them from other parts of the portal system. And thus it may happen, that the whole mass of blood obtained from the spleen after death, may differ widely in composition from the blood which flows back from the splenic vein; for it would include the portion which has been long stagnant in the spleen, as well as that which the organ has just before received from the arteries; it being only, in fact, when no such stagnation occurs, that the one will properly represent the other. It is quite conceivable, moreover, that even the blood drawn from the splenic vein during life, might not represent fairly that which is normally returning from the organ; since the relief of the backward pressure afforded by the free emission of fluid, will naturally allow a portion of the stagnant blood of the spleen to flow onwards, and thus to alter the character of the discharged sample.

We offer these suggestions as the only helps that occur to us towards a solution of the difficulty in question. One other possible fallacy, however, seems to vitiate the averages of Mr. Gray's analyses. It is quite clear that whatever the spleen withdraws from the blood, it must have given back the same amount by the time that it returns to its previous dimensions; and it seems to us likely that, whilst the period of withdrawal may be brief, the period of restoration may be long, or vice versa. The former may probably be the case with the red corpuscles, which are withdrawn by extravasation, whilst their contents are given back by slow disintegration. The latter may be the case with respect to albumen, whose appropriation by the process of cell-growth may be slow, whilst its return to the blood, by the bursting or liquefaction of its containing tissues, may be rapid. Thus, in any small number of analyses, the disappearance of corpuscles and the increase of albumen would be the ostensible change; whilst a series made upon a sufficiently long succession of samples of the blood returning from the spleen, might show that this was antagonised by a converse operation, less in amount, but distributed over a longer period. At any rate, we may safely demand that, before any physiological conclusions whatever be drawn from such tables as Mr. Gray's, the fact shall be accounted for, that, notwithstanding the organ constantly retains in its substance as much as onefifth (on the average) of the solid matter of all the blood passing through it, it does not undergo more than a limited and occasional increase in dimensions, returning in the intervals to its usual size, while the general mass of the blood is not affected in any appreciable degree by this withdrawal of its most important materials.

Mr. Gray's hypothesis of the mode in which the alteration in the proportions of the principal constituents is effected, remains to be considered. The amounts of these contained in the aortic, jugular, and splenic blood of the same animals, are given in some detail by Mr. Gray, in Table IX.; for our purpose, however, the following summary of averages will suffice:

Now, if the amounts of albumen, fibrin, and extractive, which present themselves in excess in splenic blood, as compared with aortic, bore any kind of correspondence to the amount of corpuscles which disappear, there might be some ground for supposing the addition of the former to be the result of the disintegration of the latter. But such, on Mr. Gray's own showing, is so far from being the case, that their united increase amounts to no more than 27.95 parts, whilst the diminution in the corpuscles is 68-62. Besides, there appears to us to be strong evidence that the two sets of phenomena have no direct relation, one to the other: for, as we have already remarked, a comparison of the results of individual analyses shows no constant correspondence between them; and besides, although the changes which take place in the colourless portion of the splenic parenchyma might be conceived to be influenced by those occurring in the coloured portion

with which it is so intimately intermingled, it is scarcely conceivable that the changes in the interior of the Malpighian bodies (with which, as argued by Mr. Gray himself, those of the colourless parenchyma correspond) are in any way affected by the disintegration of blood corpuscles; more especially since comparative anatomy shows us that the colourless parenchyma may perform its functions without any diffusion of red corpuscles through its substance. We are inclined to believe, therefore, that the office of the colourless parenchyma of the spleen is not only to serve as a storehouse for the surplus albumen that finds its way into the circulation on the completion of the digestive process, but also to exert an assimilating action upon it, whereby it is rendered more fit for the nutrition of the tissues; and of this assimilating action, we deem the generation of fibrin to be one of the results. And if it be true, as we have elsewhere suggested, that one special function of the red corpuscles is to assimilate or prepare that peculiar combination of materials which is required for the nutrition of the nervomuscular apparatus, the disintegration of these corpuscles in the splenie parenchyma may answer the two-fold purpose of regulating their total proportion in the mass of the blood, and of diffusing through the liquor sanguinis the materials which the nervous and muscular tissues are to draw from it for their own development.

