NOTES ON THE NATURE OF INSANITY. 243 



totally destroyed, and still the mental manifestations will remain 

 unaffected, so long as the brain shall continue to be healthy. From 

 these instances, then, may we not fairly conclude that there is a 

 necessary connexion between the mental manifestations and the 

 state of the cerebral textures; that, in the extreme cases of complete 

 torpor and of excited action, the accompanying derangement of the 

 mental manifestations is clearly referable to injury of the brain 

 with disturbance of its functions ; and that, since the instrumenta- 

 lity of the brain is absolutely requisite to the mental manifestations, 

 we may infer that the alteration previously shown to be the invari- 

 able attendant upon Insanity in extreme cases, is to be traced in all 

 others to a disordered or altered state of the cerebral organs, by a 

 process of the clearest analogy and induction? This inference more- 

 over receives conclusive support from the results of anatomical 

 investigation : thus, in old cases, there is generally, if not univer- 

 sally, disorganization of the brain ; whilst, in recent cases, disor- 

 ganization of its parts rarely occurs, but the vessels of its whole 

 surface are surcharged with blood, and thus they clearly indicate 

 the previous existence of increased cerebral action. 



Many cases, with notes of the dissections, have been adduced as 

 evidences which confirm the foregoing deductions. Of 154 males,* 

 145 had extensive traces of disease in the brain or its membranes : 

 of the remaining nine, two were idiots from their birth, one died of 

 dysentery and another of epilepsy ; the rest had not been insane for 

 more than a few months, and they died of other diseases. Of 67 

 females, 62 were found with the effects of disease in the brain or 

 its membranes : in five, no marks of previous disease were discover- 

 ed. Two of these had been idiots from their birth ; and, with one 

 exception, the rest were recent cases. Altogether, these examples 

 afford a fair illustration of what is generally found in persons whose 

 insanity had been of considerable duration ; and, at the same time, 

 they satisfactorily confirm the theory — that increased sanguineous 

 action, or increased nervous action, arises in the brain at the com- 

 mencement of insanity. 



Occasionally, there have been cases of insane persons in whom no 

 trace of disease in the brain could be detected, even on the most 

 careful inspection; but, from this, we ought not to conclude that 

 in them no cerebral disease existed. We know that morbid action 

 may continue in various parts, without leaving its effects discover- 



* These cases occurred in the practice of Sir W. C. Ellis, and some of 

 them are given in instructive detail on the pages of his valuahlc treatise. 



