Observations on mental derangement: being an application of the principles of phrenology to the elucidation of the causes, symptoms, nature, and treatment of insanity

Front matter

Sete iate: ty

eae sy

& ie

Contents

—S

INTRODUCTION, : : ; : : . - Page vii

Cuap. I.—General remarks on the Functions of the Brain and Nervous System,

Introduction

Wuen yet a student, I joined in the general burst of ridicule with which the phrenological doctrines were received at the time of Dr SpuRzHEIM’s visit to Great Britain in 1816-14, a piece of conduct which is explained, though far from justified, by the circumstance, that I was then totally unacquainted with their nature and» import. My attention was first seriously turned to the examination of these doctrines during my residence at Paris, in the autumn of 1818, when Dr Srurz- HEIM’s Observations sur la Phrenologie, then just published, were happily put into my hands, at a time when, from there being no lectures in any of the Parisian schools, I had ample leisure to peruse that work deliberately. I had not proceeded far before I became impressed with the acuteness and profundity of many of the author’s remarks on the varied phenomena of human nature, and with the simplio

Yili. ' INTRODUCTION.

city of the principles by which he explained what had previously seemed contradictory and unintellisible; and, in proportion as I advanced, the scrupulousness of statement, sobriety of judgment, and moral earnestness with which he advocated his views, and inculcated their importance, made me begin to apprehend that to condemn without inquiry was not the way to ascertain the truth of Phrenology, or to become qualified to decide in a matter of medicine or of philosophy. I therefore resolved to pause, in order to make myself acquainted with the principles of the new physiology, and to resort, as he recommended, to observation and experience for the means of verifying or disproving their accuracy, before again hazarding an opinion on the subject. In carrying this resolution into effect in the following winter session, I had the advantage of being able to attend two Courses of Lectures delivered by Dr SpurzHEIM, at Paris, on the Anatomy, Physiology, and Pathology of the Brain and Nervous System, during one of which rather a striking confirmation of his doctrine occurred. In the middle of the lecture of Ist December 1818, a brain was handed in, with a request that Dr SpurzHEim would say what dispositions it indicated, and he would then be informed how far he was correct. Dr SpurzHEemm a

INTRODUCTION. ix took the brain without any hesitation, and, after premising that the experiment was not a fair one, in as far as he was not made acquainted with the state of health, constitution, or education, of the individual, all of which it was essential for him to be aware of before drawing positive inferences ; he added, that, nevertheless, he would give an opinion on the supposition that the brain had been a sound one, and endowed with ordinary activity. After which, he proceeded to point out the peculiarities of development which it presented, and desired his auditors to remark the unusual size of the cerebellum, or organ of Amativeness, and the great development of the posterior, and of part of the middle lobes of the brain, corresponding to the organs of the lower propensities, the convolutions of which were large and rounded, forming a contrast with the deficient size of the anterior lobes, which are dedicated to the intellectual faculties. The convolutions situated under the vertex, and towards the top of the head, belonging to the organs of Self- Esteem and Firmness were also very large, while those of Veneration and Benevolence were small. These peculiarities were so well marked, that Dr SpurzHEIM felt no difficulty in inferring that the individual would be very prone to sensual indul-

* x INTRODUCTION.

gences; that “his natural tendencies would not be towards virtue ;” that he would be what is familiarly expressed in French by “ un mauvais sujet,” being a very comprehensive term for every variety of bad dispositions, and that “ he would be one to whom the law would be necessary as a guide;” but not knowing the seameneir 8 in which he had been placed, he could not say y what’ his actions might have been.

