Brain disease

“ Insanity in its initial stage does not, as a rule, involve a recognizable deviation from the normal structure of the brain, and the patient may die before such pathological changes are so manifest that we can detect them. But if the disease has been of long standing, in the majority of cases the brain shows evident marks of disease, and there may be found no striking indication to the naked eye of deviation from a healthy condition, when a microscopic examination reveals signs of advanced cerebral disease. ”

“ At the same time it is only logical to conclude that any morbid condition of the cerebral circulation or of the brain or membranes which leads to a corresponding amount of ventricular effusion, or atrophy or destruction of the nerve centres already designated, will produce the symptoms characteristic of this disease. Thus the different forms of meningitis, traumatic injuries to the cranium, chronic encephalitis, cerebral softening or degeneration, sclerosis, neoplasms of all kinds affecting the brain (cysts, cholesteatoma, psammoma, melanoma, etc.) , and parasites may occasion this disease. ”

“ A first and even a second attack may puzzle not the parents only, but also the doctor; but after the symptoms have returned a few times, the child being neither better nor worse in the intervals, it becomes evident that no serious disease is impending. The risk of an overhasty conclusion is that the depression and disturbance of the nervous system may be supposed to imply the existence of brain disease; and lead to unsuitable treatment, instead of the administration of quinine, which nine times out of ten proves a specific for ague. ”

“ At present we are only on the threshold of investigation concerning the physical causes of insanity, and have scarcely done more than recognize the possibility of molecular disease of the brain. Hereafter science will, probably, succeed in unveiling the obscure facts of molecular brain pathology, and enable the medical psychologist to predicate disease of recognized classes of brain elements from the special phenomena of mind disturbance. ”

“ It is late to begin when the brain symptoms show brain involvement. For this there must be radical and careful treatment with mercury and iodide of potash; with tonics and general building up treatment, and then even if the patient lives he may be a nuisance to himself and others.
GENERAL PARESIS. (Paretic dementia. General Paralysis of the Insane. Softening of the Brain) .—This belongs under diseases of the mind, but there are so many cases that a description of this disease may be instructive and interesting. ”

“ Indeed, nearly every pathological condition of the brain known in insanity—in kind, if not in extent and degree—may be found in diseased or injured brains where there has been no mental disease in consequence. There is only one disease, general paralysis of the insane, in which the morbid appearances discoverable after death with our present knowledge bear a definite relation to the most constant manifestations during life. ”

“ Death, they found, had been caused by a somewhat obscure and scientifically interesting form of brain disease. The tissue of the brain and the molecules of the grey matter had undergone a most extraordinary series of changes; and the younger of the two doctors, who has some reputation, I believe, as a specialist in brain trouble, made some remarks in giving his evidence which struck me deeply at the time, though I did not then grasp their full significance. ”

“ The varying degrees in which the various portions of the cortex, medullary portion, and different ganglia of the brain may be involved in the morbid process naturally give rise to a great variety in the symptoms, mental and physical, sensory and motor, emotional and intellectual, and in the relative preponderance of one or another in individual cases. The usual symptoms of any form of mental disease may for a time obscure the dementia which sooner or later must appear in general paralysis, and which, as has already been said, is the only mental symptom universally present in all cases. ”

“ It is an established fact that drugs do not affect brain structure; and it is equally well known that, in most instances, insanity causes no deterioration in nerve tissue. In these facts lies strong collateral proof that the sources of mental disease are to be sought elsewhere than in the brain. Injuries and ailments that involve change in brain substance will necessarily interfere with brain function, and, in softening of nerve tissue or in any inflammation, there are organic alterations that may be seen and noted. ”

“ A group forming about one tenth of all admissions to state hospitals is made up of patients with psychoses dependent upon gross disease of the brain. In these mental diseases there is destruction of cells of the brain, resulting from arterial changes, the effects of hemorrhages, the pressure of new growths and similar causes. ”

“ Removal of the brain, slice by slice, in the lower animals is followed by a corresponding reduction both of intelligence and of power of voluntary movements which disappear together in about an equal degree; and every observer knows that in many cases of brain disease intelligence and the power of voluntary movement alike suffer in proportion to the extent of degradation of brain substance. ”

“ If I were fully cognizant of all forms and degrees of disease, I could recite exactly how they act and in what degree they harm the delicate organism of our brain. In many instances shocks or diseases too powerful for [Pg 89] our brain to withstand, cause that portion of our brain that may control our speech, our sight, our hearing, our limbs or other organs to lose its power, with the consequence that we must suffer and be handicapped with what is properly called "a great affliction." ”

“ In the functional mental diseases there is no characteristic lesion of the brain as yet recognizable, even in the latest stages, more than is to be found in the brains of persons dying from other causes. When apparently local injuries or diseases cause insanity, they probably do so through a general disturbance of the brain or through diffuse disease resulting therefrom and for the most part affecting both hemispheres. ”

“ A man has some disease, acute or chronic, of his brain; and, as the disease advances, twitchings occur in one arm or one leg, little irrational useless movements, or rigidity, or loss of power, according to the case. Is it pure nonsense to believe that the disease has reached a certain spot on the surface of his brain? ”

