No. 196.] LONDON, SATURDAY, JUNE 2.

LECTURES

ON THE

Diseases of the Nervous System.BY

DR. CLUTTERBUCK.

LECTURE XV.

On Palsy, or Paralysis.P HSY is usually defined, a " loss of feel-

ing, or of voluntary motion, or of both to-

gether."1—Consequently, it may take place inany sensitive part of the body, as in the dif-ferent organs of sense or in parts endowedwith the power of voluntary movement, asin any of the volrwxtary or semi-vnl2zntarymuscles. It would seem that parts con-sidered as altogether involuntary in theirmovements, such as the heart and blood-vessels, and absorbing vessels, are not ab-solutely exempt from this affection; thoughthey rarely suffer, and probably to a less de-gree, in comparison with parts endowedwith sensation and voluntary motion :-Thereason is, that they are more independentof the brain, or centre of the nervous .vstem,and possess perhaps a greater degree of in-herent power, so as to be able to performtheir functions under states of considerable

oppression of the senso1’Íllm. We find, ac-

cordinl;ly, that the functions of cÌ1’culatilllt,absoi7)t&)7z, and many others of the involuntarykind, are carried on with a tolerable degreeof perfection, where the brain, from diseaseor injury, has its special powers nearly an-nihilated.

Diflerent names have been applied to

the different varieties of palsv, according tothe function that is lost or impaired, or ac-cording to the part affected. Thus, loss ofvision, from a paralytic state of the 7-ei)za,is termed amaurosis; of hearing, dysee4ra ordeafness ; of smell, anosmia ; of taste,ageusthia; and of touch, or general feeling,anrpsthesia : or, secondly, according to the

part where the loss of power is experiencedThus anv single muscle, or more than one,mav be paralyzed; as, for instance, themuscles or the tongue, by which articulation z,in speech is often impeded Qr lost(nn{!i(us).

Sometimes the act of swallowing is renderedimperfect, as far as it depends upon thetongue.A common case of palsy is that where one

side only of the body suffers; termed, then,hemiplegia. This may affect the whole side,from the crown of the head downwards ; orit may affect the upper, and not the lower

limb ; and vice versa. Sometimes the diseaseis confined to the muscles of the face, pro-ducing distortion of features, with or with-out a corresponding affection of the tongue.When the paralysis affects the muscles of theface, the corner of the mouth on the sideaffected falls, so as often to permit the es-

cape of saliva; while the opposite corner iselevated and retracted, the muscles thateffect those movements not being ccun-teracted by their antagonists on the paralyticside. If half the tongue, and the musclesconnected with it, are paralyzed, the tongue,upon being put out of the mouth, is thrust to-watds the side that is paralytic. The musclesthat move the eyelids sometimes partake inthe disease; and even those that move theglobe of the eye; though this is less common.Neither vision nor heari7ag, in general, suffersin these cases, though both sometimes do.One or two fingers alone, may be paralyzedin their movements; but this is usually aprecursor of a more extended affection.The feeling of the part is sometimes lost,

as well as the power of moving: this how-ever is less common, and argues a more se-vere state of disease. The skin of a par-ticular part, as on the cheek, &c., some-

times loses its sensibility, the musclesbeneath escaping. At other times, the sen-sibility of the skin is morbidly heightened,where the muscles are completely paralyzed.Pains resembling those of rheumatism, oftenprecede an attack of paral2sis.The blood-ressel. appear to be paralyzed Ín

some cases of hemiplegia; the pulse then isweaker than on the sound side. Theabsorbentsmay be also affected, which serves to accountfor the oedematous state of the limb on someoccasions.

There are still other varieties of he7r.i-

plegia described by authors. An old surgeon,Fabricius, speaks of palsy occurring at thesame time in one arm, and the foot on the.

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opposite side. Other authors mention aloss of feeling in one leg, and of the powerof moving in the other. I have repeatedlyobserved severe pains in the part precedethe attack of palsy. The skin of the cheekand lips is sometimes exquisitely tenderto the touch, while the muscles of those

parts are completely paralyzed. Sauvagesdescribes a case of intermitting hemiplegia,coming on daily with an accession of fever.Morgagni mentions a case (not however asfalling within his own observation,) wherethe patient had jaundice on the paralyticside only, and that very accurately defined,the right side of the nose being so affectedwithout the other. I have often observedone half of the tongue in hemiplegic patientsto be furred, while the other half was clean.The manner of attack of hemiplegia is very

