Disease and Its Causes - William Thomas Councilman (pocket ebook reader .TXT) 📗

are the structural differences in the brain as compared with the normal or usual, whether these are due to imperfection in development or to defective heredity or to the injury of disease; the extrinsic causes are those which come from without and bring the intrinsic into activity. Syphilis is a frequent cause of insanity, and probably the only cause of the condition known as general paralysis of the insane, acting by means of the injury which it produces in the cortex of the brain. The abuse of alcohol is another fertile cause, but the changes produced in this are not so obvious as in the case of syphilis. Tumors of the brain are not infrequently a cause, and the same is true of infections, even those not located in the brain. How susceptible the brain is to the effects of the toxines of the infectious diseases is shown in the frequency of delirium in these diseases. There is an interesting relation between this and alcoholism. Alcohol abuse may produce injury, but not sufficient to manifest itself under ordinary conditions; when, however, the action of toxic substance is superadded to the effect of the alcohol the delirium of fever is more marked.

Probably of greater importance than the acquired pathological conditions of the brain in producing insanity is a congenital condition in which the nervous system is defective. The most fertile cause of insanity lies in the inheritance; by this it must not be understood that insane parents produce insane offsprings, but that conditions inherited from immediate or remote ancestors appear in a diminished resistance of the nervous system which is sooner or later expressed as insanity. Given such a defective nervous system, extrinsic conditions which would have no effect on another individual or would be felt in different ways may produce insanity. In these cases occupation plays a great role. The excitement and privations of war especially in the tropics and the ennui of camps leads to insanity in soldiers; occupations such as that of the baker in which there is loss of sleep and the mental strain of students can all act in the same way. A woman who gives no sign of nervous defect may become insane under the strain of pregnancy.

Although insanity is determined by the social relations of man, that part of the social organization which is termed Society, and which has been developed by the idle as a diverting game, is a fertile source of nervous disease and even of insanity, affecting particularly females. The strenuosity of the life, the nervous excitement alternating with ennui, the lack and improper times of sleep, the lack of rest and particularly of restful occupation, the not infrequent use of alcohol in injurious amounts, are all factors calculated to make a defect operative. The so-called "coming out" of young girls is an important element in the game, and their headlong plunge into such a life at a period under any conditions full of danger to the nervous system is especially to be reprobated. If we consider the influence of the game in other respects as conducing to lack of moral sense, to alcoholic abuse (for without the seeming stimulation, but which is really the blunting of impressions which alcohol brings, the game would not be possible), to discontent, to mental enfeeblement, it is all bad. Curiously enough the game is one which in all periods has been played by the idle, but its evil influence is greater now than before when it was the game of royalty chiefly, because there are now more people living from the work of others.

The unusual mental action of the insane not infrequently expresses itself by suicide. The analysis of three hundred deaths from suicide showed pathological changes in the brain in forty-three per cent, and when we think that mental disturbances are very often without recognizable anatomical changes after death, the percentage is very large. In another analysis of one hundred and twenty-four suicides forty-four of these were mentally affected to various degrees. Five of the men and seven women were epileptics, in ten of the families there was hysteria, twenty-four of the men and four of the women were chronic alcoholics.

It is extremely difficult at the present time to say whether insanity is increasing. Statistics in all lands giving the numbers committed to insane hospitals show on their face a great increase, but so many factors enter into these statistics that their value is uncertain. There is now an ever-increasing provision for the care of the insane. Owing to the recognition of insanity as a part of nervous disease and its separation from criminality there is no longer the same attempt to conceal it as was formerly the case, and hospitals for the insane are no longer associated with ideas of Bedlam. It is generally believed that modern conditions in the hurry and excitement of life, and the extreme social differences, the greater urban life, the greater extension of factory life, all tend to an increase in insanity, but there is no absolute proof that this is true. We know very little about insanity in the Middle Ages, but the conditions then were not conducive to a quiet life. There prevailed then as now excess and want, luxury and poverty, enjoyment and deprivations, balls and dinner parties and other features of the social game. There were factions in the cities, public executions, not infrequent sieges, scenes of horror, epidemics, famines, and all these combined with religious superstition and the often unjust and cruel laws should have been factors for insanity. There were actual epidemics of insanity affecting masses of the population, as shown in the children's crusade, the Jewish massacres and the dancing mania in the Rhine provinces. Where civilization seems to be the highest, statistics show the most insane, but this most probably depends upon better recognition of the condition and better provision for asylum care.

