be an exceptional occm'rence." He also cites the well-known
case of Dupuytren, who, while lecturing to his class, in 1834,
was attacked with paralysis, and had the courage and mental
firmness to support his face with his hand until he concluded
his lecture. That mental impairment is not often tlie direct
consequence of apoplexy is undoubtedly true, the real cause
lying deeper, and being rather to be looked for in the original
diffused lesion, which gave rise to the effusion, than in the
384 PRACTICAL EELATIONS OF MORBID
effusion itself. Still, wliile adhering to tlie fundamental fact,
which, has been the groundwork of this paper, that the two
series of morbid phenomena, the psychical and the motor,
bear to each other simply the relation of different and not
constant manifestations of disease in the same organ, and that
the existence of each is to Glycomet Gp be independently proved — not
assumed — from the fact of the presence of the other, it must
yet be allowed that, in tlie larger part of all cases of hemi-
plegia, there is more or less mental impairment. The dif-
ficulty experienced by different observers in arriving at a
common conclusion woiild seem to arise from the fact that, in
very many cases, the mental unsoundness is of such a charac •
ter Buy Metformin Online as only to become revealed to a very scrutinizing and
comprehensive search — Glycomet 500 Sr one Glycomet Tablets involving a full examination, not
only of the present character Glycomet Gp2 and mental condition of the
individual, but also Glycomet 850 Mg his mental capacity and moral character
previous to the attack. There may be no delusion, no remark-
able exaltation or depression, no noticeable defect in memory,
in powers of conversation, or in capacity for the performance
of many of the duties of life, and yet there may have been pro-
duced a Glycomet 500mg total change in ways of thinking, in tastes, and
especially in the affections, and in the mode of viewing every
act in which self is deeply involved. The prudent man may
become a prodigal ; the chaste, lewd and lascivious ; the
temperate, a sot ; the kind, calm father and husband, an
irritable and unreasonable tyrant ; the religious man, profane ;
and he who was scrupulously regardful of the proprieties of
life, loAV and vulgar. It is most noticeable in this connec-
tion that, while the change of character is almost invariably
from better to worse, there are undoubtedly some occasional
exceptions to this, in which, while the intellect is weakened,
the moral tendencies become purer and more elevated. It is
of the utmost importance in the examination of such cases to
bear in mind, as Dr. Maudsley says, wlien speaking of moral
insanity, that " the individual is a social element, and to have
regard, therefore, to his social relations. That which would
hardly be offensive or unnatural in a person belonging to
the Glycomet Sr 500 lowest strata of Glycomet 500 Mg society, and certainly nowise inconsistent
with his relations there, would be most offensive and unnatural
MOTOE AND PSYCHICAL SYMPTOMS. 3S5
in one holding a good position in society, and entirely incon-
sistent Glycomet Sr witli his relations in it." Examined in this broader
and more comprehensive view, many of the cases snpposed
to be imaffected wonld undoubtedly manifest unequivocal
symptoms of mental impairment. Still, a sufficient number
of cases remain to render it imperative that insanity should
always be proved — not assumed.
Paraplegia. — As might be expected from the nature and
usual cause of this form of paralysis, mental soundness is the
rule, and impairment the exception. As a rule, paraplegia is
generally admitted Glycomet 850 to depend upon a lesion in the spinal cord,
and often in the lower portion of it. The intimate connec-
tion, Glycomet Price however, between the Glycomet 1gm brain and spinal column — so
intimate that, without violence to truth, the latter might well
be considered as a prolongation of the former, and the two
as constituting in reality a single organ — would naturally lead
to the conclusion that, not unfrequently, the existence of dis-
ease sufficient to cause paraplegia would be accompanied by
such changes in the cerebral structure also as to lead to mani-
festations of mental unsoundness, Buy Metformin either by an extension of
the disease from Glycomet 250 the cord to the brain, or, in consequence
of an original similarity in the constitution of the two in
the same individual, leading them to yield to similar causes
of disease. When the fundamental lesion is either spinal
meningitis Glycomet 500 or myelitis, this extension to Glycomet Gp1 the brain, and also
a corresponding condition of the cerebrum, is more certainly
to be looked for. If, on the other hand, either spinal apo-
plexy, or some morbid growth, or parasites existing in the
spinal column, produce paralysis by.pressm-e, the probability
of the brain being either concurrently Glycomet Gp 2 or subsequentl}' in-
volved is very small. That a certain small percentage of
the cases of paraplegia are dependent upon disease in Glycomet Tablet the
cerebi-um solely, has also been satisfactorily shown by patho-
logical investigation, and, in more or less of these, psychical
symptoms are, of course, to be anticipated. It is evident,
therefore, that although much the larger part of paraplegic
patients may be entirely free from morbid mental symptoms,
yet instances of the latter are likely to be frequent enough to
lead to a cautious scrutiny of all extraordinary acts com-
as
3S6 PRACTICAL EELATIOlSrS OF MOEBID
mitted by this class of patients : and here, as well as in liemi-
plegia, is the necessity imperative for an investigation so broad
as to take in all the elements — that of the previous character,
of the social condition, and of the original intellectual power.
Partial or Local Paralysis. — As might naturally be expected,
local paralyses, except of certain special nerves, have far less
significance in their bearing upon the subject of mental con-
dition. They are produced in general by causes operating
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