Page:Encyclopædia Britannica, Ninth Edition, v. 13.djvu/111

INSANITY 101 matter through which the vessels pass are very frequently found dilated to from two to six times their normal dimensions. If the richness of the blood supply to the grey matter is considered, this condition of dilatation must imply an immense loss of brain tissue ; moreover, the cells are frequently found suffering degeneration. In dealing with the subject of Hysteria, we have, as stated in the article especially bearing on the subject (HYSTERIA), to do with a disease which, although marked by very prominent symptoms, possesses no anatomical seat, and thus when the disease amounts to insanity we are equally in the dark as to the cerebral con ditions. The insanity following or accompanying hysteria is not a fatal one in its earlier stages, and there is no report extant of an autopsy on a recent case of this disease. Locomotor Ataxy is a disease of the spinal cord, sclerosis of its posterior columns (see ATAXY). It implicates other parts of the nervous system, for instance, the optic tracts and nerves. Insanity occasionally is concurrent with, and probably, if not certainly, is produced by an extension of the sclerosis to the cerebral convolutions. This theory meets support from the fact that the mental symptoms associated with locomotor ataxy resemble very closely those of general paralysis, in which hypertrophy of the connective tissue of the superior convolutions has been demonstrated. 4. By the term adventitious products it is meant to indicate all forms of tumours of the brain, skull-cap, and membranes. Such foreign bodies have three distinct effects on the brain structure : " 1st, They create an irritation tending to ramollissement in the nerve substance, with which they are in contact from their first appearance. 2d, They cause pressure on distant parts, which in its turn causes an alteration of the structure and nutrition. 3d, They set up progressive disease and degeneration of certain parts of -the nerve structure, the true nature of which is as yet not very well known ; but it seems to be in some way directly connected with the essential nature and constitution of all sorts of nerve substance, whether cells or fibres. Its results pathologically are an increase of the connective tissue in the form of granules, and enlargement and thicken ing of the coats of the blood-vessels; but all these seem to be secondary changes " (Clouston, " On Tumours of the Brain," Journal of Mental Science, vol. xviii.). Apoplectic clots are practically tumours. 5. Morbid conditions of the general system secondarily implicating the brain. It is of great interest from an etiological point of view to note that insanity is seldom if ever the immediate result of diseases of individual organs, but that it is more or less intimately associated with those forms of disease which result from a general constitutional instability, such as tuberculosis, rheumatism, gout, and syphilis. There are many diseases painful in character and very depressing to the nervous system, such as stone, fistula (in fact all the so-called surgical diseases of the rectum and bladder), cancer of the uterus, &c., which might be presupposed to be probable causes of insanity, yet in point of fact are not inimical to mental health. They may be so indirectly, inasmuch as they prevent sleep, but even in this wise their effect is very slight. Nor does there appear sufficient reason to connect diseases of the heart, liver, kidneys, directly with insanity. Much stress has been laid on diseases of the uterus and ovaries, and more especially on tumours of these organs, being the primary factors in the production of insanity. Skae laid down as a special form ovario- or utero-mania ; and Wergt of Illnau has described the various morbid conditions of the female organs of generation found on post-mortem examination, and has connected with them mental symptoms. But authors on gynaecology make no mention of insanity being a sequela of uterine disease, except in so far as the mental depression which in most women follows on the knowledge that they are affected by serious, perhaps fatal, disease, and the pain and anxiety inseparable therefrom, may produce sleeplessness, and consequent melancholy ; and there is no proof of such tumours exercising an extensive influence on causation by peripheral irritation. The fallacy has in the great majority of instances probably arisen from the observation often made in asylums that insanity arising from whatever cause is conditioned by the presence of uterine growths, and that delusions of a. sexual character may arise from the sensations thereby produced. Of the very few instances on record in which a direct connexion between uterine disease and insanity has been traced may be cited a case reported by Van der Kolk, in which deep melancholy and prolapsus uteri coexisted ; the mental symptoms were at once relieved by the organ being restored to its normal position. Such cases are very rare. It is still a moot point whether a true tubercular or phthisical insanity exists ; if it does, it certainly does not arise from tubercular deposits in the brain a very rare condition in the insane. Those authorities who deny the existence of phthisical insanity hold that, although mental symptoms do frequently present themselves in cases of con sumption, and although consumption is very frequent amongst the insane, the insanity is not directly dependent on the diathesis, but more probably results from the general lowering of the system, and at most is only conditioned by the primary disease. In the case of rheumatism and gout there are strong reasons for believing that an actual trans lation (metastasis) of the materies morbi occasionally takes place from affected joints to the connective tissue of the brain and cord, the evidence being choreic movements of the limbs (St Vitus s Dance) accompanied by acute mental symptoms, both of which disappear contemporane ously with the return of inflammatory swellings of the joints. Syphilis may act on the brain by the production of tumours (which, however, do not differ in their effects from those of other adventitious products), and by specific changes in the coats of the arteries, which become thickened and even occluded. As a consequence the tissues in their neighbourhood suffer deterioration. The pathological relation between sun-stroke (insolation) and brain disease has not been ascertained. A certain amount of brain congestion has been observed, but not invariably. The cerebral lesion is more probably due to the extreme depression of the whole nervous system ; but the modus operandi is unknown. The morbid condition of the general system which most frequently implicates the brain is anaemia, not itself a disease, but the result of many diseases, such as fever, and of such drains on the constitution as lactation (suckling) and imperfect nourishment. The operativeness of these drains may be assisted by over-work under unhealthy conditions. As a typical example may be cited the dress maker, poorly paid, poorly fed, working for many hours daily in an ill-ventilated room, and sleeping in an unhealthy garret. The term anosmia is not used here to indicate a condition antithetical to hyperoemia it does not imply any mechanical deprivation of blood supply ; on the contrary, the amount of blood, such as it is, is not reduced in quantity. The temporary mechanical anaemia which results from extreme cold produces its effects rapidly, short delirium and profound sleep. But it is qualitative anaemia, an impoverished state of the blood, which produces more or less permanent results on cerebral health. Inanition acts rapidly on the brain : in the case of those cast away at sea on rafts or in boats the general story is that of short delirious mania, suicide, or death from nervous exhaustion, before emaciation (i.e., before the reserve food of the system is consumed) takes place. So in cases where inanition is