We have thus endeavoured to present our readers with a fair account of Mr. Gray's researches; to show what are the points which they may be considered to have established; to state with explicitness the problems which yet remain unsolved; and to indicate the directions wherein, as it seems to us, the elucidation of these may be sought with the greatest prospect of success. We trust that we shall not be thought to have undervalued Mr. Gray's labours, because we hold some of his conclusions to be less definite and unobjectionable than he has himself supposed them to be. On the contrary, it is in the very suggestion of yet higher questions than those which he believed himself to have answered, that much of their merit in our eyes consists; and we trust that he will not consider his work accomplished, until he has attained to a satisfactory solution of these, and of others yet beyond, which may suggest themselves in the course of his further William B. Carpenter.

researches.

REVIEW II.

Lettsomian Lectures on Insanity. By FORBES WINSLOW, M. D., D. C. L., late President of the Medical Society of London.-London, 1854. 8vo. pp. 160. WHEN the London Medical and Westminster Societies were amalgamated in 1850, the council, in order to honor the memory of Dr. Lettsom, the founder and benefactor of the parent institution, established two lectureships, to be held annually by a physician and surgeon. These are the Lettsomian Professors of Medicine and Surgery. Dr. Owen Rees was nominated to be the first occupant of the chair of medicine, and Dr. Forbes Winslow was elected to be the second. It was natural to expect that Dr. Winslow would direct the attention of the Society to the subject of insanity. From an early period of his professional studies, he has investigated mental phenomena theoretically, and treated the aberrant forms of mental action curatively; and as the active and enterprising founder and editor of the Journal of Psychological Medicine' has manifested a warm interest in the advancement of mental pathology. Dr. Winslow has arranged the results of his researches and experience under three heads, constituting three lectures. The first is entitled 'The Psychological Vocation of the Physician;' its objects are to demonstrate the advantages to the theory and practice of medicine which flow from a more general and accurate knowledge of the science of mind on the part of the physician, to establish the close connexion between the two sciences, and to illustrate the true philosophic character of the medical practitioner. The second lecture is On the Medical Treatment of Insanity;' and the third On Medico-legal Evidence in Cases of Insanity.' The two latter are therefore especially practical, the first is more nearly related to medical deontology. In it the applications of mental philosophy and

* Principles of Human Physiology, fourth edition, p. 187.

logic to the daily routine of medical practice are demonstrated, and the advantages which the wise physician can confer on his patients by moral remedies are set forth. Hope, ease of mind, and the calm influences of religion, are powerful means of action on the organization, and are in the hands of the medical practitioner to a large extent. When all human means fail-and sooner or later they certainly must fail to ward off the most dreaded termination of sickness, when nothing more remains to be done than to "await the inevitable hour," it is still within the psychological vocation of the physician, alike to soothe the parting moments of the dying, and make the solemn event a useful lesson to the survivors. Again, it happens from time to time that the influences of religion and moral training, and the consolations which the Christian derives from his faith, are barren and unfelt, from certain morbid conditions of the corporeal functions. In such cases it is of vast importance that the physician be able to detect these conditions, and learn their exact relation to that bondage in which the soul is held; otherwise crime and despair may overwhelm it. Illustrations of these views are given, and the true psychological vocation of the physician in this respect is fully shown. The following quotation will illustate Dr. Winslow's enlarged views and eloquent diction:

"Finally, I would observe, that of all the subjects that can occupy the attention of the philosophic physician, none equals in importance or in grandeur those which I have had the honour of recommending to your special attention. What can compare in dignity, in sublimity, in comprehensiveness, or in the lofty aim of its disquisitions, to the study of the nature and operation of that spiritual essence, upon the right knowledge and cultivation of which depends our happiness, both in time and in eternity? As the mind advances in a knowledge of its own phenomena, the intellect expands, new sources of delight open to us, and the pleasure we experience in the pursuit of these exalted speculations impresses forcibly upon the mind itself conclusive evidence of its own DIVINITY. He who has habituated himself to trace out the numerous applications of mental philosophy to the important subjects of education, morals, and legislation; to analyse the nature of thought, the laws regulating the association of our ideas, the springs of action, the origin of our happiness, the laws of moral science, the nature of the passions, the formation of character, the foundation of our hopes, and the influence of our emotions,-will appreciate the value of this branch of science. The physician will be conscious, as he advances in a knowledge of the constitution of the mind, that his love of truth is growing strong; and whilst, in the spirit of true humility, he acknowledges the limited nature of his intellectual powers, he will, whilst contemplating their grandeur and importance, recognise the GoODNESS AND MAJESTY OF GOD." (p. 44.)

