Neurological disorder

“ Thanks to the investigations of physiologist and psychologist, usually combined in the person of a physician, "nervousness" has been found to be not an organic disease but a functional one. This is a very important distinction, for an organic disease implies impairment of the tissues of the organ, while a functional disorder means only a disturbance of its action. In a purely nervous disorder there seems to be no trouble with what the nerves and organs are, but only with what they do; it is behavior and not tissue that is at fault. ”

“ In psychopathic troubles the neuron itself may remain unaffected, may be perfectly normal and healthy. The disorder is due to association with systems of neurons which are usually not called into action by the function of that particular neuron system.
By Organopathies or Necropathies I indicate a group of psychophysiological symptoms, accompanied by structural, necrotic changes of the neuron, terminating in the ultimate death of the neuron systems, involved in the pathological process. ”

“ The basis of neurasthenia, however, is often or even generally a hereditary taint, a nervous weakness inherited from the parents.
Psychasthenia is a neurosis or psychoneurosis similar to neurasthenia, characterized by an exhaustion of the nervous system, also by weakness of the will, overscrupulousness, fear, and a feeling of the unreality of things.
Neuropathy is a disease or disorder of the nervous system. Psychopathy is a disease or disorder of the mind.
Of late years we often hear people referred to as neurotics, neurasthenics, psychasthenics, neuropaths or psychopaths. ”

“ They become virtual psychoses. In cases in which the habit can be traced to a peripheral irritation, the cutting off of this by complete section of the afferent nerves leading to the irritable nerve centre will sometimes succeed in effecting a cure. In other cases in which the source of the disorder is probably largely central in the cerebral ganglia, nerve tonics, and sedatives, and generally corroborative treatment are the most obvious means of palliation. ”

“ 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. ”

“ It cannot happen that it shall ever be extensively inflamed without a coincident exhibition of the greatest disorder in the functions of the nervous organs directly implicated in its structure, or possessing with it physiological relations that could not be safely disturbed. ”

“ Examination showed nonorganic nervous disorders, consisting in a variable and patchy anesthesia of the legs, anesthesia of the conjunctiva and pharynx, and over-reaction, with sighing, during the course of the examination. The organic signs were: exaggeration of tendon reflexes, equilibration disorder, and incapacity to stand on one foot or execute a half turn or to stand still with eyes closed, and disorder of position sense. The lumbar puncture showed no cells, a slight globulin reaction, and an albumin titer within the normal. ”

“ 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. ”

“ The more carefully and exhaustively and dispassionately 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. ”

“ Disorder, which is the effect of faulty actions of nerves, induces disease, which is the consequence of faulty actions of the vessels. There are some who find it difficult to understand how similar swellings or ulcers may form in various parts of the body in consequence of general nervous disorder, and are all curable by appeasing and removing such general disorder. The fact is indisputable. Such persons are not so much surprised that general nervous disorder should produce local effects in the nervous and muscular systems ”

“ The great diseases of the brain and spine, such as general paralysis, acute and chronic mania, and others, the author believes will all be shown to be connected with special chemical changes in neuroplasm, and that a knowledge of the composition and properties of this tissue and of its constituents will materially aid in devising modes of radical treatment in cases in which, at present, only tentative symptomatic measures are taken. ”

“ Looking backward to our Civil War, one is strongly impressed with the fact that the present volume, one of the earliest works of its kind to appear in book form, deals largely with psychiatry and functional nervous diseases, whereas during and after the American conflict the most important contributions to neurology related to organic disease, especially as illustrated by the work of Weir Mitchell and his collaborators on injuries of nerves. ”

“ The symptoms come on very suddenly in congestion of the brain. The disease may manifest itself as soon as the animal is moved out of the stall or bed, or it may come on while it is feeding. In slight cases, the animal appears excited and restless, the eyes are bright, the pupils are dilated, and the pulse beats and respirations quickened. If the animal is moving about, it may stop suddenly and show marked symptoms of a nervous disorder, such as turning around, running straight ahead and falling down. ”

“ 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. ”

“ It is true a large proportion of them do have organic disorders in connection with their neuroses. We find that most of them do have functional disorders originating purely in their mind, or because of some constitutional nervous defect and that the real fundamental condition from which they are suffering is not an organic condition but is nervous or mental and must be approached along lines of psycho-therapy. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ Neuralgia may be defined as a disease of the nervous system, manifesting itself by pains which, in the great majority of cases, are unilateral, and which appear to follow accurately the course of particular nerves, and ramify, sometimes into a few, sometimes into all, the terminal branches of those nerves. ”

“ 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. ”

“ 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. ”

“ Rarely there is scarcely any atrophy of the cortex. The central portion of the brain may be of leathery consistence, but usually shows marked sclerosis, which also may affect its different portions and the different ganglia very differently. The changes resulting from inflammatory, degenerative, and atrophic processes are general and profound.
An opinion is beginning to obtain that general paralysis is primarily a disease of the small cerebral blood-vessels, functional or vaso-motor ”

“ Hypersensitiveness, which soon is pain, to light, to sound, to smell and taste, to feeling, may all be products of hysteria when the disorder whips up function; when it paralyzes, the victim must get along as best he can until his sensorial servants come back to work. In the sphere of motion, twitchings, tremors, contractions and even convulsions, bear witness to excess of function; paralysis, to loss of it. These functional perversions, these idealistic symptoms, are cast in the same mold as those of structural disease. ”

“ By the nature of the symptoms we are taught, that the disease depends on some irregularity in the direction of the nervous influence; by the wide range of parts which are affected, that the injury is rather in the source of this influence than merely in the nerves of the parts; by the situation of the parts whose actions are impaired, and the order in which they become affected, that the proximate cause of the disease is in the superior part of the medulla spinalis; and by the absence of any injury to the senses and to the intellect, that the morbid state does not extend to the encephalon. ”

“ 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. ”

“ Men frequently do break down, of course, at an age when their tissues generally are sound enough, and there is no reason, except on the side of their nervous system, why they should not remain in vigorous health for years. But it is greatly more common for the nervous collapse to take the form of insanity, [25] or hypochondriasis, or paralysis, then that of neuralgia. ”

“ 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. ”

“ Since we know that the basis of many nervous diseases is an obliteration of certain cells of the brain or of the spinal cord, or certain tracts of the central nervous system through which impulses must pass if they are to be effective as motion, sensation or function in some other form, we realize that we cannot recreate these portions of highly organized tissue and that therefore organic nervous diseases are beyond the action of any remedies we now know or may even hope to discover. ”

“ 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. ”