On The Pathology Of Insanity
590 To the Ed it on of tiie Journal of Psychological Medicine. Sir,?An interesting work, entitled, “On tlie Nature and Proximate Canse of Insanity,” lias been kindly forwarded to me by a friend?and as it professes, among other matters, to deal with certain pathological opinions of mine, which opinions must have been derived mainly from the pages of the ” Psychological Journal,” you will allow me, perhaps, some space in that Journal, to correct the errors which, by partial quotations, the author of the above work has pro- mulgated respecting them.
I am unwilling that the facts upon which my opinions arc based should lie distorted and misrepresented; or that opinions which I repudiate utterly shoidd be given to the world as mine, upon so high an authority as that of Br. Davey.
At page 13 of the cited publication, the author writes, “I have already stated, on the authority both of Foville and Dr Hitclnnan, that in cases of acute mania, the grey matter of the brain is found of ” a most intense redness, approaching to that of erysipelas,” or “injected and of a rose colour.” It must be a source of regret to him, earnest in the pursuit of truth, and without the opportunity found in an establishment like Hanwell, or Colney Hatch, to eollect the necessary facts for himself, to discover so very manifest a discre- pancy in the reports and opinions of our most practical and scientific men. Thus, whilst Foville and Dr Hitchman affirm that the grey matter is injected and of a rose or scarlet colour, Mr. Solly is found to declare the same struc- ture to present, and in the same disorder (mania), ” a dark plum colour And further, I have before me the notes of a post-mortem examination of M. A., a patient of the Hanwell Asylum in 1842, and who died there under my care, <hiring a paroxysm of acute mania, in whom Dr Conolly has reported that “the cineritious” substance was “generally very pale,” but for these, and not less the foregoing contradictions to which I have had occasion to draw the attention, I hope to oiler a most satisfactory explanation in the succeeding remarks; and more than this, to render the same the means of demonstrating the bona fule nature and scat of mental derangement in all its various phases. No further elucidation of my opinions is given, except such extracts as would leave the reader to believe that I limited the physical causes of insanity to a roseate condition of the cerebral hemispheres. Whereas, the very con- trary is the opinion which I have inculcated both in the clinical classes at Hanwell, and in my published writings. The “plum colour” observed by Solly, and the “generally very pale appearance” recorded by Dr Conolly, are by no means ” contradictory” to my views, for in the very lecture from which I sup- pose Dr Davey lias culled “these, “contradictions,” I state, that “insanity may be produced by impaired nutrition,” as well as by “an excess of blood, or its too active circulation;” or the converse of these lrom various conditions ot the heart, and other causes. Indeed, the object of all my labours has been to show the fallacy of those theories which would assign so complicated a malady as insanity to one special corporeal ailment, whether that ailment be ” deficient nervous tone,” which has been so ably, elegantly, and modestly enforced by Dr Henry Monro, or be a ” sanguineous erethism,” as advocated by Guislaiu. (See No. 12 of this Journal.) While the examination of several hundred lunatics has convinced me, that one structure is mainly implicated in this malady, I am equally certain that the pathological conditions are most numerous, and that either a “roseate hue,” a “plum colour,” or a very “pale
GOO ON THE PATHOLOGY OF INSANITY.
state of the cerebral convolutions,” may be the concomitants of extensive mental disease; as, on the other hand, no physical change whatever may be detected after death, the disturbance of the cerebral structure being induced either mechanically by pressure of contiguous structures?by blood?poison, or by vital sympathy with remote organs.
As the faithful historian of what 1 saw, I stated that, in three cases of recent mania, the convolutions were found of a roseate hue, but I have nowhere stated that they are not found of other colour than this. On the contrary, “the burden of my song” has been, that ” there will occur a multiplicity ot visible changes in that structure, by any of which insanity may be caused;” and the last time I ever had the honour to address a public assembly of medical men, my words were these?” In conclusion, it may be restated, that, with one ex- ception,, in every case of acute idiopathic mania {i.e. which I had seen), the cineritious neurine of the hemispherical ganglia was found of a roseate or red- dish hue, and this accords with the larger experience of Eoville. In some cases there is reason to infer that this erythema may disappear in the act of dying, or immediately after death, as an inflamed conjunctiva may become blanched in the act of syncope. In dementia this structure is often pale, soft, and atro- phied. My whole object is, however, to show that insanity is not dependent upon any special form of disease in th is structure, but that any extensive pathological change of this part of the brain will be productive of mental derangement; and further, that all other physical disturbances, which produce mental disease do so by creating functional disorder, or organic change in the grey portion of the cerebral convolutions ; and that thus, we may still discover a unity of principle, even where facts appear discrepant and contradictory.”? Transactions of P. Med. Assoc., p. 152.
The special views of Dr Davey do not demand any notice from me. They have been fairly criticised in your remarks on Dr Monro’s work (Journal, p. 341), in which it is shown that the asthenic character of insanity has been fully recognised by Mr. Ncsse Hill and Crichton; while the researches of Marshall Hall had abundantly proved that analogous symptoms might be pro- duced either from an excess or defect of blood in the brain. My thanks are, however, due to Dr Davey for associating my name, even for a passing moment, with those of Eoville, Conolly, and Solly; and especially do I thank him for confirming my opinions in language so like my own as the following:? Davey.
“There can be 110 doubt that the various effusions, opacities, adhesions, and vascularities, and so on, which appear on the examination of the brain and its investing membranes, in per- sons dying insane, must be regarded as the mere elfeets of the cerebral dis- order, and not as its first cause.”? Page 38, Op. Cit., 1853. ” In the grey matter of the brain, then, is located the proximate cause of insanity.”?Page 35, Op. Cit., 1853. Hitciiman. ” I believe that before the scalpel can reveal opacity, thickening anil infiltra- tion of the membranes, or congestion, inflammation, softness, or hardness of the medullary matter, there mnst have been great and important changes long going on, and that nccroscopic appear- ances ought to be regarded more as results than causes, as the effects rather than the sourcc, of the malady.” ?Lancet, vol. ii., 1847, p. 5fi4. ” Idiotism is the result of deficient or diseased cineritious matter (existing from birth) in the convolutions of the brain; and that insanity is caused by some change, either functional or or- ganic, in the same structure.”?Lancet, Dec. 1847.
” Admitting that the proximate ” Each and all of these causes act by cause of insanity consists in an irrita- producing functional disturbance or tion (or morbid sensibility) of the grey structural change in the vesicular neu- matter.”?Page 30, 1853. rine (grey matter) of the encephalon.” ?Psychological Journal, 1850. ” Any disease whatever in the eine- ritious neurine of the convolutions of the brain, whether it be strumous de- terioration, inflammation, or anaemia, which involves, directly or indirectly, a large extent of this important struc- ture, may be productive of mental de- rangement.” ? Provincial Transac- tions, 1852.
These extracts are introduced with no invidious feeling towards my friend Dr Davey, least of all, to insinuate the fault of plagiarism against him; for of this I believe him to be wholly incapable; but for the purpose of showing that observers may agree, as well as differ, and especially for the purpose of remov- ing one “of those discrepancies” which are a source of “so much regret to him” (the unhappy wight!) “who, earnest in the pursuit of truth,” has never had the good fortune to live cither at Colney Hatch or Hanwell.
I am, Mr. Editor, Yours truly, John Hitchman. Derby County Asylum, Mickleover, August 17th, 1853.
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