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GENERAL AND FUNCTIONAL BRAIN DISEASES. NERVOUS PROSTRATION. NERVOUS EXHAUSTION. NEURASTHENIA.
NERVOUS PROSTRATION.—Is a condition of weakness or exhaustion of the nervous system, giving rise to various forms of mental and bodily inefficiency.
Causes. 1. Hereditary causes.—Some children are born of parents who are weak themselves, and who have led fast lives through business or pleasure and these parents have given their offspring a weakened body, and the children are handicapped with a nervous predisposition and furnish a considerable proportion of "nervous" patients.
2. Acquired.—It is acquired by continual worry and overwork, sexual indiscretion, excesses, irregular living and indiscretion in diet. A great many business men, teachers and journalists become "neurasthenics." It may follow infectious diseases, particularly influenza, typhoid fever and syphilis. It also follows operations sometimes. Alcohol, tobacco, morphine may produce a high grade of the disease, if their use is abused.
Symptoms.—These are varied. The most prominent symptom is fatigue. The patient feels so tired and complains of being unable to do any mental labor. It is almost impossible to put the mind on one subject for any length of time. There are headache, dizziness, want of sleep, and there is great depression of spirits; patient is gloomy, irritable in temper with manifestations of hysteria. Sometimes there are marked symptoms of spinal trouble. Pain along the spine with spots or areas of tenderness. Pains simulating rheumatism are present. There is frequently great muscular weakness, great prostration after the least exertion, and a feeling of numbness, tingling, and neuralgic pains. In spinal symptoms, there is an aching pain in the back, or in the back of the neck, which is a quite constant complaint. Then there are the anxiety symptoms in many cases. There may be only a fear of impending insanity or of approaching death, or of apoplexy, in simple cases. More frequently the anxious feeling is localized somewhere in the body, in the heart region, in the head, in the abdomen, in the thorax (chest, etc.). In some cases the anxiety becomes intense. They are so restless they do not know what to do with themselves. They throw themselves on the bed, complain, and cry, etc. Sometimes the patients become so desperate they commit suicide. Some patients do not wish to see anyone. Some patients cannot read, reading wearies them so much, or they get confused and dizzy and must stop. Some are very irritable. They complain of everything. Remember they cannot help it, usually. Some are easily insulted and claim they are misunderstood. The circulation may be disturbed in some cases. Then there is palpitation of the heart, irregular and very rapid pulse, pains, and feeling of oppression around the heart, cold hands, and feet. The heart's action may be increased by the least excitement and with the fast pulse and palpitation there are feelings of dizziness and anxiety and such patients are sure they have organic disease of the heart. No wonder. Flashes of heat, especially in the head, and transient congestion of the skin are distressing symptoms. Profuse sweating may occur. In women, especially, and sometimes in men, the hands and feet are cold, the nose is red or blue, and the face feels "pinched." Nervous dyspepsia is present in many cases. The digestion is poor and slow and constipation accompanies it. Sometimes there is neuralgia of the stomach. The sexual organs are seemingly affected, many men are "almost scared to death" and they use all sorts of quack remedies to restore their sexual vigor. Spermatorrhea is their bugbear. They usually get well if they stop worrying. In women there is the tender ovary and the menstruation may be painful or irregular. The condition of the urine in these patients is important. Many cases are complicated with lithaemia (sand-stone in the urine). It is sometimes also increased in quantity.
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PHYSICIANS' TREATMENT for Nervous Prostration.—The patient must be assured and made to believe that the disease is curable, but that it will take time and earnest help on the part of the patient. Much medicine is not needed, only enough to keep the system working well. Encouragement is what is needed from attendants. Remove the patient from the causes that produce the trouble, whether it be business, worry, over-study, too much social duties, or excesses of any kind. The patient must have confidence in the physician, and he must be attentive to the complaints of the patient. It is the height of foolishness and absurdity for a physician to tell such a patient before he has thoroughly examined him or her that the troubles are imaginary. I believe that is not prudent in the majority of cases. I have heard physicians talk that way to such patients. I thought, what fools! The patient needs proper sympathy and sensible encouragement. You must make them believe they are going to get well. If you do not wish to do this, refuse such cases, or you will fail with them. If there are any patients that need encouragement and kindly, sympathetic, judicious "cheering up," these patients are the ones, and they generally are "laughed at and made fun of" by people who should know better. Remember their troubles are real to them, and are due to exhaustion or prostration of the nervous system and this condition, as before described, produces horrid feelings and sensations of almost every part of the body. The patient must be made to believe that he may expect to get well; and he must be told that much depends upon himself, and that he must make a vigorous effort to overcome certain of his tendencies, and that all his power of will will be needed to further the progress of the cure.
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First, then, is rest.—Both mental and physical diversions, nutritious though easily digested food, and removal of baneful influences as far as possible. Physical exercise for the lazy. Rest for the anemic and weak. For business or professional men the treatment is to get away and far off, if possible, from business. It will often be found best to make out a daily programme for those that must remain at home, something to keep the mind busy without tiring, and then times of rest. The patient, if it is possible, should be away from home if home influences and surroundings are not agreeable. Dr. S. Weir Mitchell, of Philadelphia, has devised and elaborated a cure, called a rest cure, for the relief of this class of patients, and it is wonderfully successful especially in thin people. "Be the symptoms what they may, as long as they are dependent upon nerve strain, this 'cure' is to be resorted to, and if properly carried out is often attended with surprising results." "A bright, airy, easily cleaned, and comfortable room, is to be selected, and adjoining it, if possible, should be a smaller one for an attendant or nurse. The patient is put to bed and kept there from three to six weeks, or longer as may be necessary, and during this time is allowed to see no one except the nurse and doctor, since the presence of friends requires conversation and mental effort. The patient in severe cases must be fed by the nurse in order to avoid expenditure of the force required in the movement of the arms. No sitting up in bed is allowed and if any reading is done it must be done by the nurse who can read aloud for an hour a day (I have seen cases where even that could not be done). In the case of women, the hair should be dressed by the nurse to avoid any physical effort on the part of the patient. To take the place of ordinary exercise, two measures are employed, the first of which is massage or rubbing; the second, electricity. By the kneading and rubbing of the muscles and skin the liquids in the tissues are absorbed and poured into the lymph spaces, and a healthy blush is brought to the skin. This passive exercise is performed in the morning or afternoon, and should last from one-half to an hour, every part of the body being kneaded, even the face and scalp. In the afternoon or morning the various muscles should be passively exercised by electricity, each muscle being made to contact by the application of the poles of the battery to its motor points, the slowly interrupted current being used. Neither of these forms of exercise call for any expenditure of nerve force; they keep up the general nutrition. The following programme for a day's existence is an example of what the physician should order: