THE HIGHLY STRUNG NERVOUS SYSTEM
Authors: G. Rankin
Journal: BMJ (1916)

TEIERE can be nothing more sure in physiology than tlhis: tllat as we go upwards iil the scale of creation, so the nervous systemn beconmes imore hiiglhly strung.But if, on the one lhand, it becomes more intense in the enjoyment of pleasure, it must also, on the other hiand, be more sensitive to pain and to disturbing sensations of all sorts.'Thus wrote the late Sir James Goodlhart so long ago as 1891, and the trutli of hiis statement becomes more firmly established iI clinical experience as time goes on.As lhabits of life becorne gradually altered, so of necessity do tlje disorders wlhiclh interfere with the regular fulfilment of these hiabits slowly assume new features and fresh significance.Of all the tissues of the lhuman bodv there arc none so sensitive to tile influence of clhangin;g con- clitions as those that go to the make-up of the nervous system.Hence it is that we are confronted witlh an apparent inierease of nerve disturbances and diseases out of proportion to those associated witlh otlher organs or systemns.But, wlhile tlhis is true of disorders that lhave earnied a title to a namxie because by ascertainable sigLns and symiiptonms tlhey lhave acquired an individuality by whliclh they can be recognized, the same cannot be said of the fiunctional departures from normal stability.These conif0ront us at every turn and are bewildering in the multi- plicity of tlheir manifestations and often also in the perversity witlh whliclh tley mimilic true disease dependent upon actual tissue clhange.I-low far functional disturb- ance is a harbingcr of organic misclhief is a questiomi at presenit inripossible to answer, but in the case, for instance, of suclh a (lisorder as disseminated sclerosis-tllere is reason to susjg)ect that an inhlerited poor quLality of nervous strucLure mjay pass througlh tlhe trials of ftumictional poverty anid end in the bankruptcy of establislhed disease..Tfe tarrm "nieurosis " is now used as descriptive of nerve distuirbance for which no corresponding pathological clhanges in tlle nervous system can be found.Many neCurotic conditions are essentially of central origin, and are coincerned witlh every variety of subjective sensation.Tlhey are niore commnon in women than in men, and are liable to declare tllemselves under the influence of grief, exciterxient, anger, jealousy, and otlher passions by whlich cemotional cenitres are aroused to unwonted, and often un-.controlled, activity.The storm soon blows itself out, but it leaves bellind a wreckage of shattered nerves, whiel ith each succeeding ebullition find increasing difficulty in settlingc down to a well-balanced placidity.Thle central neuroses, infinite in number and variety, do not fall witllin tlhe compass of tllis comnmunication, wllicl is intended to deal only witlh those tllat manifest tlhemselve's, in all their most prominent synmptoms, through one or otlher of tlhe great organiC systems.If -we turn oU1r attention, in the first place, to the cerebro-spinal system, we hiave no difficulty in finding examples wlhichl, to dis- tinguislh them from those that are properly regarded as central or m:ental, may be conveniently differentiatedl as neuroses of periplheral type.How miany of the lheadaeles, for instance, withl whichli we are called upon to deal, are simnple neurosal manifestations I-the occipital discomfort