These counteracting processes can be stimulated sometimes by drugs, but oftener they can be best brought into play by keeping the patient in just as good condition of body and favorable condition of mind as possible for a prolonged period, so that nature accustoms herself to the defect and her powers of compensation have full play.
Unfavorable Suggestion.—What is true of organic diseases of all kinds is especially true of organic nervous diseases, and in spite of the fact that most of these are essentially incurable, so much can be done for patients that their condition is made more tolerable and indeed some of them improved to such an extent that they consider themselves quite relieved of their organic affection. One of the most serious burdens that the patient laboring under an organic nervous disease has to suffer is the consciousness drummed into him by successive physicians, by his reading, and by every possible means of suggestion, that his malady is incurable. This makes every symptom as severe in its effects as it can possibly be. Hope does not buoy up and discouragement weighs down every effort of the organism to compensate for the serious defect under which it is laboring. Nothing can be done for the disease itself, but much can be done for the patient. Many of the symptoms from which the patient suffers most are really due to his own discouragement, to that sluggish condition which develops in his body as a consequence of his lack of hope, to the absence of exercise and of air and of diversion of mind consequent upon the gloom that settles over him when he is told that his condition is incurable.
Adventitious Symptoms.—If the adventitious symptoms that are always present in cases of organic nervous disease are eliminated, if the conditions which develop from the unhygienic condition in which the patient lives because of his discouragement and retirement are removed, as a rule he feels so much better that it is hard to persuade him that some change has not come in his underlying nervous disease and that a process of cure is not at work. It is because of this that irregular practitioners so often succeed in apparently doing much more for these patients than the regular physician. The irregular does not insist on the incurability of the disease, but, on the contrary, he promises a cure. He then proceeds to relieve many bothersome symptoms that are quite extraneous to the underlying disease, but thus makes the patient ever so much more comfortable than before, gives a cheerful air to his life for a time, makes him sleep better as a consequence and it is not surprising that the patient thinks that his disease has been bettered, if not cured.
Suggestive Prophylaxis.—While we are optimistic just as far as possible since genuine nervous disease has declared itself, it must not be forgotten that we can by suggestion and warning often prevent or delay the development of nervous degenerations. This, too, is psychotherapy and must be employed wherever it seems advisable.
Post-syphilitic nervous conditions of so many kinds are likely to develop that it is important to warn the patients who are sufferers from this disease from taking up the more strenuous forms of existence. This may seem an exaggerated view of the condition, but it is amply justified by the results of the opposite rule of life in almost any physician's experience in city practice. A man who has had syphilis must be warned of the danger, one may almost say likelihood, if he takes up any of the professions in which there is much mental strain and nervous worry, that he will almost surely not live out the normal span of life without some serious nervous incident. Locomotor ataxia, and, above all, general paralysis develop, as a rule, in men who, having had syphilis, have some occupation in life that calls for considerable mental strenuosity, and involves excitement and worry. Actors, brokers, soldiers and sailors, speculators of all kinds, race-track gamblers, these are the classes from [{510}] which victims of paresis and locomotor ataxia are particularly recruited. People who have suffered from syphilis and who live the ordinary unemotional life of a teacher, or a merchant, or a writer, do not, as a rule, develop the postsyphilitic and parasyphilitic conditions.
Precocious apoplexy is especially likely to occur in patients who have had syphilis and who have then spent themselves at very hard work. I doubt if hard work alone, without some such antecedent condition, ever produces this result. Of course, it is not alone syphilis, but other serious conditions which affect the nervous system that ought to be guarded against in this same way. If there has ever been any affection of the kidneys, as a complication, for instance, of scarlet fever, then it has always seemed to me to be the duty of the family physician to warn such patients that their kidneys are more prone than those who have not suffered from such an incident to break down under any severe strain that may be put upon them by worry, especially worry following a period of strenuous work. In these cases the affection of the kidneys nearly always makes itself felt in the nervous system, and especially in the brain, and so this warning has a proper place here. Where there has been severe cerebro-spinal meningitis this warning seems also to be needful, though here our records have not been kept with sufficient care to enable us to speak positively of the necessity for the warning.
Treatment.—It is important to remember that as physicians we do not treat disease but patients. We care for patients, that is the real etymological significance of the Latin curare, we do not cure diseases in the modern sense that has come to be given to that term, of completely removing the materies morbi and setting the patient on his feet once more just as well as he was before his illness.
Relieving Incurable Disease.—A new cure for locomotor ataxia, for instance, is announced every now and then, and the evidence for its beneficial action is the testimony of patients who have been relieved of many symptoms that they thought connected directly with their spinal affection. All sorts of remedies have been employed with announced success. One man builds a particular kind of shoe for them and has a number of witnesses to his skill in curing them. Another does some slight operation on their nose or their throat or their urethra and straightway the patient feels so much better that he talks confidently about being cured. All the characteristic symptoms of the affection remain. Their knee-jerks are gone, their pupils do not react normally, they have some incoordination in their walk, but a number of other symptoms have disappeared and their walk is probably much improved because of their confidence and a certain amount of practice that they have gone through. The new hope born of confident assurance that they could be relieved gives them an appetite, makes their digestion better. This lessens the sluggishness of their bowels, gives them confidence to get out and see their friends, life takes on a new hope, they sleep better and it is no wonder they talk of having been helped or even cured.
There is a definite relation between the nervous affection in these cases and many visceral symptoms. There is no doubt, for instance, that certain cases of intractable dyspepsia are associated with tabes and that in nearly the same way obstinate constipation frequently develops. Notwithstanding the connection of these symptoms with an incurable condition of the spinal cord [{511}] that is no reason for thinking that they cannot be relieved even though no improvement of the spinal-cord lesions is expected.