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[REPRINTED FROM TEE NEW TORE MEDICAL JOURNAL, AUGUST, 1571.] 
A Treatise on Diseases of the Nervous System. By Wil- 
liam A. Hammond, M. D., Professor of Diseases of the 
Nervous System, and of Clinical Medicine, in the Bellevue 
Hospital Medical College ; Physician-in-Chief to the New 
York State Hospital for Diseases of the Nervous System, 
etc., etc. With Forty-five Illustrations. New York: D. 
Appleton & Co., 1871. Bvo, pp. 750. 
Pleadland, in his admirable essay on the action of medi- 
cine, founds his views primarily on certain propositions capable 
of distinct proof, superadding to these, hypotheses statedly not 
determined, but probable, and indulging, moreover, in other 
less certain speculations and theories, seeming to lead in the 
direction of truth. 
Dr. Hammond, in the book before us, makes no such clas- 
sification of his statements. He says in the preface: “ The 
reader will readily perceive that I have views of my own on 
every disease considered, and that I have not hesitated to ex- 
press them.” The views and observations of other writers 
upon nervous disease are so frequently quoted as to show the 
most intimate and comprehensive knowledge of the literature 
of the subject, and are often freely commented on, but the 
author’s own statements are made with a positiveness which, 
especially when the observations upon which they are based 
are embraced within a period of five years, is more convincing 
fo the student and young practitioner, than to those who have 
lived to see the most brilliant and widely-accepted theories 
exploded and forgotten, the most potent remedies and surest 
methods of u cure ” fall into disease, their names only remain- 
ing upon the catalogue of our arm amentary, an ever-accu- 
mulating testimony of human credulity and enthusiasm. 2 
BIBLIOGRAPHICAL AND LITERARY NOTES. 
The method of instruction here adopted directly supplies 
the demand of the present time, in this country, for the easy 
acquisition of the means of rapidly attaining pecuniary suc- 
cess by the practice of a specialty. It may well be hoy>ed, 
however, that the higher civilization of the future will induce 
a higher standard of knowledge, more philosophic aims, more 
diligent and reverent searching after truth for its own sake, 
than our schools now exhibit. 
The arrangement of the work and division of the subject 
on anatomical principles certainly conduce to clearness, and 
may well serve the student as a means of systematizing his 
ideas, though it may be questioned if the method has not been 
carried further, in some instances, than the present state of 
our knowledge justifies. 
The introduction relating to instruments and apparatus, 
the remainder of the work consists of five sections, respectively 
treating of diseases of the brain, of the spinal cord, cerebro- 
spinal diseases, those of nerve-cells, and of the peripheral 
nerves. Diseases of the sympathetic system, cerebro-spinal 
meningitis, chronic alcoholism, and Graves’s disease, are ex- 
cluded from consideration as being either little understood, or 
not sufficiently confined in seat and origin to the nervous sys- 
tem. Diseases are designated as far as possible by the lesion 
and not by the symptoms ; thus we search in vain in the in- 
dex for apoplexy, hemiplegia, paraplegia, hypertrophy and 
atrophy of the brain, hydrocephalus, etc. Information on 
these subjects is to be derived from the chapters on cerebral 
congestion, meningeal haemorrhage, partial cerebral anaemia 
from obliteration of cerebral arteries, cerebral softening, ce- 
rebral sclerosis, spinal haemorrhage, softening, etc. Of course 
this principle of nomenclature by lesions cannot be carried 
out in every case. Thus we have a separate chapter on apha- 
sia, the names tetanus, hydrophobia, and hysteria are re- 
tained, and the author describes for the first time an affection 
“ mainly characterized by an inability to retain the fingers 
and toes in any position in which they may be placed, and 
by their continual motion,” under the name of “ athetosis,” 
which is certainly a more convenient handle to a group of BIBLIOGRAPHICAL AND LITERARY NOTES. 
3 
symptoms than “ atrophy and disappearance of motor and 
trophic nerve-cells.” 
Those of the profession who, belonging rather to the con- 
servative class, believe that the differential diagnosis of many 
diseased conditions of the cerebro-spinal tract is wTel!nigh im- 
possible during life, and that several such conditions frequently 
coexist in the same individual, will not only be roused to 
wonder at the absoluteness with which the rules for distin- 
guishing various affections are laid down, but may find the 
book less convenient for reference than if the classification 
were based more directly on clinical history. 