The so-called functional diseases have a close relation with diseases of the nervous system, for they chiefly concern the reactions of nerve tissue. Disease expressing itself in disturbance of function only, does not seem to fit in with the conceptions of disease which have been expressed, nor can we imagine a disturbance of function which does not depend upon a change of material. Living matter does not differ intrinsically from any other sort of matter; like other matter its reactions depend upon its composition structure11 and the character of the action exerted upon it. By functional disease there is expressed merely that no anatomical or chemical change is discoverable in the material which gives the unusual reaction. The further our researches into the nature of disease extend, particularly the researches into the physiology and chemistry of disease, the smaller is the area of functional disease. In functional disease there may be either vague discomfort or actual pain under conditions when usually such would not be experienced, and on examination no condition is found which in the vast majority of cases would alone give rise to that impression on the nervous system which is interpreted as pain. In the production of the sensations of disease there can be change at any place along the line, in the sense organs, in the conducting paths or in the central organ. Thus there may be false visual impressions which may be due to changes in the retina or in the optic nerve or in the brain matter to which the nerve is distributed. It is perfectly possible that substances of an unusual character or an excess or deficiency of usual substances in the fluids around brain cells may so change them that such unusual reactions appear. There may be, of course, very marked individual susceptibility, which may be congenital or acquired. The perception of every stimulus involves activity of the nerve cells, and it is possible that the constant repetition of stimuli of an ordinary character may produce sufficient change to give rise to unusual reactions, and this particularly when there is lack of the restoration which repose and sleep bring. We know into what a condition one's nervous system may be thrown by the incessant noise attending the erection of a building in the vicinity of one's house or the pounding of a plumber working within the house, this being accentuated in the latter case by the thought of impending financial disaster. Even the confused and disagreeable sound due to the clatter of high-pitched women's voices at teas and receptions may, when frequently repeated, be productive of changes in the nerve cells sufficiently marked to give rise to the unusual reactions which are evidence of disease.

In the condition known as neurasthenia, which is often taken as a type of a functional disease, the basal and intrinsic cause is activity of the nervous system with the using up of material which is not compensated for by the renewal which comes in repose and sleep. Neurasthenia is one of the common conditions of our civilization, found among children and adults, the poor and rich, the idle and the factory worker; it is rife in the scholastic professions and among those who earn their living by brain work. It seems to be more common in the upper classes and particularly in the women, but this is because these are more subject to medical care and the condition is more in evidence. There are all sorts of symptoms attached to the condition, for the unusual mental action can be variously expressed. The cerebral form has been thus described by a well-known medical writer: "One of the most characteristic features of cerebral neurasthenia is a weary brain. The sensation is familiar enough to any fagged man, especially if he fall short of sleep. Impressions seem to go half into one's head and there sink into a woolly bed and die. Voices sound far off, the lines of a book run into one another and the meaning of them passes unperceived. Doors bang and windows rattle as they never did before; if a shoestring breaks, an imprecation is upon the lips. Business matters are in a conspiracy to go wrong. Letters are left unopened partly from want of will, partly from a senseless dread lest they contain bad news. At night the patient tosses on his bed possessed by all the cares which blacken with darkness. Headache is common, loss of memory is distressing, and in severe cases it is wider and deeper than mere inattention can explain. There is often the torture of acute hearing, or an inability to suppress attention; the hater of clocks and crowing cocks is a neurasthenic." The disease is especially common in the women players of the social game, and its unhappy victims too often seek relief from the nervous irritability which is a common early symptom in still greater nervous excitement. It is a sad commentary on our civilization that one of the means of treatment for these persons which has been found efficacious is to supply them with some restful household occupation such as knitting or plain sewing, and there are institutions which combine refuge from social activities, often called duties, with simple occupation.