Clinical lectures on neurasthenia / by Thomas Dixon Savill.

  • Savill, Thomas Dixon, 1856-1910.
Date:
1908
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Licence: In copyright

Credit: Clinical lectures on neurasthenia / by Thomas Dixon Savill. Source: Wellcome Collection.

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    There may be another possible view of the causation of neurasthenia by gastro-intestinal disorder. We know that all gross intestinal lesions are attended by a totally dispro- portionate amount of prostration, and Sir Lauder Brunton has very kindly indicated to me some experiments by Ludwig and Dolgiel in 1867 ^ which showed that a mechanical stimulus applied to the intestines greatly accelerated the flpw of blood through the carotids. Dr. Leonard Hill 2 more recently has shown something of the same kind, namely, that the blood supply to the brain varies inversely to that in the abdomen. In this way a direct or reflex nervous influence might be invoked through the sympathetic nerves terminating in the intes- tines. But in view of the generalised natme of the nervous derangement in neurasthenia, which is not, as we have seen, limited to the brain, it' seems much more probable that the essential pathological change is a widespread small quantities and limited to the large intestine, except in morbid conditions of the bowel, when they greatly increase in quantity and spread to the upper parts of the alimentary canal and its appendages, such as the gall-bladder, the appendix, and the genito-urinary apparatus —giving rise to cholecystitis, appendicitis, cystitis, etc. The b. coli is greatly increased in gaistro-intestinal catarrh, of which it is regarded as the cause by some observers. Now, it seems quite clear from an examination of the above series of cases that intestinal catarrh (which is associated with excess of bacillus coli in the stools) is a very potent agent of neurasthenia, cer- tainly in 20 per cent, (the cases with mucus), probably in 38 per cent, (if the cases of intestinal derangement without a history of mucus are included). In view of all the facts it seems so highly probable that b. coli is the cause of the toxaemia which produces the neurasthenia, that it would be worth whUe testing the opsonic index of such patients, and trying the effect of a vaccine prepared from the particular form of b. coli infecting a given patient. ‘ Sitzungsberichte der math.-phys. Classe der K. S.,” Gesells. d. Wissensch.,” Band xix, p. 257, and Ludwig’s Arbeiten fur 1867,” p. 253. * The Physiology and Pathology of the Cerebral Circulation.” J. and A. Churchill. London, 1896.