Insanity : its classification, diagnosis, and treatment : a manual for students and practitioners of medicine / by E. C. Spitzka.

  • Spitzka, E. C. (Edward Charles), 1852-1914.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Insanity : its classification, diagnosis, and treatment : a manual for students and practitioners of medicine / by E. C. Spitzka. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    changes in the ocular background hinting at if not demon- strating the nature of the disorder. (See Paretic Dementia.) Aside from insanity with organic diseases, the psychoses do not manifest such regularity in the retinal condition as to justify the loudly-trumpeted claim of Bouchut, that the ophthalmoscope is also a cerebroscope, nor the fanciful and bold assertions of those who have actually attempted to exalt this instrument to the position of a medico-legal test of insanity! In maniacal and delirious conditions generally, there may be a hyperaemic flush of the optic disk, and in stu- por and passive melancholia this region may be very anaemic. But these deviations from the ideal healthy state are not more considerable than those encountered in any large eye- clinic whose material is derived from a sane population. The writer has observed an extreme hyperaemia of the disk in three cases: one that of an acutely delirious maniac, who died of maniacal exhaustion, and whose brain exhibited commencing organic changes; the second, that of a paretic dement, the inception of whose disorder was marked by overwhelming hallucinations of fiery visions, and whose ill- ness ran a furibund and rapid course; the deep flush found in the latter case was exceeded in a sufferer from a saturnine encephalopathy with mental derangement which terminated in recovery. In all such cases other and more conclusive physical and mental signs are abundant; and while the ophthalmoscope will continue to remain a valuable instru- ment of research, it is in no sense an absolute test, and only in insanity with organic disease a collateral sign of value.* The observation of the electro-muscular reactions has led to many interesting and to some contradictory re- sults. In the present state of science it has, like the retinal examinations, a positive value only in insanity with organic disease. It is found, aside from this, that all forms of in- sanity in which irritation and excitement predominate, are marked by exaggerated irritability of the muscles, which, however, may pass to the other extreme in maniacal ex- haustion. Exaggerated reaction is found in mania and * In pubescent insanity and other forms of alienation, with which mas- turbation is a marked factor, the writer has found extreme pallor of the optic disk. But this pallor he has found in a much more intense devel- opment in five sane masturbators who had such a degree of retinal anasmia that they had gross limitation of the field of vision, without structural change.