UC-NRLF 
 
 B M 13T 5t.T 
 
 CEREBRAL LOCALIZATION 
 
 IN RELATION TO 
 
 INSANITY. 
 
UNIVERSITY OF CALIFORNIA 
 
 SAN FRANCISCO MEDICAL CENTER 
 
 LIBRARY 
 
V- 
 
 
 -. ^ 
 
 >- >£<.-^. 
 
 
u 
 
Digitized by the Internet Archive 
 
 in 2007 with funding from 
 
 IVIicrosoft Corporation 
 
 http://www.archive.org/details/cerebrallocalizaOOcarnrich 
 
CEREBRAL LOCALIZATION 
 
 IN KELATION TO 
 
 INSANITY, 
 
 WITH CASES. 
 
 [Read before the Medico-Legal Society, May 14, 1884.] 
 
 J. M. CARNOCHAN, M.D., 
 
 Subgeon-in-Cheef to the State Immigrants' Hospital, 1850 to 1873, 1880 to 1883— 
 
 Pbofebsob of Sttrgeby — ^Foemeelt Health Officeb op the Pobt 
 
 OF New Yobk and one of the Commissionebs of the 
 
 Health Depaetment of the City of New 
 
 Yobk— Membee of The Medico-Legal 
 
 Society of New Yobk, 
 
 Etc., Etc. 
 
 RE-PRINT FROM MEDICO-LEGAL JOURNAL. 
 NEW YOBK : 
 
 J. H. VAIL & CO. 
 
 18 8 4. 
 
 253604 
 
New York : 
 
 Vanden Houten & Co., Printers, 
 
 47 & 49 Liberty St. 
 
 "rffr I 
 
 1 1 
 
PEEFATORY NOTE. 
 
 With the great and rapid increasing immigration into the United States 
 from 184.0 to 1847, it became necessary to take some action in order to pro- 
 vide for the care and relief of immigrants who might most require aid and 
 protection, and to adopt some measures from motives of State economy. The 
 number of immigrants suffering from disease and accidej^t increased 
 beyond the proportion of the increase of immigration. To remedy the 
 evils, urgent at the time, the Legislature of the State of New York ap- 
 pointed a Permanent Commission for the Relief and Protection of Aliens 
 arriving at the Port of New York, the expense to be defrayed by a small 
 commutation payment, from each immigrant. Under the auspices of this 
 Commission, the Honorable Julian C. Verplanck acting as President, the 
 foundation of the large Hospital and Refuge establishment was laid for the 
 benefit of the immigrant, on a healthy island contiguous to 110th street, in 
 the 12th Ward of the city. Soon after the construction of these Institu- 
 tions, without change of residence, I was placed at the head of the Surgi- 
 cal Department, with continuous service, and a sufficient number of com- 
 petent assistants. The Hospital consisted of Departments embracing 
 General and Special Surgery, Medicine and Obstetrics. To these was added 
 a Department for Lunatics, on account of the increase of insanity among 
 the immigrant population, scattered through differents parts of the 
 country. 
 
 Acting in concert with the Resident Physician-in-Chief, the late Dr. 
 George Ford, there being no special Alienist attached to the Institution, I 
 had ample means afforded for observing and studying the characteristics 
 and abnormal conditions of the insane. From the opportunities thus pre- 
 sented, and from observations derived from cases necessarily occurring in 
 the current of private practice, I became satisfied that insanity is a morbid 
 condition of the mind, resulting directly or indirectly from disease of a 
 part or of the whole of the Brain, or from imperfect development, and that 
 it is not a disease of the mind, per se, independent of functional or struc- 
 tural change. 
 
 This view of the pathological source of Insanity bears directly upon the 
 Medico-Legal aspect of the subject, and at the suggestion of the Society, I 
 have, amidst a press of professional business, drawn up the following 
 paper. 
 
 14 East 16th Steeet, 
 June, 1884. 
 
"What should fairly and honestly be weighed is, that mental organiza- 
 -tion is the last, the highest, the consummate evolution of nature, and that, 
 therefore, it must be the last, the most complex, and most difficult object 
 of human study." — Physiology of Mind. — Maudslby. 
 
CEREBRAL LOCALIZATION IN RELATION 
 TO INSANITY.* 
 
 By J. M. CAENOCHAN, M.D., &c. 
 
 The Localization of Cerebral disease has, of late years, en- 
 gaged a large share of the attention and labors of medical 
 scientists. Germany, France and England, during the last de- 
 cade, have gained celebrity by the physiological and patho- 
 logical investigations and the knowledge contributed, by some 
 of their distinguished men, in this department of neuro- 
 pathic research. The term Cerebral Localization is derived 
 from the fact now generally accepted that the brain, or the 
 large nervous mass occupying the cranial cavity, is not a 
 single organ performing a single function, but that it is com- 
 posed of an aggregation of many organs or cerebral centres, 
 each possessing special functions, acting separately at times, 
 but at others, functionating in concert by a pre-established 
 harmony of action, by means of which the numerous com- 
 plex pTienomena of mental manifestations are produced. 
 
 A knowledge of the principles and facts underlying the 
 doctrine of cerebral localization has become a necessary in- 
 troduction to the study and comprehension of insanity. 
 
 The subject of insanity is one of great interest in a medico- 
 legal point of view, not only on account of the frequency 
 with which this condition is brought before the courts of 
 
 * Read before the Medico-Legal Society, of New York, May 14, 1884. 
 
6 ' CEREBKAL LOCALIZATION 
 
 law for adjudication in reference to tlie possession and 
 management of property, but also in cases of criminal juris- 
 prudence where grades of punishment are being balanced in 
 the scale of justice, and the life of the individual is often- 
 times at stake. There is, also, the philosophical and physio- 
 logical view of the subject in regard to its nature, etiology 
 and the various phases which it assumes, and this may be 
 called the medical aspect. The fact that opinions regarding the 
 nature of insanity differ so widely, implies that the study of 
 its characteristics is one of difficulty. In this respect in- 
 sanity resembles some other morbid conditions of the organ- 
 ism, such as catalepsy, epilepsy, hydrophobia and other 
 abnormal states of the nervous system that, as yet, are not 
 clearly comprehended. The localization of the different 
 functions of the brain, with the view of removing the obscur- 
 ity connected with the etiology and pathology of cerebral 
 diseases in general, has within the past few years received 
 more attention and careful study than at any previous time, 
 and a new and more enlarged field has been opened up in 
 this department of scientific knowledge. Emanating from 
 these researches, more exact opinions regarding the nature 
 of insanity are being entertained that are likely to remove 
 the confusion and complexity which, heretofore, have been 
 prevalent in discussions and opinions concerning the various 
 phases of mental aberration. 
 
 It is customary in the ordinary curriculum of medical stu- 
 dies to give attention to the healthy structure of the human 
 body, in order to acquire the knowledge necessary to under- 
 stand its diseases or morbid conditions. So, in the study 
 of diseases of the brain, of which insanity is one, it becomes 
 necessary to be conversant with the minute structure and 
 
IN RELATION TO INSANITY. • 7 
 
 physiology of the brain and the other parts of the nervous 
 system, I shall endeavor to follow this rule and take a hurried 
 glance at the different views entertained regarding the healthy 
 action of the mind before reaching the main subject of this 
 paper — that of insanity. 
 
 In looking into the history of mental philosophy and re- 
 tracing it for centuries back, even to the epoch when phi- 
 losophy, such as it was when it first assumed a name, it 
 becomes a matter of surprise to the student of the present 
 day to observe how indefinite and vague were the notions en- 
 tertained by the ancient philosophers concerning the nature 
 and action of the healthy mind — the mens sana. With such 
 erroneous and intangible theories and vague and unintelli- 
 gible hypotheses as are found in their writings, it might be 
 asked how could it be possible to arrive at correct opinions 
 and conclusions when discussing, or writing on the com- 
 plexities of the diseased mind — or insanity, the mens non 
 compos. 
 
 The history of the early centuries of the world affords 
 only indefinite information regarding the study of mental 
 phenomena. Some individuals were considered more wise 
 than others, and were often supposed to be endowed with 
 supernatural gifts. Possessing acute and enlarged powers 
 of observation, and from a close study of human character, 
 they gained control over their compeers, became chiefs, great 
 warriors, teachers, or astute law-makers for their time, and 
 formed systems and rules of conduct for the guidance of their 
 own actions and those of their followers. Solon and Thales and 
 the remaining ^ye of the seven wise men, mentioned as living 
 before the ante-Christian era, 494 B.C., were called 2o^iffTat 
 (teachers of wisdom), to denote their practical sagacity rather 
 
8 CEREBRAL LOCALIZATION^ 
 
 than their knowledge of philosophy as such, Heroclitus is 
 considered as the oldest writer (445 B.C.) known to have in- 
 troduced the term philosophy, as denoting a system the 
 object of which was the acquisition of true knowledge, and 
 which would reach facts in the concatenation of cause and 
 effect. Prior to the time of Heroditus, however, the scholars 
 of the day, groping amidst the complexities of mental specu- 
 lations, felt the necessity of drawing distinctions between 
 the different functions and manifestations of the mind, and 
 hence originated the numerous sects that received denomi- 
 nations according to the name of their authors, or to the 
 hypotheses identified with the peculiar doctrines promul- 
 gated. Among this class of reasoners may be enumerated 
 the Electics, the Dialectics, the Ionics, the Atomists, the 
 followers of Pythagoras, of Plato, of Socrates and of 
 Aristotle. 
 
