Preventable Diseases

by Woods Hutchinson

"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.