Preventable Diseases Part 19

After you have taken nature's wise advice, and obeyed her orders, and put yourself at rest, then there are a number of mild sedatives, with which every physician is familiar, one of which, according to the special circ.u.mstances of your case, it may be perfectly legitimate to take in moderate doses, with the approval of a physician, as a means of relieving the pain and helping to get that sleep which will complete the cure.

One other measure of relief, which, like rest, is also indicated by instinct, is worth mentioning, and that is gentle friction of the head.

One of the most instinctive tendencies of most of us when suffering from a severe headache is to put the hands to the head, either for the purpose of frantically clutching at it, rubbing as if our lives depended upon it, or pressing hard over the aching region. The mere picture of a man with his head in his hands instantly suggests the idea of headache.

Part of this is, of course, little more than a blind impulse to do something to or with the offending member. We would sometimes like to throw it away if we could, or at others to bang it against the wall. But part of it is due to the discovery, ages ago, that pressure and friction would give a certain amount of relief.

For some curious reason the nerves most frequently involved are those which are most readily accessible for this kind of treatment, namely, the long nerve-threads which run from the inner third of the eyebrow up the forehead and over the crown of the head (the so-called supraorbital or frontal branches). A corresponding pair run up the back of the neck, about half-way between the back of the ear and the spinal column, supplying the back of the head and the crown (these form the cervical plexus); and a smaller pair run up just in front of the ear into the temple, and from there on upward to join the other two pairs at the top of the head.

Broadly speaking, the position of the pain depends upon which pair of these nerves is lifting up its voice most vigorously in protest. If it be the front pair (supraorbitals) then we get the well-known frontal or forehead headache; if the back pair (known as the occipitals) then we have the deadly, constricting, band-around-the-head pain which clutches us across the back of the neck and base of the brain. If the lateral pair are chiefly affected then we get the cla.s.sic throbbing temples.

Practically all of these aches, however, are of the "fire-alarm"

character; and while certain of these nerve-gongs show some tendency to respond more readily to calls coming in from certain regions of the body, as, for instance, the forehead nerves to eye-strain, the back-of-the-head nerves (occipital) to grave toxic states of the system, the tips of any of the nerves in the crown of the head to pelvic disturbances and anaemic conditions, the lateral branches in the temples to diseases of the teeth and throat, yet there is little fixed uniformity in these relations. Eye-strain, for instance, may cause either frontal or occipital headache; and, as every one knows from experience, the pain may be felt in all parts of the head at once.

Gentle and intelligent ma.s.sage over the course of these nerves of the scalp, according to the location of the pain, will often do much to relieve the severity of the suffering.

Treat headache as a danger signal, by rest and the removal of its cause, and it will prevent at least ten times as much suffering and disability as it causes.

CHAPTER XVIII

NERVES AND NERVOUSNESS

Nerves are real things. In spite of their connection with imaginary diseases and mental disturbances, there is nothing imaginary or unsubstantial about them. There is no more genuine and obstinate malady on earth than a nervous disease. Because nerves lie in that twilight borderland between mind and matter, body and soul, the real and the ideal, the impression has got abroad that they are little better than figures of speech. Though their disturbances give rise to visions of all sorts there is nothing visionary about them; they are just as genuine and substantial a part of our bodily structure as our bones, muscles, and blood-vessels. In fact, it was this very substantiality that at the beginning prevented their proper recognition, and handicapped them with their present absurd and inappropriate name.

"Nerve" is from the Greek _neuron_, meaning tendon, or sinew, and was originally applied indiscriminately to all the different s.h.i.+ning cords which run down the limbs and among the muscles. In fact the first recognition of nerves was an utter failure to recognize. The tendon cords, which are the ropes with which the muscles work the joint pulleys, were actually included under one head with the less numerous but almost equally large and tough cords of grayer color, flatter outline, and less glistening hue, which were afterwards found to be nerve-trunks. Cutting either paralyzed the limb below the cut,--and what more proof could you ask of their having the same function?

Such is the persistence of ancient memories, that any physician could tell you of scores of cases in which he has heard the nave remark, in reference most frequently to a deep gash across the wrist, that the "nerves" were cut, and the hand was paralyzed, when what had happened was simply that the tendons had been cut across. When, after centuries of blundering in every possible direction until the right one was finally stumbled upon (which is the mechanism of progress), it was realized that some of these "nerves," the grayer and flatter ones, carried messages instead of pulling ropes, they were still far from being properly understood.

