Mental Maladies

DEMENTIA

uniting to every physical and intellectual quality all the advantages of a lofty position in society, and a large fortune. He was of the opinion that he had experienced injustice on the part of the government. His self-love was deeply wounded, and after many days of insomnia, he gave himself several thrusts with a knife, in the region of the heart. He was promptly succored, and his services were, but for a brief period, discontinued. From this time, he ex- pressed with bitterness his dissatisfaction ; but was in no respect less exact in fulfilling his duties as a commanding officer. Two years subsequently, he has an attack of cerebral congestion, for which he is largely bled. Two days later, he has a second attack, more severe than the first. He remains excited, talks much, is agitated, irritable and exacting. He does not sleep, and after a third attack, a true mania is developed. The delirium is general, attended v/ith agitation and notions of grandeur and fortune. He commits a thousand extravagances; remains almost naked ; talks incessantly ; cries aloud ; orders a thousand things at once ; is impatient ; rends ; and commits strange and impru- dent acts, which compromise his life, though he entertains no idea of suicide. Several physicians are called in consultation ; and the maniacal state of the patient cannot be denied. His age, however, and the brief duration of the disease, offer to the counsellors expectations of a cure. I affirm that the pa- tient will never recover: 1st, because three severe attacks of cerebral conges- tion had preceded the maniacal state, and that consequently there was some degree of cerebral lesion ; 2d, because, notwithstanding his incessant loqua- city, certain words are imperfectly pronounced ; and because his gait, although lively and active, is uncertain. I added, that active medication would hasten the progress of the disease ; that the country, exercise, a severe regimen, and the repeated application of leeches, to prevent new congestions, appeared to me to be the only proper course. One of the consulting physicians did not concur with me in my unfavorable prognosis, and proposed certain tentative measures. After a month spent in fruitless attempts, we were obliged to re- nounce all hope of cure. Paralysis had progressed, and dementia was con- firmed ; the patient retaining incoherent notions of grandeur, which persisted for more than two years. He regarded himself as the possessor of several provinces and kingdoms ; distributed places, and gave away millions ; and commanded, also, an army of giants. His cavalry was mounted upon horses of gigantic size ; he possessed palaces of diamond ; and his stature was 20, 30, and 40 cubits in height. He talked, both night and day ; now, in a low tone; now, loudly. He also uttered loud cries. Beset by hallucinations of hearing, he listened to the voices of imaginary beings, and replied to them ; boasting of his person, disputing with, and even abusing them. He recog- nized the members of his family, and addressed them with amiability and politeness ; but after a brief interval however, resumed his habit of constant conversation. He was sent into the country. Although in a state of com- plete dementia, frequently experiencing vertigoes, and epileptiform convulsions; although he walked with difficulty ; sometimes inclining very much toward one side, and scarcely able to articulate a word; he lived for twelve years; at the close of which period, there still remained some traces of his former po- liteness, together with those amiable and affectionate manners, for which he was distinguished before his illness. This patient owed his prolonged exist- ence to the .severe regimen to which he was subjected ; to abundant daily ex- ercise ; to the repeated application of leeches to the anus ; and the frequent employment of gentle laxatives.

Paralysis is more frequent among insane men than women. Eighteen years ago, when charged with the service of the division of the insane at the Bicetre, during the absence of M. Pariset, who was sent to Cadiz to study the yellow fever which was prevailing there ; I was struck, in comparing the number of men.

DEMENTIA. 439

insane and paralytic, at the Bicetre, and the number of paralytic women at the Salpetriere. The same observation may be made in every establishment into which both sexes are admitted. It has not escaped the notice of Doct. Foville, j)hysician-in-chief, at St. Yon, Rouen. According to this physician, they amount to one eleventh at the Institution over which he presides. Among 334 insane persons who were examined by him, 31 were paralytic, to wit : 22 men and 9 women.* At Charenton, the proportion of paralytics is still more considerable. They constitute one sixth of the whole number of admissions. In truth, of 619 insane persons who were admitted during the three years

1826, 1827 and 1828, 109 were paralytics. But the proportion of men is enormous, compared with that of women. Of 366 insane men admitted into the house, 95 were paralytics ; while of 153 women, 14 only were aifected with paralysis. This complication is most frequently observed among that class of insane persons who have yielded to venereal excesses, or have been addicted to the use of alcoholic drinks ; among those also, who have made an inordinate use of mercury, as well as those who, exercising the brain too vigo- rously, in mental strife, have, at the same time, abandoned themselves to errors of regimen.

Do not these circumstances explain sufficiently well, how it happens that there are more men insane and paralytic than women 1 They also account for the fact, that in proportion to the number of insane men, there are more para- lytics at Charenton than at the Bicetre. The insane who are admitted at the latter hospital are poor. They lead a very laborious life, and react more en- ergetically against the causes which we have just pointed out, as capable of producing paralysis. These causes exercise the less intiuence, because the laborer, engaged in manual occupations, exercises his understanding but little ; thereby fatiguing, to a trifling extent only, the brain. The insane who are ad- mitted into the establishment at Charenton, enjoy an honorable ease, are fur- nished with more means for the gratification of their passions, and exercise professions which excite the brain. Their material life is less active, and con- sequently the same causes ought to produce cerebral disturbances more fre- quently, and those of a graver character. It is true, that there are more insane persons who are paralytic, among the wealthy and elevated, than the other classes of society. The paralysis, which is now under consideration, is more rare in the south than in the north of France. It is still less frequent in Italy, and warm climates. Doct. Delaye has met with it at the hospital of Toulouse, but in five instances among one hundred and eleven insane persons ; three men and two women. Doct. Rech assures me that he met with no paralytics, among one hundred and thirty-two insane persons residing in, or admitted, from 1822 to 1825, into the ward for the insane, in the general hospital at Mont- pellier.t Professor Vulpes, physician-in-chief des maisons d'Aversa, in the kingdom of Naples, stated to me repeatedly, during his residence in Paris, in

1827, that he could scarcely mention three paralytics among five hundred in- sane persons of both sexes, who were confined and treated in the three build- ings, of which the establisment of Aversa is composed, and of which he has the charge. Whilst residing in Italy, in 1834, I established the fact that there were not only a small number of insane paralytics in the establishment at Aversa; but in all those of a similar character in southern Italy, and the Lombard-Venetian territory.

Doct. Burrows, whilst admitting that in English establishments they take no account, either of the complications of insanity, or of those maladies which terminate the existence of the insane ; believes that the number of insane para-

* Dictionary of Practical Medicine and Surgery, art. Mental Alienation, t. i. p. 504. t Medical Ephemeris of Montpcllier, 1827.

440 DEMENTIA.

lytics is less in England than in France. He adds, that m his private practice, he did not see a paralytic among twenty insane persons. This estimable au- thor attributes the frequency of paralysis among us, to a bad regimen, and to a want of precautions suited to secure the insane from atmospheric changes, whilst in England, this class is very well cared for. In Germany they censure our mode of treatment. Certain French physicians have published the opinion, that this complication was provoked by some defect of locality, or by errors of hygiene.

I am well aware of the importance which we should attach to hygienic causes in the production of diseases. I know well that the insane are more exposed than individuals in the enjoyment of good health, to sink under the depressing influence of insalubrious localities. But I will remark, that in treating of the paralysis of the insane, I speak of that which is developed before their admission into localities devoted to this class of patients ; and also, that the insane and paralytic women, whom I observed at the Salpetriere ; the insane and paralytic men, at the Bicetre ; and those of both sexes suffer- ing from the same complication at Charenton ; none of them sunk into this slate during their stay at those establishments, but were paralytic before their admission. I am convinced, that when they have learned better to distinguish the symptoms of paralysis which complicates insanity ; they will find in Eng- land, and particularly at London, as many insane paralytics as at Paris. Doc- tor Burrows seems to think that I regard paralysis of the insane as the effect and not the cause of insanity.* I have said nothing like this. I am satisfied to signalize paralysis as a frequent complication of insanity, and as rendering our prognosis less favorable. I believe, that in this double aspect, the dura- tion calls for all the attention of practitioners and physicians, whose research- es in pathological anatomy relate to mental diseases. M. A. L. Baylet de- sires to prove, that the paralysis and monomania of the rich and great are the signs of chronic meningitis ; and that this inflammation presents three w^ell marked periods : 1st, the period of ambitious monomania, with certain traces of complete paralysis ; 2d, the period of mania ; 3d, the period of de- mentia with general paralysis.

Great as has been the number of the insane which I have seen, the monoma- nia of the great has not presented to me a march so regular ; I have seen it preceded by attacks of mania, by monomania and lypemania. Paralysis com- plicates all forms of insanity, whatever may be the character of the delirium. It complicates mania and lypemania, as well as ambitious monomania, but more frequently the latter. It almost invariably complicates dementia. If in observing mania at its commencement, we discover symptoms, however trifling, of paralysis ; we may boldly affirm that dementia will succeed the former. It is equally true with monomania, whatever may be the character of the de- lirium ; and we may add moreover, that death will, at no distant day, termi- nate the disease. Neither maniacs nor monomaniacs possess, in these cases, the same energy of attention, the same vigor in the association of ideas, the same strength of will, the same tenacity of purpose, the same obstinacy in resistance, as formerly. They are agitated and transported by passion, but obey and yield ; indicating by their acts a weakened state of the brain. It has happened to me to express an assurance, that a furious maniac was already paralytic, and could not recover, notwithstanding the opinion of se- veral physicians to the contrary, who were worthy the highest esteem ; but who, having less experience with the insane, had overlooked the symptoms of paralysis, which were in truth, very marked.

* Communications on the causes, forms, symptoms and treatment, moral and medical, of Insanity. London, 1828, in Bvo.

t A treatise on diseases of the brain and its membranes, Paris, 1826, in 8vo.

DEMENTIA. 441

Called to take charge of an officer, who was suffering from ambitious mono- mania attended with fury, although the patient was in other respects strong and robust, I declared that he would not recover; and that soon, they would clearly perceive the existence of paralysis. My prognosis was founded on the two following phenomena : 1st, in the middle of a sentence, the patient articu- lated certain words more slowly than others ; 2d, it was sufficient to make him a promise, to compose him, and cause him to renounce those projects to which he was strongly inclined. A slight strabismus enabled me to form a similar conclusion respecting a monomaniac who was, at the time, fulfilling the duties of captain of a regiment.

If the diagnostic signs of chronic meningitis, were monomania, resultinor from exaggerated notions of greatness, attended by paralysis ; this #»rm of monomania would never occur without paralysis. Observation establishes the contrary. Insane women are rarely paralytic. Insane men and women, in warm climates, in the south of France and Italy, are rarely paralytic. How- ever, ambitious monomania bursts forth at Paris, among insane women ; nor is it unfrequent in the south of France, and in Italy, among the insane of both sexes. Monomania, attended by pride, exists therefore, without paraly- sis; and on the other hand, paralysis exists without delirium. How then can we admit that this form of monomania and paralysis, are pathognomonic signs of chronic meningitis? There are cases of paralysis, attended by exclusive delirium, and by the monomania of pride and ambition, in which the delirium ceases, and the paralysis persists. 1 observed, near the close of the year 1827, a fact of this kind.

An officer, connected with a company of horse belonging to the kino-'s household, is suddenly seized with an attack of monomania ; the patient be- lieving that he is a distinguished personage, and exceedingly wealthy. He commits numerous extravagances, and at the same time, experiences difficulty in uttering articulate sounds. At the expiration of five weeks the monomania ceases, but the paralysis persists, and soon invades the muscles of the limbs ; the patient suffering from frequent cerebral congestions, which provoke epi- leptiform convulsions, though delirium no longer exists. This soldier distin- guishes clearly between the state in which he now is, and that in which he has been ; demanding for the former, the aids of medicine.

When we examine the bodies of the paralytic insane, and even monomaniacs, we do not always meet with indications of inflammation of the meninges; whilst on the contrary, we sometimes meet with inflammations of the menin- ges, though there has been no delirium connected with notions of greatness.

Doctor Calmeil,* who has derived his information from the same sources with M. Bayle, that is to say ; from observations collected at Charenton ; has manifested a marked reserve with respect to his conclusion from the facts which he has reported in his work, which is in all respects so remarkable. Our learned confrere, and my collaborator in the duties which I was appoint- ed to discharge towards the insane at Charenton, was satisfied to establish by numerous facts, that chronic inflammation of the meninges, produced general paralysis, peculiar to the insane ; but was never of the opinion that he had discovered the immediate cause of that form of delirium which was ever con- nected with ideas of grandeur and wealth. Paralysis of the organs of speech, depends upon a lesion of the anterior lobules of the brain, says M. Bouillaud.t It is one of the most incontestable of facts, adds this skillful professor ; never- theless, observation does not always justify this proposition. Nature perseveres

* Paralysis, considered witli reference to llie Insane. Paris, 1826, in 8vo. t A Clinical and Physiological Treatise on Encephalitis, or Inflammation of the Brain. Paris, 1825, in 8vo.

56

442 DEMENTIA.

in maintaining her secret, notwithstanding the constant researches of physi- cians, in all ages.

I will close my remarks on the paralysis of the insane, with a few practical considerations. The paralytic insane eat gluttonously, and collect their food in the back of the mouth, in some instances, to such a degree as to prevent swallowing. This accident also happens when the paralysis, having reached the muscles of deglutition, renders the performance of this function almost impossible. Then the solid aliment, being no longer propelled into the sto- mach, is retained in the oesophagus, and compresses the larynx. In these cases, asphyxia is imminent ; and the person who, a moment ago, was dying, is restored again to life, by relieving the throat and mouth of those substances which Jaave not been conveyed into the stomach by deglutition. I once wit- nessed a very singular case, which eventually proved fatal to the patient, who is the subject of the following observation.

M., about forty years of age, after a long attack of mania, had fallen into a state of dementia. The desire for food was so strong, and the taste so per- verted, that the patient was accustomed to devour the most disgusting sub- stances, and ate all the insects he could catch during his walks in a very large garden ; such as spiders, snails, worms, butterflies, etc. He was one day served at dinner with a portion of a calf's head. He ate the whole of it with avidity, and soon after fell prostrate, in a state of unconsciousness. His face was of a purple color. His attendant, suspecting the cause of this accident, introduced a foreign body into the oesophagus, and propelled the food into the stomach. Some weeks subsequently, calf's head was again served to the same patient ; but in this instance, fearing his gluttony, they took care to cut into morsels the food which was presented to him. Scarcely had he intro- duced a little into the oesophagus, than the accident referred to above, was re- newed. The use of this variety of meat was strictly forbidden. Six months afterwards, either through forgetfulness or ignorance, they again served the calf's head to this patient. In this instance, he had swallowed too large a morsel, from which it was impossible to relieve the oesophagus, and he speedily died. On opening the body, the oesophagus was found greatly distended 'with a morsel of the meat, which he had attempted to swallow. The brain was very red, the meninges thickened and injected, and the lungs engorged with blood.

Constipation is also a frequent symptom among insane paralytics. The rec- tum being paralyzed, defecation is almost impossible. Here, fecal matters re- main for a longer or shorter period; sometimes even for twenty or thirty days, before the patient begins to complain. If not carefully attended to, by those whose duty it is to serve them, and this inconvenience obviated, the intestines become inflamed, and at length, gangrenous. Purgatives produce no effect, frictions upon the abdomen succeed no better, and the patients die. Some- times the accumulation is so great, and so hardened, that mechanical means are necessary to unload the rectum. The retention of urine, also demands special attention. It is sometimes necessary to have recourse to the catheter ; but more frequently, insane paralytics are subject to incontinence of urine, or else it is discharged by overflowing. During the day, they soil their clothing, and at night inundate the bed, if, in consequence of their feebleness, they are permitted to remain there. The urine is not slow in forming eschars, which destroy the integuments down to the bone. These patients ought to be lodg- ed upon a bed of a peculiar construction, their linen frequently changed, and washed with an infusion strongly aromatic, or even with alcohol diffused in - water. Insane paralytics are also exposed, in consequence of their extreme feebleness, to a grave accident which compromises their existence. If pre- cautions are not taken, on sitting down before a fire, they will permit them-

DEMENTIA. 443

selves to be burned, without making any complaint, so severely as to endanger life. If, while in bed, they attempt to change their position, having no longer sufficient strength to control the impulse which they give their bodies ; or in consequence of not possessing sufficient understanding to measure distances ; they permit themselves to fall, ordinarily upon their head, and die a few days afterwards. I have several times shown, that the ecchymosis of the dura-ma- ter, being propagated to the subjacent portion of the arachnoid ; or else a cir- cumscribed sanguine effusion, membraniform, and extended over the external lamina of the arachnoid, was the first result of the fall of these patients from the height of their heads ; a result which hastened their death. It happens but too frequently, that we confine either to a bed or quieting chair, the furious- ly insane, and insane paralytics ; the former, to prevent their yielding to the impulses of their fury; the latter, to avoid the falls to which they are liable while walking. We should fear abusing a measure of this nature, since the want of motion and exercise favors the progress of paralysis; and since it is often induced among furious maniacs, in consequence of the prolonged repose to which they are forcibly subjected. It is the dread of this result, which has led to the introduction, in the insane establishments of Spain, of a long chain, fastened to the bed, and attached to one of the feet. They thus protect them- selves against the fury of maniacs ; allowing, at the same time to the latter, perfect freedom of motion.

[A class of cases terminating in the disease under consideration, — and which may be found in the latter part of this chapter, — may appear peculiar, and perhaps quite new to some of the readers of this work. It forms a variety, which, if it has existed, has been little noticed so far as I can learn, by writers on insanity in this country. The only source from which I have been able to obtain information on this interesting form of disease, — not having had an opportunity to witness a case of it, — has been the last An- nual Report of Doct. Bell, Superintendent of the McLean Asylum, Charlestown, Mass. I take the liberty to transcribe what he says in reference to it, and also Doct. Conolly's description of it, which is found in the same Report. " I have regarded it (says Doct. B.), as a somewhat curious fact, that it is only within the last three years that this disease has been admitted to this institution. As late as my visit to Europe in 1840, it was un- known within our walls. Nor after seeing it so often manifested there, can I recall any case in our register, which would at all meet its characteristics, rendering it certain that it was not overlooked. Since that period, however, we have had abundant evidence that it* is not a form of disease peculiar to other countries. I find that not less than twelve or fifteen well marked cases have been received, coinciding exactly in mental and physical manifestations with those I saw, and which are so graphically described by many English and continental authors." Dr. C.'s description comprises the essential characteristics of general paralysis, and is as follows : " Men in the prime of life, intel- ligent and of active habits, have perhaps sustained a single attack of paralysis ; a slight impairment of the mind, a slight faltering in the speech, and a little infirmity in the gait, only discovered by those who look for it, are the most prominent symptoms. Yet in all these cases the death-blow is struck from the first. When the previous history of those cases can be obtained, it is usually found that certain changes of character and disposition preceded the paralytic attack. The individual who was before prudent in his conduct, has become extravagant and speculative ; or after being lively and attentive to propriety of dress and behavior, has become dull, slovenly, and occasionally forgetful of decorum. These changes have gradually appeared for a year or two, before disease has declared itself. After a little ebullition of discontent on being removed from their homes, they often become contented and full of exciting hopes. Sometimes they are fretful, because they cannot carry into effect some project or speculation connected with

444 DEMENTIA.

their former pursuits. But a vague kind of happiness soon succeeds to this state. Their liealtli, they say, was never so good, their mind never so clear, their prosperity never so secure. Fits of a convulsive character, sometimes decidedly epileptic, often supervene on this state ; and each attack leaves the mind and body weaker, until a paroxysm more severe than common, proves fatal. When this is not the course of the disease, the men- tal excitement becomes more extreme, and after some continuance, ends in an oblitera- tion of almost every faculty, in which state the patients' life may be prolonged for a con- siderable period." Thus far Doct. Conolly. Doct. Bell in conclusion says : " The cases under my care have uniformly, with a single exception, been of the male sex, and in almost every instance in those, who have borne the long continued pressure of un- usual business anxieties, either with or without reverses. The form of delusions has almost always borne reference to immense amounts of money, great power or some simi- lar exaltation. No recovery has occurred among them."

IDIOCY

Brief account of the views of authors in regard to idiocy. — Synonyms. — Origin and sig- nification of term. — Commences with life. — Idiots never reach an advanced age. — Vices of conformation almost invariably discoverable in brain. — Dementia and idiocy contrasted. — Illustrative cases. — Idiots classed in two divisions, viz., imbeciles and idiots. — Contrasted. — First variety. — Imbecilitv. — General description of imbeciles. — Cases, together with admeasurements of the head. — Remarks respecting habits and mode of life of imbeciles. — A few whose minds are capable of partial development. — Their gayety, piquant repartees, jovial manners, etc., have been the means of their introduction to the great. — At Court even is there the post o? fool. — Origin of custom. — Employed by rogues for culpable purposes. — Acts to which puberty gives rise. — Second variety. — Idiocy. — Idiots incapable of speech. — Case of Queneau, with post- mortem examination. — Other cases, describing the figure, admeasurements of the head, habits, and peculiar characteristics of idiots. — Moral and physical condition of the mothers of idiots, while pregnant with them. — Account of cases representing the ex- treme limit of idiocy from Pinel, Gall, and the records of the Salpetriere. — Idiots nearly or quite deaf as well as mutes. — The senses null or exceedingly obtuse. — Com- parative view of the condition of the blind and dumb, and idiots. — Remarkable apti- tude of many idiots for the acquisition of music, and their fondness for musical sounds- — Deductions from the above cases. — A number of the physical and predisposing causes noticed. — Exciting causes of idiocy. — -Volume and form of the heads of idiots. — Gall's limits of intelligence. — Researches of Foville, Parchappe and others, respect- ing the vices of conformation in the cranium of the idiot, and its development com- pared with that of the healthy subject. — Table of mean results of certain cranial ad- measurements.— Remarks of Morgagni and Meckel respecting the cerebral substance in idiocy. — Maiacarne, on the convolusions, etc., of the brain in idiocy. — Remarks of La- vater and Camper respecting physiognomy of idiots. — Remarks on treatment. — (Brief account of some recent attempts to improve the condition of idiots). — Cretins, Cagots and Albinos. — Cretinism. — Origin and definition of term. — History of Cretinism. — The person of the cretin described. — Like idiots, cretins may be divided into three classes. — Description of first class. — The first, the most numerous class. — Description of se- cond class. — Of third class. — Cretins not necessarily born such. — Organism develops very slowly. — Relative proportion of cretins and idiots. — Examination of the crania of idiots obtained with great difficulty. — (Description of one belonging to Dr. H. A.

446 IDIOCY.

Grant, of Hartford, Conn.) — Opinions of authors respecting the causes of cretinism va- rious.— Views of several authors noticed. — Opinion of M. Bayle in respect to the in- fluence of water in the production of cretinism. — Opinion of M. Vyn. — Immediate cause as obscure as the predisposing and remote. — Opinions of authors respecting. — Probable cause, the influence to which infants are subjected. — Do cretinism and goitre depend upon the same cause .' — Cretinism diminishing. — Causes assigned. — Albinos. — Definition of term, and description of the person of albinos. — Usually found in con- nection with the goitrous and idiotic. — Born of parents of every variety of complex- ion.— Intellectual and physical characteristics. — Natives of all countries. — Synonyms. — Testimony of ancients respecting albinos. — Characteristics, physical and intellectual, of the parents of albinos. — History of Roche. — Cagots. — Signification of term. — Pro- vincial appellations of. — Degradation of those wretched beings for centuries, extreme. — Considerations with respect to savage races of men. — Conclusion. — Cases in illustra- tion of the history of idiocy, giving an account of the mental and physical condition of idiots, together with a description of their physiognomy, and daily habits. — Seve- ral autopsies.

Much confusion pervades the writings of all those authors, vi'ho have treated the subject of mental alienation, relative to idiocy, (idiotism). Confining themselves to appearances, they have confounded idiots with persons in a state of dementia, and reciprocally ; sometimes even, with monomanics. Because the latter, absorbed by a few fixed ideas, seem to be plunged into a state of stupor, or because the understanding of others seems to be obliterated, they have con- cluded that all were idiots. Sauvages, Sagar, and Vogel, have denominated idiocy amentia, imhecillitas, ingenii, fatuitas, and Linnaeus has called it moro- sis. Cullen and Fordere, innate dementia. Dufour and Pinel have consti- tuted it a variety of insanity, which they designate by the appellation of idiot- ism. Notwithstanding, our celebrated Professor distinguishes idiocy from dementia, only by the degree of change in the understanding, and defines de- mentia, the abolition of thought; and idiocy, the obliteration of the intellectual and affective faculties. He often speaks of the latter, as of the most advanced degree of dementia ; and relates facts, from which it appears evident that he entertained no very clear notions respecting these two infirmities of the mind. Finally, he admits an acquired, and also a connate form of idiocy. The word Idlog^ privatus, solitarius, expresses the condition of a man, who, deprived of reason, is isolated in some sort, from the rest of creation. From the word idiota, idiot, idiotism has been deduced ; but as the latter word has already a grammatical signification, it has seemed to me advisable, to substitute for it, the word idiocy, and devote it to the language of medicine. Idiocy is not a disease, but a condition in which the intellectual faculties are never manifested ; or have never been developed sufficiently to enable the idiot to acquire such an amount of knowledge, as persons of his own age, and placed in similar cir- cumstances with himself, are capable of receiving. Idiocy commences with life, or at that age which precedes the development of the intellectual and affective faculties ; which are, from the first, what they are doomed to be, dur- ing the whole period of existence. Every thing about the idiot betrays an or- ganization imperfect, or arrested in progress of development. We can con- ceive of no possibility of changing this state. Nothing teaches us how to impart, for a few moments even, to the wretched idiot, an increase of reason or intelligence. He never reaches an advanced age, — rarely surviving more than thirty years, — and on laying open the brain, we almost invariably dis- cover vices of conformation.

Dementia and idiocy differ essentially ; otherwise, the principles of every classification are illusory. Like mania and monomania, dementia only com- mences with puberty ; and has a period of increase which is more or less

IDIOCY. 447

rapid. Both chronic and senile dementia, increase from year to year, by the decay of the organs, and the successive loss of some faculty. Every symp- tom betrays physical weakness ; all the features are relaxed, and the eyes are dull, and downcast. If the demented person desires to act, it is because he is impelled by a fixed idea, which has survived the general loss of intelli- gence. We can cure dementia, and conceive the possibility of suspending its symptoms. There is indeed, a diminution and privation of the energy requi- site for the exercise of the faculties, but those faculties exist still. Moral shocks, as well as certain medicaments may revive, and excite sufficient strength to produce the manifestation of certain ideas and affections. Other means also, may remove the obstacles which prevent this manifestation. If a person, who has fallen into a state of dementia does not die immediately, he may live a long time, and reach a very advanced age. On examining the body, we sometimes meet with organic lesions, but they are accidental ; for the thickening of the bones of the cranium, and the separation of their ta- bles, coinciding with senile dementia, do not characterize vices of conforma- tion. It is the same with the alterations and changes, which the cerebral sub- stance undergoes in the progress of age.

A man in a state of dementia is deprived of advantages which he formerly enjoyed ; he was a rich man, who has become poor. The idiot, on the con- trary, has always been in a state of want and misery. The condition of a man in a state of dementia may change ; that of the idiot is ever the same. The latter retains many of the features of infancy : while the former pre- serves much of the physiognomy of the adult man. In the case of both, the sensations are null, or nearly so. The man who is in a state of dementia however, indicates in his organization, and even in his intelligence, something of his past perfection ; while the idiot is, what he always was ; and is all that he can be, so Jong as his organization remains unchanged.

From this comparison, have we not a right to conclude that an affection, the epoch of whose invasion is constant (infancy), which presents special symptoms, the prognosis of which is always unfavorable, and which presents organic changes which are peculiar to it, offers a collection of features, suffi- cient to distinguish it from every other malady?

But there are persons, who appear to be deprived of sensibility and under- standing ; who are destitute of ideas, words, and the power of motion ; who remain where they are placed ; whom it is necessary to dress, and feed with a spoon. Are not these idiots? Not necessarily. These are not the actual symptoms ; and it is not one epoch only of a disease, which can furnish an abstract idea of it. On the contrary, it is necessary to study this malady dur- ing all its periods, each of them being capable of furnishing certain diagnos- tic indications. I once made a drawing, and gave the history of a girl, who presented all the symptoms which are ordinarily regarded as the signs of idi- ocy. She was terrified, and fear enchained the exercise of all her faculties.

I once had in charge a young man, twenty-seven years of age, who, deceived by a woman, and having been unable to obtain a situation which he desired, after an attack of mania, fell into a state of apparent idiocy. The face of this patient was flushed, and his eyes fixed or vague in their expression. It was necessary to dress and undress him, and to put him in bed. He' ate, only when food was conveyed to his mouth. His arms hung by his side, and his hands were tumefied. Though always standing, he walked only when obliged to, and appeared to possess neither sensation nor thought. Leeches applied to the temples, tepid baths, cold douches upon the head, and particularly, a general eruption over the surface, cured him. After his cure, he informed me that an internal voice said to him : stir, and you are last; fear rendered him motionless.

448 IDIOCY.

The sensibility and intelligence are not therefore extinct ; — the manifesta- tion of these faculties being prevented by various motives, — of which the pa- tient gives an account when cured. Whilst giving my clinical course in 1822, we had at the Salpetriere, a Mad'e B., who seemed to be in a profound stupor, and completely insensible. She remained motionless near her bed, and never spoke. I often pinched and pricked her, without her manifesting the least degree of pain. I ordered a seton to be inserted in the nape, and several blisters were applied on various parts of the body ; the same insensibility be- ing always manifested, the same obstinate silence, and the same unwillingness to walk. On one occasion, this girl did not appear at our visit ; after which period, we were unable to persuade her to remain in the dormitory at the hour of the clinic. When cured, she informed me that a pupil had pinched her. She was offended by this impertinence, which was allowable in me, but im- proper on the part of the pupils ; and resolved not to permit it to be again re- peated. Certain monomaniacs, controlled by erotic or religious ideas, present the same symptoms. In all these cases, the sensitive and intellectual faculties are clearly and energetically exercised, — appearances deceiving us, — as there is no idiocy. From the man who enjoys the use of his sensitive and intellec- tual faculties, but who, in consequence of a feeble organization, is placed in the lowest rank of social and intellectual life, to that of idiocy, there are de- grees innumerable. Who could point out and describe every shade in the de- scent, from the man who thinks to the idiot who is destitute, even of the in- stincts of our nature 1 Nevertheless, in studying facts, we may class idiots in two series, in which they may all be included. The former embraces im- beciles ; the latter, idiots properly so called. In the first class, the organiza- tion is more or less perfect ; the sensitive and intellectual faculties are some- what developed ; sensations, ideas and memory, as well as the affections, passions, and even inclinations exist; but only in a slight degree. They feel, think, speak, and are capable of acquiring a certain amount of education.

In the second series, the organization is incomplete; the senses are scarcely developed ; and sensibility, attention and memory are nul, or nearly so. Idiots have a very small number of limited ideas, beside their passions for the supply of instinctive wants ; which are expressed by certain gestures, words, monosyllables or cries. Reason does not control their actions ; which are kw, and repeated, either from habit or the force of imitation.

JFHrst variety. — Imbecility. — Imbeciles are generally well formed, and their organization is nearly normal. They enjoy the use of the intellectual and affective faculties, but in a less degree than the perfect man, and they can be developed only to a certain extent. Whatever education they may receive, imbeciles never reach the degree of reason, nor the extent and solidity of knowledge, to which their age, education and social relations, would other- wise enable them to attain. Placed in the same circumstances with other men, they do not make a like use of their understanding. M., thirty-seven years of age, belongs to a family, who enjoy an immense fortune. His mo- ther, during her pregnancy with him, experienced long seasons of disquietude, and keen moral sufferings. His head presents nothing remarkable. His hair is abundant, and his eyes small and without expression. In his physiognomy, there is something vague, uncertain and sad. The organic developments took place at a later period than is usual with children. He scarcely walked at the acre of four years. At five, he pronounced a few words ; and at six, could talk. Incapable of attention, his petulence was extreme. It was long before he learned to read and write ; nor could he ever read connectedly, nor write a letter, however short, nor remember what he read. They attempted, but in vain, to teach him one of the mechanic arts. He learned a little music, and

IDIOCY. 449

sang certain airs ; but his stock of knowledge was exceedingly limited. He was excessively timid, and until the age of eighteen years, dared not leave, alone, the paternal mansion. After that period, he was accustomed to run about at random in the fields, to talk much, and even became a babbler ; always speaking irrelevantly with respect to the subject of conversation. He frequently employed one word for another. Always cheerful, he was accus- tomed to laugh without a motive, and sometimes by himself. He passed a portion of the day, either sitting or lying down ; and it was only by conside- rable effort that he set himself in motion ; but once started, he knew not when to stop. He was never able to combine other ideas than those which are in constant use. He never formed a project, merely living from day to day. He was incapable of managing his business, or of directing an enterprise. At the age of thirty-seven years, his intelligence was certainly inferior to that of a child of ten years, notwithstanding the care that had been taken to develop it. At puberty, he manifested none of the passion proper to that age. He lived alone in the country, not thinking that his mode of life could be diffe- rent and more agreeable. The extent of his intelligence will be understood from the following fact. His physician told him he must mount a horse. Accordingly he daily spends an hour in mounting and dismounting one of his father's horses ; not suspecting that it was a ride on horse-back that had been ordered. Chance discovered this mode of obeying the doctor's command.

Whilst in charge of the ward for the insane at the Bicetre, in 1821, a rachitic imbecile died, who was of a very diminutive stature, and whose cra- nium was very small and narrow ; while the face was largely developed. His physiognomy was very changeful, and even intellectual. His countenance wore the expression of a cynical smile, and resembled much that of the most celebrated personage of the last century, as it respected the fecundity and cynical character of his mind. This imbecile, at the time of his death, was thirty-four years of age, and had been an inmate of the Bicetre for quite a number of years. He spent his life in doing and saying malicious things, and in playing tricks on those about him. He yielded himself, in a horrible de- gree, to the practice of masturbation. On the very evening of his death, he was surprised on his bed, endeavoring to gratify this fatal inclination. He had never learned either to read or write, or any trade. He was very chatty, and his repartees were the more surprising, as he was habitually accustomed to speak incoherently, incessantly, without any connection of ideas, and always irrationally. He walked much, ate voraciously, was filthy in his habits, and careless of his clothing. A cast in plaster, of the head of this imbecile, taken after death, presented the following admeasurements.

Circumference ..... 10.73 in.

From the root of the nose to the tuberosity of the occi- pital bone ..... 12.00 " Antero-posterior diameter . . . . 6.65 " Bi-temporal diameter . . . . 5.14 "

Total ..... 40.52

R. was eleven years of age at the time of her admission at the Salpetriere, and nineteen when I committed her case to writing. Her head is remarkably regular ; the forehead is high and large ; the frontal protuberances are well developed ; the facial line approaches ninety degrees ; the hair is thick and black ; the eyes large and blue ; the nose slightly flattened ; and the teeth handsome and regular. The cheeks are plump, the physiognomy mild, some- what expressive, and the skin white and supple. The limbs also are well developed. Admeasurement of the head, taken while living :

57

450

IDIOCY

Circumference ..... 19.56

From the root of the nose to the occipital protuberance 14.28 Antero-posterior diameter . . . .7.12

Bi-temporal diameter .... 5.74

m.

Total ..... 46.70

R. usually sits with her knees crossed, her hands beneath her apron, and is almost constantly raising or depressing her shoulders. Her physical health is good, and she has a good appetite. She is a gourmand, worrying herself much about what she shall have to eat at her meals ; and if she sees one of her companions eating, cries, and calls for something for herself Whilst with her parents, she was accustomed to escape and run to the shop of a pastry- cook who lived near, and devour the first pie that she saw. She was also in the habit of entering a grocer's shop, seizing upon the bottles of liquor, and if they attempted to prevent her from drinking, dashed them upon the ground. Her step is slow, and if any one approaches her, she raises her head awk- wardly, and turns her eyes to see who is coming.

