NERVES AND NERVOUSNESS

Nerves are real things. In spite of their connection with imaginary diseases and mental disturbances, there is nothing imaginary or unsubstantial about them. There is no more genuine and obstinate malady on earth than a nervous disease. Because nerves lie in that twilight borderland between mind and matter, body and soul, the real and the ideal, the impression has got abroad that they are little better than figures of speech. Though their disturbances give rise to visions of all sorts there is nothing visionary about them; they are just as genuine and substantial a part of our bodily structure as our bones, muscles, and blood-vessels. In fact, it was this very substantiality that at the beginning prevented their proper recognition, and handicapped them with their present absurd and inappropriate name.

“Nerve” is from the Greek neuron, meaning tendon, or sinew, and was originally applied indiscriminately to all the different shining cords which run down the limbs and among the muscles. In fact the first recognition of nerves was an utter failure to recognize. The tendon cords, which are the ropes with which the muscles work the joint pulleys, were actually included under one head with the less numerous but almost equally large and tough cords of grayer color, flatter outline, and less glistening hue, which were afterwards found to be nerve-trunks. Cutting either paralyzed the limb below the cut,-and what more proof could you ask of their having the same function?

Such is the persistence of ancient memories, that any physician could tell you of scores of cases in which he has heard the naïve remark, in reference most frequently to a deep gash across the wrist, that the “nerves” were cut, and the hand was paralyzed, when what had happened was simply that the tendons had been cut across. When, after centuries of blundering in every possible direction until the right one was finally stumbled upon (which is the mechanism of progress), it was realized that some of these “nerves,” the grayer and flatter ones, carried messages instead of pulling ropes, they were still far from being properly understood.

It is an amusing illustration of the blissful ignorance and charming naïveté which marked their study and discussion at this time, that nerves were for centuries regarded as hollow tubes, carrying a supply of “animal spirits” from the central reservoir of the brain to the different limbs. So seriously was this believed, that, in amputations, the cut nerve-trunks were carefully sought out and tied, for fear the vital spirits would leak out and the patient thus literally bleed to death. One can imagine how this must have added to the comfort of the luckless patient.

The term “nerves” still persists, in the old sense, in both botany and entomology, which speak of the “nerves” of a butterfly’s wing, or the “nervation” of a leaf, meaning simply the branching, fibrous framework of each.

It comes in the nature of a surprise to most of us to learn that “nerves” are real things. I shall never forget the shock of my own first convincing demonstration of this fact. It was in one of the first surgical clinics that I attended as a medical student. A woman patient was brought in, with a history of suffering the tortures of the damned for a year past, from an uncontrollable sciatica.

It was a recognized procedure in those days (and is resorted to still), when all medical, electrical, and other remedial measures had failed to relieve a furious neuralgia, for the surgeon to cut down upon the nerve-trunk, free it from its surrounding attachments, and, slipping his tenaculum or finger under it, stretch the nerve with a considerable degree of force. Whether it acts by merely setting up some trophic change in the nerve-tissue, or by tearing loose inflammatory adhesions which are binding down the nerve-trunk, the procedure gives excellent results, nearly always temporary relief, and sometimes a permanent cure.

The patient was placed upon the table and anæsthetized, and the surgeon made a free, sweeping incision down the back of the thigh, exposing the sciatic nerve. He thrust his finger into the wound, loosened up the adhesions about the nerve, hooked two fingers underneath it, and, to my wide-eyed astonishment, heaved upward upon it, until he brought into view through the gaping wound a flattened, bluish-gray cord about twice the size of a clothesline, with which he proceeded to lift the hips of the patient clear of the table. In my ignorant horror, I expected every moment to see the thing snap and the patient go down with a bump, paralyzed for life; but I never doubted after that that nerves were real things. Though it has nothing to do with this discussion, for the benefit of those of my readers who cannot bear to have a story left unfinished, I will add that the operation was as successful as it was dramatic, and the patient left the hospital completely relieved of her sciatica.

When at last it was clearly recognized that the nerves were concerned in the sending of messages from the centre to the brain, known as sensory, or centripetal, and carrying back messages from the brain to the muscles and surface, known as motor, or centrifugal,-in other words that they were the organs of the mind,-still another source of confusion sprang up, and that was the determination on the part of some to regard them from a purely mental and, so to speak, spiritual point of view, and on the part of others to regard them from a physical and anatomical point of view. This confusion is of course in full riot at the present time.