different at different times. It is oftenpreceded, and that for a considerable time,by pain in the head, variously seated; or

by some degree of imperfection or dis-turbance of one or more of the sensorial

functions; sometimes by extraordinary feel-ings in particular parts, as an extremity,especially by the sensation termed goingto sleep." Sometimes the disease makes itsattack during sleep, the patient on waking,finding himself deprived of the use of hisside, and that without any previous warning.A large proportion of cases of hemiplegia are Imere consequences of apoplexy; the stuporcharacterising this disease going off, thepower of voluntary motion on one side is ob-served to be lost. This event may be oftenforeseen by the immobility of one side

during the apoplectic state, the other sidebeing often in constant or frequent motion.Even the manner of the patient’s falling,when seized with apoplexy, will oftenenable us to predict the occurrence of hemi-plegia, if the patient should survive the

apoplectic attack: he falls towards the pa-ralyzed side.On some occasions we meet with palsy of

the lower half of the body, taken trans-

versely. This has been called paraplegia.This variety more frequentlv arises fromdisease or injury of the spinal chord, than ofthe brain itself. A peculiar kind of palsy isinduced by certain metallic poisons; as lead,and qnicksilver, and probably others. (Para-lysis venenate.)—Palsy of this kind is butlittle understood, the mode of action of suchcauses being very obscure.Thus you see that palsy is a disease sub-

ject to great variety, but this variety will beeasilv understood when the nature of theaffection is explained, that is, when the

theory of the disease is given.Theory of Palsy.—Sensibility, and the power

of voluntary movement, being derived fromthe nervous system,—that is, the brain, andits appendages the spinal chord and the nerve-,

proceeding from these,-every disorder ofsensation or 2olnntary motion in parts, mustbe considered as affections of the nervous sus-tem, or as having their seat and origin inthe parts just mentioned as constitutingthis system. Now as the brain, or cephalicportion of the nervous system, is the greatcentre of the nemous power or influence, (thespinal chord, and the nerves in general, serv.ing little other purpose than to transmit theinfluence of the brain to the sentient and

moving parts of the body,) palsy, in a gene-ral sense, is to be considered as a loss of the

nervous power in the part affected, and whichmay be occasioned either by a morbid orpreternatural state of the prime organ ofthose faculties, namely, the brain ; or bysome cause impeding or interrupting theinfluence of this organ on the sensible and

moving structures. This interruption maybe produced by disease or injury of thespinal chord, or by similar affections of thenerves themselves, either in their course orat their terminations. Now it is thosevarieties of palsy that have their origin inthe brain, that we are at present consider-ing ; the others will be easily understoodafterwards.

Every individual part of the brain is to beconsidered as performing an office differentfrom the rest, as its structure is also diffe-rent. When we consider that a nerve is abundle of distinct fibrils running parallel toeach other, and merely connected by cellu-lar tissue ; and that they can be traced thusdistinctly into the substance of the brain; itis fair to suppose, that each fibril has its

peculiar and appropriate origin in the brain;so that when disease or injury affects this

particular spot, it will show itself by a cor.responding disturbance of the function of thepart to which such nervous fibril is sent.And thus it is as easy to understand themost partial, as the most extensive paralyticaffection. They are all, in fact, the resultof a morbid or preternatural state of someparticular part of the brain, and which. it iseasy to see, may be almost infinitely variousin extent, as it may be in situation; thus

readily accounting for all that variety in thecharacter of palsy that has been mentioned.Thus hemiplegia, where one entire side ofthe body is paralyzed, must depend upon amore extensive affection of the brain, thanwhere one extremity only suffers. Amaurosisagain, or a palsy of the organ of vision,must have its origin in a different part ofthe brain from the former ; and so in othercases. If the physiology of the brain wereperfect, we should, even à priori, be able toassign the precise seat of disease in everycase ; from observation of the symptoms,or the particular function obseived to bedisturbed. And again, were morbid anatomy

perfect, that is, were it all times competent

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to point out the seat and nature of a disease,we might, by the aid of dissection, ascertainthose points. But unfortunately, neither ofthese is generally true: physiology, espe-cially that of the brain, is imperfect; andmorbid anatomy equally so. 1,1’e. are there-fore often left in the dark, in spite of theaid derivable from those studies ; and medi-cine, in consequence, is still liable to the

reproach formerly cast upon it of being" a conjectural art."We are doubtless warranted in referring