Next to the diagnostic infallibility, if we may so express 
it, which pervades the work, we are struck with the strong 
reliance placed upon electricity and medicinal agents to effect 
cure. The use of the galvanic current is advised in seven out 
of nine of all the affections treated; the use of the bromides 
in fully one-half; the oxide of zinc, strychnia, phosphorus, the 
chloride of barium, and ergot, quite frequently, and far more 
positive results are predicted than are looked for by the ma- 
jority of the profession in the treatment of diseases of the 
nervous system. Hypereemia and anaemia of the nervous 
centres are ever prominent in the author’s mind as elements 
of disease, and he gives evidence of his belief in the practica- 
bility of controlling these elements in nearly every chapter. 
The constant galvanic current, “ when used so as to stimulate 
the sympathetic nerve” (by placing the two poles on the sur- 
face of the neck), he states, has the power of contracting the 
cerebral blood-vessels, and “ a similar effect is caused by pass- 
ing the current directly through the brain, the poles being 
applied to the mastoid processes.” It is claimed that observa- 
tion with the ophthalmoscope shows contraction of the retinal 
vessels while the current is acting, “and hence there can be 
no doubt that the result is produced upon those of the brain,” 
We believe that the authorities in this community most re- 
liable on the subjects of ophthalmoscopic investigation and 
intra-ocular circulation do not confirm these statements ; at 
ary rate, we may well hesitate to accept the conclusion drawn. 
But the author is equally confident of being able to reduce 
the amount of blood in the brain by the use of bromide of 4 
BIBLIOGRAPHICAL AND LITERARY NOTES. 
potassium in the dose of twenty to forty grains three times 
daily. The phraseology of the directions given leads ns to 
suppose that the dose intended to be prescribed is from fifteen 
to thirty grains; but as the teaspoonful is used as the standard 
of measure, of which a fluidounce contains only six, the doses 
would actually be as above stated. The desired results in- 
dicated by drowsiness, etc., would be expected in what is de- 
scribed as active cerebral congestion, in about ten days. No 
explanation is offered why the result does not take place 
earlier, if the presence of the bromide in the system causes 
the contraction of the vessels and cessation of the symptoms, 
and nothing is said of the probable duration of and reaction 
from uncomplicated cephalic hyperoemia, in about ten days or 
less, if it were let entirely alone, or if an efficient purgative 
were administered. The bromides are reenforced in the au- 
thor’s practice by the oxide of zinc, in doses of two grains, 
three times daily, but, as the subsidence of symptoms does not 
appear to be hastened, the reason for its administration is not 
obvious. Iron, quinine, strychnia, and phosphoric acid, are 
advised to be used together, to overcome “a little debility and 
mental depression” succeeding the congestion. We think 
many would prefer to “ let well enough alone,” after such an 
attack. 
In cerebral anaemia, alcoholic stimulation is the author’s 
main reliance, next to nutritious diet, and with the use of the 
combination of tonics above spoken of; and the use of bromides 
when this condition is diagnosticated is discouraged in the 
strongest terms. We do not think the experience of the pro- 
fession generally coincides with that of our author as regards 
the physiological activity of the bromides, in the usual doses, 
but any prohibition of medication would seem to merit atten- 
tion. 
The direct galvanic current is stated to be equally efficient 
in regulating the diameter of the blood-vessels, and conse- 
quently the amount of blood, in the spinal cord, as in the 
cerebral mass, the poles being applied, as usual, to the skin 
over the part. Of medicinal agents, ergot, in drachm-doses, 
three times daily, is relied on to produce contraction of the 
vessels of the cord; and the indication of increase of the BIBLIOGRAPHICAL AND LITERARY NOTES. 
5 
amount of blood in the organ, and improvement of its nutri- 
tion, “is easily fulfilled by strychnia, phosphorus, phosphoric 
acid, and opium.” 
The chloride of barium is stated to have produced marked 
improvement in the symptoms in sclerosis of the brain and 
spinal cord, but no theory of its mode of action is advanced. 
Nitrate of silver still retains a place in the author’s estimation, 
though not often mentioned, and not at all in connection with 
epilepsy. When we remember the reliance placed upon it, 
and other by-gones, by the profession, in the treatment of that 
disease, not many years ago, we may be pardoned for doubting 
whether the remedies now so highly recommended are not 
destined to fall into disuse in their turn. The fluctuations in 
the condition of unmedicated epileptics are so various that 
statistics require to be based on very long and discriminating 
observation, to be valuable. 
As our author unhesitatingly reduces the essential pathol- 
ogy of epilepsy to either congestion or anaemia, we are not 
surprised to find him relying upon the bromides, the oxide of 
zinc, and, of course, the primary galvanic current, or upon 
strychnia, for great improvement or cure in a large proportion 
of cases. We are surprised, however, to find no mention of 
limitation of the quantity of food as a therapeutic measure; 
the importance of which, in most cases of epilepsy capable of 
improvement, cannot well be over-estimated. 
