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 shining 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 naïve 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 illustration of the blissful ignorance and charming
naïveté 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 butterfly'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 damned
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 anæsthetized, 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 bump,
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 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. 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 fashion, 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
fashion. 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 constitutional 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 constituents. 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 succumb 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 illustration 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 illustration, 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 illustration 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 tetanus (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 tetanus, 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 antitoxin can be obtained from
their blood, very minute quantities 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 tetanus 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 antitoxin 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
antitoxin 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 rôle 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 illustration of just how acute affections
attack the nervous system, is that furnished by diphtheria. A child
develops an attack of this disease, passes 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
pass 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 passing, that, with one of the charming logicalities
of popular reasoning, these nerve complications have been said to be
_caused by_ antitoxin, simply because the use of the antitoxin 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 class is very large and very important. It has long
been known how surely a disordered liver "predicts damnation";
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 canal, 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 accumulation 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 entity of
this name but admit its rarity.
The intelligent neurologist, nowadays, has practically no known specific
for any form of nervous disease, no remedy which acts directly and
curatively upon the nervous system itself. He relies chiefly--and this
applies to the asylum physician also--upon intestinal antisepsis, upon
rest, upon baths, upon regulation diet, and habits of life.
A number of the more sudden and fatal disturbances of the nervous
system, as for instance, the familiar "stroke of paralysis," or
apoplexy, of later middle life, are due to a defect, not in the nervous
system at all, but in the blood-vessels supplying the brain; rupture of
a vessel, and consequent escape of blood, destroys so much of the
surrounding brain-tissue as to produce paralysis, and, in extreme cases,
death. Just why the blood-vessels of the brain in general, and of one
part of the basal ganglia in particular (the _Lenticulostriate_ artery
in the internal capsule of the _corpus striatum_, the old jaw
ganglion), are so liable to rupture we do not know; but it certainly is
chiefly from a defect of the blood-vessels, and not of the brain. All of
which brings us to the following important practical conclusions.
First of all, that every attack or touch, however light, of
"nervousness," "nerves," "imagination," "neurasthenia," yes, hysteria,
_means_ something. It is the cry of protest of a smaller or larger part
of the nervous system against underfed blood, under-ventilated muscles,
lack of sunlight, lack of exercise, lack of sleep, excess of work, or
bad habits. In other words, it is the danger signal, the red light
showing the open switch, and we will disregard it at our peril.
Unfortunately, by that power of _esprit de corps_ of the entire system,
known as "pluck" or "grit," or the veto-power, physiologically termed
inhibition, we may ignore and for a time suppress the symptom, but this
in the long run is just as rational as cutting the wire that rings a
fire alarm, or blowing out the red light without closing the switch.
Nervousness is a _symptom_ which should always have _something done for
it_, especially in children. In fact, it has passed into an axiom both
with intelligent teachers and with physicians who have much to do with
the little ones, that crossness, fretfulness, laziness, lack of
initiative, and readiness to weep, in children, are almost invariably
the signs of physical disease. And this doctrine will apply to a
considerable percentage of children of larger growth.
Unfortunately, one of the first and most decided tendencies on the part
of the badly fed or poisoned nervous system, is to exaggerate the
difficulties of the situation, and to minimize its good features. The
individual "has lost his nerve," is afraid to undertake things, shrinks
from responsibility, exaggerates the difficulties that may be in the
way; hence the floods of tears, or outbursts of temper, with which
nervous children will greet the suggestion of any task or duty, however
trifling. If the nervous individual has reached that stage of maturity
when she realizes that she is not merely "naughty," but sick, then this
same process applies itself to her disease. She is sure that she is
going to die, that another attack like that will end in paralysis; as a
patient of mine once expressed it to me, "My heart jumps up in my mouth,
I bite a couple of pieces off it, and it falls back again." In short,
she so obviously and grossly exaggerates every symptom and phase of her
disease, that the impression irresistibly arises that the disease itself
is a fabrication. This view of her condition by her family or her
physician is the tragedy of the neurasthenic.
