Encephalopathy

“ There is, however, a twofold explanation of it: the circulation through the much softer tissue of the brain, unenclosed within a firm bony case as in after-life, varies with far greater rapidity in the infant than in the grown person, and hence the organ is far more easily overfilled with or emptied of its blood. Besides, any organ in which growth is going on with great rapidity is proportionately liable to become disordered or diseased. Now the brain doubles its weight in the first two years of life, and attains nearly its full size by the end of the seventh year. ”

“ In many instances, the transmission of imperfectly oxygenated blood to the brain, is an influential cause in the production of nervous disease and delicacy of constitution. The only efficient remedy for these conditions is a supply of pure blood to the brain.
800. The brain should be called into action. This organ, like the muscles, should be used, and then allowed to rest, or cease from vigorous thought. When the brain is properly called into action by moderate study, it increases in size and strength ”

“ These two facts suggest a bright as well as a dark view of disorders of the brain and nervous system in early life. If disorder is more frequent, it is excited by slighter causes, is more likely to be temporary, and even its gravest symptoms, such as convulsions and paralysis, have a less serious import in the one case than in the others. If the grown man has a fit, and still more, if that fit is followed by paralysis, we fear and with reason that some vessel in the brain-substance has given way, or that some grave, probably irreparable damage [Pg 89] has been inflicted on it. ”

“ If so, we will begin and say the great cerebral system of arteries supply the brain of which it gives quality of all fluids and electric and magnetic forces, which must be generated in the brain. Then a question arises, if the heart, lungs, liver, pancreas, lymphatics, kidneys and all parts of the body depend upon the brain for power, what do they give in return? If they give back anything it must be of the kind of the organ from whence it comes; thus a kidney cannot give liver nor spleen. Each must help to keep up the universal harmony by furnishing its mite of its own kind. ”

“ Objectively considered what is observable is hypertrophy of the cellules and nerve-tubes, excessive cerebral plethora and vascularity due to the great efflux of blood and superabundant nutrition of the encephalon. Inflammation of the meningeal covering, and of the brain itself, is, sooner or later, a further result of the chronic congestion. ”

“ At the same time it is only logical to conclude that any morbid condition of the cerebral circulation or of the brain or membranes which leads to a corresponding amount of ventricular effusion, or atrophy or destruction of the nerve centres already designated, will produce the symptoms characteristic of this disease. Thus the different forms of meningitis, traumatic injuries to the cranium, chronic encephalitis, cerebral softening or degeneration, sclerosis, neoplasms of all kinds affecting the brain (cysts, cholesteatoma, psammoma, melanoma, etc.) , and parasites may occasion this disease. ”

“ Inflammation may, however, exist in the center of the great nerve masses—the cerebrum, cerebellum, pons Varolii, or medulla at the base of the brain—without involving the surface. When, therefore, inflammation invades the brain and its enveloping membranes it is properly called encephalitis; when the membranes alone are affected it is called meningitis, or the brain substance alone cerebritis. Since all the conditions merge into one another and can scarcely be recognized separately during the life of the animal, they may here be considered together. ”

“ LIV. Now he or she who dwells mainly in the brain is subject to enormous nervous waste: and the blood, charged with refuse brain and nerve-rust, rushes to the kidneys, and there unloads its bad freight; but all servants get tired, and so do the organs named; so that after a while they cease to drain and sift so perfectly as of yore; consequently the alkaline phosphates and urea are not all discharged, but a portion is poured back into the circulation, until finally every inch of the physical body is poisoned; and a healthy soul cannot healthfully act through poisoned nerves and tainted fluids. ”

“ At birth those parts of the brain which are the seat of memory and what are understood as the higher faculties are very imperfectly developed. Variations in structure are extremely common, there are differences in different individuals in the nerves and in the number, size, form and arrangement of the nerve cells, and so complex is the structure that considerable variation can exist without detection. The tissue of the central nervous system has a considerable degree of resistance to the action of bacteria, but is, however, very susceptible to injury by means of poisons. ”

“ As we sometimes see death occur, preceded by the ordinary symptoms of cerebral inflammation, when, on examination after death, nothing can be discerned but preternatural vascularity of the membranes or substance of the brain, without the presence of any inflammatory product that can be distinguished; and as, moreover, when some inflammatory product is generated, we are in total ignorance of the laws by which, in one case, the blood-vessels pour out serum, in another secrete pus, in a third soften, and in a fourth indurate the cerebral substance ”

“ For healthy and efficient action, the brain should be primarily sound; as this organ is subject to the same general laws as other parts of the body. If the brain of the child is free from defects at birth, and acquires no improper impressions in infancy, it will not easily become diseased in after life. But, if the brain has inherited defects, or has acquired a proneness to disease by mismanagement in early life, it will more easily yield to influences that cause diseased action. The hereditary tendency to disease is one of the most powerful causes that produce nervous and mental affections. ”

“ Work and Waste of Brain Tissue Necessary––This, speaking broadly, is the rationale of the matter: just as actually as we sew or write through the instrumentality of the hand, so the child learns, thinks, feels, by means of a material organ––the very delicate nervous tissue of the cerebrum. Now this tissue is constantly and rapidly wearing away. The more it is used, whether in the way of mental effort or emotional excitement, the more it wears away. Happily, rapid new growth replaces the waste, wherefore work and consequent waste of tissue are necessary. ”