 The founders of these and other ancient schools of phil- 
 osophy became famous by the promulgation of theories of 
 mental action mixed up with speculation concerning ethics, 
 religion, the pursuit of happiness, justice, moral culture, 
 cosmology, metempsycosis etc. The Ionic school may serve 
 as a type of the methods and train of thought that agitated 
 the minds of the ante-Christian philosophers. One of the 
 problems of the Ionics was the attempt to generalize the 
 universe, and to resolve all nature into some great unity or 
 common substance or principle. Thales considered water 
 the primordial and fundamental principle. Anaximander 
 adopted as the foundation of the universe something called 
 by him the Infinite or Indeterminate, out of which the various 
 definite substances, air, fire, water etc., were generated, and 
 to which they were again resolved. Anaximenes assumed 
 
In relation to insanity. 9 
 
 air as the primordial substance which by rarifaction pro- 
 duced fire and ether, and, by condensation, water, air and 
 stone. Pythagoras gave the harmony of numbers as the 
 essence and foundation of all existing things, the different 
 numbers being representative of different natural properties 
 and powers. The Atomic theory was represented by De- 
 mocritus 430 B.C., who attempted the solution of the grand 
 problem of external perception, regarded as a leading ques- 
 tion, by the application of the Atomic hypothesis. He 
 supposed that all things were constantly throwing off images 
 of themselves, which enter the soul through the pores of 
 the organs of sense. 
 
 Socrates, 435 B.C , repudiated, the speculative doctrines of 
 the philosophers who had gone before him as to the origin 
 of all things out of water, fire, air, etc., and led the way to a 
 more precise method of thought by considering evidence as 
 the basis of reasoning, and teaching that all human things 
 should be learned by diligence in study and investigation. 
 The Platonic philosophy differed from the Socratic, in as 
 much as the doctrines of Socrates were founded on the 
 necessity of external evidence in reasoning, while the 
 platonic school is based upon idealism, as opposed to realism, 
 materialism, or sensationalism, the capacity of forming and 
 using ideas being taken as an essential quality of the mind 
 as contrasted with the external forms by which these forces 
 are manifested. Aristotle, 384, B.C., the pupil of Plato, 
 taught a philosophy differing from that of Plato in many 
 points, especially in the fundamental doctrine termed the 
 theory of ideas. The entire method of Aristotle was in 
 marked contrast to the platonic system of viewing philo- 
 sophical subjects. Aristotle was a close observer and col- 
 
10 CEREBRAL LOCALIZATION 
 
 lector of facts, from which he drew inductions. He promoted 
 the development of syllogistic reasoning, and introduced a 
 system of formal logic which became insensibly infused into 
 the minds of succeeding scientists, and has contributed 
 much to form what is correct in the methods of modern 
 metaphysicians. 
 
 The Epicurean sect and that of the Stoics formed in part 
 upon the Aristotelian doctrines, transmitted their philosophy 
 and characteristic mental speculations from the Socratic 
 epoch into the commencement of the Christian era. Thus 
 for over three thousand years, preceding the time that philo- 
 sophical theories taught by Confucius and his contempor- 
 aries in the East became known in the "West, the history of 
 philosophy informs us that the different doctrines and 
 mental speculations were mainly made up of controversial 
 theories and hypotheses concerning the operations of the 
 mind based upon no more solid foundation than the meta- 
 physical vagaries and propositions of the acknowledged 
 leaders and champions of the popular and prevailing sects 
 of the period in which they flourished. In the early cen- 
 turies, after the introduction of Christianity and the Eoman 
 Conquest, Alexandria, from its geographical position, be- 
 came the focus at which the philosophers of the East and 
 West congregated and interchanged their various dogmas 
 and theories regarding theology, literature, politics, psycho- 
 logy and other metaphysical topics of the day. At this time 
 the school of Neo Platonism^ounded on the doctrines of Plato, 
 took its origin and became the representative centre of the 
 speculative notions that grew up in the Alexandrian school, 
 from the " fusion of Greek philosophy. Oriental mysticism 
 and the Jewish and Christian controversies on religion." 
 
IN RELATION TO INSANITY. 11 
 
 The school of Gnosticism, composed of men of knowledge, 
 as the name implies, arose in the Second century. Its 
 speculations on the mind were mainly based upon the doc- 
 trines of Plato, and one of its principal efforts and studies 
 was directed towards creating a philosophy upon a Christian 
 foundation. Great theologians and metaphysicians belonged 
 to this school. The Ecumenical Councils, famous in ecclesi- 
 astical history, held at Nice, a city of Bythnia, in Asia Minor, 
 in 325, and 787, were made up of scholars of this class, among 
 whom may be mentioned Athanasius, Gregory of Nysa and 
 St Augustine, who were noted for their physiological labors 
 and mental disquisitions. 
 
 In the ninth century the Scliolastics appeared, and early in 
 their history became remarkable for their controversies on 
 nominalism and realism^ and later by the revival of the school 
 of Aristotle and the refutation of the doctrines of Pantheism. 
 The names of Alexander, of Bonaventura, Albertus Magnus, 
 Duns Scotus and Thomas Aquinas, were conspicuous at that 
 period, among the great theologians and teachers of this 
 school. From this time forward, during the following centu- 
 ries, until the time of Roger Bacon, 1214-1294, numerous 
 teachers and schools sprang into activity, more especially in 
 the Western region of civilization, chiefly occupied with theo- 
 ries on nominalism, realism, idealism, immortality of the soul 
 and other subjects appertaining to the domain of meta- 
 physical enquiry, and then receded, after having exercised, 
 for a time, their period of authority. The Platonic and 
 Aristotelian doctrines which, for many centuries, had formed 
 the basis of the different sects of philosophers, had prepared 
 the way for a closer system of ratiocination. During the 
 16th century and early part of the 17th, (1561-1626,) a new 
 
12 CEREBKAL LOCALIZATION 
 
 class of pliilosopliers appeared who abandoned the tradi- 
 tional servitude of authority dictated by their predeces- 
 sors, and adopted new methods in the analyses of n.ental 
 phenomena. About this epoch the names of Francis Bacon 
 and Rene Descartes became conspicuous in the philosophi- 
 cal world— 1561-1596. 
 
 Between the sixteenth and eighteenth centuries (that is 
 between the time that Francis Bacon enlightened the philo- 
 sophical world by his writings and John Wilson, the famous 
 Christopher North, who occupied the chair of mental and 
 moral philosophy in the University of Edinburgh, 1830), many 
 remarkable men lived and left the imprint of their powerful 
 minds on the age in which they figured, by their philosophical 
 essays and more elaborate works. Francis Bacon, Descartes, 
 ■Thomas Hobbes, Locke, Malabranche, D'Alembert, Leibnitz, 
 Bishop Berkeley, Hume, Kant, Condillac, Condor^et, Thomas 
 Reid, Dugald Stewart, Thomas Brown, John Wilson and Sir 
 William Hamilton may be named as among the most bril- 
 liant of the minds that shed lustre on the civilized world, 
 during this epoch. Each of these philosophers discussed 
 with earnestness and ability subjects embracing the general 
 domain of mental philosophy, morals, theology, politics, the 
 various processes of mental action and physics, each adopt- 
 ing peculiar methods of ratiocination and of mental analyses, 
 and often guided by antecedent education and early sur- 
 roundings. 
 
 Bacon is generally accredited with leading the way to 
 more correct methods of analytic enquiry by the intro- 
 duction of the inductive method. This system undoubtedly 
 formed the basis of a more accurate and precise school of 
 reasoning, for, in regard to whatever supposition or theory 
 
IN RELATION TO INSANITY. 13 
 
 of mental action miglit be started and advocated, the in- 
 ductive method was generally adopted, in order to prove and 
 substantiate its correctness. 
 
 Descartes, as one of the early reformers, professed to 
 admit nothing as true that was not confirmed by reason and 
 experiment. He found, as he supposed, no ground for certi- 
 tude in any of the various departments of knowledge except 
 one, and only one proposition that seemed to him to stand 
 the test of truth, and of which the truth could not be 
 doubted. That proposition was that he existed, which he 
 inferred from the fact of his possessing consciousness. He 
 could not doubt that he felt and thought, and, therefore, he 
 did not doubt that he, the feeler and thinker, existed. This 
 relation between consciousness and existence he expressed 
 by the words " Cogito, ergo sum " — " I think, therefore, I 
 exist." Such was one of the dogmas of Descartes. 
 
 The philosophical system of Hobbes, who was contempo- 
 raneous with Bacon and Descartes, was of the materialistic 
 type. He held sensation to be the basis of all knowledge, 
 thought to be a process of adding and subtracting repre- 
 sentations produced by physical impressions, and intro- 
 duced a twofold method of scientific investigation by in- 
 diiction or analysis and deduction or synthesis. 
 
 The essay on the " Human Understanding," by Locke, ap- 
 peared in 1690, and was regarded as the great authority by 
 the sensualistic philosophers of the eighteenth century. His 
 system tries to show that there are no " innate ideas,'' that 
 the mind is a tabula rasa, ideas being used for whatever is in 
 the mind. His main postulates are laid down by himself as 
 follows : — " Let us suppose the mind to be, as we say, white 
 paper, void of all characters, without any ideas, how comes 
 
14 CEREBRAL LOCALIZATION 
 
 it to be furnished ? Whence has it all the materials of 
 reason and knowledge? To this I answer in one word, 
 from experience. In that, all knowledge is founded, and from 
 that it ultimately derives itself." * * * * And, again, 
 "Our observation employed either about external sensible 
 objects, or about the internal operations of our own minds, 
 perceived and reflected un by ourselves, is that which sup- 
 plies our understanding with all the materials of thinking. 
 These two are the fountains of knowledge from whence all 
 the ideas we have, or can naturally have, do spring. These 
 are called stiisaiion and 7'e/lection, and it is important to 
 observe thafc the latter must wait on the former." 
 
