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The Morisonian Lectures on Insanity for 1873

  • David Skae (a1)
Extract

Syphilitic Insanity.—This is the first of the varieties of insanity in Dr. Skae's classification that is due to the action of a poison introduced from without. As might be expected, its symptoms are much more definite than those of the more constitutional and hereditary varieties of mental alienation. Something, too, is known of its pathology, and yet it is only about twenty years since the fact was recognised that the syphilitic poison could produce mental derangement at all. It has been described by English, French, and German authors on insanity and syphilis, but Dr. Wille, the latest German writer on the subject, has given us by far the most complete account of the disease in all its forms so far as it is at present known. An excellent abstract of his paper appeared in the “Journal of Mental Science” for January last, by Dr. Addison.† It is one of the forms of insanity that must be studied in connection with the other syphilitic affections of the nervous system, if we wish to understand it. To describe its symptoms without reference to the syphilitic form of epilepsy, of paralysis, and neuralgia, would be a mistake in every respect. Dr. Reade, of Belfast, and Dr. Todd, of London, were the first in this country to direct special attention to the occurrence of mania as a direct result of syphilis. They both showed that it was one of a train of symptoms that had the specific infection for its starting point; that those symptoms proved clearly that the nervous system, both spinal cord and brain, as well as their membranes, were involved in such cases, and that whatever cured the syphilis cured the neuroses. Dr. Duncan published three very interesting cases of syphilitic insanity in 1863.∗ Dr. Hugh Grainger Stewart published three cases in 1870.† Dr. Wille has collated the symptoms of 77 cases of syphilis, in which there were mental symptoms of one kind or other. Many of Lancereaux's cases, given in his work on syphilis, have mental impairment or disturbance as a part of their history.

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To prevent mistakes, it may be mentioned that this lecture was written entirely by Dr. Clouston.—T. S. C.

Jo. Ment. Sci., Jan., 1873.

Brit. Med. Jo.

Dublin Qu. Jo. of Med. Sci., 1863.

Since the abore was written very characteristic cases of this variety of Syaphilitio insanity have been published, by Mr. H. Hayes Newington and Dr. Batty Tuke., in the Jan. No. of the “Journal of Mental Science,” pp. 555 and 560, and in the No. of the same Journal for July, 1874, p. 262 Dr. Batty Tuke gives an admirable description of the morbid appearances found after death in one of his cases, illustrated by lithographs. His paper is a most valuable and original one. Mr. Newington suggests that where the symptoms result from a gummantous tumour the insanity should be called “Syphilomatous.”

In the same Journal, p. 564, Dr. Cadell relates a case of mental excite ment occurring contemporaneously with the secondary symptoms of syphilis.

In the April No. for 1874, Dr. Wilks relates cases of this disease, and in the Jan. No. for 1875, Dr. Hnghlings Jackson gives cases of nervous symp toms in congenital syphilis.

A fifth pathological stato as definite as the first three, and one which will probably be found to be associated with them all when looked for microrcopically, is the thickening of the coats of the small cerebral vessels by the depositions of concentric rings of plasma, thus producing a gradual diminution of the calibre of the vessels, a diminished blood supply, and subsequent softening of the brain substance and apoplexies, described by Dr. Take in this Journal for Oct., 1874, p. 352. This condition had been indicated by German syphilographers, but not described and figured as fully as Dr. Tuku has done.

In the “Edin. Med. Jonrn.,” for Dec., 1874, Mr. Hayes Nowington, in one of “The Eoyal Edin. Asylum Papers,” describes a kind of alcoholic mania of short duration, occurring as the result of alcoholic poisoning in a brain hereditarily predisposed to insanity, and very easily overset in its functions by a small quantity of the poison that would not be enough to cause delirium tremens. The brain gives way, in fact, from inherent weakness, before the latter disease has time to come on The brain weakness is shown by the small amount of self-control, and the early tendencies to vice always shown by such cases. To this kind of brain disturbance he would limit the term “Mania à Potu.”

Dr.Gasqnet, , “Journ. Ment. Sci.,” January, 1872.

Prout, , p. 176, 2nd ed. G. Bird, p. 250 and 307.

The following case has been kindly sent me by my friend Dr. Grainger Stewart :—“Wm. M., æt. 39, a light-house keeper, applied for advice at the Boyal Infirmary, July 21st, 1871, complaining of lowness of spirits and want of appetite. His friends explained that his depression had been such as to compel him to give np his employment, that he had been jealous of his wife, and required constantly to bo looked after. His urine contained oxalatcs. Ordered to be looked after, and to take 20 drops of nit. hyd. acid, dilute, three times a day. 31st, greatly better; no oxalates. Ang. 20th, quite well.”

Since the above was written, Dr. Wilka has directed attention to “Mania asa symptom of Bright's Disease.” Jo. Ment. Sci., July, 1874, p. 243.

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The British Journal of Psychiatry
  • ISSN: 0368-315X
  • EISSN: 2514-9946
  • URL: /core/journals/the-british-journal-of-psychiatry
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The Morisonian Lectures on Insanity for 1873

  • David Skae (a1)
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