Preventable Diseases

by Woods Hutchinson

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.