The Origin and Nature of Emotions [26]
of the intestine and of the urinary bladder as normal acts, and for the overcoming of obstructions in these tracts, pain compels the required muscular actions, For passing gall-stones and urinary calculi, urgent motor stimuli are awakened by pain. For each of these diversified pains the consequent muscular action is specific in type, distribution, and intensity. This statement is so commonplace that we are apt to miss the significance and the wonder of it. It is probable that every nerve-ending in the skin and every type of stimulation represents a separate motor pattern, the adequate stimulation of which causes always the same response.
Let us pass on to the discussion of another and perhaps even more interesting type of pain, that associated with infection. Not all kinds of infection are painful; and in those infections that may be associated with pain there is pain only when certain regions of the body are involved. Among the infections that are not associated with pain are scarlet fever, typhoid fever, measles, malaria, whooping-cough, typhus fever, and syphilis in its early stages. The infections that are usually, though not always, associated with pain are the pyogenic infections. The pyogenic infections and the exanthemata constitute the great majority of infections and are the basis of the discussion which follows.
I will state one of my principal conclusions first, _i. e_., that the only types of infection that are associated with pain are those in which the infection may be spread by muscular action or those in which the fixation of parts by continued muscular rigidity is an advantage; and, further, as a striking corollary, that the type of infection that may cause muscular action when it attacks one region of the body may cause no such action when it attacks another region.
The primary, and perhaps the most striking, difference between the painless exanthemata and the painful pyogenic infections is that in the case of the exanthemata the protective response of the body is a chemical one,--the formation of antibodies in the blood, which usually produce permanent immunity,--while the response to the pyogenic infections is largely phagocytic. In the pyogenic infections, in order to protect the remainder of the body, which, of course, enjoys no immunity, every possible barrier against the spread of the infection is thrown about the local point of infection. How are these barriers formed? First, lymph is poured out, then the part is fixed by the continuous contraction of the neighboring muscles and by the inhibition of those muscles that, in the course of their ordinary function, would by their contractions spread the infection. Wherever there is protective muscular rigidity there is also pain. On the other hand, in pyogenic infections in the substance of the liver, in the substance of the kidney, within the brain, in the retroperitoneal space, in the lobes of the lung, in the chambers of the heart and in the blood-vessels of the chest and the abdomen, in all locations in which muscular contractions can in no way assist in localizing the disease, pyogenic infections produce no muscular rigidity and no pain. Apparently, therefore, only those infections are painful which are associated with a protective muscular contraction. This explains why tuberculosis of the hip is painful, while tuberculosis of the lung is painless.
There is a third type of pain which modifies muscular action in a curious way. We have already stated that local pain serves an adaptive purpose. In this light let us now consider headache. Headache is one of the commonest initiatory symptoms of the various infections, especially of those infections which are accompanied by no local pain and by no local muscular action. In peritonitis, cholecystitis, pleurisy, arthritis, appendicitis, salpingitis, child-birth, in obstructions of the intestinal and the genito-urinary tract, in short, in those acute processes in which the local symptoms are powerful enough to govern the individual as a whole,--to make him lie down and keep quiet, refuse
Let us pass on to the discussion of another and perhaps even more interesting type of pain, that associated with infection. Not all kinds of infection are painful; and in those infections that may be associated with pain there is pain only when certain regions of the body are involved. Among the infections that are not associated with pain are scarlet fever, typhoid fever, measles, malaria, whooping-cough, typhus fever, and syphilis in its early stages. The infections that are usually, though not always, associated with pain are the pyogenic infections. The pyogenic infections and the exanthemata constitute the great majority of infections and are the basis of the discussion which follows.
I will state one of my principal conclusions first, _i. e_., that the only types of infection that are associated with pain are those in which the infection may be spread by muscular action or those in which the fixation of parts by continued muscular rigidity is an advantage; and, further, as a striking corollary, that the type of infection that may cause muscular action when it attacks one region of the body may cause no such action when it attacks another region.
The primary, and perhaps the most striking, difference between the painless exanthemata and the painful pyogenic infections is that in the case of the exanthemata the protective response of the body is a chemical one,--the formation of antibodies in the blood, which usually produce permanent immunity,--while the response to the pyogenic infections is largely phagocytic. In the pyogenic infections, in order to protect the remainder of the body, which, of course, enjoys no immunity, every possible barrier against the spread of the infection is thrown about the local point of infection. How are these barriers formed? First, lymph is poured out, then the part is fixed by the continuous contraction of the neighboring muscles and by the inhibition of those muscles that, in the course of their ordinary function, would by their contractions spread the infection. Wherever there is protective muscular rigidity there is also pain. On the other hand, in pyogenic infections in the substance of the liver, in the substance of the kidney, within the brain, in the retroperitoneal space, in the lobes of the lung, in the chambers of the heart and in the blood-vessels of the chest and the abdomen, in all locations in which muscular contractions can in no way assist in localizing the disease, pyogenic infections produce no muscular rigidity and no pain. Apparently, therefore, only those infections are painful which are associated with a protective muscular contraction. This explains why tuberculosis of the hip is painful, while tuberculosis of the lung is painless.
There is a third type of pain which modifies muscular action in a curious way. We have already stated that local pain serves an adaptive purpose. In this light let us now consider headache. Headache is one of the commonest initiatory symptoms of the various infections, especially of those infections which are accompanied by no local pain and by no local muscular action. In peritonitis, cholecystitis, pleurisy, arthritis, appendicitis, salpingitis, child-birth, in obstructions of the intestinal and the genito-urinary tract, in short, in those acute processes in which the local symptoms are powerful enough to govern the individual as a whole,--to make him lie down and keep quiet, refuse