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The Neurotic Theory of Rheumatism

centres, doctrine, function, nerve, lesions and body

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THE NEUROTIC THEORY OF RHEUMATISM.

One of the most prominent and popular of modern physiological doctrines is that which teaches that every physiological act and every normal function is carried on under the controlling influence of the nervous centres.

A doctrine at once so simple and so far-reaching could not fail to strike pathologists, and to be applied by them to the explanation of some of the phenomena with which they have to deal. If such and such a function is dominated by a special nervous centre, and is dependent for its due performance on the integrity of that centre, may not the derangements of that function which are noted in disease be the result of disturbances originating in its dominating centre? The general doctrine thus formulated evidently admits of wide appli cation. Theoretically there is scarcely any disorder of function to which it might not be applied with some degree of plausibility ; and there is considerable danger of our being seduced into the too free utilization of so simple a doctrine in explanation of morbid phenom ena. Against this danger we must be on our guard.

An instance of the ready appropriation of this doctrine by patholo gists we have in one of the modern views ns to the causation of py rexia. Physiology teaches that the nervous centres exercise a con- trolling influence over the heat of the body ; and clinical research has demonstrated that some injuries and non-inflammatory lesions of the nervous centres cause a rise in the temperature of the body. The increased body heat noted in such cases is clearly of neurotic origin, and the demonstration of the occurrence of such rises of tem perature naturally suggests a neurotic theory of fever. But the ap plication of this theory to the explanation of the occurrence of all forms of fever is an instance of the too free application of the doc trine in question. Because in some cases increased body heat is of neurotic origin, it does not follow that all fever is so. The inference is wider than the facts warrant.

Another example of the free application of the doctrine to the ex planation of the phenomena of disease—that which specially concerns us at present—we have in the attempt to explain by it the occurrence of rheumatic inflammation of the joints.

It is an established fact in pathology that joint troubles occur as a sequence of lesions of nerves and nerve centres. Charcot, describing them as they occur in connection with brain lesions, says that they are chiefly found iu cases of hemiplegia where the paralysis is con sequent on encephalitis or brain-softening. Brown-Sequard, refer ring to the pain sometimes experienced when paralyzed limbs are pressed upon or moved, says that such pains "depend upon a sub acute inflammation of the muscles or joints which is often mistaken for a rheumatic affection." Dr. J. R. Mitchell as far back as 1831 called attention to joint changes occurring as a sequence of injuries of the spine. More recently attention. has been prom inently directed to this subject by his son, Dr. Weir Mitchell, who describes the " curious inflammatory states of the joints" which follow injuries to nerves, especially those of the arm. Then again, as research has advanced and knowledge increased it has be come more and more certain that rheumatoid arthritis is a disease per se, quite distinct from both gout and rheumatism both in its clinical history and in its pathology ; and the special attention which as a separate ailment it has received has led pathologists more and more to lean to the view originally advanced by Remak, that the joint changes which form its characteristic feature ai-e somehow or other the result of malnutrition consequent on weakening of nerve centres.

With the growing belief in the doctrine of the localization of cere bral function, and of the part played by nerve centres in controlling and regulating the functions of organic life ; with such distinct evidence as we have that serious joint changes do take place as a consequence of lesions of nerves and nerve centres, and with the mind of the pro fession all but made up that rheumatoid arthritis is of neurotic origin,.

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