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INSANITY cannot be accurately defined, because in its various modifications it borders too closely on other nervous diseases ; and it exists in all degrees, from the least to the greatest state of cerebral derangement. But we are capable of adverting to several morbid symptoms, which seem to concur in almost all its modifications. The consideration of Insanity may be divided into two parts :—the morbid symptoms of disorder in what are called the automatic functions of the animal Machine; and the particular hallucination or kind of insanity. The former of these may be properly considered as the disease which is to be subjected to medical treatment; and it consists more or less in a too great determination of Blood to the Brain : the latter depends principally on the original structure and comparative magnitude of the different organs of the brain, or in their comparative activeness ; and it is much under the influence of moral causes. On the former depends the existence of the disease ; on the latter, the varieties in its modifications. The former may be called the disordered state of the automatic functions, the latter, that of the functions of animal life. Their division will be more fully illustrated by the subsequent detail of symptoms.
§ 2. In cases of Madness, as in all those diseases called nervous, there appears a particular determination of blood to the head, producing, in many cases of insanity, a slow inflammatory action
of the vessels of the brain and its coverings. This fact has of Late been almost indisputably proved. It was first impressed on my mind by observing the greater degree of density, hardness, and weight, of the sculls of madmen; a circumstance which became known when the students of the physiology of the brain collected a great number of crania, particularly Gall and Spurzheim. I had in
my possession a great many, which were dense like ivory, and which differed materially in texture from the sculls of healthy persons. This hardness of the cranium is not near so great in persons subject only to those nervous diseases which produce less violent and less perverted cerebral action. It is conformable to acknowledged facts to ascribe the aforesaid hardness of the scull to continued inflammation of the head.
The great determination of blood to the head in Insanity, increased during its paroxysms, may be felt at the carotid and temporal arteries, as was frequently proved to 'me when I first attended to this disease. But the great disproportion between the pulsation of the radial artery and the carotid, which would lead directly to the knowledge of the particular determination of blood, seems most distinctly
and accurately noticed in a small tract published by my friend, Dr. Thomas Mayo.' I have perceived this symptom wherever I have been permitted to examine patients during the paroxysm ; but I passed it over, from finding it to occur in other nervous disorders.
This fact of its being common in other disorders of the sensorium, shows that something more is yet necessary to produce the insane state of the brain. I believe this other thing to be referrible to the particular seat of the inflammatory action, which the determination of blood to the head either directly causes, or at least is closely connected with. And this view of the subject, corroborated by numerous facts, enables us in some measure to explain the modifications of the symptoms. In the present section I shall confine myself to the automatic functions, and to the medical treatment.
With respect, however, to the cause of the physical symptoms, there appears some obscurity : for though the cerebral inflammation be a prominent symptom, the cause of the determination of blood to this or that part of the brain remains, in many cases, unexplained. I consider it as the consequence of the too great activity of the cerebral organs, either the result of hereditary predisposition, or of violent excitement from strong emotions of the mind,
* This 'Tract, professedly founded on the long practice of Dr. Mayo, sen., is highly valuable from its perspicuity of diction, its exemption from bypothesis, and the importance of the treatment it recommends.
or as resulting from the co-operation of these causes. According to this view of the phenomena, passions which call any particular part of the brain into violent action may not only favor the disordered state of the automatic functions, which may be necessary to insanity, but may also determine the particular hallucinations. This opinion might be fairly deduced from the doctrine of the plurality of Organs in the Brain, even were there not other circumstances which could confirm it.
If we carefully examine the ostensible symptoms of disease in Insanity, we shall find them such as occur in most other nervous complaints. The hurried action of the vascular system, particularly in the pulsation of the carotid and of the temporal arteries, the determination of blood, as well as the insensibility of the stomach to stimuli, are found in numerous diseases in which the usual functions of the mind remain unimpaired. But a very similar treatment appears beneficial in all those diseases which are marked by the above phenomena ; namely, alterative medicines and depletion : because in all, the principal object is to rectify the state of the digestive functions, and to diminish the inflammatory action of the vessels of the head : consequently, the clear elucidation of the fact, that Insanity occurs where the inflammatory action affects the internal organic parts of the Brain, and that it varies according as particular Organs are affected, becomes more a subject of curious
curious speculation, than of absolute medical utility ; at least so far as respects the medical treatment. I shall proceed, however, in endeavouring to illustrate this fact, since it is closely connected with the consideration of the moral causes, and tends also to prove that the determination of blood to the head is only secondary in the chain of the physical causes of Insanity, though it evidently reacts on, and perpetuates the primary cause, which consists in irritation of the Organs, but which is often diminished or wholly removed, when, after a course of lowering medical treatment, the determination of blood is lessened or destroyed. The same argument seems applicable to the disorder of the digestive organs, which reacts on the Organs of the Brain. Hence alterative medicines and bleeding become important; since cerebral inflammation, as well as the disordered bowels, would maintain the primary cause, which, by a reflected action, would mutually keep up the disorder in the vascular and digestive organs. The primary cause, that is the too great activity of the Brain, is, therefore, the real object to be removed. The disposition to it is connate and hereditary, and is brought on by moral causes which violently excite the Brain, and also by disorders which, beginning in the digestive or vascular systems, excite those of the cerebrum by sympathy: it is subject, like disorders of other parts, to casual and periodical parox
ysms, depending on atmospherical Influence; and it is often cured by the power of depletion to remove the secondary and exciting causes. It sometimes ceases of itself, when, by great changes in the atmosphere, some external irritant is apparently withdrawn.
The doctrine, that Insanity is connected with cerebral inflammation, and that the kind of hallucinations vary according as particular organs
of the brain become the seat of the affection, is confirmed by collateral observation on other nervous diseases. In all these there appears an evident increase of the quantity or momentum of blood in the head, subject to particular laws of distribution, whereby different parts become affected. Dr. Parry has ably illustrated this fact : and it begins to be a general doctrine among other distinguished writers on medicine.
But the primary cause is apt to be overlooked, or confounded with the ostensible symptoms. The opinion maintained by M. Abernethy seems, to me at least, the most rational : for though in nervous diseases, and in those denominated local, there be a particular increase of vascular action, yet we must eventually refer this action to irritation, previously occurring in weak and susceptible parts. Moreover, when the nervous irritation occurs, from whatever cause, weakness of particular parts is not the only cause of their becoming the seat of the disease. There are atmospherical causes, which happen casually, and are insensible, that not only irritate generally, but which fix the particular symptoms, as well in the human subject as in animals. 1 This external influence is local in some regions ; and on the knowledge thereof is founded the custom of prescribing particular places as medical agents in the cure of particular diseases, and of proscribing others as insalubrious. The eyes in one place, or at one time, are most affected; the ears at another ; and so on. In these cases, the determination of blood must be referred to the recurrence of local or sympathetic irritation.
External causes of irritation produce similar effects, which are more transitory, because there be no permanent cause, acting by sympathetic influence : but when this external cause is violent, the inflammation produced reacts on the irritated nerves, and the disorder is protracted. I shall endeavour to show, in the sequel, that this is precisely the case with many kinds of insanity; that is, similar causes, acting on the cerebral organs, produce Madness, which, when they occur in the nerves of the senses, produce erroneous or imperfect sensation, and in the other parts of the body cause local complaints. Reserving this application of the doctrine to insanity to another section, I shall proceed to enumerate some of the symptoms of several dissimilar nervous complaints.
'A correct history of the plagues and epizooties which are recorded in history, compared with journals of the clectroscope, would be highly interesting.
$ 3. Too much exertion of the eyes, independently of premature paralysis of the nervous apparatus, produces local inflammation in the circumjacent parts. But opthalmic diseases occur also from sympathetic and atmospherical influence : so also of other parts.
The auditory apparatus affords an example : violent sounds, like sudden glare of light to the eyes, cause inflammation of the organ. Deafness is frequently caused by an accumulation of blood, either producing obstruction in the Eustachian trumpet, or in some other part of the ear. It is sympathetic, is under the influence of the atmosphere, and is sometimes relieved by hæmorrhages. In Epilepsy, violent affections of the Mind bring on the attack ; while it is
< sometimes referrible to the sympathy of the Brain and nervės with the overloaded or irritated stomach ; or is the result of the two causes acting together. I need not enumerate other diseases. I have already called attention to the nervous irritation, from local, sympathetic, and atmospherical irritants, as the principal cause ;--to increased vascular action and disordered bowels, as the regular concomitant and maintaining force in the disease ;-to the periodical recurrence of the symptoms which mark stages in the progress of the malady ;—and to the successful treatment by means of alterative medicines and depletion.
$4. An irritable state of the Brain, and inflammatory action of its vessels, is common to insanity of almost all kinds, and to nervous diseases of very dissimilar sorts. But the partial affections of the organs explain the peculiarities of the symptoms. Recent discoveries in physiology have taught us to regard the brain as a complication of many distinct organs, which are the material instruments of different sentiments, propensities, and intellectual faculties, of animal life. As the natural and healthy functions of these organs is different, so must they excite different maniacal ideas in a state of disease. We find, agreeably to this view, that when any particular organ be larger than ordinary in mad persons, their insanity often consists in some derangement of that particular faculty of which the large organ is the instrument. I have examined too many cases of melancholy, for example, to doubt of the following fact, which I have constantly found ; that the organ of cautiousness, or that part of the brain under the upper posterior part of the parietal bone, is generally much developed in that modification of insanity. I have observed frequently a very large cerebellum in persons deranged by furor uterinus ; and in those who, during their maniacal paroxysms, have manifested violent erotic propensities. I recollect two cases of persons with a natural genius for mechanics, who, when insane, raved of machinery, and who