hemiplegia to the brain as its primary seat,although the disease shows itself in parts ofthe system very remote from the head. Noaffection of the spinal chord, nor of the nerveswhich spring from it, could explain the dis-ease before us. Because many of the partsaffected, as the muscles of the face andtongue, derive their nerves immediatelyiyOm the brain, without any communicationwith the spinal chord. The precise part ofthe brain in which the disease is seated in

hemiplegia, is hardly yet determined, for theappearances are not always the same. Butthis, practically speaking, is of little mo-ment, for the treatment is the same, what-ever be the part of the brain in which thedisease is seated. Dissection has sufficientlyproved that the brain, generally speaking, isin a state of disorganisation, and that chieflytowards the basis. Sometimes it is found

preternaturally soft, sometimes the reverse.Blood, also, is frequently found effused; orfluid of a serous nature. Now these changescommonly result from inflammation, andthat, for the most part, of a slow and indo-lent kind: And thus ive say that hemiplegia,or palsy of one side of the body, is the resultof slow, disorganising inflammation in thebrain ; and this is always to be looked to inthe treatment.

Prognosis.—For the most part, the prog-nosis is unfavourable in palsy. Patients,it is true, do not immediately die from anattack of hemiplegia, because the parts para-lysed, and of course the part of the brainwhence those parts derive their power of

moving, are not of immediate importance tolife. A perfect recovery, however, is veryrare. The patient, in most cases, recoversto a certain degree the use of his limbs, soas to be able, with the aid of a stick as a

sapport, to walk about; but it is in a veryfew cases only, and those occurring in earlylife, that an absolute cure can be expected.At the same time, a recurrence of apoplexy,or a more severe attack of palsy, is alwaysto be apprehended in these cases, andwhich is not unlikely to prove fatal. jTo repeat what 1 before stated, then, hemi-

plegia is obviously an affection of the nerioussystem, as it consists in an interruption ofthe functions belonging to this order of parts.It is therefore strictly a nervoirs dWrde)-, and

properly classed by Dr. Cullen among theneuroses or nervous affections. And as to itsprecise seat, it belongs to the cranial portionof this system, the brain, for no other partof this system, neither the spinal chard, northe nerves themselves, however diseased,could give rise to all the symptoms that attimes characterise hemiplegia. No affectionof the spinal chm-d, for instance, and stillless any individual nerve or nerves, couldaccount for the paralytic state of the musclesof the face, as these muscles do not receivetheir nerves from the medulla spinalis, butdirectly from the brain. But an affection ofthe brain may readily occasion paralysis ofthe extremities, although these parts de-rive their nerves immediately from the spinalchord; for’ this is the medium of communication with the brain, the influence of whichit transmits to the muscles of the extremi-ties. The impaired state of one or more ofthe organs of sense, and the disturbance of themental function, which are observed in manycases of hemiplegia, show sufficiently thatthe brain is the primary seat of disease. Thisis further confirmed by the circumstance,that in a great proportion of cases, this va-riety of palsy is preceded by apoplexy, inwhich all the proper cerebral functions are

suspended. Dissection, also, in most cases,detects disease in the brain quite sufficientto account for the symptoms, and which ap-pears to be chiefly seated towards the ba-sis, and for the most part on the side oppo-site to that which is paralysed.The brain at this part is found to have

suffered inflammation, with more or less ofalteration of structure, according as thedisease has been of longer or shorter dura-tion. An accumulation of aqueous fluid inthe ventricles, as well as between the membranes, is one of the general circumstancesfound upon dissection, and, as well as thealtered structure, serves to show the realnature of the disease, viz. topical and partialinflammation in the brain. When hemiplegia ahas succeeded apoplery, and proved fatal,there are generally found marks of bloodhaving been extravasated in the brain ;such as remains of the coagulum, or somecavity in which it has been lodged, andfrom which it has been removed by slowand gradual absorption. This cavity hasbeen called the apoplectic cyst. The termi-nation of apoplexy in palsy, is easily under-stood. The blood is, in general, first effusedinto the substance of the brain, and, bymaking pressure in all directions around,produces a suspension of the cerebral func-tions altogether, that is, an apoplectic state.Soon, however, the blood bursts into theventricles, where it coagulates, the serumescaping into the neighbouring lateral ven-tiicle, and also passing into the third and

fourth. Thus, by diffusion, the effect of the

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pressure is lessened, and the organ recoversits powers in a certain degree, conscinusnessreturning, and’generally sensibzlityalso, whilethe loss of muscular power remains. Hemi-plegia, then, is the result of slow or chronicinflammation in the brain, limited in extent,and affecting one side of the brain only.

