OF THE INFLUENCE OF DISEASE UPON ATTENTION AND

MEMORY.

THE preceding imperfect outline of the subject of memory naturally leads us briefly to investigate the manner in which this function is impaired in connection with bodily disease. This takes place chiefly from injuries of the head, affections of the brain, fever, and diseases of extreme debility. Similar effects arise from intemperance and other habits of dissipation. Our present purpose, however, is, not to investigate the peculiar effects of these various causes, but to endeavor to trace the manner in which attention and memory-and we may include perception-are affected by any or all of them.

The first mental function which is impaired by bodily disease, is usually the power of attention; this we see illustrated in all febrile affections. The patient, in the early or milder stages, is incapable of fixing his mind upon any thing that requires much attention, of following out an argument, or of transacting business which calls for much thought or consideration. He is acute and intelligent as to all common occurrences, and shows no want of recollection or of the power of reasoning when his attention is excited; but he feels it an exertion that is painful to him. In a higher degree of this condition, he is still intelligent as to what is said or done at the time, or in recognising persons; but in a short time forgets every thing in regard to the person or the occurrence. He is incapable of that degree of attention which is necessary for memory, though the powers of perception are entire. In the next stage he becomes incapable of receiving the full impression from external things; and, in consequence of this, he mistakes the objects of his own thoughts for realities. This is delirium, and there are various degrees of it. In some cases the atten tion of the patient can be roused for a time, and directed to

What bodily affections influence the memory? Object of this discussion? What function first impaired? First stage, effects what? Second stage? Third stage? Its name ?

the true relations of external things, though he relapses into his delirious impressions when he is left undisturbed: in others, the false impression is constant, and cannot be corrected by any effort which is made to direct the attention; and in a third modification of this remarkable condition, he mixes up his hallucinations with external impressions in a most singular manner. He is still capable, however, of describing his impressions,-that is, of talking so as to be understood, though what he speaks of relates only to his erroneous conceptions, or mere bodily feelings. In the next stage he either does not attempt to express himself at all, or is entirely unintelligible. He is now cut off from communication with external things and with other sentient beings; and the highest degree of this is what we call coma, or stupor, which resembles profound sleep.

This description refers chiefly to the gradations in the state of the mental functions which we observe in continued fever. It is particularly interesting to trace them in this disease, because we see the various grades passing into one another, and thus showing in a connected series the leading peculiarities which, in other affections, we have to contemplate separately. These peculiarities may be chiefly referred to the following heads.

It will be observed that these heads are substantially a repetition and more full examination of those in the preceding paragraphs. The pupils will be very much assisted in understanding and remembering them, by calling to mind cases which have occurred within their own observation, and arranging them under their respective heads.

I. A state in which the attention cannot be steadily directed to a long and connected train of thought, or to any thing requiring a continued effort of mind. This takes place, as already stated, in the earlier stages of all febrile diseases. It likewise occurs in connection with the debility which succeeds acute diseases, in persons broken down by intemperance, and in the first approaches of old age. It is also often observed in a remarkable degree in connection with a disordered state of the stomach.

II. A state in which the impression made by external

Three modifications of this stage? Fourth stage? Its name? In what disease most commonly observed. First state? In what disease does it occur? Second state?

things is not sufficient to produce remembrance, though there appears to be, at the time, a perfect perception. A person so affected understands what is said to him, and answers correctly, but very soon forgets what has passed; he knows a friend, and is happy to see him, but in a short time forgets the occurrence. This is met with in a more advanced state of febrile diseases, in the higher degrees of the condition which results from habitual intemperance, and in the more advanced periods of age. It also occurs in diseases of the brain, and in cases of injuries of the head. A lady whom I attended some time ago, on account of an injury produced by a fall from a horse, lay, for the first week, in a state of perfect stupor; she then gradually revived, so as to be sensible to external impressions, and after some time to recognise her friends. But afterward, when she was entirely recovered, she had no recollection of this period of her convalescence, or of having seen various friends who then visited her, though, at the time, she recognised them, conversed with them sensibly, and was very happy to see them.