The term “nerves,” and its adjective, “nervous,” are used in two totally distinct senses: one, that which is vague and unsubstantial, purely mental or subjective, and, in the realm of disease at least, imaginary; the other, purely anatomical, referring to certain strands of tissue devoted to the purpose of transmitting impulses, and the condition affecting these strands. I am not so rash as to raise the question here,-still less to attempt to settle it,-which of these two views is the right and rational one. Whether the brain secretes thought as the liver does bile, or whether the mind created the brain and nervous system, or, as it has been epigrammatically put in a recent work on psychology, “whether the mind has a body, or the body has a mind,” I merely call attention to the fact that this confusion of meanings exists, and that its injection into the field of medicine and pathology, at least, has done an enormous amount of harm in the way of confusing problems and preventing a proper recognition of the actual facts.

The more carefully and exhaustively and dispassionately we study the disorders of the nervous system which come in the field of medicine, the more irresistibly we are drawn to the conclusion that from neurasthenia and hysteria to insanity and paralysis they are every one of them the result of some definite morbid change in some cell or strand of the nervous system. The man or woman who is nervous has poisoned nerve-cells, either from hereditary defect, or direct saturation of the tissues with toxic substances. The patient who has an imaginary disease is suffering from some kind of a hallucination produced by poison-soaked nerve-cells, such as in highest degree give rise to the delirium of fevers, and the horrid spectres of delirium tremens.

Even the man who is suffering from a “mind diseased,” and confined in one of our merciful asylums for the insane, is in that condition and position on account of physical disease, not merely of his brain, but of his entire body. The lunatic is insane, in the for once correct derivative sense of unhealthy, to the very tips of his fingers. Not merely his mind and his brain, but his liver, his stomach, his skin, his hair and fingernails, the very sweat-glands of his surface which control his bodily odor, are diseased and have been so usually for years before his mind breaks down.

Tell a competent expert to pick out of a crowd of a thousand men and women the ten who are likely to become insane, and his selection will be found almost invariably to include the two or three who will actually become so.

In fact, from even the crudest and scantiest knowledge of the actual growth of our own bodies from the ovum to the adult, it will be difficult to conceive how this relation could be otherwise, The nerve-cells and their long processes, which form the nerve-trunks, are simply one of a score of different specialized cells which exist side by side in the body. Primarily all our body-cells had the power of responding to stimuli, of digesting and elaborating food, of moving by contraction, of reproducing their kind. The nerve-cells are simply a group which have specialized exclusively upon the power of receiving and transmitting impulses. They still take food, but it has to be prepared for them by the other cells; and here, as we shall see later, is one of the dangers to which they are exposed. They still reproduce their kind, but in very much smaller and more limited degree. They still, incredible as it may seem, probably have slight powers of movement or contraction, and can draw in their processes. But they have surrendered many of their rights and neglected some of their primitive accomplishments, in order to devote themselves more exclusively and perfectly to the carrying out of one or two things.

In spite of all this, however, they still remain blood-brothers and comrades to every other cell in the body. In the language of Shylock, “If you cut them, they will bleed; if you tickle them, they will laugh; if you starve them, they will die.” In all this development, which continued up to a late hour last night, and is still going on, the nerve-tissue has lain side by side with every other tissue in the body, fed by the same blood, supplied with the same oxygen, saturated with the same body-lymph.

It is of course perfectly clear that any influence, whether beneficial or injurious, affecting the body, will also be likely to affect the nervous system, as a part of it; and this is precisely the fact, as we find it. If the body be well fed, well warmed, sufficiently exercised, without being overworked, and allowed a liberal allowance of that recharging of the human battery which we call sleep, then the nervous system will work smoothly and easily, at peace with itself and with all mankind. Its sense-organs will receive external impressions promptly and accurately. Its conducting fibres will transmit them to the centre with neither delay nor friction. The brain clearing-house will receive and dispose of them with ease and good judgment. And then, just because his nervous system is working to perfection, we say that such an individual “has no nerves.”

If the triumph of art be to conceal art, then the nerves have achieved this. They have literally effaced themselves in the well-being of the body.

If on the other hand, the food-supply is inadequate, if the sleep allowance has been cut short, whether by the demands of work or by those of fashion, if the body has been starved of oxygen and deprived of sunlight, if the whole system has been kept on the rack, whether in the sweatshop, or in the furnace of affliction, what is the effect on the nervous system? Just what might have been expected. The sense-organs shy, like a frightened horse, at every shadow or fluttering leaf. The conducting wires break, and cross, and tangle in every imaginable fashion. The central exchange, half wild with hunger, or crazed with fatigue-toxins, shrieks out as each distorted message comes in, or sulks because it can’t understand them. And then, with charming logicality, we declare that such an one is “all nerves.”