On the whole, the tendency of the therapeutics of the book 
is in the right direction, most of the remedies, in the doses 
used, not being likely to do harm—at any rate, unless it be 
where mercurialization is advised in inflammatory disease ; and 
the supporting line of treatment, as by iron, quinine, cod-liver 
oil, and stimulants, being adopted in conditions of debility. 
Anodynes are used sparingly unless where no hope of recovery 
exists. The treatment of syphilitic lesions by mercury and 
iodide of potassium is advised. The abstraction of blood, 
application of cold and heat, derivation, and counter-irritation, 
are used discriminatingly. 
The chapter on insanity occupies less than sixty pages. It 
is obviously impossible to treat a subject of such magnitude 
and importance as this, satisfactorily, within such space, but 6 
BIBLIOGRAPHICAL AND LITERARY NOTES. 
this portion of the work will be especially likely to be looked 
at with curiosity and interest on account of the peculiar views 
which have been heretofore publicly promulgated by the 
author. And we think that, if evidence were wanting that his 
stand-point is theoretical rather than practical in regard to in- 
sanity, we should find it here. His classification is not one of 
types of disease, but is based upon his own conception of what 
he calls the four “ sub-forces ” which make up the “ force ” 
called the mind, namely, perception, the intellect, the emo- 
tions, and the will. We believe this view to be founded in 
confusion of ideas. It has been customary to speak of the 
intellect, emotions, etc,, as entities, but only by a figure of 
speech. Introspection and observation tell us that they are 
modes of action, not forces, and we should keep the matter 
clearer if we spoke only of volition and intellection instead of 
the will, and the intellect. That these functions of the indi- 
vidual self are always, during life, associated with the chemical 
and vital action of nerve-cells, and that disease of the latter 
may cause irregularity and imperfection of the former, we are 
all ready to admit, and upon this ground we hold the moral 
and legal responsibility of the lunatic to be impaired or de- 
stroyed. (But neither this nor any thing in the chapter before 
us proves that cerebration constitutes the whole of the inner 
life. The voice of the vast majority of mankind contradicts 
it by reason of a consciousness higher than that of the body.) 
If our author had said that mental action was made up of 
perception, intellection, emotion, and volition, we could follow 
his thought, but even then we should claim that volition dif- 
fers from the other processes in its unity of character, and yet, 
in never being carried on but in association with the others, 
perhaps constituting their direct combined result; while we 
conceive that perception, intellection, and emotion, besides 
being varied in character, go on even in spite of previous 
volition. From this we should deduce that volition would 
never be deranged but with or through disorder of one or 
more of the other functions; moreover, we should find that 
clinical observation would confirm our view. 
The various forms of insanity are grouped together in 
classes for purposes of description and study. It is an arbi- BIBLIOGRAPHICAL AND LITERARY NOTES. 
7 
trary, not a natural grouping, and tlie same individual may 
manifest disease in very different ways at different times. As 
the study of this affection can only he pursued with advantage, 
primarily, at any rate, from the practical stand-point, by the 
observation of actual cases, a simple classification, according 
to the most prominent characteristics for the time being, is 
the most advantageous, and in Esquirol’s live classes (as given 
in the book before us), melancholia, monomania, mania, de- 
mentia, and idiocy, we have a sufficiently elaborate scheme, 
for it will often be difficult to decide in which class to put a 
given case. General paralysis, epilepsy, etc., though usually 
accompanied by characteristic mental symptoms, are not in- 
variably so, and it is more convenient to describe them as 
causes and complications of insanity than to make separate 
classes of them. 
Dr. Hammond’s seven classes are perceptional, intellect- 
ual, emotional, and volitional insanity, mania (the union of 
two or more of the preceding), general paralysis, and idiocy and 
dementia. It would be useful if lunatics could be induced to 
conform to it; but, except so far as it covers the same ground 
as Esquirol’s, it conveys false impressions of insanity as we 
really find it. The existence of volitional insanity, that in 
which the will alone is affected, is denied by the highest 
authorities, its most characteristic feature as described being 
a failure to persist long enough to be investigated, and like 
another apocryphal form, mania transitoria, invariably pre- 
senting itself as the shield for criminal acts. Volition can 
neither take place alone, nor alone be disordered. 
.Notwithstanding the imperfect success of others, Dr. Ham- 
mond essays a definition of insanity ; but, though he makes a 
step in the right direction, he still appears to us to fall short 
of the mark. The difficulty seems to have been that all the 
attempts have been not at what Whately calls an essential 
definition, but at an accidental definition or description, which 
is necessarily imperfect. A true definition separates a phrase 
from all others, and limits its signification. 