The second lecture is a clear and concise epitome of the medical treatment of insanity, as distinguished from the moral. We believe that not a few will concur with Dr. Winslow in the expression of his regret for the neglect of physical remedial agents by some of those practitioners who possess great and special opportunities for observation and practice. He attributes it principally to "the doctrine promulgated by writers of celebrity-by men referred to and reverenced as our authorities and guides in their special department of medicine, that for the cure of insanity moral treatment is entitled to the highest rank," and thus the administration of remedies suitable to the morbid corporeal states has been discountenanced, or rendered a secondary consideration. Dr. Winslow quotes one recent writer as remarking "when one man thinks himself a king, another a cobbler, and another that he can govern the world with his little finger, can physic make him think otherwise?'" Another writer of the same school observes, To prescribe for the mad, whilst its nature remains a mystery, is to prescribe for a phantom!"

Another cause, well indicated by Dr. Winslow, is the unphilosophical nature of the hypotheses which have been broached with the view of explaining the phenomena of insanity. In the early periods of the history of medicine (as it is even now in some countries), it was attributed to a Divine afflatus, to the Divine wrath, to demoniacal, Satanic, or malignant influence. These views," in a modified, less offensive, and different form,” still hold their ground in the convictions of many, and constitute the basis of the belief that insanity is an affection of the immaterial principle. Dr. Winslow argues eloquently and, we think, very conclusively, in favour of the doctrine that it is imply a disease of the brain.

"When we assert that the 'functional' or 'spiritual' theory will not bear the test of serious examination-that it is at variance with all à priori and à posteriori reasoning-that it stands in direct opposition to positive, well-recognised undeniable data, we are met by the interrogatory, Can you demonstrate to us the specific character of the change induced in the nervous matter, which it is alleged gives rise to mental derangement? and do not the scalpel and the microscope of the morbid anatomist in vain endeavour to ascertain in many cases of positive, violent, and unequivocal insanity, any appreciable structural lesion in the nervous matter, in its investing membranes, or organs in close association with the brain, sufficient to account satisfactorily for the morbid phenomena exhibited during life? One would really infer, from the reasoning and assertions of those who take these spiritual views, and who repudiate the idea of insanity ever being the result of physical change in the condition of some portion of the brain or its appendages, that the encephalon has no specific functions allotted to it; that it is altogether a useless and supernumerary organ; that it was created for no wise purposes; and that, as far as the phenomena of mind were concerned, we could have done as well without as with the brain! If this organ be not the material instrument of mind-if it be not the medium through which the spiritual portion of our nature manifests its powers-the centre of sensation-the source of volition-the seat of the passions-

The dome of thought,-the palace of the soul'—

I ask, what are its functions, its specific uses and operations?-for what object was this most exquisitely organized and complicated structure formed ?-why does it receive so large a proportion of the blood, and why is it so carefully protected from injury? These interrogatories naturally arise in the mind, when we hear so unphilosophical and so unphysiological a theory propounded with reference to the possibility of the mind being subject to disease apart from all derangement of the material organs with which it is so closely and indissolubly associated. Can we conceive a more preposterous notion than that sanctioned by high authority, and which inculcates that the spiritual principle admits of being distorted, deluded, depressed, exaggerated, perverted, exalted, independently of any form of bodily disease, or modification of nervous matter?" (p. 52.)

The anatomical objection appears always, at a first glance, to be the most insuperable, but a more mature consideration of the subject will lead to the conclusion, that structural change so important and extensive as to be easily discoverable by the anatomist, cannot be reasonably expected to be present in the cerebra of the insane, so long as the mental phenomena are simply disordered and not abolished. A certain integrity of structure is necessary for the manifestation of even the phenomena of insanity. The phenomena themselves, however, offer the most conclusive data in favour of the cerebral origin of the disease, and the practitioner whose sphere of labour brings him into constant intercourse with the insane, would, it might be supposed, fully corroborate these views; but such is not the fact. It is not, therefore, surprising that laymen should oppose the cerebral as opposed to the metaphysical theory of insanity. Yet no man of common sense, whether practitioner or not, doubts that he thinks with his brain, or that in insanity the brain is affected; and no metaphysician, except a solitary eccentric thinker, will deny the undeniable principle that the brain is the organ of the mind. This singular discrepancy between the premises and the necessary conclusion is of great importance in mental philosophy and pathology, and deserves a more special examination. We believe it is wholly due to the want of a clear and satisfactory system of cerebral physiology. The metaphysician does not possess such a system, nor does he seek to establish it; but the metaphysician guides public opinion, and the general public, with the metaphysician, therefore, ignores cerebral physiology. We put this question one day to a profound and lucid thinker of this class: Has mental philosophy or metaphysics contributed anything to the elucidation of the nature and cure of insanity, or of other aberrant forms of mental action now prevalent? His answer necessarily was, that neither had contributed anything. The writer of an able essay on Locke's Character and Philosophy, in a recent number of the Edinburgh Review,' happily illustrates the reason why metaphysical speculations are so sterile quoad medical art, and so devoid of all practical application to the needs of everyday life. He remarks:

"The metaphysician, above almost any other thinker, must. . . . draw from his own resources; patient excogitation must be his great instrument. Indeed, all great thinkers will rather delight in this, than in mere acquisition; it ever has been and ever will be, their char

acteristic. But, then, to be safe, such self-reliance must be accompanied with a careful survey of what has been done by others in the same field.”*

Thus one-half the requisite for inductive inquiry is omitted-namely, patient observation; and one-half the object to be observed is left out-namely, the cerebrum and its mode of action, as the organ of thought. The "patient excogitation " which this able writer indicates as the great instrument of metaphysical research, has been wielded in Germany by the (perhaps) greatest intellects that have appeared in any age, and yet what has been the result? In this same article we find that Sir James Mackintosh amusingly characterized this German philosophy as "accursed," and Victor Cousin as "detestable!" We are sure all who, like Sir James Mackintosh, have "endeavoured to master" it, will agree with the conclusion regarding it at which the Edinburgh reviewer has arrived. He likens the inquirer to a lover of the picturesque in a mountain region, tempted to ascend some unknown peak, on which the clouds still rest, assured they will shortly clear off. The early progress is delightful, as he glances back from time to time over the ample valley radiant in the sunlight; but when he has got into the loftier regions, and approaches the object of his aspiring ambition, circumstances are changed:

"He can see nothing but a rolling cloud of vapour, which hides every object ten inches from his nose, and after standing wetted to the skin, and shivering in 'darkness visible' for a couple of hours or so, in which the envious clouds still envelope him-now and then teased, perhaps, by a momentary rent in the veil, which seems to show him something, but too transiently to let him know what-he descends, and is glad to catch a glimpse of things in sunlight again. But for any purpose of pleasure or knowledge in ascending these cloudy regions, he might as well have sat himself down at the base of the mountain, and drawn a thick cotton night-cap over his head."

Such, we are assured by the reviewer, is the general estimate both in England and on the Continent, "of the philosophical value of a vast deal of German philosophy since Kant's time." Patient excogitation has here, then, been worse than useless.

Various reasons may be alleged for the entire neglect of cerebral physiology by professed metaphysicians. Firstly, a thorough practical knowledge of neurology is necessary to its investigation; secondly, keen powers of observation. Either of these is rarely possessed by speculative thinkers; very rarely indeed are they combined in one mind. The powerful thinkers of whom "patient excogitation" is a special characteristic, are too much abstracted from the common affairs of life to give that practical turn to their studies which is required to make them useful to curative art; and have too little taste for that minute and incessant observation which is necessary to make the accomplished neurologist or cerebral physiologist. They, therefore, almost with one consent, leave this important half of their subject to the physician and physiologist, and turn to them for guidance and instruction. A moral cowardice and deeply-rooted prejudices have influenced others. Mental philosophy has been cultivated mainly with reference to theology and morals, and it has been a constant object to harmonize its principles with the dogmas of the one and the teachings of the other. Now the study of organization in reference to these has been falsely termed materialism, and the materialist has ever been viewed by the theologian as little better than an avowed unbeliever. Religious teaching, therefore, and the dread of being stigmatised as heterodox, have both raised an almost insuperable obstacle to the study of mental philosophy, in relation to organization, by those whose special vocation such study ought to be.

It cannot be denied, we think, on the other hand, that professional views as to cerebral physiology have been deservedly neglected. With one exception-phrenology-they have never been systematized or arranged so as to be attractive or even intelligible to the metaphysician. They have too often repelled, indeed, by their crudeness, by the total absence of the metaphysical element, or by the incorporation with them of real naked materialism. To phrenology cerebral physiology owes much to numerous phrenologists it owes little. The great and fundamental doctrines of a sound and practical mental philosophy must be the fundamental doctrines of phrenology-namely, that the brain is the organ of the

The Edinburgh Review, No. 202 (April, 1854), p. 391.