Lawrence affirms that he had “examined after death the heads of many insane persons, and had hardly seen a single brain which did not exhibit obvious marks of disease;” and he further states, “that he feels convinced from his own experience, that very few heads of persons dying deranged will be examined after death without showing diseased structure, or evident signs of increased vascular activity.” The celebrated Morgagni gives similar results of his extensive dissections. Meckel and Jones are of the same opinion. However, Pinel, whose anatomical pursuits on the subject were most extensive, clearly declares that he never met with any other appearance within the cavity of the skull than are observable in opening the bodies of persons who have died of apoplexy, epilepsy, nervous fevers and convulsions. Haslam, whose experience in this matter was also very great, asserts that nothing decisive can be obtained in reference to insanity from any variations of appearance that have hitherto been detected in the brain. Greding observed in two hundred and sixteen maniacal cases which he examined, the whole of whom died of disorders unconnected with their mental ailments, that three of the heads were exceedingly large, two exceedingly small; some of the skull bones were extremely thick, others peculiarly thin; in some the frontal bones were small and contracted, in others the temporal bones compressed and narrow.

In this confusion and clashing of opinions, when unfortunately each theorist views, or fancies that he views, functional or organic derangements sufficiently evident (in his eyes at least) to support his doctrine, it is no easy matter to come to a fair conclusion. It can only be observed, that, as the wonderful sympathies of the brain with other organs especially the viscera of the abdomen, are universally acknowledged, the morbid condition in which the brain is occasionally found may have arisen from a primary morbid condition of some other organ. Hence it is difficult to say whether insanity is most generally a primary or a secondary affection. Physical causes act both upon the brain and the abdominal system. Concussion and compression of the brain will occasion nausea, vomiting, and hepatic affections, and the presence of worms in the intestines will excite convulsions and epilepsy. In regard to moral causes, they may also act directly or indirectly upon the brain, or the parts that sympathize with it. Sudden or violent emotions are known to produce an immediate effect upon our digestive functions, which may in turn by their sympathetic connexion act upon the brain and the mind, although the connexion between brain and mind is not yet proved in any conclusive manner.

However, in a practical point of view, whatever discrepancy of opinion may prevail on this subject, I think it will be found advisable to consider most, if not all recent cases of insanity, as arising from physical causes, and therefore to submit the patient to such a medical treatment in addition to moral aid, as the prevalence of morbid symptoms of local derangement are more or less evident. My own experience has fully convinced me that a morbid condition of the cerebral organ, and the viscera of the thorax and abdomen, are invariably met with, and must have proved of sufficient importance to develop symptoms which the slightest observations might have detected. How far the organic derangement may have been either the cause or the result of insanity I am not prepared to say, but they have generally borne the appearance of having originated in undue excitement.

On this most important subject I feel much gratification in quoting the following opinion of the experienced Pinel: “It appears in general that the primitive seat of insanity is in the region of the stomach and intestinal canal, and it is from this central part that mental aberration is propagated as by irradiation.” Esquirol is of opinion that insanity arises from a lesion of the vital functions of the brain, and not unfrequently from a disturbance in the various points of sensibility in different parts of the system.

That mental emotions, whether producing any alteration in the physical condition of the individual, or not, occasion various degrees of insanity, is proved by experience. The French revolution, during its execrable phases, offered a wide and fertile field of observation on this subject; and the various events that marked those fearful times were certainly well calculated to affect any brain capable of becoming deranged. The following results of these observations are curious: “Among the lunatics confined at Bicêtre,” says Pinel, “during the third year of the Republic, I observed that the exciting causes of their maladies, in a great majority of cases, were extremely vivid affections of the mind; such as ungovernable or disappointed ambition, religious fanaticism, profound chagrin, and unfortunate love. Out of one hundred and thirteen madmen with whose history I took pains to make myself acquainted, thirty-four were reduced to this state by domestic misfortunes, twenty-four by obstacles to matrimonial union, thirty by political events, and twenty-five by religious fanaticism. Those were chiefly affected who belonged to professions in which the imagination is unceasingly or ardently engaged, and not controlled in its excitement by the exercise of the tamer functions of the understanding, which are more susceptible of satiety and fatigue. Hence the Bicêtre registers were chiefly filled from the professions of priests, artists, painters, sculptors, poets, and musicians, while they contained no instances of persons whose line of life demands a predominant exercise of the judging faculty,—not one naturalist, physician, chemist, or geometrician.”

The following is a return of the supposed moral causes of insanity observed in the Salpétrière. In the years 1811 and 1812

Domestic affliction 105
Disappointed love 46
Political events 14
Fanaticism 8
Fright 38
Jealousy 18
Anger 16
Misfortunes in circumstances 77
Offended vanity 1
Total 323

In Mr. Esquirol’s private establishment during the same period:

Domestic affliction 31
Disappointed love 25
Political events 32
Fanaticism 1
Fright 8
Jealousy 14
Misfortunes 14
Offended vanity 16
Baffled ambition 12
Intense study 13
Misanthropy 2
Total 168