It is an amusing ill.u.s.tration of the blissful ignorance and charming navete which marked their study and discussion at this time, that nerves were for centuries regarded as hollow tubes, carrying a supply of "animal spirits" from the central reservoir of the brain to the different limbs. So seriously was this believed, that, in amputations, the cut nerve-trunks were carefully sought out and tied, for fear the vital spirits would leak out and the patient thus literally bleed to death. One can imagine how this must have added to the comfort of the luckless patient.

The term "nerves" still persists, in the old sense, in both botany and entomology, which speak of the "nerves" of a b.u.t.terfly's wing, or the "nervation" of a leaf, meaning simply the branching, fibrous framework of each.

It comes in the nature of a surprise to most of us to learn that "nerves" are real things. I shall never forget the shock of my own first convincing demonstration of this fact. It was in one of the first surgical clinics that I attended as a medical student. A woman patient was brought in, with a history of suffering the tortures of the d.a.m.ned for a year past, from an uncontrollable sciatica.

It was a recognized procedure in those days (and is resorted to still), when all medical, electrical, and other remedial measures had failed to relieve a furious neuralgia, for the surgeon to cut down upon the nerve-trunk, free it from its surrounding attachments, and, slipping his tenaculum or finger under it, stretch the nerve with a considerable degree of force. Whether it acts by merely setting up some trophic change in the nerve-tissue, or by tearing loose inflammatory adhesions which are binding down the nerve-trunk, the procedure gives excellent results, nearly always temporary relief, and sometimes a permanent cure.

The patient was placed upon the table and anaesthetized, and the surgeon made a free, sweeping incision down the back of the thigh, exposing the sciatic nerve. He thrust his finger into the wound, loosened up the adhesions about the nerve, hooked two fingers underneath it, and, to my wide-eyed astonishment, heaved upward upon it, until he brought into view through the gaping wound a flattened, bluish-gray cord about twice the size of a clothesline, with which he proceeded to lift the hips of the patient clear of the table. In my ignorant horror, I expected every moment to see the thing snap and the patient go down with a b.u.mp, paralyzed for life; but I never doubted after that that nerves were real things. Though it has nothing to do with this discussion, for the benefit of those of my readers who cannot bear to have a story left unfinished, I will add that the operation was as successful as it was dramatic, and the patient left the hospital completely relieved of her sciatica.

When at last it was clearly recognized that the nerves were concerned in the sending of messages from the centre to the brain, known as _sensory_, or centripetal, and carrying back messages from the brain to the muscles and surface, known as _motor_, or centrifugal,--in other words that they were the organs of the mind,--still another source of confusion sprang up, and that was the determination on the part of some to regard them from a purely mental and, so to speak, spiritual point of view, and on the part of others to regard them from a physical and anatomical point of view. This confusion is of course in full riot at the present time.

The term "nerves," and its adjective, "nervous," are used in two totally distinct senses: one, that which is vague and unsubstantial, purely mental or subjective, and, in the realm of disease at least, imaginary; the other, purely anatomical, referring to certain strands of tissue devoted to the purpose of transmitting impulses, and the condition affecting these strands. I am not so rash as to raise the question here,--still less to attempt to settle it,--which of these two views is the right and rational one. Whether the brain secretes thought as the liver does bile, or whether the mind created the brain and nervous system, or, as it has been epigrammatically put in a recent work on psychology, "whether the mind has a body, or the body has a mind," I merely call attention to the fact that this confusion of meanings exists, and that its injection into the field of medicine and pathology, at least, has done an enormous amount of harm in the way of confusing problems and preventing a proper recognition of the actual facts.

The more carefully and exhaustively and dispa.s.sionately we study the disorders of the nervous system which come in the field of medicine, the more irresistibly we are drawn to the conclusion that from neurasthenia and hysteria to insanity and paralysis they are every one of them the result of some definite morbid change in some cell or strand of the nervous system. The man or woman who is nervous has poisoned nerve-cells, either from hereditary defect, or direct saturation of the tissues with toxic substances. The patient who has an imaginary disease is suffering from some kind of a hallucination produced by poison-soaked nerve-cells, such as in highest degree give rise to the delirium of fevers, and the horrid spectres of delirium tremens.

