A Doctor's Journal
Slipped Disc
By MILES HOWARD NOT long ago a patient of mine made good his escape from an uncongenial job byllIness of a kind that was, to me, unusual in such con- ditions—slipped disc. He had been complaining about the work and the people he Worked with for some months past, but felt he could not de- cently withdraw from his post without a sound reason, since he was under contract. So he could do nothing but go on from day to day and endure it, getting more morose and disaffected. Then I had a signal from hospital that he had been ad- mitted in acute pain, which later proved to be due to pressure from a displaced disc on the nerve root. The diagnosis was beyond dispute, and he had an excellent reason for being off work and staying in bed, for the pain was quite disabling. I knew his story well. He had suffered a whole series of the 'illnesses of adaptation,' some five or six of them during his adult life, and it seemed highly likely, on principle, that the slipped disc was yet another.
So I read with especial interest a paper on stress and the disc syndrome, sent to me by a colleague who is a well-known orthopmdic sur- geon. It, is an account of an experiment with a large number of animals in the laboratory (voles) subjected to a stress-provoking situation. It was found that the nucleus of the disc was significantly larger in these than in a similar series of voles living under ordinary conditions. It may be, then, that in human beings a sustained state of tension causes the disc to swell and finery to 'slip' when strain is put upon it, as in lifting a heavy weight, or perhaps with the usual mechanical strains of everyday life. Once it has slipped, of course, the pain caused by pressure on a nerve is very real and very distressing, so the patient has to rest; and at that point in his life the rest may be valuable—it may serve, for instance, to forestall a more serious breakdown. In the biological defence-system, one malady can be employed to prevent another.
A colleague in general practice, who has many immigrants to Britain in his flock, commented to me lately on the problems of communication with these folk when they fall ill. The immigrant from Asia seems especially prone to the illnesses that spring from emotional tension; when he tries to tell his doctor how he feels and what, is wrong, he is so often limited in verbal capacity that it is hard to'comprehend what he wants to convey. Of course, this block in communication is not confined to aliens. The ill person, whatever his origins, has sometimes to find words for a state of mind or state of feeling for which words are quite inadequate. An instance of this is the dis- order now called depersonalisation: -the central feature is an alteration in the perception of the self, and the patient feels unreal, different, changed; it is a most uncomfortable way to be and not uncommonly very depressing, yet the sufferer, unless he is remarkably articulate, may be unable to express what he means. When the patient must speak in a foreign tongue, the block is even greater.
Another problem, in the foreign patient, is his difficulty or reluctance in 'taking root' in a new culture. Much illness in the immigrant is, I am sure, simply the expression of the tensions of transplanting from one kind of society to an un- familiar, perhaps threatening, one. The family doctor may come to feel that symptoms will con- tinue to appear, in one area of the body or another, until the patient decides to go back home again. It has been suggested that the appoint- ment of special welfare officers is justifiable, both for humane and for economic reasons; their task would be to help the new arrival over the period of adaptation and offer him understanding and support. This measure would certainly reduce the prevalence of illness by dealing with it at its source. It lies, in fact, in the province of pre- ventive medicine : the new preventive medicine and public health which takes into its orbit the entire field of human reactions, and not only such duties as the control of infectious diseases.
* * It is illuminating to hear about the complicated operations that can be carried out by 'learning machines' constructed by the engineer in his workshop. A note on the design of these machines appeared in New Biology lately. One problem, as the author, F. H. George, says, is that of not building-in certain stimulus-response connections. If they were all built in, the capacity of the machine would be limited to the foresight of its designer. He must design the mechanism whereby new circumstances can be recognised and new responses developed by the machine itself.
The biologist with a bent for mathematics calls such mechanisms 'logical nets'; they are, indeed, the nervous system of the machine and they can be designed to show the adaptability to circum- stance that learning demands. Feed-back loops in the network can be so placed as to act as a 'memory' for the machine, and this memory can be extended indefinitely by adding more and more loops. Even the simpler machines, with a small network and a short memory, can learn from experience and 'think,' and that prompts me to reflect on the enormous potentiality of the human brain with its thousands of millions of cells. In most of us, most of the time, how little of this is being used! And how readily responses to given stimuli become fixed, so that the nervous system ceases to learn I Another reflection is the difference in kind be- tween the learning machine, however elegant and complex, and the individual mind : the mechan- isms are similar—the learning capacity of the machine could, in theory, be made more efficient than most brains—but the machine has only the purpose put into it by the engineer and no mind of its own. In these times, the study of life is at some risk of being crowded out by veneration of machines. People are so untidy and wayward and inefficient. The logical net is neater, more predictable; -but it is people we have to live with.
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