III. The third condition is that in which external impressions are either not perceived at all, or are perceived in a manner which cannot convey any distinct notion of their relations to the mind. On this account the conceptions or trains of ideas existing in the mind itself are believed to be realities. This remarkable condition belongs properly to another part of our subject. It occurs in various forms of delirium, and constitutes the peculiar characters of insanity and dreaming. The ideas or conceptions which occupy the mind in this condition are various. They may be trains of thought excited by some passing event or some bodily sensation; and frequently the patient repeats something which is said in his hearing, and then branches off into some other train to which that has given rise. In other cases the impression is one which has been brought up by some old associations, even relating to things which the person when in health had not recollected. Of this kind there are various remarkable examples on record, especially in

Describe the effects. Diseases in which it occurs? Case described. Third statewhat? Describe its effects

regard to the memory of languages. A man, mentioned by Mr. Abernethy, had been born in France, but had spent the greater part of his life in England, and for many years had entirely lost the habit of speaking French. But when under the care of Mr. Abernethy, on account of the effects of an injury of the head, he always spoke French. A similar case occurred in St. Thomas' hospital, of a man who was in a state of stupor in consequence of an injury of the head. On his partial recovery, he spoke a language which nobody in the hospital understood, but which was soon ascertained to be Welsh. It was then discovered that he had been thirty years absent from Wales, and, before the accident, had entirely forgotten his native language. On his perfect recovery, he completely forgot his Welsh again, and recovered the English language. A lady, mentioned by Dr. Prichard, when in a state of delirium spoke a language which nobody about her understood; but which also was discovered to be Welsh. None of her friends could form any conception of the manner in which she had become acquainted with that language; but after much inquiry it was discovered, that in her childhood she had a nurse, a native of a district on the coast of Brittany, the dialect of which is closely analogous to the Welsh. The lady had at that time learned a good deal of this dialect, but had entirely forgotten it for many years before this attack of fever. The case has also been communicated to me of a lady who was a native of Germany, but married to an English gentleman, and for a considerable time accustomed to speak the English language. During an illness, of the nature of which I am not informed, she always spoke German, and could not make herself understood by her English attendants, except when her husband acted as interpreter. A woman who was a native of the Highlands, but accustomed to speak English, was under the care of Dr. Macintosh of Edinburgh, on account of an attack of apoplexy. She was so far recovered as to look around her with an appearance of intelligence, but the doctor could not make her comprehend any thing he said to her, or answer the most simple question.

Case described by Mr. Abernethy? The patient at St. Thomas' hospital. The lady mentioned by Dr. Prichard. Explanation of it? The German lady. Dr. Mactosh's patient.

He then desired one of her friends to address her in Gaelic, when she immediately answered with readiness and fluency. An Italian gentleman, mentioned by Dr. Rush, who died of the yellow fever in New York, in the beginning of his illness spoke English, in the middle of it French, but on the day of his death he spoke only Italian. A Lutheran clergyman of Philadelphia informed Dr. Rush that Germans and Swedes, of whom he had a considerable number in his congregation, when near death always prayed in their native languages, though some of them he was confident had not spoken these languages for fifty or sixty years.

A case has been related to me of a boy, who at the age of four received a fracture of the skull, for which he underwent the operation of trepan. He was at the time in a state of perfect stupor, and after his recovery retained no recollection either of the accident or the operation. At the age of fifteen, during the delirium of a fever, he gave his mother a correct description of the operation, and the persons who were present at it, with their dress, and other minute particulars. He had never been observed to allude to it before, and no means were known by which he could have acquired the circumstances which he mentioned. An eminent medical friend informs me, that during fever, without any delirium, he on one occasion repeated long passages from Homer, which he could not do when in health; and another friend has mentioned to me, that in a similar situation there were represented to his mind, in a most vivid manner, the circumstances of a journey in the Highlands, which he had performed long before, including many minute particulars which he had entirely forgotten.

In regard to the memory of languages as influenced by these affections of the brain, a condition occurs, the reverse of that now mentioned, and presenting some singular phenomena: the cause of the difference is entirely beyond our researches. The late Dr. Gregory was accustomed to mention in his lectures the case of a clergyman, who, while laboring under a disease of the brain, spoke nothing but Hebrew, which was ascertained to be the last language that he had acquired. An English lady, mentioned by Dr. Pri

Other examples. Case of the boy? Things which he remembered? Peculiar phe nomena connected with the memory of languages?