At the conclusion of the ris ae man, an éleve interne of the Hétel Dieu, came forward and said, that the brain was that of a suicide, who had dea skh hospital, and that the dispositions inferred by Dr Spurzueim coincided perfectly with those manifested during life. As I was at the same time following the surgical clinique of the celebrated DupPuyTREN, whose patient he was, and as the case was interesting both in a professional and phrenological point of view, my attention had been particularly directed to this very individual from the day of his entrance into the Hétel Dieu, to that of his death, a period of about fourteen days; and I was thus better able'to appreciate the perfect accuracy of

Dr SpurzHEImM’s conclusions, than if I had merely trusted to the report of the éléve. The man, it appeared, had been a soldier, and had, for some crime,

INTRODUCTION. Xl suffered an ignominious punishment, and been dismissed from the army, He returned to Orleans, to resume his trade of barber, but every one shunned him ; and, suspecting his wife to have been secretly his enemy, he attempted to kill her with a knife, and, being defeated in this, he stabbed himself in the side, was carried to the hospital, and died of the wound. As he lay in bed, the head sunk in the pillow, its size seemed to be small, but this arose from the anterior part, or the seat of intellect (which was very defieient) being alone visible, the whole bulk consisting of the organs of the propensities. DupvuyTREN, when commenting on tHe case, in his lecture, made daily complaints of the man’s mauvais moral, imperiousness, and violence of temper, and represented these qualities as great obstacles to his recovery. So that, altogether, the close coincidence between the facts with which I was familiar, and the remarks of Dr SpurzHerm, who had never seen the skull, and judged from the brain alone, as it lay misshapen on a flat dish, made a deep impression on my mind, as it went far to prove, not only that organic size had a powerful influence on energy of function, but that there actually were differences in different brains, appreciable to the senses, and indicative of diversity of function *.

* While writing the present pages (12th November 1830), I xil* * . INTRODUCTION: 7 a

E In continuing the practical observations which I had begun to make on living heads, I met at first with many difficulties, partly from unacquaintance with the local situations of the alleged organs, and with the limits of their respective functions; and partly also from want of experience in observing : and thus, while the general result seemed to be con- — Oe firmed, many apparent exceptions presented themselves, and gave rise to numerous doubts. In extending my observations, however, for the purpose 7. ; was invited to assist at the examination of another suicide, whose brain presented a remarkable resemblance to that of the Frenchman. In most wie x of self-destruction, large Cautiousness is found in combination with deficient Hope, and there is a tendency to settled depression or gloomy anticipation of futurity. In the two cases now before us, however, this did not hold, and the deed was apparently the result of disappointed selfishness, having no moral sympathies on which to fall back, and thus generating recklessness rather than despondency. In the recent instance there was an unfavourable combination of powerful Secretiveness, Firmness, Acquisitiveness, and Self-Esteem, with a low moral, and deficient reflection ; and, on opening the head, an effusion of whitish serum, and great vascularity of the pia mater, were found at the vertex, in the region corresponding to the organs of Self-Esteem and Firmness, as the centre, and extending laterally to those of Love of Approbation and part of Conscientiousness. ‘These appearances were remarked by several medical gentlemen. The vascularity was not in the least like that from gravitation, and it diminished in proportion as we receded from the vertex, both posteriorly and anteriorly. The act itself, I need hardly add, was the result of disease.

INTRODUCTION. -. * xi > * 4 of Pesidnaitiic these objections, natural solutions so invariably presented themselves, one after ial ther, in proportion as they were scrutinized, that, after two years’ experience, the conviction of the truth of the fundamental principles, and of the correctness of the functions ascribed to many of the larger organs, became irresistible, while I still hesitated in regard to several of the smaller organs, the evidence of which I had not sufficiently examined. Actuated by the natural feeling of improbability that so much’ should have been discovered in so short time by only two individuals, however eminent their talents and felicitous their opportunities, I still expected to meet with some important errors of detail, and, so far from being disposed to adopt implicitly all the propositions of Drs Gay and Spurz- HEIM, I rather looked for, and expected to find, some hasty conclusions or unsupported assumptions ; and my surprise was extreme to discover, that, in the whole extent of their inquiry they had proceeded with so much caution and accuracy, as, in all their essential facts and inferences, to have rendered themselves apparently invulnerable.

