Jacobi remarks, with regard to this difference in the quality of the pulse of the two sides, that when it is constantly present the case is almost always incurable.

Compression of the carotid arteries in cases of mania was first imagined and tried by Dr. Parry: it has been employed by Dr. Burrows and also by Jacobi at Siegburg. Burrows says, that in recent cases of mania the violence of the symptoms was lessened by the practice. Jacobi observes on this point:

"With respect to the result of this operation (compression of the carotids), which has been so frequently performed in our asylum, we must first of all remark that the occurrence of phenomena following it varied exceedingly in different individuals, and that in some they were scarcely to be detected. They were as follows: a feeling of burning heat which spread suddenly over the head and neck down to the chest, or, when the compression was merely upon one side, over the corresponding side of the head and neck, with a feeling of heat within the head in many cases. The face becomes darker, with frequently the production of a vivid colour, an extremely painful sensation of compression of the chest, a feeling of tension, weight, and pain in the head, giddiness, staggering, sleepiness; actual sudden sleep, with stertorous breathing; in many incipient syncope, with uncertainty in the use of the lower extremities, stumbling, and in some cases they suddenly fall down with entire insensibility, but speedily recover. One of these patients fell before me at the moment when both carotids were compressed, as if struck down by a blow, but came to himself in a few moments, and complained of a headache; in another the syncope was not so complete, continued for some time; and a third said, when he recovered from the state of insensibility, looking wildly around him, that he had suddenly fallen asleep, and could not collect himself upon waking, so as to remember where he was." (p. 383.)

We here have a collection of symptoms in all probability arising from violent pressure, not only upon the carotid artery, but also upon the veins and nerves of the neck, and we are not surprised at finding that Jacobi considered the plan of compression of no practical value in treatment, although he adds that, when carefully employed, the appearance or absence of any of the above-mentioned results of the proceeding may afford considerable assistance in the diagnosis of the case.

II. The second table refers to the state-1st, of the upper part of the alimentary canal, teeth, gums, appetite, thirst, &c.; 2d, of the lower part of the digestive organs; 3d, the function of the kidneys and condition of the urine; 4th, of the skin; and lastly, of the functions of the entire apparatus of nutritive or organic life. The results of these observations are simply remarkable for the very little departure from the usual condition of health which they exhibit. The secretion of saliva was frequently increased and the appetite was often excessive; notwithstanding this latter fact, however, the nutrition was in the generality of cases in a very low state, but there was no constant disorder in the digestive system. On this point the experience of Dr. Jacobi is contrary to that of all English and French practical writers who have observed that the function of secretion and the state of the mucous membrane of the alimentary canal in maniacs is very much disordered, so much as to cause a peculiar fetor which has been noticed by very many observers. In the third section of his 'Observations,' upon the pathology and cure of mental disorders, Jacobi endeavoured to disprove an observation of Esquirol, who remarks that there

is a smell peculiar to the insane, proceeding partly from the skin and partly from the breath, although in the present work he passes it over unnoticed. He accounts for the increased desire for food as well as for the abundant secretion of the salivary glands by the somewhat unsatisfactory expression of an alienated condition of the functions of the nervous system, and he devotes a considerable portion of this section to extracts from other writers, which he compares, or rather contrasts, with his own observations. He has looked through the writings of other authors, in which descriptions of cases have been given, and has found that out of 130 which have been described in various works, the state of the tongue is mentioned in only 13, that of the bowels in 25, and the condition of the salivary organs and secretion in only one, while no writer gives a description of mania without mentioning particularly the condition of the various organs. The tendency of these remarks would lead us to look upon such general accounts of the diseases, when they differ from his own, even though narrated by Esquirol himself, with a certain degree of suspicion.

The fulness of these tabular statements has certainly the advantage of bearing an appearance of authenticity and weight; but it must be evident that the observation of the practitioner may be diverted by the great number of particulars which he is called upon to notice from directing itself to symptoms which, to a mind not so engaged, would present themselves as essential and characteristic.

III. The third chapter and table is drawn up under four heads, and gives-1st, a statement of the age and temperament, the form of the skeleton, development of the muscles, colour of the hair and iris; 2d, the state of the organs of sense, and sleep; 3d, that of the brain and nervous system, exclusive of the higher psychical powers; and 4th, that of the organs of generation.