Broadly speaking, _no_ disease, even of the nervous system, is ever
purely imaginary. Some part of the patient's nervous system is poisoned,
or he would not imagine himself to be sick. We can all of us find
trouble enough in some part of our complex bodily machinery, if we go
around hunting for it; but this is precisely what the healthy man, or
woman, _never_ does. They have other things to occupy them, and are far
more liable to run into danger by pushing ahead at full steam, and
neglecting small creakings and jarrings until something important in the
gear jams, or goes snap, and brings them to a halt, than they are to be
wasting time and energy worrying over things that may never happen.
Worry, in fact, is a sign of disease instead of a cause. To put it very
crudely, whenever the blood and fluids of a body become impoverished
below a certain degree, or become loaded with fatigue poisons, or other
waste products above a certain point, then the nervous system proceeds
to make itself felt. Either the perceptive end-organs become color-blind
and read yellow for blue, or are astigmatic and report oval for round;
or the conducting nerve-strands tangle up the messages, or deliver them
to the wrong centre; or the central clearing-house, puzzled by the
crooked messages, loses its head, and begins to throw the inkstands
about, or goes down in a sulk. In other words, the nervous system goes
on a strike. But it is perfectly idle to endeavor to treat it with
cheering words, or kindly meant falsehoods, to the effect that "nothing
is really the matter." Like any other strike, it can be rationally dealt
with only by improving the conditions under which the operatives have to
work, and meeting their demands for higher wages, or shorter hours.
We were accustomed at one time to divide diseases into two great
classes, organic and functional. By the former, we meant those in which
there was some positive defect of structure, which could be recognized
by the eye or the microscope; by the latter, those diseases in which
this could not be discovered, in which, so to speak, the machine was all
right, but simply wouldn't work. It goes without saying that the latter
class was simply a confession of our ignorance, and one which is
steadily and rapidly diminishing as science progresses.
If the machine won't work, there is a reason for it somewhere, and our
business is to find it out, and not loftily to assure our patients that
there is nothing much the matter, and all they need is rest, or a little
cheerful occupation. Furthermore, the most inane thing that a
sympathizing friend or kindly physician can do to a neurasthenic, is to
advise him to take his mind off himself or his symptoms. The utter
inability to do that very thing is one of the chief symptoms of the
disease, which will not disappear until the underlying cause has been
carefully studied out and removed.
"Nerves," "neurasthenia," "psychasthenia," and "hysteria," are all the
names of _symptoms_ of _definite bodily disease_. The modern physician
regards it as his duty to study out and discover the nature of this
disease, and, if possible, remove it, rather than to give high-sounding,
soul-satisfying names to the symptoms, and advise the patient to "cheer
up"; which advice costs nothing--and is worth just what it costs.
"But," some one will say at once, "if nervous diseases are simply the
reflection of general bodily states, as sanitary conditions improve
under civilization, should they not become less frequent? And yet, any
newspaper will tell you that nervous diseases are rapidly on the
increase." This is a widespread belief, not only on the part of the
public, but of many scientists and a considerable number of physicians;
but it is, I believe, unfounded.
In the first place, we have no reliable statistical basis for a positive
statement, either one way or another. Our ignorance of the precise
prevalence of disease in savagery, in barbarism, and even under
civilization up to fifty years ago, is absolute and profound. It is only
since 1840 that vital statistics of any value, except as to gross deaths
and births, began to be kept. So far as we are able to judge from our
study of savage tribes by the explorer, the army surgeon, and the
medical missionary, the savage nervous system is far less well balanced
and adjustable than that of civilized man. Hysteria, instead of
occurring only in individual instances, attacks whole villages and
tribes. In fact, the average savage lives in a state alternating between
naïve and childish self-satisfaction and panic-stricken terror, with
their resultant cowardice and cruelty on the one hand, and unbridled
lust and delusions of grandeur on the other. The much-vaunted strain of
civilization upon the nervous system is not one-fifth that of savagery.
Think of living in a state when any night might see your village raided,
your hut burned, yourself killed or tortured at the stake, and your wife
and children carried into slavery. Read the old hymns and see how
devoutly thankful our pious ancestors _were every day_ at finding
themselves alive in the morning,--"Safely through another night,"--and
fancy the nerve-strain of never knowing, when you lay down to sleep,
whether some one of the djinns, or voodoos, or vampires would swoop down
upon you before morning. Think of facing death by famine every winter,
by drought or cyclone every summer, and by open war or secret
scalp-raid every month in the year; and then say that the racking
nerve-strain of the commuter's time-table, the deadly clash of the
wheat-pit, or the rasping grind of office-hours, would be ruinous to the
uncivilized nervous system. Certainly, in those belated savages, the
dwellers in our slums, hysteria, diseases of the imagination, enjoyment
of ill health, and the whole brood of functional nervous disturbances
are just as common as they are on Fifth Avenue.
It is not even certain that insanity is increasing. Insanity is quite
common among savages; just how common is difficult to say, on account of
their peculiar methods of treating it. The stupid and the dangerous
forms are very apt to be simply knocked on the head, while the more
harmless and fantastic varieties are turned into priests and prophets
and become the founders of the earlier religions. A somewhat similar
state of affairs of course prevailed among civilized races up to within
the last three-quarters of a century. The idiot and the harmless lunatic
were permitted to run at large, and the latter, as court and village
fools, furnished no small part of popular entertainment, since organized
into vaudeville. Only the dangerous or violent maniacs were actually
shut up; consequently, the number of insane in a community a century ago
refers solely to this class. Hence, in every country where statistics
have been kept, as larger and larger percentages of these unfortunates
have been gathered into hospitals, where they can be kindly cared for
and intelligently treated, the number of the registered insane has
steadily increased up to a certain point. This was reached some fifteen
years ago in Great Britain, in Germany, in Sweden, and in other
countries which have taken the lead in asylum reform, and has remained
practically stationary since, at the comparatively low rate of from two
to three per thousand living. This limit shows signs of having been
reached in the United States already; and this gradual increase of
recognition and registration is the only basis for the alleged increase
of insanity under modern conditions.
It is also a significant fact that the lower and less favorably situated
stratum of our population furnishes not only the largest number of
inmates, but the largest percentage of insanity in proportion to their
numbers, while the most highly educated and highly civilized classes
furnish the lowest. Immigrants furnish nearly three times as many
inmates per thousand to our American asylums as the native born.
It is, however, true that in each succeeding census a steadily
increasing number and percentage of the deaths is attributed to diseases
of the nervous system. This, however, does not yet exceed fifteen or
twenty per cent of the whole, which would be, so to speak, the natural
probable percentage of deaths due to failure of one of the five great
systems of the body: the digestive, the respiratory, the circulatory,
the glandular, the nervous. Two elements may certainly be counted upon
as contributing in very large degree to this apparent increase. One is
the enormous saving of life which has been accomplished by sanitation
and medical progress during the first five years of life, infant
mortality having been reduced in many instances fifty to sixty per
cent, thus of course leaving a larger number of individuals to die later
in life by the diseases especially of the blood-vessels, kidneys, and
nervous system, which are most apt to occur after middle life. The other
is the great increase in medical knowledge, resulting in the more
accurate discovery of the causes of death, and a more correct reporting
and classifying of the same.
In short, a careful review of all the facts available to date leads us
decidedly to the conclusion that the nervous system is the toughest and
most resisting tissue of the body, and that its highest function, the
mind, has the greatest stability of any of our bodily powers. Only one
man in six dies of disease of the nervous system, as contrasted with
nearly one in three from diseases of the lungs; and only one individual
in four hundred becomes insane, as contrasted with from three to ten
times that number whose digestive systems, whose locomotor apparatus,
whose heart and blood-vessels become hopelessly deranged without
actually killing them.