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CHRONIC CONVULSIVE DISEASES.

CHAPTER I.

INTRODUCTION TO THE PATHOLOGY OF NERVOUS DISEASES.

"Der einheitliche Grund aller Erscheinungen, gesunder wie kranker, ist nur das Leben selbst, und eine von dem übrigen Leben abgelöste, neben ihm bestehende und für sich seiende Krankheit besteht nicht. Was wir Krankheit nennen, ist nur eine Abstraction, ein Begriff, womit wir gewisse Erscheinungscomplexe des Lebens aus der Summe der übrigen heraussondern, ohne dass in der Natur selbst eine solche Sonderung bestünde."-VIRCHOW.

Ir is not long since the pathology of diseases of the nervous system was in the rear of that established in regard of almost all other groups of organs. The phenomena of nervous disturbance were of such complication and variety, and the relations between structural and functional changes were so uncertain, and as it then appeared contradictory, that it seemed hopeless to look for any general principles to which they might be reduced. Now, however, it may be affirmed that diseases of the nervous system furnish a key to the interpretation of all others; for the very conditions giving rise to difficulties which seemed well-nigh insurmountable, have, by their investigation and solution, opened a way for the light to fall upon many distant and dark places of the science of Medicine. Careful study of diseases of the nervous system has shown that much, previously regarded as established truth, is demonstrably wrong; that the direct causes of symptoms are not those which have been supposed; that the lesions, to which pain, and spasms, paralysis, and the like have been referred, are but the remote

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occasions of their production; and that there are certain portions of the nervous centres which mediate between almost all anatomical changes and the symptoms or phenomena of disease. Thus the conclusions arrived at, in removing much of the mystery from disorders of the brain and spinal cord, have contributed largely to a better understanding of those which affect all other organs in the body.

In order to apply pathological science in its present condition to the interpretation of convulsive affections, it is necessary to state, and I will do so as briefly as possible, the principles upon which that interpretation rests. By so doing, the terms employed will acquire a definite meaning, and will be helps rather than hindrances to our progress, as they have often been.

§ I. If we attempt to define what we mean by "disease," we shall, I think, be driven to say,-it is the sum-total of modifications of function and structure present at a given time. The words pneumonia and pleuritis refer to anatomical changes; asthma and epilepsy to functional conditions; phthisis and tuberculosis to some general modifications of nutrition; hooping-cough and writer's cramp, each to a special symptom; typhoid fever and urinæmia to poisoned blood; and there are other terms of which it would be rather difficult to say what they mean. It is evident then, that when we say a man's disease is pneumonia, or any one of the above pairs, that we use the term in a different sense from that in which we employ it when it is applied to either of the others.

By pneumonia, however, we mean more than an anatomical condition; by epilepsy we imply more than functional change; the terms phthisis, hooping-cough, and typhoid, convey more than changes in nutrition generally, special symptoms, or poisoned blood. Looked at from the side of life, disease means a group of altered functions, with their correlated changes in

structure.

§ II. The measure of disease is the degree in which it hinders a man from performing any or all of the functions of manhood-physical, animal, intellectual, moral, domestic, social. Its importance bears direct relation to that of the kind of activity which it limits or prevents.

Looked at from the highest point of view, the hypochondriac

man, the hysteric woman, or the epileptic youth, are more diseased, although their organs may present no discoverable change, than are those whose brain, lungs, or limbs may be invaded or partially destroyed by tubercle, or cancer. In the former group, the individuals may be useless to society, a distress to their friends, and to themselves; in the latter, in spite of pain and weakness, they may be yet doing the work that is given them to do. Death is the final issue and triumph of disease, and the degree to which it is induced is the measure of the evil; but this is not to be gauged only by its relation to time. There may be a life-long death of all but mere physical existence; there often is intense life amidst rapid, torturing decay. The measure of disease, then, is the degree to which it induces complete or partial death; the degree in which it perverts or limits life.

§ III. The classification of diseases has always been a difficult problem; the three elements upon which it is based are organ, function, and nature of morbid change; and sometimes one of these has had primary importance, and sometimes another; but all systems of arrangement have been, confessedly, more or less unsatisfactory, and diseases of the nervous system have been among the most unmanageable.

In a work which I published in 1855,† some reasons were given for preferring to classify diseases in such manner as to form groups presenting clinical resemblance, rather than local or pathological; and thus such terms as apoplectic diseases, convulsive diseases, and the like, were used to denote maladies presenting prominent symptoms in common, but differing, often very widely, in their anatomical relations.

It still seems to me that such an arrangement approximates the most closely to a "natural system;" and that, although fraught with many difficulties, it is yet open to fewer objections, at all events in the present state of science, than any other.

The man who has lost the use of his right arm is, practically speaking, more closely related to his neighbour who has met with the same misfortune, although from a different cause, than * Vide "Facts and Laws of Life," an Introductory Lecture by the Author,

p. 10.

† Diagnosis of Diseases of the Brain, Spinal Cord, Nerves, and their Appendages, p. 48.

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