The brain, by which we mean the biggest one near the mouth,-we have little brains, or ganglia all over our bodies,-so far from being an absolute monarch, is not even a constitutional one, or a president of a republic, but a mere house of congress of the modern type, which can do little but register and obey the demands of its constituents. The brain originates nothing. Impulses are brought to it from the sense-organs by the nerves. They set up in it certain vibrations, or chemical disturbances. It responds to these much as blue litmus paper turns red when a weak acid is dropped on it, or as lemonade fizzes when you put soda in it. If more than one of these vibrations are set up simultaneously, it “chooses” between them, by responding to the strongest. If the response differs from the stimulus, it is because of its huge deference to precedent as established by the records of previous stimuli with which its tissues are stored.

This brings us to the interesting and important question, What are the causes of these disturbances of the nerve-tissues? Probably the most important single result that has been reached in our study of nervous diseases in the last fifteen years, is that the cause of them in easily eighty per cent of all cases lies entirely outside of the nervous system.

The stomach burns, the nerve-tissues send in the fire alarm and order out the engines. The liver goes on a strike, and the body-garbage, which it has failed to burn to clean ashes and clear smoke, poisons the nerve-cells, and they remonstrate accordingly, on behalf of the other tissues. The heart, or blood-vessels, fails to supply a certain muscle with its due rations of blood and the nerves of the region cry out in the agony of cramp.

We have discovered, by half a century of careful study in the hospital and in the sick-room, not only that the nerve-tissues are usually poisoned by defect of other tissues of the body, but that they are among the very last of the body-stuffs to succumb to an intoxication. The complications of a given disease involving the nervous system are almost invariably the last of all to appear. This is one of the things that has given nervous diseases such a bad name for unmanageableness and incurableness, and that for years made us regard their study as so nearly hopeless, so far as any helpful results were concerned.

When a disease has, so to speak, soaked into the inmost core of the nerve-fibre, it has got a hold which it will take months and even years to dislodge. And before your remedies can reach it, it will often have done irreparable damage. An illustration of the care taken to spare the nervous system is furnished by its behavior in starvation. If a man or an animal has almost died of starvation, the tissues of the body will be found to have been wasted in very varying degrees, the fat, of course, most of all; in fact this will have almost entirely disappeared, all but three per cent. Then come the liver and great glands, which will have shrunk about sixty per cent; then the muscles, thirty per cent; then the heart and blood-vessels. Last of all, the nervous system, which will scarcely have wasted to any appreciable degree. In fact, it is an obvious instance of jettison on the part of the body, throwing overboard those tissues which it could most easily spare, and hanging on like grim death to those which were absolutely essential to its continued existence, viz., the heart and the nervous system. To use a cannibalistic and more correct illustration, it is killing and eating the less useful and valuable members of its family, in order that their flesh may keep alive the two or three most indispensable.

Another illustration is the actual behavior of the nerve-stuff in disease. This is most clearly shown in those clear-cut disturbances which are definitely known to be due to a specific infection; in other words, invasion of the body by a disease-organism, or germ.

First of all, it may be stated that physicians are now substantially agreed that two-thirds of the general diseases of the nervous system are due to the extension of one of these acute infections to the nerve-tissue; and this extension almost invariably comes late in the disease. The only exceptions to this rule in the whole list of infectious diseases are two, epidemic cerebro-spinal meningitis (spotted fever), and tetanus (lockjaw). Both of these have an extraordinary and deadly preference for the nervous system from the very start, and this is what gives them their frightful mortality and discouraging outlook. Even of this small number of exceptions, we are not altogether certain as to epidemic meningitis, inasmuch as we do not know how long the germ may have existed in the other tissues of the body before it succeeded in working its way to and attacking the brain and spinal cord.

The case of tetanus, however, is perfectly clear in this regard, and exceedingly interesting, inasmuch as it explains why a disease specially involving the nervous system from the start is so excessively hard to check or cure. The germ of the disease, long ago identified as one having its habitat in farm or garden soils,-particularly those which have been heavily fertilized with horse manure,-gets into the system through a cut or scratch upon the surface, into which the soil is rubbed. These infected cuts, for obvious reasons, are most frequently upon the hands or feet.

