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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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