On finding their statements in regard to the conditions required for the healthy manifestations of mind, thus borne out, and aware that a true physiobs

Xiv INTRODUCTION.

logy of the brain should not only derive confirmation from its morbid phenomena, but that it was, in fact, the only basis on which an intelligible and consistent view of the pathological derangements of the mental faculties, and the means required for their cure, could rest, I resolved not to lose the favourable opportunity of prosecuting the inquiry, which then presented itself in the announcement of a Course of Clinical Lectures on Mental Derangement, at the Hospice de la Salpetriere, by the celebrated Esouirot, the friend, pupil, and successor of Pixex. This course Laccordingly attended in the spring of 1819, being the first which was given ; and, amid the numerous forms of disordered mind, congregated in so large an establishment, I felt great interest in tracing the consistency which still appeared to obtain between the phenomena and the physiological principles unfolded by the founders of the new philosophy. So closely, indeed, did the descriptions of the various forms and transitions of insanity, and the distinctive features of the numerous cases referred to by the Professor in illustration, (the subjects of most of which were then to be seen in the asylum), correspond with the doctrines which I was engaged in studying, that I very naturally supposed that M. Esquirow himself must be

INTRODUCTION. KV a phrenologist; and accordingly, in a letter to a friend in Edinburgh, written on’ my return from one of the lectures, after mentioning where I had been, I added, that on that day the Professor had finished the symptoms attending disorder of the intellectual faculties, and that, though he had made no allusion to nena gy yet he proceeded to discuss each separately, 4p 4 as Dr. SpuRZzHEIM himself would have done; and, after referring to some cases of lesion of particular powers, which Phrenology seemed to explain, I concluded by saying, as the result of the whole, that. he appeared to lean much to the new views, although he had not spoken of them by name. This remarkable coincidence strengthened the impression already made on me in favour of Phrenology, but still many doubts remained.

Having met Dr Spurzueim shortly after the letter referred to was despatched, I happened to express to him the gratification I felt in M. Esgurrows Lectures, and my belief that the latter must be a good phrenologist. My surprise, it may be conceived, was very great, when Dr SPURZHEIM informed me, that notwithstanding the remarkable coincidence which I had observed between all the facts and most of the opinions of M. Esguirou and

Xvl INTRODUCTION.

those of Phrenology, the Professor was nevertheless opposed to the new doctrines. Nor was I long left in doubt on this point; for, in some of his subsequent lectures, that gentleman introduced Dr Ga1’s opinions, merely to add that he totally differed from them; while every fact which he mentioned, and every case which he quoted, seemed to me to corroborate the fundamental propositions of the very philosophy, which, in the abstract, he unqualifiedly condemned. He mentioned objections, indeed, but these were either entirely founded on misconception, or they were the hackneyed and thread-bare assertions, which the slightest acquaintance with the subject enables every one to solve for himself, and which have already been refuted, times without number, in every country in Europe. He spoke also of instances in which Drs Ga and SpuRZHEIM had gone wrong in their opinions of individual heads in the asylum, and of which he had preserved casts; but he neither stated precisely in what the errors had consisted, nor did he exhibit the casts ; so that he afforded no means of determining whether a mistake had occurred, or, if so, whether the fault lay in the science, or merely in its individual application, in which last, as in chemistry or in natural philosophy, an error may be committed, without

INTRODUCTION. xvii affecting the truth of the general law. But, as every observation which he made, and every case which he exhibited, appeared to be in harmony with Phrenology, and nowise to warrant the unfavourable conclusions which M. Esgurrot had drawn from them, I could not attach very great importance to them as disproving the doctrines I was investigating; and accordingly continued my inquiry.

Feeling at every step I made in the examination of Dr Gatt’s discoveries, a deeper and deeper sense of their importance and practical usefulness, if they should prove to be true, and having made myself sufficiently acquainted with his principles, to be able to follow their application, I then entered upon the perusal of Dr SpurzHeErim’s French work, Sur la Folie*, with much attention, and with constant reference to the cases and phenomena brought under review, in the wards and lecture-room of the Salpetriére ; and, when thus employed, I became still more alive to the value of Phrenology as a branch of professional knowledge, and lost no opportunity of testing its evidences by a comparison with nature. Shortly after this, viz. in 1820, a trea-

* This admirable work, which was published in 1818, had appeared two years previously in English, under the title of “ O0- servations on Insanity,” but I had not seen it.