Even the man who is suffering from a "mind diseased," and confined in one of our merciful asylums for the insane, is in that condition and position on account of physical disease, not merely of his brain, but of his entire body. The lunatic is insane, in the for once correct derivative sense of unhealthy, to the very tips of his fingers. Not merely his mind and his brain, but his liver, his stomach, his skin, his hair and fingernails, the very sweat-glands of his surface which control his bodily odor, are diseased and have been so usually for years before his mind breaks down.

Tell a competent expert to pick out of a crowd of a thousand men and women the ten who are likely to become insane, and his selection will be found almost invariably to include the two or three who will actually become so.

In fact, from even the crudest and scantiest knowledge of the actual growth of our own bodies from the ovum to the adult, it will be difficult to conceive how this relation could be otherwise, The nerve-cells and their long processes, which form the nerve-trunks, are simply one of a score of different specialized cells which exist side by side in the body. Primarily all our body-cells had the power of responding to stimuli, of digesting and elaborating food, of moving by contraction, of reproducing their kind. The nerve-cells are simply a group which have specialized exclusively upon the power of receiving and transmitting impulses. They still take food, but it has to be prepared for them by the other cells; and here, as we shall see later, is one of the dangers to which they are exposed. They still reproduce their kind, but in very much smaller and more limited degree. They still, incredible as it may seem, probably have slight powers of movement or contraction, and can draw in their processes. But they have surrendered many of their rights and neglected some of their primitive accomplishments, in order to devote themselves more exclusively and perfectly to the carrying out of one or two things.

In spite of all this, however, they still remain blood-brothers and comrades to every other cell in the body. In the language of Shylock, "If you cut them, they will bleed; if you tickle them, they will laugh; if you starve them, they will die." In all this development, which continued up to a late hour last night, and is still going on, the nerve-tissue has lain side by side with every other tissue in the body, fed by the same blood, supplied with the same oxygen, saturated with the same body-lymph.

It is of course perfectly clear that any influence, whether beneficial or injurious, affecting the body, will also be likely to affect the nervous system, as a part of it; and this is precisely the fact, as we find it. If the body be well fed, well warmed, sufficiently exercised, without being overworked, and allowed a liberal allowance of that recharging of the human battery which we call sleep, then the nervous system will work smoothly and easily, at peace with itself and with all mankind. Its sense-organs will receive external impressions promptly and accurately. Its conducting fibres will transmit them to the centre with neither delay nor friction. The brain clearing-house will receive and dispose of them with ease and good judgment. And then, just because his nervous system is working to perfection, we say that such an individual "has no nerves."

If the triumph of art be to conceal art, then the nerves have achieved this. They have literally effaced themselves in the well-being of the body.

If on the other hand, the food-supply is inadequate, if the sleep allowance has been cut short, whether by the demands of work or by those of fas.h.i.+on, if the body has been starved of oxygen and deprived of sunlight, if the whole system has been kept on the rack, whether in the sweatshop, or in the furnace of affliction, what is the effect on the nervous system? Just what might have been expected. The sense-organs shy, like a frightened horse, at every shadow or fluttering leaf. The conducting wires break, and cross, and tangle in every imaginable fas.h.i.+on. The central exchange, half wild with hunger, or crazed with fatigue-toxins, shrieks out as each distorted message comes in, or sulks because it can't understand them. And then, with charming logicality, we declare that such an one is "all nerves."

The brain, by which we mean the biggest one near the mouth,--we have little brains, or _ganglia_ all over our bodies,--so far from being an absolute monarch, is not even a const.i.tutional one, or a president of a republic, but a mere house of congress of the modern type, which can do little but register and obey the demands of its const.i.tuents. The brain originates nothing. Impulses are brought to it from the sense-organs by the nerves. They set up in it certain vibrations, or chemical disturbances. It responds to these much as blue litmus paper turns red when a weak acid is dropped on it, or as lemonade fizzes when you put soda in it. If more than one of these vibrations are set up simultaneously, it "chooses" between them, by responding to the strongest. If the response differs from the stimulus, it is because of its huge deference to precedent as established by the records of previous stimuli with which its tissues are stored.

This brings us to the interesting and important question, What are the causes of these disturbances of the nerve-tissues? Probably the most important single result that has been reached in our study of nervous diseases in the last fifteen years, is that the cause of them in easily eighty per cent of all cases _lies entirely outside of the nervous system_.

The stomach burns, the nerve-tissues send in the fire alarm and order out the engines. The liver goes on a strike, and the body-garbage, which it has failed to burn to clean ashes and clear smoke, poisons the nerve-cells, and they remonstrate accordingly, on behalf of the other tissues. The heart, or blood-vessels, fails to supply a certain muscle with its due rations of blood and the nerves of the region cry out in the agony of cramp.

