I am also very careful as to being sure of the absence of certain forms of organic disease before flattering myself with the probability of success. But not all organic troubles forbid the use of this treatment. Advanced Bright's disease does, though the early stages of contracted kidney are decidedly benefited by it, if proper diet be prescribed; but intestinal troubles which are not tubercular or malignant do not; nor do moderate signs of chronic pulmonary deposits, or bronchitis.[13]
Some special consideration needs to be given to the subject of heart-disease. Especially in cases of broken compensation, by lessening the work required of the heart so that it needs to beat both less often and with less force, the simple maintenance of the recumbent position is a great aid to recovery, and massage properly used will still further relieve the heart. Disturbed compensation is usually accompanied by failure of nutrition, often by distinct anæmia, and these and the anxiety which naturally enough affects the mind of a person with cardiac disorder are all best handled, at first at least, by quiet and rest. Later, the methods of Schott, baths and resistance movements, may carry the improvement further. Even in old and established cases of valvular disease much may be done if the patient have confidence and the physician courage enough to insist upon a sufficient length of rest. The palpitation and dyspnoea of exophthalmic goitre are promptly helped by rest and massage, and with other suitable measures added, cures may be effected even in this intractable ailment.
In former editions I have advised against any attempt to treat the true melancholias, which are not mere depression of spirits from loss of all hope of relief, by this method, but wider experience has convinced me that rest and seclusion may often be successfully prescribed to a certain extent and in certain cases.
Those in which the most good has been done have been the cases of agitated melancholia with attacks, more or less clearly periodic, of excitement, during which their delusions take acuter hold of them and drive them to wild extravagance of noisy talk and bodily restlessness. Whether such patients must be put to bed or not one must judge in each instance, taking into account the general nutrition. In my own practice I certainly do put them to bed now much oftener than formerly. It is not desirable to keep them there for the six or eight weeks which full treatment would demand. Usually it will be of advantage to order, say, two weeks of "absolute rest," observing the usual precautions about getting the patient up, prescribing bed again when the early signs of an attack of agitation appear, and keeping him there for a couple of days on each occasion, during which the full schedule of treatment is to be minutely carried out.
Goodell and, more recently, Playfair have pointed out the fact that some cases of disease of the uterine appendages such as would ordinarily be considered hopeless, except for surgical treatment, have in their hands recovered to all appearances entirely; and my own list of patients condemned to the removal of the ovaries but recovering and remaining well has now grown to a formidable length. Playfair observes also that he believes it possible that in even very severe and extensive disease the health of the patient may be sufficiently improved to render operation unnecessary.[14]
In cases of floating kidney some very satisfactory results have been reached by long rest; and although it may be necessary to keep the patient supine for three months or more, the reasonable probability of permanent replacement of the organ is much greater than from operative attempts at fixation, apart from the danger and pain of surgical procedures. Persons with floating kidney are nearly always thin, often giving a history of rapid loss of weight, have usually various symptoms of gastric and intestinal disturbance, and present therefore subjects in all ways suitable for a fattening and blood-making régime which shall furnish padding to hold the kidney firmly in its normal place.
The treatment of locomotor ataxia and some allied states by this method, with certain modifications, has yielded such good results that I now undertake with reasonable confidence the charge of such patients; and the subject is so important and has as yet influenced so little the futile drugging treatment of these wretched cases that it seems worth while to devote a special chapter to it, although the affections named can scarcely be said to be included under the head of neurasthenic disease.
In the following chapters I shall treat of the means which I have employed, and shall not hesitate to give such minute details as shall enable others to profit by my failures and successes. In describing the remedies used, and the mode of using them in combination, I shall relate a sufficient number of cases to illustrate both the happier results and the causes of occasional failure.
The treatment I am about to describe consists in seclusion, certain forms of diet, rest in bed, massage (or manipulation), and electricity; and I desire to insist anew on the fact that in most cases it is the combined use of these means that is wanted. How far they may be modified or used separately in some instances, I shall have occasion to point out as I discuss the various agencies alluded to.