She understands every thing that is said to her. She has a little memory, and relates certain facts which she heard while at home. She replies correctly and slowly, in a lisping and stifled tone of voice. She asks few questions ; but demands her repasts, articles for the toilet, dolls, etc. She sings certain airs, is acquainted with the value of money, counts it, and preserves it to buy dainties and toys. She is cheerful when her mother pays her a visit, and is regarded by strangers as a domestic. She is fond of dolls, with which she amuses herself, but does not preserve them ; leaving them wherever she hap- pens to go. She is timorous and frightened at the least noise. She is also mild and diffident ; and if dressed in a manner more than usually tidy, is delight- ed, and displays herself to every one. Full of vanity, she is very sensible to flat- tery, and smiles with complacency when her person is commended. She is cunning and conceited. On wetting her bed, as she sometimes does, she de- fends herself, and accuses the servant girls of it. She detests her room-mate, who is a mute, and poorly clad. She has been caught thrusting needles into a blistered surface, which had been made upon the person of her wretched com- panion. She knew her letters and could read a few words. On seeing one write, she takes the pen, as if desirous of making the attempt. Her mother could never learn her to sew, knit, or take charge of household matters ; still less to read connectedly, or write. Though she dresses herself alone, she calls for the assistance of a servant girl to adjust her garments in a proper manner. She is fond of men, smiles in their presence, and runs after them. Notwithstand- ing she is nineteen years of age, she has never menstruated. Her mother, while pregnant, had been dreadfully frightened. The child was born feeble, but grew until two years of age, when an arrest took place in the development of the organs. She did not walk until four years of age ; her understanding was developed at a still later period ; and she did not talk until she was seven years old. With respect to her reason, this imbecile resembles a child of seven or eight years. It is probable that in a more favorable condition, she would have acquired an amount of instruction which would have permitted her, with some degree of watchfulness on the part of her friends, to live in society.

P., twenty-two years of age, was admitted at the Salpetriere, Aug. 27th, 1812. Her mother while pregnant, experienced certain severe trials. P. had a feeble and sickly infancy, and learns to walk at a very late period. When five years of age, she suffered from a severe illness, resulting, it was supposed, from a fright. Since this period, the progress of intelligence has ceased, al- though the organs are well developed. Her stature is above the medium size,

IDIOCY. * 451

her step easy, slow, and somewhat haughty ; her hair of a chestnut color, and her forehead lofty. Her eyes are blue, face flushed, chin small and sharp, teeth white, and well arranged, the occipital region well developed, the physi- ognomy mild and friendly, skin fair, and the limbs well formed. The ad- measurements of the head, taken during life, are as follows :

Circumference 33.66 in.

Antero-posterior diameter ..... 7.87 "

Bi-temporal diameter ...... 6.10 "

From the curve at the root of the nose, to the occipital

tuberosity 14.29 "

Total 61.92 "

The menses appeared at thirteen, and were abundant and regular at fourteen years of age. After that period, her disposition became less amiable, and she refused to labor. The sight of men caused the color to mount into her cheeks, and she was accustomed to escape from the house of her parents, to run about and play with little boys. The intellectual capacity of this imbecile is considerable. She attends both to what she sees and hears. She has some memory, forms a sufficiently accurate judgment respecting the most common things, and replies correctly, but in a hesitating tone, to such questions as are addressed to her. In vain do they endeavor to teach her to read and labor. She knows a few letters, and that is all. She has learned how to arrange dolls, and amuse herself with them. She dresses herself, combs her hair, washes herself, makes her bed, and calls for a change of linen. She goes for her food, but is unwilling to receive it, except in the dishes appropriated to her use. Very haughty, she disdains her companions ; and notwithstanding she is habitually mild, opposition irritates her. She is then perverse, abusive in her language, and when angry, strikes. If any one strikes her, she returns their blows with interest. She is excessively obstinate, and never yields. She has neither fear nor jealousy. She walks much, and sports with her com- panions. She is very fond of her mother, caresses her, and if the latter is long absent, she becomes sad. She accuses her father-in-law, whom she dislikes, of treating his other children better than herself; and particularly of supply- ing them with handsomer clothing. She is observant of the attentions that are paid her. The sight of men produces a strong impression, and she is on the watch for the workmen, when permitted to enter the courts of the hos- pital. Never has she become habituated to continued labor. Her physiogno- my expresses her joy, on receiving a new dress, and she hastens to display herself to her companions and the domestics of the house. When I caused her portrait to be taken, in consequence of the regularity in the form of her head, and the harmony of the features of her countenance, which contrasted with the feebleness of her understanding, she seemed to be transported with joy. Nevertheless, I found much difficulty in inducing her to keep her seat, which she was constantly disposed to leave. I was never able to take a cast of her face ; for so soon as she felt the softened plaster over her eyes, she would open them. She has often essayed in vain, to keep her eyelids closed, and often wept with mortification at her inability to submit successfully to the operation.

Imbeciles are incapable of attention ; their sensations are feeble and fuga- cious ; their memory dull and inaccurate ; and their will without energy. They can combine and compare, but are unable to rise to general and abstract notions. They are not, in general, deprived of the power of speech ; and if a few of them are mutes, they very readily express, by the play of their counte- nance and gestures, their thoughts, desires, and wants. They learn to read

452 • IDIOCY.

and write, and also music. They exercise the mechanic arts, but perform im- perfectly every thing that they attempt. They live in their respective families like strangers or great children. If not directed in what they do, in the dis- charge of social usages and duties, and in the administration of their affairs, they become the victims of their incapacity and improvidence. Possessing little sensibility, although irritable, they part with their relatives without regret, as well as those who take charge of them. Some, however, are very grateful, and susceptible of love or hatred ; but their affections are not durable. They seek for sexual commerce, often with transports. The function of nutri- tion is well executed. To this extent do imbeciles possess aptitudes, inclina- tions and dispositions, which contrast with the feebleness of their organization, sensibility and intelligence.

Imbeciles are nothing of themselves. They produce nothing ; and all their movements, both intellectual and moral, are aroused only by foreign impulses. They neither think nor act, but through others. Their will is without energy. They will and do not will. They cannot follow a conversation, still less a dis- cussion ; and know not how to conduct a project to its close. They regard as serious, things the most gay ; and laugh at those that are most sad. Does something interest them ; their eyes are fixed, but they do not see. They hear, but do not comprehend ; although they affect to have both seen and under- stood. They reply correctly ; but you must not ask them many questions, nor require from them responses which demand reflection, or are contrary to their habits. Usually self-satisfied, they speak of themselves in a tone indicative of such a frame of mind ; or seek for expressions to which their physiognomy does not respond. Their gestures and position are odd, and rarely in harmony with what they think or say. Their management betrays them, as well as their development, which indicates a want of capacity, and a determinate end. They are deceitful, mischievous, liars, quarrelsome and irascible, but pol- troons. Puffed up by pretensions ; easily led and controlled ; incapable of application and labor ; they are parasitic beings ; of no use, either to them- selves or their fellow-creatures. If they work, it is necessary to direct and excite them incessantly, since they are excessively indolent. In hospitals, these imbeciles are the servants or laughing-stock of every body. They are the good people of the house, and are called, more especially, imbeciles. This variety is denominated by authors, fatuity. Imbeciles of this character, present some points of resemblance with maniacs without fury, in the mobility and versati- lity of their ideas, sentiments, desires and actions.

There are other imbeciles however, who possess a small number only of sensations and ideas, and have little memory. Their language also is limited. They distinguish those with whom they live, love their relatives, and are mindful of the cares that are extended to them. They are passionate, thievish, obstinate and peevish. The sight of a person of the opposite sex agitates and disturbs them. They are capable of receiving a trifling amount of education, and it is possible, by dint of effort, to develop that portion of sensibility and understanding which they possess. Still, this education is limited to the ordinary matters of life. Habit, and the force of imitation, produce a great effect upon their ideas, affections and acts ; impressing upon their mode of life a kind of regularity, which it would be wrong to regard as the effect of reasoning. They provide for their wants, know how to clothe themselves, procure nourishment, and are capable of performing ordinary household labors.

Finally, there are imbeciles, the faculties of some of whom are more energetic than those of others, and whose understandings are capable of partial development. They have an aptitude only for certain things, for which they have a decided taste and a marked inclination. They possess an understanding for whatever relates to their inclinations and aptitudes, and

IDIOCY. 453

judge of them very correctly ; but are incapable of every thing else. They sometimes learn a trade, but nothing more. They also learn to read, but cannot write. They understand music in some instances, and play upon an instrument, but can neither read nor write. You can oblige them, neither to remember, reflect nor foresee. They produce nothing, invent nothing, perfect nothing. Such are partial imbeciles.

The innocence and jovial manners ; the gayety and piquant repartees ; the pleasant and sometimes very judicious sallies of some imbeciles ; have caused them to be admitted into the presence of the great, and even that of kings, to divert them from their distressing ennui, and to afford them recrea- tion. There is, in courts even, the post of fool. All those who discharged the duties of this office were not imbeciles, some of them being adroit rogues. If Triboulet was a witty imbecile, Angely and Brusquet were adroit knaves, who gave proof of their intelligence, by amassing immense fortunes.

The custom of having fools to entertain the great, reaches back into remote antiquity. History tells us that Lucius Junius Brutus, simulated folly so well that Aruns and Titus, sons of Tarquin, having been sent to Delphos to consult the oracle, brought him back, to make sport for them. This ridi- culous abuse was handed down even to our own time, and was so general in the middle ages, that a council, held at Paris in 1212, defended the bishops for having about their persons, fools to make them laugh. Charles V., says Le Sage, caused a letter to be written to the mayor and magistracy of the city of Troyes, to have them, as was customary, provide him with a fool, Thcvenin, his own fool being dead. If the great had their fools, the people indemnified themselves, by celebrating in different cities, what was called the feast of fools. Potemkin, had for his fool, one Mosse who, according to M. de Segur, did not conceal the truth from his master.

Imbeciles are usually timid, cowardly and obedient. Evil-doers but too frequently abuse their unfortunate dispositions, and employ these wretched beings to set fire to buldings, or commit some culpable act, by intimidating or seducing them, by the allurement of a recompense, which flatters their senses or appetites. Since imbeciles are not deprived of all intelligence, they possess desires and passions proportioned to the development of their sensi- tive and intellectual faculties. They have inclinations more or less imperious, and sometimes perverse ones. They rob to satisfy their gluttony ; to pro- cure articles for the toilet ; or from some other motive. We saw, in the chapter on Monomania, the cases of incendiary imbeciles described. At the epoch of puberty, the instinct of reproduction becomes developed, and imbe- ciles become amorous ; yielding themselves to the practice of onanism, to a degree the more frightful, as they are ignorant of the evils to which this dreadful habit exposes them. Men seek for women, girls become coquettes, and those are often brought to hospitals between the ages of fourteen and eighteen years, who, having attained to puberty, pursue men, are intracta- ble, and regardless of the commands of their parents. There was once at the Salpetriere an imbecile, who fulfilled the severest labors of the house, for a very trifling consideration. In several instances, after having obtained a few sous, she carried them to a working man, and abandoned herself to his lust ; returning to him no more, after she became pregnant. The following case shows that imbeciles are not always deprived of moral sensibility, and are capable of becoming melancholies.

A girl whose name was V., tall, with chestnut-colored hair, blue eyes, flushed face, a changeless physiognomy, — though sometimes indulging in a stupid laugh, — was admitted at the Salpetriere May 27th, 1811, aged twenty- two years. From early life, it was observed that her understanding was not developed in proportion to the organic growth. She remained incapable of articulating distinctly, and could acquire nothing. When fourteen she men-

454 ' iDiocy.

struated. She grew tall rapidly, and suffered from convulsions, particularly at the menstrual periods, notwithstanding the flow was abundant. At the time of her admission into the hospital, she had the appearance of a person in the enjoyment of perfect health, but could not reply to the most simple and ordinary questions, though she endeavored to do so ; making a sign that she comprehended them. She uttered cries, and often continued to cry for a quarter of an hour. Her appetite was good, and her sleep equally so. Her dejections were often involuntary. She knew not how to dress herself, but displaced nothing, and was mild and obedient. From the movements going on around her, she was accustomed to judge as to the time of rising, retir- ing, or taking her meals. She very readily found her ward on returning from her walk. In a word, she had an understanding of the primary wants of existence, but nothing farther. Though never passionate, she was suscepti- ble of ennui. During the month of July, 1812, she was struck by one of her companions, and was so deeply grieved in consequence of it, that she was no longer willing to partake of any thing but water. Profound sighs often escaped her ; she became emaciated ; scorbutic patches appeared ; she grew feeble ; and in the month of September was confined to her bed, and vomited blood. Refusing all nourishment and every remedy, she was seized with a slow fever, and died October 31st, 1812.

At the post-mortem examination, which was made on the 1st of Nov., I found the cranium voluminous and thickened, and the brow very projecting. The facial angle measured more than 70'~', the median line of the cranial cavi- ty was warped, the dura-mater very adherent to the cranium, the external lamina of the arachnoid covered with a false membrane, resembling the fibrine of»blood, a serous effusion into the cavity of the arachnoid which was slightly injected, and serum at the base of the cranium. The brain was very dense, the grey substance discolored, and the white injected. The membrane which lines the lateral ventricles had formed adhesions at several points ; a circum- stance which lessened their capacity. There were serous cysts in the tissue of the choroid plexuses. The peduncles of the cerebellum, very near the annular protuberance, were disorganized ; their substance in this portion was greyish and puriform to the extent of two or three lines in breadth, and six or seven in depth; the pineal gland appeared to be cartilaginous, and the cere- bellum was very dense. The peritoneum, particularly in the pelvic cavity, was dotted with small black points. The ascending colon and ccecum were reddish externally, whilst their mucous membrane was brown. The gall blad- der contained bile, inspissated, grained, and very brown. The hymen closed the entrance to the vagina, and the ovaries were very much injected.

Imbeciles possess therefore sensibility, a certain degree of intelligence, and a weak memory. They comprehend what is said to them, make use of speech, or if mute, express themselves by signs. They are capable of acquiring a certain amount of education, and possess moral affections : but given up to their own control, they very easily become degraded. Imperfectly nourished, and poorly protected from the effects of the weather ; filthy in their habits, and giving themselves up to errors of regimen ; their health becomes impair- ed ; the little intelligence with which they were originally endowed, enfeebled ; and at length, the imbecile, who is brought to a hospital, presents all the cha- racteristics of idiocy.

Second variety. — Idiocy. — We have, at last, reached the utmost limit of human degradation. Here, the intellectual and moral faculties are almost null ; not that they have been destroyed, but never developed. Among idiots, the want of intelligence and sensibility, is often in proportion to the vices of organization. There are merely the rudiments of intelligence, and instinct controls all the faculties. The power of speech even, does not exist. In rare

IDIOCY. 455

instances, we find certain faculties developed, and a natural aptitude for the exercise of certain talents.

Q,uenau was admitted at the Salpetriere in 1781, at the age of ten years. She had a good constitution, and an ordinary fulness of habit. The face was more fully developed than the cranium. The top of the head was depressed, the occipital portion small, the forehead flattened and receding. The follow- ing admeasurement was taken during life :

Circumference ..... 20.07 in.

From the curve at the root of the nose, to the

tuberosity of the occipital bone . . 11.33 "

Antero-posterior diameter .... 6.92 Bi-temporal diameter .... 5.63

li

Total ..... 43.95

Her physiognomy is stupid ; expressing sufficiently well her disposition to beg. She is constantly exposed to the air, whatever the weather ; extending her hand to every one for a few pieces of money, with which she purchases food, as she has a craving appetite. It is necessary to dress her. When she attempts to speak, she utters a hoarse cry, or a sort of articulate, jerking grunt, which she continues, until she is understood. She comprehends by a gesture, what is intended to be communicated to her ; provided it has reference to nothing beyond the most common wants of life. She is grateful to the nurse who attends upon her ; and to those who give her money, or food ; and expresses her thankfulness, by kissing her fingers, and raising her eyes up- wards. She understands, when spoken to slowly, and in a loud tone of voice. Though habitually gentle, she becomes angry when she cannot satisfy her gluttony, and tears all her clothing except her chemise, which she preserves from a sense of shame ; taking care to cover her throat with her hands. She has never been able to learn a trade.

This imbecile is, notwithstanding, a musician. Does she witness dancing, she leaps in time ; or does she hear singing, she repeats in a rough voice, not the words, but the airs, of which she has learned a great many. A pupil at the Salpetriere plays upon the violin ; Quenau follows the sound, and with a curious attention, seeks from whence it comes, and gradually approaches the musician. M. Guerry improvises an air. She follows him ; retaining and re- peating it, when requested. He commences an air, and she follows him quite to the close. M. Despres, an interne of the hospital, sings a complicated air; Quenau redoubles her attention, fixes her eyes upon the pupil, contracts her features, and endeavors to put herself in unison with the singer. Fruits, of which she is extravagantly fond, are placed at her door ; and she manifests, both by her looks and gestures, her desire to take them ; but at the moment when she is ready to lay hold of them, M. Despres beats time and sings. She immediately begins to beat time also, and abandons the fruits, which she seizes upon with avidity, so soon as the singing ceases. Does one play upon the flute, Q,uenau is all ear. So attentive is she, as to repeat the airs played.

On the 25th of August, 1833, M. Litz, at the invitation of M. Leuret, with pleasure assisted in the following experiments, which were made in presence of Doct. Mitivie, in the study of M. Pariset, physician of the division of the insane at the Salpetriere.* M. Litz improvises several airs. Q,uenau takes them up, but experiencing difficulty in repeating them, — her voice being inca- pable of reaching the pitch in which this celebrated musician sang ; — her

* M. Leuret published a detailed account of this experiment, with the phrenological history of Quenau in the Medical Gazette, for the year 1836.

456 IDIOCY.

features express both the effort and inconvenience. M. Litz touches the pia- no : duenau is motionless ; her eyes watching the fingers of the great per- former ; or else she commences a sort of convulsive movement ; turning her- self in various directions ; biting her fists ; stamping with her foot ; raising her eyes upward ; and using every effort to put herself in unison. The tran- sition from a grave to an acute sound, provokes a sudden contraction of all the muscles, as if she was agitated by an electrical discharge. This last expe- riment was repeated more than twenty times, and always with the same result. Doct. Leuret induces her to leave the study, and shows her some apricots. As soon, however, as M. Litz touches the piano, she returns, and while the instrument is to be heard, her eye is fixed upon the musician, and she returns to the apricots only when the music ceases. Notwithstanding this singular musical capacity, her cranium does not offer the protuberance pointed out by Gall, as indicating the organ of music. On the 15th of January, 1837, Q,ue- nau, at the age of sixty-six years, died of acute pneumonia. At the post-mor- tem examination, which was made by M. Mitivie, physician to the division of the insane at the Salpetriere ; it was shown that the scalp was somewhat thick- er on the left than the right side, that the median line inclined to the right, that the pia-mater was slightly infiltrated, and that the brain, which was some- what soft, presented no remarkable lesion. The lung presented changes, characteristic of the disease of which she had died.

G. is admitted at the Salpetriere in 1813, at the age of nineteen years. She is of small stature, and moderately full habit. Her head is very voluminous, and its conformation irregular. The forehead is remarkably high, large and projecting ; and the frontal protuberances are very prominent, particularly the left. The facial angle is more than ninety degrees. Her hair is a blond, the eyes small, of a chestnut color, and concealed beneath her arching eye- brows. She is cross-eyed ; her mouth is large, teeth white, and her complexion swarthy and sun-burnt. Her physiognomy is convulsive, and habitually ex- presses mildness and joy. The following dimensions were taken while the subject was still living :

Circumference of head ..... 20.63 in. From the curve at the root of the nose, to the occipi- tal tuberosity 12.91 "

Antero-posterior diameter ..... 7.28 "

Bi-temporal diameter ..:... 5.90 "

Total 46.72

She eats gluttonously, and without discretion ; crowding forward with her fingers, the food which she has accumulated in her mouth ; still not possessing sufficient intelligence to go for it, at the hours of distribution. The dejections are involuntary, and the menses abundant and regular. She walks little; all her movements being convulsive. She draws along the left side of the body, and uses her left arm with difficulty. It is necessary to dress her when she wets up, and to put her to bed like a child. She is insensible, and protects herself neither from the heat, cold nor rain. She recognizes the nurse who attends upon her, often embraces her, expresses her joy and recognition of her by kissing her hand, smiling, and shaking her head. Her disposition is ex- tremely mild and good. If a disturbance occurs at any time, she goes and informs the person in charge. She is obedient, as well as very obstinate. She takes care to cover her throat whilst being dressed, and if a wish seems to be manifested to raise her garments, she removes the offending hand. Never- theless, she does not blush ; showing that she does not possess the sentiment of shame ; and the indications of decency which she manifests, are the result of

IDIOCY. 457

habits contracted in infancy. She articulates the following syllables only ; pa-pa, ma-ma, which she repeats on every occasion, as well to express her anger, as to testify her joy. She constantly carries in her right hand some rags rolled up into the staape of a doll ; and to testify her satisfaction or resent- ment, she strikes it violently, several times in succession, upon the right tem- ple. She has retained a fragment of a popular air, which she sings often, over and over again, with an expression of satisfaction. The condition of this fe- male remained a long time stationary ; but within four years she has made some slight intellectual advancement. She now goes after her own food, calls for it if forgotten, and rejects what does not suit her. Her dejections are in- voluntary (*ly during the night. In the day-time she goes to the privy. She articulates, though imperfectly, certain words, which she employs to express her desires. She exerts herself to repeat what she hears, without being able to effect her purpose. She makes numerous grimaces ; seeming to attach to them ideas, which she (»nnot otherwise express-

M. v., is the offspring of " a mother who, during pregnancy, remained in a state of stupor. Notwithstanding the cares lavished upon his infancy, his health was very feeble, and it was not until he was six years of age that, one day while playing, he suddenly pronounced the word papa. When seven years of age, he had a very severe attack of cerebral fever, which, however, did not prevent the development of the organs, but was followed by a serious disturbance of the intellectual and affective faculties, and arrested their devel- opment, already so feeble and backward. After this period he becomes irrita- ble and turbulent. He tears, breaks, strikes and spits upon those who ap- proach him, and utters, both night and day, piercing and plaintive cries. He is easily frightened ; noise, the sight of animals, etc., producing this effect. Some one having called him a hog, he remembers, and still frequently repeats the word ; employing it on every occasion. When ten years of age, he was placed at the Institution for the deaf and dumb at Paris, without results favo- rable to the development of his understanding. At a later period, he was placed at a private hospital, and at length committed, several years since, to a lady who lives in the country, and who takes the utmost care of this wretch- ed child. When seventeen years of age, his stature is 27.75 inches. The vertebral column is slightly curved in the dorsal region. The top of the head is slightly depressed ; the hair of a deep chestnut color, abundant, harsh and bristling ; — a circumstance which prevents one from judging of the flatten- ing of the vertex. The eyes are blue, the look mild, the mouth largely cleft, and the lower lip thick. The physiognomy, though habitually convulsive, is not wanting in expression, and is sometimes sad and melancholy. The coun- tenance is wrinkled, in consequence of his habitual grimaces. The following are the admeasurements of the head taken from the living subject :

Circumference , . . . , 21.53 in. From the curve at the root of the nose to the occi- pital tuberosity .... 12.99 " Occipito-frontal diameter .... 7.08 " Bi-temporal diameter . . . 5.99 "

Total . . . . . 47.-59

His limbs are well developed, and his skin white. He often suffers from furuncles on different regions, and from aphthm in the mouth. His appetite is not strong, and he prefers vegetables to meats. He likes to be properly served, though he conducts with little propriety himself; as he is constantly spitting about him during his repast, even upon his plate cover. If a new

58

458 IDIOCY.

dish is served up to him, he carries his fingers to his mouth, to indicate that they may give it him to taste. He does so, and if it is not acceptable, pushes it aside. On the contrary, he testifies great impatience to have it, if it is to his taste. His sleep is often interrupted by cries, and lasts only from one to three hours. This young man was never able to learn, either to read, write, or speak. Notwithstanding, some of the intellectual faculties acted to a certain extent. He recognizes very readily, both persons and places. He combines certain ideas, and though he does not speak, articulates, in his own way, certain sounds, of which he forms words, to which he attaches a signifi- cation. Thus he says pa pa paa, ma ma maa, and applies these syllables to the lady, who has charge of him. He says also ho ho jour, me me, ont taking the hand of those persons who approach him, and whom he knows. He is exces- sively mobile, being constantly in motion, and suffering from a tremulous movement in all his limbs. He is perpetually in mischief; spitting upon those around him, pinching, patting, kicking, and th»)wing them down ; and afterwards laughing. When he wishes to play a trick upon any one, he assumes a mild and friendly tone, in order to induce them to approach him. While walking in the country, he approaches near to those whom he meets ; spits upon them, and escapes, laughing and uttering a cry, M hi hi. On returning from his walk, he hastens to reach home first, and conceals himself, in order to impose upon some of the people of the house. Every object and person that he has not seen before, interest him. If a stranger enters the house in which he lives, he cries and struggrles, until he has been recognized by some one of his associates. Before passing from one place to another, he looks attentively, as if to reassure himself by this exploration.

DEMENTIA (part 2)

He is sensible of the good that is done him, and becomes irritated by im- proper proceedings. " He is mild, diffident, and timid. If opposed, he carries his complaints to the lady who has charge of him; repeating at the same time, the monosyllables ma ma ma. A female servant having struck him upon the arm, he remains irritated during the whole day ; crying every moment ma ma ma; pointing by turns, to the arm that had been struck, and also to the ser- vant who inflicted the blow; and becoming composed, only when the latter, after a rebuke, manifested regret. On hearing a carriage, he says brrr, wish- ing doubtless to imitate the sound of wheels. He once pronounced the name of his father, whom he had not for a long time seen. He was formerly afraid of animals, but no longer fears them ; caressing the horses, and playing with the house dog. He is at all times agitated, and disposed to lacerate his per- son, although he fears the injury. Within a year particularly, he has torn his lips ; dashed his head against the walls and furniture ; and struck himself with his fists in his eyes. He would be disposed to onanism were he not watched ; and makes attempts to touch both men and women.

M. de G., is another idiot, thirty-six years of age, who was admitted at Cha- renton Aug. 6th, 1825. Whilst pregnant, his mother experienced a severe moral affection. His stature is a little above the medium size ; he is of ordi- nary fulness of habit, his head of a beautiful conformation, his hair of a chest- nut color, and his eyes grey : his forehead is large, high and open.. His phy- siognomy is gentle, and vague ; yet more expressive than the extent of his understanding would seem to indicate.

Great circumference Antero-posterior curve Transverse curve Antero-posterior diameter Transverse diameter

Total .... 64.07

22.44

13.89

13.38

7.87

6.49

IDIOCY. 459

The limbs are well formed, and his head is habitually inclined toward the earth. The trunk inclines slightly forward, the fore-arms are flexed, and the fingers con- stantly bent ; the thumb of the left hand alone being extended. The hands, also closed, are affected with a kind of convulsive tremblincr. When he walks, he approaches walls or trees, in order to rub his garments against them. When he descends a stair-way, or a sloping ground, he walks slowly, and endeavors to support himself, throwing his body backward and his arms in front. The motion of his fingers and arms, the balancing of his head and trunk from be- fore backward, give to his attitude something altogether peculiar. His health is good, the functions of nutritive life are satisfactorily executed, and his appe- tite is excellent. He eats his soup with a spoon, but if his bread and other food are not cut into morsels, he becomes impatient, goes around the table, takes the meat in his fingers, looks at it, puts it again upon his plate, takes it up again, carries it to his mouth, and after making certain vain efforts to divide it, throws it upon the floor. If his food is cut in pieces, he takes it with a spoon, not knowing how to use a fork.

It was with much difficulty that they accustomed him to wear a cap, and take care of his shoes, stockings and gloves. Some years sioce, while making his toilet, he was wounded at the end of one of his fingers ; since which, he conceals his fingers, whenever any one attempts to touch them. It is to him a great trial to have his nails pared, and his feet washed. It is necessary to con- fine his gloves to his wrists, which makes him sad. He looks steadily at his hands, and makes great efforts to free himself from this appendage. Incapable of unbuttoning his clothes, if he has a want to satisfy, he goes to his own, or some other attendant, (never to the patients), asks, by signs, their assistance, and goes with them to the privy. If there is no domestic at hand, he goes out alone, but being unable to undo his clothing, soils himself; when he dares not again go out, until some one comes to cleanse and bring him in. He rises from his bed at night, evacuates the bowels or bladder upon the middle of the floor of his chamber, and again retires. He sleeps well ; retiring and rising at fixed hours. When the hour for getting up arrives, he informs his atten- dant by striking together his teeth. If the servant delays, he leaps from his bed, and walks about in his shirt. If desired to remain in bed, he becomes impatient. When he retires, he takes the bolster in his arms, turns upon his face, laughs aloud several times, and goes to sleep. He was never able either to read or write, or to articulate the least sound ; although he was not deaf He distinguishes both persons and things, of which he has daily observation. He recognizes his attendant without difficulty, as well as those persons who manifest an interest in him ; looks for them again, and smiles at their ap- proach ; while he flies from others, and looks sad when they come near him. He is very submissive, both to the gestures and voice of his attendant, whom he servilely obeys. Until the age of twenty-one years, he was accustomed to sing incessantly, without articulating any sound. At this epoch however, he ceased to sing, after an attack of acute articular rheumatism. Notwithstand- ing, music still produces a powerful impression, and strongly excites him. The excitement is proportionate to the number and noise of the instruments. On endeavoring to make him hear the sound of a flute, he seemed to be scarcely sensible of it. When, on the contrary, he hears loud-sounding music, he bursts into a fit of laughter, and dances or leaps almost in time. Since the period of puberty, the presence of women exercises upon him a remarkable influence, though less energetic than music. On being embraced one day, by a lady who paid him certain special attentions, his joy and excitement were not augmented, although his countenance was expressive of "satisfaction. He is an onanist. He refrains during the day, because he is watched ; but when in bed, if left alone, he abandons himself to this fatal practice ; ceasing so soon as he is spoken to, or perceives that he is observed. It has been noticed.

460 IDIOCY.

that on being put upon his bed without any covering, he abstains. Is it fear or shame that restrains him? This is not his only vicious inclination. He robs the sick of their wine, and is very careful to conceal himself both from them and the attendants.

E., aged twenty-three years, is of small stature, but large, thick set, and provided with much fatty cellular tissue. The forehead, rising at a right angle, is flattened. The temporal regions are prominent. Her hair is abundant, of a chestnut color, and harsh. Her eyes are dark, small, crossed, and almost constantly convulsed ; which causes them to be directed upward. Her physi- ognomy is mild, and somewhat expressive. The arms are short, slightly rigid, and move convulsively. She is unable to open her hands completely. The fingers are almost invariably flexed, and, as it were, contracted; being capable of extension, only one by one, and then slowly, and with effect. Ordinarily the index only remains extended. The head rises rounding to its summit, and is flattened from before backward ; so that the fronto-occipital diameter is less than the bi-temporal ; as the admeasurements of the head, taken upon the living subject, indicate.

Circumference . . . ._ . . 20.00 in.

From the curvature at the root of the nose to the •

occipital tuberosity .... 11.81 "

Antero-posterior diameter . . . 6.10 "

Bi-temporal diameter .... 6.33 "

Total ..... 44.24

She is well nourished, though she eats sparingly. Her dejections are easy, and her menses regular. Her gait is painful ; waddling and hesitating. She moves with little assurance, and remains habitually in a sitting posture. Her sensations are fugacious, and she has little memory. She recognizes persons whom she often sees, and knows how to count as far as twenty and beyond. If one asks for a certain number, she shows, in her way, as many fingers as there are units in the number demanded. She knows the value of certain pieces of coin, and distinguishes the utensils that she is asked for, if they are at hand. She is fond, both of flowers and fruits. She does not speak ; but understands, and goes to seek the object, the name of which has been mentioned to her. She never learned to talk. She expresses her thoughts and affections by two sounds, the one prolonged, hihihiii ; the other, hehehee, which she forms by hastening the respiration, and modulates variously, ac- cording to what she desires to express. The affective qualities predominate in this case. She is very affectionate, and attaches herself to those with whom she resides, especially to those who have the care of her. She came from the Orphan's Hospital with an imbecile, with whom she is pleased, and shares her food, with whatever else is given her. If any one of her compan- ions commits an act which leads to enquiries, she interests herself in it. She is timid, very modest and always decently clad. She testifies her affec- tion after the manner of certain animals : by approaching those who are the objects of it, rubbing herself against them, panting, and making many gestures.

Aba is an idiot of the Bicetre, about thirty years of age. His stature is below the medium size, his limbs well formed, his head large enough, but flattened posteriorly ; the forehead is low, the nose broad and flat, the mouth laro-e, and the physiognomy vague, uncertain, and without expression. He sometimes seems to meditate. Sometimes, his physiognomy expresses a slight smile, and a malicious aspect, particularly when he beholds strangers. His head, on being measured, presents the following proportions :

20.98

in

7.20

(<

6.10

a

12.59

a

IDIOCY. 461

Circumference ..... Occipito-frontal diameter

Bi-temporal diameter ....

From the curve at the root of the nose to the occi- pital protuberance

Total ..... 46.87

His physical health is good ; his movements are free ; he eats slowly, and often stops in the attitude of a man who thinks, fears, is astonished, and curious ; which emotions however, soon cease. He soils his bed. The sen- sibility and understanding of this idiot were arrested, so to speak, in their rudimentary state. His sensations are slight and temporary. Attention is very feeble, and can be brought to bear but upon a small number of objects ; and the memory is almost null. He comprehends somethings that are said to him ; for instance ; to wash himself, and to go to bed. He occasionally makes some noise by rubbing the teeth together, and seems to be pleased by it. He knows the attendant who has charge of him, but does not speak. He merely pronounces in a low tone, the syllables ba, ha, ha, which he repeats on every occasion. He has contracted certain habits like the following : he dresses himself; goes after his food, and retires to answer to the calls of na- ture. He collects all the little motes which settle upon his arm, or which he finds upon the garments of others. I presented to him, says M. Leuret, physician to the division of the insane at the Bicetre, who communicated this case to me, a piece of money. He smiled on receiving it, looked at it, turned it over and over, put it to his mouth, and then handed it back to me. I show him apples, and he takes them with manifest pleasure. He nibbles one of them, at first round and round, but finally swallows it, even to the seeds. I extend my hand, in order that he may give me one of them, and he understands ; presenting me the apple which he is eating, but without letting go of it. I repeat the act ; he presents me a piece, and retires smiling. An attendant takes one of them from him, and leaves the chamber in which we were. Aba follows him with his eyes; but having lost sight of him, appears to have no farther recollection of him. After some minutes the servant re-enters, and Aba extends to him his hand for his apple.

Aba is an onanist as well as a thief; robbing, even with address, particular- ly articles of food ; and the vice is carried in his case, to a very considerable extent. He had one day robbed a companion of his food, who, in order to punish him, endeavored in the contest to plunge his head in a bucket of cold water. Aba was thrown down, and one of his arms fractured. During the efforts at reduction, he manifested no pain, and even seemed to smile. Did he suffer ? He often showed me the injured arm, while the apparatus was upon it, and some time indeed, after its removal.

Matteau, at the age of ten years, was admitted at the Salpetriere, May 7th, 1836, and the following observations made in 1837. She is both rachitic and epileptic. Though she was the offspring of a bandy-legged father, her mother had given birth, both before and after her confinement with M., to healthy, and well formed children. The stature of this idiot is 51.02 inches. Her hair is of a light chestnut color, her eyes blue, eyebrows blond, and her look fixed, and without expression. Her eyelids, usually in motion, are sometimes closed, as if she slept. The forehead is low, and the supra-orbital protube- rances, salient. She has a rounded snub-nose. The inferior lip is large and pendant, and the physiognomy, ordinarily stupid, becomes animated, only when expressing pain. The admeasurements of the head, are as follows :

19.13

in

10.63

a

6.85

11

4.68

a

462 IDIOCY.

Circuinference ....