Hemiplegùt exists in very different de-grees, according to the degree and extentof mischief in the brain. Sometimes thisis very slight ; as may be presumed from thetrivial nature of the symptoms, and theirspeedy and perfect removal by an appro-priate method of cure. These, symptomsoften are temporary, recurring from time totime, and lasting but for a short period;the patient hesitating a little in his speech,or articulating indistinctly, or complainingof a slight tingling in one of the extremities.In these cases the prognosis is favourable,many such yielding readily and perfectly toan active mode of cure. In other cases, the

injury done to the organ is too great to beremedied ; as when the structure is mate-

rially altered, or blood is copiously effused.In these, only a partial amendment, at best,is to be expected. In young subjects, a

recovery now and then takes place, and thatwhere the disease is of an aggravated nature;but even in these, the cure is seldom com-

plete. In old persons, a recovery is not tobe hoped for. ,

Treat.ment.-The treatment of hemiplegia is I,very easy, provided you keep the few ’,general principles in view which I have Ialready mentioned. You must bear in mindthat you are treating a case of slow or chronicinflammation of the brain, and limited in

extent ; the precise seat of which, however, iis of no moment. The means to be em-

ployed are exactly those that are requiredin cases of chronic inflammation in general,that is, they are antiphlogistic in their nature,but must, of course, be accommodated intheir application to the circumstances ofthe individual case. Slight cases, if recent,may be treated with great probability ofeffecting a cure ; because it is likely that thebrain has as yet sustained no material de-rangement of its structure. These caseswill generally be found accompanied withmore or less of febrile action, as indicated bythe heat of the skin and foulness of the

tongue ; which last is of itself sufficient toshow the existence of active inflammationin the diseased part of the brain. As longas this symptom (a foul tongne) remains,there is a necessity, in general, for the useof antiphlogistic measures, especially generalbleeding from the arm, which is by far themost effectual mode of drawing blood.

Nothing but the extreme of weakness inthe patient, such indeed as is very rarelymet with, should prevent our having re-course to it, I need not observe, that the

t quantity of blood drawn, should be well pro.! portioned to the actual state of the patient.In weak persons, from four to six ounces isa sufficient drawing; in strong ones, as

, much as twelve or sixteen may be required.It is seldom necessary or proper to exceed

this quantity ; for you must remember, as Itold you before, that it is slow or chronic in-

flammation you are treating, and which pro-t bably had subsisted some time before it at-tracted notice. In all such cases, no singlebleeding, however large, can accomplish thepurpose ; it is only by slow and gradual

. means, that the disease can be eftèctuallyremedied. The inflammatory action in thepart is first to be subdued ; this being ac-complished, the part will gradually return toits natural state, (provided the disease beslight and recent,) so as to be able to reosume its functions. For this purpose blood-letting may be required, and that repeatedlyfor many times, at intervals of a few days,or two or three weeks, according to the ur-gency of the symptoms, and the habit of thepatient. I have often thus bled a patientten or a dozen times, or even more, in thespace of a few weeks; and not unfrequentlywith the most complete success, the generalstrength remaining nearly unimpaired, pro-vided the bleeding is not carried to excessin point of quantity at one time, and pro-vided also the patient is allowed to take foodaccording to his inclination ; for there is

nothing I am more convinced of from obser-vation, than that it is not necessary, nor in.deed advantageous, but rather the contrary,to reduce the diet of the patient in any con-siderable degree. All that is necessary is,to confine him to a simple and ordinary modeof living; and then the appetite may besafely trusted. By thus allowing the pa.tient to take food moderately, (not even ex-cluding animal food,) the loss of blood isbetter sustained, but is not, according to myobservation, rendered thereby less effectualas a remedy. This, I know, is not the gene-ral opinion or practice in such cases, but Ihave no doubt of its propriety, being almostdaily a witness of its advantages; and I havetherefore no hesitation in recommending theplan to you for adoption. All strong drinksought to be strictly interdicted, as direcltystimnlant to the vascular action of the brain;which food, moderately taken, is not, With

respect to the extent to which the plan ofrepeated bleeding is to be carried, it is im-possible to lay down any precise rule. The.

object to be aimed at, is the complete re-moval of the inflammation from the part ofthe brain affected ; a point that is best

judged of by the feelings of the patient, andthe state of the general system. As long aspain is complained of in the head, and espe-cially if attended with heat or throbbing ;and as long as the tongue continues dry and

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furred, with or without other marks offebrile action, you may be sure the inflam-matory action is not removed.

