Clinical lectures on neurasthenia.

  • Savill, Thomas Dixon, 1856-1910.
Date:
1902
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Licence: In copyright

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

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    of tetanus are illustrations of the profound effect produced by the toxin 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:—(i) it is practically con- fined 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) it runs a natural course and has a more or less definite duration; and (4) it is intimately associated with scarlatina. Similarly, I believe that the early stage and acute advent of infantile paralysis might be explained in the same way. The limita- tion of the lesion to the cells in the anterior horns is not against the toxic theory, because we know that other toxins, lead, for instance, may have a specific tissue proclivity for particular nerves. We see other illustrations of this hetero- toxic group in the peripheral neuritis of beri-beri, and that due to alcoholic excesses; probably also in several other kinds of peripheral neuritis, and in the paraplegia after fevers. All of these diseases were classed as functional before changes were discovered in the nerves, and at the present time they still belong in their early phases to the functional group. III.—In the same way alterations of function without, at any rate at first, structural changes, may be brought about by toxic substances manufactured within the body. In spite of the advances made in recent years in our knowledge of the chemico-vital changes which take place in the body, we are still very much in the dark on this subject. Nevertheless,