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Letter 7484

Crichton-Browne, James to Darwin, C. R.

16 Feb 1871

    Summary Add

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    Values CD's approbation more than that of anyone else now living.

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    CD's "searching questions". Sends answers separately.

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    Offers his observation on morbid pigmentation of skin.

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    Offers photographs of abnormal features in patients – ears with bristles, women with two sets of nipples.

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    Encloses notes on weeping and laughter in the insane.

Transcription

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[Enclosure: 1]

1. Nothing is more characteristic of simple melancholia than a tendency to weep on the slightest occasion or on no occasion, and to weep disproportionately on the occurrence of any real cause of grief. One of the most frequent entries in our Case Books with reference to this class of patients is ``Intensely emotional, cries when spoken to.'' I could any day point out to you in this Asylum a number of melancholics, who sit rocking themselves rhythmically backwards and forwards and who whenever you address them, stop this motion, purse up their eyes, pull down the corners of their lips more determinately and shed tears. The readiness and copiousness of the lachrymal secretion under such circumstances is sometimes remarkable. To illustrate the reasons given by melancholics for excessive manifestations of sorrow I may mention the case of a girl lately under my care, who wept a whole day and then confessed to me that she was crying because she remembered she had once shaved off her eyebrows to promote their growth. My observations lead me to believe, that the ideas connected with emotional displays such as I have been describing in melancholics, are generally egotistic. Any remark connected with their own state, or anticipations, `a kind word' or an admonition is especially apt to plunge them into an unrestrained outburst of feeling. I believe I have read of some distinguished men (Poets?) who were very prone to tears—and I believe I have noted that in them it was the sentiment of pity that excited the weeping.

Acute maniacs have paroxysms of violent weeping ``blubbering'' in the midst of their ravings

All patients affected by hemiplegia (paralysis of one half of the body) whether insane or not in the ordinary acceptation of that term, manifest extreme emotional susceptibility. Such is also the case with many patients in whom ``brain-wasting'' is taking place or who are passing into premature dotage and senile decay. The form of emotional exhibition in such cases is most commonly weeping. An ordinary greeting or a simple question, produces—quivering of the features and a flow of tears. The greeting is responded to, or the question is answered, directly enough, in the midst of this exhibition of grief—and then perhaps, some painful notion suggests itself. It has seemed to me under such circumstances that the effort at expression was misdirected or too widely diffused that the consequent signs of grief suggested some painful impression, and that this was then referred to, as an explanation of the display of feeling. In many cases however this theory will not hold good, as no sorrowful or distressing idea comes up at all and the incongruity of the weeping seems never to be recognised. I have watched many cases in which the emotional manifestation continued into a state of complete fatuity, in which the power of speech had been altogether lost. Looking at the patient or addressing them would still induce movements of the features and an effusion of tears.

If desirable I can send quotations from standard authorities corroborating the proneness of hemiplegic patients to emotional manifestations. The fact is indeed well recognised by the whole medical profession.

2. There are undoubtedly many idiots and lunatics who laugh inordinately and without occasion  In my specialty we have a term Euphoria—insane joyousness—which is meant to designate the condition in which this occurs. Only yesterday (Feby 15) an idiot boy who cannot speak, described to me very graphically by signs, amidst explosions of laughter and with his face c<o>vered, with the broadest smil<es how> anoth<er> inmate of the Asylum had <    > him a black eye. <    > I wo<ul>d be c<    >t<    > <    > tha<    > <    >igh<    > <    > and frequent <    > me<    > on<    > <    > amongst idiots an<d> <    > are of course many <    > give evidence of no emotion or <    > who do not rise above reflex acts—, who are stolid or simpl<y> restless. There are others who constantl<y> moan & cry and evince painful mental states. There are others who are only destructive and passionate  But above these in the highest class of idiots and [also] imbeciles, the pleasurable emotions are I believe the most general. There are many idiots and imbeciles, who are constantly smiling and laughing, who are `pleas<ed> with a rattle, tickled by a straw'  I shall endeavour to procure and forward photographs of some of these `good tempered idiots' as we call them who are now under my care. In some of them the expression of the face is a stereotyped smile. They are persistently joyous & benign  No ideas can possibly be connected with such an emotional state. Such creatures have <no> <se>nse of the ludicrous. They <laugh> <    > because ``it is their <nature> <    > They <    > chuckle or <    > a<    > <    > food as ple<as>ed <    > they are stroked <    > caressed, when b<    > <    >[illeg]<    > are presented to them <    > when they hear music. Some of them laug<h> more than usual when they walk or attempt any muscular exertion  In imbeciles and the weak minded where joyousness & laughter become connected with ideas, those appertaining to personal vanity are first found to be operative. Next come those associated with the approbation of others and the love of display.

Amongst lunatics as distinguished from idiots the placid or tremulous smile of the general paralytic is of course well known. In woman labouring under erotomania, nymphomania, or any disorder of the sexual propensities, I have observed that hilarity is predominant  I can supply a photograph very characteristic of the combination of mirthfulness and lu<st>. In certain chronic maniacs cachma<    > are frequent, as <    > acute maniacs. In these <    > however pretend to <    > in any pre chol<  > <    > whi<  > <    >

3. In those lunatics in whom brisling of the hairs is extreme, the disease is generally permanent or mortal. I have however seen cases in which there was a moderate degree of bristling & in which restoration of health and of the ordinary smoothness of the hair subsequently took place.

4. Large photographs of the insane are not to be purchased anywhere  I shall do my best to supply the desiderata.

J. Crichton Browne M.D. F.P.<S.> | Wakefield.

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