Part 14 (2/2)

But it is true that the stand-point in Dr Clarke's book is somewhat different from this He scarcely alludes to the presence of pain in , to itself constitute a sufficient warning against over mental exertion, indeed, to render such exertion iainst a more insidious accident, that may occur without pain, and which is er is haeical flow to such an extent that the vitality of the patient is drained as froe estions, or even to ainates in functional disturbance, in exhaustion of the nervous system by intellectual exertion On account of the ier, the period of real incapacity for er than conscious discoical afflux of blood to the uterus--which, by the means described, es but one kind of proof of this assertion He relates a certain nu in the in irls, whose menstruation was at first perfectly normal, became, after two or three years' study at school, liable to es, so excessive that their health was coanic cause for such disorder could be discovered By interruption of study, rest, aes were diminished, the health restored In several of these cases, however, resumption of study on the old plan was followed by the immediate return of all the previous accidents, and often the constitution was entirely ruined

We think that this argu, which should prove whisky drinking to be an efficient[37]

cause of yellow fever A physician ht select twenty cases of men, personally known to him, who had lived twenty and thirty years in New York or Boston, and never had yellow fever During this time they had taken little or no whisky, but afterwards, re, and, at varying intervals froht the fever, and in many instances, died Therefore, fever was due, at least in these cases, to the newly contracted habit of drinking whisky

-A and -B = -C -A +B = C Therefore, C = A

Hamerton, in his little book on the intellectual life, accuses wo them, of a ”plentiful lack” of intellectual curiosity If their attention is attracted to a phenomenon, they rarely inquire as to its cause If an assertion is nation, but rarely analyze the conditions upon which the assertion is based This re women, by the total absence of curiosity that has been shown in regard to the physiological facts in question The assertion that nervous excite an apparatus apparently so reence as is the vascular syste physiological facts and a mechanism the reverse of simple Into these facts and this mechanism it behooves all to inquire, who assu Dr Clarke's theory and the deductions that have been made from it

This theory concerns exclusively one class of uterine haees, those, namely, which may be traced to the influence of the nervous syste such influence it is iia, that are very frequently present in just such cases as Dr Clarke describes These are prolonged sedentary position, and deficiency of physical exercise Either may determine anemia, or impoverishment of the blood, a condition which alone is sufficient to induce excessive menstrual flow[38] But, in addition, each has a special actioncontinuance of a sedentary position the equilibrium of the circulation is disturbed, the blood is driven froans and the dependent portions of the trunk, hence to the pelvis; but al down over the school-desk Hence, the uterine haeirls, are paralleled by the nose-bleeding, coirls and boys, and very frequent in such circumstances The cramped position of the chest interferes with respiration; the bowels are generally constipated, and both conditions again favor congestions of the visceral organs, including the uterus, but not confined to it To deficiency of physical exercise is due, besides the disturbance in the equilibrium of the circulation, first, a loss of heat that should be evolved during the chemical processes of muscular action; second, a loss of stimulus to the spinal cord, which has, therefore, less power to control ganglionic action This latter, therefore, becoularity will be presently described The influence of these two conditions--cramped sedentary position, and deficiency of muscular exercise--either sufficient to induce uterine haee, must, therefore, be eliminated, before such accident can be attributed to any other cause less simple and direct The first criticism to be addressed to the ”statistics” contained in Dr Clarke's clinical chapter, is, that this necessary elimination has not been made, and one possible cause arbitrarily selected out of an entire group of known causes

As far as athered from his book, Dr Clarke's theory may be thus formulated Two intense nervous actions cannot, without detrianization The mental labor deical process of menstruation on the other, are each connected with intense action of different parts of the nervous system They are, therefore, incompatible with each other; and from the attempt to sustain them simultaneously, results, first, the ieneral exhaustion of the over-burdened nervous system To this exhaustion is to be attributed the uterine haees upon which Dr Clarke insists as the accident particularly liable to be induced by any continuous, _ie_, non-inter, system of education

For non-medical readers it is important to develop the ellipsis and explain the facts upon which, if anywhere, this theory is based

The nervous systereat sections, called respectively, the ganglionic system, and the cerebro-spinal; the latter forata, that connects them; the former, constituted by smaller masses of nervous matter distributed in three ways: First, in a double chain lying on each side of the spinal cord, from the upper part of the neck to the pelvic cavity that terminates the trunk These lia Second, in so-called plexuses, occupying different positions in the cavity of the trunk, and standing in especial relation to various organs; the solar or coeliac plexus to the stomach, liver, and spleen; the two renal plexuses to the kidneys; the mesenteric plexuses to the intestine; finally, on each side of the pelvis, the hypogastric plexus to the bladder, uterus, and ovaries--the so-called genito-urinary organs Third, besides these principal ganglia exist others, much ans--as the heart (intro-cardiac ganglia), the intestine (intestinal ganglia)