Xvill INTRODUCTION.

tise, entitled De la Folie, made its appearance from the pen of M. Grorcrt, and met in many quarters with much commendation, for the precision, consistency, and soundness of its doctrines. This work proved not only to be very ably written, but to be based throughout on the principles of Phrenology, and to be devoted, in its whole substance, to the advocation of the same doctrines in regard to mental affections, which, with some slight differences, it was the sole object of that previously published by Dr SpurzHeEim, to inculcate. Of the latter, however, M. Grorcret made no mention whatever, although he referred to Dr Gat’s writings and lectures as the sources of many of his ideas; and, so oddly are opinions biassed by preconceived notions, that it is said to have happened that the same critic, who expressed his disrespect for the views as published by the one author, bestowed his approbation upon them as coming from the other. Iam uncertain whether this allegation be strictly correct; but I am quite secure in stating, that Dr SpuRzHEIM’s book, although in substance the same, met with a very different reception from that published by Dr

GEORGET.

From M. Grorcert thus openly proclaiming opinions on insanity and on the functions of the brain,

INTRODUCTION. Xix coincident at least with those previously published by Dr SpurzHEiM, it was to be supposed that he had received his professional education, far from the influence, and especially far from the alleged antiphrenological facts of M. Esqu1rot; as one would naturally imagine, that, if living within reach of that gentleman, any leaning towards Phrenology would have been instantly counteracted by his opposing evidence; yet it happened curiously enough, that GrorRGET was not only in communication with, but that he was actually the friend and pupil of M. Esgurrot, and, in his capacity of éléve interne, resided for several years, “ vivant pour ainsi dire continuellement au milieu de douze cents malades,” in the very hospital to which the other was physician, and spending the greater part of his time in studying and investigating the very cases and facts on which Esgurrot founded his unbelief! And not only did he there obtain a conviction of the general truth of the phrenological discoveries, but, impressed with their importance to the farther advancement of our professional knowledge of mental diseases, he printed the work referred to, enforcing his conviction on the ground of its being supported by fact, and, with becoming respect, dedicated it to his illustrious preceptors PineL and Esguirot, who, by the sera xX INTRODUCTION.

vices which they have rendered to science and to humanity, by the unwearied and benevolent exercise of their great talents in the vast field which they have dedicated their lives to cultivate, well merited the tribute.

Encouraged by the flattering reception which GEORGET met with, Fatrer*, Voisin, and some other able French authors, speedily appeared, inculcating essentially the same views, and with still greater fearlessness, with so much good effect, that a large portion of the younger French writers and physicians now adopt Ga.u’s anatomical and physiological expositions of the brain as equally sound with Breii’s and MacEenpir’s expositions of the nerves. Few of them, it is true, are very conversant with the details of Phrenology; but of the fundamental principles, that the brain consists of an aggregate of distinct organs, each having a distinct function, and that power of function is influenced by organic size, they have not a shadow of a doubt. Under the guidance of these principles, a great advance has of late years been making in France, in the study and discrimination of nervous and mental diseases.

* FaLRET, De l’Hypochondrie et du Suicide. + Voisin, Des Causes des Maladies Mentales.

INTRODUCTION. XXi

In our own country these occurrences have not been without their effect ; for it seems to me indubitable, that to Dr SpurzHrEim’s labours and demonstrations, both oral and published, we are more indebted for the remarkable progress made of late years in our acquaintance with the anatomy, physiology and pathology of the brain and nervous system, than most of those who have profited by his researches only at second hand are at all aware of. Many, indeed, whose knowledge has come to them thus indirectly, and who have perhaps derived it through the unsuspected medium of some continental writer, who has adopted, without acknowledging, the phrenological principles, are persons who, not knowing what Phrenology is, and fancying it to be something extremely absurd and fantastical, positively dread being considered either as advocates of, or believers in, the new views. But the day is not far distant when such individuals may find reason to regret their continued inattention to the subject. While a doubt remains of nature and phrenology being identical, fear of the consequences of avowing belief in it is rational, because belief in error is always hurtful. But, when once a conviction, founded on evidence either of its truth or falsity, is obtained, we possess a shield more than fit to protect us

XX11 INTRODUCTION.

against all the dangers of taking our stand on the result to which such evidence has Jed us. Acting im accordance with this position, on obtaining what I conceived to be demonstrative proof of Phrenology being founded in nature, I avowed my belief in it, and have ever since advocated its cause, and, so far from having had any Treason to regret the course I have pursued, I have, on the contrary, to thank it for obligations as permanent and valuable, as the temporary ridicule which it brought along with it is evanescent and contemptible.