Frontooccipital curve .... Antero-posterior diameter Bi-temporal diameter ....

Total ..... 41.29

We notice, in the case of this idiot, a deviation of the spine to the left ; an ulcer about the size of a twenty-five cent piece, occupying the middle of the back, and a vast cicatrix, extending over a great portion of the left posterior region of the trunk, the neck and superior extremity, and over the posterior and superior part of the thigh of the same side. This ulcer, and these cica- trices, are the result of a fall into the fire during an epileptic seizure, to which she has been subject, from the age of seven years. When eighteen months old, this girl suffered from convulsions, which arrested her physical and intellectual development.

On her arrival at the hospital, she refused all nourishment, and passed nei- ther urine nor fecal matter, for three days ; after which variola made its ap- pearance. The course and termination of the latter affection, were regular. After that period, the epileptic attacks occurred daily, and were sometimes, five or six in number, during the twenty-four hours. She is habitually motion- less; her head inclined to the right, or resting upon the breast, and the fore- head reposing upon the knees. One of her arms hangs by her side ; the hand strongly flexed upon the forearm, and the fingers upon the hand. The other is usually in the mouth; the lips performing the action of suction, either upon the hand, or the arm of the chair in which she is fastened. If permitted to stand up, she totters, and sits down awkwardly upon the ground. However, she sometimes leaves her seat, and takes a few steps. If touched at any time, she utters piercing cries, opening widely her mouth, and knitting the eye- brows. She often cries during the night. A stranger to the noise which she makes, she is not disturbed either by singing, cries or noise. She knows those who have charge of her, and caresses them. Is she shown the door, and, at the same time, informed that her brother has arrived ; she turns her eyes slightly in the direction indicated. She only pronounces the words pa pa, ma ma, and sometimes the syllables coc coc, at the same time, regarding the sun. She is incapable of putting on her clothes, and of entertaining any notions of propriety, or any consciousness of her wants. When she witnesses the distribution of food among her companions, she opens her mouth, and ex- tends her hand, as if to demand her share. Finally, she eats much, voracious- ly, and without discernment. Her dejections are involuntary, and she yields herself to the practice of onanism.

Before analysing the cases which precede, in order to deduce from them general views respecting idiocy, ought we not, by new facts, to reach that de- gree of idiocy, which is the extreme limit of human degradation, in which even instinct no longer exists ; that limit at which man, deprived of every attribute, is no longer any thing more than a monster which vegetates ? Pinel has published the history,* together with a design of the cranium of an idiot, who was at the Salpetriere in 1805. It resembled the sheep, both in its tastes, its mode of life, and the form of its head. She had an aversion to meat, and eat, with avidity, both fruits and roots ; drinking nothing but water. Her demonstrations of sensibility, of joy or grief, were limited to the repeating of the words, imperfectly articulated ; be, ma tate. She would alternately flex

* A Treatise on Mental Alienation, Paris, 1809, in 8vo. p. 179.

IDIOCY. 463

and extend the head, and rub it against the breast of her nurse. If she de- sired to resist, or express her dissatisfaction, she sought to strike, with the crown of the head inclined. She was extremely choleric, and many times, I saw her in the bath, making efforts to get out, and repeating in an acute tone, be, he, he. The back, loins and shoulders were covered with flexible and black hair, from one to two inches in length. She could never be induced to sit in a chair, or upon a bench, even to take her food. No sooner was she seated, than she slipped down upon the earth, and was accustomed to sleep with her extremities closely gathered about her, after the manner of animals. Pinel examined this case, and furnished us with the dimensions of the head of this idiot, compared with those of the cranium of a little girl of seven years :

Idiot of 11 years. Girl of seven years.

Length of cranium . . . 5.11 in. . 7.08 in.

Breadth .... 3.53 " . 5.11 "

Depth . . . . 5.11 " . 6.29

<<

'Gall has in his collection, and exhibited at his lectures, a plaster cast of the head of an idiot, resembling in every particular, that published by Pinel.*

The state of degradation of some idiots is such, that they are deprived of certain of the senses, do not possess the instinct of self-preservation, and lead a life which is altogether negative. We had at the Salpetriere in 1812, an idiot who was found lying by the dead body of her mother, who was supposed to have been dead for three days. On being sent to the hospital, June 20th, by order of the police, this idiot, who was twenty-seven years of age, very much emaciated, very pale, rachitic, blind, and deaf and dumb, uttered, from time to time, an acute, although inarticulate and stifled cry. Her limbs were atrophied, and, being drawn up under the thighs, — she could not walk. It was necessary to convey liquid aliments into the mouth, and even so far as the (Esophagus. She knew neither how to chew nor swkllow. She was nourished with broth and wine, and died at the expiration of a few days. The weight of the dead body was forty-three pounds ; the bones of the cranium spungy, and very thin; being only from .11 to .15 of an inch in thickness. The brain, which was atrophied, did not possess half its original weight, and the convolu- tions were narrow, close and shallow. The cortical substance was discolored, and the white very dense, and yellowish. The lateral ventricles, very slightly developed, were destitute of serum. I was unable to preserve the skeleton ; the bones being destroyed by maceration.

In 1817, there died at the same hospital, an idiot twenty-five years of age, who was deaf, dumb, blind and rachitic. She could not rest upon the back, in consequence of the vicious conformation of the trunk ; and not having the instinct to change her position, it was necessary to turn her from time to time, now upon one side, and now upon the other. If placed in a sitting posture, she had not the strength requisite to maintain it, and allowed herself to fall down again. When food was conveyed to her mouth, her lips and head were slightly moved, as if to withdraw them from the article which was presented her. By crowding the spoon into her mouth, the jaws separated, but it was necessary to carry it quite to the oesophagus, in order that the food might reach the stomach. Always sitting upon the haunches in bed, she loved to be cover- ed, even in summer. If the coverings were removed, she uttered a harsh cry, and endeavored to replace them with her hand; but if they were not near, she ceased her efforts, and remained gathered up in bed. She was accustomed to

* Functions of the Brain.

464 IDIOCY.

pronounce very imperfectly, rarely, and without motive, the syllables md, md, especially when touched. If she perceived any one approaching her, she ut- tered a cry similar to that of a cross dog, which she once repeated, whenever they commenced feeding her. She died four months after her admission into the hospital. The following is the result of a post-mortem examination. The head, at first sight, does not appear very irregular, but is small, and the occi- pital region compressed. The forehead, slightly elevated, and depressed late- rally, retreats immediately above the superciliary arches. The two eyeballs, present no trace of organization, and the crystalline lens is very small, hard, opake, and of a dull white color. The two superior conoidal teeth are double, and fixed, the one before the other. The bones of the cranium are thin and spungy, and very easily cut. On exposing the dura-mater, the convolutions are not apparent, and a fluctuation is experienced beneath the meninges. The latter being cut, a large quantity of serum flows forth, contained in the lateral ventricles, which were dilated, at the expense of nearly the entire cere- bral substance. The pia-mater is, in some sort, invested by a stratum of cere bral substance, of not more than 25 or 30 millimetres (.98 or 1.18 inches) in thickness. The folds of cerebral substance which separate the two ventricles, the cornua Ammonis, and the corpora striata are destroyed. The corpus cal- losum is very dense and slightly yellow, the optic thalami are atrophied, and their gray substance of an ash color. The optic nerves are reduced to the neurilema merely. The lungs are contracted and atrophied, although crepi- tating. The heart, which is small, and its muscular substance pale, is easily torn. The skeleton, which I have preserved in my collection, is very remarka- ble. The cranium, on being measured, furnishes the following proportions :

Entire height of the skeleton . . . 41.73 in.

Circumference of the cranium . . 18.89 in.

From the curvature at the root of the nose to the occi- pital tuberosity ..... 10.43 " Antero-posterior diameter . . . 6.18 "

Bi-temporal diameter .... 5.35 "

Total, embracing only the four last numbers . 40.85 in.

The spine presents a curvature, which is concave towards the left, and ex- tends from the eleventh to the twenty-first vertebra. A second curvature in the opposite direction, is formed by the lumbar vertebrte, whose apophyses are firmly united. The ribs of the left side, proceed directly forward from their angular points, and those of the right instead of being convex externally, project, by their convexity, into the thoracic cavity. The sternum projects almost horizontally, and its abdominal apophyses is wanting. The pelvic bones have not the normal form. The iliac portions are convex towards the pelvic cavity, and separated anteriorly, to the extent only of 1.57 of an inch. The pubic portions, projected anteriorly, approach each other so nearly, that they touch at some points ; whence it results, that the pelvic basin is almost obliterated. The lower extremities are slender, and all the bones present nodo- sities, numerous false unions, and defects of ossification. The left thigh is larger and shorter than the right, and slightly twisted towards its inferior extremity. The heads of the thigh bones are atrophied, and that of the right is only .39 of an inch in extent. The corresponding cotyloid cavity does not exist. The humerus, as well as the radius and ulna, present several swellings and adhesions. The lower jaw, ribs, scapulae, the metacarpal bones, and cer- tain of the phalanges of the left side ; together with the bones of the metatar-

IDIOCY. 465

sus, present numerous vices of conformation, resembling consolidated frac- tures. The skeleton is very light ; the bones have lost their polish, are rough, fatty and yellowish. The bones of the cranium are spungy and thin ; being only from 4 to 6 millimetres (.15 to .23 of an inch) in thickness.

During the same year, there was brought into the division of the insane at the Salpetriere, an idiot who had been found in one of the bateaux, which de- scend from the Bourgogne to Paris. She appeared to be about twenty years of age, and was both deaf and dumb. The abdomen was greatly distended with serum. Her head was small, inclining to the right. The eyes, which were blue, remained open and fixed, the dilated pupils not contracting. The eye-lids did not close on the approach of light. Nevertheless, this idiot seem- ed to look, as children are accustomed to do, when they begin to see. She manifested besides, no sign of sensibility, whether she was touched or pinched, or the coverings by which she was surrounded, were removed. The dejec- tions were serous, frequent and involuntary. When liquid aliment was pre- sented in a spoon to her lips, she was accustomed to open wide her mouth, and keep it open, so long as fluids were poured into it, which it was necessary to convey to the fauces, in order that they might pass into the stomach. She did not shut her lips, until two or three minutes after they had ceased to feed her. The body reposed upon the left hip, in such a way that she could not extend herself upon the bed, but remained there slightly inclined, sustained by pillows, and maintained this position, having neither instinct, nor the power to change. She died at the expiration of a month, without serious suffering, and on opening the body, we found the left ventricle of the brain distended with serum, which had taken the place of the cerebral lobe of the same side, which no longer existed. The convolutions of the right lobe were extremely small, shallow, and much compressed ; the right ventricle being almost obliterated. The cerebral substance, which was very dense, and stretching rather than tearing, was of a dirty white. The cerebellum was small, and remarkably hard, particularly the gray substance, which was almost friable, at the surface of this organ. The arachnoid was infiltrated and thickened, without adhe- sions. The gray substance of the remaining portions of the organ, was pale. The lungs were atrophied, and compressed into the superior portion of the chest; and the pleurae contained serum, as well as the peritoneal cavity. The heart was small and very soft. The muscles were pale, and easily torn.

The skeleton of this idiot, which makes a part of my collection, is remarka- ble for its lightness, and the enormous curvature of the vertebral column, as well as the peculiar direction of the pelvis, and the narrowness of the left cavity of the thorax. The head is small, a little inclined to the right, and more developed in the direction of its depth than breadth. The cranium is flattened at the sides, and a little depressed anteriorly. The forehead is nar- row, retreating rapidly, and presents at its middle portion an unequal swel- ling, circumscribed by a circular depression. The coronal suture is not en- tirely closed. The thickness of the bones of the cranium, — of which I shall furnish the admeasurements, — is only from three to four millimetres (.11 to .15 of an inch.)

Measure of the cranium. Circumference ..... 17.32 in. From the curvature at the root of the nose, to the pos- terior margin of the occipital foramen . 10.03 " Antero-posterior diameter .... 5.98 " Bi-temporal diameter . ... . 4.60 "

Total ..... 37.93

59

466 IDIOCY.

The cervical portion of the vertebral canal, is nearly straight, but twisted in some sort upon itself; whence it happens, that the bodies of the superior vertebree are turned to a trifling extent to the right, which occasions the devi- ation of the head to the same side. The inferior half of the spine, describes an arc whose chord is 3.14 inches. The convexity of the curvature projects downward and to the left, while the concavity is upward and to the right. The bodies of the vertebras, are therefore turned almost entirely to the left. The pelvic cavity is so far changed from its usual position, that its superior opening is directed downward and to the left, whilst the inferior one is directed backward, and to the right. The pelvis has been rotated laterally, placing it horizontally beneath the base of the chest ; the iliac portion of the right coxal bone, the cotyloid cavity, and the anterior border of the left iliac, almost touching the ribs. The trunk, during life, reposed upon this margin, which Ijad undoubtedly caused the swelling and erosion of the left anterior and infe- rior iliac spine. The heads of the thigh bones are very small, and the cotyloid cavities shallow, and irregular in their circumference. The left margin of the sacrum looks downward, and the right upward ; so that the position of this bone is almost horizontal. The thorax, which is thrown to the right, is form- ed almost wholly of the right cavity, which is 5.90 inches in diameter, whilst the left is only .98 of an inch. The ribs of the left side, on reaching their angles respectively, project abruptly before the spinal column. The sternum is thrown to the left.

Idiots are rachitic, scrofulous, epileptic or paralytic. The head, either too large or small, is badly formed; and the occipital region flattened and small, in proportion to the face. The features are irregular; the forehead is low, narrow, and almost pointed ; retreating greatly, and more salient on the right than the left side. The eyes are convulsive, crossed, and of an unequal size, and the lips are thick. The mouth is large, and when open, permits the saliva to escape. The gums are fungous, and the teeth decayed. The defective conformation, or want of symmetry in the organs of sensation, indicates clearly enough, that the action of the senses is imperfect. Idiots are partially or entirely deaf, or hear imperfectly. They are mutes, or articulate with diffi- culty, certain monosyllables. Their incapacity to speak, depends upon their deafness, on the imperfect conformation of the organs of speech, and upon the circumstance, that they are incapable of imitating the movements, adapted to the articulation of sounds. Some utter cries more or less acute, suppressed or harsh. Deprived of an eye, they see imperfectly, or are blind. Taste and smell are equally imperfect; for these wretched beings do not distinguish the qualities of sapid or odorous bodies. They roll themselves amidst the most filthy and fetid ordure, and devour the most disgusting substances; eating herbs, straw, linen, wool, tobacco and fecal matters. They drink either urine, or spring water. I have found in the stomach of an idiot, fragments of linen, which had once constituted a portion of his dress ; in another case, the cecum was filled with straw, which had led to an inflammation and gangrene of the intestinal membranes. They devour indeed, whatever comes in their way.

An idiot to whom I had given some apricots, at first put them in her mouth and ate the pulp ; being unable to bite through the stones, she swallowed them, as she had already done the pulp of the fruit. She thus ate nine apri- cots in succession, and would have eaten more had I not feared that she would have been sick. The touch, far from rectifying the other senses, or proving a substitute for them, is not sure. The arms of idiots are of un- equal length, contracted and atrophied ; the hands are deformed, distorted and small ; the fingers are slender, crooked, maimed, or deprived of motion ; and the skin is thick, rugose and insensible. Idiots extend the arms and hands in a vague and convulsive manner ; lay hold of bodies awkwardly ; are

IDIOCY. 467

unable to retain them, and permit them to escape from theij hands. They walk awkwardly ; waddling, or advancing by successive jerks ; and are easily thrown to the earth. Some of them remain wherever they are placed. Those who walk, march about without an object, or without its being possible to guess what they propose to themselves.

The senses of idiots therefore, being scarcely developed, and the sensations imperfectly perceived, the understanding can make no greater proportion- ate advance, since its instruments are defective. Their senses, strangers to the external world, are incapable of exercising a corrective influence over each other ; nor can education prove a substitute to so many disadvantages, as in the case of the blind and deaf and dumb, in whom the senses which remain, supply to a certain extent, those of which they are deprived. The ideas which man acquires by those senses, of which the blind and dumb are deprived, are doubtless wanting to them ; but the understanding remaining unimpaired, although deprived of certain of its instruments, exercises itself altogether, in acquiring general notions and abstract ideas. The blind also, as well as mutes, whose powers of attention may be called forth by various means, so well pointed out by Doct. Itard, and so successfully applied to the education of the Savage of Aveyron,* are capable of receiving an education, while idiots are not.

Incapable of attention, idiots cannot control their senses. They hear, but do not understand ; they see but do not regard. Having no ideas, and think- ing not, they have nothing to desire ; therefore have no need of signs, or of speech. It is indeed useless, to him who neither thinks nor desires. More- over, we can judge of the degree of understanding which idiots possess, by the extent of their vocabulary. They utter certain imperfectly articulated sounds and cries, or prolonged bellowings, which they interrupt in order to separate the lips, as if they desired to laugh. If they do articulate certain words, they attach to them little sense. Some have only a cry, indicative of pain and pleasure. However, there are those who, like children, form by imitation and habit, a language of action, and even an articulate one ; which is understood only by those who live with, and have charge of them. It expresses merely the first wants of life, and those instinctive appetites which they are, unaided, incapable of gratifying. Of what utility would language be to him who cannot think, and has nothing to communicate to his fellow beings ? Idiots are mutes, because they have nothing to say. Those who have a language of action, employ only a small number of gestures, as signs of their instinctive wants. Do they act, every thing is wrongly done. We perceive the disorder, awkwardness, and slowness of their acts. The under- standing remains as at birth, or at the period when the arrest of development took place. The digestive functions of idiots are usually very well accom- plished ; and they eat much and with voracity. With the female sex, men- struation is regular, and abundant. These wretched beings do not always testify a desire to eat ; not seeming to be apprised of hunger, until they per- ceive food. Sometimes, in order to nourish them, it is necessary to convey the food to their mouth, and sometimes even to the fauces. Their secretions are involuntary, and are passed everywhere, and without shame.

Idiots do not always possess the instinctive faculties. They are below the brute ; for animals possess the instinct of self-preservation and reproduction. Idiots do not possess this instinct, and have no sense of their existence. They have neither pain nor pleasure ; hatred nor love. They are untimely births. They are monsters, and doomed, in consequence, to an immediate

* Tlie Education of a Savage, Paris, 1807, in 8vo. — An account of the new developments of the Savage of Aveyron, Paris. 1807, in 8vo.

468 IDIOCY.

death, unless the tenderness of parents, or public commiseration preserve them. Yet, who would not be surprised at the facility which the major part of idiots possess, of singing, and remembering a variety of airs? Beside the examples which I have above related, I ought here to remark, that nearly all the idiot children, for whom I have been consulted, sing some certain air with more or less correctness ; or at least, certain passages of music, although deprived of speech.

The habitudes of some idiots are very singular. They seem to be ma- chines, set in motion in order to produce invariably the same movements. With them, habit takes the place of intelligence. An idiot who was twenty- three years of age when I saw him, of the usual stature, a slender person, fore- head flattened, the complexion pale, the eyes crossed, articulation scarcely possible, and the dejections involuntary, was always accustomed to walk to the same place ; sometimes enlivening his walk by bowing and rapidly rais- ing the body ; or by shaking one of his arms, and laughing loudly. If any one placed an obstacle across the path to which he was partial, he was both grieved and angry, until it had been removed. Never did he remove it him- self

Among the idiots of the Salpetriere, there are several who are incapable of either dressing or feeding themselves. Their dejections are involuntary, and they remain almost naked; indifferent to the rain, cold, or heat of the sun. There is one who, as soon as she rises in the morning, sits down upon the end of the same bench, and there balances herself backwards and forwards; strik- ing her shoulders violently against the wall. This balancing is continued and regular ; being sometimes more rapid and vigorous than at others, and she then utters a stifled cry. Thus she passes her days and life ; exposed to every atmospheric vicissitude, and a stranger to all external impressions. I found twenty years ago, in the hospital of Poitiers, extended upon the straw in the same apartment, two little idiots, one of whom constantly laughed, and the other wept. Idiots are strongly inclined to masturbation, and yield themselves to the excessive practice of it in the presence of any one, without either mod- esty or shame.

I once saw an idiot thirteen years of age, who had, ever since the age of seven, possessed all the signs of virility ; the penis being very large, and the pubes covered with hair. He seemed to live, only to masturbate. Doct. Hain- dorf, — who published in German, twenty-five years ago, an excellent treatise on mental alienation, — relates a remarkable example of obstinacy, which dis- played itself in the person of an idiot. Born in the mountains of Rawn, he was deprived of the power of speech, and brought to the hospital of St. Julien, Wurtzburg. He was permitted to wander about in the garden of this estab- lishment, where he was seen, covered only with a linen garment. He was ac- customed to amuse himself, in moving about in a circle, from within which, he would pluck up the grass, and collect stones, which he placed in a pile, and afterwards threw away. Thus he occupied himself, without either purpose or design ; and during this exercise his muscles were convulsively contracted. If prevented from moving about, and piling up stones, he would begin to pull different parts of his body, and to scoop up the earth with his feet, which were naked, and covered with callosities. If put in a place of confinement, he be- came furious, and endeavored to set himself at liberty. So soon as he had obtained his freedom, he commenced his circular movements, and collecting stones. He ate and drank whatever was given him, and always returned to the same place, for his food and sleep. He was often accustomed to gnaw a bit of wood, and swallow what he could obtain in this way; but so soon as a word was spoken to him, in connection with a fixed look, he fled to conceal himself The slightest noise terrified, and caused him to retire ; but he would

IDIOCY. 469

soon return, to resume his habitual exercise. He gave no indication of prac- ticing onanism. All his acts were similar, and repeated at fixed periods of the day. The features of his countenance were disordered, the lips project- ing, the teeth of a dirty white, and the eye, half concealed beneath the lid, did not permit the pupil to be seen. The outline of his mouth, was towards the eyes. The physiognomy was destitute of expression, and the head, which was very small, presented a remarkable flattening of the vertex.

The insensibility of idiots is sometimes most remarkable, although enjoying the use of their senses. We have seen these wretched beings bite and lace- rate themselves, and also tear out their hair. I have seen an idiot who, with her fingers and nails, had pierced through her cheek, play with a finger placed in the opening, and end by tearing it to the very commissure of the lips, with- out seeming to suffer. Some of them have had their feet frozen, without pay- ing the least attention to it. An idiot, having become pregnant, is confined without the slightest suspicion of what has taken place ; and desires to leave her bed, saying she is not sick. These wretched beings are reduced to such a degree of insensibility and brutishness, that they do not understand the cause of their pain, nor distinguish, whether it is internal or external. Their con- sciousness of self-existence is so slight, that they are not aware that a disor- dered portion of the system, at any time appertains to themselves, and many even mutilate themselves. When sick, they do not complain, but remain gathered up in bed, without manifesting the least suffering, or without being able to divine the cause or seat of the affection. They die even, without the power .of aiding themselves. Their moral degradation, is in relation with their privation of physical sensibility.

An idiot, says Doct. Haindorf, who was kept in the hospital of Saltzburg, did not appear susceptible of any fear. They desired to make the trial, whether he would not be impressed by the sight of a man who, having simu- lated death, should rise again. With this intent, an attendant laid himself down upon a bench, enveloped in a sheet, and the idiot was ordered to watch the dead man. Perceiving that he moved, the idiot advised him to remain tranquil. Notwithstanding this advice, the pretended dead man arose ; when the idiot seizes a hatchet, and at first, cuts off" a foot, and without being de- terred by the cries of the unfortunate person, decapitates him at a second blow ; after which, he remains composedly by the dead body. When re- proved for his conduct, he coldly replied : if the dead man had remained tran- quil, I should have done nothing to him.

A lypemaniac desired to die, but was nevertheless unwilling to commit the act, because it was a crime ; preferring to subject herself to the condemna- tion of death, by the commission of some capital offence. Being left on one occasion with an idiot, she persuaded the latter to permit her to cut oflf her head ; an act which she accordingly performed. The means employed by the lypemaniac were of a character to furnish an opportunity for repentance, to any one but an idiot, and to protect herself even after the first essays had been made to effect this frightful design. Gall states, that an idiot, having slain two children of his brother, comes smiling, to relate to the wretched father what he has just done. Harder says, that an idiot cut the throat of a man, after having seen the same act performed upon a hog.

Each of the cases which I have just related, would furnish matter for much comment. From them all, I deduce the following propositions : Idiocy pre- sents innumerable varieties, as it respects sensibility, and the intellectual and moral capacity. Some idiots possess aptitudes and inclinations ; and almost all, even those who are deprived of the power of speech, sing, and retain a recollection of tunes. Though no constant and direct relation subsists, be- tween the vice of organization, and the various degrees of sensibility and understanding among idiots ; we must be convinced, that the more considera-

470 IDIOCY.

ble are the organic deformities, the more marked are the imperfections of sen- sibility and intelligence. No particular volume nor form of the head are pe- culiar to idiocy ; notwithstanding, it is proper to observe, that the smallest heads appertain to the most degraded class of idiots. Although we meet with idiots havino; large heads, the forms of the heads are not, more than the volume, a rigorous index of the sensitive and intellectual capacity. Their capability of acquiring an education, though limited to the power of imitation, and the primary wants of instinctive life, is not a sufficient indication to cha- racterize the principal varieties of idiocy, although Dr. F. Voisin may be of this opinion.* Speech, that essential attribute of man, which has been given him to express his thoughts ; being the sign, most frequently in relation with the intellectual capacity of idiots, furnishes the character of the principal vari- eties of idiocy.

In the first degree of imbecility, speech is free and easy. In the second, it is less easy, and the vocabulary is more circumscribed. In the first degree of idiocy, properly so called, the idiot uses merely words and short phrases. Idiots of the second degree, articulate only monosyllables, or certain cries. Finally, in the third degree of idiocy, there is neither speech nor phrases ; words nor monosyllables.

The causes of idiocy, which are almost invariably local and physical, prevent the development of the organs, and render them unfit for the manifestation of intelligence ; thus differing from insanity, whose intellectual and moral causes, ordinarily super-excite the brain, exalt the sensations, and occasion permanent exhaustion. To the number of the physical and predisposing causes of idi- ocy, we must add the influence of the sun, water and air ; the manner of living among mothers; hereditary predisposition ; certain localities favorable to the development of scrofula; and mountainous countries, such as Scotland and Norway. There are more idiots in countries than cities. It is not unu- sual, that there are several idiots belonging to the same family. I knew two young gentlemen, sole heirs of a distinguished family, who were idiots. We have at the Salpetriere, an idiot girl, whose mother had but three children ; two daughters and a son ; all of whom were idiots.

Sometimes also, in the same family, there is one idiot, and other children who are insane. I have known idiots become mothers, but have never known their children to become so. The exciting causes of idiocy are numerous. Lively moral affections on the part of mothers during gestation, has an influ- ence upon the child in utero ; and improper management during parturition may produce the same effect. The custom pointed out by Hippocrates, which certain matrons have of kneading in some sort, the heads of newly-born chil- dren, by wounding the brain, may occasion idiocy : also blows upon the head, whether from falling or otherwise. Convulsions, whatever may be their cause, and also epilepsy, provoke this affection. Sometimes a single convulsion, or attack of epilepsy, is sufficient to arrest the development of the organs, and the ulterior progress of the understanding, in a child who, until that period, had appeared highly intellectual. Acute and chronic hydrocephalus, also pro- duces fatal effects ; and a cerebral fever or meningitis which occurred in in- fancy, has occasioned idiocy. The effects of these causes are noticed from the period of birth, and produce the congenital form of idiocy. Children belong- ing to this class, have heads, either very small or large, and the features of the countenance are imperfectly delineated. They take the breast with difficulty, nurse poorly, do not gain strength, and it is long before their eyes, (which are crossed,) follow the light. They are lean, pale, and do not walk before the age of from five to seven years, and sometimes, not before puberty. They are in-

* Application of tiie Phyeiology of the Brain, to the study of children who require a special education : Paris, 1830, in 8vo.

IDIOCY. 471

capable of learning to speak, or acquire only certain words, or syllables, and this, at a comparatively late period of life.

Children are sometimes born in a state of perfect health, and grow, at the same time that their understanding develops itself; but possess an unusual de- gree of susceptibility ; are lively, irritable, choleric ; of a brilliant imagina- tion, a well developed understanding, and an active mind. This activity, not being in relation with the physical forces, they exercise and speedily exhaust themselves. Their understanding remains stationary ; making no farther ad- vances; and the hopes, which were recently raised so high, are dashed for- ever. This is accidental, or acquired idiocy. Sometimes also, an accidental cause arrests the development of the organs and intelligence.

The crania of idiots ordinarily present vices of conformation. Both the volume and form of the cranium among idiots, offer as many varieties, as do the crania of sound men. There is indeed, no form proper to idiocy. A head too small or too large, in proportion to the height of the body, may be that of an imbecile or idiot. The same is true of a regular, as well as of a deformed head. The numerous researches that have been made with respect to the conformation of the head, had for their object its volume, the form of the cranium, and the features of the countenance. Hippocrates had pointed out the too small head, — which he calls microcephalon, — as one of the causes of idiocy. Willis has described the brain of an idiot, which had not half the usual volume. Brown, at Amsterdam, has in his possession a similar cere- brum, and severd crania of microcephala. Pinel has given an account of the cranium of an idiot, which was remarkable for its imperfect conformation, and also that of one who could scarcely be said to have a cranium, while the face was very fully developed. M. Richerand in his physiology, cites seve- ral examples of crania, which were very slightly developed. Gall has figured* two very small crania, and limits intelligence to crania which are only from 14 to 17 inches in circumference.

Vesale pretends that the heads of the Germans are flattened posteriorly, in consequence of a custom of theirs which requires that their children should sleep upon the back ; and gives a sketch of the cranium of an idiot, whose occiput is very much flattened. Prochaska, Malacarne and Ackerman, have given descriptions of the crania and brains of idiots, which differ much from each other.

According to Cuvier, the relations of the ctanium to the face, indicate the degree of intelligence among both animals and man. A small cranium and large face, are indicative of an inferior degree of intelligence. Pinel has applied the calculations of geometry to the appreciation of the cranial capa- city. He has pointed out, as peculiar to idiots, a flattened cranium, and a want of symmetry between the right and left portions of it. In the case of one idiot, the height of the head was only one tenth part of the structure of the individual. May not these vices of conformation, this defective develop- ment of the cranium be attributed with propriety, to rachitis and scrofula, so frequent among idiots ?

Those suffering from hydrocephalus, are not all deprived of understanding; but the cases which I have related, prove that idiots are often hydrocephalic, although their crania may be small. These idiots are rachitic, and their limbs atrophied, deformed and contracted. I have a large number of the busts and heads of idiots, cast after death. In general, the summit of the cranium is elliptical, the diameter of the fronto-occipital region is extended, and the parietal flattened, towards the temporal suture. This circumstance, which renders the foreheads of certain idiots almost pointed, the flattening of the

* Anatomy and Physiology of the JVervous System.

472

IDIOCY.

occipital and coronal regions, and the inequality of the right and left portions of the cranial cavity, are phenomena the most constant, and perhaps most worthy of attention, on the part of those who desire explications.

There was brought to the Salpetriere Dec. 15, 1815, one who had been an imbecile from birth, who was in the habit of becro-inor, and was maltreated and violated, in 1813, by foreign soldiers. Though of medium stature, she ap- peared small, in consequence of a curvature of the spine, from which a pro- tuberance projected upon the left haunch. The head is voluminous, the face long, large, and, as it were, flattened, and the forehead upright. The hair is abundant, and of a chestnut color ; the eyes of a chestnut color, and some- times crossed ; the mouth is large, and seems to be square when open ; the teeth are carious, and the gums fungous ; the palatine arch forms a reenter- ing angle, at the point of union of the maxillary bones, and the velum palati is bifurcated. The head, measured upon the plaster cast taken after death, gives the following proportions :

Circumference .... Fronto-occipital curvature Antero-posterior diameter »

Bi-temporal diameter .

Total ..... 46.71

21.06

in,

12.71

((

6.57

((

6.37

((

This singular head exceeds considerably the usual size of well formed heads. The face is 6.10 inches in length, and the antero-posterior exceeds the bi-temporal diameter, by only .19 of an inch. The forehead is 2.75 inches high, and from one orbital apophysis to the other, is 5.11 inches. The face is flattened, and the occipital region narrow, compared with the coronal. The hands of this imbecile, as well as her feet, present an extraordinary conformation, with respect to their length. The fingers approximate at their extremities, and are united by the skin. The nails touch, and are always dis- tinct. We distinguish beneath the skin, five fingers on the right, and six on the left hand. So closely are they confined one to the other, that they cannot be bent, nor separated. The feet present the same vice of conformation. Notwithstanding this faulty condition, she can, though imperfectly, spin, han- dle the needle, fasten a pin, and untie a knot. Though of a very limited un- derstanding, she recognizes those who serve her, regards the calls of nature, eats well, sleeps, and her menstruation is regular. She left her father with indifference, nor does she ever speak of him. She regards men with satisfac- tion, has no sense of shame, and is very covetous. By showing her some pieces of money, she may be induced to do whatever any one desires. She often calls for jewelry and ear-rings ; always in order to be married on the following day. She articulates certain words with difficulty, but vivacity ; is choleric, but timid ; and laughs and weeps, at the slightest occurrence. She died one year after her admission, of a verminous affection. I found 73 lumbricoid worms in the digestive canal, and even in the oesophagus.

M. Foville,* physician to the Asylum for the insane at Rouen, in an essay full of interest, points out a vice of conformation in the cranium, which he has often witnessed in that hospital. He has observed a circular depression of the head, which, passing from the forehead over the temporal regions, extends around, below the occipital protuberance. This is a consequence of the com- pression of a fillet, placed upon the forehead of children, and maintained in its position by strings, which confine unduly, this portion of the head. Inter-

* Deformity of the Cranium, Paris, 1834, in 8vo,

IDIOCY.

473

fering thus with the regular development of the cranium, it deforms, and ren- ders very prominent, the occipital region, while the forehead is very much flattened. This defect is observed in the south of France, and must necessa- rily impair the development of the understanding.

In the interesting researches of Dr. Parchappe,* — physician to the Asylum for the insane at Rouen, — he compares the volume and form of the cranium, modified by stature, age, sex, the physiological and pathological condition of the understanding, with the mass and volume of the encephalon; and con- cludes that if there exists a general relation between these two terms, facts are wanting to deduce rigorously from this relation, the different degrees of intel- lectual and moral capacity. Dr. Lelut, physician to the Salpetriere, who has published such interesting essays, respecting mental alienation, has also made some researches, respecting the relative volume and form of the cranium, in the healthy man and the idiot. He is of the opinion, that the cranium of the latter is a little less developed ; but that this difference is not so great as it ap- pears, and has been represented to be, since the time of the ancient writers. According to this author, the more the volume of the cranium lessens, the nearer do we reach the lowest degree of idiocy. The frontal portion of the cranium of idiots is, in fact, as large and expansive as that of men in general ; and indeed, the dimensions of their crania are as great as those of other men. How much labor is still necessary, and what careful and extended research, before we shall be able to establish, with precision, the coincidence, in volume and form of the brain, with the intellectual capacity.

With each case of idiocy which I have published in this chapter, I have also given the admeasurements of the heaS, taken during life. By bringing them together, we may compare the means, with the results obtained by my young confreres : time will not permit me to do it. For those who are fond of this kind of investigations, I subjoin a table of the mean results of admeasure- ments of the head, taken from women in the enjoyment of good health, and from plaster casts, taken after death, in the case of 36 insane women, 17 imbe- ciles, and 17 idiots. In the case of three idiots, whose heads were very small, the admeasurements were taken from the crania.

TABLE OF CRANIAL ADMEASUREMENTS.

Circumfe- rence.

Antero- posterior curvature.

Antero- posterior diameter.

Transverse diameter.

Totals.

Women in a state of health

21.87 in.

13.30 in.

