Popular Science Monthly/Volume 38/December 1890/The Sensations of Pleasure and Pain
By Dr. E. HEINRICH KISCH.
ALL our sensations, from the most trifling pleasure to the highest delight, from the hardly perceptible discomfort to the keenest anguish, the whole gradation of manifold variations of feeling, originate from the propagation of excitations from without through the nerves to the central organ of the nervous system and to consciousness. The nerves are the conductors of the stimulus-waves which go to the nerve cells of curious terminal forms in the brain and spinal marrow; and every excitation that touches any part of those conductors releases a sensation, the pleasant or unpleasant character of which depends first upon its intensity. To a certain degree every moderately strong excitation affecting us is agreeable and begets a feeling of pleasure rising to lively delight. An excitation surpassing this limit calls out an uncomfortable feeling which passes into pain. A gentle stroking of our skin, for example, is enjoyed; a strong pressure upon it evokes an uncomfortable feeling, which, continuing, passes into pain. Harmonious musical tones please our ears, but discordant noises make us miserable.
That a stimulus striking the sensitive nerves should reach our consciousness as a pain depends not on the force of the attack only, but also on the delicacy of the nervous system, which varies with different men to a considerable degree. Thus, many persons having finely developed organs of those senses can smell and taste many things of which other persons can hardly conceive; and much that is painful to an over-delicate lady causes no inconvenience to the hardy, coarse rustic. Also in various conditions of disordered health the whole nervous system or part of the sensitive nerves suffers from excessive sensitiveness, in consequence of which insignificant affections cause agony.
Neuralgias, or pains in particular nervous tracts, may be brought about by various causes by disease in the terminal ramifications of the nerves, from disorders in the nerve-stem, through illness of the brain or spinal marrow, or from some irritation affecting another distant nerve, transmitted to this one through the central nervous system by what is called a reflex process. The common expression, "nervous pain," conveys no distinction respecting the character or source of the affection; but to the physician it is a matter of great importance to determine the precise source of the affection and the means of contending with it.
One of the most common neuralgias is a pain in the eyes; it is felt in the region of the trigeminal nerve, and frequently becomes almost unendurable and very obstinate. It occurs usually in single attacks, which return at various intervals and last sometimes only a few minutes, and sometimes a quarter of an hour or more. The painful feeling, which may be described as that of a boring, piercing, stretching, or tearing, generally radiates from a circumscribed spot in the neighborhood of the nervous ramifications, in the region of the eyes, face, and lower jaw, and may extend to the neighboring nervous regions, to the back of the head, the arms, and the breast. It not rarely becomes so fearfully intense and rasping that persons afflicted with it act as if mad, tossing themselves violently around and crying out in the most heart-rending manner. To this are added disorders of sensation. The eyes become red, vision is troubled with specks and spots, the flow of tears becomes excessive, the hearing is dulled or vexed with hummings, and the patient suffers from an unpleasant taste and burning in the nostrils. Companion afflictions set in, like twitchings and cramps of the facial muscles, eruptions on the skin, swellings, and a whole list of other disorders. To these bodily woes are added mental depression, life becomes a burden, and the sufferers are sometimes tempted to suicide.
This neuralgia may arise from a variety of causes; from a cold, an unsound tooth, from general sickness, or from debility or exhaustion. It is sometimes connected with disorders of remote organs, as of the digestive system, and by reflex action from pains prevailing there.
Sciatica, or hip-gout, is another frequently occurring neuralgia, which has its seat in the hip-nerve and its branches, and is thence transmitted through the whole lower part of the system, from the pelvis to the toes. The pain is usually confined to certain points, and rises on motion, and often at night, to great heights. It is a disease of middle age, prevailing with men and women, and originates from a variety of causes. The hip-nerve is exposed by its situation to be easily injured by cold and accidents; and the affection is often brought on from stagnation of blood, disorders of the lower body, and internal diseases. It is very persistent, and may interfere with business activity and occasion sickness through many years.
These diseases are cited as examples. Many other nerves are the seat and starting-points of pains which after long continuance give rise to an exaggerated sensitiveness of the whole nervous system, to increased acuteness in all the nervous regions, by which sound thought and feeling are deeply disturbed. It is evident that full attention should be given at once to nervous pains and the means of counteracting them. First, every pernicious influence which may directly exert an irritating influence upon the nerves should be removed; then the remote causes which manifest themselves by nervous pains should be dealt with.
