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energies upon the provision of ideas furnished by memory, and by its own emotional and instinctive habits.

Pathology of Monomania.-Every one conversant with the phenomena of insanity, is aware that there is a considerable number of patients in whom the aberrations from mental soundness are limited in the range of objects to which they apply, and in the range of subjective faculties which they implicate. In many instances of this kind, an enduring perversion of the modes of thought, the foundations of belief, and the workings of emotion on one, or at least a few objects, are the well recognised symptoms of that form of disease which systematic readers treat on under the head of Monomania. It would be incorrect to say, that in the purest cases of monomania none of the faculties are weakened, since the simplest hallucination or delusion proves a want of healthy energy in the perception or the judgment. But as a whole, and outside the morbid subject of opinion and feeling, the mind is not weakened. Moreover, the general health of such patients is excellent; and if they die of any acute intercurrent disease, no pathological appearances are observed in the brain. To account for the perverted opinions and emotions of such patients upon the principles advocated in this essay, is a more difficult task than in the more numerous cases in which existent pathological change can be demonstrated in the cerebral organ itself, or reasonably inferred from the accompanying symptoms. Considering the vigorous and healthy activity of the mental functions most implicated in monomania, on all subjects outside the circle of delusive opinion; considering the unimpaired state of the bodily health so frequent in these cases; and lastly, considering the absence of pathological appearances in the brain after death; it is impossible to attribute the mental phenomena to active processes of disease existing in the cerebral organs. But inasmuch as all perverted function is dependent upon abnormal states of the material organs; inasmuch as many instances of the kind under consideration originate in the ordinary causes of morbid change, and are accompanied during the early part of their course by the ordinary symptoms of cerebral disease, and that they sometimes, though rarely, give way under the influence of time and moral treatment; it is certain that these functional perversions are dependent upon abnormal states of their organ; states which it is difficult to recognize as pathological, however they may deviate from the standard of structural perfection. The only rational explanation, of which these conditions of functional perversion with apparent health of the

organism appears capable, is, that afforded by the establishment of a habit of cell-growth and nutrition in the mould or type impressed by a previous state of diseased action.

A diseased state of the blood-vessels of the organ establishes a certain irregularity in its cell development, and impresses upon the intimate structure of the organ an abnormal habit of nutrition, which endures after the pathological factors have been removed.

The physiological habit or constitution of the whole body is frequently altered by an attack of acute zymotic disease, which has, nevertheless, left behind it no legacy of determinate pathological change.

That which takes place in the body at large is by no means uncommon in its most important organs, and an irregular habit of functional activity is a frequent legacy of disease in the stomach, kidneys, and uterus. This habit depends upon a peculiar arrangement of cells, or mode of cell-growth, impressed by diseased processes, and continuing in the same mould or type after these processes have ceased.

This explanation of diseased function arising from physiological growth, taking place in a pathological mould or type, has been admirably elucidated in Mr. Paget's second lecture on "Surgical Pathology." He says:

"The last condition which I mention as essential to healthy nutrition, is a healthy state of the part to be nourished."

"This is indeed involved in the very idea of assimilation which is accomplished in the formative process, wherein the materials are supposed to be made like to the structures among which they are deposited; for unless the type be good the antetype cannot be."

"When any part or any constituent of the blood has been injured or diseased, its unhealthy state will interfere with its nutrition, long after the immediate effects of the injury or disease have passed away. Just as in healthy parts, the formative process exactly assimilates the new materials to the old, so does it in diseased parts; the new formed blood and tissues takes the likeness of the old ones in all their peculiarities, whether normal or abnormal; and hence the healthy state of the part to be nourished may be said to be essential to the healthy process of nutrition."

"After any injury or disease by which the structure of a part is impaired, we find the altered structure, whether an induration, a cicatrix, or any other, as it were, perpetuated by assimilation. It is not that an unhealthy process continues; the result is due to the process of exact assimilation operating

in a part of which the structure has been changed; the same process which once preserved the healthy state maintains now the diseased one.'