Other remedies are of little importance,compared with bloodletting, and are only use-ful as contributing to the same general pur-pose, the removal of inflammation. Occu-sional purging is of advantage ; but it is not

- necessary to carry it to the extent of

harassing the patient greatly, as is oftendone. Nor is there any advantage in theemployment of calomel for the purpose onthe contrary, this is often rather injurious,by exciting febrile action in the system, asit is sure to do if carried far or often re-peated ; while, as a mere purgative, it isone of the least effectual. ’By treatment ofthis kind, sufficiently persevered in, manyrecoveries may be effected, where the cir-cumstances are favourable ; but at all timesthere is a tendency to a renewal of the in-flammatory action, as in the case of otherdiseases. This recurrence is to be guardedagainst, as far as possible, by the counter-irritation of an issue or seton, and by occa-sional purging; all causes calculated to ex-cite the vascular action of the brain beingcautiously avoided, such as the use of strongdrinks, and great mental exertion or emotion.

I have said nothing of the treatment ofthe paralysed parts themselves, because, in Ireality, it is a matter of little moment. It Iis usual on these occasions to apply stimu-lants of various kinds to the skin ; as fric-tions with ammonia, mustard, horseradish, andvarious others. Blistering, also, has been ex-tensively used ; but all without advantage ;which you will not wonder at, when youreflect that the primary or real disease, isnot in the limbs themselves, but in thebrain. It is useless, therefore, to stimulatethe limbs in any way. Electricity has beenhighly recommended in paralytic affections,but upon a mistaken principle. It was ob-served that an electric shock, passed throughthe muscles of a paralysed limb, producedcontraction, although the will had totally lostits influence over them. It was imagined,therefore, that a repetition of the same ap-plication would restore the power of thelimb. But electricity, like other stimulants,gives no new pauer to act ; it merely callsinto action, that which already exists ; but,in so doing, at the same time, expends, andultimatelv exhausts it ; leaving the partworse than before. And this is really whattakes place; the contractions become lessand less, upon each application of the sti.

mulus, and at length cease to be producedat all ; the power of the muscles being ex-hausted and destroyed by this over exer-tion. It has been proposed to apply electri-l’ity to the brain itself, a thing easy enoughto be accomplished ; but here it is mani-

festly calculated to aggravate the disease,

by further irritating parts that are already) in a state of over-excitement, and indeed ofactual inflammation, though of a chronickind. General stimidants, such as ammonia,cantharides, mercury, and various others, havelikewise been administered internally; uponthe supposition that the disease is foundedin debility, or general weakness of system.But both reason and experience are againstsuch practice. In short, nothing can beusefully done beyond what I have stated;and it is wrong to harass the patient withvain attempts to cure. In old paralyticaffections, a course of warm bathing hasbeen sometimes serviceable ; bnt in recentaffections of the sort, and especially in cor-pulent habits, and where febrile symptomsindicate the presence of active inflamma-tion, warm bathing is highly objectionable,,as tending to induce apoplexy, by exciting,as it does, the vascular action of the brain.

Paraplegia, as I observed before, is a palsyof the lower half of the body, both sidesbeing affected at the same time ; in whichrespect it differs from hemiplegia. Paraple-gia may originate in the brain; but, in ge-neral, it proceeds from disease or injury ofthe spinal chord. If it proceed from thebrain, it must be from an affection of bothsides of the organ. The attending symp-toms will generally show, whether the dis-ease is of cerebral or spinal origin. If thebrain be the part primarily affected, therewill probably be head-ache, with more or lessof disorder in the functions of the brain ;whilst, if the spinal chm-d be the primary seatof disease, it will generally be discoveredby the pain felt in the back, tenderness tothe touch when the spine is strongly press-ed upon for examination, and, if the diseasehas been of long standing, some prominenceor other deformity of the spine, will be ge-nerally detected.The treatment of this variety of palsy, is

to be conducted upon the same general prin-ciples, as those I have already explained toyou. The object is the removal of the in-flammation, whether seated in the brain orin the spine is of little moment. The meansare the same, for the most part, in both

cases’; accommodated, of course, to the stateof the patient, and directed, as far as canbe done, to the part originally diseased. Inthe case of the spine being diseased, thehorizontal posture, coutinued for manymonths, or till all signs of active inflamma-tion have disappeared, is of the first im-

portance. This is the only effectual methodof takiug off pressure from the diseased

part, all machinery not only failing in geile-ral to do any good, but for the most partdoing injury.

