[Footnote: Volunteer report presented to Nebraska State Medical
Society, May, 1885, at Grand Island, Neb.]
By L.A. MERRIAM, M.D., Omaha, Neb.,
Professor of the Principles and Practice of Medicine in the
University of Nebraska College of Medicine, Lincoln, Neb.
The records of the Nebraska State Medical Society show that the only
report of progress on nervous and mental diseases ever made in the
history of the society (sixteen years) was made by the writer last year;
and expecting that those appointed to make a report this year would,
judging by the history of the past, fail to prepare such a report, I have
seen fit to prepare a brief volunteer report of such items of progress as
have come to my notice during the last twelve months. I have not been
able to learn that any original work has been done in our State during
the past year, nor that those having charge of the insane hospital have
utilized the material at their command to add to the sum of our knowledge
of mental diseases.
Last year I said: "There is a growing sentiment that many diseases not
heretofore regarded as nervous (and perhaps all diseases) are of nervous
origin." This truth, that all pathologico-histological changes in the
tissues of the body are degenerative in character, and, whether caused by
a parasite, a poison, or some unknown influence, are first brought about
by or through a changed innervation, is one that is being accepted very
largely by the best men in the profession, and the accumulation of facts
is increasing rapidly, and the acceptance of this great truth will prove
to be little short of revolutionary in its influence on the treatment of
the disease. This is the outgrowth of the study of disease from the
standpoint of the evolution hypothesis. Derangements of function precede
abnormalities of structure; hence the innervation must be at fault before
the organ fails. Hence the art of healing should aim at grappling with
the neuroses first, for the local trophic changes, perverted secretions,
and structural abnormalities are the effects or symptoms, not the causes
of the disease. Dr. J.L. Thudicum has studied the chemical constitution
of the brain, and he holds that, "When the normal composition of the
brain shall be known to the uttermost item, then pathology can begin its
search for abnormal compounds or derangements of quantities." 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 whole drift of recent brain inquiry sets toward the notion that the
brain always acts as a whole, and that no part of it can be discharging
without altering the tensions of all the other parts; for an identical
feeling cannot recur, for it would have to recur in an unmodified brain,
which is an impossibility, since the structure of the brain itself is
continually growing different under the pressure of experience.
Insanity is a disease of the most highly differentiated parts of the
nervous system, in which the psychical functions, as thought, feeling,
and volition, are seriously impaired, revealing itself in a series of
mental phenomena. Institutions for the insane were at first founded for
public relief, and not to benefit the insane; but this idea has changed
in the past, and there is a growing feeling that a natural and domestic
abode, adapted to the varying severity of the different degrees of
insanity, should be the place for the insane, with some reference to
their wants and necessities, and that many patients (not all) could be
better treated in a domestic or segregate asylum than in the prison-like
structures that so often exist, and that the asylum should be as much
house-like and home-like in character as the nature of the insanity would
permit; while exercise and feeding are accounted as among the best
remedies in some cases of insanity, particularly in acute mania.
The new disease called morbus Thomsenii, of which I wrote in my report
last year, has been carefully studied by several men of eminence, and the
following conclusions have been reached as to its pathology: The weight
of the evidence seems to prove that it is of a neuropathic rather than a
myopathic nature, and that it depends on an exaggerated activity of the
nervous apparatus which produces muscular tone, and that it has much
analogy to the muscular phenomena of hysterical hypnosis, the genesis of
which is precisely explained by a functional hyperactivity of the nervous
centers of muscular activity. Until quite recently it was supposed that
the rhythmical action of the heart was entirely due to the periodical and
orderly discharge of motor nerve force in the nerve ganglia which are
scattered through the organ; but recent physiological observations, more
especially the brilliant researches of Graskell, seem to show that the
influence of the cardiac ganglia is not indispensable, and that the
muscular fiber itself, in some of the lower animals, at all events
possesses the power of rhythmical contraction.
Several valuable additions to our knowledge of the anatomy of the nervous
system have been made by Huschke, Exner, Fuchs, and Tuczek.
Tuczek and Fuchs have confirmed the discoveries of Exner, that there are
no medullated nerve fibers in the convolutions of the infant, and
Flechzig has developed this law, that "medullated nerve fibers appear
first in the region of the pyramidal tracts and corona radiata, and
extend from them to the convolutions and periphery of the brain," being
practically completed about the eighth year. This fact is of practical
importance in nervous and mental diseases, since it is becoming an
admitted truth that the histological changes in disease follow in an
inverse order the developmental processes taking place in the embryo.
Hence the recent physiological division of the nervous system by Dr.
Hughlings Jackson into highest, middle, and lowest centers, and the
evolution of the cerebro-spinal functions from the most automatic to the
least automatic, from the most simple to the most complex, from the most
organized to the least organized. In the recognition of this division we
have the promise of a steadier and more scientific advance, both in the
physiology and in the pathology of the nervous system.
Mr. Victor Horsley has recently demonstrated the existence of true
sensory nerves supplying the nerve trunks of nervi-nervorum.