6.98 in.

5.29 in.

47.44 in,

Insane

20.82

11.50

6.96

5.67

44.95

Imbeciles

20.19

11.49

6.69

5.63

44.

Idiots

19.92

11.26

6.85

5.39

43.42

Idiots micro- cephalous.

15.07

7.51

4.88

4.17

31.63

From this table, we learn 1st ; that the circumference of the head, accord- ng to admeasurements, taken from among women enjoying the use of their reason; from insane women, imbeciles and idiots; diminishes in an almost equal proportion, from the woman in the enjoyment of usual health, to the

* Researches on the Encephalon, Paris, 1836, in 8vo. 60

474 IDIOCY

idiot deprived even of instinct. 2d. That the fronto-occipital curvature di- minishes in a remarkable degree, from the woman of sound mind, to the insane female ; whilst no variation is noticed from the insane person to the imbecile, and a difference of but six millimetres between the latter and idiocy. 3d. That the fronto-occipital diameter is the same in the case of the woman en- joying the use of her reason, and the insane woman ; and that there is a dimi- nution of but six millimetres, between the insane person and idiot ; while the difference is enormous, on passing to the lowest degree of idiocy. 4th. That the bi-temporal diameter is more considerable in the case of the insane woman, and even the imbecile and idiot, than in that of the woman possessing the ordi- nary degree of intelligence. 5th. That if we suppose, that the sum of these four admeasurements, express the volume of the brain ; it follows that the volume of this organ, diminishing in the same proportion with the intellectual capa- city ; that of the cranium, would be the expression of this capacity.

Morgagni found the brain very dense : Meckel says that the cerebral substance of idiots, is more dry, light and friable, than that of persons in the enjoyment of a sound mind. Malacarne assures us, that the convolutions of the brain are numerous, in proportion to the intelligence, and that the plates or lamellae of the cerebellum, are least numerous among those who are deprived of understanding. The convolutions are small, atrophied, compact and shallow. Perhaps the capacity of the lateral sinuses of the cerebellum have been neg- lected. I have found, in nearly every idiot whose body I have examined, the lateral ventricles much confined, and of very limited capacity. The physiog- nomy of imbeciles and idiots is very peculiar, so that they are recognized as soon as seen. Lavater says, that the receding forehead, whose curvature is spheroidal ; the large, prominent and open lips, whose commissures are wide- ly separated ; and the chin projecting forward, or retreating, indicate idiocy. Camper, who sought in the facial angle only a characteristic of the beauty of the face, fixes at ninety degrees, the extreme limit of this angle. There are, however, idiots, whose facial angle is more than this ; and very sensible persons, in whom it does not measure eighty degrees.

It will be observed, that I have nothing to say, respecting the treatment of a constitutional condition. Nevertheless, we may, to a certain extent, ame- liorate the lot of imbeciles, by giving a proper direction to their habits and actions ; as well as by accustoming them to some labor, that shall turn to the profit of the poor, or serve as a means of diversion to the rich. Idiots re- quire very careful and assiduous domestic attentions.

[By tlie politeness of Lewis Weld, Esq., Principal of the Asylum for the deaf and dumb, at Hartford, Conn., who has recently visited several of the Institutions in Europe designed for this interesting class of our fellow-beings, — and who is expected, at no dis- tant day to make a report of this visit, — I have been favored with the following particu- lars respecting a class of imbeciles and idiots, twelve in number, who are enjoying the philanthropic instructions of M. Saegert, himself the superintendent of an institution for mutes, at Berlin, Prussia. At the commencement of their pupilage, says Mr. Weld, a small number only could speak intelligibly, some were unable to walk, few were capable of attending to the primary necessities of life, and all required the attentions of very young children. M. Ssgert has had one of these wretched beings under his care for the space of two years, two for one and a half years each, — both of whom are deaf and dumb, — the period during which the remaining ones had been under instruction, varying from five months to two weeks; a single individual having been admitted at the last named period. Their ages varied from eight to twenty years. Their improvement has been regarded as decidedly encouraging. They are now able to dress and undress themselves, wash their faces and hands, walk about, partake of their food with propriety, etc., etc.

IDIOCY. 475

Their occupations, calculated to develop and exercise the mind, are principally drawing, writing, and knitting. Some sing a little ; others dance. In drawing, they not unfre- quently seem, on meeting with a comparatively difficult point, to pause, and after a time proceed with their work, as if by a process of reasoning they had been enabled to sur- mount the difficulty. They also submit understandingly, to restraint and the discipline of the house. Besides the physiognomy characteristic of idiocy, I am informed, that with most of them, the head is mal-formed. The hygienic means emplo3'ed by M. S. are limited to diet and exercise. In addition to his own observations and carefully formed opinions, he has consulted every author of authority who has treated of the subject of idiocy, and — I am happy to be able to state — is soon to publish the results of his experience. M. Guggenbuhl of Abendburg, Switzerland, has a school for cretins, and employs medical, as well as other measures ttf relief and improvement. He has fourteen or fifteen pupils under his care, and receives them at the early age of five years. M. Seguin, of Paris, has also a school for the instruction of idiots. Mr. Weld did not however, visit either of the latter institutions. Upon the statement just made, which is not only exceedingly brief, — barely sufficient to direct the minds of medical men to the subject to which it refers, — but containing few of the data upon which an intelligent opinion could be formed, it might seem invidious to comment, did not our remarks accord with the sentiments expressed, and the hopes entertained by the benevolent men who have undertaken this work. It certainly is a thankless office, and would indeed seem to be the offspring of a disingenuous and uncharitable spirit, to do otherwise than bid " God speed" to efforts which have for their object the amelioration of the physical condition, and the elevation in the scale of intelligence, of any class, however degraded, of our fellow men. We have however learned from some degree of observation, and in com- mon with others from personal experience also, that time, talent and labor, may all be so expended, as virtually to be thrown away. It therefore becomes a duty, at the same time that we witness new proofs of a growing benevolence, and find the active charities of man opening new fields of philanthropic effort, to enquire what fruits may be fairly anticipated as a reward; scanning with the eye of reason as well as philanthropy, the means pursued as well as the ends contemplated, by the various benevolent schemes and enterprises, that almost daily demand our notice and approval. The doctrine of perpet- ual motion has ever found advocates and believers, notwithstanding the demonstrable impossibility of effecting the object contemplated thereby; and not a few have wasted months and years of their lives, and not a little bewildered their brains, by their attempts to compass this impossibility. So also, the navigating the air by means of balloons, has been attempted by misguided men, who, having made clear to their own minds, some one of the many elements which must concur to secure its practicability, have engaged in a ruinous enterprise, for want of a clear appreciation of all the conditions of the pro- blem. With reference to the undertaking more particularly before us, we have reason to believe that the gentlemen who are experimenting upon the mind of the idiot, are pro- ceeding cautiously and intelligently in their work ; are making it collateral to other occupations of known and acknowledged importance, and are wasting neither their talents nor resources, nor in any respect compromising the present or future well-being of the unhappy subjects of their experiments. For these, in addition to other considerations offered, we should hesitate before expressing an opinion with regard to the results of their labors, and leave it for time to make them manifest.]

Without imitating that species of worship, which they are in the habit of pay- ing to idiots and cretins in certain countries, where it is regarded as a special favor of heaven, to have an idiot or cretin in one's family ; we should treat with much care, those wretched beings who, left to themselves, are exposed to all the causes of destruction. We habituate them, in time, to a suitable regi-

476 IDIOCY.

men ; but their indolence, apathy, and resistance to every movement which only augment their slovenliness, together with their propensity to onanism, require an enlightened, and very active watchfulness. Nothing could have prevented imbecility and idiocy ; but authors who have written on cretinism, particularly Fodere, offer most important advice respecting the propagation of this last infirmity.

Both cretins, cagots, and even albinos, have been classed among idiots. Cretinism is a remarkable variety of idiocy. Cretins are idiots of the moun- tains, though they are sometimes found in the plains. They do not differ essentially from our idiots, with respect to the feebleness of their sensibility and intellectual capacity ; but in the symptoms and circumstances peculiar to cretinism. We denominate cretins, those idiots and imbeciles who ordi- narily inhabit the gorges of mountains. This name is derived, it is said, from the word chretien, because these wretched beings, simple and inoffen- sive in their manners and habits, were venerated as holy personages. Permit me to hazard an hypothesis. Did not the appellation cretin come from the word cretine, which in an earlier age, signified alluvion? Has not this name been transferred to individuals who have become enfeebled, in consequence of living in the midst of an alluvial region ? In fact, is not cretinism endemic in gorges of the mountains, which are more or less marshy, and exposed to a moist air ? M. de Maugiron, of the Society of Sciences at Lyons, is the first who noticed with special attention this unfortunate class, and wrote an essay on cretinism. M. de Saussure,* in his journey to the Alps, speaks at length of cretins, and the causes of their infirmities.

Richard Clayton! assures us, that cretins are rarely more than four feet two inches in height, that the greater part of them are deaf and dumb, and that they become old at a comparatively early period of life. Clayton, doubtless speaks only of cretins who are reduced to the lowest degree of mental and physical degradation. L. Ramond| has described the cretins of the Pyrenees, compared them with those of the Alps, and demonstrated that the causes which are said to produce cretinism in the Alps, do not exist in the Pyrenees. William Cox§ has pointed out the different degrees of degradation with respect to intelligence, which exist among cretins ; from that which borders upon a normal state, to that in which the cretin becomes a mere organized being that vegetates. Fodere|l has published an excellent work on the cre- tins of the Alps, whom he had long seen, and carefully observed. Parr, in his researches among the Americans, remarks, that he saw many cretins and albinos at the Isthmus of Panama. Cretins present the same characteris- tics, the same varieties of intellectual incapacity, and of physicial and moral insensibility, which we observe among idiots. They are however, distin- guished from the latter, inasmuch as they are born usually, in the gorges of mountains, and amidst local and material circumstances, which are not met with elsewhere; and because they display goitres more or less voluminous; and are all remarkably lymphatic and scrofulous.

The stature of cretins is small, and their skin pale, wan, livid, flaccid and wrinkled Their muscles are soft, relaxed, and without strength; their limbs large and thick. The abdomen is very voluminous. The head is usually gross, now flattened posteriorly, and now depressed at the top. The hair is fine, and of a blond color. The eyes are widely separated, and concealed be-

* Travels among the, Mps.

t Memoirs of the Literary and Philosophical Society of Manchester. t Journey to the Pyrenees.

§ Letters on the Civil, Political, and Natural Condition of the S%ciss. Paris, 1782, 2 vols, in 8vo.

II A Treatise on Goitre and Cretinism. Paris, year viii. in 8vo.

IDIOCY. 477

neath bushy eye-brows; the lids are red and weeping ; the look askance and stupid ; the nose is flattened, and the lips are thick. The tongue is pendant, and the mouth, half open, overflows with mucus, which runs down, over their garments. The lower jaw is prolonged, and the face swollen, which causes it to appear square ; and the physiognomy without expression, is stupid. With some cretins, the neck is short and thick ; while in other cases, it is lono- and slender. All are not afflicted with goitre. For the most part, the lower extre- mities are unequal, short, and infiltrated ; and the step is slow, awkward and insecure. They are slovenly in the extreme. Furthermore, the digestive functions are well executed. Cretins are gluttons, and also very lascivious. Like idiots, they may be distributed into three classes. Cretins of the first class, hold the head properly, have an animated look, and an easy gait. Their ideas are few, and incomplete; but they distinguish between the most common affairs of life, as well as good and evil. They are incapable of followino- a process of reasoning, ask few questions, and reply correctly. Their speech however, is interrupted by grimaces, and convulsive muscular movements. This constitutes the most numerous class of cretins.

Cretins of the second class, have a livid skin, deformed features, a long neck, soft and flaccid flesh. They are goitrous, their heads imperfectly formed, and their limbs large and heavy. They express themselves by gestures only, or by convulsive cries, have little sensibility, experience and express merely their physical wants. Their understanding goes no farther than a gross instinct, and they become attached to no one. In the third class, the cretins are mute, deaf, or blind ; the look indicating, that at best, they see imperfectly. They pos- sess no sense of taste, but eat whatever is put into their mouth. They are equally insensible, to good or bad treatment. It is necessary to carry them about, as their dullness and stupidity are most profound. All infants who become cretins, are not born such. It is only about the second, third or fourth year, that the development of the understanding is arrested. However, children who are to become cretins, are born with a small goitre, nurse with difiiculty, are bloated and always drowsy. They neither walk nor speak, at the same age with other children. It is not until the age of ten or twelve years, that they are able to walk, speak a few words, and convey their food to their mouth. Pu- berty is late. These wretched beings are found seated, ordinarily before their respective habitations. To go from their bed to the common fire-place in win- ter, and outside of the door in summer, is, for them, a long journey, as they walk little. It would be desirable to be able to compare the different forms of the crania of cretins, with those of the idiots inhabiting the plains and cities. I have been unable to obtain more than a single specimen of the crania of cretins, although I have sought for them in the Pyrenees and Alps, and seve- ral physicians have promised them to me. The prejudices of the country, have doubtless proved an insurmountable obstacle to the fulfillment of the promises of my confreres.

[I have recently examined the skull of a cretin, belonging to my friend, Dr. H. A. Grant, of Hartford, Ct. The Doctor informs me, that while en route from Martigny to Mont St. Bernard, he accidentally paused in the neighborhood of a church-yard. He entered it, and while w^alking about among the tombs, happened to glance at the church which was a little way off, and observed in a niche, something resembling the skull of a human being. On inquiring of his conductor, who was acquainted in those parts, what it was, and why it had been placed there, he was told that it was the skull of a cretin boy, from eight to ten years of age, who, in consequence of his perverse disposition, and acts of cruelty and murder — for he had actually killed his own mother — had been decapitated after death, and his head placed where it then was, as a terror to all evil doers belonging

478 iDiocy.

to this class. A plate of glass once stood before it, but this had long since been broken, and the naked skull stood bleaching beneath the sun and winds of heaven. Without expressing much interest in this statement at the time, Doctor G. resolved, if possible, to * possess himself of it. On his return a few days subsequently, he halted again at this sequestered spot, and sending his servants in an opposite direction, availed himself of the opportunity to despoil the church of this singular relic. So long had it been expos- ed, that the sutures easily separated, and it was readily deposited beneath the folds of his cloak. This skull is of the usual thickness and density. The bones of the face are unusually small, while the breadth across the root of the nose from the internal canthus of one eye to that of the other, is nearly two inches. The head is singularly shaped; the anterior portion being low and narrow, while its breadth across from one parietal protuberance to the other, is, in contrast, remarkably large. The vertex is also very flat; rising little if any, above the low forehead. The occipital bone has unfortunately been misplaced or lost. In other respects the skull is entire. In proof of the fact that the age of the child was correctly given, it will be proper to observe, that the second teeth had not all been cut at the time of his death ; several now being exposed to view, by the decay of the integument and alveolar processes. We took the admeasurements of the skull, with a view, at the same time that we furnished an idea of its size, to pre- sent also, the striking contrast which exists between the parietal and frontal portions.

DEMENTIA (part 3)

Circumference of skull ..... 19.2-5 inches

From root of nose to occipital protuberance, about . . 10.00 " From mastoid process of one side to the same on the other,

over parietal protuberances .... l.'3.]2 " From junction of frontal with parietal bone, from side to side

just below parietal protuberances . . . 12.87 "

From corresponding points over frontal bone . . 6.50 "

A family of the Pyrenees is thus described. The physiognomy of the mo- ther contrasts singularly with that of her two children ; the goitrous enlarge- ments of the latter, particularly that of the young man, being much less volu- minous than that of the mother. The forehead of the young man is far more retreating than that of his sister. The eyes of both are concealed beneath the orbit, and the chin is also very retreating. The lips of both, and particularly those of the daughter, project, and the mouth remains partially open. Their physiognomy is expressive of the most perfect stupidity. They do not speak, but utter a sort of grunt. They walk insecurely and slowly ; help themselves to food ; but require assistance in dressing. They employed certain signs to express their desires, which were limited to the first wants of life. They re- cognized their mother, and loved to be near her. Rarely did one move abroad without the other ; and in the house, they were always accustomed to sit side by side. The daughter was sent to the hospital at Toulouse, where I saw her in 1828. She was of medium stature ; her head small, and flattened at its crown; the eyes small, and concealed beneath the orbit; the lips thick, the mouth gaping, and filled with mucus. Two small goitres were appended to her chin. She walked awkwardly, and with a waddling gait. She did not speak, but uttered a grave, deep sound, to express her joy, as well as suffering. She had a well marked taste for strong substances, and seized upon tobacco with avidity. She appeared gratified when I gave it to her, and conveyed it immediately to her nose. I gave her some pieces of money ; she took them in her hand, looked at them attentively, and expressed her recognition of them, by uttering certain stifled and articulate sounds. She has since died, and M. Delaye, physician-in-chief of the hospital of Toulouse, sent me her cranium,

IDIOCY. 479

the dimensions of which are as follows. The left half of the cranium is more prominent than the right :

Circumference ..... 20.07 in. Curvature from the root of the nose to the occipital

tuberosity . . . . . 9.64 "

Antero-posterior diameter .... 6.G1 "

Bi-temporal diameter .... 5.70 "

Total . . . , . 42.02

I have remarked, that cretinism is endemic in the gorges of mountains, and in certain plains. We meet with cretins among the Alps, the Pyrenees, the Asturias, in Scotland, among the Krapack or Carpathian mountains, in Tar- tary, among the Cordilleras, etc., etc. Cretins are far more numerous in coun- tries where cretinism is endemic, than are idiots in the plains and cities. Cretins are so numerous in these countries, that in the department of the Alps alone, there were 3,000 cretins in 1812, — according to a memorial from which I shall borrow much, — while idiocy is a rare phenomenon among us. In fact, in hospitals for the insane, only one thirtieth at most, are idiots. In the crene- ral table of the insane admitted at the Salpetriere, during four years, within three months, and published by Pinel, we find that out of 1,002 insane women who were admitted, only 36 were idiots. The reports of the same hospital, from the year 1804 to 1814, out of 2,804 insane women, present 98 cases of idiocy.* The same is true at the Bicetre. According to an unpublished me- morial of Pussin, as well as the reports made by Doct. Hebreard, physician to this hospital, and the reports published by Count Pastoret in 1816,t out of 2,154 insane men admitted at the Bicetre during ten years, 69 were idiots.

The examination of these reports, justifies what I remarked above, when announcing that idiocy is a rare phenomenon among us ; since, out of 7,950 insane persons of both sexes, there are only 203 idiots. Pinel says, that one quarter of the inmates of the Bicetre and Salpetriere, are idiots. This is evi- dently an error in compiling, since the statistical tables of the same work show the contrary. Reil, and others who have written since the celebrated French professor, have repeated the same error. The vague acceptation of the word idiotism, explains this apparent contradiction between what has been ad- vanced by these distinguished masters, and the results of observation. Those authors, who have observed cretins, and written on the subject of cretinism have expressed different, and often conflicting opinions, respecting the causes of this infirmity. We meet with cretins in low, deep and narrow valleys, and in gorges surrounded by high mountains.

A celebrated Italian traveler, whose name has escaped me, assures us, that cretins are far less numerous, in the gorges of magnesian, than calcarious mountains. Saussure has observed that there are no cretins found above an elevation of 600 toises| {3,600 feet). He does not concur in opinion, with those authors who believe that snow-water or melted ice, and waters contain- ing calcarious sulphates, are the cause of cretinism. The inhabitants of high mountains, he says, drink the same waters and are not goitrous. This savant attaches little importance to marshy emanations, to bad nourish- ment, to drunkenness and debauchery, as a cause of this infirmity, because the effects of these influences are not perceived among the inhabitants of the plains. He attributes cretinism, to the stagnant, heated and vitiated air,

* Report to the general Council of Hospitals. Paris, 1816, in 4to. t Treatise on Mental Alienation. Paris, 1809, in 8vo. p. 186 \ A toise is two yards.

480 IDIOCY.

which tlie inhabitants of the valleys respire ; for, adds he, villages having a southern exposure, contain the largest number of cretins. The cretins of the Pyrenees, which were observed by Rainond, inhabit valleys having a northern exposure, respire a dry and temperate air, and drink pure and running water. It is therefore to other causes than those indicated by Saussure, that we are to attribute cretinism. Sloth and supineness can with no more propriety, be charged with it. The inhabitants of Beam and Navarre, though very active, are nevertheless subject to goitre and cretinism. Can we however, convince ourselves with Ramond, that misery, and the state of abasement and con- tempt of which cretins are the objects, may have gradually produced the cretinism of the inhabitants of the Pyrenees 1 Certainly not. The cretins of the Valais, are regarded with a kind of consideration in addition to nu- merous affectionate attentions, and are not miserable.

Fodere does not admit, that the waters which are drank by the inhabitants of the valleys of the Alps, are the cause of cretinism, the inhabitants of high mountains having no other waters to drink. This learned professor is of opi- nion, that cretinism is produced by the warm, humid, concentrated and stag- nant air, which is respired in the gorges. In an unpublished memoir which Count Rambuteau sent to the minister of the interior in 1812, — a memoir which I have freely laid under contribution, — the aged prefect of the Simplon ex- presses the belief, that the Rhone, overflowing at the period when the snows melt, leaves in the plains of the Valais, marshy waters, which exhale impure vapors ; and that the waters, in descending from the summits of the moun- tains, are charged with the muriate and carbonate of lime, which render them unhealthy. These are not the only circumstances however, which contribute to the production of cretinism. He rejects the opinion of those who attribute it to waters, produced from ice and melted snows. In the Valais even, says M. Rambuteau, the habitations which are situated on high mountains, where they breathe a pure and free air, present to our notice a robust population.

In the valley of the Rhone, many of the more extended portions of it, are exempt from goitres and cretinism, where the air is well agitated, and throughout the greater part of the lateral valleys, where they receive the re- freshing winds from the north : when removed from marshes, and water of a good quality is drank. Cretins on the contrary, are most numerous in villages situated in valleys, encompassed by high mountains, and exposed, during four months, to the rays of a burning sun. The heat, reflected from the naked and scorching rocks, is so concentrated, that the inhabitants respire only a stifling and heated 'air, and the south wind, especially referred to by Hippo- crates, for its depressing effect upon the process of innervation, prevails there constantly.

It is remarkable, that the valleys in which goitrous persons only are found, border on those in which cretins reside ; and that in approaching the latter, goitres begin to appear ; at first rare, then more frequent. At length, we see them both existing together. The habitations of the Valais are low, narrow and filthy. The air in them is not renewed, nor does the light penetrate them. The domestic animals live there, in company with human beings. The food of the latter is bad, and composed of salted meats, potatoes, maize and chest- nuts. The indolence, sloth, drunkenness and debauchery ; the insufficient attention which is paid to new-born children, and the accidents which happen in consequence of their abandonment ; are all secondary, but powerful causes, which augment the fatal influences of the sun, water and air.

To all these denials of the injurious influence of the waters, Dr. Bailly op- poses the contrary results of his observations. Goitre or bronchocele proceeds, says this physician, from uncleanly and hard waters, which run, sheltered from the sun, and the action of the air, |s do those which flow from the crevices of

IDIOCY. 481

rocks, from mountains, or the bowels of the earth, and which are drank sliortly after they appear. It is true, adds our confrere, that goitre is produced from the quality of the water, and not from the condition of the atmosphere ; and that there are springs in the Leman, the use of whose waters for eight days only, produces or augments this tumor. Those persons in the same vil- lage, who do not drink of the water of these springs, are in no respect affect- ed with goitre, and do not become idiots, although living within gun-shot of the other inhabitants. M. Vyn, in his excellent itinerary in Switzerland, dis- cusses the various opinions that have been promulgated respecting the causes of cretinism, and expresses his dissatisfaction with them all. He is of the opinion, that this infirmity is produced by the sudden and frequent transition from a warm to a cold temperature. This is produced by very cold currents of air, which escape from narrow gorges, and from the great reduction of tem- perature after sunset, in comparison with its elevation during the day.

The immediate organic causes of cretinism, are no better known nor deter- mined, than are the predisposing and remote. Thus, one attributes it to the smallness of the head among cretins, and the flattening of the vertex and occi- pital region. Malacarne contends, that the small size of the cranium, or rather its narrowness, does not permit the brain to become developed ; and hence it is incapable of fulfilling its functions. Ackermann concluded, that the flattening of the occipital region, noticed among many cretins, by displacing the bundles of nerves at their origin, impaired their action, and consequently the development of the understanding. Some observers have found the brain very dense, and others, hydrocephalic. Some authors attribute cretinism to the compression of the carotids, produced by the submaxillary glands which had been very much developed by scrofula. Is cretinism the result of a con- genital vice ? Is the deformity of the cranium always the cause of this infir- mity, or rather is it not often a malady acquired after birth ? Josias Simler, — an historian of the Valais, who wrote in 1574, — pretends that the midv/ives of his time, knew, at the moment of birth, whether the infant was to be a cre- tin. If such was the fact, cretins were born with some appreciable vice of conformation ; after which, the dwelling in valleys which were humid and warm, the state of the atmosphere, the quality of the waters, and bad'regimen, exercised only a secondary influence.

But M. Rambuteau assures us, that it is very rare that we can decide at birth, whether the infant is to be a cretin ; and besides, how are we to explain the improvement which the inhabitants of the valleys experience, on changing their residence to high mountains, or the marked diminution observed for many years in the number of cretins? It is the more probable supposition, that the influences to which infants are subjected, are the producing cause of this malady ; for, as we have already said, children are not born cretins, nor do they become so, previous to the second, and sometimes the fourth or fifth year. Another interesting problem to solve is the following : Do cretinism and goitre depend essentially upon the same causes? Since the major part of cre- tins are goitrous, some observers have decided the question in the affirmative. However, there are facts that ought to inspire doubts respecting this identity of origin. Cretins spring from goitrous parents, though this is not always the case ; and it is not unusual to see in the same family, infant cretins, and chil- dren whose understandings are fully developed, though they are the offspring of the same father and mother. It is not always the case, that cretins are found where goitre exists ; and reciprocally, where there are idiots, cretins are not always found. Thus goitre does not necessarily influence the development of the organs and intellectual faculties, but is complicated with idiocy in certain countries.

It is a constant observation, says M. Rambuteau, that cretins who are mar- ried to persons exempt from cretinism, give birth to children, sound both in

61

482 IDIOCY.

body and mind; while individuals who are well formed and intelligent, beget cretins. We cannot say what would be the result of a marriage between two cretins, as such unions never take place. It is notorious, that both fathers and mothers who stammer, (a very common occurrence in the Valais), often give birth to idiots ; and that in families where the first born is an idiot, the younger children are equally so. It has also been observed, that the Valaisannes, who marry French or Savoyard refugees, are more likely to produce cretins, than when they are allied to the people of the country. We can account for this phenomenon, by calling to mind the fact, that the French and Savoyards who take refuge in the Valais, are men without principle, education or resources ; who are enervated by the excessive heat of the valleys, by drunkenness and debauchery ; who become apathetic and besotted, and who, — marrying before becoming acclimated, — produce feeble and scrofulous children, subject to the fatal influences, of all the causes which favor the production of goitre and cre- tinism ; whilst the Valaisannes, who are connected by marriage with French- men belonging to the higher classes, and in easy circumstances, give birth, as do the inhabitants of the lofty mountains, to strong and robust children.

Whatever may be the remote and proximate causes of cretinism, it is con- soling to know, that the number of cretins has been diminishing in the Alps and Pyrenees for the last forty years. The late prefect of the Simplon, attributed this diminution to the dykes, which prevent the inundations of the Rhone ; to the drying up of the marshes ; to the grubbing up of the soil ; and finally, to the improved regimen adopted by the inhabitants of the Alps, who have become more industrious, and less addicted to crapulence and drunken- ness. Fodere assures us, that the care which is taken to rear the children upon high mountains, that industry, commerce, and the use of coffee, have powerfully contributed to lessen the number of this unfortunate class of our fellow-beings. Ramond agrees in sentiment with these authors, as it respects the diminution of cretinism. Perhaps we ought also to attribute something to the influence of the light that has, at length, penetrated these countries. The prejudices and superstitious regard which they entertain for these unhappy be- ings, the mistaken attentions which they lavished upon them, contributed to render indolent, apathetic and stupid — cretins in a word — those unfortunate beings who, at this day, without being deprived of the cares which are due to those who are deformed by nature, are reared with a greater share of discre- tion.

We denominate albinos, those persons who, accidentally, and in conse- quence of a malady ordinarily congenital, have a milk-white skin, the hair of the head and person of a shining whiteness, and rose-colored eyes. The skin of albinos is pale, of a milk-white color, and covered with a white down; the hair of the head, eyelids, eyebrows, beard, and that of the other parts of the body, being of a shining white. The cornea, deprived of the pigmentum, leaves exposed to view, the blood-vessels which traverse the eye- balls ; a circumstance which gives to the eyes their rose color. A continual winking agitates the eyelids ; and the pupils contract and dilate frequently. They fly the light, the shining of which prevents them from perceiving ob- jects ; nor do they see distinctly, except during the twilight, and when the moon illuminates the horizon. This condition is often complicated with imbecility and idiocy. Wherever we meet with albinos, there we also find the goitrous and idiots. Albinos do not constitute a distinct race of men as has been pretended. The birth of an albino is an accident. He springs from parents, black, olive or copper colored, in the torrid zone. With us, he is born of parents whose complexions are of the usual whiteness, and whose remaining children resemble their father and mother. The constitution of albinos is generally debilitated, and their intellectual capacity feeble.

Do albinos reproduce their like? We do not know, as we are destitute

IDIOCY. 483

of observations on this point ; still it is certain, that when united with healthy persons, they engender a healthy offspring. The Kakrelaks of Asia are regarded as fruitful. That worthy missionary, M. Dubois, who, for thirty years, preached Christianity in India, baptized the infant of a female Kakre- lake and a European soldier. This infirmity of the human species is more frequent within the tropics than in Europe. We meet with albinos in the Island of Ceylon, bearing the name ofbcdas, and that of Kakrelaks in Ame- rica. The albinos of South Africa are called dandos.

■ Albinos were known among the ancients. We read in the fragments of Ctesias, that the Indians are black by nature and not from the influence of the sun. I have seen however, says this author, two women and five men who were white. Pliny relates that in Albania, at the foot of the Caucasus, we meet with individuals whose eyes are glaucous, who are white from birth, and who see better at night than during the day. Fifty years ago, they were accustomed to display at Paris, two albinos, who were born in the mountains of Auvergne. M. Blandin* states, that a friend of his was acquainted with a family of albinos in the environs of Paris. We all saw at Paris, fifteen years ago, an albino, who, it was said, came from the Black Forest, was well formed, although of small size and low stature, spoke several languages, was married, and had two children, who did not participate in the infirmity of their father. The chaplain of the hospital of , is an albino.

M. D., who is not far from fifty years of age, was the offspring of very healthy parents, but is an albino. His developments are like those of other children, although of a delicate constitution, and endowed with the usual share of intelligence. His disposition is very mild and acquiescent, though timid. Until the age of seven years, he did not see during the day, but after that period, habituated himself gradually to the impression of light, until he was enabled to see, and to distinguish objects which were at hand. He is myopic, and obliged to bring close to his eyes whatever he desires to see or to read. He received a most carefully conducted education, and profited by it to some extent, without however acquiring a remarkable degree of intelligence. Until his appearance in society when about eighteen years of age, he permit- ted his snow-white locks to fall freely over his shoulders. He then put on a wig and spectacles, and frequented society, in which he always appeared .somewhat constrained. He is now married, and has two children whose com- plexions are very dark.

Every physician has visited Roche, an albino, who has been for a great many years an inmate at the Bicetre. He was about thirty-four years of age when I saw him in 1821. He is of medium stature, of more than ordinary fullness of habit, his skin delicate, of a milky whiteness, with a slightly rose- colored tinge. The volume of his head is proportioned to the size of his body, and well enough formed ; although the forehead is flattened. Measure of the head.

Circumference . . . . .21.65 in.

Curvature from the root of the nose to the occipital

protuberance .... 12.00 "

Antero-posterior diameter .... 7.24 " Transverse diameter .... 6.10 "

Total 46.99

The hair, both upon the head and person, is of a shining whiteness ; and his eyelids are in constant motion. If the twinkling ceases, they remain

* Dictionary of Medicine and Practical Surgery, art. Mhino, p. 454.

484 IDIOCY.

Iialf closed. Tlie ball of the eye is rose colored. Roche sees illuminated objects imperfectly, his vision is very limited, and he regards objects, like one suffering from myopia. He sees best in the shade, and is pleased to remain in his cell. His physiognomy is without expression, even when he is vexed. His step is awkward and uncertain, and his motions quick. He walks in his shirt, with naked feet ; runs about without stockings, sings, cries aloud, and breaks whatever comes in his way. His voice is clamorous, and becomes acute when he is opposed. This albino 'has no connected ideas, and articulates imperfectly the few words that he has learned. Indeed, it is scarcely possible to understand what he wishes to say. He understands, when addressed re- specting his habits, and the ordinary wants of life. He extends his hand for tobacco, and raises up his shirt, to which he has doubtless become accustomed by the allurement of money, which the curious have bestowed upon him. He eats largely, collects together whatever he meets with, is irritable but not perverse. He is much addicted to onanism. Some time since, he lost his hair, and now remains better clad, and can spend his time in a dormitory.

Cagots. — We give this appellation to a race of men who, plunged in the deepest calamity, pursued by contempt, abuse and disgrace, are found dis- persed along the sea-coast, from the north, to the south of France. " In the solitudes of little Brittanny, says Ramond, they are known to have been treated with barbarity. Scarcely have they been permitted in the most highly civilized periods, to engage in the occupations of shoemakers and coopers. Theparliament of Rennes was obliged to interfere, to secure to them the rights of sepulture. We find them at that time, known by the name of cacous and cagneux, and the dukes of Bretagne had commanded, that they should not ap- pear in pu'ulic without a distinctive mark. Towards Atheunis, we find a simi- lar class concealed in the Island of Maillezais. La Rochelle is peopled with coliberts or slaves. They appear again under the name of cahcts in Guienne and Gascon, refugees in the marshes, lagunes and heaths of those regions which have been for a long time uninhabitable. In the two Navarres, they are sometimes called caffos. They were thus called in the ancient For, which was compiled about the year 1074. We discover them finally, in the mountains of Beam, Bigorre, and in the four valleys and province of Comminges. It was these cagots or capots that, in the eleventh century, we learn, were given away, bequeathed and sold as slaves ; regarded here, as elsewhere, as infected and leprous persons ; entering the church only through a small and separate door, and having their holy water and seats apart ; that, in many places, the priests were unwilling to receive to confession, and to whom the ancient For of Beam was thought to do a favor, by taking seven witnesses from among them, as evidence ; who were, in 1460, the objects of a claim, on the part of the states of Beam, who desired that they should be prevented from walking with naked feet in the streets, through fear of infec- tion ; and that they should wear upon their dress their former distinctive mark, the foot of a duck or goose.

The cagots were doomed from time immemorial to wretchedness, misery, iornominv and infirmities. Infamous and accursed, they were avoided and cast oif by the population generally ; banished into remote places, incapable of con- necting themselves with the other inhabitants, or of engaging in any other oc- cupations, than those of wood-cutters or carpenters. They were also obliged to march first to every fire, and render to the community the most degrading services. It was not until about the middle of the last century, that the parlia- ment of Bordeaux passed a decree, by which it was forbidden to treat in an abusive manner, any pretended descendant of the race of Giezi, and to treat them as agots, ragots, gahets or ladrcs. They require also, the execution of the decrees of this court, of the 9th July, 1723, and the 22d of Nov. 1735, on penalty of a fine of 200 livres. The same decree commands, that the gahets

IDIOCY. 485

shall be admitted to all general and special assemblies which may be called by the inhabitants, to mtxnicipal charges, and to the honors of the church, like other persons. The parliament of Toulouse passed a similar decree, July 11th 1746, in confirmation of two former ones, passed during the month of August, 1703, and on the 11th of Aug. 1745. Ramond prepared a learned disserta- tion on the origin of this race of men, who presented the same physical cha- racteristics, and the same intellectual and moral stupidity, in the different pro- vinces. This savant has been able to offer, however, only conjectures. Are they the remains of those ancient people, who have successively made incur- sions upon Gaul ? Are they the Sarrazins, a remnant who have escaped the sword of Charles Martel ? Are they the leprous, who have been banished from society, and exiles in secluded and desert places, where they have degenerated; not daring to quit their retreat? It still remains to be explained, how beings so base and degraded, living away from society which disdains and treats them in the grossest manner, have maintained their existence for so many cen- turies. Lastly, since the beginning of the last century, prejudices having ceased to exist against these wretched beings ; and Nogues, a physician, having raised his voice in their favor, and declared that they were strong, robust and intelligent men ; the authority of parliament having also set limits to their state of idiocy ; we now rarely meet with one of this unfortunate class; and I have only spoken of them here, with a view to bring to mind another proof of the deplorable effects which misery, contempt and ignorance, produce upon the human understanding.