But, it may be said, even granting Phrenology to be the true physiology of the brain, and the latter to be the only sound basis of its pathology, is it not premature to seek to apply its principles to the improvement of medicine, seeing that so much is wanting to fill up its details? To this an answer may easily be given. False theories are now prevalent, which necessarily mislead and divert attention from the proper investigation of the subject, and beget confusion and uncertainty of practice; and, therefore, even if Phrenology only approximate more nearly to the truth than they, the assistance which it will afford must be proportionally more ee ; and, therefore, its leading principles, being already established on an irresistible td * INTRODUCTION. xxiii induction ‘of facts, we are authorised, by reason and analogy, to make use of them, so far as they are ap- . PCEOte: as freely and d authoritatively as we do of the general ] principles of Paheihiedl and el ‘science, neither of which has yet attained any thing like the perfection which time and cultivation will one day bring along with them. © But, in speaking thus of Phrenology, it must be recollected that I refer to it as it exists in the minds of those who have actually studied it, and not in the crude and. contradictory form in ‘which 4it is presented to us — by those who have never examined its pretensions. And, if this equitable rule be followed, it will be found, that both in its principles and in its facts, it is advanced far beyond what those who are unacquainted with it have the least conception of. We judge of Chemistry as it exists inthe works and” minds of its most eminent cultivators, and not as it comes forth from those of its half initiated disciples ; and, in like ‘manner, we form our opinions in regard to Natural Philosophy, and the applications of its principles, not as unfolded to us in the pages of a newspaper, or in the hastily got up articles of a review, but as they come from the minds of a La- PLACE, a Puayrarr, a LEesuiE, or a Gay-Lussac.

No good ‘reason can be given why a different and

- s ne : XXiv . INTRODUCTION. : :

Jess equitable rule should be applied to Phrenology ; on the contrary, from its being a new science, candour and justice would wither require that a more en dilieliowrance should be qnadelfor its real and supposed deficiencies. .

There is yet another _reason svich amply warrants the earliest possible application of the new doctrines to the elucidation of mental affections ; and that is the importance of general principles to the successful direction of inquiry, which has been too much overlooked by several late experimental physiologists. Disgusted with the visionary theories which once maintained a mischievous _ascendency over the minds of men, and Jed them far from the observation of the phenomena occurring in the great, laboratories of nature, we have passed, in

~ our aversion, almost to the opposite ext e, and, discarding general views, we cry aloud for facts. And as facts are the only basis of accurate knowledge, it is fortunate for mankind that the present mode should be attended with so much practical - usefulness. But facts alone are not sufficient, and unless they be collated, and their relations to each other and to general laws be deduced by a careful induction, they: lose the greater part of their value, and become, to use the apposite illustration of an i a?

INTRODUCTION. — ~ 9 xy

* - able writer on political economy *, little better than the undigested erudition of an almanack-maker, and afford no means of judging of we truth or

_ falsehood of a principle or rule of practice. Appa-

| rently i impr essed with this conviction, the eloquent

Professor of Medicine i in the London University, in recommending the study of mental philosophy, as necessary to enable medical practitioners to perform with credit the important part of their duties connected with mental diseases, remarks, that without it “even experience, supposing that they had opportunities of acquiring it, which they have not, would merely impart to them a little practical dexterity, very limited, and very likely to fail them in the greatest need ; it is the acquisition of principles of practice which can alone prepare them for the various, the sudden, and the alarming phenomenady which demand their attention in this department of medicine +.” Even to observe accurately, requires a es of intelligence and ae © a freedom from prejudice, and a patience of investigation, which can be found united only i in a mind pustandigpive to the influence of general laws, and ardent in the pursuit of every difficulty and of ery anomaly to their

* Say, as quoted in Macouttoow’ s Political Econoiny, p. 21.° ++ Conoxty on the Indications of Insanity, p. 37.

