Imagini ale paginilor
PDF
ePub

ings of the originator of the method. It must be read and studied to be appreciated.

The Practitioner's Medical Dictionary. An Illustrated Dictionary of Medicine and Allied Subjects, Including All the Words and Phrases Generally Used in Medicine, with Their Proper Pronunciation, Derivation and Spelling. By GEORGE M. GOULD, A. M., M. D. (Philadelphia: P. Blakiston's Son & Co.)

To attempt a critical review or analysis of a dictionary would be an almost hopeless task. In the present instance such a task is unnecessary. Dr. Gould's dictionaries have an established fame from which nothing can detract, and to which but little could be added by any encomions of the reviewer.

The present volume is a very convenient work. It comprises over a thousand pages, but is printed on thin paper and is not therefore bulky and inconvenient. It is bound in leather with flexible covers, and will be found to be a convenient and useful addition to the practitioner's library table.

Illustrations of the Gross Morbid Anatomy of the Brain in the Insane. A Selection of Seventy-five Plates Showing the Pathological Conditions Found in Post-Mortem Examinations of the Brain in Mental Disease. By I. M. BLACKBURN, M. D., Pathologist to the Government Hospital for the Insane, Washington, D. C., etc. (Washington: Government Printing Office, 1908.)

Dr. Blackburn has given to the profession in this beautifully executed series of photographs a most valuable contribution. He presents in this series of seventy-five plates accurate representations of the gross conditions found, in a form which permits not only the study of the plates in question but their comparison with conditions found in other cases.

No attempt is made, owing to the limitations of the work, to give a clinical history of the cases, or to connect the lesions portrayed with the symptoms observed during life. Neither are the plates presented as showing the essential morbid anatomy of any form of mental disease except paresis, and possibly senile insanity and arterio-sclerotic insanity. We congratulate Dr. Blackburn upon the completion of a work upon which he has spent many months of conscientious labor.

Insomnia and Nerve Strain. By HENRY S. UPSON, M. D., etc. (New York and London: G. P. Putnam's Sons, 1908.)

The author tells us in his preface that "among the insanities some groups due to changes in the organ of the mind are understood in course and nature. Others, called psychoses, aberrations that come alike to young and old, mysterious legacies, have all the terrors that attach to mystery and occur in forms of strange and violent contrast." This would seem to mean that he regards some forms of insanity as psychoses and

some forms as something else. What the distinction and why the difference in designation he does not, however, make plain.

He states that the present attitude of the medical profession and the public toward the psychoses is almost one of Mahometan fatalism. This may be true as far as the public is concerned, but the signs of the times appear to us to indicate an opposite state of mind as regards the medical profession. Never has there been a period in which more active interest has been shown in the study, treatment and prevention of insanity. Dr. Upson appears to have reached the conclusion that the general professional belief is that insanity, with rare exceptions, is a disease without lesion. On the contrary we think the consensus of professional opinion is that insanity is but a symptom of some physical disturbance either primarily of the brain, or in its results affecting the brain and its functions. Indeed there are some who believe that the too general acceptance of a physical cause for mental disturbance has resulted in overlooking the occasional and important mental factors in the etiology of the psychoses.

The book is written with apparently two objects in view, one to announce the author's discovery of the "vaso-neural circuit," the other to emphasize the influence of disease or malformation of the teeth, impaction, alveolar abscess and the like in the causation of various forms of insanity, and the care of these psychoses by dental manipulation and treatment.

The author has done well to call attention to the possible influence of dental maladies in the etiology of mental disturbance, and something of value will, we trust, flow from his observations. But one can but wish that in his little work he had given less time and space to the promulgation of his theories and more to a better clinical analysis of his cases. Such a course will carry more conviction than the recital of a series of cases labeled mania, dementia præcox, and what not, with no clear statement of the origin, course and treatment of the cases.

AMERICAN

JOURNAL OF INSANITY

AN ANALYSIS OF PSYCHOSES ASSOCIATED WITH GRAVES' DISEASE.*

BY FREDERIC H. PACKARD, M. D.,

Pathologist and Assistant Physician, McLean Hospital, Waverley, Mass. The not infrequent occurrence of a psychosis in the course of Graves' disease gives rise to such questions as: Is there a relation between the Graves' disease and the psychosis? If so, what is that relation? Do the psychoses occurring under such circumstances correspond in character to the various recognized psychoses, or do they show such characteristics as should entitle them to special classification? What is the prognosis in such cases? etc.

With the hope of answering these and some other questions I have undertaken an analysis of 82 cases presenting psychoses associated with Graves' disease. A few cases were patients at the McLean Hospital; most of the cases were collected from the literature.

As is well known, the diagnosis of Graves' disease is frequently made without the presence of all the classical physical symptoms, and frequently when the symptoms are very slight, so much so at times as to make the diagnosis doubtful. Among the cases to be here considered, however, the physical symptoms were in each instance tolerably well marked.

The interest in Graves' disease has for many years been considerable, and its frequent association with a psychosis has been noted. Many articles with reference to its etiology, and especially with reference to its treatment, have been written, and have aroused considerable interest. Many of the authors, however, have been general medical men or surgeons, and the psychiatric

* Read at the sixty-fifth annual meeting of the American Medico-Psychological Association, Atlantic City, N. J., June 1-4, 1909.

side of the question has been comparatively neglected. For many years such psychoses as were observed were considered to be the direct result of the Graves' disease, and have often been classified as Graves' psychosis. In text-books of psychiatry usually little or nothing is to be found concerning this subject. More recently attempts have been made to answer some of the questions above, and the analyses of a few cases here and there have given rise to some doubt as to the direct relationship between Graves' disease and the psychoses associated with it. Numerous opinions have been expressed, some to the effect that both the Graves' disease and the psychoses had a common etiology based upon auto-intoxication or inherited degeneracy; and some, recognizing the similarity between many of the psychoses seen with Graves' disease and in manic-depressive insanity, have gone so far as to suggest that in all cases of manic-depressive insanity we have as an etiological factor some disease of the thyroid. It will not be attempted to discuss these various theories, but merely to present an analysis of the cases collected and to draw some conclusions from the results.

The present collection of 82 cases includes 20 men and 62 women. In dealing with them, the fact was at once striking that of the 54 cases in which the heredity was stated, 63% showed a heredity for mental disease. In six cases there was also heredity for Graves' disease. In 26 cases, 32% of the total number, there were evidences of a neurotic or psychopathic make-up, and this figure is probably much too low, since in many cases no sufficient data were given to allow one to judge concerning this point. In this same connection is to be noted that 12 cases, 15% of the total number, had had psychoses previous to the onset of any objective symptoms of Graves' disease. Two had had more than one previous attack; in one case a psychosis had preceded the Graves' disease by two years, in one by eighteen years, in one by seventeen years, in two by five years, in one by four years, and in the remaining six the exact time was not given.

The age at onset of the Graves' disease varied from 18 to 63 years, the average being 33.9 years. Likewise the age at onset of the psychoses showed a wide variation, 18 to 66 years, the average being 35.8 years. That is, the psychosis came, on an average, about two years after the Graves' disease.

« ÎnapoiContinuă »