Neurologist

“ Those who handled best the neuropsychiatric problems of the present war were in large part qualified not merely by a knowledge of psychology and psychiatry, but far more by a thorough training in organic neurology. The problems of psychiatry can be grasped fully only by those who have a fundamental knowledge of the anatomy, physiology, and diseases of the nervous system.
Dr. Southard, preëminently a neuropathologist, is well grounded in organic neurology, and shows at every turn his capabilities for considering the neuroses, psychoses, and insanities from the standpoint of the neurologist. ”

“ The neurologist to whom a psychological training is truly invaluable, finds himself ill at ease when in his investigations he strikes a problem which has to be studied mainly from a psychological point of view. A piece of tissue, a lump of protoplasm, a nerve cell with its dendrons and axons can be stained, mounted, observed, and experimented upon, but who can get hold of a fact of consciousness, of an elementary psychic state, of a sensation, of a feeling, of an idea, stain them, put them under the microscope for scientific investigation? ”

“ Reëducation is not infrequently in evidence. The patient in one way or another is taught how to do things which he had lost the way of doing.
It is interesting to American neurologists to note how frequently in the reports, especially of French observers, the “Weir Mitchell treatment” was the method employed, including isolation, the faradic current, massage, and Swedish movements, hydrotherapy, dietetic measures, reëducative processes, and powerful suggestion variously exhibited, especially through the mastery of the physician over the patient. ”

“ Upon the death of the patient, a correlation of the symptoms observed during life and the loss of brain substance found at the post-mortem examination has enabled neurologists to associate certain parts of the brain surface with certain functions ”

“ In other words, there is every reason to believe that numerous "centres," in this restricted sense, exist in the brain that have as yet eluded the investigator. Indeed, the current conception regards the entire cerebral cortex as chiefly composed of centres of ultimate co-ordination of impressions, which in their cruder form are received by more primitive nervous tissues—the basal ganglia, the cerebellum and medulla, and the spinal cord.
This, of course, is equivalent to postulating the cerebral cortex as the exclusive seat of higher intellection. ”

“ We should remember that the nervous system is one continuous structure, and it is only the necessities of nomenclature and the ingenuity of anatomists that have divided it into so many parts. It is as continuous as is an oak tree with its various branches. The spinal cord and the nerves are composed in varying proportions of the same materials as is that part of the system which we call the brain: injury and disease with them give rise to symptoms analogous to similar injury or disease to the brain. ”

“ Bodily functions and bodily health are regulated and sustained by what may be called the lower nerve centres in the medulla of the brain. It is by the exercise of these centres, which in turn control the circulation, the secretion of various glands, &c., that the body combats disease. This work is continually going on and we are for the most part quite unconscious of it. But, says Mr. Dearmer, ‘we now know that these centres are in direct connexion with the higher centres of the cortex of the brain.’ I should think we do. ”

“ Perhaps in no department have the results been more surprising than in the growth of our knowledge of the functions of the brain and nerves. Not only has experimental science given us clear and accurate data upon the localization of certain functions of the brain and of the paths of sensatory and of motor impulses, but it has opened an entirely new field in the diagnosis and treatment of the diseases of these organs, in certain directions of a most practical nature, enabling us to resort to measures of relief undreamed of even thirty years ago. ”

“ Neither medicine nor physiology opposes the use of the clinical method in cerebral localization. But only circumscribed lesions that have little or no tendency to become general, or to act at a distance by compressing the brain, or otherwise, can come to the aid of our theory. When there is a lesion of the cortical region of the brain which fulfills these conditions, the resulting symptoms may be of two orders—either stimulative or paralytic of the true function. ”

“ 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 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. ”

“ The nervous system of the human body, you understand, is so closely interrelated that when you touch one part you never know what.... The thing which we doctors must take into consideration is the total reaction on the patient. That is the weak point with so many specialists. They consider only the immediate seat of the trouble and not the sum-total of the effect on the patient. You often hear them say of an operation that killed the patient that it was a ‘success.’ And in the case of spinal trouble like Mr. Knapp’s, of course the entire nervous system is.... ”

“ 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. ”

“ The cerebrum, or fore brain, is divided into two hemispheres, each of which is further divided into numerous lobes consisting of grey and white nervous substance and millions of nerve cells and fine blood vessels. The hemispheric ganglia are the instruments through which the intellectual powers manifest themselves. If these instruments have become imperfect in structure through retarded development by wrong environment and education, or have been damaged in any manner by severe shock, violence or disease, the manifestations of intelligence are affected in a corresponding degree. ”

“ No organ possesses a vascular system so delicate and complex as the brain's, nor is there any so sensitive to the action of causes that modify the circulation. For this reason, disorders seated in the brain are peculiarly amenable to electric treatment, and, when carefully applied, it is remedial in brain-fevers, mental delirium, headaches, and sleeplessness. Physicians who first employed the current were quite aware of this benign influence of the galvanic fluid over brain-disorders, and even had the idea of utilizing it in the treatment of insanity. ”

“ 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. ”

“ 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. ”

“ In this volume will be found described some of the most recent acquisitions to our knowledge of the neurology of war. But its principal aim is to initiate the medical man who is not a specialist into the examination of nerve injuries. He will quickly learn how to recognise the nervous territory affected, and the development of the various clinical features; he will be in a position to pronounce a precise diagnosis, and to foresee the consequences of this or that lesion.
THE TREATMENT AND REPAIR OF NERVE LESIONS (Vol. II) . ”

“ 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. ”

“ Not ours is the task of analyzing special methods of neurological and mental differential diagnosis such as are used in the psychiatric clinic and in the office of the nerve specialist. There the family history with reference to nervous and other diseases, the history of the patient himself, the infectious diseases which he has passed through, his habits and anomalies, his use of alcohol and of drugs, his experiences in social life, the demands of his profession, his recent troubles and their first origin are to be recorded carefully. ”

“ At no time has so much been done to advance our knowledge of diseases of the nervous system as during the last thirty years of the 19th century. The localization of function in the cerebral and in the cerebellar cortex has doubtless been the main cause of this progress, and has proceeded pari passu with an extended insight into the structure and connexions of the parts concerned. The pathology of aphasia, as worked out by a combination of the experimental, the pathological and the anatomical lines of inquiry is a favourable example of what has been accomplished. ”

“ Intellect, Emotion, and Volition. Physiologists assign to the cerebrum its functions, and neurological, as well as phrenological writers, have located them as represented in Fig. 68. True, there is no structural division between the parts of the cerebrum to indicate this diversity of function, nor is there any perceptible limit between the sensory and motor filaments of the game nerve. As no one has any reason for denying that separate portions of the brain may manifest distinct functions of the mind, we shall assume it as a conceded proposition. ”

“ 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. ”

“ The anatomy and physiology of the last century, however, prepared the way for the successful elucidation of the subject, and the first great step forward was made by Sir Charles Bell about the year 1825, in establishing the double action of the nervous system, or that impressions from the external world pour in upon the brain through one set of nerve-lines, while all the mandates of volition controlling human activity are transmitted outward along another system of nerve-lines. ”

“ While turning around in a circle has been already noticed there remains, in certain cerebral forms, the peculiar phenomenon of the animal rotating rapidly on its longitudinal axis. The patient falls on its side and rolls over and over. Among the brain lesions with which it has been experimentally identified are injuries to the middle peduncles of the cerebellum, or of the superoexternal portion of the cerebral peduncles, or of the posterior part of the encephalon, or of different parts of the hemispheres. ”

“ Again, we can most of us remember using very imperfect physiological knowledge to fix, more or less successfully, the locality of an organic lesion in the brain. I also remember such attempts being described as a mere scientific game, which could only be won after the player was beaten, since when the accuracy of diagnosis was established, its object was already lost; but who would say this now, when purely physiological research and purely diagnostic success have led to one of the most brilliant achievements of practical Medicine, the operative treatment of organic diseases of the brain? ”