XXVI INTRODUCTION.

origin in some previously unperceived condition affecting the production of the expected result. So that, if we take it for granted that he who confines himself to simple observation, will be the most successful in the collection of trustworthy facts, and in the discovery of important natural truths, we shall infallibly fall into error. So prone, in fact, is the human mind to go back to principles, that scarcely any thing can be perceived without some relation to general laws, or to some other better known phenomena suggesting itself; and, in this way, as has been acutely remarked by Dr Cutten, “ the simplest narrative of a case almost always involves some theories,” and our mode of observation being thus insensibly affected by our previous views, it becomes a point of primary consequence that these ia be correct; and, accordingly, by pothetical notions are found to prevail and to satisfy the mind,

in exact proportion as ‘the intellectual powers are weak, and education and knowledge are incomplete; and well has it been eid by the same author, that, in this state, ‘ in white: is commonly called experience, we have only arule transferred from a case imperfectly known, to one of which we are equally ignorant. Hence that most fertile source of error, the applying deductions drawn from the result of

INTRODUCTION. XXVIl one case to another case, the circumstances of which are not precisely similar. Without principles deduced from analytical reasoning, experience is a useless and a blind guide*.”

In medicine, perhaps, more than in any other department of science, a knowledge of, and reference to principles, wherever practicable, is indispensable, for nowhere does the mere sequence of events, the post hoc ergo propter hoc mode of argument, so often lead into error. Even in the simplest act of the animal system, a combination of causes and circumstances is at work, the failure of one of which, in itself apparently insignificant, may vitiate the expected result, and if this source of error be not guarded against by sound directing principles, the inferences deduced may happen to be at direct variance with the truth; and it is in the habitual watching and j ust appreciation of all collateral conditions and differences, that an observer who is acquainted with, and acts under the direction of, established principles shews his superiority over one who proceeds without any such guidance. The former not only collects facts for his basis, but he is more scrupulous in subjecting them to examination before admitting them to be facts, and is more careful in in-

* CuLien’s MS. Lectures, quoted by Maccuttocn, lib. cit. p- 21.

XXVIil INTRODUCTION.

vestigating modifying influences, in comparing results, and endeavouring, by tracing their previously unperceived relations, to arrive at the discovery of general truths, which may be useful, not only in directing him in new emergencies, but also in amending his practice on more common occasions; while the latter may equally treasure up facts, but from want of attention to the peculiar circumstances under which they are met with, from not comparing their resemblances or distinguishing their differences with sufficient minuteness, he can never advance with certainty, or, by a fair logical inference from the facts, deduce general rules by which to provide against new or unexpected events.

Moved by such considerations as these; aware, in common with all medical men, that a knowledge of the conditions required for the healthy performance of functions, must not only precede, but direct the completion of our acquaintance with their morbid alterations; and convinced, from long observation and often repeated experience, that Phrenology is the true physiology of the brain, I feel perfectly justified, and am assured, that the candid and unprejudiced reader will join me, in applying its principles, so far as they will go, to the farther advancement of our knowledge of mental affections, with-

INTRODUCTION. XX1X out waiting to lose the benefit within our reach for the distant prospect of a greater good, which we may never live to reap, and the arrival of which, the very attempt in which we are engaged, is the best calculated to hasten.

Before concluding, I must be allowed to express my gratitude to Dr SpurzHEiM for the great amount of useful information, derived either directly from his works, lectures, and friendly conversation, or suggested indirectly by the admirable applications of principle to the relief of human suffering, and to the acceleration of human improvement, of which his works exhibit so many examples. My aim in the present work is usefulness, and not novelty or originality; and to Dr SpurzHEIM, accordingly, I willingly own myself indebted for the largest portion of what will prove to be the most important ideas contained in the present pages. To the writings of PinreL, Broussais, Dr Burrows, Grorcer, and some others, I am also indebted, not only for numerous cases in illustration, but for many valuable practical remarks. And had not the greater part. of this work been actually in print, and the whole of it written, before I could obtain access to a copy of Dr Cono.ty’s late publication on the same