It is quite natural that Neurasthenia should manifest itself in those portions of the nervous system that are most vulnerable. And since the lumbo-sacral region is less fully supplied with blood than other parts, it suffers more from the consequence of nervous exhaustion.
Another reason why the small of the back is subject to numerous symptoms of disease, is because of its relation to several important organs, as well as to the functions of the lower extremities. Abdominal plethora, with consequent haemorrhoidal fullness, favors passive congestion of the lower spinal vessels; and a similar vascular relaxation often accompanies affection of the female genital organs. Sexual excess very naturally exhausts, first of all, those spinal centres which have to do with the genitals. And long or severe exercise of the legs induces backache and weakness in the lumbar region.
Still another factor in the interesting symptomatology of this region is fatigue from strain; as after lifting heavy loads, after violent gymnastic exercise, etc. The ligaments and muscles are overtaxed, and with them often the spinal cord itself. From this factor arises many symptoms common in scrofulous children, who suffer from spinal curvature. It also accounts for the prevalence of Lumbago in person of a weak nervous system.
Symptoms of the lumbo-sacral region may be considered under various heads, according to the particular nerves affected. The filum terminale ends at the first or second lumbar vertebra: below this point nerves go to the various tissues from the lower part of the gluteal region to the feet. Hence, here is included nervous control of the flexors, and extensors, and abductors and adductors of the lower limbs, of the anal and vesical sphincters, and of the genitalia.
We will take Nux Vomica as a typical remedy, and consider others in connection with it.
Nux Vom. is eminently suited to backache accompanying abdominal plethora, with Piles, constipation and urging to urinate. Pain, as if, beaten or bruised. Pains, worse at night; the patient must sit up in order to turn over from side to side. Back worse at 4 or 4 P.M.
Allopathic physicians hesitate to employ Nux if there is any spinal congestion, since they believe it may cause irreparable mischief (Hammond). But if the universal characteristic of the drug is present, we, who depend solely upon molecular action, can administer the remedy regardless of the status of the blood- vessels.
This universal characteristic is in harmonious action with the various functions of the body.
If we apply this to the symptoms accompanying lumbar Neurasthenia, we find: Stiffness of the legs, with tottering gait; trembling to the limbs, with sudden sensation of loss of power. Tension in the calves. Convulsive jerks of the legs. Ineffectual urging to micturition and to defecation not from atony, but from irregular, in co-ordinate action or from spasmodic constriction. If paralysis obtains, it is ever associated with evidences of irritation, such as violent jerks, great debility, but with over-sensitiveness to external impressions. All this arises from the well-known fact that Strychnie increases reflex excitability.
PHOSPHORUS, in many respects, is very similar to Nux.Vom. But increases impressionability. Both cause spinal Anaemia. But Phosphorus tends to a complete Paralysis. Nux generally to an incomplete Paralysis, depending upon exhaustion, though both have proved useful in spinal-softening.
Phosphorus causes: Nervous sensitiveness with weakness, most severe in the lower portion of the spine, in the region of the last lumbar vertebra and in the sacrum (very common seats of Neurasthenia).
Every trifling fatigue, or the carrying of even a light bundle, causes pains in the back. Pain at the union of the sacrum and last vertebra; worse, while standing, with numbness of the feet when pressing on the last two lumbar vertebrae. Small of the back weak and as if, asleep. Burning also, in small spots; better from rubbing. Back pains as if broken.
Legs feel weak; feel as heavy as lead, with numbness, trembling and coldness. Numbness increased by every exertion. Awkward, stumbling gait, not from clumsiness, but from sheer weakness.
Urination involuntary; passes during coughing or if the inclination is not immediately attended to. A similar weakness of the anal sphincter; stool involuntary, the moment faecal matter enters the rectum. Involuntary passages on the least motion, as though the anus stood open.
