Chapter V.

Temporal Lobe.

This chapter concerns the temporal, and the next the parietal, lobe; but it is desirable to preface the main subjects of these two chapters by some remarks on a large area partly pertaining to both the lobes mentioned, and partly to the occipital.

The only papers dealing with latah, with which I am acquainted, are a brochure by Mr. H. O. O'Brien, of the Straits Settlements Civil Service, published some years ago in the Asiatic Journal, and a short notice by Dr. A. M. Browne, of Sydney, published in the Provincial Medical Journal, 1887; though the Miryachit of the Siberians and Lapps, the jumping disease of America, and the Bah-tschi of the Siamese, diseases allied to, if not identical with, that which forms the subject of this essay, have been all fully described. Quite recently, and since I had begun to put these notes together, Dr. Van Brero has written a paper on the subject; and Mr. F. A. Swettenham, the British Resident of Perak, has published a book called “Malay Sketches” in which there is a chapter on latah, dwelling principally on the humorous side of the question as it appears to bystanders. Mr. Swettenham likens latah to cases of hypnotism shown him in one of the Paris hospitals.

Dr. Bevan Lewis ascribes to the Deiters cells of the brain a phagocyte function; as the scavengers of the brain they absorb and remove effete material, and also according to his view attach themselves to degenerated nerve-cells, whereby these structures are gradually through their agency absorbed and removed.

This is the first asylum of the London County Council and the fifth for London, and it stands on a hill 230 feet above ordnance datum in a freehold estate of 269 acres, one-and-a-half miles from Woodford Station, on the Great Eastern Railway. It is about nine miles from the Royal Exchange. The ground was bought by the Middlesex Justices for £39,415. They first visited the spot on 27th February, 1886, almost seven years before patients were received. About 70 acres of the ground is woodland, and the soil is clay with beds of gravel interspersed. The Justices proceeded to fence in the estate, build two lodges, lay down a granite tramway from these to the building site, and level the top of the hill, a plateau of about a dozen acres in extent, for all the central and some of the outside blocks, and also to complete the foundations, when the Local Government Act of 1888 transferred the care of lunatics and the management of County Asylums to the County Councils.

It is frequently levied as a reproach to prison surgeons that they fail to realise how slender and impalpable is the border-line between crime and insanity, and that the proper inmates of an asylum are too frequently treated with the penal discipline of a prison.

The object of this paper is not so much to relate anything that is new as to show that mental symptoms are not always easy of classification when associated with organic changes in nerve tracts outside the cerebral cavity.

For some years past the leading authorities have been generally agreed that the neuroglia is a tissue composed exclusively of special cells and their processes. Ramon y Cajal, for example, describes it as consisting of small cells provided with very fine, wavy, and only slightly ramified processes, which, after a variable course, terminate freely or attach themselves to the surface of the capillaries. From observations made with the aid of a new method, Professor Weigert, of Frankfurt, has arrived at a theory regarding the constitution of the neuroglia which is diametrically opposed to this now generally accepted view. He published a preliminary note on the subject in 1890, but it was only a year ago that he gave a full account of his researches, together with a description of an important improvement in his method. This improved method, in which methyl violet is the staining agent employed, is one that is exceedingly complicated and troublesome to carry out. It gives preparations in which the neuroglia-fibres and the nuclei of the neuroglia-cells are stained violet, while the protoplasm of the cells remains unstained and invisible. The reaction succeeds only in the human subject, and, as a rule, only with tissues that are moderately fresh. The results that he has obtained with this method have led Weigert to advocate the view that the neuroglia-fibres, which have hitherto been regarded as processes of the Deiters' cells, are chemically distinct, and morphologically separate, from the cell-protoplasm; in other words that the fibres which are stained violet in his preparations are not processes of the cells, but are completely differentiated from them. It is clear that we cannot rightly understand the nature of the pathological changes that occur in the neuroglia until this question of the structure of the normal tissue is settled in our minds. Weigert's theory is certain to give rise to a large amount of discussion in the near future. I wish now to offer merely a small contribution to that discussion. I have for some weeks been working with Weigert's method in the course of a study of the normal histology and pathological anatomy of the neuroglia. Already I feel convinced in my own mind that Weigert has been led into an error by certain fallacious appearances produced by his method, and that the older view of the structure of the neuroglia is the correct one.

The present is the day when we are searching for any deviation from the normal type, that we may put it down as a sign of degeneracy, a word that is having a more and more extended meaning, and is already serving an evil purpose as signifying more than is actually warranted. Formerly a degenerate was an individual so different physically and mentally from the average, that he could be set off into a class by himself. We knew him when we saw him, because he was distinct from the average. Now it needs only some slight imperfection of development in an organ, or tissue, or some slight irregularity of action in the brain as shown in speech, or action, to brand an individual as presenting indications of degeneration.

The following case may serve the purpose of illustrating a few remarks on the subject of Post-Operative Insanity, which, perhaps, has not received as much attention in this country as might have been expected.

In popular estimation there is no surer relief from itching than by scratching. The lower classes have no better remedy for anger than cursing. The more educated indulge in reproaches and complaints often referring to other causes than the immediate source of irritation. Experience, however, has taught us that, in only too many instances, the practices thus indulged in are positively deleterious; and that abnormal feeling is further aggravated by giving way to these impulses of reflex action. Still, there is a momentary relief, and a feeling of comfort which in a great number of cases is all that can be expected by the physician.

We conceive that the ideal position of a pathologist is that in which his laboratory stands in direct communication with the wards of an institution—whether hospital or asylum—rendering intercourse with those engaged in clinical research easy, whilst he himself is absolutely free to prosecute his special studies. To expect the laboratory worker to undertake clinical, a fortiori, administrative duties appears unphilosophical, an incongruity, an indication of imperfect appreciation of the value of time and specialised energy. Those who have experience of the exacting nature of research work will, we believe, at once concede that nothing can be more irritating nor more detrimental to good work than to have to relinquish temporarily some absorbing laboratory pursuit in order to engage in the work of the office or the wards. In medical circles in this country we are unfortunately only too familiar with this mélange of occupations, this professional polymorphism, in consequence of which our leading men are compelled to appear in various characters during the course of a day, exchanging frock-coat for laboratory blouse, and this again for lecturer's gown, throughout manifesting an adaptability truly astonishing. But such versatility, admirable in itself, is necessarily inconsistent with steady progress in special directions. It is therefore no wonder that in research work there is danger of lagging behind our continental confrères, labouring consistently in special departments of science, and less concerned with the commercial potentialities of professional life, as we know it.