A text-book on nervous diseases by American authors / edited by Francis X. Dercum.

  • Dercum, Francis X. (Francis Xavier), 1856-1931.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: A text-book on nervous diseases by American authors / edited by Francis X. Dercum. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    of nervous diseases heredity frequently plays an important part. This fact lends a peculiar value to the family history. As far as possible, facts bearing upon any diseases from which the parents or other relatives may have suf- fered should be brought to light. Special attention should, of course, be paid to those which bear directly upon the nervous system. In this connec- tion it is not sufficient merely to inquire whether a grandparent, father or mother, uncle or aunt, brother or sister has been insane, has had epilepsy or other nervous affection, but also to determine whether there be a history of alcoholic excess, of dissipation, of gout, of rheumatism, of syphilis, and even of tuberculosis in the ancestry. The nervous features presented by family histories are of three kinds. The first is illustrated by a class of patients in whom we obtain merely a history of general nervousness, of irritability, of invalidism, or of chronic headaches as existing in this or that member of the family. In other words, we obtain a history which is suggestive, other things equal, of a neurasthenic strain in the ancestry. The second is illustrated by a class from which we learn that one or more relatives have suffered from insanity, epilepsy, or organic nervous disease; or there may be a history of suicide, of an occasional feeble-minded or idiotic child, or of strange personal eccen- tricities. A patient with such a history is more or less liable to serious nervous or mental disease ; he is apt to have what is known as the neuro- pathic constitution or the insane neurosis, as it is also called. There is in such a patient an inherent tendency to certain forms of nervous degene- ration. The third is illustrated by a class of jDatients in whose family his- tories nervous features are apparently lacking, but in their stead various ele- ments are present also potent for ill; among them are alcoholism, the various diathetic diseases, such as gout and rheumatism, and infectious diseases, such as syphilis and tuberculosis. That alcoholism in the ancestors is of grave significance is shown by two facts: first, the admitted physical inferiority of the children of alcoholic parents, and, secondly, the transmission of the alco- holic habit from one generation to another. Diathetic affections, in their turn, are not infrequently related to neurasthenia, migraine, and other func- tional nervous troubles in the offspring. The importance of syphilis in the ancestry is shown either by the direct transmission of the disease to the foitus, causing, among other things, an arrest of development, or by the pro- duction of a markedly neurasthenic and feeble stock. As in all other classes of aflections, the personal history is also of great importance. The method of eliciting it differs in no respect from that used in studying other diseases. Our inquiries should be especially directed to determine whether the nervous system of the patient has been normal in its development, whether it has shown itself prone to disturbances, and, finally, whether it has been exposed to certain deleterious influences. Thus we inquire in certain cases, as to the time when the child began to talk, what progress it made at school, whether or not at the age of puberty nervous symptoms were present, and whether or not during adolescence the mental and emotional life of the individual was normal. Further, we should inquire as to the history of convulsions in early childhood, of frequently recurring headaches, of neuralgia, or of excessive irritability and nervousness. Finally, we must question our patient as to a history of grave illnesses, of exposure, of injuries, of alcoholic and other excesses. In this connection, too, it is of the greatest importance to determine the existence of syphilitic infection, or, if this be denied, a history of promiscuous exposure. In no other class of diseases does syphilis play so gi^eat a role. Questions directed to determine the presence or absence of this malady are, in organic nervous affections, absolutely essential.