Small doses of the organism have been injected into animals; then, when they have recovered, larger ones, and so on, after the manner of the bacillus of diphtheria, until a powerful antitoxin can be obtained from their blood, very minute quantities of which will promptly kill the bacilli in a test-tube. For seven or eight years past we have been injecting this into every patient with tetanus that came under our observation, but so far with very limited benefit, even though the injections were made directly into the spinal cord, or brain substance. The problem puzzled us for years, until finally Cattani stumbled upon the explanation. While we had been supposing that the poison was carried, as almost every other known poison is, through the blood-vessels, or lymph-channels, to the heart and thence to the brain, he clearly proved that it ran up the central axis of the nerve-trunks, and consequently, when it had got once fairly started up this channel, was as safe from the attack of any antitoxin merely present in the general circulation and fluids of the body, as the copper of the Atlantic cable is from the eroding action of the sea-water. If, in his experimental animals, he carefully sought for the cut end of the nerve-trunk in the wound that had been infected, and injected the antitoxin directly into that, the disease was stopped. Or it might even be “headed off” by the crude method of cutting directly across the nerve-trunk at a point above that yet reached by the infection.

The commonest and most fatal of all forms of general diseases of the nervous system are those which are due to the later extensions of general infections.

First and foremost stands syphilis, due to the invasion of the blood by a clearly defined spirillum, the Treponema pallida of Schaudinn. This first attacks the mucous membranes of the throat and mouth, then the skin, then the great internal organs like the liver and stomach, then the bones, and, last of all, the nervous system. The length of time which the poison takes to reach the nervous system is something which at first sight is almost incredible, viz., from one and a half to fifteen years. It is true that in rare instances brain symptoms will manifest themselves within six or eight months; but these are usually due to pressure by inflammatory growths on the bones of the skull and its lining membrane (dura mater). It is not too much to say that this disease plays the greatest single rôle in nervous pathology. Three of the commonest and most fatal diseases of the spinal cord and brain, paresis (general paralysis of the insane), locomotor ataxia, and lateral sclerosis, are due to it.

Naturally, when a poison has taken a decade or a decade and a half to penetrate to the nerve-tissues, it does irreparable damage long before it can be dislodged or neutralized.

A similar aftermath may occur in almost all of the acute infectious diseases. Every year adds a new one to the list capable of causing cerebral complications. Tuberculosis, diphtheria, scarlet fever, typhoid, smallpox, influenza, have now well-recognized cerebral and nervous complications, some temporary, some permanent. A form of tuberculosis attacking the coverings (meninges) of the brain-hence known as meningitis-is far the commonest fatal brain-disease of infancy and childhood.

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.

Worry, in fact, is a sign of disease instead of a cause. To put it very crudely, whenever the blood and fluids of a body become impoverished below a certain degree, or become loaded with fatigue poisons, or other waste products above a certain point, then the nervous system proceeds to make itself felt. Either the perceptive end-organs become color-blind and read yellow for blue, or are astigmatic and report oval for round; or the conducting nerve-strands tangle up the messages, or deliver them to the wrong centre; or the central clearing-house, puzzled by the crooked messages, loses its head, and begins to throw the inkstands about, or goes down in a sulk. In other words, the nervous system goes on a strike. But it is perfectly idle to endeavor to treat it with cheering words, or kindly meant falsehoods, to the effect that “nothing is really the matter.” Like any other strike, it can be rationally dealt with only by improving the conditions under which the operatives have to work, and meeting their demands for higher wages, or shorter hours.

We were accustomed at one time to divide diseases into two great classes, organic and functional. By the former, we meant those in which there was some positive defect of structure, which could be recognized by the eye or the microscope; by the latter, those diseases in which this could not be discovered, in which, so to speak, the machine was all right, but simply wouldn’t work. It goes without saying that the latter class was simply a confession of our ignorance, and one which is steadily and rapidly diminishing as science progresses.

If the machine won’t work, there is a reason for it somewhere, and our business is to find it out, and not loftily to assure our patients that there is nothing much the matter, and all they need is rest, or a little cheerful occupation. Furthermore, the most inane thing that a sympathizing friend or kindly physician can do to a neurasthenic, is to advise him to take his mind off himself or his symptoms. The utter inability to do that very thing is one of the chief symptoms of the disease, which will not disappear until the underlying cause has been carefully studied out and removed.

“Nerves,” “neurasthenia,” “psychasthenia,” and “hysteria,” are all the names of symptoms of definite bodily disease. The modern physician regards it as his duty to study out and discover the nature of this disease, and, if possible, remove it, rather than to give high-sounding, soul-satisfying names to the symptoms, and advise the patient to “cheer up”; which advice costs nothing-and is worth just what it costs.

“But,” some one will say at once, “if nervous diseases are simply the reflection of general bodily states, as sanitary conditions improve under civilization, should they not become less frequent? And yet, any newspaper will tell you that nervous diseases are rapidly on the increase.” This is a widespread belief, not only on the part of the public, but of many scientists and a considerable number of physicians; but it is, I believe, unfounded.

