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evidence of derangement. The pulse is the pulse of excitement without power. ’ The value of these signs, the author stated, was often not suffi- ciently estimated until it was too late to repair the cerebral mischief done. Dr. Winslow then pointed out the treatment of incipient insanity. He stated that no specific plan of treatment could be pursued which would be applicable to every case. The medical practitioner must be guided in his treatment by the circum- stances connected with each case brought under his considera- tion. As a general rule, he deprecated bleeding in the early or advanced stages of insanity ; there were, however, cases in which considerable vascular action was going on in the brain, and for the removal of which it was necessary to abstract blood both locally and generally. Dr. Winslow also spoke of the exhibition of morphia, purgatives, counter-irritants, and the application of cold in the treatment of insanity, and pointed out the states of brain in which they were admissible. Mr. HEADLAND complained that the paper had failed in eluci- dating any new point connected with the subject discussed. He shewed that cause and effect had frequently been confounded, and referred to cases in which insanity existed without any ap- preciable physical change. He considered that the pathological condition was often the effect and not the cause of the mental disease. He had little expectation of insanity being either cured .or prevented by physical remedies, but trusted that moral treat- ment and training might be of service in effecting, to some i extent, its eradication. Altering the habits of the people would tend greatly to this desirable end. He shewed the difficulty of preventing the accomplishment of suicide where insanity on that point existed, although it was easy enough to detect its presence. Mr. DENDY referred many states of mental aberration to a want of balance in the circulation of the brain, principally in respect to venous congestion. The discussion was adjourned. .Blogzda.7f, Febmaarf J 0, 1845. A COMMUNICATION was read from Mr. Curtis, in reference to the valerianate of zinc, in which it was stated that he had administered this medicine with great advantage in a variety of ’; cases of tinnitus aurium, nervous deafness, amaurosis, and muscse volitante’. The dose was a grain. He intr< duced the medicine to the Society with the view of iuducing the members to try it in cases of nervous debility; and as, at present, it was not easily pro- curable in London, he had placed some of the medicine in the hands of the President, to supply any gentleman who would wish to give it a trial. This remedy had the advantage of having mineral and vegetable properties. Mr. HIRD had employed this medicine in two cases of hysterical neuralgia. In one case it was of advantage. A MEMBER had also used the valerianate of zinc in a case of brain afiection closely resembling delirium tremens. It was of much benefit. The discussion of Dr. F. WINSLOw’s paper was then resumed. Dr. CosTELLO was astonished at the opinions expressed, at the last meeting, by Mr. Headland, as they were perfectly opposed to pathology. Mr. HEADLAND explained, that in the absence of paralysis or other manifest physical disease, in a great majority of cases of insanity, there would be no appreciable change in the bra;n after death. There was no relation whatever between the amount of physical disease and the mental aberration. He referred to a case published in THE LANCET some years since, in which there was complete destruction of a great portion of both hemispheres of the brain, and yet mind remained perfect to the last. Mr. DENDY drew an analogy between simple concussion and incipient insanity, in which recovery took place, one from a moral, the other from a physical influence. Dr. CnowNE considered that every mental disease had a physical origin. In all cases of insanity there would be a phy- sical change, though it might not be always appreciable. The brain might be temporarily affected by some change in the cir- culation, independent of organic changes, as spasm and diarrhoea might exist ithout physical lesion. Dr. AnsoN shewed that disorder of function of the brain might exist without appreciable organic change. Yet who doubted its presence any more than they did the presence of organic change in the kidney (though not to be detected) in certain disorders of function of that organ? Dr. CLUTTERBUCK regarded insanity as not a disease per se, but merely a symptom of disordered function of the brain. If we admitted-and, he thought, it could not be reasonably doubted-that the brain was the orgap through which the mind was manifested, it followed that every disordered condition of the mind was dependent on some disordered condition of the brain ; not always, it was true, obvious or appreciable, but still, it was clear that the br4in.wm not in a sound state of health. Not always to the extent of disorganization, for it was known that insanity often left the patient for a time, and then recurred, from causes not very obvious. The brain was often found diseased in cases of insanity, but we wanted proof that those changes were always the cause of the insanity. Authors of eminence, however, had asserted that they had always found the brain diseased in cases of insanity ; Sutherland and Haslam were of this number; and Mr. Lawrence, out of seventy-two cases, had found the brain diseased in all, a structural change existing in each case. These facts did not prove that the structural disease was the cause of the symptoms, but it shewed that iu insanity the brain was not sound. That these conditions were not the proximate cause of the insane phenomena, however, was’ proved, for they existed independent of insanity. We found opacity of the membranes, increased vascularity, bloody points, induration, softening, and serous effusions of the brain, in cases in which insanity did not exist. Changes, however, might’ exist beyond what we were at present enabled to discover. What then caused this state of brain? He believed that it was always the result of inflammation which had existed at some period or other. He thought this, because inflammation was’ the great disorganizing process ; and if disorganized, therefore, the brain must, at one time, have been inflamed. The dis- organization was the result, in some way, of inflammation. We might often trace insanity in its early stages to the influence of’ extreme mental emotion, the effects of alcohol, or of local in- juries, the insanity subsiding on the subsidence of these causes, so that we had cause and effect at once before us. He complained that the term incubation was not expressive of the manner in which insanity progressed in its early stages. Con- firmed insanity was incurable, as the brain had become per-’ manently affected. The time for treatment was in the early* stage ; subdue the inflammation then, and you subdued the symptom, and the brain regained its natural condition. Dr. WIGAN agreed with Dr. Clutterbuck, except as to in- flammation being the first cause in all cases. He briefly referred to his opinions on the duality of the brain and mind. Dr. CosTELLO agreed in the main with Dr. Clutterbuck; but believed that the changes of the brain connected with insanity might be dependent on other causes than inflammation. Thus there was a peculiar shining appearance of the white portion of the brain, not the result of inflammation, frequently found in cases of insanity. He ailuded to the state of irritation, the- result of long suckling, of softening of isolated portions of brain,’ in which the vessels were impervious to injection, as being often’ passed over in examinations of the brain of lunatics. Mr. HEADLAND replied. He shewed that no observations which had been made affected the position with which he had started. He shewed, from reference to statistical facts, that’ insanity bore a ratio to the state of mental and physical destitu- tion which prevailed, and he particularly directed attention to the: prevalence of insanity in Wales. He shewed the little benefit likely to result from merely physical agents in the prevention of this disease, and trusted for the alleviation of mankind from this distressing malady to increased physical comforts, and im- proved mental and moral training. HOSPITAL REPORTS. COLCHESTER HOSPITAL. STRICTURE AND ULCERATION OF THE (ESOPHAGUS, WITH OSSI- FICATION OF THE TRACHEA AND HYPERTROPHY OF THE* HEART. H- was admitted into the hospital, under Dr. E. Williams, in January, 1839, complaining of his rejecting food immediately after swallowing it, accompanied with pain at the pit of the stomach. On the 5th of February he was found in articulo mortis, the eyes remarkably protuberant, with subsultus, or spasmodic twitchings. The oesophagus was contracted, about four inches above the cardiac orifice. The mucous membrane was ulcerated, and very adherent to the bifurcation of the trachea and to the arch of the aorta, and separated but by the intervention of the cellular mem- brane. In the laryngeal region the cartilages of the trachea were ossi, fied, and apparently seemed to press on the oesophagus. The lungs were healthy but excessively engorged, the cells being tinged with a frothy, sanguineous fluid ; externally, th presented the natural violet hue.