Sphincter weakness is not a common accompaniment of Neurasthenia, but in some cases it exists, and is manifested by slight prolapsus recti during stool, and by some dribbling after micturition. Phosphorus, then, stands, as it were in the borderline between spinal weakness and organic spinal disease. Dr. Hammond has observed involuntary urination as a precursor of Loco-motor Ataxia, manifesting the disease long before the appearance of any of the ataxic symptoms. It behoves us to remember this clinical fact, and to strive to cure all sphincter relaxations with the hope that we may be warding off incurable organic lesions.
Dribbling after micturition is found under: Agaricus, Selen, Helon, Graphites, Silicea, Calcarea carb. Natrum Mur. Picric Acid., Petroleum, Conium, Kali Carb. Cannab. Ind., Argentum Nit., Staphysagria.
SELENIUM is suitable to Neurasthenia from sexual excess, with dribbling of prostatic fluid and also of semen, both at stool, the latter also during sleep.
HELONIAS applies excellently to Neurasthenia when the lumbo- sacral region is weak and feels tired. Burning and aching. Feeling of numbness in the legs; numb feet while sitting. Feels tired all over, but better from motion or when the mind is occupied.
GRAPHITES is neglected in spinal disease. It is applicable to both sexes, to the male with impotence, to the female who, though obese, is really anaemic, with profuse leucorrhoea and weak back, and with delayed, scanty menses. The limbs go to sleep readily, and walking is difficult from muscular weakness. Sudden sinking of strength. Throbbing of the blood-vessels; rush of blood to the chest and head, but not from true plethora. The blood is watery and contains a relative preponderance of white corpuscles. Vertigo to falling, and faintness, in the morning. Spinal Anaemia, with pain, mostly noticed in the cervical region, but also noticeable in the lumbar region. The patient is cold from want of animal heat, and suffers from flatulency, as under all the Carbons, and also, from a herpetic, rough, rhagadic skin; eruptions oozing a sticky moisture.
NATRUM MURIATICUM, in its first effect stimulates the nervous system, causing muscular contractions very much like those induced by Galvanism. It also increases the red corpuscles, glandular secretion, digestion, etc. It is from this stimulating action that Salt is so effective when applied locally with friction to weak muscles, etc. Later, however,, Natrum Mur. exhausts the nerves, diminishes glandular activity, and develops asthenia and anaemia with emaciation. The skin is dry, harsh and sallow; mucous membranes are dry, cracked and glazed, with smarting and rawness, or with scanty, corroding discharges. Great complaints are made that the mouth is dry, when in reality the annoyance arises from the stickiness of the secretions; they are not normally fluid.
Now, from this atonic effect of Salt, we observe Spinal Neurasthenia. The small of the back feels paralyzed, especially in the morning, on arising. Back feels as if, broken. Legs weak, trembling; worse in the morning. Feet heavy as lead. With all this, it may readily occur that the bladder becomes weak: troublesome dribbling of urine after a normal stool. And we may admit this vesical symptom as a concomitant of spinal weakness, even though the prover had no such association, because such a combination is quite in keeping with the genius of the remedy. We may regard both spinal and cystic atony as a part of a general tendency in Salt to produce exhaustion, hence not as a symptom of Paralysis, but rather of Neurasthenia.
PICRIC ACID is a new claimant for recognition in spinal affections. Studied in its relation to the localities we are considering, we find that it causes heavy, dull pain in the small of the back; aching, extending into the legs; dragging sensation; tiredness; weak feeling in lumbar and sacral regions with excessive languor. Then, too, the legs are weak and heavy.
The prover who recorded dribbling of urine after micturition, suffered from a general tiredness from the least exertion; the mind was dull, so that he could read but little; mental work prostrated him. He suffered from occipital headache, throbbing in the cerebellum. In fact nearly all his head symptoms were occipital. He refers to morning erection, recurring on four successive days. His symptoms, then are just what we would expect from congestion of the spine; and they constitute a group worthy of consideration in the precursory stage of Loco-motor Ataxia to which Dr. Hammond refers. The tendency of the Picric Acid disease is rather to softening than to sclerosis. But if, as Dr. Hammond surmises, the involuntary micturition which precedes Tabes is due to congestion, why should not Picric Acid act in such a contingency?