A system of practical medicine. By American authors. Vol. 5

by Unknown

When nervous exhaustion has been produced by over-use of any one organ or system of organs, absolute rest of such organ is a primary necessity. Thus, when there has been sexual excess absolute avoidance of use of the sexual organs must be enjoined, and in married Americans it is often essential to insist upon man and wife occupying distinct apartments¹ or even to separate them by a journey.

¹ Because in this country man and wife habitually occupy one bed. Sexual continence under these circumstances can only be obtained at the cost of a suppressed sexual excitement worse than moderate indulgence.

Again, in cases of brain-tire it is the brain which should be rested. To rest an overwearied, excited brain is often not an easy task. In attempting it the effort should be to obtain the following results: 1st. The removal of all cares, anxieties, and all brain-work, especially those of such character as have been connected with the breakdown. 2d. The maintenance of the interest of the patient, so that the past shall for the time being be forgotten, and the present not overweighted with irksomeness. 3d. Invigoration of the physical health of the whole body, and especially of the nervous system. In order to obtain the first of these measures of relief, isolation of some sort is essential; for the second mental occupation is usually required; for the third fresh air, exercise, or some substitute is to be superadded to abundant food and rest.

The proper method of meeting these indications varies greatly, not only with the varying physical conditions and idiosyncrasies of patients, but also with their diverse domestic and pecuniary relations. To give detailed directions for every case is impossible, and I shall therefore limit myself first to simple cases of brain-tire in which the muscular strength is preserved; second, to cases of profound general neurasthenia.

In brain-tire travel is usually recommended, and travel affords, when properly directed, separation from old cares and thoughts, a maintenance of interest by a succession of novel sights and experiences, and the physical stimulation of fresh air and exercise. In bad cases general travel is too stimulating, and ocean-voyaging is much better. Upon the ocean is to be found nothing provocative of thought, only complete isolation, fresh air, enjoyment if the patient be fond of the sea, and a sufficient exercise, especially if the sufferer in any large measure works in the management of a sailing vessel. Hence prolonged yachting affords in many cases our best method of relief. The isolation of the North Woods or any other large primeval wilderness may be complete, the air most fresh, and the exercise to be had also boundless, but at the same time controllable; the man may, according to his will, lie in his tent and be fed by his guide or be unceasingly active. If the life be agreeable to the sufferer, and sufficient care against undue exposure be exercised, the camp-cure is most efficient. European travel may serve almost equally well, provided hard journeying, sight-seeing, and even cities are avoided. The quiet of Switzerland or the Tyrol may bring restoration when the bustle of London and Paris might complete the ruin.

To those who cannot travel extensively the seashore, mountains, or lowlands of the United States are open, and the best way of meeting the indications in any individual case must be determined by a joint consultation between doctor and patient.

There are cases of neurasthenia in which the slightest exercise does harm, and in which even the unconscious effort of company and conversation is an injury. Between the extremely exhausted and the slightly brain-tired is every grade of case, and much tact is often required in properly regulating the treatment of the individual case.

It is only the most severe forms of neurasthenia which require the use of the so-called rest-cure. For such, however, it is a very valuable method of treatment. It finds its most brilliant application undoubtedly in neurasthenic women, but, more or less modified according to circumstances, it has a wide scope in the treatment of both sexes. When the bodily condition is developed by prolonged lactation, nursing, grief, overwork, acute disease, or other temporary or removable cause, the rest-cure may give permanent relief; and even when the cause of the neurasthenia is largely inherited feebleness of constitution, it is a valuable though a more temporary remedy. This method of treatment has long been used in this city, and was especially dwelt upon in its general scope by Samuel Jackson, but in its modern form it has become a very valuable method of treatment, essentially different in its details from what it was formerly, and far more potent in its influence. To S. Weir Mitchell is due a great debt of gratitude, for by him has this improvement been made.

The principles of the rest-cure are absolute rest, forced feeding, and passive exercise. Absolute rest is often prescribed by the physician without being sufficiently definite and insisted upon. When it is desired to apply it most strictly, it should be clearly explained that the patient is not to be allowed to get out of bed even to pass urine or feces, not to feed himself or herself, or perform any act of the toilet whatsoever. The rest also must be for the mind as well as for the body, and it is essential that the patient be isolated. Separation from friends should especially be insisted upon in the case of women. It may be possible to separate a man in his own house completely from his daily cares, but a woman in her own house is in the midst of her daily business, and is like a man placed in the corner of his factory. In obstinately severe cases of neurasthenia complete and absolute isolation is a sine quâ non, and especially when there is a decidedly hysterical element is it necessary to separate the patient entirely from her friends. Under these circumstances there must be a well-trained nurse who is personally agreeable to the patient. The confinement would be very irksome to any except the most exhausted patient were it not for the daily visit of those engaged in the treatment; to further provide against ennui the nurse should be a good reader, so that under the definite instructions of the physician she can occupy a certain portion of the time in reading to the patient.