Imatges de pÓgina
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adds, that a red colour is any proof that disease existed in the alimentary canal during life; inasmuch as an intestine found to be red in the dead body, was not necessarily so during life.

“ M. Andral attributes the position of intestinal congestion, with Messrs. Trousseau and Rigot, to the mechanical descent of the fluid blood, according to the posture which the body is made to assume after death ; and in one case, where the vascularity was in the anterior part of the stomach, owing to the body lying on its back, he was disposed to refer the appearance to gastritis, which, with much candour, he states he should not do now. That this cause operates, to a certain extent, in producing the phenomenon in question, particularly when the larger vessels are concerned, is quite certain ; but, though I have remarked, that vascularity is found • principally in the posterior part of the great end of the stomach, and in the lesser curvature, yet nothing is more common than to see great turgescence of vessels on the upper surface (in relation to the position of the body) both of the intestines and brain ; and it occurs everywhere in the minute vessels of the inner membrane of the stomach and bowels, where an attraction is exercised between the coats and their contents, which prevents any material change of position in the latter.

“M. Andral is disposed to refer the transudation which takes place through the sides of vessels some time after death, to putrefaction. But I see no reason to alter the opinion which I have expressed on this subject, namely, that` putrefaction will doubtless increase, but it does not seem at all necessary to transuda. tion.' The animal fibre has a power to resist the passage of a fluid during life; but very soon after death, and long before putrefaction can be considered as having at all taken place, the power is lost, and various well known phenomena speedily oceur in every part of the body, which are dependent on that unknown and inscrutable change, which the loss of vitality has effected in the animal machine. Transudation of bile from the gall-bladder, and of blood into the thoracic or abdominal cavities, are among the commonest examples ; and the veins of the stomach and bowels will exhibit the same appearance in a day, or day and a half from death; but in a still shorter time if an inverted vascular stomach is extended upon a flat surface, and kept moist and undisturbed. I may mention too, as an additional proof of the same circumstance, the point mentioned at page 4 of this communication ; and may add, that the same will happen in a tied carotid artery or intestine, containing either of the fluids employed, and made to dip into a vessel containing a portion of the other.'

There is a point which deserves some notice, because we cannot doubt that inattention or ignorance respecting it has not unfrequently led to error. It is this. The follicles which are sometimes exceedingly distinct in various parts of the stomach may readily be mistaken for minute uleerations. To avoid that mistake it is necessary, of course, to keep the liability to it in view. Dr. Yelloly suggests, as a mode of determining the nature of the case, the employment of a minute injection. If there was ulceration, the injection would be extravasated. We fear the test is of too difficult application to be generally employed, and that the most practical recommendation is, to use great care in distinguishing the real state of the parts.

Dr. Yelloly alludes to the opinion of Otto, Trousseau, Rigot, and Billardopinions which correspond more or less exactly with his own, and he adds :

“ It would have saved them, however, much labour, and perhaps, to a certain degree have modified some of their deductions, had they been so far acquainted with our Transactions, as to have known what had been done in this country on the same subject. Life is, indeed, too short, and the difficulties which attend the prosecntion of philosophical inquiries too considerable, to afford that there should be no division of labour in science: and that men of talents and energy should occupy themselves in investigations which have already been prosecuted in other quarters, without being aware of what has already been done on the same subject. Science is common property, of which every one may avail himself at his pleasure ; but the talents of able men belong also in a certain degree to the public; and it is a species of duty for such as are qualified, by their abi

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lities and industry, to enlarge the boundaries of science, to employ themselves in the most provident manner possible for the common benefit." 27.

We have quoted this passage, because it represents a fact which should be knowo. We are amongst the last who are likely to undervalue the labours of the French in science, and, more particularly, in pathology. But their very success has tended to enconrace that vanity which is said to be their national characteristic, and to make them undervalue and neglect whatever is not done by themselves. The ignorance of the French, in reference to the state of medi. cine in this country is preposterous. Whilst they are behind us in all that is practical, with the exception of the mere performance of operations, they exhibit, if they do not affect, an utter indifference to our labours and our existing knowledge, and rarely notice either, unless it be to misconceive or to mis-state thein.

The consequences are such as might have been expected. Even in pathology, we daily see facts or opinions published as novelties by French writers, when they have been long anticipated here. In practical medicine and surgery, we see plans of treatment proposed and lauded, which experience in this country has already sanctioned or condemned. We find ideas of disease prevailing undisturbed in France, which science has exploded in England. And, finally, we are visited every now and then, by some French tourist, who, knowing little of our language, nothing of our literature, ignorant of our practice, and incapable of understanding it-pays a hurried visit to a few hospitals, where he sees not much, and comprehends much less—yet, is so charmed with his own sagacity, and so contented with his amount of information, that he publishes on his return to his own country, a full, and of course an accurate account of the medical science and practice of this.s-Med. Chir. Rev.

ABSTRACT OF THE REPORT OF M. DESPORTES ON THE SERVICE

OF THE SALPETRIERE AND BICETRE LUNATIC HOSPITALS.

The work of M. Desportes consists of two sections. The first exhibits a series of eighteen statistical tables, giving an account of the number of patients for each year, the name or character of each form of the disease, the occupation of the patient, the causes of the insanity, the relapses, the length of time each patient was under treatment, and lastly, the issue of each case. The second comprises the practical and philosophical deductions which may be drawa from chese tables.

These tables are arranged in three classes. In the first class are grouped the cases, which were observed during the years 1825, 6, and 7; in the second, those observed in the years 1828, 9, and 30, and in the last, those observed in the three following years, 1831-2-3.

• · Considering the almost national character of the Medico-Chirurgical Transactions, it is very remarkable how little they seem to be known among the best French medical writers, even in reference to some of our most distinguished names. A curious exemplification of this occurs in Cruveilhier, who informs us in the 3d livraison of his Anatomie Pathologique, (pl. 6, p. 10) that he lately made a very convincing experiment ('une experience bien convaincante'), to prove, that disease on one side of the spinal marrow, produces its effect on ihe same, and not the opposite side of the body. But the point had been examined many years previously by Sir Astley Cooper, at my request, in consequence of the contradictory evidence on the subject; and a similar conclusion, confirming a valuable experiment of Galen, arrived at by direct experiment on a dog, of which an account was published by me in the first volume of the Medico Chirurgical Transactions, p. 197."

† MM. Bouillaud and Magendie have, on several occasions, been convicted of this neglect of English medical literature.

The French constantly treat chronic inflammation of the testis as cancer. They retain the terms and the ideas of white swelling, &c.

A Lyons surgeon lately gave a striking example of the assurance resulting from profound ignorance of all chat a traveller, who affects to describe a foreign nation, ahould know.

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Number of Patients admitted, discharged, and cured, during Nine years from

1825 to 1833 inclusive. Admitted .

8,272 lunatics. Discharged, cured.

2,763

not cured 1,863 Dead

. . 3,854 The relative mortality to the number of cases admitted may appear, at first sight, to be extremely high; but we are to remember, “que la mort frappe surtout les incurables."

The number of admissions during the last triennial period was greater than in either of the two preceding periods. The cause of this increase is most probably to be found in the agitation of the public mind induced by the revolution of July, 1831. In 'the following year too, the epoch of the cholera, there were more admissions than usual. A similar increase in admissions was noticed also in private lunatic establishments, during these two years. In an article published by Dr. Belhomme in the bulletins of the Medico-practical Society, he has particularly alluded to the influence of stirring political and public events on the development of insanity.

" It seems to me,

says he, “ well established, that not only great political events exert an influence on the development of insanity, but also that the number of insane persons must necessarily have increased in France during the last forty years, in consequence of the violent commotions, which have sncceeded each other during that period. That such has been the case, is clearly proved by the uniform increase of admissions into our great lunatic establishments after any violent excitement of the public mind.".

During the nine years, to which the report of M. Desportes alludes, the num. ber of admissions of female patients has been more numerous by about onefourth.