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Yet, though this increase and persistance of the morbid structure be the general and larger rule, another within it is to be remembered: namely, that in these structures there is usually (especially in youth,) a tendency towards the healthy state. Hence cicatrices, after long endurance, and even much increase, may, as it is said, wear out; and thickenings and indurations of parts may give way, and all again become pliant and elastic."

"I can hardly doubt that herein is the solution of what has been made a hindrance to the reception of the whole truth concerning the connection of an immaterial mind with the brain. When the brain is said to be essential, as the organ or instrument of the mind in its relations with the external world, not only to the perception of sensations, but to the subsequent intellectual acts, and especially to the memory of things which have been the objects of sense, it is asked, How can the brain be the organ of memory, when you suppose its substance to be ever changing? Or how is it that your assumed nutritive change of all the particles of the brain, is not as destructive of all memory and knowledge of sensuous things, as the sudden destruction by some great injury is? The answer is, because of the exactness of assimilation accomplished in the formative process. The effect once produced by an impression on the brain, whether in perception or intellectual act, is fixed and there retained; because the part, be it what it may, which has been thereby changed, is exactly represented in the part which, in the course of nutrition, succeeds to it. Thus, in the recollection of sensuous things, the mind refers to a brain, in which are retained the effects, or rather the likenesses, of changes that past impressions and intellectual acts had made. As, in some way passing far our knowledge, the mind perceived, and took cognizance of, the change made by the first impression of an object acting through the sense organs on the brain; so afterwards it perceives and recognises the likeness of that change in the parts inserted in the process of nutrition."

Mr. Paget thus supplies arguments for a strictly cerebral view of mental power, which go deep to the root of the matter. If he repudiates the conclusions to which his reasoning necessarily tends, it may be owing to some lack of confidence in his audience. He may think that to teach the identity of mind and of cerebral function, is mental food too strong for the College of Surgeons. As Mephisto exclaims:

VOL. III. NO. 21.


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To resume, the theory of partial insanity without appreciabie change of the brain, is as follows: When the disease first exists, it is attended by pathological states of the cerebral Vessels. A morbid condition of the cerebral organization is occasioned, attended by the phenomena of insanity. After a short time the vessels recover their tone, the brain is nourished, and its size maintained as a whole. But the original balance of its organs is not regained; their nutrition having been impressed in the type or mould of their diseased state. Perhaps some of the cerebral organs encroach on others by their actual bulk; undoubtedly, some of them overbear others by their greater activity. The result is chronic mental disease, of a nature which leaves behind no pathological appearances.

(To be continued.)

On the various Forms of Mental Disorder, (being the Substance of Lectures Delivered at the York School of Medicine,) by DANIEL H. TUKE, M.D., Visiting Medical Officer to the York Retreat.

(Continued from page 246.)

In describing the symptoms arising from the derangement of the group of faculties last under consideration, namely, those termed moral, and with which man is specially endowed, as contrasted with the lower animals, it might have seemed natural to detail those morbid mental phenomena, which Prichard and others have so much dwelt upon when treating of moral insanity. But such a perverted condition of the moral sense is so almost invariably indicated, and often only discovered by the activity of the animal propensities, that it is more convenient to treat of it under the third class of mental disorders. It is likewise more consistent with our adopted principle of classification, which consists in referring each mental disorder to that group of faculties, the affection of which is essential to its manifestations. In homicidal mania, the animal propensities are of necessity called into action, whether the homicidal act be the result of their diseased action, in association with a healthy condition of the higher sentiments, or of their normal action when associated with, and therefore uncontrolled by, a state of the moral sense rendered powerless or feeble by disease; be it congenital or acquired, or the result of functional disorder or structural changes. We usually become cognizant of diseased mental conditions by positive, not by negative, symptoms; some overt act or explosion of passion will, in general, be the first proof of such disease of the moral sentiments, as involves their occlusion or inertness, when they ought to be in exercise. Should the disease be of such a nature as to increase the activity of these faculties, then we have an exhibition of religious excitement or ecstasy, a morbid condition already treated of.

That intellectual power, and the perception of moral truths do not necessarily exist in the same degree in the same person; that they do not always develop themselves pari passu, are propositions which, as the result of common observation, obtain general acceptance. But that there should be anything like congenital defect of the moral sense (anomia of


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