 Such, in brief, may be said to comprise the principal 
 dogmas of one of the greatest philosophers of the last 
 century. 
 
 It is somewhat remarkable that the postulates of Locke 
 somewhat coincide with the theories of Gall, who based his 
 doctrines upon the localization of certain faculties in special 
 parts of the brain, while Locke reached his conclusions 
 through introspective and abstract ratiocination. Bishop 
 Berkeley followed soon after Locke, and published among 
 other writings his " Treatise Concerning the Principles of 
 Human Knowledge," in which he proposed a scheme of ab- 
 solute Idealism. He affirmed that there was no proof of the 
 existence of a material world, and gave the name of " ideas '* 
 to the objects of which we are conscious in perception, attri- 
 buting them to a supernatural agency that causes them to 
 pass in a real and orderly succession before the mind. 
 
 In contrast with the school of Berkeley, Hume's philoso- 
 phy was directed towards naturalism and scepticism. He 
 believed that ideas were copies of impressions of individual 
 
IN EELATION TO INSANITY. 15 
 
 things. He gives an exposition of the basis of his system 
 thus : — '* All the perceptions of the human mind resolve 
 themselves into two distinct kinds, which I call impressions 
 and ideas. The difference between them consists in the 
 degrees of force and liveliness with which they strike upon 
 the mind and make their way into our thought and con- 
 sciousness. Those perceptions which enter with most force 
 and violence we may name impressions, and under this name 
 include all our sensations, passions and emotions as they 
 make their first appearance in the soul. By ideas I mean 
 the faint images of these in thinking and reasoning." The 
 opinions of Hume had great currency, and became the stimu- 
 lating influence of the notable systems of D'Alembert, Mar- 
 montel, Diderot, Condor^et, Condillac, Helvetius, Males- 
 herbes and other philosophers of his time. 
 
 Kant, 1724, became imbued with the scepticism of Hume 
 in regard to the objective validity of our ideas, especially in 
 relation to the idea of causality. He conceived a system of 
 critical philosophy which, from its metaphysical character, 
 had received the name of transcendentalism. The central 
 object of this system seems to be twofold ; first, to separate 
 the necessary and universal incogaition from the knowledge 
 we derive through the senses ; secondly, to determine the 
 limits of cognition. It is difficult to follow the transcenden- 
 tal ratiocination of Kant, and probably the nearest concep- 
 tion we can obtain of his meaning, except by a deep study 
 of his various works, is derived from the definition given of 
 the word transcendental, which has been applied to his 
 system — viz, '* all philosophy which carries its investigations 
 beyond the sphere of things which fall under our senses is 
 transcendental, and the term is thus synonymous with meta- 
 
16 CEREBRAL LOCALIZATIOI^ 
 
 physical. Transcendental philosophy may begin with ex- 
 perience, and thence proceed beyond it ; or it may start 
 from ideas a priori which are in our mind. In the latter 
 case, the philosophy is purely transcendental, while in the 
 former it is of a mixed character." 
 
 Leibnitz, 1646-1716, remarkable for his scholarship and 
 the vastness of its range, is perhaps more noted for his doc- 
 trines of the action of the mind than for his other great ac- 
 quirements. The most important hypotheses of his system 
 may be stated to be his doctrine as to the origin of Ideas, his 
 theory of the Monads, of the pre-established Harmony and 
 the theory of Optimism. Ideas are supposed to come from 
 spiritual Monads ; the theory of Optimism affirms the doc- 
 trine that the universe, being the work of an infinitely per- 
 fect Being, is the best that could be created ; that everything 
 is ordered eventually for the best, so that everything is good 
 in relation to the whole — all being made to promote the 
 general good. 
 
 His celebrated doctrine of pre-established Harmony is 
 that which has claimed most attention. It supposes " the 
 mind and the body to be two distinct and independent ma- 
 chines, each having its own independent though simultane- 
 ous action, but both so regulated by a harmony pre-established 
 by God, that their mutual actions shall correspond with each 
 other, and shall occur in exact and infallible unison." This 
 hypothesis has been called by another philosopher " the 
 dream of a great mind." 
 
 Thomas Keid, one of the noted Scotch philosophers, pub- 
 lished several essays on philosophical subjects : in 1785, his 
 treatise on the Philosophy of the Intellectual Powers ; and 
 in 1788, the philosophy of the Active Powers appeared. His 
 
tN RELATION TO INSANITY. Vt 
 
 Writings attracted much attention, and he became, in his own 
 country, the chief of a school whose aim was to " deliver 
 philosophy from scepticism by resting finally on principles 
 of intuitive or a priori origin." Eeid was succeeded in Scot- 
 land by Dugald Stewart (1775) ; and Thomas Brown (1809), fol- 
 lowed up the controversies begun by Reid against the systems 
 of Berkeley and Hume. Brown was succeeded by John Wil- 
 son as professor of moral and mental philosophy in the 
 University of Edinburgh, and he was succeeded by Sir 
 William Hamilton. The two last named teachers were pro- 
 found scholars, and contributed learned essays and treatises 
 on subjects connected with the study of the mind, ethics and 
 politics, but their names are not associated with any import- 
 ant system in the domain of mental philosophy. 
 
 It is seen from the brief apergu just made, that the various 
 philosophical systems heretofore mentioned as controlling 
 the psychological world, since the commencement of the 
 Christian era, have been constructed by the introspective 
 action of the mind itself, acting upon the very subject which 
 it wishes to define and analyze, without any premises to be 
 used as the basis of ratiocination other than the fleeting 
 phases of the mind itself. From the resulting confusion and 
 the variety of conjectural speculations that have arisen, during 
 so many centuries, the conclusion to be most readily drawn 
 is, that there may be, as D'Alembert truly says, " a great 
 deal of pJiilosophizing in which there is very little of philo- 
 sophy." 
 
 Since the time of Sir William Hamilton, 1829-36, a school 
 of philosophy has sprung up whose methods of research in 
 the realms of thought are based on the materialistic theory 
 that mental manifestations, of whatever character, are the 
 
18 CEREBRAL LOCALIZATION 
 
 essential functions of vital organizations. Of this new class 
 of scientists Herbert Spencer may be mentioned as the most 
 distinguished representative, but long before the publica- 
 tions of this writer were issued, a philosopher had appeared 
 who was intently engaged in the prosecution of the study of 
 the Brain and nervous system, with the main object in view 
 of confirming his theory that the phenomena of mental 
 manifestations were in direct correlation with the structure 
 and development of the cerebro-spinal axis and the nervous 
 appendages connected with it. 
 
 Franz Joseph Gall was born in Baden in 1753, and after 
 studying at Baden, Bruchsal and Strasbourg, received the 
 degree of Doctor of Medicine at Vienna, in 1785. He was 
 possessed of unusual powers of observation, and early in life 
 began to observe and compare the craniological formation 
 of man, and to refer the variety of mental peculiarities and 
 of moral characteristics of persons thus examined to the 
 diversified development of the cranium, resting his theory 
 upon the alleged approximate similaritj^ existing between 
 the outline of the cranium and the external configuration of 
 the Brain. 
 
 In 1796, he gave lectures on this subject in Vienna, but the 
 new theory met with much opposition, and in 1805 he was 
 interdicted by the government from repeating his lectures in 
 public. Gall, after this, visited Paris, and entered upon the 
 practice of medicine, and at the same time, with his pupil 
 Spurzheim, commenced a series of studies upon the Brain 
 and nervous system that resulted in the completion of 
 several important works, among which may be mentioned 
 Philosophisch-Medlcinisclie UntersucJiungen (1791), BecJierches 
 
IN RELATION TO INSANITY. 19 
 
 swr le Systeme Nerveux (1810-19), and Siir VOrigine des 
 Qualites Morales et de Facultes Intelleduelles (1822-25). 
 
 Spurzheira, following up the principles of his master, 
 visited Scotland, England, and finally America, giving lec- 
 tures to inculcate the system of mental philosophy inaugu- 
 rated by Gall. These two scientists, like most founders of a 
 sect, claimed too much for their theory. Gall, as a part of 
 his system, wished to establish certain empirical doctrines 
 under the term of phrenology, upon the assumption that the 
 relative development of the centres of the brain can be ac- 
 curately determined by external examination of the cranium, 
 " by protuberance in one part as contrasted with depression 
 in another quarter, and by other indications in their nature, 
 not demonstrable, in any special instance, without post- 
 mortem examination, and yet having a certain degree of 
 foundation in the general truths of physiology." It was this 
 pretention of imposing an untenable dogma upon his general 
 system that led to the rejection of his general theory re- 
 garding the functionating powers of the brain. The leading 
 positions of Gall, however, have been verified, and have 
 been absorbed into the scientific psychology of the present 
 epoch under the denomination of psycho-physics in Ger- 
 many and cerebral psychology in England. Wagner, 
 Huschke, Bain, Carpenter, Terrier, Spencer, Huxley, Tyndal, 
 Maudsley and Darwin are the leading representatives of this 
 school of philosophy of the present day. 
 
 Still the subject of Insanity is clouded by the dogmas of 
 the metaphysical school of philosophy, and is so entangled 
 by ancient theories concerning the normal constitution of 
 the mind and the primeval methods of studying the mind in 
 
20 CEREBEAL LOCALIZATION 
 
 health or in disease, tliat no two authors can be found who 
 give a precisely similar definition of Insanit3^ 
 
 Gall commenced his system of localizing the organs and 
 functions of the brain by apportioning the brain into regions, 
 limiting them, in general, by the dividing furrows or fissures 
 of the several lobes. To the convolutions of the frontal lobe, 
 the intellectual and perceptive group of centres were allotted. 
 In the posterior lobe and lower range of the middle lobe, the 
 affective organs and those of the animal propensities were 
 found ; while the moral and aesthetic group of centres were 
 located in the upper and coronal parts of the brain. The 
 cerebellum is supposed to have the function of presiding 
 over procreative activity. As concerns these propositions, 
 with the exception of the functions attributed to the cere- 
 bellum, recent experiments in vivisection have, in a great 
 measure, verified their accuracy. No one conversant with 
 the modern discoveries in physiology can be in doubt, even 
 in the present condition of medical science, concerning the 
 possibility of localizing many organs of the brain through 
 the activity and instrumentality of which ct-rtain spepial 
 functions are made manifest. 
 