M. Desportes observes that, by a singular coincidence, the number of insane patients under treatment and in a state of convalescence, which amounted to 318 on the 31st December, 1827, and to 3,127 on the 31st December, 1830, was exactly 318 on the 31st December, 1833.

In what months of the year have the admissions been most numerous ? The sollowing is a table in M. Desportes' report. Of 8,272 admissions during nine years, there were 281 during June; 268 during July ; 255 during May; and 237 during April. From this table it would appear that the month of June, when the hot season commences, is the period of the aggravation of insanity.

Now as to the influence of the weather on the curability of the patients, we have the following data :

Of the 8,272 patients, the months in which there were the greatest number of cures, were

1st Series.-In March, 36; in October, 44; in June, 43; in August, 42; and in May, 42.

2d Series. In October, 40; in July, 44; in August, 47 ; and in June, 48. In other months the cures were less numerous.

3d Series.- In September, 76; in February, 59; in May, 56; in July, 58; in August, 60; and in October, 67.

We see by these tables, that it is at the trimestral epochs, which are marked by a change of season, that the cures have been most numerous; and especially in the month of October, in which alone there were 151 cures.

M. Desportes furnishes us with the following average relative to the cures effected.

First Series. Of 2956 there were 881 cured.-1 in 335.
Second Series.-0f 2869 there were 834 cured-lin 324.
Third Series.-Of 3354 there were 962 cured-1 in 361.

We are next informed that the female patients were kept longer in the hospitals than the males. The reason of this is, that the former may be more effeciually and permanently cured. The men, having more means of subsistence, are of themselves generally more anxious to be discharged, when they once begin to feel themselves better. But it may be with propriety argued against this plan,

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that the danger of relapse must be the greater ; and such, in truth, we find it to be the case.

Relapses are more frequent among the men than among the women. The following are the results of M. Desportes' report. In the first series, mentioned above, there was one relapse in every twelve men; whereas among the women there was one in every sixteen. In the second series, the proportion was one in every ten among the men ; and one in every thirteen among the women. In the third series, the proportion was one in every nineteen among the former ; and among the latter one in every twenty-iwo. He attributes this difference, in a certaio degree at least, to the greater irregularity of life among

the
men,

than among

the women. M. Belhomme is not quite inclined to agree with M. Desportes in this parti. cular. He attempts to explain the difference by alluding to the difference in the cause and in the character of insanity among the two sexes. Among men, he says, it is most frequently idiopathie; whereas among the women, it is much more often merely sympathetic. Now the former, or the idiopathic insanity, is very frequently associated with lesions of the encephalon; while in the sympathetic form of the disease, there is generally no organic mischief, but only a morbidly excited state of the nervous system.

He adduces, as a proof of the correctness of these statements, that paralysis is much more frequent among insane male than female patients. This reasoning is certainly very plausible, and.confirms, to a certain extent, the opinion of M. Belhomme, that idiopathic insanity affects men rather than women. thus furnished with a satisfactory explanation of the greater frequency of relapses among the male patients.

The following results, as to the mortality of the insane patients, are afforded os by M. Desportes' memoir. In the first series, there was one death in every six of the men, and one in every ten of the women. In the second and third series, the advantage is still more decided in favour of the women. The medium age of the deceased was, in the first series, between forty-nine and fifty among the men, and between fifty and fifty-one among the women; in the second series, the medium age among the men was forty-eight years, and among the women between fifty-three and fifty-four; and in the third series, it was between fortyseven and forty-eight among the former, and between fifty and filty-one among the latter.

As to the months in which the mortality chiefly occurred, January seems to have been the inost fatal.

The observation of other physicians agrees with this statement. The severe cold of winter appears to be very hartful to the insane.

M. Desportes next proceeds to give an analysis of the occupations of the insane, their ages, and of the diseases from which the patients usually died.

The following table presents us with a view of the ages of the 8272 patients admitted during nine years.