We have discovered, by half a century of careful study in the hospital and in the sick-room, not only that the nerve-tissues are usually poisoned by defect of other tissues of the body, but that they are among the very last of the body-stuffs to succ.u.mb to an intoxication. The complications of a given disease involving the nervous system are almost invariably the last of all to appear. This is one of the things that has given nervous diseases such a bad name for unmanageableness and incurableness, and that for years made us regard their study as so nearly hopeless, so far as any helpful results were concerned.

When a disease has, so to speak, soaked into the inmost core of the nerve-fibre, it has got a hold which it will take months and even years to dislodge. And before your remedies can reach it, it will often have done irreparable damage. An ill.u.s.tration of the care taken to spare the nervous system is furnished by its behavior in starvation. If a man or an animal has almost died of starvation, the tissues of the body will be found to have been wasted in very varying degrees, the fat, of course, most of all; in fact this will have almost entirely disappeared, all but three per cent. Then come the liver and great glands, which will have shrunk about sixty per cent; then the muscles, thirty per cent; then the heart and blood-vessels. Last of all, the nervous system, which will scarcely have wasted to any appreciable degree. In fact, it is an obvious instance of jettison on the part of the body, throwing overboard those tissues which it could most easily spare, and hanging on like grim death to those which were absolutely essential to its continued existence, viz., the heart and the nervous system. To use a cannibalistic and more correct ill.u.s.tration, it is killing and eating the less useful and valuable members of its family, in order that their flesh may keep alive the two or three most indispensable.

Another ill.u.s.tration is the actual behavior of the nerve-stuff in disease. This is most clearly shown in those clear-cut disturbances which are definitely known to be due to a specific infection; in other words, invasion of the body by a disease-organism, or germ.

First of all, it may be stated that physicians are now substantially agreed that two-thirds of the general diseases of the nervous system are due to the extension of one of these acute infections to the nerve-tissue; and this extension almost invariably comes late in the disease. The only exceptions to this rule in the whole list of infectious diseases are two, epidemic cerebro-spinal meningitis (spotted fever), and teta.n.u.s (lockjaw). Both of these have an extraordinary and deadly preference for the nervous system from the very start, and this is what gives them their frightful mortality and discouraging outlook.

Even of this small number of exceptions, we are not altogether certain as to epidemic meningitis, inasmuch as we do not know how long the germ may have existed in the other tissues of the body before it succeeded in working its way to and attacking the brain and spinal cord.

The case of teta.n.u.s, however, is perfectly clear in this regard, and exceedingly interesting, inasmuch as it explains why a disease specially involving the nervous system from the start is so excessively hard to check or cure. The germ of the disease, long ago identified as one having its habitat in farm or garden soils,--particularly those which have been heavily fertilized with horse manure,--gets into the system through a cut or scratch upon the surface, into which the soil is rubbed. These infected cuts, for obvious reasons, are most frequently upon the hands or feet.

Small doses of the organism have been injected into animals; then, when they have recovered, larger ones, and so on, after the manner of the bacillus of diphtheria, until a powerful ant.i.toxin can be obtained from their blood, very minute quant.i.ties of which will promptly kill the bacilli in a test-tube. For seven or eight years past we have been injecting this into every patient with teta.n.u.s that came under our observation, but so far with very limited benefit, even though the injections were made directly into the spinal cord, or brain substance.

The problem puzzled us for years, until finally Cattani stumbled upon the explanation. While we had been supposing that the poison was carried, as almost every other known poison is, through the blood-vessels, or lymph-channels, to the heart and thence to the brain, he clearly proved that it ran up the central axis of the nerve-trunks, and consequently, when it had got once fairly started up this channel, was as safe from the attack of any ant.i.toxin merely present in the general circulation and fluids of the body, as the copper of the Atlantic cable is from the eroding action of the sea-water. If, in his experimental animals, he carefully sought for the cut end of the nerve-trunk in the wound that had been infected, and injected the ant.i.toxin directly into that, the disease was stopped. Or it might even be "headed off" by the crude method of cutting directly across the nerve-trunk at a point above that yet reached by the infection.

The commonest and most fatal of all forms of general diseases of the nervous system are those which are due to the later extensions of general infections.

First and foremost stands syphilis, due to the invasion of the blood by a clearly defined _spirillum_, the _Treponema pallida_ of Schaudinn.

