The modern malady

by Cyril Bennett

It is really surprising that so successful a practitioner should have been short-sighted enough to treat a mere symptom instead of the disease in which it originated. He appeared to think that his patient was suffering from hallucination, from a morbid idea, and that if he could remove the idea, she would be well. Had he realised that morbid ideas argue a morbid condition of the nerves, and that the mere removal of one hallucination after another would not suffice to repair actual nerve-waste, he would certainly have refrained from expending his own nerve-force in a vain endeavour. But I am glad to know that he at any rate refrained from dissipating still further the poor woman’s small capital of strength by frightening her and discouraging her. In this respect his method compares favourably with that now in vogue at many hospitals.

Here are three instances of more modern usage.

A woman of the labouring class presented herself at a country hospital for treatment. She declared herself to be afflicted with severe pain in one leg, rendering it almost helpless, and preventing her from accomplishing her daily work. The medical gentlemen to whom she addressed herself could find nothing wrong with the limb, and harshly told her that her complaint was “hysteria.” One would have thought that having discovered the disease and given it a name, they would have done something to cure it. Not at all. The woman was sent away unrelieved, to be a burden on her unhappy family or on the community, as the case might be. Yet these gentlemen had probably heard of such things as nerves, and knew them to be an even more essential part of the body than the legs. Their refusal to treat the patient in question would have been excusable had they systematically excluded all nervous cases, but this does not appear to have been their practice. The poor woman went home and struggled to do her work, but failed from weakness. In despair she consulted a quack, who put her on an efficacious course of treatment and cured her triumphantly. A member of the Hospital Committee, having these facts brought under his notice, attended the next meeting, and moved that that quack should at once be taken on to the staff to assist the medical gentlemen with his valuable advice. The motion was lost.

Another woman, suffering from severe nervous exhaustion, applied for relief at a large hospital in London, and received the same answer—“Only hysteria.” One would really have thought that a disease so widely recognised, and causing so much perplexity, would be a bad enough thing to have without more being expected of one. However, the woman was told that her complaint was all sham and nonsense, and she was sent about her business. She went in despondency, for she was in a fearfully exhausted condition. Soon afterwards a painful malady made its appearance of the description usually considered “interesting,” and the same hospital, which had closed its doors on the invalid, now opened them wide, received her with kindness, and studied the disease diligently. They failed to cure it, but that is a detail. Indeed, I think they would have cured it if they could, but perhaps it was incurable. This hospital admits itself to have been mistaken. It says it was wrong in crediting the patient with “hysteria;” she was really suffering, the doctors say, from the exhaustion preceding this particular form of disease. In short, if they could have cured the neurasthenia, which was the woman’s sole disease when she went to the hospital in the first instance, she need never have contracted the disease which was found so interesting. Lower the vitality of the whole organism, and the part originally weakest breaks down; or the patient may be exposed to some malign influence,—such as blood-poisoning, for example,—which, in health, she would have been able to withstand, but to which, in an enfeebled condition, she falls an easy prey. I had watched this patient become ill. I had even tried to arrest her downward progress; but my hands being tied, I could accomplish very little. She was of neurasthenic inheritance, and was put in unfavourable conditions. A hospital, taking entire possession of her at the right moment, might have done a good deal.

At another hospital a young probationer began to break down from overwork. She fell a victim to neurasthenia, and a very painful and distressing malady she found it. She consulted one of the medical staff, who rebuked her, told her she was suffering from “hysteria,” and ordered her to go and work. Her health would have been destroyed, and she would have been forced to abandon her career, had not a kindly, sensible physician—such as, happily, abound in the much-tried medical profession—come to the rescue, set her feet upon a rock, and ordered her goings. She is still leading an active, useful life.

There have probably been many cases in which the patient has become neurasthenic from monotony and want of occupation, and in which her cure has seemingly been effected by her being forced to exertion. As a matter of fact, the good results have been obtained chiefly by the patient being placed in better conditions, and I have seen many such cases, who have been entered in the doctor’s book as cured, relapse again on the smallest provocation. Yet, as I have said before, neurasthenia can be cured, and ought to be cured; and if we fail in our efforts, there must be a screw loose in our mode of treatment.

One more instance of failure may be given here, out of a very large number that might be recorded.

A young lady, rendered justly anxious by increasing nerve-weakness, consulted a well-known physician. He asked what ailed her. She described her symptoms, the most usual symptoms of neurasthenia. His comment on her report was singular. He wondered that she should have come to him at all, having no more than that the matter with her. One is again tempted to ask what more one can be expected to have the matter? Surely, continued languor, depression, neuralgia, and weakness are a sufficiently heavy burden for anybody to bear, to say nothing of want of comprehension on the part of others. Did the good gentleman wish the lady to wait until she had developed something more “interesting”? Not at all. We should wrong him by entertaining any such idea. He merely believed neurasthenia to be three parts fuss and nonsense, and he thought he was proving himself a kind friend to the young lady by rousing her to a sense of her duty—the duty of dragging herself about and saying nothing of her ailments. It is odd how very ready we all are to preach duty—to somebody else. Nevertheless, let us honour the conscientious physician for his honesty. Unfortunately, he failed to cure the young lady, and for anything I know to the contrary, she may by this time have developed something extremely interesting.

CHAPTER IV.
ERRONEOUS NOTIONS.

IT will be readily conceded that in order to treat nervous disease successfully, we must have some special qualifications for our task. We need not only learning, but experience and powers of ready observation. Indeed, mere learning will avail us little in a still undiscovered country, or in one where the observations of our predecessors have been so frequently and unavoidably erroneous. But if it be true that all disease is in a sense nervous disease—an affection of the nerves of some particular part of the organism—the importance of the study of neurasthenia cannot be overrated, provided that we study it from Nature, and do not rely wholly on prevalent teaching concerning the mode of treatment required.