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.