 The discoveries of Sir Charles Bell, 1811, corroborated by 
 Magendie and Longet in 1840, have placed the spinal centres 
 of general sensibility and of locomotion in the posterior and 
 anterior columns of the medulla spinalis, and, in tracing the 
 nervous strands of white medullary matter and the gray 
 cineritious substance of this organ upwards into the brain, 
 at different sections, the motor and reflex centres of the 
 functions of respiration, of digestion, of the tongue and 
 the pharynx are definitely located at the medulla oblon- 
 gata. Also, in connection with the extended continuity 
 
IN RELATION TO INSANITY. 21 
 
 and prolongation of these same strands and ganglionic depo- 
 sits of gray matter and piercing tlie brain at the junction of the 
 medulla oblongata with the pors varolii, the nerve of audition 
 and the motor nerve of the face are seen, the first taking 
 origin at the gray matter of the fourth ventricle, and the 
 second connected at its root, with the motor part of the 
 medulla oblongata. Anterior to these, and still in connec- 
 tion with the advancing strands, the nerve of the external 
 rectus, the sixth pair, and the nerve of the other motor muscles 
 of the eye-ball and of the orbit, the third pair, are met 
 with — the sixth pair, connected with the medulla oblongata, 
 emanating from the substance of the brain in front of the 
 pons varolii ; and the trunk of the third pair from the side 
 of the crus cerebri, from the deep part of which it takes its 
 origin. The root of the fourth pair of nerves, called pathe- 
 tici, from their action in turning the globe of the eye upwards 
 in the expression of prayer, is placed near the surface of the 
 fourth ventricle, at the calamus scriptorius. The sensory 
 portion of the ffth pair of nerves, the nerve of general sensi- 
 bility of the face and of the appendages of the organs of spe- 
 cial sense, has its real origin localized at the medulla 
 oblongata and in the interior of the pons varolii, and is seen 
 piercing the po7is, anteriorly upon its external side. The 
 motor portion of the fifth pair takes its origin in connection 
 with the pyramidal or motor portion of medulla oblongata. 
 
 The nervous centres of the organs of special sense, of smell, 
 of sight, and of hearing, can also be localized with the same 
 degree of precision and certainty. That of hearing, the por- 
 tio mollis of the seventh pair, has already been located. The 
 visual centre is known to be placed in connection with the 
 tubercula quadrigemina, and the corpora geniculata of the 
 
22 CEREBRAL LOCALIZATION 
 
 optic thalamus ; and that of the olfacHve sense at the poste- 
 rior part of the anterior lobe, the lower part of the middle 
 lobe, and at other proximal points of origin. 
 
 The great basal ganglia — the tuhercula quadrigemina^ the 
 optic thalami, and the corpora striata, large aggregations of 
 cineritious nervous substance, intermingled with white fibres 
 seated inferiorlj and in the interior of the brain, are known 
 to be auxiliary to the functions of motion and of general 
 and special sensation, and to serve as the means of elaborat- 
 ing the nervous influence which supplies the organs that are 
 in connection with them. 
 
 The evidences and examples thus given of the identification 
 of certain functional manifestations, such as motion and sen- 
 sation, with defined or limited parts of the medulla spinalis 
 'and of the cerebral strands continued from it, and, also, of a 
 similar correlation and identification between the functions 
 of the special senses and the nervous centres on which they 
 are dependent, serve as examples of the reality and utility of 
 the principle of localization, and are as much mental in 
 character as those functions attributed to the more intro- 
 spective or psj'chological organs. 
 
 The localization of the functions of the cerebral convolu- 
 tions on the surface of the brain has not been, as yet, so 
 absolutely defined or limited as those referred to in the in- 
 terior and lower part of the brain. It is generally conceded, 
 however, with whatever other functions they may be classed, 
 that the convolutions placed on the general surface of the 
 cerebrum are the seat of the intellectual or reasoning 
 faculties and of the other mental functions differently mani- 
 fested, such as the emotions, etc. 
 
 Becently a new role has been assigned to the cortex of the 
 
IN RELATION TO INSANITY. 23 
 
 cerebral convolutions to which, previously, the functionating 
 power of the superior mental qualifications alone had been 
 referred. In 1870, two physiologists, M M. Fritsch and 
 Hitzig, remarked that an electric current made to pass 
 along the head from right to left produced movements in 
 certain muscles of the eyes. Experiments were then made 
 upon the brains of dogs and other inferior animals, with re- 
 sults of a similar character. In 1873, Hitzig published a 
 memoir in which he announced that the electric excitation 
 of certain regions on the surface of the brain produced con- 
 tractions in certain groups of muscles connected with defi- 
 nite movements of the head, body and limbs. 
 
 About the same time, this subject was pursued farther by 
 Terrier of London, who made his experiments upon the 
 brain of the monkey, as being more closely allied in con- 
 figuration to the human brain. Ferrier localized the motor 
 regions of the cerebral hemispheres, in general terms, in the 
 convolutions about the upper portion of the Fissure of 
 Kolando, especially in the ascending frontal and ascend- 
 ing parietal convolutions. Centres of sensation have, also, 
 been assigned to the cortex of certain parts of the brain, 
 but these have not been localized as definitely as those of 
 motion, but, as far as known, are supposed to be localized in 
 the postero-lateral regions of the hemispheres. The exper- 
 iments and statements of these distinguished physiologists 
 have given an extended impetus to the study of this depart- 
 ment of physiology, and have been accepted by many 
 as established facts. On the other hand, active opposition 
 has been made to their assertions, the motor efi'ect of the 
 electric excitation being attributed to the extension of its 
 influence to the medullary fibres passing onward from the 
 
24 CEREBEAL LOCALIZATIOI? 
 
 corona radiata to be dovetailed or interlaced among the several 
 layers of the cells and cineritious substance of the cerebral 
 cortex. This argument is not without weight ; for example, the 
 optic tracts have their origin in three separate nuclei of gray 
 matter, viz., in the nates of the tubercula quadrigeminxx, the 
 corpus geniculatum externum and the optic thalamus, and, 
 according to Meynert and Huguenin, there are indirect con- 
 nections between these nuclei and the cortex of the hemi- 
 spheres, consisting of diverging fibres from the optic thala- 
 mus and the corpus geniculatum. These fibres take part in 
 the formation of the corona radiala, and pursue their course 
 toward the gyrus angularis placed at the posterior part of 
 the hemisphere and considered by Ferrier as a visual centre. 
 Again, in disease or excitation of tlie Convolution of Broca, 
 the same general explanation may be given in regard to the 
 voluntary combination of ideation and of muscular movements 
 necessary for intelligent articulation, the motor centre of which 
 is placed in correlation with the posterior and lower part of 
 the third left frontal convolution, through the influence, direct 
 or reflex, of the fibres of the hypoglossal nerve and its origin 
 at the medulla oblongata — the defect or destruction of which 
 combination produces aphasia in its different forms. 
 
 There are two kinds of aphasia, the amnesic aphasia, 
 where the patient cannot say what he wishes, because he 
 cannot recollect the words or ideas he wants to express, nor 
 can he write them ; and the ataxic aphasia, where the patient 
 knows the words or ideas he wants, but cannot speak or 
 read aloud or articulate even what he has written. 
 
 These conditions are entirely distinct in origin or in 
 causality — the ideal or amnesic aphasia can be referred to 
 the morbid condition of the cortex alone, and the ataxic 
 
tN RELATION TO INSANITY. 2§ 
 
 aphasia to the abnormal condition of the hypoglossal nerve 
 and the white substance of the Broca convolution. If both 
 substances of the convolution, the cortex and the white med- 
 ullary substances, are diseased, the aphasia becomes com- 
 plete, there being neither the ideation of language nor the 
 power of articulating it. 
 
 There is probability that the hypoglossal or motor nerve 
 of the tongue, taking origin in the motor apparatus of the 
 bulb, is indirectly in connection with the convolution of Broca 
 through radiating fibres communicating with the bulb. 
 
 The theory of localizing motor and sensory centres in 
 the cortex of the hemispheres, even if regarded as es- 
 tablished, must be looked upon as an ancillary arrangement. 
 The most important functions belonging to the cerebral 
 hemispheres, as a whole, are directly connected with the 
 exercise of the various psychical or mental manifestations. 
 This correlation of the mutual dependence of function upon 
 organization rests upon such established proofs as to be no 
 longer a subject of argument among physiologists. The re- 
 sults following the partial or total removal of the hemi- 
 spheres by vivisection made upon the lower animals; of in- 
 juries or diseases of the brain ; and of imperfect development, 
 as in cases of idiocy, can only be alluded to, at present, as 
 corroborative of the physiological fact that the organs of the 
 mind are located in the encephalon, and are mainly func- 
 tionalized and manifested through the instrumentality of the 
 hemispherical ganglia of the cortical substance of the cerebral 
 convolutions. 
 
 A classification, founded upon this anatomical basis of the 
 normal actions of the mind, is likely to remain and take pre- 
 cedence of other classifications resting upon purely ideal 
 hypotheses. 
 