This first attacks the mucous membranes of the throat and mouth, then the skin, then the great internal organs like the liver and stomach, then the bones, and, last of all, the nervous system. The length of time which the poison takes to reach the nervous system is something which at first sight is almost incredible, viz., from one and a half to fifteen years. It is true that in rare instances brain symptoms will manifest themselves within six or eight months; but these are usually due to pressure by inflammatory growths on the bones of the skull and its lining membrane (_dura mater_). It is not too much to say that this disease plays the greatest single role in nervous pathology. Three of the commonest and most fatal diseases of the spinal cord and brain, _paresis_ (general paralysis of the insane), _locomotor ataxia_, and _lateral sclerosis_, are due to it.

Naturally, when a poison has taken a decade or a decade and a half to penetrate to the nerve-tissues, it does irreparable damage long before it can be dislodged or neutralized.

A similar aftermath may occur in almost all of the acute infectious diseases. Every year adds a new one to the list capable of causing cerebral complications. Tuberculosis, diphtheria, scarlet fever, typhoid, smallpox, influenza, have now well-recognized cerebral and nervous complications, some temporary, some permanent. A form of tuberculosis attacking the coverings (_meninges_) of the brain--hence known as meningitis--is far the commonest fatal brain-disease of infancy and childhood.

Perhaps the most striking ill.u.s.tration of just how acute affections attack the nervous system, is that furnished by diphtheria. A child develops an attack of this disease, pa.s.ses the crisis safely, and begins to recover. A few days later, it is allowed to sit up in bed. Suddenly, after some slight exertion, or often without any apparent cause, the face blanches, the eyes stare widely, the child gasps two or three times, and is dead: sudden heart failure, due to the poisoning either of the heart muscle itself, or of the nerves supplying the heart, by the toxin of the disease. Moral: Keep diphtheria patients strictly at rest in bed for at least a week after the crisis is past. Another case will pa.s.s this period safely, though perhaps with a rapid and weak heart, for days or weeks; then one morning the child will choke when swallowing milk. The next time it is attempted, the milk, instead of going down the throat, comes back through the nostrils. Paralysis of the soft palate has developed, apparently from a local saturation of the nerves with the poison. This may go no further, or it may extend, as it commonly does, to the nerves of the eye, and the child squints and can no longer read, if old enough, because the muscle of accommodation also is paralyzed.

The arms and limbs may be affected, and in extreme cases the nerves of respiration supplying the diaphragm may be involved, and the child dies of suffocation. In the majority of cases, however, fortunately, after this paralysis has lasted from three to six weeks, it gradually subsides, and may clear up completely, though not at all infrequently one or more muscles may remain permanently damaged by the attack, giving, for instance, a palatal tone to the voice, or interfering with the production of singing tones. Occasionally a permanent squint may follow.

It might be said in pa.s.sing, that, with one of the charming logicalities of popular reasoning, these nerve complications have been said to be _caused by_ ant.i.toxin, simply because the use of the ant.i.toxin saves more children alive to develop them.

The next group of nervous diseases may be roughly described as due to the failure of some part of the digestive system, like the stomach and intestines, properly to elaborate its food; or of one of the great glands, like the liver, thyroid, or suprarenal, properly to supply its secretion, which is needed to neutralize the poisons normally produced in the body. This cla.s.s is very large and very important. It has long been known how surely a disordered liver "predicts d.a.m.nation"; melancholia, or "black bilious condition," hypochondria, or "under the rib-cartilages" (where the liver lies), are every-day figures of speech.

A thorough house-cleaning of the alimentary ca.n.a.l, together with proper stimulation of the skin and kidneys, and an intelligent regulation of diet, are our most important measures in the treatment of diseases of the nervous system, even in those extreme forms known as insanity.

Closely allied to these are those disturbances of the nervous system lumped together under the soul-satisfying designation of "neurasthenia,"

which are chiefly due to the acc.u.mulation in the system of the fatigue poisons, or substances due to prolonged overstrain, under-rest, or underfeeding of the system. Neurasthenia is the "fatigue neurosis," as a leading expert terms it. It may be due to any morbid condition under heaven. It is "that blessed word Mesopotamia" of the slipshod diagnostician. Nearly one-fourth of the cases which come into our sanatoria for tuberculosis have been diagnosed and treated for months and even years as "neurasthenia." It satisfies the patient--and it means nothing; though some experts contend for a distinct disease ent.i.ty of this name but admit its rarity.