Clinical lectures on Neurasthenia.

  • Savill, Thomas Dixon, 1856-1910.
Date:
1899
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Licence: Public Domain Mark

Credit: Clinical lectures on Neurasthenia. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    would probably be discovered by improved apparatus and methods, constitute the first sub-division of the so-called functional disorders. Many diseases were formerly grouped as functional before the introduction of the microscope, which since then have been known to be associated with definite structural changes. The chnical features of these, like those actually included among the organic diseases, would be a certain permanence, stability, and constancy of the symptoms, perhaps even incurabiUty. Applying these clinical tests, by the method of analogy, we might possibly include in this group paralysis agitans, senile tremor, and certain other tremors and clonic spasms. II.—Secondly, we must not forget that profound altera- tions of function may be produced by blood conditions due to toxic substances introduced into the body from without. The coma of typhus and typhoid fevers and the convulsions of tetanus are illustrations of the profound effect produced by the toxine evolved from a specific microbe. In this group, which we might call hetero-toxic disorders, we should expect the case to run somewhat the course of an acute specific fever, namely, a period of rise, a crisis, and a fall, after a more or less definite duration. The symptoms would be as symmetrical and as widespread as the blood itself. By applying the method of analogy, and grouping numbers of cases together, I have long believed chorea to be due to a specific microbe, for four reasons :—(1) It is prac- tically confined to childhood; (2) It frequently arises by what is called imitation of one child by another, but what might equally well be called infection of one child from another. (3) The natural course of the disease and its more or less definite duration; and (4) its intimate association with scarlatina. Similarly, I believe that the early stage and acute advent of infantile paralysis migbt be explained in the same way.^ We see other illustrations of this hetero-toxic group in the peripheral neuritis of beri- beri, and that due to alcoholic excesses; probably also several other kinds of peripheral neuritis, and the para- > The limitation of tho lesion to tho cells in the anterior horns is not a<^ainst the toxic theory, because we know that lead sometimes has a specific tissue proclivity for tho musculo-spiral nerves.