Neurological disease

“ The third stage is the most destructive, especially to the nervous system, for this disease is recognized as the greatest factor in organic disturbances of the nervous system.
It not rarely is the cause of cerebral and spinal meningitis, paralysis of the legs, paralysis of one side of the body, and that most helpless and terrible disease, softening of the brain and many other diseases which affect the spinal cord, which are seldom ever cured. The majority 79of those diseased are left with physical or mental infirmities, rendering them public charges. ”

“ From the ascendency of the nervous system in the physical and mental composition, diseases of the nerves are very liable to appear, but not as a primary derangement any more than as a complication grafted upon some previously-existing disease. Nervous headache, neuralgia, epilepsy, insomnia, and hysteria, are among the nervous affections most liable to appear, either as primary or secondary derangements. With this class it is difficult to give an opinion as to the result in any serious disease (prognosis) , as they often die of diseases that in other temperaments are deemed trifling ”

“ If the cause is removed and the altered condition of the nerve cells goes only so far, it remains what we call a functional disease. If it goes so far that the cells show alteration, we have an organic disease of the nervous system. ”

“ While the complicated nature of nerve diseases requires very careful treatment of great individual variety, the general rule is that the re-enforcement of the nerves with the material of which they are built, together with regeneration of the blood, which, when in normal condition prevents such disturbances, will bring about a cure. Of course this is sometimes a slow process, especially when, as in the case of epilepsy, the nervous disease is of an hereditary character, and the resistant power of the nerves is correspondingly weak. ”

“ Nevertheless, in a number of cases the disease has been traced back to taking cold, to physical as well as cerebral over-exertion, mental excitement, sorrow caused by misfortunes, poverty of nutrition, excessive use of tobacco, etc. In some cases the disease commences in the spinal cord in the form of progressive muscular atrophy or amyotrophic lateral sclerosis, and gradually extends to the medulla oblongata; in many other cases no particular cause can be found. The disease is rarely if ever met with in persons under twenty years of age, but is confined to adult life and old age. ”

“ For these troubles are just those which most often puzzle the physician, leading him to change his diagnosis and the patient to change his doctor very frequently. Again, it is just these functional nervous disorders which, affecting as they do every part of the body and every organ, give rise to the false idea of “many diseases”—an idea based on the patient’s multitudinous sufferings.
Organic disease often runs its course accompanied by very little suffering, or with a very definite localization of the malady in one part of the body. ”

“ The Nervous System is not easily Damaged. The nervous system is subject to a good many more diseases than are either the muscles or the bones; but, considering how complex it is, it is not nearly so easily damaged or thrown out of balance as we usually imagine, and has astonishing powers of repair. Instead of being one of the first parts of the body to be attacked by a disease, such as an infection or a fever, it is one of the very last to feel the effects of disease, except in the sense that it often gives early that invaluable danger signal, pain.
Headache. ”

“ Epileptic seizures usually with granulomatous lesions in the brain are the main clinical manifestations of the cerebral disease in the chronic phase. Symptoms common with brain tumors such as headaches, disturbance of speech, and paralysis often develop. ”

“ Anatomical changes in the brain or its membranes do exist in a considerable number of cases of chronic Bright's disease. Chronic meningitis with thickening of the pia mater and an increase of serum is quite common; anæmia and oedema of the brain-tissue are often seen. But there are a great many cases with cerebral symptoms without such lesions, and with such lesions without cerebral symptoms. ”

“ The onset of general paralysis is slow and gradual, and the earliest symptoms may be either physical or mental. The disease may commence either in the brain itself or the spinal cord may be primarily the seat of lesion, the brain becoming affected secondarily. ”

“ He says that not only are stigmata and ecstasies capable of explanation when taken apart from one another, but that by their union they constitute what in pathology is called aggregate of symptoms. According to this, stigmata and ecstasies would constitute an altogether unique morbid state, to which the professor gives the following name and definition: “Stigmatic neuropathy is a nervous disease, having its seat in the base of the medulla oblongata, the first stage of which consists in the paralysis of the vaso-motor centre, and the second in its excitation.” ”

“ 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 succumb to an intoxication. The complications of a given disease involving the nervous system are almost invariably the last of all to appear. ”

“ Cases of brain abscess, of spinal focal lesions, and meningeal hemorrhage are in evidence, aphasias, monoplegias, Jacksonian spasm, and thalamic disease receiving consideration.
All neurologists know the difficulties in diagnosticating epilepsy in the absence of opportunities to see attacks and to receive the carefully analyzed statement of the observers of the patient. ”

“ A number of instances are on record by careful observers—and are probably much more numerous than is commonly suspected—where no decisive evidence of spinal or cerebral disease could be detected during life, and yet disseminated foci of sclerosis existed in the nerve-centres. ”

“ The fact is notorious that severe loss of blood is always followed by headache; and if there be the least predisposition to neuralgia, this headache will very commonly take the form of the severest clavus. And, in like manner, chronic states of anæmia and of mal-nutrition undoubtedly aggravate every existing neuralgia, and bring out lurking tendencies to the disease. ”

“ Care should be taken not to operate in cases presenting other symptoms which suggest the remotest suspicion of organic cerebral disease, and the existence of unilaterally increased tendinous reflexes or tremor should be carefully looked for as contraindications.
Braces and apparatus are often worse than useless, increasing not only the patient's discomfort, but aggravating the malady. ”

“ 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. ”

“ Neuralgia and Headache.—In the grown person neuralgia, as many of us know to our cost, is by no means infrequent; in the child it is very rare, and when a child complains of severe pain in the head, or of severe pain to the knee or hip apart from rheumatism, it is almost invariably the sign of disease of the brain in the one case, of the hip-joint in the other. To this rule there are indeed exceptions, but it will always be well to leave it to the doctor to determine—no easy matter by the bye—whether any given case is one of the rare exceptions or not. ”

“ The cause is obvious when the close connection between the brain and the nerve ganglia is considered. If nervous force is diverted in directions other than those followed in the digestion of food, exactly similar results occur as when the pneumogastric nerve is severed.
Does the physical condition of the body in like manner affect the mind? Observation shows not only that it does influence brain function, but that the results of disease are always and continuously displayed mentally. ”

“ It is an established fact that drugs do not affect brain structure; and it is equally well known that, in most instances, insanity causes no deterioration in nerve tissue. In these facts lies strong collateral proof that the sources of mental disease are to be sought elsewhere than in the brain. Injuries and ailments that involve change in brain substance will necessarily interfere with brain function, and, in softening of nerve tissue or in any inflammation, there are organic alterations that may be seen and noted. ”

“ But when all these conditions have been excluded and when the symptoms are apparently due to a cerebral affection, there is one group of cases in which localizing brain symptoms are absent and in which the chief indications of disease are headache, double optic neuritis, and often vomiting. In most of these cases syphilis can be also excluded. A diagnosis of brain tumor is given, and the growth is thought to be situated in some region in which the localizing symptoms are at first indefinite—cerebellum, temporo-sphenoidal lobe, or prefrontal region. Such a diagnosis often proves to be correct. ”

“ 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. ”

“ 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. ”

“ In this case the secondary action becomes the more important of the two.
The most dangerous symptoms of disease are evidenced in the nervous system. Neurotics are employed to control these symptoms as they arise, but Hæmatics are used to combat the cause of the disorder. As to their relative efficacy, there is an advantage and a disadvantage on each side. On the one hand, nerve-medicines are more numerous and more powerful than blood-medicines, and thus in the control of symptoms they are wielded with more immediate certainty than the others in the counteraction of diseases. ”

“ Neurasthenia in the young may be a purely functional nervous disease, though it is probable that in most cases the nervous system is congenitally defective, or at least is unable to perform the functions which have been assumed by the patient. ”

“ Autopsies have shown meningeal and cortical congestion, degeneration of the nerve cells, and thickening of the vessels with endothelial proliferation of the glia. Venous thrombosis and multiple hemorrhages also occur. In a study of the cerebrospinal fluid Boveri [210] found the pressure slightly greater in many cases with an increase in the albumen and globulin content and a mild lymphocytosis in occasional cases. The findings are not characteristic or of great diagnostic value. Efforts to isolate the organism responsible for this disease have so far been unsuccessful. ”

“ Therapeutic experience in this vascular group has almost as good a toll of successes as in the diffuse neurosyphilis group above mentioned, that is to say, the modern systematic treatment and even the old pre-salvarsan treatments have succeeded fairly well in removing the products of inflammation from the membranes of the nervous system and in abolishing vascular disease.
The old principle that the dead neurone in the central nervous system cannot be regenerated remains a perfectly firm principle ”

“ Somatopsychoses simulate physical and organic nervous troubles. Thus, many “hysterical” forms simulate tabes, or paralysis agitans, hemiplegia, paraplegia, or epilepsy, while many of the neurasthenic, hypochondriacal, and their allied states may simulate tumor, cancer, intestinal and glandular derangements, cardiac, laryngeal, pneumonic, hepatic, splanchnic ovarian, tubal, uterine, renal, and other bodily afflictions.
The neuropsychoses or psychoneuroses simulate all forms of mental disease, beginning with melancholia and mania, and ending with general paresis and dementia. ”

“ As far as the minor symptoms are concerned, the disease is usually chronic, for as soon as one symptom has been overcome another takes its place, and there is little hope of cure save when the case is taken vigorously in hand in childhood, treatment being best given in a home or hospital. Home treatment consists in an attempt to inculcate the lost or never-acquired habit of self-control, and in the hygienic measures laid down for neuropaths in general in the rest of this book.
In a major attack, show no sympathy. ”