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 INSANITY 307 sds (probably the adventitious tunic of Vir- chow). They are caDed perivascular cavities, and present the appearance of holes seen in Gruyere cheese. They are generally empty, having smooth walls, without any lining mem- brane, but some of them containing the ves- tiges of blood vessels, with a few granules of heematoidine. Drs. Batty, Tuke, and Ruther- ford have also observed holes differing some- what from these, which, from their ragged character, they regard as produced by a solution of continuity of brain tissue, or to extravasa- tion and subsequent absorption of blood. The cells of the corpora striata and other nerve centres, and of the convolutions, are found in a state of pigmentary degeneration, and some- times in place of this fatty degeneration. Rind- fleisch, Rokitansky, Wedl, Tuke, and Ruther- ford have pointed out hypertrophy of the con- nective tissue in long standing cases of insanity, and particularly in the cortical layers of the brain in general paralysis. Increase of connec- tive tissue was at one time thought to be pecu- liar to general paralysis, but it is now known to be common to dementia following chronic ma- nia, as well as that which is consecutive to syph- ilis and in congenital idiocy. Schroeder van der Kolk found dark pigmentary degeneration in the ganglionic cells of the hypoglossal nerve, in a case of dementia after mania, where there was partial paralysis of the tongue. Pigmen- tary changes of a like nature have been found in the retina, in what is called retinitis pig- mentosa; and it is an interesting fact that they occur in members of the same family and where there is common deficiency of de- velopment. A pathological condition has been found in general paralysis by Drs. Poincari and Henri Bonnet, which it is thought will throw much light on the nature of this peculiar dis- ease. They have found brown pigmentary de- generation in the ganglionic cells of the whole chain of the great sympathetic nerve, to a de- gree far greater than in other cases. In the cervical and thoracic ganglia they found a sub- stitution of adipose cells for nerve cells, and they are led to believe that this is the starting point of the disease. A remarkable morbid appearance sometimes found, called the insane ear, or haematoma auris, caused by an effu- sion of blood between the perichondrium and cartilage, which without bursting shrinks away and leaves the ear shrivelled, is a peculiar and it is thought certain evidence that the person is or has at some time been insane. The sub- ject received particular attention from Dr. E. R. Hun while special pathologist to the New York state lunatic asylum at tJtica ; and from his investigations, which were published in the "American Journal of Insanity" for July, 1870, he established the following general conditions. Preceding the appearance of the tumor, one (rarely both) of the ears becomes red and swollen, the face and eyes of the patient at the same time indicating strong de- termination of blood to the head. Sometimes, however, the redness is absent, while the tume- faction is caused by an oedematous state of the auricle. In the course of a few hours, or it may be several days, an effusion of blood ap- pears on the concave surface of the auricle, varying in size from a bean to a hen's egg, in the latter case obliterating the natural ridges and depressions. Although apparently hard and unyielding, a careful examination detects a feeling of fluctuation and sometimes slight crepitation, supposed to be owing to the break- ing up of blood clots. The skin is smooth and distended, and of a purple color, except that of the lobe, which is unchanged. If the skin is ruptured, clotted blood escapes ; and if let alone, the opening closes and the sac refills. If kept open, however, a sero-purulent discharge takes place, which may continue for a long time, exudation of plastic lymph occurring in the mean time, uniting the walls of the cavity, and by subsequent contraction of the cicatrix pro- ducing the peculiar shrivelled appearance which is the sequence of the acute affection. When the sac does not become ruptured, much less deformity results. Examinations of the pulse of the insane have revealed some remarkable characteristics, which are described in the arti- cle PULSE. Enumeration of the Insane. The following table of the insane in various coun- tries, compiled from the report of Dr. E. T. Wilkins, commissioner in lunacy for the state of California, made in December, 1871, con- tains the most complete synopsis of informa- tion that can be procured at the present time : COUNTRIES. '{ i- 2 "5 3 1" No. of InMne In institu- tions. Total number of intan*. Tot.! population. United States 1870 1870 1870 1870 1866 1>64 1664 1864 1864 1664 1665 1868 ls-60 1S60 66 176 46 44 99 59 64 18 11 51 12 15,792 85,918* 6,035* 10,258 81,992 8,191 5,740 10..W5 8,215 1,660 5,481 8,179 1,271 657 87,882 54,718* 7,571* 17,194 60,726 16,929 4899t 7,481 6^35 7,612 88,555,988 22,090,168 8,222,a?T 6,195,288 87,988,906 24,268,820 19,252,863 18,747,687 13.n0ii.0i ) 4,807,440 4,984,451 8,592,415 2,605,024 8,859,728 1,668,254 Scotland Italy Other German states. Austria (proper) Holland Denmark 1S64 8 TABLE OF INSTITUTIONS FOE THE INSANE IN THE UNITED STATES. 1840 State 1842; State 1886! Corporate. 1818 Corporate. Augusta, Me Concord, N. H Brattleboro, Vt Somerville, Mass Boston, Mass ]1889i City. Taunton, Mass [18581 State Worcester, Maes '1S82 State Northampton, Mass.. 1S57! State Providence, E.I 1845! Corporate. No. of patienta at clou of 1873. Male. Female. Total 205 140 287 80 106 210 65 206 127 288 81 91 196 261 228 64 411 267 470 161 197 484 469 483 129
 * Including idiots. t In 1861.