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, ‘Vardrop, Bright, Burrows, and Bennett, have considered this subject at some length-l"

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 suflicient 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 Cmur."

1' “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.



M. Falret, of the Hospice de la Salpetricre, has published the results of his dissections in ninety-two cases of chronic mania. In twenty of these there were “ (lea le'sions diverses du caeur, coincidant avec des alterations c/zronigues du ccrveau, 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 oedema 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, d pr'z'orz', 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, 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 difi'erence 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 GENERATloN.—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 aliena— tion, 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 exlenso, 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.


General Principles of Cerebral Pathology, Diagnosis, Treatment, and Prop/glans.

PATHOLOGY.—It was never my intention to enter, in this work, at any length into a consideration of the subject of cerebral and mental pathology. This vast and important field of scientific research must, as far as this treatise is concerned, be but cursorily examined, if not left altogether unexplored. This is unavoidable, considering the number of complex and disputed questions involved in its investigation. '

The obscurity that envelopes the pathology of the brain is admitted by every writer whose attention has been directed to its analysis. How vain and illusory would it he were I to attempt to embody in a few pages anything approximating to an accurate conception of the numerous changes, functional and organic, which the brain, appendages, and vessels are susceptible of, and which are known to give rise to a variety of types of cerebral disease and mental disorder?

Let me briefly illustrate the difficulties of the subject. A gentleman, aged fifty-six, apparently in good health, and with, it is alleged, no constitutional predisposition to disease of the brain, was the subject of a. violent mental shock. I purposely avoid going more into detail. Insanity, in its most acute form, developed itself. The mental excitement was of a most frightful and alarming

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