26 CEREBKAL LOCALIZATION 
 
 If the regions of motor centres are confidently asserted 
 to be localized in certain parts of the cortex, just mentioned, 
 the same is not so positively stated in regard to centres of 
 sensibility. 
 
 According to Betz, of Kiew, the postero-Iateral regions of the 
 gray cortex of the convolutions are destined for functions 
 of sensibility. These regions would comprise the convolu- 
 tions in which the ribbon of Yicq d'Azyr is situated, and 
 particularly, the temporal lobe and the sphenoidal lobe in- 
 cluding the triangvlar lobule and the quadrilateral lobule placed 
 upon the internal face of the hemisphere. Some authors 
 locate the sensorium commune^ the common centre of sensa- 
 tion, in these regions, and, according to Charcot, this 
 hypothesis is founded upon anatomical and pathological 
 considerations. Admitting the fact urged by many ex- 
 perimenters that an important influence resides in the gray 
 cortex of the convolutions in certain parts of the brain to 
 which certain motor and sensory functions are attributed, 
 there is sufficient proof that the encephalon is the seat of 
 the various phenomena of intelligence, and that the gray 
 cortex of the cerebral convolutions, regarded as a whole, is 
 composed of a plurality of nervous centres through the 
 functionating powers of which the mental faculties are per- 
 formed and made manifest. Moreover, the material con- 
 ditions of the intelligence, of the sentiments and of the 
 instincts, have to be brought into correlation and asso- 
 ciated with each other, and this is brought about by the 
 various intercommunicating medullary white fibres of which 
 the remaining substance of the convolutions is made up. 
 
 The cortex of the convolutions, in fact, overlaps and en- 
 doses four species or kinds of fibres which terminate, most 
 
IN RELATION TO INSANITY. 27 
 
 probably, among the cells of the gray substance and, from 
 the part they perform, are denominated commissural fibres ; 
 arcijorm or fibres of association ; peduncular and radiating 
 fibres. The phenomena of the special senses and of general 
 sensibility and motion are entirely mental in character and 
 are the productions of particular cineritious and medullary 
 centres. It is only carrj'ing the analogy farther, to attribute 
 the intellectual, affective and other faculties to the functional 
 influence evolved from the ganglionic centres of the convolu- 
 tions with which they are correlated. Wherever placed in 
 the brain, the gray matter and white medullary fibres are in 
 direct or indirect communication, the one supplying the 
 ps^^chic or ideal functionating influence, while the others act 
 as the internuncial heralds and messengers. 
 
 As heretofore mentioned, Locke compared the original 
 vacant condition of the mind to a white sheet of paper, (the 
 tabula rasa), devoid of characters, but possessing the suscep- 
 tibility of receiving and retaining perceptions, from impres- 
 sions derived through the external senses, which percep- 
 tions he called sensations. This class of perceptions, accord- 
 ing to the theory of Gall, are also produced through the ex- 
 ternal senses and are evolved by the agency of peculiar 
 stimuli acting upon the dormant susceptibilities of the cere- 
 bral convolutions, and arousing their special functions into 
 activity. The other class of mental action or ideas, follow- 
 ing sensation, called by Locke reflection, and which he sup- 
 posed to originate, through the action of the mind itself, 
 according to the materialistic doctrine, would be considered 
 as nothing more than the active ideation of the cineritious 
 cells of the same or of another set of convolutions. 
 
 The phenomena of the mind are apparently so infinite 
 
28 CEREBEAL LOCALIZATION 
 
 that it might seem a hopeless effort to attempt to reduce, 
 under a few heads, the innumerable sensations and feelings 
 which diversify almost every moment of existence. The 
 philosophers of various sects, however, from remote ages, 
 have assumed the task of rendering to psychological science 
 the same kind of generalization which, in physical research, 
 has proved of such utility, by adopting systems of mental 
 classification. 
 
 One leading classification which was sanctioned and 
 adopted by metaphysicians for many ages, is the division 
 of mental phenomena into those which belong to the under- 
 standing, and those which belong to the loill. 
 
 Another division of the phenomena of the mind, somewhat 
 resembling the ancient division of philosophy into the con- 
 templative and the active, is, into those which belong to the 
 intellectical powers and those which belong to the active 
 powers. Another classification of mental phenomena,, more 
 allied to the views entertained by the metaphysicians of 
 the different systems of philosophy of the present day, is the 
 arrangement of all the mental phenomena into two definite 
 classes, according as the causes or immediate antecedents of 
 our feelings are themselves material or mental. The former 
 of this class — that of the external affections of the mind — is 
 so simple as to require but little subdivision. The other 
 class, however, that of the internal affections, or states of 
 mind, comprehend so large a proportion of mental phe- 
 nomena, and are of such a various character, as to require 
 a number of subdivisions. 
 
 The first great subdivision of the internal class is into our 
 intellectual states of mind and our emotions, and these appear 
 to exhaust completely the whole internal affections of th© 
 
IN RELATION TO INSANITY. 29 
 
 mind. We have sensations or perceptions of the objects that 
 affect our bodily organs ; these are termed sensitive or exter- 
 nal affections of the mind ; we remember objects, we imagine 
 them in new situations, we compare their relations, these 
 mere conceptions or notions of objects and their qualities, as 
 elements of our general knowledge are what are termed 
 the intellectual states of the mind ; we are moved with cer- 
 tain lively feelings on the consideration of what we thus 
 perceive, or remember, or imagine, or compare, with feelings, 
 for example, of beauty, or sublimity, or astonishment, or 
 love, or hate, or hope, or fear ; these and various other vivid 
 feelings, analagous to them, are our emotions. 
 
 There is no portion of our consciousness which does not 
 appear to be included in one or other of these three 
 divisions. This, in brief, is the classification of Brown, and 
 approaches, by purely mental ratiocination, the arrangement 
 adopted by the materialistic philosophers. 
 
 In contrast with the classifications of the mental phenom- 
 ena just mentioned, formed by the mind itself reasoning upon 
 the mind, is the classification of the functions of the mind 
 constructed upon a basis purely organic or material. It rests 
 upon the doctrine that there are two entities only in nature 
 — matter and mind ; the one dependent upon the other, 
 both indestructible, but susceptible of change in their 
 relations. The brain is viewed as the organ of the mind, 
 subdivided into a plurality of organs, which, to simplify 
 description, are arranged in separate regions and localized 
 according to the character and nature of their special func- 
 tions. By this doctrine, no doubt is allowed to exist in 
 regard to the functions of the brain, as a whole, and, 
 although diversity of opinion may arise as to the precise 
 
30 CEREBRAL LOCALIZATION 
 
 assignment of place among the co-operating parts, it is 
 asserted that in the encephalic lobes are localized the 
 material coiiditlons of intelligence, the sentiments, and the 
 instincts. The classification, thus founded, arranges all the 
 mental phenomena into the intellect ual faculties, the moral 
 faculties, and the affective faculties, including the animal pro- 
 pensities. 
 
 In order to render more intelligible the dogmas of the 
 organic classification, a new nomenclature for certain ex- 
 pressions, such as faculty, power, activity, memory, atten- 
 tion, perception, and conception, has been adopted. To the 
 process of the mind, as manifested through the action of 
 the organs, the term faculty is applied. Power, in whatever 
 degree possessed, is capability of feeling, perceiving, or 
 thinking. Activity is simply readiness and quickness. 
 Memory is not regarded as a general /ac?^?/^/ of the mind, 
 as is customary with the metaphysicians, but is considered 
 an attribute or a mode of action of the faculties. Percep- 
 tion is a susceptibility of an organ put into activity, and not 
 a distinct faculty of mind, so of conception, it is but a mode 
 of action of the faculties and not a faculty ; it is the suscep- 
 tibility of the faculties started into activity by internal 
 causes. For example, in regard to memory, the painter may 
 have a memory for colors which the sculptor does not 
 possess, the linguist may have a memory for language not 
 understood by the mathematician, and so on with other 
 supposed metaphysical faculties which are not regarded as 
 such, but looked upon as merely susceptibilities of organs 
 put into a state of activity by external or internal causes. 
 
 On the external aspect of the Hemispheres, the three 
 principal fissures are seen, the fissure of Eolando, the fissure 
 
IN RELATION TO INSANITY. 3l 
 
 of Sylvius and the external perpendicular fissure. Tlie four 
 lobes of the hemispheres are divided by natural fissures 
 and by artificial lines ; these lobes contain the convolutions 
 which are limited by numerous anfractuosities coursing in a 
 serpentine manner in various directions, and are much more 
 regular and constant than might be expected from a cursory 
 examination. The same general disposition of furrows and 
 convolutions is found to be present upon the base of 
 the brain and along the internal surface of the hemi- 
 spheres. The cerebral lobes are named according to their 
 situation, as follows : the Frontal lobe, the Parietal lobe, the 
 Temporo-sphenoidal lobe and the Occipital lobe. 
 
 The Frontal lobe is much the largest of the four, and pre- 
 sents, on its external surface, an amount of cortical or gray 
 substance nearly as extensive as that of the other three lobes 
 united. It is divided from the parietal lobe by the fissure of 
 Eolando, and contains within its limits four principal con- 
 volutions. The frontal ascending, and the first, second and 
 third frontal convolutions. The para-central convolution is 
 partly placed upon the inner aspect of the lobe. 
 
 The Parietal lobe is limited in front by the fissure of Ro- 
 lando, posteriorly, although imperfectly, by the external per- 
 pendicular fissure, inferiorly, by the posterior prolongation 
 of the fissure of Sylvius. Externally, on this lobe, a notable 
 fissure is met with, the inter-parietal fissare ; and three con- 
 volutions, the ascending parietal convolution, the superior 
 parietal convolution and the inferior parietal convolution. 
 Upon the internal hemispherical aspect, the quadrilateral 
 lobule, the precuneus and a part of the para-central lobule 
 are placed. 
 