In the first place, we have no reliable statistical basis for a positive statement, either one way or another. Our ignorance of the precise prevalence of disease in savagery, in barbarism, and even under civilization up to fifty years ago, is absolute and profound. It is only since 1840 that vital statistics of any value, except as to gross deaths and births, began to be kept. So far as we are able to judge from our study of savage tribes by the explorer, the army surgeon, and the medical missionary, the savage nervous system is far less well balanced and adjustable than that of civilized man. Hysteria, instead of occurring only in individual instances, attacks whole villages and tribes. In fact, the average savage lives in a state alternating between naïve and childish self-satisfaction and panic-stricken terror, with their resultant cowardice and cruelty on the one hand, and unbridled lust and delusions of grandeur on the other. The much-vaunted strain of civilization upon the nervous system is not one-fifth that of savagery.

Think of living in a state when any night might see your village raided, your hut burned, yourself killed or tortured at the stake, and your wife and children carried into slavery. Read the old hymns and see how devoutly thankful our pious ancestors were every day at finding themselves alive in the morning,-“Safely through another night,”-and fancy the nerve-strain of never knowing, when you lay down to sleep, whether some one of the djinns, or voodoos, or vampires would swoop down upon you before morning. Think of facing death by famine every winter, by drought or cyclone every summer, and by open war or secret scalp-raid every month in the year; and then say that the racking nerve-strain of the commuter’s time-table, the deadly clash of the wheat-pit, or the rasping grind of office-hours, would be ruinous to the uncivilized nervous system. Certainly, in those belated savages, the dwellers in our slums, hysteria, diseases of the imagination, enjoyment of ill health, and the whole brood of functional nervous disturbances are just as common as they are on Fifth Avenue.

It is not even certain that insanity is increasing. Insanity is quite common among savages; just how common is difficult to say, on account of their peculiar methods of treating it. The stupid and the dangerous forms are very apt to be simply knocked on the head, while the more harmless and fantastic varieties are turned into priests and prophets and become the founders of the earlier religions. A somewhat similar state of affairs of course prevailed among civilized races up to within the last three-quarters of a century. The idiot and the harmless lunatic were permitted to run at large, and the latter, as court and village fools, furnished no small part of popular entertainment, since organized into vaudeville. Only the dangerous or violent maniacs were actually shut up; consequently, the number of insane in a community a century ago refers solely to this class. Hence, in every country where statistics have been kept, as larger and larger percentages of these unfortunates have been gathered into hospitals, where they can be kindly cared for and intelligently treated, the number of the registered insane has steadily increased up to a certain point. This was reached some fifteen years ago in Great Britain, in Germany, in Sweden, and in other countries which have taken the lead in asylum reform, and has remained practically stationary since, at the comparatively low rate of from two to three per thousand living. This limit shows signs of having been reached in the United States already; and this gradual increase of recognition and registration is the only basis for the alleged increase of insanity under modern conditions.

It is also a significant fact that the lower and less favorably situated stratum of our population furnishes not only the largest number of inmates, but the largest percentage of insanity in proportion to their numbers, while the most highly educated and highly civilized classes furnish the lowest. Immigrants furnish nearly three times as many inmates per thousand to our American asylums as the native born.

It is, however, true that in each succeeding census a steadily increasing number and percentage of the deaths is attributed to diseases of the nervous system. This, however, does not yet exceed fifteen or twenty per cent of the whole, which would be, so to speak, the natural probable percentage of deaths due to failure of one of the five great systems of the body: the digestive, the respiratory, the circulatory, the glandular, the nervous. Two elements may certainly be counted upon as contributing in very large degree to this apparent increase. One is the enormous saving of life which has been accomplished by sanitation and medical progress during the first five years of life, infant mortality having been reduced in many instances fifty to sixty per cent, thus of course leaving a larger number of individuals to die later in life by the diseases especially of the blood-vessels, kidneys, and nervous system, which are most apt to occur after middle life. The other is the great increase in medical knowledge, resulting in the more accurate discovery of the causes of death, and a more correct reporting and classifying of the same.

In short, a careful review of all the facts available to date leads us decidedly to the conclusion that the nervous system is the toughest and most resisting tissue of the body, and that its highest function, the mind, has the greatest stability of any of our bodily powers. Only one man in six dies of disease of the nervous system, as contrasted with nearly one in three from diseases of the lungs; and only one individual in four hundred becomes insane, as contrasted with from three to ten times that number whose digestive systems, whose locomotor apparatus, whose heart and blood-vessels become hopelessly deranged without actually killing them.