Obrázky stránek
PDF
ePub

well, worried over her children's future, thought she had various diseases, that she had been wicked all her life, and that God had forsaken her. She would shut her mouth and refuse to talk. This culminated in five weeks in violence of speech and action, screaming and throwing furniture about the room. She was eating little and losing weight rapidly.

It then became necessary to remove her from her home, and she was taken to an Old School hospital. During her residence there she was much confused and deluded, having hallucinations of hearing and sight, thinking the nurses were devils, that she herself had brought suffering to others. She was violent and noisy. She ate very little and gradually grew more confused, deluded, and violent, and later became filthy in her habits. The main underlying delusion seemed to be that things in the world were all wrong, that she ought to set them right, and that people about her prevented her from righting the wrongs.

She was then so violent to the nurses when they attempted to care for her and clean up her room that it became necessary to restrain her with a camisole.

When she came under my observation she retained all the above-mentioned delusions and hallucinations. She also came with the prognosis of an incurable mental disease. She thought she heard her children calling her, that they were kept upstairs away from her. She thought her urine holy water and her feces sacred balm. She was a very dangerous patient at this time, requiring three and four nurses to manage her when taken from the camisole. She would resist everything that was done for her. Every few minutes she would scream out, cursing and calling people about her devils, thought she had the responsibility of the world upon her shoulders.

With such an unfavorable prognosis and such grave symptoms it was thought advisable to try an experiment with thyroid extract. She was then given 2 grs. of extract of thyroid three times a day. For the following week she continued very restless, excited, and violent. Temperature ranged about 100. Pulse, 120. On the ninth day she ap

peared more quiet and seemed to realize her condition. The thyroid was then discontinued. The tenth day she was rational at times. Temperature on the eleventh day was normal and she had improved very decidedly, although very weak and crying easily. From this time she gained steadily, was discharged recovered at the expiration of three weeks and four days.

The entire time of her treatment by me was five weeks, during nine days of which she was receiving thyroid. The improvement continued until her discharge as recovered a fortunate result for a person apparently hopelessly insane.

AUTO-INTOXICATION AS AN ETIOLOGICAL FACTOR IN THE PRODUCTION OF MENTAL DISTURBANCES.

to treatment.

BY S. C. FULLER, M.D.

[Read before the Boston Homœopathic Medical Society.]

The cause of mental disturbances has been a field for speculation and investigation since the time of Hippocrates in the fifth century B.C. Cælius Aurelianus four hundred years later (1), although he may not have discovered the causes of insanity, certainly determined that many cases were amenable He stands out conspicuously in the history of psychiatry for his scientific conception of good therapeutics and humane treatment of this class of cases. The innovations which he introduced, and his methods of treatment, read not unlike those in vogue in Massachusetts to-day. This celebrated physician of the first century A.D. conducted and successfully operated what we are pleased to term the modern insane hospital. This he accomplished in the face of that influential ancient mythology which held so strong a sway over the minds of men, and when, not unlike in our own times, men were accustomed to refer the inexplicable to divine interventions of beneficence.

With the decay of that ancient civilization came a reversion

to the primitive, unscientific, and inhumane conception of psycho-therapeutics. These methods held long and undisputed sway until there again appeared scientific investigators, particularly in Germany and France; chief among whom was Pinel of France.

The statement "that there is nothing new under the sun" we are at times constrained to accept as particularly true of medicine, especially when we review the history of our profession. I cannot in this connection refrain from quoting Hippocrates, who, in speaking of epilepsy, then popularly termed the "sacred disease," remarks: "The sacred disease appears to me no wise more divine nor more sacred than other diseases, but has a natural cause from which it originates, like other affections." It was his aim to show the inconsistency of a belief in the divine origin of epilepsy, when so many other brain disturbances were no less mysterious in their origin.

What to me seems particularly interesting, especially as it bears on the subject of this paper, is another utterance of this great physician of Cos: "This disease" — meaning epilepsy" is formed from those things which enter into and go out of the body, and it is not more difficult to understand and cure than the others, neither is it more divine than other diseases. . . . Men ought to know that from nothing else but the brain (the soul and psychic manifestations were located in the stomach by one eminent physician of the middle ages) come joy, despondency and lamentation, . . . and by the same organ we become mad and delirious" (2).