In this place, we may naturally introduce a few considerations respecting savage races of men. Do savages exist? If we understand by this term, men endowed with intelligence, living alone, isolated, strangers to all civilization, without education, and having never had communication with others of their species, doubtless they do not exist. There are however, people who lead a wandering life in the woods, upon mountains, and on the banks of rivers; who are destitute of the blessings of civilization, and whom we call savages. They have few ideas. To render themselves intelligible, to exchange thoughts and desires, they have but a small number of words. They have sensations and passions ; they compare and foresee ; they exercise volition, and live in society. Doubtless their sensations are less acute, their ideas less, and their wants less than our own. Their foresight also is less, and their understanding is less cultivated. They are less civilized than men who inhabit our cities, and dwell in our capitals. Savages however, are endowed with the same fa- culties, and there is no difference between them and us, but that which exists between a man who has been educated, and one who has not; between the ignorant man, and him who has been instructed ; between the man without experience, and him who has much of it ; between the man who yields himself to the sway of brutal passions, and him who has learned to control them. And these men, found in the woods, towards whom the eloquence of the philoso- phers of the last century awakened the interest of the civilized world; v/hom they exhibited, with a degree of affectation, to public curiosity, as perfect men, superior even to Newton and Bossuet ; only wanted education. Those wretch- ed beings were not savages, but idiots; abandoned and fugitive imbeciles; whom the instinct of self-preservation, and a thousand fortuitous circumstances had preserved from death.

A criminal mother, or a family in distress, aband(wis an idiot or imbecile son ; an imbecile escapes from the paternal mansion, and wanders in the woods, not knowing how to find his way back. Favoring circumstances pro- long his existence ; he becomes swift of foot, in order to avoid danger ; and climbs trees to protect himself from the pursuit of certain animals which threaten him. Pressed by hunger, he nourishes himself with whatever comes to hand. He is timid, because he has been frightened ; and is obstinate, be-

486 IDIOCY.

cause his understanding is feeble. This unfortunate being is found by hunts- men, brought into a city, conducted to a capital, placed in a national school, and committed to the charge of the most celebrated tutors. Both court and city, interest themselves in his past condition and education. Savans write volumes to prove that this is a savage, who will become a Leibnitz or Buffon. The observant and modest physician assures them that he is an idiot. They appeal from this decision, and commence writing and discussing the subject anew. The most approved modes of instruction, and the most intelligent cares are bestowed upon the education of this pretended savage.

But from all these pretensions, efforts, promises and expectations, what is the result? That the observing physician had judged correctly. The pre- tended savage was only an idiot. Such was the judgment of Pinel respecting the savage of Aveyron.* We may from this conclude, that men who are de- prived of understanding, isolated, and found in the mountains and forests, are imbeciles, or idiots who have wandered away from their homes, or have been abandoned.

CASES IN ILLUSTRATION OF THE HISTORY OF IDIOCY.

Dargent, twenty-four years of age, admitted at the Salpetriere Sept. 8th, 1820, is tail, the head voluminous, and the forehead high. The frontal protu- berance of the right side is more salient than that of the left, whilst the pro- jection of the occipital region is more Tnarked on the left. The eyes are chest- nut colored, her look vague, teeth handsome, the countenance swollen and flushed, the physiognomy stupid, the limbs well formed, and the skin white. She eats alone, but knows not enough to go for her food, and collects every variety of disgusting substance. Her dejections are involuntary. She does not speak, nor does she engage in any thing, unless it be to play with rags rolled up into the shape of a doll. Of a gentle disposition, she is rarely angry, and testifies by her caresses, her remembrance of persons who take charge of her. In the month of March, 1824, she was thrown down by an insane per- son. She was menstruating at the time, but by this accident, the menses were suppressed. For some days she refused food, but soon resumed her former habits. The menses however did not return. On the 18th of May, a con- tinued cough was developed, attended with dyspncea. On the 20th, her face was much flushed, the respiration difficult, the pulse hard and frequent, and the abdomen soft. We cannot determine the amount of the expectoration, which is swallowed. She was bled, gum water, and loch were given her ; and on the 21st there was a remission. Leeches to the anus. On the 22d, as the cough persisted, a vesicatory was applied to the arm. On the 24th, the op- pression was very considerable, and a vesicatory applied to the chest. On the 26th, oil was given to counteract the constipation ; 27th, alvine dejections ; 28th, abdomen painful, and fifteen leeches applied; 29th, persistence of the pulmonary symptoms, attended with a diarrhcea; 31st, laborious respiration, and diarrhoea ; on the 2d of June, she died, and the body was examined.

Autojjsy. — Head large, and the ])ones of the cranium thickened and more dense than natural. Arachnoid slightly injected ; convolutions less numerous than usual, and shallow, particularly on the left side ; lateral ventricles very much shrunken, particularly that on the right side; cerebellum of normal con- sistence, and less dense than the brain ; lungs tuberculous and cavernous. There was serum in the pericardium, and the heart was small. The stomach contains the puriform substance which was thrown from the lungs, and swal-

* Nothing can be more interesting, than the two reports of Dr. Itard, on the wonderful attention which our confrere lavished upon this idiot, to develop his understanding.

IDIOCY. 487

lowed during life. Mucous membrane of the intestines reddened at certain points. Proportions of the plaster cast of the head :

Circumference ..... 21.37 in. Curvature from the root of the nose to the occipital

protuberance .... 13.38 "

Antero-posterior diameter . . . 7.20

Bi-temporal diameter .... 5.59

((

Total . . . . . 47.54

Delatre, about twenty-one years of age, is the daughter of an imbecile father. She is small in stature, head small, and forehead low. At the height of two fingers' breadth above the superciliary arches, the cranium is flattened, and we observe a more marked depression at the crown of the head. The eyes are red, and almost fixed, the look vague, the external commissures of the eyelids is higher than the internal, and the pupil dilated. From infancy, she is par- tially deaf, but from the age of nineteen years, her deafness seems to have di- minished. The nose, which is depressed at its root, terminates in a point. The upper lip is thicker than the lower, by several lines. The chin is bifur- cated, and tends upward. The physiognomy is expressive of sadness. Ad- measurements of the head upon the living subject :

Circumference ..... 20.47 in. From the curvature at the root of the nose to the oc- cipital protuberance . . •. 12.28 " Antero-posterior diameter . . . 7.24 " Bi-temporal diameter . . . G.18 "

Total ..... 46.17

She has a heavy, sluggish gait, and is incapable of running. She does not take a firm hold of objects with her hands, nor can she handle a broom. She remains isolated from her companions ; sitting usually upon the ground, and raking about the earth. She also collects together rags, and unravels them. She has a habit of holding a cord between her teeth, and with one of her hands, while with the other, she causes it to vibrate. Does any one approach her, she regards them with a savage expression. Does she see signs made by any one, she gazes with her mouth open. She dresses and undresses herself without assistance, but is incapable of taking any farther care of her person, and willingly receives such things as are given her. She is fond of chansfino- her linen, and awaits, with pleasure, the arrival of the Sabbath, that she may be clad in her neatest attire. During the distribution of food, she becomes an- gry if required to wait, and is not served before the rest. She smells her food, and rejects it if not agreeable to her. If she sees any thing given to her com- panions to eat, she signifies by signs that she would not be forgotten. She recognizes her father, and caresses him. She is grateful, but this sentiment is evanescent; and testifies her satisfaction by a sort of grunt, which is peculiar to her. She robs, retains, and defends what she has taken. She never gives away any thing, and is obstinate only in preserving either the rags which she has collected, her food, or the fruits of her robberies. Is she opposed, she utters a cry, but articulates no sound. At certain periods, particularly those of menstruation, she becomes irritable and choleric; springs at the person, and tries to seize hold of, and strangle those who displease her. When she has permitted herself to commit an act in anger, and has struck any one, she immediately flies. She is destitute of the sense of shame, loves

488 IDIOCY.

to remain naked, and appears to be occupied in considering her person. Very much given to masturbation, the presence of men seems to produce no effect upon her. She sleeps well, is never sick, and menstruates regularly.

Grous is nineteen years of age. Her mother while nursing her, was frightened by a mad woman, who endeavored to take this child by force from her arms. Her understanding did not unfold in proportion to the development of the body, and when eighteen months old, she suffered from confluent variola. She did not begin to walk, until two years of age. When three years old, she had a severe attack of disease, and from that period, there was a complete arrest in the development of the understanding. At the age of seven years, the physical forces were reestablished, and at fourteen, a spontaneous eruption of the menses took place.

She is tall; her head is small, flattened, and slightly developed. The occipital region is remarkably small. The hair and eyebrows are of a chest- nut color ; the forehead is narrow ; the eyes blue ; and the lower lip, which is the larger, is projecting. The teeth are in a good state of preserva- tion ; the skin is sun-burnt, and the physiognomy stupid. Admeasurements of the head, taken during life.

Circumference ..... 19.84 in. Froin curvature at the root of the nose to the occi- pital protuberance . . . , 11.14 " Occipito-frontal diameter .... 7.00 " Bi-temporal diameter .... 5.74 "

Total ..... 43.72

Her limbs are well formed, though her gait is awkward, slow and hesitat- ing. In walking, she extends her liands, like an infant who is essaying his powers. Her head is inclined towards the earth, and her body is very prone. She sits habitually, either on the ground or upon a bench, holding in her hand a doll, with which she plays ; or rolling up in her fingers, her clothing and bonnet. If she is walking and is stopped, she does not appear either angry or impatient. At night, she leaves her bed, and runs about, without a motive, in the dormitory. Since the age of fourteen years, the epoch of her first menstruation, she has become perverse, especially at the menstrual periods, and throws down her companions without any provocation. If vexed at one of her associates, she lacerates her own skin, and accuses the person, who has in one way or another opposed her. During these attacks of anger, she throws about her wooden shoes. She is extremely obstinate and timid, and conceals herself if spoken to with severity ; but immediately begins again, what had provoked the language of censure. She has never been able to learn any thing, nor is she acquainted with those things which relate to the first wants of life, nor does she recognize the persons who have the constant care of her. It is necessary to dress her, make her bed, and carry to her her food, upon which she seizes with voracity. She can only articulate monosyl- lables, and that with difficulty ; thus creating a jargon which the children comprehend better than her mother. Is she presented with any thing that pleases her, she emits from the trachea the articulate sounds he, he, heou, and smiles. Her voice is infantile, drawling and shrill. She retains a single air, which it pleases her to trill. She fixes her attention upon objects that sur- round her ; but has no memory farther than to recall what has been promised her. If any one puts money in her hand, she hastens to purchase dainties with it. She understands its value, and if any one endeavors to deceive her, she is vexed, and becomes angry, though she has no words wherewith to ex- press this sentiment. Although she appears to be incapable of chagrin and

IDIOCY. 489

ennui, and since the time of her admission into the hospital, has testified nei- ther regret nor surprise. She receives her mother with satisfaction, when she comes to visit her. She recognizes the nurse who has charge of her, and sometimes manifests her generosity by giving to her some of the articles which her mother brings. She is particularly pleased with children. Although fond of the toilet, she is unable to keep a garment more than a few days without tearing it in pieces, to make a species of doll. The presence of men agitates her powerfully, and her feelings betray themselves by a smile, a reddening of the face, and by actions (by no means equivocal), which she does not dissem- ble, even in the presence of several persons. Is a man near her, she pretends to suffer from pain in her bowels, prostrates herself upon the earth like epi- leptics, and imitates their convulsions. So soon however as any one threatens her, or throws water in her face, she ceases the game. The functions of nutritive life are properly executed, and her menses regular.

Brikton, aged twenty years, is the offspring of a healthy mother, and a father who is habitually in a state of intoxication. She has two brothers, who were never capable of learning to read. She came into the world in a pitiful con- dition, and it was only after two years' nursing, that she learned how to find the breast of her mother. It was at this age that she began to draw herself about upon her knees, her hands and limbs ; and pronounce the words papa and mamma. She had convulsions during both her first and second dentition. She did not walk previous to her seventh year, and at twelve was very small ; after which period her growth was rapid. She was not accustomed to play with children of her own age, but knew how to defend herself At fifteen years of age, the menses appeared, but were shortly after suppressed for eight months ; since which period they have been both regular and abundant. She is of medium stature ; of a very full habit ; and her head is small in propor- tion to the size of the face. The hair is of a brown color, and abundant in quantity ; the forehead narrow and low. The right eye is blue, and the left red ; the nose is large, and flattened at its root ; the mouth large ; the lips thick and projecting ; the teeth poor, and the jaws large. The chin is round, the neck short and large, and the face injected and sunburnt. The physiog- nomy is composed, but without expression. Admeasurements of the head :

Circumference . . . . .19.13 in.

From the curvature at the root of the nose to the occi- pital protuberance . . . . 12.24 " Antero-posterior diameter . . . 7.08 " Transverse diameter . . . 5.63 "

Total ..... 44.08

The limbs are , short and large, and the breasts developed. She moves slowly, her step is awkward, and she extends her hands when walking. She notices what is passing around her, and appears to be occupied with it. Thus, on seeing one of her companions put on a pair of shoes, she understands, and says, they fit well. She responds accurately enough, to such questions as are addressed to her. She was able to learn but a few of the letters; and never, either to read or write. She has a little memory, and recalls certain events which transpired in her own family, of which she was a witness ; but confounds them when wishing to speak of them. If any one enquires her age, she re- plies ; " I don 't know, but mother does." She is acquainted with the value of certain pieces of money, and makes a proper use of it. Although she knows the name of the street in which her parents reside, she never recognizes it a second time. It was with much difficulty that she was taught to dress her- self She was never able to knit ; but goes to look after her food. She some-

62

490 IDIOCY.

times discharges the severest labors of the hospital. Her disposition is mild. She loves her mother, and those who have the charge of her. She becomes angry when provoked, but possesses the sentiment of shame and modesty. She is not fond of play, lives isolated, without inquietude or ennui ; often repeating that she is free from anxiety. Her physical health is good.

Barboulax, twenty years of age, dismissed from the hospital for incurable women, at the age of fourteen years, is of the ordinary stature. Her head is large, and the forehead, which is of moderate elevation, is flattened at the sides. The frontal protuberances are slightly marked, and separated by a trifling depression. The hair, eyebrows and eyelashes are very black. A few white hairs are noticed on the forehead. Her eyes, — concealed by enor- mous cheeks, — of a chestnut color, and moist, open languidly and without expression. The nose is large, the mouth wide, face flushed, the physiognomy timid and infantine, and the neck short.

Circumference of the head . . . 21.26 in. From curvature at the root of the nose to the

occipital protuberance . . . 12.71 "

Antero-posterior diameter . . . 7.20 "

Transverse diameter .... 5.90 "

Total . . . . . 47.07

The limbs are well developed, but large, and the movements awkward and heavy. She walks but little, and is habitually seated upon the haunches, in a corner of the dormitory, without an idea of going into the court. When any one looks at her, she conceals her face with the fore arm, and with the hand of the other arm rapidly rubs her clothing. If an attempt is made to remove her arm, she resists ; and if force is employed, she blushes, weeps, and ap- pears like one in ill humor. Though habitually tranquil, she gets angry when opposed, bites, kicks, and throws her wooden shoes. If struck, she remains disconcerted, and says, beaten. She is sensible both to praise and censure ; possesses the sentiment of shame and modesty, and easily entertains feelings of jealousy. Previous to her admission into the Salpetriere, she threw a child from a window, whom she saw, with feelings of jealousy, affec- tionately caressed, and manifested no regret in consequence of it. She knew no sadness, ennui nor coquetry. She expresses her thankfulness to the servant girl who takes care of her, and is particularly affectionate to one of her com- panions. Her vocabulary is limited to a small number of words. She says yes and no, often unseasonably ; and beaten, when she is struck. She knows how to dress herself, but is not always very successful. Some one is obliged to wash her, and comb her hair. She does not know how to look after her food, and if it is not brought to her, will not call for it. She never calls for any thing, but collects, either clean or filthy rags, for the purpose of making various kinds of dolls. Her general health is good, and the menses are re- gular.

Coulmin, twenty years of age, is small and rachitic, of a slender habit of body, skin sunburnt, the left temple greatly depressed, the forehead high, and the vertex slightly flattened.

Circumference ..... From curvature at the root of the nose to the occi- pital tuberosity .... Fronto-occipital diameter Bi-temporal diameter

20.70

in.

12.20

<i

6.88

<c

5.78

((

Total ..... 45.56

/

IDIOCY. 491

Her hair is blond, her eyelids are inflamed and red, her eyes small and blue. Her nose is short, lips thick, and the saliva flows from the mouth. The chin is round, and the pavilion of the ears very large. The limbs are very slender, the head is inclined forward, and the back much arched. Her step is insecure ; one foot scarcely touching the earth before it is taken up, and the body advances hesitatingly. Her look is besotted. When laughing, she opens the lips so much as to expose completely the teeth. She eats largely, and feeds upon the filthiest articles. If hungry, she stamps with her feet ; and calls the nurses sluts, when they are tardy in bringing her food. The dejections are involuntary, and her turns have never appeared. She is quiet, and sleeps at night, but soils her bed. When she has risen and is dressed in the morning, she is conducted to a bench, where she seats herself upon the haunches, the chin being placed upon her knees, and balances herself con- stantly from before backward. She rarely walks. She knows only the nurse who has charge of her. It is necessary to get her up, wash and dress her, and undress her before retiring at night. Attentions to cleanliness vex her, and she often repeats the words beast and hog, to express either her dis- satisfaction or anger ; or else some desire, which is limited always to a craving for food. She is not deaf, and the striking of the clock apprises her of the hour for the distribution of food. When any one speaks to her about walk- ing, she quits her bench and takes a few steps. She tries to sing, by repeat- ing la la la la ; and when she utters one of the two or three words which form her vocabulary, her voice is harsh ; imitating the low mewing of a cat. Indifferent to everything, she seems to be destitute of modesty. She laughs and weeps, is obstinate and choleric. Her countenance then becomes flushed, and the mucus which habitually escapes from her mouth, becomes augmented. She spits in the face, and bites others and herself. Nothing seems to frighten her, and she manifests no sentiment of recognition. It is necessary for her to wear the camisole, to prevent her from washing herself with her urine, from rolling in the gutters, and even the privy, and also from collecting the filthiest ordure.

Brault, aged twenty-six years, entered the Salpetriere September 3d, 1812, at the age of sixteen years. She is of medium stature, and her head is small, particularly the posterior portion. She carries her head, alternately, on the right and left side. Her hair is chestnut colored, her eyes are blue, moving convulsively, and cannot remain a long time fixed. Her forehead is flattened at the sides, narrow, and almost pointed. The lips are constantly separated by a convulsive laugh. Two of her incisor teeth are very large and project- ing ; the chin also is very voluminous, forming a double fold. The face is gross and flushed. The physiognomy is without expression, the limbs large and short, the fingers small and slender. This last peculiarity is frequently noticed among idiots. Admeasurements of the head, taken from the living subject :

Circumference .....

From the root of the nose to the occipital tuberosity Antero-posterior diameter Bi-temporal diameter ....

Total 47.03

It is necessary to get her up, and dress her in the morning, and to undress her at night. She does not go for her food ; yet utters the word pignon when she desires food, and agnon, when she wishes drink. She seems to be pleased, when her food is handed her, and seizes upon it gluttonously. Her appetite is very great, and her dejections involuntary. She passes the day, seated upon

20.55

in

13.50

((

6.88

((

6.10

((

492 IDIOCY.

a bench or the ground. She often has a needle in her fingers, which she passes awain and again, through some rags. When she retires at nicht, she says to the chamber-maid; good night, nurse. She walks awkwardly, and moves her hands convulsively when walking. She cannot run, and if it rains, she does not seek a shelter. Although her intellectual faculties are very limit- ed, she does not seem to be an entire stranger to what is passing around her. She recognizes the sound of the clock which announces the hour for food. She articulates, more or less imperfectly, five or six words, and the sounds which she utters, are very dull. We sometimes hear her sing the four follow- ing syllables : la la la la. She is very choleric, particularly at the menstrual periods, or when provoked ; throwing her clogs at the head of the person who excites her anger. She is also very obstinate. It is but three months since the death of her mother, to whom she no longer refers ; though she was ac- customed to receive her with pleasure, and to caress her at every visit. She recognizes the servant girl, but manifests no gratitude for her attentions. If threatened, she weeps. She possesses not the sentiment of modesty. She knows not how to play, but keeps some rags in her hand, which she twists about awkwardly in her fingers.

Laguette, about fifty years of age, is of the ordinary stature. Her head, which is greatly inclined forward, is small, and flattened at the sides; the oc- ciput is slightly projecting, and the forehead, which is elevated, retreating. The frontal protuberances are slightly marked. The hair is of a brown color, sprinkled with white ; the eye-brows are similar in color, and the eyes small, red and crossed. The nose is large and long, the mouth of medium size, and the lips are pale, thin and wrinkled. The incisor teeth are wanting, the chin is round and turned up, the complexion is dark, and the countenance flattened and wrinkled. The physiognomy expresses astonishment and stupidity. The measure of the head furnishes the following proportions :

Circumference ..... 20.11 in. From the curvature of the nose to the occipital tubero- sity ..... 12.79 " Antero-posterior diameter .... 7.16 " Bi-temporal diameter .... 5.G7 "

Total ..... 45.73

She applies her hands to her person, and makes sudden motions with her head, similar to those which we see in sheep. The limbs are developed, she walks slowly and awkwardly, turns her attention to what is going on around her, distinguishes objects, and understands what is said to her. She repeats several times in succession, and with energy, the monosyllables he, he, he, when any thing strongly interests her. She knows how to indicate to the nurse where her shoes should be, even when she has deposited them some time since, in a corner. She is extremely indolent, and is sometimes noisy during the night. The dejections are involuntary, both night and day. She flies, whenever her companions manifest a disposition to strike her, but attacks no one. When angry, she hurls her clogs against the walls, overturns the house- hold utensils, tears her clothing, stockings and chemise ; after which, she betakes herself to the nurse, and requests her by signs, to repair what she has just torn in pieces ; expressing her satisfaction, when her garments are again put in order. To prevent her from mischief, they are obliged to confine her to her bed ; which, however, does not prevent her from destroying with her teeth, the camisole, in order to disembarrass herself She experiences a sense of hunger, but it is necessary to bring to her her food, which, before touching, she examines with care, both by the senses of sight and smell. She eats

/

IDIOCY. 493

much, and loves to smell of flowers. It is necessary both to dress and wash her, though I have endeavored to make her dress herself. She has succeeded, — either well or ill — and puts on the camisole without repugnance. If she is arrested in this act by any obstacle, she seeks for aid, by making some sign, by bleating, or by scratching her forehead or head quickly, and several times in succession.

She expresses her thanks when clean linen is given her. She loves to see people well clad, and salutes, and even does reverence, at the desire of the nurse, to persons who give her tobacco, which she seizes with avidity, and conveys quickly to her nose. She possesses no sense of modesty, and is often naked ; appearing to regard herself with pleasure. She is much given to onanism. She is alive to reproaches, and weeps ; but her regrets are mo- mentary, and she is soon guilty of the fault, which has just cost her censure. This idiot learned the air, Vive Henri IV., which she sings, while repeating he, he, be, and turning round and round. Her menses have long ceased, nor has she seemed to experience, in consequence of this occurrence, the least change in her health, which is excellent.

Ferrandier, twenty-two years of age, whose stature is somewhat above the medium size, has a sunburnt, though pliant and soft skin, and a small head, which is habitually inclined forward, and to one side. The cranium is but slightly developed, in comparison with the face ; the forehead is narrow, the occiput flattened, and the vertex elevated. The hair is brown and abundant, the eyes blue, the eyelids thickened, and slightly opened, and the look am- bio-uous. The jaws are large, the nose is small, the lips are prominent, inclin- ing upward, and partially open. She conveys into her mouth with the tongue, the mucus which is constantly discharging from her nostrils. Her teeth are white, chin round, physiognomy stupid, neck short and large, breasts volumi- nous and pendant, and the pelvis large. The superior extremities are small and without strength ; the lower are short, and infiltrated during winter, and the right side is weaker than the left. The measures of the head are taken over the face.

Circumference ..... 19.40 in. From curvature at the root of the nose to the occi- pital tuberosity .... 11.61 Antero-posterior diameter . . . 6.65 " Bi-temporal diameter . . . . 5.31 "

Total 42.97

She walks very slowly, cannot run, nor ascend a stairway without assis- tance. She remains seated in the court and upon the earth, usually in the same- place. She is epileptic, and the attacks return every seven or eight days. The dejections are, during the night, involuntary. She understands what is said, and replies to the questions that are addressed to her. She is susceptible of attention to the objects that are presented to her, and to what is passing around her. Still she is incapable of doing the least thing. It is necessary to dress, comb and wash her. She plays with dolls, and, excepting errors, counts a hundred. She keeps the money that is given her, and saves it to purchase dainties.

She trills certain airs that she has heard, and entertains an affection for one of her companions, whom she embraces tenderly and often. It was observed that she had a falling out with her companion, which lasted eight days ; dur- ing which period, she no longer sought for, nor embraced her. They at length became at one again, judging from their embraces. She is very grateful for the attentions that are paid her, but is obstinate, and easily made

494 IDIOCY.

angry. She then strikes, bites and tears every thing that comes within he rreach, and it becomes necessary to restrain her with the camisole. She is insensi- ble to reproaches, and inaccessible to fear. She has no sense of modesty, and is pleased in being near to men. The health of this idiot is good, and her men- struation regular.

Gaudin, admitted at the Salpetriere April 7th, 1824, at the age of twenty years, is scrofulous and rachitic, as well as deaf and mute. The head is small, forehead narrow, and the temporal regions developed. The eyes are small and blue, the look is crossed and fixed, the hair of a chestnut color and the teeth handsome. The face is flushed, and the physiognomy without expression. The limbs are very slender, habitually bent, and contracted at the left side. Deprived of all sensation, and not expressing, even by gestures, the first wants of nutrition, it is necessary to introduce food into her mouth when she swallows it. The dejections are involuntary. Passing most of her time in bed, she remains in the same position, and if uncovered, her limbs move convulsively, particularly to the right, and she manifests impatience. Many efforts have been made to seat her in a chair, but she slides from it, and permits herself to fall. Her sensibility has often been interrogated by pinching ; but she manifests no sign of pain. She has never been regular. Since her admission into the hospital, her health has suffered daily. She has become very much emaciated, and the features of the countenance are ex- pressive of uneasiness. In vain did we explore the different cavities ; in vain did we watch for some indication, that might explain her progressive and rapid emaciation; and she died on the 26th of June, one month and a half after her admission into the hospital.

The post-mortem examination was made on the day following, at the clinic. The bones are slender, and friable to such a degree as to be destroyed by maceration. The cranium is small, the dura-mater healthy, and the convolu- tions atrophied and very compact. The arachnoid, which is injected, presents, at the level of the frontal protuberances, two osseous points, from three to four lines in diameter, and adheres to the cortical substance, throughout a great extent of the hemispheres. This substance is red, while the white is injected, and a little soft. The corpora striata and optic thalami, are greatly injected. The capacity of the ventricles is but slight, and the cerebellum equally injected. The annular protuberance is less dense than usual, the spinal marrow slightly consistent, the lungs are hepatized, the heart is small and flaccid, and the mucous membrane of the stomach is soft and red. Pro- portions of the plaster cast taken after death.

Circumference of head Antero-posterior curvature Occipito-frontal diameter . Bi-temporal diameter

Total ..... 43.09

Audry, twenty-three years of age, is of medium stature. The head is large, the occipital region developed, and the forehead narrow and flattened. The eyes are very black, and sometimes crossed ; and the lids are often, and closely, shut. She often covers them. The hair is very black and crisped, the complexion of the face is of an olive color, while that of the person is brown. The nose is large and flat, lips large, teeth beautiful, ears very large, feet large and flat, the breasts hard, and the physiognomy stupid. The ad- measurements of the head were taken from the living person :

19.48 :

in.

11.41

(C

6.57

((

5.63

<(

r

22.44

in

12.51

<(

7.67

(<

5.94

((

IDIOCY. 495

Circumference . . ' .

Curvature from the nose to the occiput Antero-posterior diameter Bi-temporal diameter ....

Total ..... 48.56

The limbs are well developed. She does not walk however, but remains always seated upon her heels, now upon the ground, and now upon an arm- chair ; balancing herself backwards and forwards, exposed to every variation of temperature, with no other clothing than a chemise ; looking to the right and left, without understanding what is demanded of her, and probably with- out comprehending any thing that is going on around. She occupies herself however, much of the time, in looking at her hands, which she brings very near her eyes.

The instinct of this idiot is almost null. She only knows the person who is in the habit of attending upon her, or giving her tobacco. She not only does not speak, but merely pronounces the following syllable, which she repeats incessantly, and with the more vivacity, whenever any thing impresses her in an agreeable or painful manner. Bron, hrou, is her only language, which she is almost constantly muttering ; and which has caused her to re- ceive, in the hospital, the name of Bourdon. It is necessary to dress her, and put her to bed like a child, and to carry to her her food, which she de- vours with voracity, after having smelled of it. She is very timid, and the least noise frightens her. She expresses her fright, by gathering her whole body, so to speak, into the greatest degree of compactness possible. Her fright having passed, she endeavors to laugh. She has no affection for any one, nor the instinct of self-defence, when smitten. She has an excessive fondness for tobacco. She presents not her hand, but her arm, to every person who passes near her ; and when they have placed some tobacco upon it, she conveys it with a sort of avidity and sensuality, first to her nose, and afterwards to her mouth. She licks, both her chemise, and the bench on which she has been sitting, if the smallest quantity of tobacco still adheres to them. When she has no more, she expels from her nose what she has just snuffed up, in order afterwards to swallow it.

An effort has been made, to cause her to understand that she must dance, if she wishes to obtain tobacco. Then, at the slightest intimation, and espe- cially, when she is shown tobacco or a snuff box, she jumps about, her feet in motion under her, and her arms extended upward. Her hearing seems to be imperfect, for it is necessary to speak several times, to attract her attention ; but the sight of tobacco is sufficient to arouse her solicitude. Whilst I was getting a sketch of her, I was accustomed to give her apricots, the pulp of which she ate ; but not succeeding in biting the stone, she swallowed it. She possesses not the sentiment of shame. I have often seen her, seated upon an arm-chair, playing with her breasts, the nipples of which she would twist round with her fingers. I have also seen her urinate, and notice with a sort of cu- riosity, the urine as it passed off in a stream. Her other necessities were satisfied involuntarily, wherever she happened to find herself. In other respects, she is well ; and the menses are very regular and abundant. She gives herself up to the practice of onanism to a frightful extent, in open day, and in the presence of every body. Several times in my own, and the presence of the draughtsman, she endeavored to gratify this inclination, without seeming to suspect that she was in the presence of any one. Her physical insensibility is such, that by pinching her, or drawing a feather over her lips, or eyelids, it was impossible for me to produce the least indication of sensibility. Since the time of her admission, which was six years since, she has somewhat im-

496 IDIOCY.

proved. She knows how to intimate, by signs, that she has not been served to her food, permits herself to be clothed, and assists in putting on her cloth- incp; she puts a bonnet on her head, takes the same chair, which is pierced, draws it to the same place, puts upon it a night vessel, and seats herself there- on. When unable to obtain tobacco, either by gestures or murmurs, she leaves her seat, and makes mimic efforts to effect her purpose. In 1826, Au- dry was seized with the confluent form of variola, and died with it on the sixth day. During her illness, she did not manifest the least pain. When food was brought, she testified no desire either to eat or drink, but accepted whatever was conveyed to her mouth.

JEFFERSON MEDICAL COLLEGE.

SESSION OF 1846—7.

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at press Tliorn.son's Domestic Management of the Sick Room'

1 vol. 12mo, extra cloth. Tokeah, by Sealsfield. price 25 cents. Walpole's Letters, in 4 large vols. Svo, ex cloth. Walpole's New Letters to Sir Horace ISIann, 2 v. Svo. Walpole's Memoirs of George the Third, 2 vols. 8vo. White's Universal History, a new and improved work for Schools, Colleges. <!cc., with Questions by Pro- fessor Hart, in 1 vol. large 12nio, extra cloth, or half bound. Wheaion's International Law, 1 vol. large Svo, lavr

sheep or extra cloth, 3d edition, much improved. Wheaton on the Right of Search, in 1 vol. Svo. Mrs. Washington Potts, by Miss Leslie, 25 cents. Wraxall's Posthumous IVIemoirs, 1 vol Svo. Wraxall's Historical Memoirs. 1 vol. Svo. Youait on the Horse, &c., 1 vol. Svo. Youatt on the Dog, with plates, preparing.

TO THE IMEEDICAI. FHOFESSIOIT.

The following list presents nearly all the works on Medical Science published, at press and preparing by the Subscribers. They will be found to be executed in a superior style, and sold at prices as low as can be afforded consistent with correct editions. These works can be had in all the principal bookstores throughout the Union; from which, or from the subscribers, all in- formation relative to prices, &c., can be obtained, on application, free of postage.

L,EJl K BLi^jyCU.lRIt, PhiladelphHu

Anatomical Atlas, by Smith & Horner, imp. 8vo, 650 figs.

Ariioti's Elementsof Physics, new ed.l vol. Svo, 4S4pp.

American Medical Journal, quarterly at $5 a year.

Abercrorabie on the Stomach, 1 vol. 8vo, 320 pages.

Abercrombie on the Brain, new ed , 1 vol. 8vo, 3'J4 pp.

Alison's Outlines of Pathology, in 1 vol. 8vo, 420 pp.

Ashwell on Females, one vol. Svo, 520 pages.

Andral on the Blood, 120 pages, Svo.

Bird on Urinary Deposits, 1 vol. Svo, 223 pp.

Bird's Natural Philosophy, preparing.

Burrovrs on Cerebral Circulation, preparing.

Budd on the Liver, 1 vol. Svo, 392 pp.

Buckland's Geology and Mineralogy, 2 vols. Svo, with

numerous plates and maps. Berzelius on the Kidneys and Urine, 1 vol. Svo, lEOpp. Bridgewater Treatises, with numerous illustrations, 7

vols. 8vo, 3257 pp. Bartlett on Fevers, &c., 1 vol. 8vo., .394 pages. Bartlett's Philosophy of Medicine, 1 vol. 8vo, 312 pp. Brigham on Mental Excitement, 1 vol. 12mo. 204 pp. Billing's Principles of Medicine, 1 vol 8vo, 304 pp. Brodie on Urinary Organs, 1 vol. Svo, 214 pp. Brodie on the Joints, 1 vol. Svo, 216 pp. Brodie's Surgical Lectures, 1 vol. Svo, 350 pp. Benedict's Compendium of Chapman's Lectures, 1 vol.

Svo, 258 pp. Chapman on Viscera, 1 vol. Svo, 384 pages. Chapman on Fevers, Gout, &c., 1 vol. Svo. 450 pp. Chelius' Surgery, by South and Norris. at press. Chitty's Medical Jurisprudence, Svo, 510 pp. Clater and Skinner's Farrier. 12itio, cloth, 220 pp. Carpenter's Principles of Human Physiology, 1 vol.