“ In life, the slightest perturbation in the cerebral circulation is enough to prevent thought and sensation utterly. Now, if a few drops of blood too much or too little in the brain of an animal in full health suffice to alter the regularity of its psychical manifestations, much more certainly will the completeness of the brain's action be deranged if it is awakened by an injection of foreign blood, a forcible entry too, which, of necessity, cannot cause the blood to circulate with suitable pressure and equipoise. ”

“ The blood of man is also affected by this same force, and the moment a man’s circulation begins to run down, owing to stinted nutrition, we find that the first symptoms of trouble appear in the head.... The brain failing to receive its accustomed amount of blood, such troubles as impaired memory, inability to concentrate the attention, sleeplessness, nervousness, irritableness, the blues and slight headaches develop; and the impulses sent all [Pg 200] over the body becoming feebler, the various organs do not perform their functions as satisfactorily as usual. ”

“ He can predict all the movements that will take place as certainly as a chemist knows in advance the reaction he will obtain from mixing certain bodies.
Pathology confirms our conclusion respecting these higher functions of the cerebrum. Loss of cerebral substance, in man, is followed by a weakening of the intellectual powers. They make a very childish mistake who attempt to deal with the physiological materialism of our day by citing the American crow-bar case, or any number of cases of brain-loss unaccompanied by marked intellectual enfeeblement. ”

“ Insanity may, both in its acute and chronic form, be the result or symptom of simple anomalous excitation or nutrition of the brain or of inhibition of some of its portions, without any change in its gross appearance which can be detected by our present methods of research. In the majority of cases there are found diseased conditions which become more manifest the longer the duration of the disease, appearing for the most part in the blood-vessels, pia mater, and cortex of the brain, but also in the medullary portion, many of which are recognized only in their late stages. ”

“ That a functional disturbance of the brain exists in such cases is self-evident; but for aught we know this may be due to some slight molecular, chemical, or vital changes in the nerve-cells of the gray matter of the brain or of a group of cells, not denoted by any peculiar physical signs during life, and which can leave no possible traces after death. To cause mental derangement, it may be only necessary that these microscopic cells should be temporarily deprived of their normal supply of oxygen through the vascular system ”

“ It is very probably the hard-worked vasomotor center which proves to be the vulnerable spot. With its release of the blood-vessels in certain areas from its reenforeing influence comes the cerebral anemia. Then, we may suppose, the nerve-cells become less active than in the brain which has its full supply of blood, that they cease to send impulses over the usual routes, either because gaps have opened or because such impulses as do arise are permitted to stray and be scattered, producing no effect in consciousness or one which is quite bizarre and meaningless. ”

“ Such consideration is, however, without the sphere of the present paper, which deals with cerebral manifestations in relation to ordinary disease, and not with those ailments which belong to the province of the alienist physician. To one form of disorder of the cerebral cells alone may reference be made here, and that is as to the effects of mental over-strain. Brain-tissue can be developed by exercise, and worn out by overwork. When this latter condition has been induced, there exists that irritability which forms part of the early stage of the exhaustion of nerve-matter. ”

“ The muscles and nerves may react, the heart may be kept beating, and organs of the body when removed and supplied with blood will continue to function. Certain tissues die early, and the first to succumb to the lack of oxygenated blood are the nerve cells of the brain. If respiration and circulation have ceased for as short a time as twelve minutes, life ceases in certain of these cells and cannot be restored. This is again an example of the greater vulnerability of the more highly differentiated structure in which all other forms of cell activity are subordinated to function. ”

“ Ardent spirits also tend to produce an over-fullness of the cerebral vessels, and to affect the functions of the brain in a manner which strangely blends stupidity, brightness, and exhilaration. Effects so unnatural, and so frequently ending in disease, influence injuriously the nutrition of the nervous centres. And to interfere with the nutrition of any part of the body is simply to impair the life and power of its structure. ”

“ It is, therefore, not difficult to understand how, when the circulation is in a state of permanent excitement, a very slight cause may suffice to overturn its equilibrium, and occasion a greater flow of blood to the brain than the organ is able to bear. Congestion of the brain, however, is not by any means limited to this season, but may occur at other times without any obvious exciting cause, and with no other explanation than is furnished by the well-known fact that all periods of development such as childhood, are periods during which the growing organs are most apt to become disordered. ”

“ It proceeds too and does obtain blood abundantly to and from the heart, but the results obtained are not satisfactory, and another leaf is opened of why no good results are obtained and where is the mystery, what quality and element of force and vitality has been withheld? A thought strikes him that the cerebro spinal fluid is the highest known element that is contained in the human body, and unless the brain furnishes this fluid in abundance a disabled condition of the body will remain. ”

“ We meet with the preponderance of nervous diseases in the refined and cultivated classes, where, by premature and stimulating processes of education, there has been forced an elaboration of brain-structure, hastening the functional activity of the brain, with no due regard to the law of evolutional precedence. Normal growth and development will give us healthy minds, while a structurally degraded centric nervous system, or an altered quality of blood, and secondary disturbance of nerve-function, will antagonize healthy mental manifestation. ”

“ The most usual cause of the disease, however, particularly in children, is an irritation which is sympathetically communicated to the brain, from a disturbance in the chylopoietic organs; and particularly from a functional disorder of the liver. The cerebral disorder, to which a derangement in the digestive functions thus gives rise, is only one of those numerous effects which arise out of sympathies, subsisting between these organs and different parts of the system. ”