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?
PULSATILLA is neglected in Neurasthenia of men. It causes sensation in the back as if, it was tightly bandaged a very characteristic symptom, which may be mistaken for the girdle of Myelitis. It means simply an irritation of the posterior nerves, not inflammation. There is, too, in the Pulsatilla case, a peculiar sensation, aptly compared to a sense of sub- cutaneous ulceration. It is a sort of smarting.
Accompanying the backache is a general fatigue with heavy, tired aching, not relieved by repose. The patient feels weary in the morning, vying with Nux. Such a condition of the nervous system may be produced by dyspepsia, or by excess in venery.
The general condition of the patient is one of relaxation, with poor blood, defective animal heat and diminished motility. Pulsatilla, in large doses, at first excites the heart and circulation and then weakens the cardiac walls and relaxes the veins. Engorgements and varicosities follow; and hence the patient, despite his chilliness, is oppressed in a warm room. Autopsies on poisoned animals showed hyperaemia of the spinal meninges not an active congestion but a passive fullness of lax vessels. Hence arise numbness, crawling, going to sleep of the limbs, feeble heart’s action, etc.
As a “venous remedy”, Pulsatilla is nearly related to Hamamelis -is a drug much abused by the laity and much neglected by the profession. It causes dull backache, weakness of the limbs, with going to sleep of various parts of the body., and great languor. Seminal emissions give rise to dull pains in the loins and increase the weariness. If there are present, enlarged veins or soreness in the course of the blood-vessels, the choice of Hamamelis is certain.
SEPIA is another drug resembling Pulsatilla. It relaxes the tissues and favours stasis. The patient complains of aching in the lumbar region. Sense of sub-cutaneous ulceration. Soreness and pain in the sacral region. Dull heavy aching from sacrum to thighs. Weakness in the small of the back. Limbs go to sleep. Numbness after manual labour (like Phosphorus). Sensation as if, drops came from the bladder after urinating. Atony of rectum or bladder, urging even for papescent stool; urine is tardy on beginning to flow.
And here we may mention Sulphur, which has caused Paraplegia from spinal congestion. It produces violent bruised pain in the small of the back, down to the coccyx; weakness; formication; legs weak, numb, paralytic. Sudden violent jerks of the limbs as the patient falls of to sleep-a symptom of organic spinal affections, but also present in so-called functional disease. Abdominal plethora, Haemorrhoids, etc., very much like Nux and Sepia.
But in pure nervous weakness, we may expect good results from such remedies as the following:-
DIOSCOREA, excellent when weak back and weak knees follows seminal loss. Calcarea follows well. And Cobalt is a good substitute if the backache is markedly worse while the patient is sitting.
NYMPHAEA ODORATA claims attention for weak lumbar region, with weak bladder and weak legs.
ZINC has backache worse when sitting and from long walks. Legs weak, trembling; hungry at 11 A.M. with increase of spinal weakness. Small of the back weak, while walking. Muscular twitchings. Wine increases the pains and the nervous weakness. Violent pain in the small of the back when walking, steadily relieved by continuing to walk. Drawing in the back.
Aesculus Glabra and Aesculus Hippocastanum,, both cause paralytic weakness. The latter induces hyperaemia, with numbness, Pricking, tingling, great sacro-lumbar pain; and especially a paralytic weakness of the symphyses, making locomotion difficult or impossible. It may be that the Aesculus patient must display also irritation of the mucous membranes, catarrh, gastric disturbances and symptoms of Piles. But nervous symptoms, in Dr. Burt’s provings at least, were the first to appear.
This symptom of the symphysis calls to mind a much profounder remedy that Aesculus. We refer to Argentum Nit. Silver Nitrate impresses the nervous system most profoundly. At first, it irritates the sensory nerves and increase reflex excitability somewhat like Strychnia; but soon paretic symptoms appear, characterized by vertigo, unsteady gait, trembling, headache, etc. His legs feel weak, as after a long journey. The legs jerk during sleep. Pains in the small of the back, relieved when standing or walking. The lumbar region feels rigid, as if, put on the stretch; paralytic heaviness. Sacral region so painful that blowing or sneezing makes him start. Backache or rising, but not on walking. Symphyses weak, loose, as if, they would give way.
Inco-ordination is present, even in non-tabetic cases. In a restless, nervous state, he fails to judge of distances, and dodges projecting signs. etc. This is due in part also to the dizziness, which is constant. He staggers in the dark or when the eyes are closed. He is depressed in mind, gloomy, even to thoughts of suicide. He suffers from dull frontal headache, with nausea, irritations and burning in the stomach, with great prostration and restlessness. The heart beats irregularly with a faint feeling in the praecordia. Emotions increase the palpitation.
In other cases, somewhat akin to those suggesting Silver, Arsenic is the remedy. We must not neglect Arsenic in neuroses. Its irritating effects are noticed in nervous, as well as in other tissues. There are loss of strength in the small of the back; pain, as if, bruised; aching. Starting of the limbs when falling asleep. Legs uneasy, he cannot lie still, reminding us of the fidgetiness of Zincum met. Legs weak. Feet feel fuzzy, numb and cold; distressing general weakness disproportionately severe. Arsenic affects especially the lower portion of the spine.
