Extracts from Daniel Hack Tuke

Extracts from the Presidential Address delivered at the Annual Meeting of the Medico-Psychological Association, held at University College London, 2.8.1881 on Progress of Psychological Medicine during the Last Forty Years: 1841-1881 reproduced as chapter eleven in Chapters in the History of the Insane in the British Isles, and from related material in that book.

Cerebral reflex action.

In a sketch, however brief, of the progress of Psychological Medicine since the foundation of this Association in 1841, it would be a serious omission not to notice the important contributions of the late Professor Laycock [1812-1856] shortly before as well as after that year. In 1840 he first promulgated the opinion that

"the brain, although [p.469] the organ of consciousness, is subject to the laws of reflex action, and in this respect does not differ from other ganglia of the nervous system." (*)

* A Treatise on the Nervous Diseases of Women by Thomas Laycock, M.D., 1840, chapter 9 p. 107.

And in a paper read before the British Association, September, 1844, he observed,

"Insanity and dreaming present the best field for investigating the laws of that extension of action from one portion of the brain to the other, by which ideas follow each other in sequence, giving as an illustration the case of a patient at the York Retreat, whose will being suspended, he expressed ideas as they spontaneously arose in associated sequence, the combination being singularly varied, but traceable to a common root or centre of impulse."

"Researches of this kind," Laycock continues, " whether instituted on the insane, the somnambulist, the dreamer, or the delirio"us, must be considered like researches in analytical chemistry. The re-agent is the impression made on the brain ; the molecular changes following the applications of the reagent are made known to us as ideas."

British and Foreign Medical Review, January, 1845, p. 311.

Time will not allow me to cite other passages in these remarkable papers, or later ones ; but these are sufficient to show the germ at that early period of the doctrine of cerebral reflex action, and the unconscious cerebration of Carpenter, the seeds having been already sown by Unzer and Prochaska, and arising out of it, that of automatic states occasioned or permitted by the abeyance of a higher restraining power - the Will, [p.470] according to Laycock, in the case he employs as an illustration of his doctrine. His teaching in regard to mental and nervous disorders due to vaso-motor disturbance also deserves recognition.

Henry Monro

Dr Henry Monro, again, in a treatise published in 1851, put forward a theory of the pathology of insanity, the essence of which was that the cerebral masses having lost their static equilibrium exhibit in their functions two different degrees of deficient nervous action (coincidently), viz. irritable excess of action and partial paralysis. He maintained that these two states do not fall alike upon all the seats of mental operations, but that there is

" a partial suspension of action " of " higher faculties, such as reason and will,"

while there is an irritable excess of action of the seats of the more elementary faculties, such as conception, etc., and hence delusions and the excessive rapidity of successive ideas. Dr. Monro compares this condition to a case of paralysis, combined with convulsions ; and discusses the question whether the temporary and partial paralysis occurring as he supposes in insanity,

" results directly and entirely from excessive depression of the nervous centres of those higher faculties, or partly in an indirect manner from nervous energy being abstracted to other parts which are in more violent exercise at the time." *

* " Remarks on Insanity, its Nature and Treatment," p. 14.

This, it will be seen, is a still clearer statement of the doctrine that insanity is caused by the depression or paralysis of the higher nervous centres and excessive action of others.

p.471

Hughlings Jackson

John Hughlings Jackson was a founder of Brain

As is well known, Dr Hughlings Jackson, whose views regarding active states of nerve structures as liberations of energy or discharges, are familiar to us all, has adopted and extended Laycock's doctrine, which he designates as " one of inestimable value," and has urged the importance of Monro's doctrine of negative and positive states in cases of insanity, using the term "insanity" in an exceedingly wide sense.

Adopting the hypothesis of evolution as enunciated by Herbert Spencer, Dr Hughlings Jackson thinks that cases of insanity, and indeed all other nervous diseases, may be considered as examples of Dissolution, this being, I need not say, the term Spencer uses for the process which is the reverse of Evolution.

Insanity, then, according to this view, is dissolution beginning at the highest cerebral centres, which centres, according to Jackson, represent or re-represent the whole organism. There are distinguishable, .he believes, cases of uniform dissolution, the process affecting the highest centres nearly uniformly, and cases of partial dissolution in which only some parts of these centres are affected. The dissolution, again, whether uniform or partial, varies in "depth"; the deeper it is, the more general are the manifestations remaining possible. The degree of " depth " of dissolution is, however, but one factor in this comparative study of insanity. Another is the rapidity with which it is effected. To this, Dr Jackson attaches extreme importance, believing that degrees of it account for degrees of activity of those nervous arrangements next lower than those hors de combat in the dissolution. Another factor is the kind of person to whom dissolution "comes". And the last factor is the influence of circumstances on the patient undergoing mental dissolution. All factors should, of course, be considered in each case, or, as Dr Jackson characteristically puts it,

"insanity is a function of four variables".

I refer to these opinions to show the direction in which some modern speculation on the nature of insanity tends, that thus tracing the course of thought in recent years we may see how, step by step, certain views have been reached, some of them generally adopted, others regarded as still requiring proof before they can be accepted.