 The Temporo-sphenoidal lobe is bounded superiorly by the 
 
32 CEREBRAL LOCALtZATiOl^ 
 
 posterior prolongation of the fissure of Sylvius, anteriorly by 
 the anterior part of the fissure of Sylvius, posteriorly, by an 
 imaginary perpendicular line dropped from the posterior part 
 of the inter-parietal fissure, ending at the basal surface of the 
 brain, inferiorly, by the surface at the base of the brain. 
 This lobe contains a marked fissure called the parallel fis- 
 sure, and the temporal convolutions designated as the first, 
 second and third. 
 
 The Occipital lobe is bounded superiorly, by the external 
 perpendicular fissure, anteriorly, by the imaginary line men- 
 tioned as forming the posterior boundary of the temporal 
 lobe, posteriorly, by the cerebral cortex, and inferiorly by 
 the lower part of the hemisphere. This lobe is small, irreg- 
 ular, and is formed by three convolutions, the superior oc- 
 cipital convolution, the middle occipital convolution, and 
 the inferior occipital convolution. The internal hemispher- 
 ical aspect presents the cuniform lobule and the fissure of 
 the hippocampus. This, in brief, is a summary of the lobes, 
 convolutions, fissures and lobules of the cerebral hemi- 
 spheres. In each of the regions thus designated, certain or- 
 gans are localized, and when subjected to certain states of 
 activity, the various mental phenomena of which the mind is 
 susceptible are evolved. 
 
 In addition to this analysis of the action of the mind, it is 
 not to be overlooked that there exists an auxiliary nervous 
 apparatus known as the Organic or SympatJwtic System of 
 nerves, which communicate generally with the other part of 
 the nervous system known as the cerebro-spinal axis. The 
 Sympathetic system of nerves supplies the organs of the great 
 splanchnic cavities, such as the heart, lungs, stomach, liver, 
 etc., and, anastomosing freely with the nervous branches 
 
iii RELATION TO INSANITY. 3^ 
 
 springing from tlie spinal marrow and the brain, influences, 
 in health and in disease, the functions of the brain. Morbid 
 changes that occur in the blood and the Reflex Action of some 
 portions of the nervous system must, also, be recognized. 
 
 The improved anatomy of the brain and the possibility of 
 assigning to particular parts of the cerebro-spinal system 
 certain functions with invariable exactness have recently 
 directed the attention of physiologists more closely to the 
 study of the cerebral cortex. The results of the experiments 
 of Fritsch, Hitzic and Terrier are prominent in reference to 
 the localization of certain motor centres among the sub- 
 stance of the gray matter of the convolutions. These ex- 
 periments seem to controvert the principle so long main- 
 tained that the gray ganglionic substance of the brain is not 
 excitable by the electric current, or any other stimulus. 
 Although the doctrine of placing motor centres in the con- 
 volutions is not universally accepted, it seems as likely for 
 motor and sensory influence to be located in the substance 
 of the gray matter of the cortex as among the gray matter of 
 the corpus striatum, a fact which is not doubted at the present 
 time. It may be, that extremely delicate medullary fibres 
 from some points of the corona radians may be prolonged 
 into the substance of the cortex. Be this as it may, there is 
 undeniable evidence that the encephalon presides over and 
 functionates the phenomena of intellectual and affective 
 ideation. The accumulation of facts sufficiently prove this 
 theory. In man, the moral and most noble qualities, the 
 ability to compare impressions, to express remembrance, be- 
 come enfeebled or entirely disappear when grave lesions 
 of the encephalon occur. The simple compression of this 
 organ produces a state of torpor or of coma which ceases 
 
34 CEREBRAL LOCALIZATION 
 
 with the removal of the compression ; the development of 
 intelligence and of the moral aptitudes and perceptions fol- 
 low, step by step, the evolution of infancy and the perfec- 
 tioning of the encephalic mass : a malformation of this mass 
 is the invariable antecedent cause of imbecility or idiocy. 
 As all mental phenomena are comprised in the intellectual, 
 the affective or instinctive faculties, the difficulty of assigning, 
 in the present state of science, the exact confines of each cere- 
 bral organ, does not controvert or invalidate the general prin- 
 ciple of cerebral localization, or disturb the proposition that 
 there is always present a mutual and reciprocal relation be- 
 tween the existence of material organs with the performance 
 of mental functions. It is well known and established that 
 the functions of sensation and motion are definitely placed 
 in certain fixed localities of the medulla spinalis and brain, 
 that the vital actions necessary for the completion of respira- 
 tion, of circulation, of digestion and other important functions 
 have their functional origin in and about the medulla ob- 
 longata — that the origin of the nerves of special sense have 
 their definite site in the part of the brain assigned to them, 
 that the pons varolii, the tubercula quadrigemina, the optic 
 thalami, and the corpora striata have their individual func- 
 tions allotted to them, and that among the convolutions of 
 the brain the function of the ideation and the exercise of arti- 
 culate language is distinctly placed in the third frontal con- 
 volution of the left hemisphere. The principal once estab- 
 lished, that the brain is a multiple organ composed of many 
 organs and that the site of an organ and its function can be 
 localized and separated from the others in the general struc- 
 ture of the encephalon, is sufficient to authorize the asser- 
 tion, by induction, that each mental function must, also, be 
 
IN RELATION TO INSANITY. 35 
 
 associated with its especial organ. Upon this correlation of 
 organ and function, a system of mental philosophy may be 
 formed, resting upon a more solid basis and of more easy 
 comprehension than the systems of metapliysics founded by 
 reasoning emanating from the action of the mind itself, re- 
 flecting upon itself, in order to arrive at conclusions. This 
 view of the constitution of the mind will lead to a more cor- 
 rect understanding of the subject of insanity. 
 
 The healthy condition of the organs and the harmony of 
 action existing between organ and function will indicate a 
 healthy condition of mind — the mens sana. The disturbance 
 of this harmony of action, occurring from a morbid condition 
 of the organs, will result in disease and disturbance of the 
 mental functions, whence insanity arises — the non compos 
 mentis of jurists. 
 
 It is not necessary, at present, to claim for the doctrine of 
 localization the precise limitation of the cerebral organs. 
 What is claimed for the principle is, that the brain, as a 
 whole, is the organ of the phenomena of mind, that it is 
 composed of an aggregation of organs, and that the organs 
 are the functionating sources of the individual mental func- 
 tions. It remains for the future to develop the system, as 
 has been done iu other organs, by physiological and patho- 
 logical research, as, for example, the localization of the 
 organ and function of articulate language in the convolution 
 of Broca. 
 
 From observation and from comparative and pathological 
 anatomy, certain mental faculties, under different terms, have 
 been allotted to certain regions of the encephalon. To the 
 frontal lobes have been assigned the organs of the intellect- 
 ual faculties ; to the posterior or occipital region, the affect- 
 
36 CEREBRAL LOCALIZATION 
 
 ive or emotional organs ; to the temporo-spJienoidal regions, 
 the animal propensities, while the moral sentiments are 
 stated to have their organs developed on the coronal region 
 of the brain. These assignments of place, whether alto- 
 gether correct or otherwise, will serve as a basis for the 
 farther confirmation of the doctrine of cerebral localization. 
 
 As regards the proposed definition of Insanity, it is neces- 
 sary to admit the doctrine as established, that the Brain is 
 the organ of the mind ; that it is a complex machine 
 composed of many parts through the instrumentality 
 or functionating influence, of which all mental phenom- 
 ena are manifested. With this view of the functions of the 
 brain and of the localization of the organs, it must also be 
 understood, that though all the organs of the brain may be 
 diseased at once, yet that it is quite possible for some organs 
 to be in a diseased or abnormal condition, while others, at 
 the same time, are perfectly healthy. The influence of the 
 Organic system of nerves distributed to the organs of the 
 great splanchnic cavities, and the sympathies exercised 
 through them upon the Encephalon, have to be considered, 
 in studying the direct and indirect etiological sources of In- 
 sanity. 
 
 As Ideation or the operations of the Brain are accom- 
 plished at the expense of changes — of partial or total disin- 
 tegration taking place in the cells of the gray matter — it can 
 be understood that particular organs may suffer if their 
 functions are overtaxed beyond the physiological limit of 
 waste and repair. If this pre-established harmony of relative 
 metamorphosis, continually progressing in health, become 
 temporarily disturbed, modifications of cerebral change must 
 ■occur, accompaaied by signs of mental exhaustion or dis- 
 
IN RELATION TO INSANITY. 37 
 
 turbance ; if prolonged for a length of time abnormal men- 
 tal manifestations will appear, representing different forms 
 of insanity, according to the degree or intensity of the pro- 
 gressive change and the character and number of the impli- 
 cated organs. 
 
 From the premises just given, a correct definition of In- 
 sanity would be, a morbid condition of a part or of the whole 
 brain, as manifested by correct reasoning from false prem- 
 ises ; by incorrect reasoning from correct premises ; and by 
 incorrect reasoning from false premises, according to the kind 
 of insanity. 
 
 In the first case, the false premises originate in one part 
 of the brain which is diseased while the other part, the 
 reasoning part, is sound and acting correctly. In the second 
 case, the premises originate in a healthy part of the brain, 
 while the reasoning organs are morbidly affected. In the 
 third case, the part of the brain in which the premises 
 originate and also the reasoning part, are both morbidly 
 affected or diseased. 
 