This fuzziness suggests another drug. Alumina. pain through the lower vertebra as from the thrust of a hot iron. Bruised pain. Legs heavy, he can scarcely drag them; when walking he staggers. Nates go to sleep while sitting. Tension in legs Numbness of the heel on stepping upon the foot. Heaviness of the feet. Soles pain, when stepping upon them as though they were soft and swollen.
Rectum inactive, as if, paralyzed. Urine passes when urging to stool a very unphysiological condition, but very characteristic of the remedy.
Boenninghausen cured several cases of undoubted Locomotor Ataxia with Aluminium. But the drug is also applicable to Neurasthenia. Dr. T.F. Allen records cures with Alumina, His patients were tired, drowsy, unconquerable disposition to lie down. Impaired co-ordination. Loss of contractile power of the bowel, with lack of secretion and tendency to rupture of the haemorrhoidal vessels. Weak bladder. Fulminatory pains. Sudden jerks and starts from sleep.
Cocculus Indicus causes paralytic pain in the small of the back, with spasmodic drawing across the hips, preventing walking. Knees sink under him from weakness. The soles of the feet go to sleep while he sits, with sticking as from pains. Attacks of paralytic weakness, with pains in the back.
There is in Cocculus a peculiar combination of convulsive irritability with paralytic weakness, eminently qualifying the remedy for Neurasthenia. Like Strychnine its active principle Picrotoxine, causes tetanic spasms. But respiration is accelerated by the latter, not from spasm of the respiratory muscles only, but by spasm of the glottis and there is not the same over-susceptibility to touch in the two poisons. In the Cocculus, spasms tend more directly to Paralysis than in Strychnine; and we observe a speedily developed relaxation of tissues as shown in the empty, gone feeling in all the splanchnic cavities.
We find Cocculus needed, then, when any loss of sleep, any drain on the mental powers, or any loss of fluids, leads to speedy nervous exhaustion, combined with irritability. Thus, though sleepy, he is so nervous and weak that he cannot calm his brain. Though very tired, he is too restless to keep still.
Gelsemium is a priceless boon, the introduction of which is mainly due to the provings made by Dr. J.C.Morgan.
It causes dull pain in the lumbar and sacral regions. Weak back. Loss of muscular control, ending, in complete motor Paralysis. Every little exertion causes fatigue of the legs, with muscular soreness. The patient is languid, listless and drowsy.
In protracted sleeplessness from nervous exhaustion, it disputes the honors with Cocculus.
The various preparations of Peruvian Bark, though almost universally abused, nevertheless, are of inestimable value in anaemia with spinal irritation or exhaustion. No remedy equals China in weak back from loss of animals fluids, especially in rapid or excessive loss. With the weakness are usually evidences of over-sensitiveness; excessive tenderness of the surfaces, making the least touch unendurable; senses morbidly acute; restless and fidgety despite the tiredness and exhaustion.
CHININUM ARSENICOSUM caused a pressure in the “solar plexus” (usually felt only after eating tough meat or hard nuts, of which, however, the prover had not eaten) extending to the back, where it changed to a pinching sensation: spine painfully sensitive to touch at this point. Heart as if, it had stopped; no perception of its beating. Legs weary.
This “solar pressure” compares with the well-known China pressure, and seems like a genuine symptom. The weak heart is a very common accompaniment of Neurasthenia.
CHININUM SULPHURICUM, according to the confirmed provings of Otto Piper, causes an excellent picture of Neurasthenia; Despondency. Aversion to mental labour. Mental confusion. Lustreless eyes; dim vision; sensitive to the glare of light. Noises in the ears. Sickly expression. Oppression of the epigastrium from flatus; abdomen distended. Difficult stool from inertia. Urine contained phosphates. Sexual depression. Oppression of the chest with tenderness of third dorsal vertebra. Sticking in the apex of the heart. Sensitiveness of the last cervical and first dorsal vertebrae; dorsal most sensitive during the chill; limbs weak, feel bruised, feel numb and trembling on slight exertion. Sensation during stool as if, drops of fluid passed from right hand to shoulder. Emaciation. Weak and dull after a siesta. Excessive general sensitiveness of the body. Sleep unrefreshing. Sleepless. Chill, with tender dorsal spine. Heat of the face.
The only evidence that the drug causes sensitiveness of the lumbar vertebre is contained in the remark by the prover that during chill the dorsal vertebrae are more sensitive than either the cervical or the lumbar.
Finally, the sort of pain experienced is sometimes of importance. The pains of Neurasthenia simulate those of Ataxia, but are transient, usually less severe, and referred to the lumbo-sacral region only. Ipomoea helps, especially when they provoke nausea; Sulphur when there are transverse stitches; Natrum Mur. with cutting through the back: Zinc cutting down into the legs; Sepia pains go around like Pulsatilla, Berberis, etc., or down the thighs; Gelsemium when there is severe pain extending into the hips. Bruised sensation is common to nearly all. Tension is marked in Zinc, Nux vomica, Sulphur, Natrum Mur. and Valerian; while sensation of a band is very characteristic of Pulsatilla.
The lumbar spine is sensitive in Phosphorus, Agaricus, Bryonia, Lycopod., Pulsatilla, Sepia, Arsenic, Alumina.
Those who suffer from lumbar weakness should avoid tea, as it tends to increase the disease.