Svo, 644 pages, with cuts, second edition. Carpenter's General and Comparative Physiology, 1

vol. Svo, preparing, many plates. Carpenter's Vegetable Physiology, 1 vol. 12mo, vvith

cuts, 300 pp. Carpenter's Manual, or Elements of Physiology, 1 vol.

Svo, 566 pages, many cuts. Carpenter's Cyclopedia of Natural Science, preparing. Cooper, Sir Astley on Hernia, imp. Svo, plates. 423 pp. Cooper on Dislocations, 1 vol. Svo, with cuts, 500 pp. Cooper on ihe Testis and Thymus Gland, 1 vol. impe- rial Svo, many plates. Cooperontlie Anatomy and Diseasesof the Breast, &c.

&c., 1 vol. imperial 8vp. splendid lithographic plates. Condie on Diseases of Children, 1 vol. Svo, 0.52 pages. Churchill on Females, 3d edition. 1 vol. 8vo, 572 pp. Churchill's Midwifery, 1 vol. Svo. 520 pp., many cuts. Cyclopcedia of Practical Medicine, by Forbes, &c.

Edited by Dunglison, in 4 large super-royal vols.,

3154 double columned pages. Carson's Medical Formulary, in preparation. Dewees' Midwifery, with plates, lOtli edit., 660 pp. Dewees on Children, Sth edition, 548 pp. Dewees on Females, with plates, t<th edition. 5.32 pp. Durlacher on Corns, Bunions, &c.. 1 vol. 12mo , 1.34 pp. Dunglison's Physiology, 6th edition, 2 vols. Svo, 1350

pages, with 370 cuts. Dunglison's Therapeutics and Materia Medica, a new

edition, with cuts, 2 vols. Svo, 986 pages. Dnnglison's Medical Dictionary, 6ih edition, 1 vol. Svo,

804 very large pages, double columns Dunglison on New Remedies, 4th edition, 616 pp. Dunglison on^Human Health, in 1 vol Svo, 464 pp. Dunglison's Practice oi Medicine, 2d edition, 2 vols.

Svo, 1322 pp. Dunglison's Medical Student, 1 vol 12mo. 312 pp. Dniitt's Surgery. 1 vol. Svo. 534 pp., 2d ed., many cuts. Ellis' Medical Formulary, a new edition, nearly ready. EUiot.son's Mesmeric Cases, Svo, 5G pp. Esquirol on Insanity, by Hunt, 496 pp. Fownes' Elementary Chemistry, 1 vol. royal 12mo, 460

pages, many cuts. Fevers. General and Special, edited by Clymer, 1 vol.

Svo, 600 pages.

Fergusson's Practical Surgery, 1 vol. Svo, 2d ed , 640 pp.

Graham's Chemistry, with cms, 1 vol. Svo, 750 pp.

Griffith's Chemistry of the Four Seasons, 1 vol. 12mo, • with cuts.

Griffith's Medical Botany, many illustrations, at press.

Guthrie on the Bladder and Urethra, 1 vol. bvo. 150 pp.

Hoblyn's Dictionary of Medical Terms, by Hays, 1 vol. large 12mo, 402 pagdS.

Harris on the Maxillary Sinus, 1 vol. Svo, 166 pages.

Horner's Special Anatomy, 2 vols. &vo, 7ih ed., cuts.

Horner's Mew Dissector, 1 vol. 12nio, with many cuts.

Hasse's Pathological Anati my, nearly ready.

Hope on the Heart. 1 vol 8yo, with plates, a new ed.

Harrison on the Nervous System, 1 vol. Svo, 292 pp.

Hughes on the Lungs and Heart, 1 vol. 12nio, 270 pp.

Jones' (T. Wharton) Manual of Ophthalmic Surgery, with many cuts, at press.

Jones and Todd on the Ear. 1 vol., preparing.

Kirby on Animals, many plates, 1 vol Svo. 520 pp.

Kirby and Spence's Entomology, 1 vol. Svo, 600 pages, plates, plain or colored.

Lawrence on the Eye, a new ed., many cuts, 1 vol. Svo.

Lawrence on Ruptures, 1 vol. Svo, 4b0 pp.

Liston's Surgery, by Mutter, 1 vol. Svo, 566 pp., many cuts.

Miller's Principles of Surgery, 1 vol. Svo, 526 pp.

Miller's Practice of Surgery, 1 vol. Svo, 496 pp.

Maury's Dental Surgery, with plates, 1 vol. Svo, 286 pp.

Muller's Physiology, 1 vol. fevo. 886 pages.

Medical News and Library, published monthly.

Meigs' Translation of Colombat de l'Is6re on the Dis- eases of Females. 1 vol. Svo, 720 pp,

Metcalf on Calorie, in one large vol , Svo. (at press.)

Ptout on the Stomach, 1 vol. Svo, col'd plates, 466 pp.

Popular Medicine, by Coales, 1 vol. Svo. 614 pages.

I hilip on Protracted Indigestion, 1 vol., 240 pages.

Phillips on Scrotula, 1 vol Svo, 350 pages.

Pereira's Materia Medica, 2 vols Svo. 1580 very large and closely printed pages. Second Edition.

Ro) le's Materia Medica, with wood-cuts, nearly ready.

Roget's Animal and Vegetable Physiology, with many cuts 2 vols. Svo, 872 pages.

Roget's Outlines of Physiology, 1 vol. Svo. 516 pages.

Rigby's System of Midwifery, 1 vol. Svo. 492 pages.

Ricord on Venereal, new edition, 1 vol. Svo. 256 pages.

Ricord's large work on Venereal Diseases, with nume- rous plates preparing

Ramsboiham on Parturition, with many plates, 1 vol imperial bvo, a new and improved ediiion, 520 pp.

Robertson on the Teeth, 1 vol. Svo, 230 pages.

Simon's Chemistry of Man, 1 vol. Svo, 730 pages.

Taylor's new work on Medical Jurisprudence, by Grif- fith, 1 vol Svo, 540 pages.

Traill's Medical Jurisprudence. 1 vol. Svo, 234 pages.

Trimmer's Geology and Mineralogy, 1 vol. Svo, 528 pp.

Todd & Bowman's Physiology, publishing in the Medi- cal News and Library, many cuts.

Thomson on the Sick Room, 1 vol. 12mo. 360 pp , cuts.

Vogel's Pathological Anatomy, with plates, preparing.

VValshe on the Diseases of the Lungs, 1 vol. 12mo, 310 pages.

Watson's Principles and Practice of Physic, by Con- die. 1 vol. Svo, 1060 large pages.

Wilson's Human Anatomy, with cuts, 1vol. Svo, anew and improved edition. 60S pages

Wilson's Dissector, or Practical and Surgical Anato- my, by Goddard, with cuts, 1 vol. ]2mo, 444 pages.

Wilson on the Skin, 1 vol. Svo, .370 pages.

Williams' Pathology, or Principles of Medicine, 1 vol. Svo, 384 pages.

Williams' Lectures on the Stomach, &c., preparing.

Williams on the Respiratory Organs, by Clymer, 1 vol, Svo, 500 pages.

Youatt on the Horse, by Skinner, cut», 448 pp. 1 vol. 8w).

Youatt and Clater's Cattle Doctor, 1 vol. 12mo, wilk cuts, 292 pages.

♦♦♦ They have other work? in pteparation not included in this list

LEA & BLANCHARD'S PUBLICATIONS.

No-w Ready, CARPENTER'S NEW WORK.

A MANUAL, OR

ELEMENTS OF PHYSIOLOGY,

INCLUDING PHYSIOLOGICAL ANATOMY.

FOR THE USE OF THE MEDICAL STUDENT. BY WILLIAM B. CARPENTER, M. D., F. R. S.,

FuUerian Professor of Physiology in the Royal Institution of Great Britain, &c.

With One Hundred and Eighty Illustrations,

IN ONE OCTAVO VOLUME OF 566 PAGES

Elegantly printed to match his " Principles of Human Physiology." The sheets of this volume, in their passage through the press have been carefully examined by Dr. Meredith Clymer, the editor of Dr. Carpenter's Principles of Physiology. The manner in which the work is brought up to the day, and its perfect adaptation to its purposes as an elementary text- book for students have rendered unnecessary any alterations or additions. The efforts of the pub- lishers have therefore been directed to obtaining a correct reprint of the London edition.

"Tlie auiiior has shown singular skill in preserving so marked a liae of disiinction between the present Manual and the • Principles of Physiology' previously publislied by hitn. They are both on precisely the same subject; but the one is neither a copy, nor an abstract, nor an alindginent of the other. In one thing, how- ever, they are exactly alike— in their general excellence, and in their perfect adaptation to their respective purposes. The reputation of Dr. Carpenter as a pliysiologist is too well established throughout the whole medi- cal world to admit of increase from any connneudaiion ol our.s; but we should be doing injustice to our own feelings if we did not here express our admiration of his great intellectual powers, of his extensive learning, of the comprehensiveness of his views, of the quickness with which he seizesthe important points and bearings of each subject, of the logical order in winch he arranges his lacls, and of the clearness and precision with ■which he explains, and exposes his doctrines. Dr. Carpenter's various treatises are in tact models in their respective departments. It is their great and varied excellence which accounts for their unrivalled popularity. AVe can pay no higher compliment to the work before us, than to say, that it is equal in merit to the Ibrmer productions of the author. This is equivalent to say ing that it i.«, without question, the best manual or short treatise on physiology extant. Although designed for the student, and I'ramed expressly to meet his wants ; it is a work, we will venture to say, that may be consulted with advantage by most physicians and surgeons, how- ever learned." — The British and Foreign Medical Review.

CARPENTER'S HUMAN PHYSIOLOGY.

PRINCIPLES OF HUMAN PHYSIOLOGY,

WITH THEIR CHIEF APPLICATIONS TO

PATHOLOGY, HYGIENE, AND FORENSIC MEDICINE. BY WILLIAM B. CARPENTER, M.D,, F. R. S., &c.

Second American, from a IVew and Revised London Edition.

WITH NOTES AND ADDITIONS

BY MEREDITH CLYMER, M.D., «&:c. With Two Hundred and Sixteen Wood-cut and other Illustrationa,

In one octavo volume, of about 650 closely and beautifully printed pages.

The very rapid sale of a large impression of the first edition is an evidence of the merits of this valuable work and that it has beeu duly appreciated by the profession of this country. The publishers hope that the present edition will be found still more worthy of approbation, not only from tlie additions of the author and editor, but also from its superior execution, and the abundance of its illustrations. No less than eighty-five wood-cuts and another lithographic plate will be found to have beeu added, affording ihe most material assistance to the student.

■' We have much satisfaction in declaring our opinion that this work is the best systematic treatise on physi- ology in our own language, and the best adapted for the student existing in any language. ' — Medico- CMrurgi- cal Review.

•'The work as it now stands is the only Treatise on Physiology in the English language which exhibits a clear and connected, and comprehensive view of the present condition of that science '''—London and Edinburgh Monthly Journal.

CARPENTER'S POPULAR TREATISE

CARPENTER'S POPULAR TREATISE ON VEGETABLE PHYSIOLOGY.

In one neat duodecimo volume, extra cloth, with numerous illustrations.

This woik forms a part of Carpenter's Popular Cyclopadia of Natural Science, the remainder of wliich will be published with all the beautiful illustrations.

CARPENTER'S PRINCIPLES OF GEiNERAL AND COxMPARATIVE

PHYSIOLOGY, AND HIS WORK ON ANIMAL PHYSIOLOGY,

WITH ALL THE BEAUTIFUL ILLUSTRATIONS, ARE NOW PREPARLNO.

LEA & BLANCH A RD'S PUBLICATIONS. 7

LISTON AlwTllfTTEEiliRin^

A BEAUTIFUL VOLUME, PROFUSELY ILLUSTRATED.

LECTURES ON THE~OPERATIONS OF SURGERY,

AND ON

DISEASES AND ACCIDENTS REQUIRING OPERATIONS

DELIVERED AT UNIVERSITY COLLEGE, LONDON,

BY ROBERT LISTON, ESQ., F.R.S., &c.

EDITED, WITH NUMEROUS ALTERATIONS AND ADDITIONS

EDITED, WITH NUMEROUS ALTERATIONS AND ADDITIONS, BY T. D. MUTTER, M.D.,

PROFESSOR OF SURGERY IN THE JEFFERSON MEDICAL COLLEGE, PHILADELPHIA.

IN ONE LARGE AND BEAUTIFULLY PRINTED OCTAVO VOLUME. WITH TWO HUNDRED AND SIXTEEN ILLUSTRATIONS ON WOOD. This work contains much original matter of Professor Miitter's, amounting to about two hundred and fifty pages, embodying the resuks of his great experience, and adapting the whole to the wants of the American Profession. The Lectures are those which have attracted so much attention as published in the Lancet They are here reproduced entire, omitting none of the original wood engravings, and introducing many new and valuable ones, rendering this altogether one of the most completely illustrated works of the kind that has for some time been presented to the medical public. Among the additions of Professor Miitter will be found full and elaborate Treatises on Staphyloraphy, the different Plastic Ope- rations, Club-Foot, Affections of the Eye, Deformities from Burns, and many other important subjects, not to be met with in so enlarged a form in, perhaps, 'any other work on Surgery. The chapters containing them are fully illustrated with numerous original and highly curious engravings.

"This )s a very attractive book, both in respect to mechanical execution and contents. Printed on fine ■white paper, with a fair new type, and embellished with more than 200 well execuied wood cuts, it presents altogether as beautiful an appearance as a work of art as its uiitter is interesting and important to tlie prac- tical surgeon. The lecture on operations on the eye is a very lucid and instructive one, but we can only refer to it in the most cursory manner. The editor has fully supplied everyttiing that was wanting to render the chapter complete, and we would gladly quote his remarks on the operations of Strabismus and Staphyloma, did our limits permit. The chapter on Cataract, by Dr. Mutter, extending over thirty pages, we look upon as one of the most valuable essays on the subject in the language. It is clear and methodical, sufficiently full, yet precise, and ahoandmg in practical precepts ot tlie highest interest. The remarks on drforinities of the nose are evidently the result of much experience and observation. The operations for hare-lip and cieft palate ara treated at considerable length, and made exceedingly clear by means of the accompanying illustrations: we can recommend these sections alone as worth far more to the surgeon than many times the price of the whole work. The same remark will apply to the next lecture, on the Diseases of ihe Antrum, CariousTeelh, Erected Tumours of the Face, and Solid and Kncysteo Tumors. We know of no systematic work on surgery in which the anaplastic operations for removal or remedying deformities of the face are so fully and satisfactorily de^ scribed as in this. But we have already exceeded our limits, and can only say in conclusion that l-ision's Lec- tures, with Miiiter's additions, should be in every surgeon's library, and in every student's hands, who wishes to post up his surgical knowledge to the present moment,"— TAe New York Journal of Medicine.

" The.se lectures will be found eminently practical, a point of no small moment in a work on Surgery. Indeed, we have no hesitation in affirming, that it is a compendium of the modern practice of Surgery as complete and accurate as any treatise of similar dimensions in the English language. — The Western Lancet.

Lately Published, a New and Much Improved Edition of DRUITT'S SURGERY.

THE PRINCIPLES AND PRACTICE OF MODERN SURGERY.

By ROBERT DRUITT, Surgeon. FROM THE THIRD LONDON EDITION.

ILLUSTRATED BY ONE HUNDRED AND FIFTY-THREE WOOD ENGRAVINGS.

WITH NOTES AND COM.MENTS,

By JOSHUA B. FLINT, M. M., S. S.

In One Volume, Octavo.

"An unsurpassalDle compendium not only of surgical but of medicai' practice." — Louden Medical Gazette.

8 LEA & BLANCHARD'S PUBLICATIONS.

BRODIE'S SURGICAL WORKS.

NOW READY,

CLINICAL LECTURES ON SURGERY

DELTVEP.ED AT ST. GEORGE'S HOSPITAL

By SIR BENJAMIN BRODIE, Bart., V. P. R.S.,

SERJEANT SUHGEON TO THE QUEEN, ETC. ETC.

IN ONE NEAT OCTAVO VOLUME.

These Lectures, in passing through the columns of ''The Medical News/' during the last year, have received the unanimous approbation of the profession in this country and will no doubt be eagerly sought for in their complete state. '

" Sir Benjamin Brodie has long been distinguished as a surgeon, even among those in the front rank, and may now be regarded as occupying the first place in Great Britain, if not in the world. It IS not as a mere operator that he is distinguished — that, it must be conceded by all right thinking minds, is but a very humble part of the qualifications of a surgeon— but as a profound pathologist and therapeutist. We may be prejudiced or mistaken, but in these higher and really intellectual qualifications, we know of no living surgeon that approaches him. His well considered opinions and practical instructions are conveyed, too, in language so appropriate, so simple, clear and chaste that one scarcely knows whether most to admire the excellence of the matter or the beauty of the' style in which it is clothed. Theory and practice go hand in hand throughout. Rarely is a pre- cept given without being illustrated by some apposite case, selected from his vast experience, and always in the fewest and most expressive words. Nothing more than is necessary to enforce the point is said, and nothing that is necessary is left untold." — The Medical Examiner.

" It would not be easy to find in the same compass more useful matter than is embraced in each of these discourses, or indeed in this volume. We the less regret the limited extracts we have it in our power to make from it, because we feel sure that it will in a short time find its way into all the medical libraries in the country.'— TAe Western Journal of Medicine and Surgery.

"Sir B. Brodie has rendered his clinical lectures— what all clinical lectures should be — clear, impressive and practical expositions of curative measures, in which all the most important features of the subject are plainly set forth, without being unnecessarily encumbered with details. We attach a very high value to these Lectures: their style is clear, demonstrative and unaffected, de- cided and energetic ; but altogether free from dogmatism or over-confidence. They are strictly practical ; and much of the information which they contain will assuredly do the reader and his patients good service in time of need." — Medical Gazette.

BRODIE ON URINARY ORGANS.

LECTIIRES

LECTIIRES ON THE DISEASES OF THE URINARY ORGANS.

FROM THE THIRD LONDON EDITION.

WITH ALrER\TlO\S AND ADI)[TIOiVS.

In One Small Octavo Volume, Cloth This work has been entirely revised throughout, some ot the author's views have been modified, and a considerable proportion of new matter has been added, among which is a lecture on the Operation of Lithotomy.

BRODIE ON THE JOINTS.

PATHOLOGICAL A\D MfKGICAL OBSERVATIONS

ON THE DISEASES OF THE JOINTS.

FR'»V1 'JHE FOURTH LONDON EDITION.

mnth the Author's ^(trrfitions uWO mwtows.

In One Small Octavo Volume, Cloth.

^ "To both the practical physician and the student, then, this little volume will be one of much service, inasmuch as we have here a condensed view of these complicated subjects thoroughly investigated by the aid of the light afforded by modern Pathological Surgery." — N. Y. Journal of Medicine.

LEA & BLANCHARD'S PUBLICATIONS. 9

THE SIXTH EDITION OF DUNGLISON'S MEDICAL DICTIONARY.

To 1846.

fflEDICAL~LEXICON.

A DICTIONARY

OF

MEDICAL SCIENCE.

CONTAINING

CONTAINING

A CONCISE ACCOUNT OF THE VARIOUS SUBJECTS AND TERMS ; WITH

A CONCISE ACCOUNT OF THE VARIOUS SUBJECTS AND TERMS ; WITH

THE FRENCH AND OTHER SYNONYMES ; NOTICES OF CLIMATES

THE FRENCH AND OTHER SYNONYMES ; NOTICES OF CLIMATES

AND OF CELEBRATED MINERAL WATERS; FORMULA

AND OF CELEBRATED MINERAL WATERS; FORMULA

FOR VARIOUS OFFICINAL AND EMPIRICAL PREPA-

FOR VARIOUS OFFICINAL AND EMPIRICAL PREPA- RATIONS, &c.

BY ROBLEY DUNGLISON, M. D.,'

Professor of the Institutes of Medicine, &c. in Jefferson Medical College, Philadelphia.

SIXTH EDITION, REVISED AND GREATLY ENLARGED.

In one Royal Octavo Volume of over 800 very large pages, double columns.

Strongly bound in the best leather, raised bands.

It is not necessary for the author to say more, as a preface to this sixth edition of his dictionary, than that he has be&towed the same care on its revision and improvement, which he did on the others. luproof of this, he may remark, that the present edition com\)rises ne<ir\y two thousand Jive, hundred suhiec.l^ aiid terms not con- tained in the last. Many of these have been introduced into medical terminology in consequence of the pro- gress of the science ; and others had escaped him in previous revisions.

It is the author's anxious wish to render the work a satisfactory and desirable — if not indispensable — Lexicon, in which the student may search without disappointmentfor every term that has been legitimated in the nomen- clature of the science. This desideratum he is enabled to attempt in successive editions, by reasonof the work not being stereotyped; and the present edition certainly offers stronger claims to the attention of the practi- tioner and student than any of its predecessors.— Prf/ace to Sixth. Edition, May 1S46.

A NEW EDITION OF

THE MEDICAL STUDENT,

OR AIDS TO THE STUDY OF MEDICINE.

A REVISED AND MODIFIED EDITION.

BY ROBLEY DUNGLISON, M. D., In One neat 12mo. volume.

HUMAN HEALTH;

OR, THE INFLUENCE OF ATMOSPHERE AND LOCALITY, CHANGE OF AIR

OR, THE INFLUENCE OF ATMOSPHERE AND LOCALITY, CHANGE OF AIR

AND CLIMATE, SEASONS, FOOD, CLOTHING, BATHING AND MINE-

AND CLIMATE, SEASONS, FOOD, CLOTHING, BATHING AND MINE-

RAL SPRINGS, EXERCISE, SLEEP, CORPOREAL AND INTEL-

RAL SPRINGS, EXERCISE, SLEEP, CORPOREAL AND INTEL- LECTUAL PURSUITS, &c. &c., ON HEALTHY MAN:

CONSTITUTING

CONSTITUTING ELEMENTS OF HYGlf^NE.

BY ROBLEY DU N G L I S 0 N, M. D.

A New Edition with many Modifications and Additions. In One Volume, 8vo.

DUNGLISON ON NEW^ REMEDIES.

NEW RE"MEDIES,

PHARMACEUTICALLY AND THERAPEUTICALLY CONSIDERED.

FOURTH EDITION.

WITH EXTENSIVE MODIFICATIONS AND ADDITIONS

WITH EXTENSIVE MODIFICATIONS AND ADDITIONS, BY ROBLEY DUNGLISON, M. D., &c.

The numerous valuable therapeutical agents which have of late years been introduced into the Materia Medica, render it a difficult matter for the practitioner to keep up with the advancement of the science, espe- cially as the descriptions ol them are difficult of access, being scattered so widely through transactions of learned societies, journals, monographs, &c. &c. To obviate this difficulty, and to place within reach of the profession this important information in a compendious form, is the object of the present volume, and the num- ber of editions through which it has passed show that its utility has not been underrated.

1X7= Apothecaries and Physicians may rely upon having a late edition of this useful work.

10 LEA & BLANCHARD'S PUBLICATIONS.

PROFESSORnDUITOUSON^^

NOW READY.— A NEW EDITION OF

DUNGLISON'S PHYSIOLOGY,

Brought up to 1846.

HUMAN P HY S I O L 0 G Y

WITH

THREE HUNDRED AND SEVENTif ILLUSTRATIONS.

BY ROBLEY DUNGLISON, M. D.,

PEOFESSOE OF THE I.\STITUTES OF MEDICIJVE IN THE JEFFEKSGN MEDICAL COLLEGE, PHILADELPHIA,

&C. &C.

S I X T H E D I T I O N.

GREATLY IMPROVED. In two large octavo volumes, containing nearly \25Q pages.

" It is but necesary for the Author to say that all the cares that were bestowed on the preparation of the fifth edition have been extended to the sixth, and even to a greater amount. Nothing of importance that has been recorded since its publication, has, he believes, escaped his attention. Upwards of seventy illustra- tions have been added ; and many of the former cuts have been replaced by others. The work, he trusts will be found entirely on a level with the existing advanced state of physiological science."

In mechanical and artistical execution, this edition is far in advance of any former one. The illustrations liave been subjected to a thorough revision, many have been rejected and their places supplied with superior ones, and numerous new wood-cuts have been added vvlierever perspicuity or novelty seemed to require them.

THE PRACTICE OF MEDICINE,

OR A TREATISE ON

SPECIAL PATHOLOGY AND THERAPEUTICS.

BY ROBLET DLOsTGLISON, M.D.

CONTAINING

CONTAINING

THE DISEASES OF THE ALIMENTARY CANAL, THE DISEASES OF THE

THE DISEASES OF THE ALIMENTARY CANAL, THE DISEASES OF THE

CIRCULATORY APPARATUS, DISEASES OF THE GLANDULAR OR-

CIRCULATORY APPARATUS, DISEASES OF THE GLANDULAR OR-

GANS, DISEASES OF THE ORGANS OF THE SENSES, DISEASES

GANS, DISEASES OF THE ORGANS OF THE SENSES, DISEASES

OF THE RESPIRATORY ORGANS, DISEASES OF THE GLAN-

OF THE RESPIRATORY ORGANS, DISEASES OF THE GLAN-

DIFORM GANGLIONS, DISEASES OF THE NERVOUS SYS-

DIFORM GANGLIONS, DISEASES OF THE NERVOUS SYS-

TEM, DISEASES OF THE ORGANS OF REPRODUC-

TEM, DISEASES OF THE ORGANS OF REPRODUC-

TION, DISEASES INVOLVING VARIOUS ORGANS

«!fec. &c.

In Two Volumes, Octavo.

This work has been introduced as a text-book in many of the Medical Colleges, and the general favor with which it has been received, is a guarantee of its value to the practitioner and student.

" In the volumes before us, Dr. Dunglisnn lias proved that his acquaintance with the present facts and doctrines, wheresoever originating, is most extensive and intimate, and the judgment, skill, and impartiality with which the materials of the worli have been collected, weighed, arranged, and exposed, are strikingly manifested in every chapter. Great care is everywhere taken to indicate the source of information, and under the head ol" treatment, formula of the most appropriate reme- dies are everywhere introduced. In conclusion, we congratulate the students and junior practi- tioners of America on possessing in the present volumes a work of standard merit, to which they may confidently refer in their doutsts and difficulties." — Brit, and For. Med. Rev. for July, 1842.

" Since the foregoing observations were written, we have received a second edition of Dungli- son's work, a sufficient indication of the high character it has already attained in America, and justly attained." — Ibid, for October, 1844.

LEA & BLANCHARD'S PUBLICATIONS. 11

NOW READY

DUNGLISON'S THERAPEUTICS.

A NEW EDITION, MUCH IMPROVED, TO 1S46.

GENERAL THERAPEUTICS AND MATERIA MEDICA.

WITH ONE HUNDRED AND TWENTY ILLUSTRATIONS. ADAPTED FOR A MEDICAL TEXT-BOOK.

BY ROBLEY DUNGLISON, M.D.,

Professor of Institutes of Medicine, etc. in Jefferson Medical College; Late Professor of Materia Medica, etc.

in the Universities of Virginia and Maryland, and in Jefferson Medical College.

Third Edition, Revised and Improved, in Two Octavo Volumes, well hou-iLd.

In this edition much improvement will be found over the former ones. The author has stthjected it to a thorough revision, and has endeavored to so modify the work as to make it a more complete and exact exponent of the present state of knowledge on the important .'subjects of which it treats. The favor with which the former editions were received, demanded that the present should be ren- dered still more worthy of the patronage of the profession, and this alteration will be found not only in the matter of the volumes, but also in the numerous illustrations introduced, and the gene- ral improvement in the appearance of the work.

LIST OF ILLUSTRATIONS.— Vol. L

1. Cepliaglis Ipecacuanha. 17. Legume and leafletof C 37. Cetraria Tslandica, 57. I/ycopus Virginiciis.

2. Brown Ipecacuan. root. ohovata. 38. Fucus vesiculosus. 58. Strychnos Nax Vomica.

3. Striated ipecacuan. root IS. Tinnevelly Senna. 39 Inhaler. 59. Rma graveolt- ns.

— Undulated Ipecacu- 19. Cassia Marilandica. 40. Cantharides. GO. Secale oornulum.

anha root. 20. Podophyllum. 41. Leoiitodon Tarnxacum.fil. Cinnntnoraum Zeylani-

4. Tonidium Ipecac, root 21. llpliradendroncarnbogi-42. Erigerou I'hiladelplii- cum.

5. Gillenia stipulacea. o'ides. cum. 62. Cardamom.

6. Lobelia inflata. 22. Momordica E!ateri«m. 43 Arbutus Uva ursi. G3. Cariopliylliisaromaticus

7. Sans;uinaria Canadensis 23. Apocynum cannaliinunr]44. Kupatoriumpertbliatum.()4. Fceniculum vulgare.

8. Apocynum Aadrosaemi- 24. Convolvulus pai)(luralLis4.5. Asclepia.* tu!'wosa. 0.5. Monarda coceinea.

folium. 25. Chenopodium Anlhel- 46. Arum triphyllum. 60. Hedeoma pulegioides.

9. Eryihronium America- mimiciim. 47. Carthamus linctorius. 67. Myrislica nioschata.

num. 26. Spigelia Marilandica. 48. Warm-bath. 63.. Nutmeg in ihe shell sur-

10. Euphorbia corollata. 27. N'^phrodium Filix max. 49. Hip-bath. rounded by the mace.

11. Ficus Carica. 23. Pnnica granatnm. 50 Fool-bath. 69. Gaultheria procuinbens.

12. Ricinis communis. 29, .30. Inhaling Bottles. 51. Hyoscyamus Niger. 70. Juniperus communis.

13. Rheum palmatum. 31. Balsamadend'n Myrrha. 52. Datura Stramonium. 71. Citrus Auranlium.

14. Rheum compaclum. 32. Acacia Arabica. 53. Conium maculatum. 72. Laurus camphora.

15. Aloe Socotorina. 33. Olea Europa?a. 54. Hamulus Lupnius. 73. Drymis Winleri.

16. Legume and leaflet of34 Saccharum officinarura.oo. Dried lupulinic gTain74 Acorus Ciilamus.

Acute leaved Alexan- 35. Linuin usitatissimum. with its hilum magn:fi'd 75. Piper nigrum,

drian Senna. 36. Astragalus verus. 56. Cannabis sativa. 76. Electrical Apparatus for

Medical purposes. VOL. II.

1. Cocculus palmatus. 13. TTepatica Americana. 26. Abies excelsa. 35. Parlic's of Potato starch

(Male plant.) 14. Indigo. 27. Ranunculus acris. seen by the microscope.

2. Gentiana Catesbsei. 15. Cornus Florida. 28. Aralia nudicaulis. 36. Janipha Manihot.

3. Frasera Walteri. 16. Liriodendron tulipifera 29. Solanum dulcamara, -37. Panicles of Tapioca as

4. Sabbatia angularis. 17. Dyospyros Virginiana. 30. Tacca pinnanfida. seen by the microscope.

5. Coptis trifolia. 13. Heuchera acerifolia. 31. Particles of Tahiti Ar-3S. Sagus Rumpliii.

6. Aletns farinosa. 19. SpirEea tomenlosa. row-root. .39 Particles of Sago-meal.

7. AristolochiaserpentariaSO. Stance Caroliniana. 32. Particles of white East 40. Particlesof Potato sago.

8. Asarura Canadense. 21. Colchiciim autumnale. India Arrow-root. 41. Cycas revoluta or the

9. Anthemis Cotula. 22. Veratritm Album. Var 33. Particles of West India Japan Sago-tree.

10. IVIagnolia glanca. Albirtorum. Arrow-root. 42. Avena Sativa.

11. JMagnoIia macrophylla. 23. Cm cifiiga racemosa- 34. Particles of Tous-les- 43. Parti's of Wheat Starch

12. Geum Virginianum. 24, 25. Shower-bath. mois.

"Our junior brethren in America will find in these volumes of Professor Dunglison. a 'Thesaueits MsDiCJk- MiNUitt,' more valuable than a large purse of go\Ay—Mtdico-Chirurgical Review/or Jan, 1845.

NEW AND IMPROVED EDITION, TO JULY, 1846.

THE MED fc AL FOR M U L A R Y :

BEING A COLLECTION OF PRESCRIPTIONS, DERIVED FROM THE WRITINGS AND PRACTICE OF MANY OF

BEING A COLLECTION OF PRESCRIPTIONS, DERIVED FROM THE WRITINGS AND PRACTICE OF MANY OF THE MOST EMINENT PHYSICIANS OF AMERICA AND EUROPE.

TO WHICH IS ADDED AN APPENDIX

CONTAINING THE USUAL DIETETIC PREPARATIONS AND ANTIlJOTES FOR POISONS. THE WHOLE ACCOMPANIE.T WITH A FEW BRIEF PHARMACEUTIC AND MEDICAL OBSERVATIONS.

BY BENJAMIN ELLIS, M.D.,

Late Professor of Materia Medica and Pharmacy in tlie Philadelphia College of Pharmacy.

EIGHTH EDITION, WITH EXTENSIVE ALTERATIONS AND ADDITIONS.

BY SAMUEL GEORGE MORTON, M. D.

In One neat Octavo Volume.

This popular work has been too extensively and favorably known to the profession in the United Slates to require any remarks in introducing a new edition, except to state that the improvements in it will be found to be numerous and important. Great care has been taken in its passage through the press to insure the utmost accuracy, and it is cojfidently presented as worthy the increased confidence of physicians and apothecaries.

12 LEA & BLANCHARD'S PUBLICATIONS.

HAS SE ' sTIraOLOGfCAL^^

AN ANATOMICAL DESCRIPTION

AN ANATOMICAL DESCRIPTION

OF THE DISEASES OF THE

ORGANS OF CIRCULATION AND RESPIRATION.

BY CHARLES EWALD HASSE,

Professor of Pathology and Clinical Medicine in the University of Zurich, &c.

TRANSLATED AND EDITED BY

W. E. S W AINE, M.D., &c. In one octavo volume,

A New "Work, Just Ready.— July 1846. HOPE ON THE HEART,— New Edition.

A TREATISE ON THE DISEASES

OF THE HEART AND GREAT VESSELS,

AND ON THE AFFECTIONS WHICH MAY BE MISTAKEN

FOR THEM.

COMPRISING THE AUTHOR'S VIEW OF THE PHYSIOLOGY OF THE HEART'S

COMPRISING THE AUTHOR'S VIEW OF THE PHYSIOLOGY OF THE HEART'S

ACTION AND SOUNDS AS DEMONSTRATED BY HIS EXPERIMENTS

ACTION AND SOUNDS AS DEMONSTRATED BY HIS EXPERIMENTS

ON THE MOTIONS AND SOUNDS IN 1S30, AND ON THE

SOUNDS IN 1S34-5.

BY J. HOP^, M.D., F.R.S., &c. &c,

Second American from the Third London Edition. WITH NOTES AND A DETAIL OF RECENT EXPERIMENTS.

BY C. W. PENNOCK, M.D., &c.

In one octavo volume of nearly 600 pages, with lithographic plates.

HUGHES ON THE LUNGS AND HEART,

CLINICAL INTRODUCTION TO THE PRACTICE OF AUSCULTATION,

AND OTHER MODES OF PHYSICAL DIAGNOSIS.

INTENDED TO SIMPLIFY THE STUDY OF THE DISEASES OF THE HEART

AND LUNGS. BY H. M. HUGHES, M.D., &e.

In One Duodecimo Volume, with a plate.

A NEW WORK.— PHILLIPS ON SCROFULA.

jrUST nEJlDW—JTuly 1846.

SCR O^ U L A,

ITS NATURE, ITS PREVALENCE, ITS CAUSES, AND THE PRINCIPLES OF

ITS TREATMENT.

BY BENJAMIN PHILLIPS, M. D., F. R. S., &c.

In one neat octavo volume, with a plate.