 This definition is not hypothetical : it is founded upon the 
 character and constitution of the normal mind and from 
 observation and study of the Insane, while living, followed 
 up by future necroscopic examination. Resting upon 
 Organized Structure for its derivation, it will lead to more 
 correct methods of reasoning when mental Alienation, in 
 its diversified modifications and phases, becomes the subject 
 of discussion or of judicial investigation. 
 
 The arguments and statements here advanced concern- 
 ing evolution, and the dependence of mind upon matter, to 
 prove and establish a scientific proposition, are in no way cor- 
 roborative of Peism or Atheism. The Creator chooses His 
 
38 CEREBRAL LOCALIZATION 
 
 own way of maiutaining correlation between man and Him- 
 self, and has planted in the human brain a set of organs 
 which obliges us to acknowledge the great First Cause " who 
 hath produced and will receive the soul." 
 
 The following cases of cerebral disease typically illustrate 
 the perversion of function in co-relation with the locality of 
 the lesion. In three of the cases given in detail, a limited 
 portion of the brain was changed in structure, while the cor- 
 tex of the convolutions remained sound and functionated in 
 a normal manner ; the fourth case is an example of the mor- 
 bid condition of the encephalon, mainly of the cortex, fol- 
 lowed by acute mania in which all the psychical functions 
 were abnormally manifested : 
 
 Case 1. — The history of which dates back, during its 
 progress as far as twenty years, commenced with cerebral 
 sanguineous effusion accompanied by an apoplectic seizure, 
 and terminated by abdominal dropsy and cirrhosis of the 
 liver. The autopsy confirmed in a very positive manner the 
 connection that existed between the cerebral lesions and the 
 symptoms following the several attacks, taking place at 
 short intervals, at the beginning of the disease. The injury 
 found to have been inflicted upon the deep-seated portions 
 of the cerebrum in proximity to and in the structure of 
 the basal ganglions indicated severe shock at the time of 
 seizure. 
 
 The patient, A F , merchant, set. 50, orig- 
 inally of good constitution, of superior intelligence, san- 
 guineo-nervous temperament, and of exceedingly sensitive 
 
m RELATION TO INSANITY. 39 
 
 disposition, after a prolonged period of bad health, the 
 principal feature of which was a hemiplegic condition of the 
 right side, called me in consultation for the first time, about 
 two years previous to his decease. The history of the case 
 up to that time was related to me by a member of his fam- 
 ily, as follows : On August 1, 1862, at the age of thirty two, 
 while laboring under great mental depression and agitation, 
 and under the strain of anticipated commercial disaster, he 
 was suddenly seized about mid-day with an apoplectic at- 
 tack, and was discovered in his library lying prostrate upon 
 a sofa, completely insensible, breathing stertorously, and 
 showing the other signs of cerebral sanguineous eifusion. A 
 physician was hurriedly called. The patient was carried up 
 one flight of stairs to bed, and received proper medical at- 
 tention. In twenty-four hours he showed signs of improve- 
 ment, and by the following Sunday had so far recuperated 
 as to sit up in bed and read the morning papers. During 
 the night (about 2 A. m.) he was again taken very ill, losing 
 his speech and the power of locomotion. In about a week 
 after this attack he regained in a great degree his speech, 
 and began slowly to recover somewhat the power of walking. 
 In September, under advice, he went to the country, and 
 continued to improve, gaining strength. This favorable turn 
 in his condition was but of short duration ; for in February, 
 some five months alter the second attack, he experienced 
 another severe paralytic stroke, falling suddenly, while at 
 the breakfast table, to the floor, insensible, speechless, and 
 unable to move, with other symptoms so grave that his fam- 
 ily supposed he was dying. He continued without much 
 change in this helpless condition for about two weeks. He 
 then commenced to show signs of returning intelligence, and 
 
40 CEREBRAL LOCALIZATIOl^ 
 
 after a time regained very slight locomotive power. His 
 right side remained paralytic, the right arm useless, and in 
 efforts to walk, the right leg was put in motion mainly by 
 being dragged. He was never able to assist in dressing him- 
 self after the last attack, and alluded to the paralytic side as 
 his "dead side." Speech remained thick and indistinct. 
 
 The above statement contains the main features of this 
 patient's history from the inception of his malady up to the 
 time — a period of about eighteen years — when I was iSrst 
 called to see him. Notwithstanding the prolonged duration 
 of the hemiplegia, the anterior part of the brain, after the 
 immediate rude effects of the effusion had subsided, con- 
 tinued to act normally, and although otherwise helpless in a 
 great degree, he directed his private affairs and household 
 arrangements with discretion and good judgment. 
 
 The muscles of the face supplied by the portio dura, and 
 of the orbit by the third pair or motores oculorum, showed no 
 signs of morbid action. The organs of special sense mani- 
 fested no impairment of function until the last year of his 
 illness, when vision became defective, indicating extension of 
 the cerebral lesion, and articulation was so difficult as to 
 render speech barely intelligible. At this period the left side 
 became affected by loss of sensation. 
 
 After the acute symptoms of the attack alluded to had 
 subsided the patient fell into a passive state, hemiplegia of 
 the right side being confirmed, and medical treatment of 
 little use. He was well nursed, received every hygienic at- 
 tention, and his general health was good. He was in the 
 habit of spending the summers at his country-seat to avoid 
 the heat of the city, returning to town at the beginning of 
 winter In the autumn of 1880 he became worse, and I was 
 
In relation to insanity. 41 
 
 then requested to visit liira. At this time, the hemiplegia 
 was very complete, the right leg dragging helplessly in any 
 attempt at locomotion, and the right arm hanging lifelessly 
 by the side, with some contraction of the wrist and fingers. 
 Sensation, also, on this side was much impaired. Under the 
 influence of tonics — quinine, nux vomica, phosphorus, etc. — 
 administered in small doses, slight improvement took place. 
 He continued to be interested in daily affairs, read the news- 
 papers, and supervised some building operations. About 
 twelve months prior to his death general sensibility on both 
 sides became still more diminished, and on the left side to 
 the extent of losing almost entirely the sensation of touch. 
 Vision, also, became so impaired as to prevent his reading 
 the daily papers, which, being one of the few pastimes still 
 left to him, caused him to become greatly disheartened and 
 despondent. A slight improvement afterward took place in 
 the eyesight, and also in the tactile perceptions of the left 
 side, but neither was restored to its condition prior to the 
 relapse. In the early part of 1882 a sharp attack of jaun- 
 dice came on, with tenderness over the hepatic region. This 
 was followed by induration of the liver, oedema of the limbs, 
 and abdominal dropsy, which required the operation of 
 paracentesis to relieve the distress resulting from distension 
 and difficulty of respiration. The patient continued to grow 
 weaker, and gradually sank under the various complications 
 from which he had suffered, dying in August of the same 
 year, about twenty years after the first paralytic stroke. 
 
 The immediate cause of death in this case was cirrhosis 
 of the liver and its sequent abdominal dropsy. The diag- 
 nosis I had given during life attributed the primary disease 
 — the apoplectic seizures, accompanied by hemiplegia, and 
 
42 CEREBRAL LOCALIZATION 
 
 subsequently complicated with partial anaesthesia — to san- 
 guineous effusion in the region of the corpus striatum of the 
 left side, followed by softening of the structureof the corpus 
 striatum, this invading the internal capsule, and extending to 
 parts of the optic thalamus of the same. side. 
 
 TJie loss of sensation and the diminution of motor power 
 on the left side and the defect of vision can be accounted for 
 by the diseased ^jondition of the lenticular portion of the 
 corpus striatum, of part of the optic thalamus of the rigJit 
 side, and of the posterior portion of the internal capsule, 
 occurring during the progress of the malady, and which the 
 autopsy revealed. 
 
 AuTOPBY.-:-The brain was placed on a marble slab, the 
 base downward. With a fine cerebrum knife the left hemis- 
 phei*e was cut horizontal!}^ so as to expose the centrum ovale 
 of Vieussens ; another section, about four millimetres deeper 
 on the hemisphere, was then made in the same direction, 
 immediately over the roof of the lateral ventricle* The 
 lateral ventricle was now laid open by inserting the handle 
 of a scalpel along the internal margin and breaking down 
 the roof of the ventricle as far as the interior and poste- 
 rior cornua, and pushing externally to one side the white 
 substance overlying the ventricle. The upper surface of 
 the corpus striatum, the optic thalamus, the choroid plexus, 
 velum interpositum, and other parts of the ventricle were 
 thus exposed. The two last-mentioned structures being re- 
 moved, the upper surfaces of the corpus striatum and of the 
 optic thalamus were fully brought into view, and presented 
 the smooth, normal appearance common to the lining mem- 
 brane of the ventricle. A section was next made by passing 
 the knife vertically and transversely across the frontal lobe 
 
IN RELATION TO INSANITY. 43 
 
 immediately in front of the anterior extremity of the corpus 
 striatum. This section was joined by another carried longi- 
 tudinally and vertically backward near and parallel to the 
 great median' fissure, thus detaching a somewhat triangular 
 portion of the frontal lobe, and exposing the structure of 
 the anterior extremity of the corpus striatum and of the^ in- 
 dentations in front of the convolutions of {he island of Keil. 
 On the surface thus presented nothing abnormal was seen. 
 Another transverse section, parallel to the previous one, 
 and about five millimetres posterior to it, was made through 
 the corpus striatum and the other tissues immediately 
 below it. The face of this section showed the fibres of the 
 internal capsule located between the gray substance of the 
 caudate and lenticular ganglions to be in a diseased condi- 
 tion. The lenticular portion presented a small cavity sur- 
 rounded by yellow, softened structure encroaching upon 
 the medullary fibres of the internal capsule. A third sec- 
 tion was now made, about three millimetres behind the 
 second, parallel to it, and a little in front of the line of de- 
 pression that exists between the corpus striatum and the 
 optic thalamus. This section opened up the middle part of 
 the corpus striatum, in which was found a cavity, when held 
 apart, large enough to contain a small bean, and the walls of 
 which, to the extent of several millimetres, were surrounded 
 by a pultaceous creamy substance which here invaded and 
 destroyed the fibres of the internal capsule. The internal 
 surface of this cavity was in part rough, congested, and of 
 dark purple color. It extended a short distance into the 
 anterior and external side of the optic thalamus, and was 
 there also surrounded for a space of some millimetres by 
 softened cerebral substance. A fourth transverse and verti- 
 