Prof. Hamilton, of Aberdeen, claims that the corpus callosum is not a
commissure, but the decussation of cortical fibers on their way down to
enter the internal and external capsules of the opposite side.
Profs. Burt G. Wilder, of Ithaca, and T. Jefrie Parker, of New Zealand
Institute, have proposed a new nomenclature for macroscopic encephalic
anatomy, which, while seemingly imperfect in many respects, has, at
least, the merit of stimulating thought, and has given an impulse to a
reform which will not cease until something has been actually
accomplished in this direction. The object being to substitute for many
of the polynomial terms, technical and vernacular, now in use, technical
names which are brief and consist of a single word. This has already been
adopted by several neurologists, of whom we may mention Spitzka, Ramsey,
Wright, and H.T. Osborn.
Luys holds that the brain, as a whole, changes its position in the
cranial cavity according to different attitudes of the body, the free
spaces on the upper side being occupied by cerebro-spinal fluid, which,
obeying the laws of gravity, is displaced by the heavier brain substance
in different positions of the body.
Luys claims that momentary vertigo, often produced by changing from a
horizontal to a vertical position, seasickness, pain in movement in cases
of meningitis, epileptic attacks at night, etc., may be by this
explained. These views of Luys are accepted as true, but to a less extent
than taught by Luys. The prevalent idea that a lesion of one hemisphere
produces a paralysis upon the opposite side of the body alone is no
longer tenable, for each hemisphere is connected with both sides of the
body by motor tracts, the larger of the motor tracts decussating and the
smaller not decussating in the medulla. Hence a lesion of one hemisphere
produces paralysis upon the opposite side of the body. It has recently
been established that a lesion of one hemisphere in the visual area
produces, not blindness in the opposite eye, as was formerly supposed,
but a certain degree of blindness in both eyes, that in the opposite eye
being greater in extent than that in the eye of the same side. Analogy
would indicate that other sensations follow the same law, hence the
probability is that all the sensations from one side of the body do not
pass to the parietal cortex of the opposite side, but that, while the
majority so pass, a portion go up to the cortex of the same side from
which they come.
Dr. Hammond says that the chief feature of the new Siberian disease
called miryachit is, that the victims are obliged to mimic and execute
movements that they see in others, and which motions they are ordered to
execute.
Dr. Beard, in June, 1880, observed the same condition when traveling
among the Maine hunters, near Moosehead Lake. These men are called
jumpers, or jumping Frenchmen. Those subject to it start when any sudden
noise reaches the ears. It appears to be due to the fact that motor
impulse is excited by perceptions without the necessary concurrence of
the volition of the individual to cause the discharge, and are analogous
to epileptiform paroxysms due to reflex action.
The term spiritualism has come to signify more than has usually been
ascribed to it, for some recent authors are now using the term to denote
a neurosis or nervous affection peculiar to that class of people who
claim to be able to commune with the spirits of the dead.
Evidence obtained from clinical observations has tended of late to locate
the pathological lesions of chorea in the cerebral cortex.
Dr. Godlee's operation of removing a tumor from the brain marks an
important step in cerebral localization, and cerebral surgery bids fair
to take a prominent place in the treatment of mental diseases.
Wernicke has observed that the size of the occipital lobes is in
proportion to the size of the optic tracts, and that the occipital lobes
are the centers of vision.
Hughlings Jackson has observed that limited and general convulsions were
often produced by disease in the cortex of the so-called motor
convolutions. The sense of smell has been localized by Munk in the gyri
hippocampi, while the center of hearing has been demonstrated to be in
the temporal lobes. The center for the muscles of the face and tongue is
in the inferior part of the central convolution; that for the arm, in the
central part; that for the leg, in the superior part of the same
convolution; the center for the muscles and for general sensibility, in
the angular gyrus; and the center for the muscles of the trunk, in the
frontal lobes. In pure motor aphasia the lesion is in the posterior part
of the left third frontal convolution; in cases of pure sensory aphasia,
the lesion is in the left first temporal convolution.
The relation of the cerebrum to cutaneous diseases has been studied much
of late, and it is now held that the cutaneous eruptions are mainly due
to the degree of inhibiting effect exerted upon the vaso-motor center.
The relation of the spinal cord to skin eruptions has been more
thoroughly investigated and more abundant evidence supplied to
demonstrate the influence degeneration of the spinal cord has in causing
skin diseases, notably zoster, urticaria, and eczema.
This rheumatism, pneumonia, diabetes, and some kidney diseases and liver
affections are often the result of persistent nervous disturbance is now
held. That a high temperature (the highest recorded) has resulted from
injuries of the spinal cord, and where the influence of microzymes is
excluded, is not a matter of question. In one instance, the temperature
reached 122° F., and remained for seven weeks between 108° and 118° F.
The patient was a lady; the result was recovery. Hence it cannot be fever
which kills or produces rapid softening of the heart and other organs in
fatal cases of typhoid. Fever, so far as it consists in elevation of
temperature, can be a simple neurosis.
Many other items of progress might be presented did time permit,
particularly in the treatment of nervous affections, but this I leave for
another occasion.
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