"There can be no doubt that there was ample room for a fresh review of scrofula, and that a work on the subject, from a writer of learning, industry, and talent, must be acceptable; and such, after a careful perusal, the work before us appears to be. Very uncommon pains seem to have been taken in collecting information from men as well as books. Our impression of this work is, that it is a very important accession to our profes- sionalliterature, and does the greatest credit to the industry, research and talent of the author. Its utility is, we think, likely to extend far beyond the limits of professional society."— TAeio/irfo/i Medical Gazette.

This work is just published. The author has been for years engaged in the collection of materials and sta- tistics from all parts of the world.

SMALL BOOKS ON GREAT SUBJECTS.

"The Connection between Physiology and Intellectual Science."

Forming No. 3 of a series of small Avorks now issuing^ at Tweuty-five Cents each.

To be followed shortly by " Philosophical Theories and Philosophical Experience," — On Man's Power over Himself to Prevent or Control Insanity," — "An Introduction to Practical Organic Che- mistry,"— "An Introduction to Vegetable Physiology, with References to the Works of De Can- dolle, Lindley, &c.," and several other new and valuable works. Each one to form a very neat and portable volume,

55" These works have acquired great popularity in England, and the publishers take pleasure in introducing the series neatly printed, and at so low a price.

LEA & BLANCHARD'S PUBLICATIONS. 13

COMPENDIliroFcH^ LECTUEES.

A COMPENDIUM OF LECTURES

ON THE

THEORY AND PRACTICE OF MEDICINE.

DELIVERED BY PROFESSOR CHAPMAN IN THE UNIVERSITY OF PENN- SYLVANIA.

PREPARED, WITH PERMISSION, FROM DR. CHAPMAN'S MANUSCRIPTS,

AND PUBLISHED WITH HIS APPROBATION

BY N. D. BENEDICT, M. D.

IN ONE VERY NEAT OCTAVO VOLUME.

CONTENTS.

Remarks on the Classification of Diseases — Fever in General — Intermittent Fever — Remittent Fever — Continued Fever, (Mild, Intermediate, and Extreme Forms) — Yellow Fever — Endemic Pneu- monic, or Spotted Fever — Diseases of the Heart and Blood-vessels, (Inflammatory, Organic, and Nervous) — Acute Carditis, Pericarditis, and Endocarditis — Chronic Carditis, Pericarditis, and En- docarditis— Hypertrophy of the Heart — Dilatation of the Heart — Atrophy of the Heart — Rupture of the Heart — Affections of the Valves of the Heart — Palpitations — Acute Arteritis — Degenera- rations of Arteries — Aneurism of Arteries — Phlebitis — Acute Inflammation of the Throat — Chronic Inflammation of the Throat — Dysphagia — Parotitis — Dysentery, (Inflammatory) — Dysentery, (Con- gestive)— Diarrhcea — Cholera Morbus — Cholera Infantum — Flatulent Colic — Bilious Colic — Colica Pictonum — Acute Peritonitis — Chronic Peritonitis — Acute Catarrh — Catarrhus iEstivus — Chronic Catarrh — Acute Bronchitis — Chronic Bronchitis — Catarrhus Senilis — Acute Infantile Bronchitis — Chronic Infantile Bronchitis — Croup — Acute Infantile Asthma — Whooping-Cough — Acute Laryn- gitis— Chronic Laryngitis — Pleuropneumonia — Congestive Pneumonia — Chronic Pleurisy and Pneumonia — Apoplexy — Palsy — Epilepsy — Hysteria — Chorea — Neuralgia — Diabetes. The subjects treated of in this volume are entirely distinct from those considered in Dr.

Chapman's two works on "Thoracic and Abdominal Viscera," and on "Eruptive Fevers,"

«&c. These works are ail printed and bound to match, and form three very neal octavo

volumes.

LECTURES ON THE MORE IMPORTANT DISEASES

OF THE

THORACIC AND ABDOMINAL VISCERA.

DELIVERED IN THE UNIVERSITY OF PENNSYLVANIA. BY N. CHAPMAN, M. D.

PHOFESSOR OF THE THEORY AND PRACTICE OF MEDICINE, ETC. ' ,

In One Volume, Octavo.

CHAPMAN ON FEVERS, &c.

LECTURES ON THE MORE IMPORTANT

ERUPTIVE FEVERS, HJIMORRHAGES AND DROPSIES,

AND ON GOUT AND RHEUMATISM

DELIVERED IN THE UNIVERSITY OF PENNSYLVANIA. By N. CHAPMAN, M.D.,

PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE, ETC. ETC.

In One Neat Octavo Volume. "The name of Chapman stands deservedly high in the annals of American medical science. A teacher and a lecturer for nearly forty years, in the oldest and, we believe, the first medical school on this side of the At- lantic, the intimate friend and companion of Rush, Kuhn, Physick, Wislar, Woodhouse, Dewees, and a host of others, scarcely less renowned. Professor Chapman reflecisuponlhe profession of this generation something of the genius and wisdom of that which has passed; he stands out the able and eloquent champion of the doc- trines and principles of other times, when Cullen's " first lines" formed the rule of faiih for all tlie Doctors in Medicine throughout Christendom. In him is embodied the experience of threescore and ten, strengthened by reading, and enlightened by a familiar intercourse with many of the ablest medical men in the New and Old World. In conclusion, we njust declare our belief that the name of Chapman will survive when thai of many of his cotemporaries shall have been forgotten ; when other generations shall ireid the great theatre of human affairs, and when other discoveries yet undisclosed, shall shed a brighter light upon the path of medi- cal science. The various lectures which he has been publishing, containing, as they do, the doctrines that he has so long and so eloquently taught to large and admiring classes, we doubt not will be welcomed with delight by his numerous pupils throughout the Union."— iVeio Orleans Medical Journal.

14 LEA & BLANCHARD'S PUBLICATIONS.

horne¥^¥TnTtomy,

NEW EDITION— To be Ready by October.

SPECIAL ANATOMY

AND

HISTOLOGY.

BY

WILLIAM E. HORNER, M, D.,

PROFESSOR OF ANATOMY IN THE UNIVERSITY OF PENNSYLVANIA, &c. &c.

SEVENTH EDITION

WITH MANY IMPROVEMENTS AND ADDITIONS. In iiDO Octavo Volumes, with Illustrations on Wood. This standard work has been so long before the profession, and has been so extensively used, that, in annoinicing the new edition, it is only neces- sary to state that it will undergo a most careful revision ; the author will introduce many illustrations relating to Microscopical Anatomy, and will add a large amount of text on these various points of investigation that are rapidly advancing and attracting so much attention. This new edi- tion will be arranged to refer conveniently to the illustrations in Smith and Horner's Anatomical Atlas, and will be ready for the Fall Lectures.

HORNER'S DISSECTOR.

THE UNITED STATES DISSECTOR,

BEING A NEW EDITION, WITH EXTENSIVE MODIFICATIONS, AND

ALMOST REWRITTEN,

OF

"HORNER'S PRACTICAL ANATOMY."

IN ONE VERY NEAT VOLUME

IN ONE VERY NEAT VOLUME, ROYAL 12mo. With many Illustrations on Wood. The numerous alterations and additions which this work has under- gone, the improvements which have been made in it, and the numerous wood-cuts which have been introduced, render it almost a new work.

It is the standard work for the Students in the University of Pennsyl- vania.

BUDD ON THE LIVER.

ON DISEASES OF THE LIVER.

BY GEORGE BUDD, M.D., F.R.S.,

Professor of Medicine in King's College, London, &c. &c. With colored -plates, and numerous uwod-cuts. In one neat octavo volume. " We cannot too strongly recommend llie dligent siiidy of this volume. The work cannot fail to rank the name of its author amimg the most enlightened pathologists and soundest practitioners of the day."— ilfcdico- CAirurgical Review.

/

SMITH & HORNER'S ANATOMICAL ATLAS.

Just Published, Price Five Dollars in Parts.

AN

ANATOMICAL ATLAS

lUUSTRATIVE OF THE STKTJGTURE OF THE HUMAN EQBY.

BY HENRY H. SMITH, M.D.,

Fellow of the College of Phxjsiciam, S^c

UNDER THE SUPERVISION OF

WILLIAM E. HORNER, M. U.,

Professor of Anatomy in the Univerdty of PennsylvMua,

In One large Volume, Imperial Octavo.

This work is but just completed, having been delayed over the time intended by the great difficulty in giving to the illustrations the desired finish and perfection. It consists of five parts, v^hose contents are as follow*:

Part I. The Bones and Ligaments, witli one hundred and thirty engravings.

Part II. The Muscular and Dermoid Systems, virith ninet>'-one engravings.

jPart III. The Organs of Digestion and Generation, witli one hundred and ninety-one engravings.

Part IV. The Organs of Respiration and Circulation, with ninety-eight engravings.

Part V. The Nervous System and the Senses, with one hundred and twenty-six engravings. Forming altogether a complete System of Anatoiuical Plates, of nearly

SIX HUNDRED AND FIFTY FIGURES

SIX HUNDRED AND FIFTY FIGURES, executed in the best style of art, and making one large imperial octavo volume. Those wlio do not want it in parts can have the work bound in extra cloth or sheep at an extra cost.

Tliis work possesses novelty both in the design and the execution. It is the first attempt to apply engraving on wood, on a large scale, to the illustration of human anatomy, and the beauty of the parts issued induces the publishers to flatter themselves with the hope of the perfect success of their undertaking. The plan of the ■work is at once novel and convenient. Each page is perfect in itself, tlie references being immediately under the figures, so that the eye takes in the whole at a glance, and obviates the necessity of continual reference backwards and forwards. The cuts are selected from the best and most accurate sources ; and, where neces- sary, original drawings have been made I'rom the admirable Anatomical Collection of the University of Penn- sylvania. It embraces all the late beautiful discoveries arising from tlie use of the microscope in the investi- gation of the minute strucmre of the tissues.

In the getting up of this very complete work, the publishers have spared neither pains nor expense, and they now present it to the profession, with the full confidence that it will be deemed all that is wanted in a scientific and artistical point of view, while, at the same time, its very low price places it within the reach of all.

It is partindarly adapted to supjily the place of skeletons or subjects, as the profession will see by examining the list of plates

" These fi<Tires are well selected, and present a complete and accurate representation of that wonderful fabric, the human body. The plan of this Atlas, which renders it so peculiarly convemenl for the student, and us superb artistical execution, have been already pointed out. We must congratulate the student upon the completion of this atlas, as it is the most convenient work of the kind that has yet appeared; and, we must add, the very beautiful manner in which it is 'got up' is so creditable to the country as to be flattering to our national pride." — American Medical Journal. . , ,

"This IS an exquisite volume, and a beautiful specimen of art. We have numerous Anatomical Atlases,! but we will venture to say that none equal it in cheapness, and none surpass it in faithfulness and spirit. We strongly recommend to our friends, both urban and suburljan, the purchase of this excellent work, for which both editor and publisher deserve the thanks of the profession."— JVffrfscai Exayniner.

"We would strongly re«ommend it, not only to the student, but also to the working practiti'oner, who, although grown rusty in the toils of his harness, still has the desire, and often the necessity, of refreshing his knowledge in this fundamental part of the science of medicine."— iVew York Jo^irnal of Mrduine and Surg.

" The plan of this Atlas is admirable, and its execution superior to any thing ot tlie kind before published in this country. It is a real labour-saving affair, and we regard its publication as the greatest boon that could be conferred on the student of anatomy. It will be equally valuable to the practitioner, by allording hiin an easy means of recalling the details learned in tlie dissecting room, and which are soon forgotten."— .ilmenca/i Medi- cal Journal. • i i, i ■ ■

" It is a beautiful as well as particularly useful design, which should be extensively patronized by physicians. Burgeons and medical students." — Boston Med. and Surg. Journal.

" It hits been the aim of the author of the Atlas to comprise in it ttie valuable points of all previous works, to embrace the latest microscopical observations on tlie anatomy of the tissues, and by placing it at a moderate price to enable all to acquire it who may need its assistance in the dissecting or operating room, or other field of practice."— WM!<rn Journal of Med. and Surgery.

"These numbers complete the series of this beautiful work, which fully merits the praise bestowed upon the earlier numbers. AVe regard all the engravings as possessing an accuracy only equalled by their beamy, and cordially recommend the work to all engaged in the study of anatomy."— A'ew York Journal of Medicine

and Surgery. , ■ • , t , ,

"A more elegant work than the one before us could not easily be placed by a physician upon the table of his student.*"— Veitem Journal of Medicine and Surgery.

"We were much pleased with Part I, but the Second Part gratifies us still more, both as regards the attract- ive nature of the subject, (The Dermoid and Muscular Systems.) and the beautiful artistical execution of ihe Illustrations. We have here delineated the most accurate microscopic views of some of the tissues, as. for instance the cellular and adipose tissues, the epidermis, rete mucosum and cutis vera, the sebaceous and perspiratory or-ans of the skin, the perspirator)' glands and hairs of tiie skin, and the hair and nails. Then follows the general anatomy of the muscles, and, lastly, their separate delineations. We would recomnicnd this Anatomical Atlas to our readers in the very strongest terms."— JVm/> York Journal of Medicine and Sur- gery.

16 LEA & BLANCHARD'S PUBLICATIONS.

THERAPEUTICAL LIBRARY.

PEREIRA'S MATERIA MEDICA.

WITH NEARLY THREE HUNDRED ENGRAVINGS ON WOOD. A NEW EDITION, LATELY PUBLISHED.

THE ELEMENTS OF

MATERIA MEDICA AND THERAPEUTICS.

COMPREHENDING THE NATURAL HISTORY, PREPARATION, PROPERTIES, COMPO-

COMPREHENDING THE NATURAL HISTORY, PREPARATION, PROPERTIES, COMPO- SITION, EFFECTS AND USES OF MEDICINES.

BY JONATHAN PEREIRA, M. D., F. R. S. and L. S.,

Member of the Society of Pharmacy of Paris ; Examiner in Materia Medica and Pharmacy of the University of London; Lecturer on Materia Medica at the London Hospital, &c. &c.

Second American, from the last London Edition, enlarged and improved. WITH NOTES AND ADDITIONS BY JOSEPH CARSON, M.D.

In Two Volumes, Octavo, containing Fifteen Hundred very large Pages, illustrated by- Two Hundred and Seventy-five Wood-cuts.

Part I. contains the General Action and Classification of Medicines and the Mineral Materia .Medica. Part II., the Vegetable and Animal Kingdoms, including diagrams explanatory of the l>rocesses of the Pharmacopoeias, a tabular view of the History of the Materia Medica, from the earliest times to the present day, with the Introduction of the Processes of the New Edinburgh Pharmacoposia, and a very copious index. It also contains additional articles on Mental Remedies, Light, Heat, Cold, Electricity, Magnetism, Exercise, Dietetics and Climate, and many additional Wood-cuts, illustrative of Pharmaceutical Operations, Crystallography, Shape and Organization of the Feculas of Commerce, and the Natural History of the Materia Medica.

In passing through the press the second edition of this standard work, the opportunity has been taken by the editor to correct any mistakes or inadvertencies that may have escaped him or the autlior, in the first edition. It may now be considered as entirely worthy of the confidence of the physician and pharmaceutist, as an accurate edition of the most complete work extant on the subject.

"An Encyclopoedia of knowledge in that department of medical science — by the common consent of the pro- fession the most elaborate and scientific Treatise on Materia Medica incur language." — Western Journal of

Medicine and Surgery.

THE STUDENT'S TEXT-BOOK OF MATERIA MEBICA.

NCW AT PRESS,

A MANUAL OF

A MANUAL OF MATERIA MEDICA AND THERAPEUTICS.

By J. FORBES ROYLE, M. D.,

PROFESSOK IN KING'S COLLEGE, LONDON.

EDITED BY

J. CARSON, M.D.,

Professor of Materia Medica and Pharmacy in tlie Philadelphia College of Pharmacy, etc. etc.

In One Octavo Volume, with Numerous Splendid Illustrations.

This work will contain all the most recent information and investigations in the various branches connected with the Materia Medica, and under the supervision of its able editor, will receive whatever alterations and additions may be necessary to adapt it to the United States Pharmacopoeia, and to the practice of this country. The high character of the author will attract attention to the work as a text-book for the next session of the various colleges, if ready. The numerous and beautiful illustrations will far surpass anything that has as yet been attempted in this way. This volume will be brought out in a style to match Fer- guson's Surgery, Wilson's Anatomy, &c., and will be sold at a low price.

LEA & BLANCHARD'S PUBLICATIONS. H

THE GREAT~MEDICAl7^^ THE CYCLOP/EDIA OF PRACTICAL MEDICiNE;

COMPRISING TREATISES ON THE

NATURE AND TREATMENT OF DISEASES,

MATERIA MEDICA k THERAPEUTICS,

DISEASES OE WOMEN AND CHILDREN,

MEDICAL JURISPRUDENCE, &». &c.

EDITED BY

JOHN FORBES, M. D., F. R. S., ALEXANDER TWEEDIE, M.D., F.R.S.,

AND

JOHN CONOLLY, M.D.

REVISED, WITH ADDITIONS,

By ROBLEY DUNGLISON, M.D.

THIS WORK IS NOW COMPLETE, AND FORMS

FOUR LARGE SUPER-ROYAL, OCTAVO VOLUMES,

CONTAINING THIRTY-TWO HUNDRED AND FIFTY-FOUR

CONTAINING THIRTY-TWO HUNDRED AND FIFTY-FOUR UNUSUALLY LARGE PAGES IN DOUBLE COLUMNS,^

PRINTED ON GOOD PAPER, WITH A NEW AND CLEAR TYPE.

THE WHOLE WELL AND STRONGLY BOUND

WITH RAISED BANDS AND DOUBLE TITLES. Or, to be had in twenty-four parts, at Fifty Cents each.

For a list of Articles and Authors, together with opinions of the press, see Supplement to the Nth vember number of the Medical News and Library.

This work having been completed and placed before the profession, has been- steadily advancing in favor with all classes of physicians. The nu- merous advantages which it combines, beyond those of any other work ; the weight which each article carries with it, as being the production of some physician of acknowledged reputation who has devoted himself especially to the subject confided to him, the great diversity of topics treated of; the compendiousness with which everything of importance is digested into a comparatively small space ; the manner in which it has been brought up to the day, everything necessary to the American prac- titioner having been added by Dr. Dunglison ; the neatness of its mecha- nical execution, and the extremely low price at which it is afforded, combine to render it one of the most attractive works now before the pro- fession. As a book for constant and reliable reference, it presents advan- tages which are shared by no other work of the kind. To country prac- titioners, especially, it is absolutely invaluable, comprising in a mode- rate space, and trifling cost, the matter for which they would have to accumulate libraries, when removed from public collections. The steady and increasing demand with which it has been favored since its completion, shows that its merits have been appreciated, and that it is now universally considered as the

LIBRARY FOR CONSULTATION AND REFEiENGE.

18 LEA & BLANCHARD'S PUBLICATIONS.

WORKS BY PROFESSORS CHURCHILL, MEIGS, &c. CHUHCHII<Z.'S l^IDWIPEHY.

A New Edition, Just Published.

ON THE THEORY AND PRACTICE OF MIDWIFERY,

BY FLEETWOOD CHURCHILL, M.D.. M. 11.1. A.,

Licenliate of the Colle-je of Physicians in Ireland; Physician to the Western Lying-in Hospital ; Lecturer on IVIidwifery, &c., in the Richmond Hospital Medical School. &c. &:c.

WITH NOTES AND ADDITIONS

WITH NOTES AND ADDITIONS BY ROBERT M. HUSTON, M. D.,

Professor of Materia Medica and General Therapeutics, and formerly of Obstetrics and the Diseases of Wo- men and Children in the Jefferson Medical College of Philadelphia; President of the Philadelphia

Medical Society, &;c. &c.

« SECOND AMERICAN EDITION.

WITH ONE HUNDRED AND TWENTY-EIGHT ILIiUSTRATIONS,

ENGRAVED BY GILBERT FROM DRAWINGS BY BAGG AND OTHERS.

In One beautiful Octavo Volume. The call for a second edition of Dr. Churchill's Midwifery, within so short a time after the ap- pearance of the first, is satisfactory evidence that the profession in this country appreciate the high value of the work. Both as a text-book for the student and as a manual for the practitioner, it hag a deservedly great reputation, especially for the fulness and clearness with which the physiological details are wrought out and brought to illustrate the practical part. To render the present edition ■worthy of a continuance of the favor and confidence so signally manifested towards its predecessor, the editor has carefully added all the new facts and observations which have transpired since the publication of the last edition, or such at least as appeared to him deserving of being recorded. These relate to some of the most important points in physiology and obstetrical practice. Various new illustrations have been introduced, and the whole brought up, as far as possible, to the day of publication.

A NEW EDITION OF CHURCHILL ON FEMALES.

THE DISEASES OF FEMALES,

INCLXTDING THOSE OF

PREGNANCY AND CHILDBED. BY FLEETWOOD CHURCHILL, M.D.,

Author of " Theory and Practice of Midwifery," &c. &c. THIRD AMERICAN, FROM THE SECOND LONDON EDITION, WITH ILLUSTRATIONS- EDITED, WITH NOTES, BY ROBERT M. HUSTON, M. D., &c. &c. In One Volume, 8vo,

" In complying with the demand of the profession in this country for a third edition, the Editor has much pleasure in the opportunity thus afforded of presenting the work in its more perfect form. All the additional references and illustrations contained in the English copy are retained in this."

A TREATISE ON THE DISEASES OF FEMALES, AND ON THE SPECIAL HYGIENE OF THEIR SEX.

WITH NUMEROUS WOOD-CUTS.

BY COLO MB AT DE L'ISERE, M. D.,

Chevalier of the Legion of Honor; late Surgeon to the Hospital of the Rue de Valois, devoted to the Diseases

of Females, &c. &c.

TRANSLATED, WITH MANY NOTES AND ADDITIONS,

By C. D. MEIGS, M-D.,

Professor of Obstetrics and Diseases of Women and Children in the Jefferson Medical College, &c. &c.

In One Large Volume, 8vo. " We are satisfied it is destined to take the front rank in this department of medical science; it is beyond all comparison, the most learned Treatise on the Diseases of Females that has ever been written, there being more than one thousand distinct authorities quoted and collected by the inde- fatigable author. It is in fact a complete exposition of tiie opinions and practical methods of all the celebrated practitioners of ancient and modern times. The Editor and Translator has per- formed his part in a manner hardly to be surpassed. The translation is faithful to the original, and yet elegant. More tlian one hundred pages of original matter have been incorporated in the text, constituting a seventh part of the whole volume." — JVet/; York Journal of Medicine.

LEA & BLANCHARD'S PUBLICATIONS. 19

WORKS BTlPROFlfSSOR^WrirDEWEES.

NEW EDITIONS.

DEWEES'S MIDWIFERY.

A COMPREHENSIVE SYSTEM OF MIDWIFERY.

CHIEFLY DESIGNED TO FACILITATE THE INQUIRIES OF THOSE WHO MAY BE PUR- SUING THIS BRANCH OF STUDY- ILLUSTRATED BY OCCASIONAL CASES AND MANY ENGRAVINGS. Tenth Edition, with the Author's last Improvements and Corrections.

BY WILLIAM P. DEWEES, M. D„

LATE PROFESSOR OF MIDWIFERY IN THE UNIVERSITY OF PENNSYLVANIA, ETC.

In one volume, octavo. That this work, notwithstanding the length of time it has been before the profession, and the numerous treatises that have appeared since it was written, should have still maintained its ground, and passed to edition after edition, is sufficient proof that in it the great practical talents of the author were fully placed before the profession. Of the hook itself it would be superfluous to speak, having been so long and so favorably known throughout the country as to have become identified with American Obstetrical Science.

DEWEES ON FEMALES.

A TREATISE ON THE DISEASES OE FEMALES.

BY WILLIAM P. DEWEES, M. D., &c.

LATE PROFESSOR OF MIDWIFERY IN THE UNIVERSITY OF PENNSYLVANIA, ETC.

EIGHTH EDITION, With the Author's last Improvements and Corrections.

In one octavo volume, with plates.

DEWEES ON CHILDREN.

A TREATISE ON THE

PHYSICAL AND MEDICAL TREATMENT OF CHILDREN,

BY WILLIAM P. DEWEES, M.D.,

LATE PROFESSOR OF MIDWIFERY IN THE UNIVERSITY OF PENNSYLVANIA, ETC. ETC.

EIGHTH EDITION. In one volume, octavo.

This edition emboclies the notes and additions prepared by Dr. Dewees before his death, and will be found much improved.

The objects of this work are, 1st, to teach those whohavethe charee of children, eitheras parent orguardian, the most approved methods of securing and improving their physical powers. This is attempted by pointing out the duties which the parent or the guardian owes for this purpose, to this interestine but helpless class of beings, and the manner by which their duties shall be fulfilled. And 2d, to render available a long experi- ence to those objects of our affection when they become diseased. In attempting this, the author has avoided as much as possible, " technicality," and has siven, if he does not flatter himself too much, to each disease of which he treats, its appropriate and designating characters, with a fidelity that will prevent any two being con- founded together, with the best mode of treating them, that either his own experience or that of others has sugsested.

Physicians cannot too strongly recommend the use of this book in all families.

ASHWELL ON THE DISEASES OF FEMALES.

A PRACTICAL TREATISE ON THE

DISEASES PECULIAR TO WOMEN.

U.LUSTRATED BY CASES

DERIVED FROM HOSPITAL AND PRIVATE PRACTICE.

By SAMUEL ASHWELL, M. D.,

Member of the Royal College of Physicians ; Obsieiric Physician and Lecturer to Guy's Hospital, &c.

Edited by PAUL BECK GODDARD, M. D.

The whole complete in one large octavo volume. " The most able, and certainly the most standard and practical work on female diseases that we have yet seen." — Medico-Chirurgical Review.

20 LEA & BLANCH ARD'S PUBLICATIONS.

LATELY PUBLISHED, A NEW EDITION OF

WILSON^S HUMAN ANATOMY,

MUCH IMPROVED.

A SYSTEM OF HUMAN ANATOMY,

GENERAL AND SPECIAL.

BY ERASMUS WILSON, M.D.,

LECTURER ON ANATOMY, LONDON.

SECOND AMERICAN EDITION, EDITED BY

PAUL B. GODDARD, A. M., M. D.,

Professor of Anatomy and Histology in the Franklin Medical College, Philadelphia. WITH OVER TWO HUNDRED ILLUSTRATIONS.

Beautifully Printed from the Second London Edition, in One very neat Octavo Volume.

" Mr. Wilson, before the publication of this work, was very favorably known to the profession by his trea- tise on Practical and Surgical Anatomy: and, as this is the Second American Edition, from the second London Edition, since 1840, any special commendation of the high value of the present work, on our part, would be mipererogatory. Besides, the work has been translated at Berlin, and overtures were repeatedly made to the London publisher for its reproduction in France. The work is, undoubtedly, a complete system of human anatomy, brought up to the present day. The illustrations are certainly very beautiful, the originals having been expressly designed and executed for this work by the celebrated Bagg of London; and, in the American edition they have been copied in a masterly and spirited manner. As a text-book in the various colleges we would commend it in the highest terms." — New York Journal of Medicine.

WILSON'S DISSECTOR.

THE DISSECTOR;

OE, PEACTICAL AND SURGICAL ANATOMY.

BY ERASMUS WILSON,

Author of "A System of Human Anatomy, &c.

WITH ONE HUNDRED AND SIX ILLUSTRATIONS.

MODIFIED AND RE-ARRANGED BY

PAUL B. GODDARD, M. D.,

Professor of Anatomy and Histology in the Franklin Medical College, Philadelphia.

In One Large Royal Duodecimo Volume, Sheep.

" It strikes us as being all that a "Dissector" should be. The wood-cuts are numerous and will afibrd the student the most essential aid in the dissecting room." — West. Journ. of Med. and Surg.

WILSON ON THE SKIN.

A PRACTICAL AND THEORETICAL TREATISE

ON THE

DIAGNOSIS, PATHOLOGY AND TREATMENT

OF DISEASES OF THE SKIN;

ARRANGED ACCORDING TO A NATURAL SYSTEM OF CLASSIFICATION,

AND PRECEDED BY

AN OUTLINE OF THE ANATOMY AND PHYSIOLOGY OF THE SKUV.

BY ERASMUS WILSON,

Lecturer on Anatomy and Physiology in the Middlesex Hospital Medical School, &c. &c. In One Neat Octavo Volume, Cloth. " It is a sound book of practice. As a practical guide to the classification, diagrnosis and treatment of the dig eases of the skin, the hook is complete. We know nothing, considered iii this aspect, better in our language: it is a safe authority in all the matters which, in this range of diseases, engage the practitioner's attention, and possesses the high quality, unknown, we believe, to every older manual, o( being on a level with Science's high waier mank.— Medical Times.

LEA & BLANCHARD'S PUBLICATIONS. 21

A NEW AND COMPLETE WORK ON FEVERS.

FE YER S;

THEIR DIAGNOSIS, PATHOLOGY & TREATMENT.

PREPARED AND EDITED WITH LARGE ADDITIONS,

FROM THE ESSAYS ON FEVER IN

TWEEDIE'S LIBRARY OF PRACTICAL MEDICINE,

BY MEREDITH CLYMER, M. D.,

Professor of the Principles and Practice of Medicine «i Franklin Medical College, Philadelphia; Consulting Physician to the Philadelphia Hospital ; Fellow of the Col- lege of Physicians, fyc. ^c.

In one octavo volume of 600 pages.

The want of a distinct treatise on Fevers, embodying the received doctrines of their pathology and treatment has long been felt and generally acknowledged. To supply this deficiency in medical literature is the object of the present volume. It has been prepared from the Essays on Fever contributed by Drs. Christison, Shapter, Burrows, Gregory and Locock, to Dr. Tweedie's " Library of Practical Medicine," and will be found to embrace the whole class of

Idiopathic Fevers,— Continued, Periodical, Eruptive, and Puerperal.

The additions of the Editor, amounting to about one-half of the volume, have been chiefly made with reference to the Fevers of this country. It has been his aim to render the work as complete as possible, and to adapt it particularly to the necessities of the American Practitioner.

WILLIAMS' PATHOLOGY.

COMPRISING

GENERAL PATHOLOGY AND THERAPEUTICS,

AND A GENERAL VIEW OF

ETIOLOGY. NOSOLOGY, SEMEIOLOGY, DIAGNOSIS AND PROGNOSIS. BY CHARLES J. B. WILLIAMS, M. D., F.R.S.,

Fellow of the Royal College of Physicians, &c. WITH NOTKS AND AnDITIONS,

BY MEREDITH CLYMER, M.D., &c.

In one volume, 8vo,

WILLIAMS AND CLYMER ON THE CHEST, &c

A TREATISE ON THE

DISEASES OF THE RESPIRATORY ORGANS,

INCLTJDINO

THE TRACHEA, LARYNX, LUNGS, AND PLEURA.

BY CHARLES J. B. WILLIAMS, M.D., Ck)nsulting Physician to the Hospital for Consumption and Diseases of the Chest j Author of

"Principles of Medicine," &c. &c.

WITH NUMEROUS ADDITIONS AND NOTES,

BY MEREDITH CLYMER, M.D, &c.

In one neat octavo volume, with cuts.

This work recommends itself to the notice of the profession as containing a more particular and

detailed account of the affections of which it treats than perhaps any other volume before the public,

"The wood-cuts illustrating the physical exmination of the che?t, are admirably executed, and the whole mechanical execution of the work does much credit to the publishers. This work is undoubtedly destined to take precedence of all others yet published on the ' Respiratory Organs,' and as a text-book for teachers ami students, no better in the present slate of Ike science is to be expected.'"— iVeio York Journal ofMedieina.

22 LEA & BLA CHARD'S PUBLICATIONS.

KIRBY & SPENCEWS^ USE.

AN INTRODUCTION TO ENTOMOLOGY;

OR, ELEMENTS OF THE NATURAL HISTORY OF INSECTS : COMPRISING

AN ACCOUNT OF NOXIOUS AND USEFUL INSECTS, OF THEIR

METAMORPHOSES, FOOD, STRATAGEMS, HABITATIONS,

SOCIETIES, MOTIONS, NOISES, HYBERNATION,

INSTINCT, &c., &c.

With Plates. Plain or Colored.

By WILLIAM KIRBY, M.A., F.R.S. And WILLIAM SPENCE, Esq., F.R.S.

FROM THE SIXTH LONDON EDITION.

Which was Corrected and Considerably Enlarged,

In One Large Octavo Volume, extra doth.

sZ^!LZl\u'^nnll''nn^TT Stands, is acknowledged to be the best extant as a popular introduclion to the r-reeabirm.rer" f "' '" T?"' °^^"'^"1?^ =^"J nuerestlng information, conveyed in a simple and fast vo ,ne^ shein! J '• ''/V^'r I'**' ^-l'^'""- f'^™ which tins is prnned, the authors have omitted he two ^onof tr^irineinles^nL Jh''^*" '°'" P^P"'"/'^^- «'«! arranged it as it now is. forming a complete exposi uon ot the principles of the study, unincumbered with Anatomical or scientific details.

has iiot''m'',irhTe'ilr1'';^.'tt.l """ physician engaged in an engros.itig practice, whether in town or country, whi e ih^few Ire ,h^. perusal Ot hooks unconnected with his prot'ess.on; but we know just as well, that

tT, o-ivP tn n Jf. = I > "^'""^'^'1 il' l'"S'"«s, the many have the command of more time than they are disposed KactT an vC, , h' 'T "°T "'^"^' "■' "'" "°"''^ ^"^"^^' '^>' ""'^'>' --^"y >"""^ P^.vs'can, waiting works « fhT, ^r ^ .?, f i^ ''°'"'' '^ecause unoccupied ! Why not spend these hours in the study of such mav find'mnt.erl«^n'=^' ^'^.^P^nc^-f herein the physiologist, farmer, horiiculturist. philosopher, and moralist, may bm\matteTtoinsiraclhm.— The Western Journal of Medicine and Surgery. '^ ^ ' "^

r,olItruv^'^'^rr^TR °,''*'' "^7^' which has for iriany years enjoyed a very high and constantly increasing and amhen .^ . "■ f°?^'''^ ^ '^"""^"^ '^'^"^'^^ "P"" """"''^ ^'^i*^"'^^ '" "^i^ Country. It is a free, carefifi

lhrn^^\n^urJf^u 1°'' ? ''k ''""i^ extensive department of study, of which it treats, and has done mucli scienimr" s , de, .fn^r"" Tu ^.''^^'^h which, until us publication, has found comparatively little favor with the scientihc students ot Great Bri am. The treatise of Messrs. Kirby & 8i>e>ce is well adapted, not only by its one e'r° Trf '« l,f ''y "\^«>-'^<^."v'^ ^ty'^- 'o uttroduce the subject to popular tavor. It is thrown into the Ibrm =it,u =?;. 1 a'"'°usl' abounding to some extent in scientific terms, it is divested of technicality so far as pos- verv" n IfrnJ,'' ^'''"y/?'"eeable intermixture of anecdotes, &c.. is made a pleasant and entertaining, as well as tpvLJh J H "''. important work. It is now reprinted from the sixlh London edition, which has been

^iven «n„. , ?'"','"''"'; ' i'" ^?™^ V?' hanclsome octavo volume of about GOO pages. Those who have never rl-fuJ^L \T V° ® ^'ibJ'^ctof which It treats, will find embodied in it an immense amount of very iiue- restmgaad useful informatiou, set forth in an agreeable and attractive style."-iV. Y. Couritrand Enquirer

THE CHEMISTRY

OF THE

FOUR SEASONS,

BY THOMAS GRIFFITH,

Lecturer on Chemistry at St. Bartholomew's Hospital, &c. &c. IN ONE VERY NEAT DUODECIMO VOLUME. With Numerous Wood- cuts. A New Work. The object of this little book is to show in a popular and agreeable manner the chemical airency exerted in the various phenomena of nature. It forms a neat volume for the Centre Table. °

A TEXT BOOK OF

PRACTICAL GEOLOGY AND MINERALOGY,

WITH INSTRUCTIONS FOR THE QUALITATIVE ANALYSIS OF MINERALS,

BY JOSHUA TRIMMER, F. G. S.