“ The fortunate issue of these cases though frequent, is by no means invariable, for sometimes they are but the precursors of that formidable, I might indeed say, all but hopeless disease, water on the brain. But even of itself congestion of the brain is by no means a trivial ailment, for it may pass into a stage in which the smaller discomforts of the child lead to the sad mistake that the condition of the child is improving, instead of which it is really the dulling of sensibility from approaching death. The head, indeed, becomes less hot, the flush of the face grows slighter and less constant ”

“ After there is evidence of definite atrophic and degenerative disease in the brain, as indicated by great mental impairment and muscular paralysis, the mental and physical symptoms may be subject to great changes, without any apparent cause but vaso-motor disturbances, and alternating rapidly from extreme intellectual confusion and absence of mind to a clear, even if temporary, mental state. Less extreme changes in the condition of the mind are common. ”

“ Such consideration is, however, without the sphere of the present paper, which deals with cerebral manifestations in relation to ordinary disease, and not with those ailments which belong to the province of the alienist physician. To one form of disorder of the cerebral cells alone may reference be made here, and that is as to the effects of mental over-strain. Brain-tissue can be developed by exercise, and worn out by overwork. When this latter condition has been induced, there exists that irritability which forms part of the early stage of the exhaustion of nerve-matter. ”

“ When a healthy brain is transmitted to children, and their treatment from infancy is judicious and rational, its health becomes so firmly established that, in after life, its power of endurance will be greatly increased, and it will be enabled most effectually to ward off the insidious attacks of disease. On the other hand, where this organ has either inherited deficiencies and imperfections, or where they have been subsequently induced by early mismanagement, it becomes peculiarly susceptible, and frequently yields to the slightest attacks. ”

“ PATHOLOGY AND MORBID ANATOMY.—Migraine not being a fatal disease, we know nothing of the changes which exist in the brain; we can only surmise what are the conditions which exist in the brain during and before an attack. ”

“ In the course of epilepsy there arises gradually a typical degeneration of the brain. The degeneration is, however, only discoverable in severe cases and when the disease has existed for some time. If the attacks have only existed for a relatively short time, not more than a few years, the brain as a rule shows nothing. Seventeen per cent. of our patients suffer from progressive paralysis and senile dementia. Both diseases present characteristic changes in the brain. In paralysis there is most extensive shrinkage of the brain, so that the cortex is often reduced by one half. ”

“ Diseases and injuries of the brain are notoriously difficult to diagnosticate. This may well be because it has always been so well protected by the skull that there have been evolved within it few tell-tale self-protective responses, so that in the presence of injury and disease within itself the brain remains remarkably silent. It should occasion no surprise that there are in the brain no receptors, the mechanical stimulation of which can cause pain, because its bony covering has always prevented the adaptive implantation within it of contact pain receptors. ”

“ Occasionally the fluid escapes into the cavity of the cranium, which it fills, pressing down the brain to the base of the skull. As a consequence, the functions of the brain are interfered with, and the mental condition is impaired. The child is dull, listless and irritable, and sometimes imbecile. The special senses become affected as the disease advances; sight is often lost, as is also hearing. ”

“ The most usual cause of the disease, however, particularly in children, is an irritation which is sympathetically communicated to the brain, from a disturbance in the chylopoietic organs; and particularly from a functional disorder of the liver. The cerebral disorder, to which a derangement in the digestive functions thus gives rise, is only one of those numerous effects which arise out of sympathies, subsisting between these organs and different parts of the system. ”

“ Notwithstanding the discharge of worms gives no relief in this disease, yet there is good reason to believe, that it has, in some instances, been produced by them. The morbid action continues in the brain, as in other cases of disease, after the cause which induced it, has ceased to act upon the body.
6. From the dissections of Lieutaud, Quin, and others, it appears further, that the internal dropsy of the brain has been observed to succeed each of the following diseases, viz. the colic, palsy, melancholy, dysentery, dentition, insolation, and scrophula, also the sudden healing of old sores. ”

“ But when all these conditions have been excluded and when the symptoms are apparently due to a cerebral affection, there is one group of cases in which localizing brain symptoms are absent and in which the chief indications of disease are headache, double optic neuritis, and often vomiting. In most of these cases syphilis can be also excluded. A diagnosis of brain tumor is given, and the growth is thought to be situated in some region in which the localizing symptoms are at first indefinite—cerebellum, temporo-sphenoidal lobe, or prefrontal region. Such a diagnosis often proves to be correct. ”

“ This dogma leads to absolute sterility as soon as universal validity is ascribed to it. There are undoubted psychogenic mental diseases (the so-called hysterical) which are properly regarded as functional in contrast with organic diseases which rest upon demonstrable anatomical changes. Disorders of the brain should only be called organic when the psychic symptoms depend upon an undoubtedly primary disease of the brain. Now in dementia praecox this is by no means a settled question. ”

“ The brain is not one large homogeneous organ to be healthy or diseased, orderly or deranged, throughout at any one period. Inflammations, and diseases generally, which affect the brain as a whole do not commonly cause insanity properly so called. The organ of the mind is a composite, or aggregate of cells, or molecules, any number or series of which may be affected with disease while the rest remain healthy. ”

“ Disease, then, plays a great part in school life today. Not only the diseases that are infectious, but also others. Not only present diseases, but diseases that are supposed to be over and done with. And what is the effect of it all on children as learners? It appears that some kinds of disease and deformity do not hinder the development of the brain. There are few dwarfs who are inferior to other people in intelligence—not a few have been famous men—such, for example, as Æsop, and Pope. And some kinds of disease stimulate brain cells, as Dr. ”