The muscular system was, in the generality of these cases, moderately developed, and the degree of bodily strength was in relation with it. Esquirol, Ideler, Pinel, Neumann, Rush, and, in fact, almost every writer upon the subject describe the muscular power as excessive, enabling the patients to break their chains, &c., whereas Jacobi asserts from his own observations that no increase whatever in the strength takes place, and that a single attendant is generally able to overcome a patient during an attack of maniacal excitement, so as to put him under restraint.

The senses were slightly disordered in 12 out of 50 cases, in the generality of whom the abnormal condition consisted in an increased sensibility of the ear and eye, a dislike to loud sounds, and a slight degree of intolerance of light: common sensation was in an altered state in many cases; and in a large proportion sleep during the night was almost entirely absent.

Paralysis and other disorders of the brain and nervous system were not very frequent. In most cases the brain was the first part of the nervous system which was affected, while in some the disease was said to have commenced in the sympathetic-in others simultaneously in both sets of

nerves.

Among the male patients but very few exhibited any signs of inordinate excitement of the generative organs, and among the females the only re

markable fact was the frequency with which the catamenial discharge was found wanting, returning in some when the mania became confirmed-in others as a commencement of convalescencc.

IV. The fourth table gives an account of the morbid psychical phenomena in maniacs; in the appetites, moral feeling, and exercise of the will; in intellect, imagination, association of ideas and judgment, as well as the state of the mental faculties during the remission.

After giving an account of the relative numbers in which the various phenomena presented themselves, a repetition of which would be of no interest to our readers, the author remarks:

"From this table it is seen that a general violent psychical excitement, hastiness, and mental irritability, with tendency to break out into fury and rage, exists almost always in mania, united with an inclination to act violently towards others, a love of destruction, inattention to the rules of cleanliness, sometimes also with a complete alteration in the natural disposition of the individual; whilst, on the contrary, morbid excitement of the genital organs, rudeness of manners and lewdness, which are not natural to the patient, are only decidedly seen in the minority.

He describes as the source of their behaviour an ungovernable change of the appetites, sometimes displaying itself but slightly, but generally breaking out into excess of malicious, insolent merriment, occasionally preluding a state of depression and anxiety. The exact subjects or material which furnishes them with ideas during the period of maniacal paroxysm are traced by Jacobi to three sources:-1st, objects which present themselves to the cognizance of the senses, as we so frequently see in the delirium of typhus; 2d, pictures of past events called up in the memory; and, 3d, single isolated words, phrases, or numbers which the patient remembers and repeats without cessation, and frequently with the most violent gestures. And here we must recollect that out of 228 cases of mania which the author notices, only 20 showed any illusion to such an extent as to become an element in their ideas during the period of excitement.

Dr. Jacobi considers that this form of madness differs from a merely excited state of the mind produced by illusions, and that during the attack itself certain causes (momente) act upon the mind, and influence the maniacal language and gestures, whereas most authors consider that a disorderly and confused state of the ideas, or even an illusion, is the exciting cause of the paroxysms. Esquirol says that the multiplicity of the ideas, and the rapidity with which they are received, the faulty association, and the deception of the senses, and want of attention, lead astray the judgment of the patient, and by over-exciting and over-straining his passions drive him on to violent and dangerous extremes.

The third division of the work, On the causes of mental disorders which have the character of mania,' is subdivided into four chapters: 1st. General influences, circumstances of climate and weather, condition of the country, food, family, morals, political state of the people. 2d. Influence of sex, age, bodily constitution, temperament, intellectual abilities, religion, occupation. 3d. Hereditary and congenital causes. 4th. Acquired, remote, and exciting causes.

The statistical or numerical results presented to us in this part of the

volume are based on too few data to be admitted as general conclusions. We have access to data much more extensive, which we hope to lay before our readers on another occasion; we shall therefore, for the present, pass over the principal results of this portion of our author's work. We must, however, find room for a brief notice of his peculiar views respecting the nature and causes of insanity.

Most authors consider mental or moral causes as of more frequent operation than physical in producing diseases of the mind; but, according to Jacobi, those who think thus formed their opinions not upon the accurate observation of facts, or, at any rate, they only observe those occurrences which are immediately antecedent to the maniacal attack. This remark of the author respecting the psychical causes of mania in some measure involves the consideration of a view peculiar to him. He thinks, for instance, that the brain is not (as most observers, from its structure and from pathological facts, are led to conclude) the only organ of all psychical actions, but that the bones, ligaments, muscles, in fact every part of the system, has an equal share in producing the phenomena which are usually referred to the mind! This is in a few words the substance of his theory, to which we alluded in the commencement of the present article, when speaking of his former works, and of which the following is an abridged account, taken partly from his 'Sammlungen,' and partly from the work now under consideration.

After giving quotations from various authors who consider the brain as exclusively the organ of the mind, he says that if we will examine the facts which tend to elucidate the relation of psychical phenomena to the entire organism of the human body, we shall necessarily be led to conclude that besides the brain and the nerves, the whole system, as well as the individual organs, are in immediate relation to the original production, and to the various forms of these phenomena. In regard to the bony fabric, for example, he says that, from the improved manner of examining such subjects, the time will come when the physiologist will contemplate the os sacrum quite as fully as the os frontis, if he wishes to determine what had been the degree of mental endowment of the individual, and "when the form of the skull being given, it will be no proper trial of skill if he is called upon to describe the mental powers of a Philoctetes or an Ulysses." How often, he continues, do we see peculiarities in the skin and its appendages, hair of a certain colour or strength, and peculiar cutaneous secretion, temperature, &c., connected with some particular condition of the mental powers? while varieties in the state of the mental faculties are continually observed upon the recession or reappearance of cutaneous eruptions, &c. The vascular system, he says, is on all hands allowed to be closely allied to mental phenomena; a man with a large development of the arterial system is active, hopeful, sanguine, and enterprising; and a contrary condition of the vascular system is found in men disinclined to active exertion, and slow in judgment and resolution. The organs of voice have similar indications, and in like manner the stomach and alimentary canal; for instance, different kinds of food produce different effects. "Some men are incapable of deep thought in the morning before they have taken coffee; some require half, some an entire bottle of

XLIII-XXII.

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wine to make them sociable." Similar facts are brought forward respecting the muscular and other systems.

Holding, as he docs, such views as these, it is perfectly intelligible how Jacobi can admit that discases of any part of the system do not act upon the mind and produce insanity through the medium of the brain. Being not less than the brain parts of the organism connecting the mind to the body, the imperfection of the instrument in any instance prevents the possibility of a natural or healthy action of the mental faculties. We may connect with this idea of Dr. Jacobi the fact of his leaving out of his list of causes one which is of frequent occurrence, and which is always enumerated in other works upon the subject, viz. injuries of the head. Although there is a certain amount of truth in his remark concerning the occasional occurrence of insanity in cases which do not manifest cerebral disease, and are dependent on the disorder of other organs, his view is utterly untenable as a true theory of insanity; and certainly he has been able to establish the truth of no such thing in any part of his writings.

We find nothing in the sections on treatment which would interest our readers. It is evident that the system of non-restraint, as carried out in this country with such admirable results, is imperfectly known and practised at Siegburg.

In conclusion, we must say that although the present volume contains much that is valuable, and merits a place in the library of every physician who treats insane patients, or studies insanity, it will add much less to the previous stock of our knowledge, and to the widely-spread reputation of its author, than we had anticipated before perusing it.

ART. II.

Physiologie Pathologique, ou Recherches cliniques, expérimentales, et microscopiques sur l'Inflammation, la Tuberculization, les Tumeurs, la formation du Cal, &c. Par H. LEBERT, M.D. Accompagné d'un Atlas de vingt-deux planches gravées. Deux Tomes.-Paris, 1845. Pathological Physiology, or Clinical, Experimental, and Microscopical Researches on Inflammation, Tuberculization, Tumours, the formation of Callus, &c. By II. LEBERT, M.D. With twenty-two engraved plates. 2 Vols.-Paris, 1845. 8vo, pp. 554 and 515.

THE volumes we are about to notice contain the first attempt yet made in the French language to present a general view of the minute nature and constitution (as discoverable with the microscope) of the processes and products of disease. The work is entitled to a welcome in France, where a very remarkable state of ignorance concerning the advances made of late years in this country and in Germany in the department in question prevails. The amount of favour with which it may claim to be received here must depend upon the amount of novelty in fact, inference, or doctrine it contains-upon the degree of critical acumen it exhibits in separating the mountains of dross from the sprinkling of gold scattered through the recent literature of pathology, and upon the fairness and con