diseases of the brain.

There can be no doubt among those whose duty it is to investigate the disorders of the mind in all their numerous phases, that cardiac disease exercises a material influence over the psychical functions of the cerebrum. How common it is for the physician whilst performing his autopsies in acute and particularly chronic cases of insanity, to discover apparently long-existing organic disease of the heart, especially in its valvular structure. All writers on the subject of insanity have called attention to this fact.

*"Traité des Maladies du Cœur."

"On Diseases of the Heart," by Dr. Hope. "Dictionary of Medicine," by Dr. Copland. Communication read at the College of Physicians, March 30, 1835, by Dr. Watson. "On Disease of the Heart," by Dr. Wardrop. "Medical Reports," by Dr. Bright. Disorders of the Cerebral Circulation,"

by Dr. Burrows.

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M. Falret, of the Hospice de la Salpêtrière, has published the results of his dissections in ninety-two cases of chronic mania. In twenty of these there were des lésions diverses du cœur, coincidant avec des alterations chroniques du cerveau, ou des membranes cérébrales."

More recently, Morel, when referring to the connexion between the central circulatory system and cerebral diseases, observes, "that the affections of the heart enter largely into the etiology of mental affections." A patient under his care, subject to maniacal paroxysms, imagined that he had confined in his chest an animal that was devouring his heart. After death, hypertrophy of this organ was discovered, with disease interfering with the free passage of the blood through the auriculo-ventricular orifice. These organic changes in the substance of the heart, as well as in its valves, associated with insanity, give rise to great difficulty of respiration, headache, restlessness, insomnia, and severe paroxysms of irritability. These symptoms are often associated with great œdema of the extremities. Morel adds, "I have observed among such patients the periodical return of strange ideas, hypochondriacal sensations, and often special hallucinations, which arise with the increase of the impediment to the circulation and the cerebral congestion which is the consequence of it. These hallucinations. are usually of a terrifying nature." "It is known," says M. Saucerotte, "what a powerful shock the beating of the arteries occasions to the encephalic mass, and one conceives, à priori, what disorder might be caused to the intelligence if they were repeated with abnormal frequency, on the organ destined to elaborate the ideas. We are bound also to consider the effect thus produced in the physiological stimulation and nutrition of the brain. The blood, altered in its character, and hurried or impeded in its course through the cerebral vessels,

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must produce profound modifications in the nervous tissue of the organ of thought."

In the early stage of insanity the pulse occasionally indicates great activity of the centre of circulation, but more generally the action of the heart is feeble, and the state of the pulse establishes the presence of great vascular, vital, and nervous depression. This condition of the radial artery is quite compatible with a considerable amount of acute mental agitation and muscular violence.

There is considerable difference in the action of the radial, carotid, and temporal vessels, as well as in the intensity of the pulsation of the ascending and descending aorta. Jacobi has called particular attention to this phenomenon, but the consideration of this important and interesting physiological and pathological subject must be deferred for another occasion.

RESPIRATION AND GENERATION.-There are no special morbid conditions of the respiratory function which can be considered symptomatic of incipient insanity, or as indicative of the commencement of organic disease of the brain. The lungs are, no doubt, in close organic sympathy with the brain, and in many cases of mental alienation, the two organs in a marked manner reciprocally influence each other.

The autopsies of the insane often reveal extensive disorganizations of the substance as well as investing membrane of the lungs, which have seriously complicated the psychical disorder, and interfered with the satisfactory progress of the case.

The generative functions in some forms of cerebral disorder are exalted. In other states of the brain and nervous system, they are perverted, impaired, or altogether paralysed. I have known insanity, of a senile type, develope itself by a sudden and unnatural manifestation of virile inclination and capacity, at a period of

life when this function is generally considered to be in a state of dormancy. But this important subject, in all its numerous ramifications, physiological, pathological, and psychological, will be analysed in extenso, when I proceed to consider, in the succeeding volume, the obscure diseases of the cerebrum, but particularly the cerebellum, as influencing, directly and indirectly, the reproductive organs.

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