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.