A treatise on diseases of the nervous system / by L. Harrison Mettler.

  • Mettler, Lee Harrison.
Date:
1905, ©1904
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Licence: Public Domain Mark

Credit: A treatise on diseases of the nervous system / by L. Harrison Mettler. 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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    the fact that in certain of the lowest vertebrates (fishes) whose move- ments require the nicest sort of equihbrium there are no semicircular canals; in view of the fact that experimentation has shown, as in the dog. that equilibrium may be recovered and maintained after the com- plete removal of the labyrinth; in view of the fact that both anatomy and physiology point out that the sense of equilibrium is essentially a complicated sensory-motor phenomenon: and finally, in view of the fact that the anatomy of the apparatus of equilibration, of which the semicircular canals form only a part, offers a more rational basis for its sensory-motor character than does so limited an organ as the semi- circular canals alone: I think that we are still justified in asserting that the semicircular canals are not alone the organs of equilibration, and that the vertigo of ]\Ieniere's disease is not due solely to injury of the canals, but to the injury done to the elaborate and complicated apparatus of equilibration of which the canals constitute a part. One object in presenting all this is to show that vertigo, if our knowledge of the anatomy of the apparatus of equilibration is at all correct, may be produced by irritation of any of its other ramifications, as, for instance, in the eye and in the stomach as well as in the ear. Hence, it seems to me that Gowers' statement referring to other forms of vertigo than aural vertigo is too much of a pure assumption as it stands: It is certain that in the majority of cases in which such vertigo has been ascribed to other causes, these have only had an exciting influence and the symptom has been essentially due to the eflfeci of unobtrusive labyrinthine disease, bringing the center into an unstable condition. The study of vertigo is one of the most intricate in medicine, and though we are quite familiar with its subjective and objective mani- festations, its immediate cause remains yet a profound myster}-. The maintenance of equilibrium cannot be satisfactorily assigned to any single center, though its disturbance m.ay easily depend upon a number of distant reflex disturbances. There is a multiplicity of impressions constantly pouring in upon the brain through the various avenues of sense which must necessarily keep the mind in a state of extreme ten- sion, so that the slightest exaggeration one way or the other will result in mental confusion and more or less vertigo. We learn instinctively how to control and marshal these ever-passing sensations before the mind, but if for a time they become too frequent, rapid or sudden, th-^ controlling force of the intellect is weakened and we are confused and overcome by them. Everybody knows how quickly vertigo is estab- lished by rapidly revolving mirrors, peculiar whirring sounds, electrical sensations upon the skin and such distant irritative conditions as dys- pepsia and constipation. Physiological psychologists are agreed now that our knowledge of the relationship of things, as well as of space and its dimensions, is the result of experience gained from the use of our muscles. The infant learns these dimensions by the frequent application of its hands to the objects which it sees; and the sight, which is the only other sense that reveals to us an extended object, and that never shows us more