The removal of a decayed tooth may cure a face-pain at once and forever; taking away a body pressing upon the hip-nerve may be a complete remedy for a sciatica. Like ends may be reached in other cases by a regulated way of living which will lead to improved digestion and a more healthy circulation. The simple operation of an aperient, as I have had occasion to observe at Marienbad, has sometimes at once alleviated nervous pains that had defied every sort of treatment for years. Yet we do not always succeed in elucidating the causes of such troubles and removing them.
In such case the task of the physician, seeking to alleviate the pain, is to reduce the sensitiveness of the nerves. Sometimes he seeks to attain that object by applying counter-irritants on the skin along the course of the nerve or in its neighborhood. Of such are mustard-plasters, Spanish flies, burning, and dry cupping. Electrical treatment constitutes one of the most important applications for curing sick nerves. With alleviation of the pain, weakening of the attacks, and quieting of the nervous excitement, it also often induces improvement and cure in desperate cases. The same is also frequently accomplished by the use of warm baths, such as may be had at many natural thermal springs, sulphur, and other medical baths. Sometimes, when the pains are refractory to the application of heat, cold baths, washing and rubbing are of effectual service; and the cold-water method not rarely achieves real triumphs in cases of long standing, particularly when the neuralgia is the result of a cold, and it is desired, by hardening the organs of the skin, to make them less sensitive to changes of weather. Local applications of cold in the shape of ice-bags, cold poultices, etc., afford effective means of reducing the supersensitiveness of a nerve. Sometimes drugs are necessary which have the property when introduced into the blood of increasing or reducing the power of feeling. These remedies are applied outwardly or inwardly, and many of them have been known from ancient times. Narcotics taken inwardly, like opium and morphine, should be used with great care, and reluctantly. Beneficial and even indispensable as may be the pain-stilling and quieting operation of these drugs, it must not be forgotten that the human organization easily accustoms itself to them, so that ever more frequent application and larger doses of them are demanded, and, at last, bodily disease and mental disorder are brought on through the general poisoning they occasion. The moment when a man afflicted with neuralgia receives the morphine injection for the first time, to free himself temporarily from pain, may be decisive for his whole future life. It soon happens that the anodyne is resorted to, not merely for unendurable nervous attacks, but for every little discomfort, care, and grief, so that the veil of forgetfulness may be drawn over the unpleasantness and the pressure of the unwelcome reality may pass away in dreaminess. Thus the unhappy man sinks from step to step in the slough of opium-poisoning, from which deliverance is possible only rarely and with difficulty. Energy, the power of resistance, the sense of duty and pleasure in action are lost, and he becomes a physical wreck; indolent and indifferent, timid and uneasy, emotional and excitable, the unhappy man presents the most critical symptoms of what is called "morphinism." Similarly terrible consequences follow the habitual use of other quieting drugs, including the preparations of cocaine. Those, therefore, who suffer from nervous disorders can not be too earnestly warned never to use any such preparations, except in extreme cases, by the prescription of their physician.
Massage has recently played a considerable part among the remedies applied for the removal of nervous pains. Good effects are obtained in neuralgias which originate from colds or stagnation of the blood by means of the kneading and the muscular exercises which are implied in this term. The structures in which the disordered nerves branch out should be worked in all directions, but only by experienced, intelligent hands—with pressure, rubbing, kneading, shaking, and moving, in order to remove the disturbance. Rough handling by awkward persons, such as those to whom the process is too often intrusted, may do more harm than good. Health gymnastics is included among the movement cures which are resorted to for the alleviation of nervous pains. In many cases, too, the opposite course—complete rest—is prescribed for quieting the excited nervous system, for the reduction of oversensitiveness.
In desperate cases, where medicines and mechanical applications have failed, surgical operations are called in, to remove the pain by severing the nerves. The results which have been often attained by this operation justify its application.
The best protection against nervous disorders is found in sparing the nervous force; in avoiding overexertion of body and mind; in systematic practice of bodily exertion and muscular exercise; in a wise alternation of work and recreation, and in hardening the power of resistance of the body and steeling that of the mind; in everything that can protect our emotional nature against degenerating into sentimentality, our feeling into tenderness.—Translated, for the Popular Science Monthly from Die Gartenlaube.