WITH TWO HUNDRED AND TWELVE WOOD-CUTS.

A handsome octavo volume, bound in embossed cloth.

This is a systematic introduction to Mineralogy, and Geology, admirably calculated to instruct the student in those sciences. The organic remains of the various formations are well illustrated by numerous figures, which are drawn with great accuracy.

LEA & BLANCHARD'S PUBLICATIONS. 23

GRAHAM'S CHEMISTRY,

THE ELEMENTS OF CHEMISTRY.

LNCLUDING THE APPLICATION OF THE SCIENCE TO THE ARTS.

With Numerous Illustrations.

BY THOMAS GRAHAM, F. R. S. L. and E. D.

Professor of Chemistry in University College. London, &c. (Sec. WITH NOTES AND ADDITIONS,

BY ROBERT BRIDGES, M. D., &c. &c,

In One Volume Octavo.

The great advancement recently made in all branches of chemical investigation, renders neces- sary an enlarged work which shall clearly elucidate the numerous discoveries, especially in the department connected with organic Chemistry and Physiology, in which such gigantic strides have been made during the last few years. The present treatise is considered by eminent judges to fulfil these indications, and to be peculiarly adapted to the necessities of the advanced medical Btudent and practitioner. In adapting it to the wants of the American profession, the editor has endeavored to render his portion of the work worthy the exalted reputation of the first chemist ot England. It is already introduced in many of the Colleges, and has universal approbation.

FOWNES'S CHEMISTRY FOR STUDENTS.

ELEMENTARY CHEMISTRY

THEORETICAL AND PRACTICAL.

J

By GEORGE FOWNES, Ph. D.,

Chemical Lecturer in the Middlesex Hospital Medical School, &c. &c.

With Numerous Illustrations. Edited, -with Additions, By ROBERT BRIDGES, M. D.,

Professor of General and Pharmaceutical Chemistry in the Philadelphia College of Pharmacy, &c.&c. In one large duodecimo volume, sheep or extra cloth.

The character of this work is such as to recommend it to all colleges in want of an elementary text-book, and to all practitioners who wish to place a compendious manual in the hands of their students. It is fully brought up to the day, containing all the late views and discoveries that have so entirely changed the face of the science, and it is completely illustrated with very numerous wood engravings explanatory of all the different processes and forms of apparatus. Though strictly scientific, it is written with great clearness and simplicity of style, rendering it easy to be mastered by those commencing the study. The low price at which it is sold, places it within the reach of all.

Though tfiis work has been so recently published, it has already been adopted as a text-book by many of the Medical Institutions throughout the country. As a work for the first class student, and as an introduction to the larger systems of Chemistry, such as Graham's, there has been but one opinion expressed concerning it, and it may now he considered as

THE TEXT-BOOK FOR THE CHEMICAL STUDENT.

SIMON'S CHEMj^STRY OF MAN.

ANIMAL CHEMISTRY.

WITH REFERENCE TO THE PHYSIOLOGY & PATHOLOGY OF MAN.

BY DR. J. FRANZ SIMON.

TRANSLATED AND EDITED BY GEORGE E. DAY, M. A. & L. M. Cantab., &c.

With plates. In one octavo volume, of over seven hundred pages , sheep, or in two parts, boards. This important work is now complete and may be had in one large octavo volume. Those who obtained the first part can procure the second separate.

•' No treatise on physiological chemistry approaches, in fulness and accuracy of detail, the work which stands at the head of this article. It is the production of a man of true German assiduity, who has added to his own researches the results of the labors of nearly every other inquirer in this interesting!: branch of science. — The death of such a laborer, which is mentioned in the preface to the work as having occurred prematurely in 1S12, is indeed a calamity to science. He had hardly reached the middle term of life, and yet had made himself known all over Europe, and in our country, where his name has been tamiliar for several years as among the

most successful of the cultivators of the Chemistry of Man It is a vast repository of facts, to which ite

teacher aud student may refer with equal satisfaction."— Ifte Western Journalof Medicine and Surgeru-

24 LEA & BLANCHARD'S PUBLICATIONS.

w A T s 0 NVmFficFoFp H Y S I c.

New Edition by Condie.

LECTURES ON THE

PRINCIPLES AND PRACTICE OF PHYSIC.

DELIVERED AT KINg's COLLEGE, LONDON.

BY THOMAS WATSON, M. D., &c. &c. Second American, from the Second Londoii Edition.

REVISED, WITH ADDITIONS,

BY D. FRANCIS CONDIE, M. D., Author of a work on the "Diseases of Children," &c.

In one Octavo Volume,

Of nearly ELEVEN HUNDRED Large Pages, strongly hound with raised bands.

" We know of no work better calculated, for being placed in the hands of the student, and for a text-book, and as such we are sure it will be very extensively adopted. On every important point the author seems to have posted up his knowledge to the day." — American Medical Journal.

The rapid sale of the first edition of this work is an evidence of its merits, and of its general favor with the American practitioner. To commend it still more strongly to the profession, the publishers have gone to a great expense in preparing this edition with larger type, finer paper, and stronger binding, with raised bands. It is edited with reference particularly to American practice, by Dr. Condie ; and with these numerous improvements, the price is still kept so low as to be within the reach of all, and to render it among the cheapest works offered to the profession. It has been received with the utmost favor by the medical press, both of this country and of England, a few of the notices of which, together with a letter from Professor Chapman, will be found in the Supple- ment to The Medical News and Library, for November, 1845,

A NEW AND IMPROVED EDITION OF

RAMSBOTHAM'S STANDARD WORK ON PARTURITION.

THE PRINCIPLES AND PRACTICE OF

OBSTETRIC MEDICINE AND SURGERY,

IN REFERENCE TO

THE PROCESS OF PARTURITION.

ILLUSTRATED BY

One hundred and forty-eight Large Fig-ures on 55 I^ithograpMc Plates.

BY FRANCIS H. RAMSBOTHAM, M. D., &c.

A NEW EDITION, FROM THE ENLARGED AND REVISED LONDON EDITION. In one large imperial octavo volume, well bound. The present edition of this etandard work will be found to contain numerous and important improvemenis over the last. Besides much additional matter, ihere are several more plates and wood-cuts, and those which were before used have been re-drawn. This book has long been known lo the profession, by whom it has been most flatteringly received. A. more extended advertisement, with a recommendatory letter from Professor Hodge of the University of Pennsylvania, may be seen in the November Supplement lo The Medical News.

CONDIE ON CHILDREN.

A PRACTICAL TREATISE ON

THE 'DISEASES OF CHILDREN,

BY D. FRANCIS CONDIE, M. D.,

Fellow of the College of Physicians ; Member of the American Philosophical Society, &c. &c.

IN ONE VOLUME, OCTAVO. 10=" The Publishers would particularly call the attention of the Profession to an examination of this work. "Dr. Condie, from the very groat labor which he has evidently bestowed upon this book, is entitled to our respect as an indefatigable and conscientious student; but if we consider the results of his labor, we cannot but admit his claim to a place in the very first rank of eminent writers on the practice of medicine. Retrard- iug his treatise aa a whole, it is more complete and accurate in its descriptions, while it is more copious and more judicious in its therapeutical precepts than any of its predecessors, and we feel persuaded that the Ame- rican medical profession will very soon regard it, not only as a very good, but as the very best ' Praciica Tceatise on the Diseasea of Children.' "—-Am. Med. Journal.

LEA & BLANCHARD'S PUBLICATIONS. 25

THE SURGICAL WORKS OF SIR ASTLEY COOPER.

LEA & BLANCHARD have how completed the last volume of the illustrated works of Sir Aslley Cooper. They form an elegant series; the works on Hernia, the Testis, the Thymus Gland and the Breast, being printed, illustrated and bound to match, in imperial octavo with numerous LITHOGRAPHIC PLATES, while the Treatise on Dislocations is in a neat medium octavo form, with NUMEROUS WOODCUTS similar to the last London edition.

SIR ASTLEY COOPER OU HERNIA,

With One Hundred and Thirty Figures in Liltiography»

— >

THE ANATOMY AND SURGICAL TREATMENT OF

ABDOMINAL HERNIA.

By Sir ASTLEY COOPER, Bart.

Edited by C. Aston Key, Surgeon to Guy's Hospital, &c.

This important work of Sir Astley is printed from the authorized second edition, published in London, in large super-royal folio, and edited by his nephew, Professor Key. It contains all the Plates and all the Letterpress- there are no omissions, mterfolaiioiis, or modifications— it s the complete work in

One Liarge Imperial Octavo "Volume. With over 130 Figures on 26 Plates, and over 400 Large Pages of Letterpress. The correctness of the Plates is guaranteed by a revision and close examination under the eye of a distin- guished Surgeon of this city.

ANOTHER VOLUME OF THE SERIES CONTAINS HIS TREATISE

ON THE STRUCTURE AND DISEASES 6F IM TESTIS.

Illustrated by uO Figures. From the Second London Edition. BY BKANSBY B. cooper, ESQ.

AND ALSO ON THE ANATOMY OF THE THYMUS GLAND.

Illustrated by 57 Figures.

The two works together in one beautiful imperial octavo volume, illustrated with twenty-nine plates in the best style of lithography, and printed and bound to match.

The Series is concluded by

COOPER ON THE

ANATOMY AND DISEASES OF THE BREAST, &o.,

This larcre and beautiful volume contains THE ANATOMY OF THE BREAST;

THE COMPARATIYE ANATOMY OF THE MAMMARY GLANDS;

ILLUSTRATIONS OF THE DISEASES OF THE BREAST;

'And Twenty-five Miscellaneous Surgical Papers, now first published in a collected form.

By Sir ASTLEY COOPER, Bart., F.R. S., &c.

The whole in one large imperial octave volume, illustrated with tw i hundred and fifty-two figures on thirty six Lithographic Plates; well and strongly bound.

COOPER ON FRACTURES AND DISLOCATIONS,

WITH NUMEROUS WOOD-CUTS.

A TREATISE ON DISIOGATIQNS AND FRACTURES OF THE JOINTS.

By Sir ASTLEY COOPER, Bart., F. R. S., Sergeant Surgeon to the King, &c.

A NEW EDITION MUCH ENLARGED ;

Edited by BRANSBY COOPER, F. R. S., Surgeon to Guy's Hospital.

WITH ADDITIONAL OBSERVATIONS FROM

Professor JOHN C. WARREN, of Boston. With numerous engravings on wood, after designs by Bagg, a memoir and a splendid portrait of Sir

Astley. Li one octavo volume.

The peculiar value of this, as of all "f .^ir Astljey Cooper's works, consists in its eminently practical charac- ter. His nephew, Bransby B. Cooper, from his own experience, has added a number of cases. Besides this, Sir' As' lev left behind him very cimsiderable additions in M.S. for the express purpose of being introduced into this edition' The volume is embellished with ONE HUNDRED AND THIKTY-THREE WOODCUTS, and contains the history of no less than three hundred and sixty-one casf s, thus embodying the records of a lifeof practice of the Author and his various editors. There are also additinnal Observations from notes fur- Dished by John C. Warren, M. D., the Professor of Anatomy and Surgery in Harvard University.

" After ihe fiat of the profession, it would be absurd in us to eulogize Sir Aslley Cooper's Work on Fractures and Dislocations. It is a national one, and will probably subsist as long as English Surgery,' -Medico-Chi- rurs'cal Review.

y

26 LEA & BLANCHARD'S PUBLICATIONS.

A NEW MEDICAL DICTIONARY, In one Volume, large 12mo., now ready, at a low price.

A DICTIONARY OF

THE TERMS USED IN MEDICINE

AND

THE COLLATERAL SCIENCES; By RICHARD D. HOBLYN, A.M., Oxon.

FIRST AMERICAN, FROM THE SECOND LONDON EDITION.

REVISED, WITH NUMEROUS ADDITIONS,

By ISAAC HAYS, M.D.,

Editor of the American Journal of the Medical Sciences.

Believing that a work of this kind would be useful to the profession in this country, the publishers have issued an edition in a neat form for the office table, at a low price. Its object is to serve aa an introduction to the larger and more elaborate Dictionaries, and to assist J^he student commencing the study of Medicine, by presenting in a concise form an explanation of the terms most used in Medicine and the Collateral Sciences, by giving the etymology and definition in a manner as simple and clear as possible, without going into details ; and bringing up the work to the present time by including the numerous terms lately introduced. This design the author has so ably .executed as to elicit the highest encomiums of the medical press.

It has been edited with especial reference to the wants of the American practitioner, the native medicinal plants being introduced, with the formula; for the various officinal preparations : and the whole being made to conform to the Pharmacopceia of the United States. It is now ready in one neat royal duodecimo volume of four hundred pages in double columns.

TAYLOR'S MEDICAL JURISPRUDENCE.

MEDICAL JURISPRUDENCE.

. By ALFRED S. TAYLOR,

Lecturer on Medical Jurisprudence and Chemistry at Guy's Hospital, &c. With Numerous Notes and Additions, and references to American Practice and Law.

Br R. E. GRIFFITH, M. D. In one volume, 8vo.

" We rpcommend Mr. Taylor's work as the ablest, most comprehensive, and, above all, the m 'st practically useful book which exists on the subject of lecal medicine. Any man of sound judgment, who has mastered the contents of Taylor's ' Medical Jurisprudence,' may go into a courlof law with the most perfect confidence of bein? able to acquit h\mse\{ creditably. "—Medico-Ckirurgical Review.

" As we expected, it has become truly the manual of both the medical and legal professions, and is regarded by all as the standard authority on the subject; the autlior, also, as we find from the public prints, is the person consulted, almost as a matter of course, in the more difficult medico- legal cases. — The British and Foreign Medical Review.

LAWRENCE ON THE EYE. New Edition— Now Ready.

A TREATISE ON THE DISEASES OF THE EYE.

BY W. LAWRENCE, F. R. S.,

Surgeon Extraordinary to the Queen, Surgeon to St. Bartholomew's Hospital, &c. &c.

SECOND AMERICAN, FROM THE LAST LONDON EDITION,

With many Modifications and Additions, and the I/itnoduction of over one hundred Illustrations,

BY ISAAC HAYS, M.D., Surgeon to Will's Hospital, Physician to the Philadelphia Orphan Asylum, &.c. &c.

IN ONE LARGE OCTAVO VOLUME.

The character of this work is too well known to require a word of commendation. It is justly considered the best we possess on the subject. In this ediiiou will be found many important alterations and improvements, bringing the work up to the level of the present state of knowledge on the subjects of Ophthalmic f^urgery and Practice. The chapters on the Anatomy and Physiology of the Organ have received especial augmentations, and many new cuts have been introduced, rendering the whole clear and comprehensible.

LEA & BLANCHARD'S PUBLICATIONS. 27

MILLER'S SURGICAL WORKS.

THE PRINCaPLES OF SURGERY.

BY JAMES MILLER, F. R. S.E., F.R. C.S.E.,

Professor of Surgery in the University of E'linburgh, &c. In one neat octavo volume, to match the Author -s volume on " Practice.'"

" No one can peruse this work without the conviction that he has been addressed by an accom- plished surgeon, endowed with no mean literary skill or doubtful good sense, and who knows how to grace or illumine his subjects with the later lights of our rapidly advancing physiology. The book deserves a strong recommendation, and must secure itself a general perusal." — Medical Times.

" We feel no hesitation in expressing our opinion that it presents the philosophy of the science more fully and clearly than any other work in the language with which we are acquainted." — Phi- ladelphia Medical Examiner .

" To the student who wishes to acquire a useful practical knowledge of the pathology of sur- gical diseases, it is impossible to recommend abetter guide than the present treatise by'^Mr. Mil- ler."— Edinburgh Medical and Surgical Journal.

"An admirable epitome of the surgical science of the day. Being written by a sound practical surgeon accustomed to the public teaching of his science, it has the clearness of diction and ar- rangement which renders it an excellent manual for the students as well as that amount of scien- tific and practical information which makes it a safe and valuable guide to the practitioner."— TAe Lancet.

JUST PUBLISHED.

THE PRACTICE OF SURGERY.

BY JAMES MILLER.

Professor of Surgery in the University of Edinburgh.

In one neat octavo volume.

This work is printed and bound to match the " Principles of Surgery," by Professor Miller lately issued by L. & B. Either volume may be had separately. '

" This work, with the preceding one, forms a complete text-book of surgery, and has been under- taken by the author at the request of his pupils. Although, as we are modestly informed in the preface, it is not put forth in rivalry of the excellent works on practical surgery which already exist, we think we may take upon ourselves to say, that it will form a very successful and formidable rival to most of them. While it does not offer the same attractive illustrations, with which some of our recent text-books have been embellished, and while it will not, as indeed is not its design, set aside the more complete and elaborate works of reference which the profession is in possession of, we have no hesitation in stating that the two volumes form, together, a more complete text-book of surgery than any one that has been heretofore offered to the student."— TAe Northern Journal qf Medicine.

" Mr. Miller is already known in his profession as an able writer and a well informed surgeon, and the book before us is calculated to maintain his reputation. We recommend it to those who want a sound guide, or wish to refresh their recollections. The characteristics which especially distinguish the work are, its plain good sense, or the selection of the important from the unimport- ant announcements in surgery ; the sound indications of the judgment to be exercised in the treat- ment of surgical diseases." — The Lancet.

A NEW AND IMPROVED EDITION OF

FERGUSSON'S OPERATIVE SURGERY.

A SYSTEM OF PRACTICAL SURGERY.

BY WILLIAM FERGUSSON, F. R. S. E.

SECOND AMERICAN EDITION, REVISED AND IMPROVED. With Two Hundred and Fifty-two Blustrations from Drawings by Bagg, Engraved by Gilbert,

With Notes and Additional Illustrations,

BY GEORGE W. N ORRIS, M.D.,&c.

In one beautiful octavo volume of six hundred and forty large pages.

"If we were to say that this volume by Mr. Fergusson, is one excellently adapted to the student, and the yet inexperienced practitioner of surgery, we should restrict unduly its range. It is of the kind which every medi- cal man ought lo have by him for ready reference, as a. guide to the prompt treatment of many accidents and injuries, which whilst he hesitates, may be followed by incurable defects, and deformities of structure, if not by death itself. In drawing to a close our notice of Mr. Fergusson's Practical Surgery, we cannot refrain from again adverting to ihe numerous and beautiful illustrations by wood-cuts, which contribute so admirably to ■elucidate the descriptions in the text. Dr. Norris has, as usual, acquitted himself judiciously in ixis otfice of a.nnotator. His additions are strictly practical and to the ^o\aV—Bulktin of Medical Science.

28 LEA & BLANCH ARD'S PUBLICATIONS.

LIBRARY OF SURGERY.

CHELIUS'S SYSTEM OF SURGERY.

A SYSTEM OF SURGEEY.

By J. M. CHELIUS,

Doctor in Medicine and Surgery, Public Professor of General and Ophthalmic Surgery, etc. etc. in the

University of Heidelberg.

TRANSLATED FROM THE GERMAN, AND ACCOMPANIED WITH ADDITIONAL NOTES AND OBSERVATIONS,

By JOHN F. SOUTH,

SURGEON TO ST. THOMAS'S HOSPITAL.

EDITED, WITH REFERENCE TO AMERICAN AUTHORITIES, By GEORGE W. NORRIS, M.D.

Publishing in Numbers, at Fifty Cents eacH.

Nine Numbers are now ready: and the whole is expected to be complete by September next, forming

Three Large Octavo Volumes.

That this work should have passed to six editions in Germany, and have been tAnslated into no less than seven languages, is sufficient proof of its value. It contains what is, perhaps, embraced to an equal extent by no other work on the subject now before the public— a complete System of Surgery, both in its principles and practice. The additions of the translator, IVIr. South, are very numerous, bringing the work up to the very day of publication, and embodying whatever may have been omitted by the author respecting English Sur- gery; while Dr. Norris will lake equal care in representing the state of the Science in America.

'■Judging from a single number only of this work, we have no hesitation in saying that, if the remaining por- tions correspond at all with the first, it will be by far the most complete and scientific System of Surgery in ths Knglish language. We have, indeed, seen no work which so nearly comes up to our idea of what such a pro- duction should be, both as a practical guide and as a work of reference, as this; and the fact that it has passed through six editions in Germany, and been translated into seven languages, is sufficiently convincing proof of its value. It is methodical and concise, clear and accurate; omiiting all minor details and fruitless speculations, it gives us all the information we want in the shortest and simplest form " — The New York Journal of MedicinA.

"The scope of Professor Chelius's Manual is indicated by its title : it professes to treat, systematically, of the science and art of Surgery, but within such compass as to render the work an appropriate introduction and companion to his lectures. The care, however, which has been bestowed upon its construction, and the labor which its research evinces, would be ill repaid were it confined to this sphere; and we may conscientiously say, that we know of no Manual of Surgery, on the whole, more deserving of public confidence, or more vali*- able as a guide and refresher to the young practitioner. It is not our intention at present critically to analyze Mr. South's labors; but we should be guilty of an injustice to him and to our readers if we did not cordially recommend his work as having fair promise of forming, what it is the translator's ambition it should be, a sound and comprehensive system of Practical Surgery. The notes and text are so intermingled as to render it coit- tinuously readable, without presenting those abrupt transitions which are so disagreeable in many viorks simi- larly arranged. The faults of omission &c., at which we have hinted in our comments on the first chapter of our author's work, (viz. that on 'Inflammation') have been amply compensated by the copious and excellent digest of his translator and annotalor who is justly proud of availing himself of the labors of our own coun- trymen in this department of pathology, while he gives their due meed of notice and respect to the contributions of our continental brethren. The references which are given to original works have evidently been carefully collated, and will be found of great value lo ihe student and practitioner who may wish lor more copious in- formation on any particular branch of Surgery; and the practical remarks and illustrations with which the work abounds, are a good guarantee of the translator's ability lo do justice to his task, at the same time that they prove that Mr. South has not failed to avail himself industriously of the large opportunities which his Hos- pital appointment has afforded him." — T/te British and Foreign Medical Review.

" We will, therefore, content ourselves for the present with directing the attention of the profession to it, as being the most complete system of Surgery in any language, and one that is of equal utility as a practical guide and as a work of reference. The fact of ils having reached six editions in Germany, and its having been irsns- lated into seven languages, .are more convincing proofs of its value ilian anything that we can say. Mr. South has performed his task with much judgment, and has certainly made a most useful addition to the medical lite- rature of this country by rendering Chelius's work into English " — The Lancet.

"This work has long been the chief texi-book on Surgery in the principal schools of Germany, and the pub- lication of five editions of it in the original and of translations into no less than eight foreign languages, show the high estimation in which it is held. As a sysiemalic work on Surgery it has merits of a high order. It is methodical and concise— and on the whole clear and aeeurate. The most necessary information is conveyed in the shortest and simplest form. Minor details and fruitless speculations are avoided. It is, in fact, essen- tially a practical book. This work was first published nearly twenty years ago. and its solid and permanent reputation has no doubt led Mr. S^outli to undertake ihe present translation of the latest edition of it. which, w« are informed, is still passing through ihe press in (lermany. Wn should have felt at a loss to select any one better qualified for the task than the translaior of Otto's Compendium of Human and Comparative Pathological Anatomy — a surgeon to a large hospital, whose induisiry and opporiunities have enabled him to keep pace with the improvements of his time." — The Medico-Chirurgical Recie^v.

"Although Great Britain can boast of some of the most skilful surgeons, both among her past and her present professorsof that branch of medical science, no vi'ork professing to be a complete system of Surgery has beea published in the British dominions since that of Benjamin Bell, now more than half a century old.

"This omission in English medical literature is fully ami saiisfactorily .supplied by the translation of Professor Chelius's System of Surgery by a gentleman excellently fitted for ihe task, both by his extensive reading, and the opportunities of practical experience which he has enjoyed for years as surgeon- to one of our largest me- tropolitan hospitals. The fact of Professor Chelius's work having been translated into seven languages is suf- ficient proof of the estimation in which it is held by our continental brethren, and the English edition, now in •ourse of publication, loses none of the value of ihe original from the treatment received at the hands of its translator. The notes and additions of Professor South are numerous, and contain the opinions resulting from his vast experience, and from that of his colleague.

" We are free to confess, prejudiced though perhaps we are, in favor of the English practice of surgery, that ftis work is one of great value, and one which every practitioner and advanced student should possess." — The Medical Tiines.

W O R K S

IN

VARIOUS DEPARTMENTS

OF

MEDICINE AND SURGERY,

PUBLISHED

BY LEA & BLANCHARD.

AMERICAN JOURNAL OF THE MEDICAL SCIENCES, Edited by Isaac Hays, M. D.

Published quarterly at $5 00 per annum.

ANDRAL ON THE BLOOD. Pathological Haematology ; an Essay on the Blood in Dis- ease. Translated by J. F. Meigs and Alfred Stille. In one octavo volume, cloth.

ARNOTT'S PHYSICS. The Elements of Physics in plain or non-technical language. A New Edition. Edited by Isaac Hays, M. D. In 1 vol. 8vo., sheep, with 176 wood-cuts.

ABERCROMBIE ON THE STOMACH. Pathological and Practical Researches on Dis- eases of the Stomach, Intestinal Canal, &c. Fourth Edition. In 1 vol. 8vo., sheep.

ABERCROMBIE ON THE BRAIN. Pathological and Practical Researches on the Dis- eases of the Brain and Spinal Cord. A New Edition. In one octavo volume, sheep.

ALISON'S PATHOLOGY. Outlines of Pathology and Practice of Medicine. In three parts, containing Preliminary Observations, Inflammatory and Febrile Diseases, and Chronic or Non-Febrile Diseases. In one neat octavo volume, sheep.

BIRD ON URINARY DEPOSITS, Urinary Deposits, their Diagnosis, Pathology and The- rapeutical Indications. In one neat octavo volume, cloth, with numerous wood-cuts.

BERZELIUS ON THE KIDNEYS AND URINE, in 1 vol. 8vo., cloth.

BUCKLAND'S GEOLOGY. Geology and Mineralogy, with reference to Natural Theology. A Bridgewater Treatise. In two octavo volumes, with numerous maps, plates, &c.

BRIDGEWATER TREATISES. The whole complete in 7 vols. 8vo., containing Roget's Animal and Vegetable Physiology, in 2 vols., with many cuts; Kirby on the History, Habits and Instinct of Animals, 1 vol. with plates ; Prout on Chemistry ; Chalmers on the Moral Condition of Man ; Whewell on Astronomy ; Bell on the Hand ; Kidd on the Phy- sical Condition of Man; and Buckland's Geology, 3 vols., with many plates and maps.

BARTLETT ON FEVERS OF U. S. The History, Diagnosis and Treatment of Typhus and Typhoid Fevers, and on Bilious Remittent and Yellow Fever. In 1 vol. 8vo., ex. cloth.

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CLATER AND SKINNER'S FARRIER. Every Man his own Farrier. Containing, the Causes, Symptoms, and most approved Methods of Cure of the Diseases of Horses. — From the 28th London Edition. Edited by Skinner. In one 12mo. volume, cloth.

CLATER AND YOUATT'S CATTLE DOCTOR. Every Man his own Cattle Doctor.— Containing the Diseases of Oxen, Sheep, Swine, &c. Edited by Youatt, and revised by Skinner. With Wood-cuts. In one volume 12mo.

DURLACHER ON CORNS, BUNIONS, &c. A Treatise on Corns, Bunions, the Dis- eases of Nails, and the General Management of the Feet. In one 12mo. volume, cloth.

ELLIOTSON'S MESMERIC CASES. In one octavo pamphlet.

ESQUIROL ON INSANITY. Mental Maladies, Considered in Relation to Medicine, Hy- giene and Medical Jurisprudence. Translated bv E. K. Hunt, M. D., &c. In 1 vol. 8vo.

GUTHRIE ON THE BLADDER, &c. The Anatomy of the Bladder and Urethra, and the Treatment of the Obstructions to which those passages are liable. In I vol. 8vo.

HARRIS ON MAXILLARY SINUS. Dissertation on the Diseases of the Maxillary Sinus. In one small octavo volume, cloth.

29

30

LEA & BLANCHARD'S PUBLICATIONS.

KIRBY ON ANIMALS. The History, Habits and Instinct of Animals. A Bridgewater Treatise. In one large volume 8vo. with plates.

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MAURY'S DENTAL SURGERY. A Treatise on the Dental Art, founded on Actual Ex- perience. Illustrated by 241 Lithographic Figures and 54 Wood-cuts. Translated by J. B. Savier. In one octavo volume, sheep.

MULLER'S PHYSIOLOGY. Elements of Physiology, Translated by Wm. Baly, M.D., and edited and arranged bv John Bell, M. D. In one large octavo volume, sheep.

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PHILIP ON INDIGESTION. A Treatise on Protracted Indigestion. In 1 vol. 8vo.

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ROGET'S OUTLINES OF PHYSIOLOGY. Outlines of Physiology and Phrenology. In one large octavo volume, cloth.

RIGBY'S MIDVVIFERY. A System of Midwifery. With Wood-cuts. In 1 vol. 8vo.

KICORD ON VENEREAL. A Practical Treatise on Venereal Diseases; with a Thera- peutical Summary, and a Special Formulary. In I vol. 8vo., cloth.

KOBER rSON ON TEETH. A Practical Treatise on the Human Teeth, with plates. One small volume octavo, cloth.

TRAILL'S MEDICAL JURISPRUDENCE. Outlines of a Course of Lectures on Medi- cal Jurisprudence. Revised, with numerous notes. In one octavo volume, cloth.

THOMSON'S SICK ROOM. Domestic Management of the Sick Room, Necessary in Aid of Medical Treatment, for the Cure of Diseases. Edited by R.E.Griffith, M.D. In one large royal 12mo. volume, extra cloth, with Wood-cuts.

WALSHE ON THE LUNGS. Physical Diagnosis of the Diseases of the Lungs. In one neat 12mo. volume, extra cloth.

YOUATT ON THE HORSE. The Horse: containing a full account of the Diseases of the Horse, with their mode of Treatment; his Anatomy, and the usual Operations per- formed on him; his Breeding, Breaking, and Management; and Hints on his Sound- ness, and Purchase and Sale. Together with a General History of the Horse ; a Dis- sertation on the American Trotting Horse, how trained and jockeyed, an account of his remarkable performances; and an Essay on the Ass and the Mule. By J. S. Skinner, Assistant Postmaster General, and Editor of the Turf Register. In one volume, octavo, ••with numerous Cuts.

MSniC^l, W^ORKS, at JPresa and Preparing:

A MANUAL OF MATERIA MEDICA AND Therapeutics. By J. Forbes Royle, M. D.,&c. Edited by J. Carson, M. D., &c. In 1 vol. Svc, numerous wood-cuts, [nearly ready).

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LECTURES ILLUSTRATIVE OF VARIOUS Subjects in Pathology and Surgery. By Sir B. Brodie — completing his works.

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LEA & BLANCHARD'S PUBLICATIONS. 31

(See Page 33.)

THE yEDiCO-OHlRURGIGAL REVIEW,

EDINBURGH MEDICAL AND SURGICAL JOURNAL,

AND NUMEROUS OTHERS.

WHILE FROM FRANCE

THE GAZETTE MEDICALE DE PAKIS— L'EXPERIENCE— BEVUE MEDICALE —JOURNAL DE MEDECINE— JOUKNAL DES CONNAISSANCES MEDICO-CHIRURGICALES, "

AND VARIOUS OTHERS, WITH THE

ZEITSCHRIFT FUR DIE GESAMMTE MEDICIN,

WITH SEVERAL OTHERS FROM GERMANY,

AND THE BIBLTOTHEK FOR L^GER, OF DENMARK,

TOGETHER WITH

Alii THS ATflSERICAST JOUHSJALS,

ARE PUT IN REQUISITION. It will thus be seen that the material for a full Summary of all

NEW MATTERS AND LMPORTANT DISCOVERIES

is full and ample, while the exertions of the Editor and the time of publication insure a fulness

and newness to this department.

ALL THE LATE AND IMPORTANT

AIVIERICAN IISSTELLIGEF^CE,

is fully recorded — while

TME ]?I0.1JTIII.Y rHEll^S

furnishes the lighter and floating information, and embraces important Books for

THE LIBRARY DEPART M.EHT.

Among those works already published in the Monthlrj Library and News, may be mentioned

WATSON'S LECTURES ON THE PRAGTIGE OF PHYSIC,

AS ALSO

BRODIE'S LECTURES ON SURGERY,

CONCLUDED IN MARCH OF THIS YEAR, (1846). The work for the year 184G is a new orie,

TODD & BOWMAN'S

PHYSIOLOGICAL ANATOMY & PHYSIOLOGY OF MAN.

NOW PUBLISHING IN ENGLAND.

This work has already earned for its authors a high reputation in Europe and this country. It will be reproduced entire, with all the numerous and beautiful wood-cuts. Each Work in the Library is regularly paged so as to be bound separately.

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For the Medical Journal and the Medical News, if paid for by the firsl of February of each Year, and the amount remitted free of cost to the Publishers, . . . - - Five Dollars.

For the Journal only, when ordered without funds, or paid for

after the first of February of each year, . - - Five Dollars.

For the Medical News only, to be paid for always in advance,

and free of postage, -------- One Dollar.

i^ In no case can the News be sent without pay in advance. =^

32 TWO MEDICAL PERIODICALS FOR FIVE DOLLARS A YEAR.

rn TT "C*

AMERICAN JOURNAL OF THE MEDICAL SCIENCES,

Edited by ISAAC HAYS, M. D.

SURGEON TO WILLS' HOSPITAL, ETC.

Published Quarterly on the first of January, April, July and October ; each Number having at least

264 large and closely printed pages.

WHEN NECESSARY, CASES ARE Fully Illustrated with lilTHOGRAPHIC PLATES and WOOD-CUTS.

ALSO,

Sl)e illelrical 5Ieu)6 anJr Cibrarg,

Of 32 Large Pages, Published Monthly, is given Gratis to Subscribers

to The Journal who pay, by the first of February of each year, Five Dollars free of expense to the

Publishers.

Under the new law the postage on the Journal is reduced to about 13^ cents per number, while the News and Library is sent through the mail as a Newspaper.

Persons wishing to subscribe, to commence with the January number for 1847, should advise the publishers at once, as the whole quantity for the present and two past years was taken up early in the year.

The publishers do not deem it necessary to refer to the past course of the Journal. It is suffi- cient that for the last TWENTY-SEVEN YEARS it has received the approbation of the profession at home and abroad ; but they would call attention to the extended and liberal arrangement exist- ing and to be pursued that shall embody the latest intelligence from all quarters.

ITS PAGES WILL BE DEVOTED FIRST TO

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FROM ALL SECTIONS OF THE UNION, WITH

REVIEWS OF ALL NEW WORKS

OF INTEREST, AND

While its QUARTERLY SUMMARY will embrace a full and extended

RETROSPECT AND ABSTRACT

FROM THE VARIOUS

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With reference to this department, the arrangements of the publishers are very extensive and em- brace for the gleanings of the editor the various Journals from

GREAT BRITAIN, FRANCE, GERMANY, DENMARK, ITALY,

^JVn OTIfER SEC'TlOJ\'S OF THE VV^ORLn.

INCLUDING AS PROMINENT AMONG THE ENGLISH,

BRAITHWAITE'S RETROSPECT,

RANKING'S HALF-YEARLY ABSTRACT,

THE LONDON MEDICAL TIMES, THE LONDON MEDICAL GAZETTE,

FORBES' BRITISH AND FOREIGN QUARTERLY.

(Continued on Page 31.)

55" This paper may be delivered to any physician if declined by the person to whom it is ad- dressed, or if they have removed — and Postmasters and others will particularly oblige the publish- ers by furnishing a list of the Physicians and Lawyers of their county or neighborhood. InaTdition to the business it may bring to the office, a copy of" The Complete Florist," or such other volume, will be sent by mail gratis for any ten or more names furnished free of cost. Philadelphia, July, 1846.

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