Each of these nervous masses contains nerve-cells as well as nerve-fibres, and is capable of generating nerve-force Each, therefore, acts like a lionic systeous to the nervous syste the lower animals--the crustacea and mollusks These possess neither brain nor spinal cord; their nerve-centres, instead of being concentrated in a craniuh the cavities of the trunk, as are the visceral plexuses in vertebrated animals In these, however, the addition of a brain and spinal cord to the original rudimentary nervous system, powerfully ree of control is variable, according to the relative predominance of the one or the other; and this predo to different species of vertebrated ani to different individuals, in that which presents the most conspicuous capacity for individual variation--the human species Up to a certain point, increased development of the cerebro-spinal system, attended by an increased development of the osseo-reater elaboration of the ganglionic nerves supplying the viscera, upon whose efficient action the nutrition of this fra scale, the exactness of this correlation ceases The muscles and bones are sans, especially the brain, becomes more elaborate; and hence the control exercised over the functions of the ganglionic systeh the relative size of the two systeed

Such control or predo ways: First

The functions of animal life, presided over by the cerebro-spinal systeetative or nutritive life, carried on by the ganglionic That is to say, the acts of locomotion sustained by the spinal cord and the nervo-ht and will, sustained by the brain--are relatively estion, respiration, circulation, etc, dependent on the functions of the ganglionic nerves Second These latter functions are theularity and more force, when the activity of the cerebro-spinal systelionic Within certain lis possess over lower animals a superiority, not only of intellect, but of capacity for digesting various articles of food; and oftheir temperature in more various states of the external atmosphere Third Finally, the actions of the cerebro-spinal systeular and powerful when not liable to interruption frolionic nerves, and the visceral functions presided over by theests, he falls into a state of torpor that exceeds in degree, but not in kind, the drowsy ru her cud Such animals are slaves to their nutritive functions, by which those of the brain and spinal cord may at any time be, as it were, oppressed and overwhelmed The capacity for independence increases with every rise in the hierarchical scale of vertebrates, until it culminates in man--able to think and talk over his dinner; toblood to his cerebral hemispheres; to sustain in complete unconsciousness innumerable delicate and complicated chemical meta every conscious effort of his ht and will

The peculiarities that, when coarsely euish different species of aniradations, as varieties a the different classes, and even different individuals of the human race Here may be found, at least, faint echoes and distant rehout the anidom The classification of sex is certainly one of those that offer an interesting opportunity for such co between the operations of the ganglionic, and those of the cerebro-spinal system As the authors who have asserted the complete subordination of the brain to the instincts in woman, have thus, perhaps unconsciously, reduced her to the anatomical level of the crustacea; so those who, like Dr Clarke, insist on the incompatibility between cerebral action and the process of ovulation, ilionic activity in woical inferiors of the animals or individuals in whom no such incompatibility exists

Were such opposition between cerebral and ganglionic functions only noted when a rhythmical intermittence was introduced into the latter, and were such rhythht indeed be possible to fix upon woical inferiority, alical actions--of the beating of the heart, the secretions of the stoestion of the spleen, the circulation of the brain, quite as decidedly as of the ripening of cells in the ovary The tidal waves described by Michelet have become the exclusive theme of his eloquence, mainly because his attention was not attracted to any but those connected with the more obvious phenomena of menstruation But er cycles--waves of pulse and of temperature, of sleep and wakefulness, interard to the latter, it is noticeable that an intermittent excretion, as of bile or urine, is provided for by a continuous secretion, and that the same is true of the excretion upon whose rhythm an erroneously exceptional emphasis has been laid--that of the menstrual fluid Here, as elsewhere, the interrowth--effected by precisely such processes of cellular assimilation and metamorphosis as take place in the elerowth in question is effected in the ovaries; the final stage of the process, the rupture of the containing cell or ovisac, and escape of the ovule, is attended by a concentration of nervous activity in the ganglionic ous to that which occurs in the solar plexus at periods of digestion; the fall of the ovule is itself analogous to the shedding of epithelial cells in the gastric follicles; the afflux of blood to the utero-ovarian veins, analogous to the periodical congestion of the gastro-splenic vascular apparatus Only, in this last case, the congestion results in the elaboration of a fluid secretion, the gastric juice; in the utero-ovarian plexus, where no secretion is required, the blood itself is discharged It is difficult, with these facts, to understand the assertion that, ”Periodicity is the grand (_ie_ exclusive) characteristic of the feestion and ofthe consciousness of the individual whose body is the theatre of such extraordinary phenomena Various abnormal conditions raise the one or the other to the sphere of consciousness--various stages in their evolution Consciousness of nutritive functions is always painful, and digestion, quite as well as ovulation,to cerebral tranquility and efficiency The longer duration of the latter is compensated by the more frequent occurrence of the for at least fifteen days of everythree or four hours after each meal, or froestive function is much more often the occasion of conscious discomfort, than is the function of ovulation Whenever it becomes so, the dyspeptic approaches the condition of the reptiles or ruestion so absorbs the powers of the nervous system that all other modes of its activity are suspended But such a condition is universally regarded as an evidence of disease, nor could any considerations concerning the colionic nerves of the stoestion, convert the ical type for the race At the most may it be admitted:

1st That in civilized communities dyspepsia is a very common disease

2d That dyspeptics require rest of estion

_Caeteris paribus_, these sa frolionic system--that connected with menstruation A third proposition is, moreover, common to both, namely, that repose of the cerebro-spinal systelionic activity, unless in exceptionally estion occupies froenerally sufficient to avert discomfort Similarly, the process of ovulation continues over fifteen days--menstruation lasts from three to six--but even in the cases that deh, and hter disturbance of norestion painful than to cause painful ovulation, that is, pain preceding the menstrual flow Pain in menstruation, which is much more frequent, is dependent upon other conditions than the activity of the ovaries, and lasts a very much shorter time than does either the function of ovulation, or even than the uterine congestion secondary to it Outside of actual uterine disease, the pain at this moment is most often dependent on uterine cramp, itself excited by a spasmodic contraction of blood-vessels that interfere with its circulation As these remarks are addressed to non-medical readers, a word of explanation is here necessary

It has been shown by experiment that the sudden arrest of the circulation in muscular fibre is sufficient to induce in the latter violent contractions Thus, the cranation of blood in their muscles These cramps are even more easily induced in the muscular fibre of the viscera--the unstriped, involuntary muscles--such as exist in the intestine, bladder, and uterus Anything that will cause a sudden contraction of the blood-vessels in the uterus will, therefore, by cutting off the supply of blood, cause the muscular fibre of the uterus to contract in painful cramps The small blood-vessels are themselves provided with circular muscular fibres, whose contraction necessarily draws the walls of the vessels together, obliterates their canal, and shuts out the blood This contraction is effected by stimulation of the fine nerves, called vaso-motor, that are distributed to these anglia, that forlionic system from which the nerves of the ovaries and other viscera are supplied The utero-ovarian blood-vessels derive their nerves froastric plexus, which, forlia and spinal cord, is the exclusive source of the innervation of the uterus and ovaries The ganglionic nervous exciteestion of the uterus, is easily coan At the very moment, therefore, that the uterine blood-vessels are dilated, and blood is being exhaled into the uterine cavity, an excessive stimulation of the vaso-motor nerves may cause the blood-vessels to contract; the flow is then temporarily arrested, the circulation in the uterus disturbed, and its muscular fibres thrown into cramps

Or the opposite event may occur As the stimulation of the vaso-motor nerves causes contraction of the blood-vessels, so their exhaustion or paralysis causes relaxation of these same vessels, consequently, over-distension with blood; and, if the door to haee be once opened by the existence of the menstrual nisus, an excessive flow of blood[39] Such vaso-motor paralysis may depend on one of three circuinal stimulus may be excessive, and hence necessarily followed by reaction

2nd Schiff has shown that galvanization of a cerebro-spinal nerve causes a dilatation of the blood-vessels in the vicinity, as if the vaso-motor force were overpowered by the excessive sti nerves If excessive action of the brain or spinal cord be analogous in its effects to galvanisht be supposed to cause vaso-eneral exhaustion of the nervous systelionic and cerebro-spinal apparatus, the vaso-motor nerves suffer with the rest, and the blood-vessels lose their tone in consequence It is to such exhaustion that Dr Clarke especially attributes excessive uterine haeirls, and, as already said, he refers the exhaustion to a single cause, namely, to the attempt to impose on the nervous system two actions of equal intensity, contrary to the fundamental law that an intense evolution of nerve-force in one part of the organism necessitates repose in the remainder

Independently of the three conditions where excessive menstruation is connected with vaso-motor paralysis, a fourth may be found directly in the excitement of the ovarian plexus of nerves This evolution of nerve-force which accompanies the maturation of the ovule, is the immediate cause of the afflux of blood to the utero-ovarian vessels The effect upon the latter is probably due to the spinal nerve-fibres contained in the plexus, and upon which the ganglionic excitealvanism in Schiff's experiment, already described Direct stimulation of the vaso-motor nerves, alone, as has been said, contracts the blood-vessels Stimulation of the spinal fibres associated with them exercises the contrary effect An excessive stilionic masses, would have an effect similar to that of excessive stimulation directly addressed to the cerebro-spinal system, and the blood-vessels would be not only dilated, but paralyzed