The determining causes of the pathological states met with in the cerebral cells may be due to morbid activity of the cells themselves (Virchow), or to abnormal conditions of the vascular system influencing their nutrition. These may be—(1) inefficiency of the vis-a-tergo; (2) diminution of the nutritive properties of the blood; or, (3) obstruction in the vessels to the blood-supply; and their frequent association with insanity affords every reason for regarding them, in numerous instances, as direct cause and effect, and for viewing many of the changes in the brains of the insane as of a secondary nature—the results of defective nourishment. Mal-nutrition of a nerve-cell must invariably induce abrogation or diminution of its normal functional activity, with atrophy of its structural elements. The condition of fatty and granular degeneration of the cellular elements of the brain is so universally met with, as to fail to account for the great diversity of clinical phenomena, and hence the various morbid states of the vascular system in the insane become of considerable primary etiological importance. As results of this disordered circulation, there is induced an asthenic irritability, and subsequently the destruction of the normal excitability of the cerebrum, associated with the characteristic physical appearances of wasting and decay.
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