In palsy of a still more limited nature, andwhich can be traced to a disease of some

particular nerve or nerves, (as, for instance,

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where a tumour is formed in the axilla, andwhich presses upon the great trunks ofnerves in that situation,) your aim shouldbe to remove, if possible, -the cause that in- -tercepts the influence of the brain upon theparalytic part, by the removal of a tumour,or other mechanical cause.. In all thesecases, internal medicine is of very little use.

There is another variety of palsy producedby poisonous substances of a inine),al nature,as lead, mercury, arsenic, and perhaps others.That occasioned by lead is the one most

generally met with, and it lias peculiarcharacters, which distinguish it from palsy ofthe ordinary kind. Lead, any how appliedto the body, whether taken internally, orapplied externally, or inhaled in the formof vapour in breathing, gives rise, after anuncertain period, to disease in a great pro-portion of instances, and of a very peculiarnature, and which admits of no satisfactory iexplanation. Constipation of bowels, at-tended with the most violent colic pains, iscommonly the symptom first complained of.Hence the term ci1lica saturnina, or colicfrom lead. It is often called the painters’colic, from its frequent occurrence in per-sons accustomed to work on this mineral ;but it is observed also in plumbers andglaziers, and is produced in them by fre-quently handling lead in their ordinary bu-siness. It has been called from situationcolica pictormm, or colic of Poitou, a provinceof France; and colica Damnoniorum, or Devon-shire colic. In those cases, the poison is in-troduced into the system through the me-dium of the wine and cider of those coun-tries, holding lead in solution.

In this species of colic, after a time, painsare felt about the shoulders and arms ; andthis by degrees is followed by an inabilityto act with the muscles of the fore-arm,which waste away in a considerable degree,especially the muscles in the palm of thehaud, and which bend the thumb. Fpilepsy,likewise, takes place in some of these affec-tions. Lead is the general, and probablythe sole, cause capable of producing thekind of colic, and other consequences, weare now considering.

If the disease has not continued long,and the application of the cause be avoided,the symptoms often subside slowly of them-selves. If it has continued for a length oftime, and the muscles are greatly wasted,there is but little probability of the diseasebeing removed. The remedies generallyemployed are cathartics of a warm or stimu-lant kind ; with fomentations to relieve pain;or the warm bath. Many years ago, 1 sawreason to believe that mereemy was, in somesort, a counterpoison to lead. When calomel,for instance, was administered in small andrepeated doses, so as to affect the mouth, itnot only proved an effectual remedy for the

constipation, but appeared to relieve alsothe paralytic state of muscles. This remedy,however, was only useful where the diramhad been of no long continuance. It is of

’ consequence in these cases to keep thehands open, and the wrists extended, bymeans of splints, during the night, in orderto guard against a fixed contraction of theparts ; making every effort to use the handsduring the day.The next affections of the muscular system

we shall have to notice, are those wherethere is a preternatural contraction of mns-cles. and that either of a permanent kind(called spasm), or alternating with relaxa·tion (convulsion) ; of both which there areseveral varieties.

FOREIGN DEPARTMENT.

Biographical Notice of 31. Pinel.

M. PHILIPPE PINEL was born at SaintPaul, near Lavaur, in the Department ofTarn, on the llth of April, 1743. He firststudied medicine at Toulouse, where he gra-duated. A few years afterwards he cameto llontpellier, then so celebrated for its

faculty of medicine, and completed at thisplace his medical studies. At the expira-tion of some time, M. Pinel, led by the eon.sciousness of his own powers, came to Paris,the only theatre where genius could actwith all its energy. There M. Pinel, en-dowed with a true spirit of philosophy anda keen judgment, applied himself to thestudy of natural history, on which branchof knowledge he published several tracts.In 1781, he published a translation of Cul-len’s Practice of Physic; this was soon suc.ceeded by an edition of the works of Bag-livi, which he enriched with notes. These,his first productions, made him known in avery advantageous point of view. At thisepoch, so remarkable by the change whichwas gradually taking place in the human

mind, and the light which the philosophersof the 18th century had spread on almostall the branches of human knowledge ; at

this time M. Pinel was intimately acquaint-ed with all the literati of Paris, as Chaptal,Berthollet, Fourcroy, Sabatier, Desault, &0.

The administration of hospitals confided firstto Pinel’s care the division of the aliénésat Bicetre, then some vears after he wasnamed chief physician of the large esta.

blishment known by the name of Salpétrière.During the time of his being physician atBicetre, M. Pinel gave proofs of the great.