You will see that the physician who lived previous to 500 B.C. quoted by Hippocrates and Hippocrates himself had a crude idea of auto-intoxication. So much, then, for the antiquity of my subject, but time cannot wither nor custom stale its infinite variety. Hippocrates gave us a suggestion which after twenty-five centuries we are beginning to carry out. The investigation at the present time of the toxins formed. in the gastro-intestinal tract, and the rôle auto-infection plays in the production of disturbed mental states has already thrown a flood of light on the etiology of epilepsy, some

forms of melancholia, mania, and other nervous conditions which are not essentially mental. You will understand that all intoxications do not necessarily proceed from the gastrointestinal tract, nor is it my purpose to maintain that autointoxications are the only causative factors in mental disturbances. It is really not a strange thing for cases to come to autopsy, in which is discovered no visible cause for a muchdisturbed mental state, and this, too, after the most improved technique in examination has been applied. On the other hand, there do occur cases in which we are positive that pathological lesions in remote parts were undoubtedly the cause of the mental unbalance.

The neurone conception of Waldeyer, and the discovery. of the collaterals of axones and their end arborizations by Golgi and S. Raymond y Cajal has enabled histologists to study more closely the action of toxins on nerve cells, and degenerations in these nerve units. Dr. Lewelly F. Barker in his recent work, "The Nervous System and its Constituent. Neurones," in summing up the neurone concept, estimates that in the nervous system there are about three trillion neurones, that each neurone is morphologically and physiologically independent (if protoplasmic bridges be excepted); and that while "nerve conduction paths may, and probably usually do, in higher animals, at least involve more than one neurone, the neurones being, as it were, superimposed upon one another to make simple or more complex chains, or chains of neurone groups, one individual neurone through its various processes position to be affected by and in turn to affect several or many other neurones." Now when we consider that each neurone with its end arborizations terminating, perhaps, in some distant part of the body and continually bathed in the lymph, it is not difficult to conceive how a neurone may suffer

is in a

from

poisonous substances in the lymph and blood. That neurones are not more frequently affected may be explained partly by that selective affinity which makes an amoeba draw in its pseudopoda when its surroundings are hostile, and partly by the fact that many of the toxins formed are neutralized by the alexines or protective secretions of the leuco

cytes, and that fine adjustment to changed conditions which is constantly taking place within the body. There are times, however, when, like the amoeba, its discrimination does not save, when the alexines are unable to neutralize the toxins, when it fails, for some reason, to adapt itself to altered circumstances and succumbs to the inevitable.

As the result of studies in the Pathological Institute, New York State Hospital, of the effect of known poisonous substances on nerve cells, there have been recognized three general stages in the cycle of nerve cell degeneration, namely, (3) cytolysis, cytothesis, and cytoclasis. By cytolysis is meant that degeneration which takes place in a cell as a result of a poison, which does not destroy but inhibits or impairs its function for the time being. By cytothesis is meant the process of repair which takes place in a cell which has undergone cytolysis, thus bringing it back to its normal condition. By cytoclasis is meant a more advanced degeneration than cytolysis; in fact, it is a complete destruction of func tion and protoplasm which results in cell vacuolation. No cytothesis or repair can follow cytoclasis. This, then, explains both the recovery from and the succumbing to toxis.

Dr. Alexander McLane Hamilton, studying the connection of intestinal autotoxis with certain common forms of insanity (4), "found that the injection of a number of rabbits with urine from persons suffering from mental disturbances produced no characteristic nor constant result." Urines with great increase in indican (according to Hamilton) are as a rule toxic. "They denote certain putrefactive changes taking place in the intestinal tract." This observer has found, and my experience has been the same, "that urines rich in indican. contain little or no preformed sulphuric acid." "When the sulphate ratio is materially changed, it is likely to indicate autotoxis in connection with an increase in the amount of etheral sulphates." Prominent among Hamilton's conclusions is the following: "Fugacious and changing illusions and hallucinations, unsystematized delusions, confusion and ver bigeration in connection with insomnia, pallor, intestinal indigestion, constipation, and rapid exhaustion are due to

« PředchozíPokračovat »