Dr. Hammond says: “ Insanity, strictly speaking, is only 
a symptom, and I would define it as a manifestation of disease 
of the brain, characterized by a general or partial derange- 8 
BIBLIOGRAPHICAL AND LITERARY NOTES. 
ment of one or more faculties of the mind, and in which, while 
consciousness is not abolished, mental freedom is perverted, 
weakened, or destroyed.” The words “ characterized by ” 
seem at first refer to “ disease,” but the context shows them to 
refer to “manifestation.” We must therefore substitute con- 
sisting in for “ characterized by.” The succeeding clauses are 
either merely an extraneous deduction in regard to the indi- 
vidual, not belonging to the definition at all, or a gratuitous 
repetition of the idea included in “derangement of one or 
more faculties of the mind.” 
To be perfect, a definition must be simple. Insanity is, 
primarily, of course, unhealthiness • secondarily, unhealthy 
mental action • and by still further limitation, unhealthy men- 
tal action dependent on disease of the train. We cannot go 
far beyond this. It covers the ground exactly, and no more. 
The term is also frequently and necessarily applied to the dis- 
ease itself, as we have no other name for it. 
The author is often happy in description, and quotes 
various interesting cases, some of which have done duty in 
the text-books far too long, especially when brought forward, 
as here, after the lapse of years, in support of the doctrine of 
momentary insanity. Of course the existence of such a form 
cannot be disproved, but the accounts upon which the doctrine 
rests' are so meagre, ancient, and unsatisfactory, and it is so 
inconsistent with modern impartial observation of the disease, 
that we look forward to its ultimate universal recognition as a 
chimera. 
The illustrations of this chapter are singularly infelicitous, 
considering that they were selected from a large number of 
photographs of patients in the New York Asylum. Acute 
mania in the person of a Celtic maiden wears an expression 
of imbecility; one illustration of mania with depression, of 
which the text says “ apprehension and terror are plainly 
depicted on her countenance,” stares with a placidity rivalling 
Mrs. Jarley’s wax-works. The next is the picture of a micro- 
cephalic Celt, without expression, of unknown history, but in- 
tended to illustrate the same disease. Then comes a reproduc- 
tion of the case of general paralysis from the frontispiece of 
Bucknill and Tuke, even worse than the original, soon followed BIBLIOGRAPHICAL AND LITEEAEY NOTES. 
bv a figure representing dementia, in which the fixed attitude, 
clasped hands, and closed eyes would seem to indicate a deter- 
mined shutting out of the external world, rather than mental 
weakness. 
The illustrations in other parts-of the work are excellent. 
The author’s clear and terse style of diction renders the 
book exceedingly readable, and the cases reported and cited 
add much to the interest of the text. There is little in it be- 
yond the comprehension of the average student of medicine; 
and the fourth volume of Dr. Austin Flint, Jr.’s, “Physiology 
of Man,” soon to be published, will make it more useful to 
him, the two together being intended to form a complete work 
on the physiology and pathology of the nervous system. 
The symptoms, causes, diagnosis, prognosis, morbid anat- 
omy, pathology, and treatment of each affection, are distin- 
guished by separate headings of broad-faced type, which is 
exceedingly convenient of reference, and adds to the appear- 
ance of the pages. The paper is of an agreeable tint, and the 
typography is very fine, and surprisingly free from error. 
The morbid anatomy and pathology are of course brought 
fully up to the present state of knowledge, and there is much 
statistical information under these and other heads, gathered 
from every source, and here brought together for the first time, 
and wherever possible this is relied on as the basis of doctrine. 
The changes of structure are accurately described, as regards 
both gross and microscopic appearances, and the latest investi- 
gations of the minute anatomy of the nervous centres are not 
merely alluded to but freely quoted, and the author’s own ob- 
servations are frequently given, confirming and adding to what 
others have done in this field. 
The portrayal of symptoms is often graphic and striking. 
The phenomena of disease are so described as to impress them- 
selves forcibly on the mind of the student. There is so much 
that is entertaining in the mental and other manifestations ol 
nervous disorder, especially when presented as they are here, 
that a work of this kind will find many readers outside the 
profession, and, it may be hoped, will serve not only to interest 
and amuse, but to induce a closer observance of those hygienic 
laws upon whose violation many of the ailments here treated 10 
BIBLIOGRAPHICAL AND LITERARY NOTES. 
of depend. There is probably no community in the world 
more in need of caution and warning as to the abuse of the 
nervous system than our own. The majority of the busy 
crowd that tills the streets of this city are working at high 
pressure, and many only realize that human powers are indis- 
solubly associated with physical structure when overtaken by 
actual disease. 
Some of the latter portions of the volume are not elabo- 
rated with the care displayed in the earlier part, but system 
and order prevail throughout.