Seats And Causes Of Diseases Investigated By Anatomy
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Seats And Causes Of Diseases Investigated By Anatomy, Giovanni Battista Morgagni, 1761 AD
Giovanni Battista Morgagni (1682-1771) M D Bologna, F R S, professor of medicine, later of anatomy, University of Padua
The seats and causes of diseases investigated by anatomy; in five books, containing a great variety of dissections, with remarks . . . Translated from the Latin . . . by Benjamin Alexander, M.D., 1769 London, Millar et al. 3 vols Vol. I, pp. 144-5, 156-8, 161-2
First published in Latin, Venice 1761
SEATS AND CAUSES OF MADNESS
Madness, to use the words of Willis . . . 'is so far akin to melancholy that these disorders often mutually interchange their appearances, and go over one into the other'. And you often see physicians doubting, on the one hand, from taciturnity and fear, and on the other, from loquacity and boldness, every now and then alternately appearing in the same patient whether they should pronounce him to be afflicted with madness, or with melancholy. And this consideration made me endure, with more patience the answers which I have frequently receiv'd, when, upon dissecting the heads of persons who have been disorder'd in their senses, I have enquir'd with which of the two deliria they had been affected; answers, which were frequently ambiguous, and often repugnant to each other, and yet perhaps true in the long course of the disease. Wherefore, although in the dissections I am going to describe to you, I shall signify when I know that the patient inclin'd most to the one, or to the other state of the disorder; yet as I shall be able to do that but seldom, I chose rather to comprehend in this one letter what relates to either of these deliria .. .
If . . . Valsalva has had as frequent opportunities of dissecting other bodies of insane persons, as he had of attending to their disorders while living; I doubt not but he would certainly have observ'd, what I have observ'd in all I have hitherto examin'd, that is, a considerable hardnes in the brain. But as to what relates to those tumid bodies in the plexth choroides, and to the little bodies which he describ'd at the sides of the: longitudinal sinus; I believe, I have already mention'd to you a large' extuberance in that plexus than either of these, and yet not in the head of a maniac, or melancholic person. And I suspect that those corpuscles, which rais'd themselves up here and there from the dura mater, were probably of the same kind with these, which were afterwards call'd glands by Pacchioni, which are seated in those very places, being sometimes less, yet often still much more, conspicuous. But although these are neither preternatural, as the cavities, or pits, impress'd on the inside of the skull, to receive these little masses, evidently shew, nor were unknown to anatomists two ages ago, after Vesalius, who calls them tubercula; and though they were even again set forth as new appearances, a little before Valsalva was born; yet at the same time in which he wrote that observation, they had been, in some measure, forgotten again .. .
If you join these six dissections of mine with that which I describ'd to you in the first letter, and compare them all with those you have in the sepulchretum, or other books, you will immediately perceive, that among those things which others have observ'd, some of them have been never found by me, a few rarely, many often, and others indeed always. For example, that I did not find, even in the man who was in like manner believ'd to be made mad from a philtre, the pia mater not 'insinuating itself', as usual, 'between the convolutions of the brain', my silence on this head, in the history of the butcher, plainly shews. And that I never saw worms in the brain, and indeed never expected to see them, the first letter sufficiently shews . . . Baglivi affirms, 'that he had dissected two maniacs at Naples, and that he had found the dura mater hard, as a piece of board, and almost dried up' . . . yet in those I dissected, I certainly know that there was not any: and even as to that appearance, which I describ'd in the first letter, as being found in the dura mater, the disorder was not, I think, to be referr'd to this kind, that Baglivi and Willis take notice of, as it was contain'd within a certain small space. Yet, since them, two very experienc'd men, Littre and Geoffroy, each of them, found both the meninges diseas'd, in separate maniacal patients : in the one, it was more compact; in the other, it was more thick and firm : not to say any thing of the falciform process, which Geoffroy saw at the same time, almost every where cover'd with bony lamina, or plates. And this sirmness or thickness of one, or both, of the meninges, in maniacs, has been remark'd also by others, as you will read in Alexander Camerarius, and the celebrated Van Swieten : and I should, perhaps, be ready to believe that this appearance was brought on by long and violent deliria, if I did not know that the same had been seen by Wepfer, and even after melancholy deliria by King, after foolishness or idiotism by others, and even by myself in those whose understanding had been perfectly sound. Yet I see, that this is much less rarely to be found, than those large kinds of glands in the interior parts of the brain, which are describ'd in the observation of Valsalva; although at the same time I know, that, in two melancholic persons, appearances, in some measure similar to these, have been found in the same places. Nor have the same thing ever occurr'd to me, which have occurr'd to Santorini, in two old men, one an idiot, and the other slightly disorder'd in mind; I mean, foveolx, or little pits, sill'd with lymph, or a yellowish little body in the meditullium of the brain : and still less what Willis, Kerckringius, and King, have seen, the bulk of the brain much less than it naturally is.
But rarely, and indeed only once, have I seen, in the dissection of insane persons, those deep sulci in the corpus callosum, or the aerial bubbles in the sanguiferous vessels of the brain, and the medullary substance thereof brown, most of which, I suppose, are merely accidental in disorders of this kind; and I have certainly describ'd them to you in others who were not insane. Nor do I see that they have been observ'd in those by others : nay, Lancisi remark'd in an idiot, that the substance of the brain was 'more white than natural'; as he also remark'd some things different in the corpus callosum. On the other hand, I have often seen the vessels of the brain distended with blood, and more often, water under the meninges, or in the ventricles; nor perhaps should rarely have lit upon an enlarg'd or schirrhous spleen, if I had always had time to examine the viscera of those whose brain I dissected. All which the celebrated Hoyerus saw, at one time, in the body of a maniac : and Van Swieten saw the vessels distended `with a very black and pitch-like blood', in a melancholic woman; as that very skilful anatomist Phil. Conrad. Fabricius found the plexus choroides `frequently turgid and inslated', in maniacs : and a quantity of extravasated water not only in an idiot, King, and others, but also in a melancholic woman, Wepfer ; and in maniacal persons, those who are mention'd with honour by Van Swieten, who thence explains the aphorism which we have mention'd above, if a dropsy comes on after madness, 'tis a good sign, by supposing that the water is reabsorb'd from the brain, and carried to some other part . . . And very few things occur at present, indeed, on the subject of the pineal gland. For Diemerbroeck, although he points out many observations, that have been made by others, of sand and calculi being found in that gland, yet . . . I contend, that they were not all maniacs, or melancholic persons, in whom I have seen this disorder, but that, on the contrary, many had labour'd under other disorders . . . Boerhaave, perhaps, animadverted to other histories, which had fall'n under his notice, when he asserted, 'from anatomical dissections, that the cerebrum of maniacal persons was dry, hard, friable, and yellow in its cortical substance' . . . But although . . . I always found, at least a hardness of the medullary substance of its hemispheres; and though I think that the circumstance is not to be neglected, by any means, yet I do not believe, that so much is to be attributed to it, that we should ascribe disorders of the mind to this, as to their only cause, and prove our hypothesis by very subtle and specious explications . . . And that you may understand, why I do not lay so much stress upon this hardness, I would have you know, that in some persons likewise, whose minds had not been disorder'd, I did not sind the cerebrum less hard than in these.
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