From 10 to 19

years

of
age

626
20 to 29

1568 30 to 39

2024 40 to 49

1683 50 to 59

1051 60 to 69

782 70 to 79

484
80 to 90

8
90 to 99
Age unknown

15 The greatest number, therefore, was from thirty to thirty-nine years of age.

The professions or occupations also seem to have a very marked influence on the development of insaniiy.

It has been remarked by many observers, that there are always a number of insane sent from the army to the public lunatic hospitals. All persons too who have been subjected to strong mental or moral excitement, as love, ambition, or interest; merchants who have suffered reverses of fortune, or persons who have

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left off business, without betaking themselves to some active employment, are very frequently the victims of derangement.

The following table of the occupations of the patients, whom M. Desportes examined, may be interesting.

Among the male patients there were 445 day-labourers, 124 tailors, 161 shoemakers, 101 cabinet-makers, 81 masons, 97 clerks, 62 domestic servants, 17 washermen, 1 embroiderer, 23 cooks, and 1082 occupations unknown.

Among the women, there were 924 seamstresses, 397 domestic servants, 503 day-work-women, 188 washerwomen, 133 embroiderers, 88 cooks, 50 shoemakers, and 339 occupations unknown.

The great frequency of insanity among females, who have been milliners and seamstresses, is perhaps not to be wondered at, when we remember that so many of these poor creatures are, from their personal charms and other circumstances, more exposed than others of their sex to seduction and ultimately to destitation and poverty. The grief which follows, their anxiety and distress if they become mothers, the anguish of disappointment, are unquestionably the causes of the frequent occurrence of insanity among them.

M. Desportes remarks that insanity is more frequent among female, than among male celibataires. The following statement is very interesting, as it shows that the unmarried life is decidedly more exposed to the misery, of mental derangement, than the dual state," as the poet Cowper terms matrimony.

The celibataires of the two sexes were in the proportion of 47-16 in every hundred cases admitted into the hospitals; married persons in the proportion only of 3-55 in the 100; widowers and widows in the proportion of 13-27 in the 100 ; and those who had been divorced, or whose civil condition was unknown, in the

proportion of 4-7.

The most frequent and powerful predisposing and exciting causes of insanity, among the patients examined by M. Desportes, will be seen by the following statement:

Predisposing Causes.--Hereditary predisposition in 736 cases ; defect of intellectual development in 642 cases ; and premature or natural old age in 753.

Physical Causes.-Cerebral congestions or hæmorrhages, inducing paralysis or delirium, 656 ; epilepsy and convulsions, 492; efforts of menstruation, critical period of life, 383 ; consequences of parturition, 218; pregnancy, 48; hysteria, 100; abuse of spirituons liquors, 414; poverty and destitution, 109 ; syphilitic disease, 51; misconduct and debauchery, 216.

Moral Causes.-Domestic distress, 392 ; reverses of fortune, 150 ; ambition, 139; disappointed love, 114; fright, 124 ; unknown causes, 1576.

The influence of hereditary predisposition is strongly shown by the preceding table. The number of patients, so situated, amounts to an eleventh of the whole number of admissions, viz. 8272. The author very properly alludes to the great impropriety of marriages in certain families ; but ii is very doubtful whether most people will be willing to adopt his advice, “les medecins seuls peuvent etre consultés avec avantage dans ces sortes de cas."

Dr. Belhomme directs the attention of his readers particularly to the marked influence of the uterine functions, as one of the most frequent causes of insanity among females. The above table shows that not fewer than 9A2 cases are attributable either to the efforts of menstruation, the suppression of the catamenia, their cessation, or to pregnancy, the sequelæ of parturition, suckling, &c., or, lastly, lo hysteria and other nervous affections, which are, more or less, obviously connected with the state of the uterus.

We shall now proceed to state the result of M. Desportes' inquiries as to the most frequent causes of death among insane patients. 1st Series, 1825-6-7, out of 1246 deaths,

253 were caused by organic disease of the encephalon,
395 by organic disease of the thoracic viscera,
445 by organic disease of the abdominal viscera,

188 by cachectic diseases.
2d Series, 1828-9-30, out of 1200 deaths,

237 were caused by diseases of the encephalon,

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