44 CEREBRAL LOCALIZATION 
 
 cal section was made, through the anterior third of the optic 
 thalamus. This showed the termination of the cavity 
 and softened substance mentioned as existing in the 
 corpus striatum and extending into the antero-lateral part 
 of the optic thalamus. A fifth transverse and vertical sec- 
 tion continued the examination across and through the 
 posterior third of the optic thalamus, exposing a cavity 
 large enough to contain a garden pea. This centre of 
 hemorrhagic effusion was found also surrounded by softened 
 structure. A transverse and a vertical section made on a 
 level with the margin of the anterior tubercles (the nates) of 
 the tubercula quadrigemina showed nothing abnormal. A 
 transverse section made to drop vertically, as if through the 
 ^arieto-occipital lobes, exposed a cavity in the white cere- 
 bral substance, nearly on a level with the centrum ovale, 
 large enough to contain an ordinary-sized filbert. The wall 
 of this cavity was directed toward the cuneiform lobe, and 
 extended superiorly in the direction of the convolutions of 
 the quadrilateral lobe. The white structure around this 
 cavity was soft and pultaceous to the extent of several milli- 
 metres. The remaining parts of the left cerebral hemis- 
 phere presented no deviations from the normal condition. 
 
 The i^ight cerebral hemisphere was now examined by first 
 making the ordinary transverse section of the hemisphere to 
 expose the white substance of the centrum ovale of Yieus- 
 sens. A similar section, carried some lines deeper, opened 
 a cavity, situated about the centre of the white substance of 
 the cerebrum, of sufficient extent to contain a large-sized 
 hazel-nut. This cavity was somewhat triangular in shape, 
 extended laterally and internally toward the outer side of the 
 optic thalamus and of the corpus striatum, and externally 
 
IN RELATION TO INSANITY. 45 
 
 about three centimetres and a half from the ascending pari- 
 etal lobe. The perimeter of the cavity was surrounded by 
 softened cerebral structure, invading inwardly the external 
 wall of the lateral ventricle, the lenticular portion of the 
 corpus striatum external to the internal capsule, and, to a limi- 
 ted extent, the posterior part of the internal capsule. The 
 caudate ganglion and the anterior portions of the internal 
 capsule were found to be unchanged. The remaining parts 
 of the white medullary substance of the right and left hem- 
 ispheres presented nothing abnormal. The gray cortical 
 substance overlying the lobes and lobules of both hemis- 
 pheres was in a perfectly healthy condition, as were also the 
 dura mater, pia mater, and arachnoid membranes. The an- 
 fractuosities or sulci between the convolutions were of un- 
 usual depth, particularly in the fronto-parietal regions. 
 
 Upon a careful examination of the external and internal 
 structure of the cerebellum, no change from the normal or- 
 ganization was perceptible. 
 
 The localization of the cerebral structures at fault in this 
 case was diagnosticated, during life. The loss of motion on 
 the left side was characteristic of disease of the corpus 
 striatum, including part of the internal capsule of the left 
 hemisphere. The anaesthesia, diminished motor power on 
 the left side and imperfection of vision appearing, during 
 the progress of the disease, represented the extension of the 
 cerebral softening {ramollissement) of the external part of the 
 corpus striatum of the right hemisphere and of the optic 
 thalami. The cavity and softening found around it in the 
 posterior part of the left hemisphere in proximity to the 
 gyrus angularis may have modified somewhat the function of 
 vision, 
 
46 . CEREBEAL LOCALIZATION 
 
 The defective articulation resulted from the Wallericm 
 degeneration, met with in the medullary strands, passing 
 backward and downward from the basal ganglions through 
 the medulla oblongata, interfering with the origin and func- 
 tion of the hypoglossal nerve. 
 
 Case 2. — Is noticeable from the definite localization of the 
 disorganization of cerebral structure and the equally limited 
 perversion of function, Experiments by vivisection, and 
 more particularly pathological observations, attest the inti- 
 mate connection of the tuber cula qiiadrigemina with the rest 
 of the nervous apparatus of vision. — A male patient, aged 
 thirty-five years, of spare habit and in feeble health, was ad- 
 mitted to 'the ophthalmic department of the State Immi- 
 grants' Hospital, for amaurosis. He was entirely blind in 
 both eyes, not being able to distinguish light from darkness 
 in open day. His face presented a vacant stare, the pupils 
 dilated and irresponsive to light, and the globes of the eyes 
 apparently immovable. He walked with the unsteady gait 
 of the blind, and had somewhat lost the power of locomo- 
 tion. The internal humors of the eyes were translucent ; 
 the retinae appeared pale, anaemic, and somewhat puckered. 
 
 This patient contracted a typhoid fever, to which he suc- 
 cumbed three weeks after the attack, and thus afforded an 
 opportunity for a postmortem examination. The brain, with 
 the exception of being somewhat paler than natural, pre- 
 sented nothing specially abnormal until reaching the region 
 of the tubercula quadrigemina. A bundle of hydatids, two 
 of them as large as good-sized peas, with several others of 
 smaller proportions, was to be seen directly over and im- 
 planted upon these organs. The tubercula quadrigemina 
 were slightly atrophied, and the process of ramolUssement had 
 
IN RELATION TO INSANITY. 47 
 
 begun. The optic tracts, chiasma, and optic nerves were 
 abnormally wliite, shrunken, and cord-like, and the retinae 
 paler than natural, and somewhat atrophied. The diagnosis 
 had decided the amaurosis to have originated from cerebral 
 disturbance, and suitable treatment had been observed, 
 without any beneficial result. 
 
 Case 3. — Another case of similar import to that just re- 
 lated is recorded by Jobert de Lamballe. 
 
 "Chez un malade, la vue baissa graduellement, les pupilles 
 se dilaterent, et il n'y eut plus perception que d'une faible 
 lueur. C'est par I'oeil droit que la perte de la vue commen^a, 
 et bientot I'oeil gauche cessa de voir a son tour. L'autopsie 
 fit decouvrir une tumeur comprimant les tubercules quad- 
 rijumeaux : mais la 'paire gauche avait plus souffert de la 
 compression que la droite ; aussi I'atrophie etait-elle plus 
 marquee chez la premiere." 
 
 The previous cases, in which the internal cerebral structure 
 was found to be deceased, manifesting corresponding special 
 functional disorder, while the cortex of the convolutions con- 
 tinued to perform its functions normally, are in contrast 
 with the following case in which the cortex was found at 
 fault, accompanied by symptons of acute mania, while the 
 functions of motion and of general and special sensation 
 were not lost. 
 
 Case 4. — I was lately called in consultation to see a gentle- 
 man, about forty years of age, originally of good constitution, 
 a free liver, addicted, at times, to immoderate use of alco- 
 holic liquors. At my visit, he was laboring under the symp- 
 toms of acute mania — flushed face, wild and vacant expres- 
 sion, restlessness, throwing himself upon a couch and getting 
 suddenly up, walking rapidly to and fro, incoherent, full of 
 
48 CEREBRAL LOCALIZATION IN RELATION TO INSANITY. 
 
 delusions and hallucinations, imagining the presence of hid- 
 eous animals and of non-existing dangers to his person, mut- 
 tering unintelligible sentences and utterly uncognizant of his 
 condition and of the entreaties of his attendants. The pulse 
 was rapid, great thirst, refusing food, at times inclined to be 
 violent. 
 
 These symptoms continued unabated for a period of two 
 days, when the patient, gradually becoming weaker, finally 
 ran into a comatose condition and died, laboring under the 
 symptoms of cerebral effusion. 
 
 Autopsy. — Upon removal of the calvarium and opening 
 the dura mater^ a quantity of serous fluid escaped, exposing 
 the upper surface of the encephalon. Both hemispheres 
 presented a congested state, the veins running, tortuous 
 over the convolutions, distended with dark colored blood. 
 The arachnoid exhibited generally a thickened, opaline ap- 
 pearance. The pia mater was universally red, showing a 
 vascular condition, as if injected by colored " size." This 
 appearance was also manifested in the anfractuosities be- 
 tween the convolutions. The ventricles were full of yellow 
 serum, and the vellum interpositum and choriod plexuses 
 were turgid with blood. 
 
 A section of each hemisphere, exposing the white sub- 
 stance of the centrum ovale displayed an unusual number 
 red dots of escaping blood, showing that the medullary sub- 
 stance of the brain had participated somewhat in the severi- 
 ty of the attack, but no other morbid changes were found in 
 the internal substance of the brain. 
 
 In this case, the characteristic pathological changes of the 
 encephalon were followed by manifestations of universal and 
 overwhelming mental aberration, in the form of acute mania. 
 
THE LIBRARY 
 UNIVERSITY OF CALIFORNIA 
 
 San Francisco 
 
 THIS BOOK IS DUE ON THE LAST DATE STAMPED BELOW 
 
 Books not returned on time are subject to fines according to the Library 
 Lending Code. 
 
 Books not in demand may be renewed if application is made before 
 expiration of loan period. 
 
 15m-5,'70(N6489s4)4128-A33-9 
 
♦'^ , " > 
 
 y.:, ^--v>-.: 
 
 4 
 
 k^^a'\: