WHEN, thirty-five years ago, the writer first made the acquaintance of what is now called neurasthenia, it was known as spinal irritation, and the best of modern researches have been unable to give a better definition beyond a functional disturbance of the spinal and cerebral nerves, dependent on a morbid process, for which “irritation” is as proper a term as any.
As deaths do not occur, autopsies throw no light on the subject. Briefly stated, neurasthenia, when observed from the beginning through its chronic course, has a period of prodromal symptoms followed by a protracted acute, and succeeded by a still more protracted chronic, state, between the end of which and the beginning of convalescence there is a very vague, often indiscernible, boundary line.
The prodromal symptoms are quite indefinite and very variable, pointing to nothing in particular. Loss of appetite, irregular sleep, excitability alternating with lassitude, etc., are often overlooked, especially when the second stage-display of unusual mental and physical energy without subsequent fatigue- becomes apparent. This is often mistaken for a sign of unusually good health. When a young girl or mature woman, married or unmarried, feels that she can study ten hours a day and devote half of her night to pleasure or business; when besides much mental occupation she begins to rejoice in long walks without fatigue, that is the time when the mischief is going on without exciting timely suspicion.
Relief is at last sought when the functional disorder of the nerves has gone to the opposite extreme, and becomes manifest in what is properly and popularly termed “nervous prostration,” when instead of having no sense of fatigue, the best bodily or mental effort seems intolerable, in grave cases rendering the patient a helpless being, completely dependent on the unremitting assistance of others whom she )it is usually a woman) rules with the inexorable power of the vis inertiae.
During this usually very protracted period of the disease convalescence usually sets in, but so imperceptibly that the physician alone can sometimes estimate its progress, which is unnoticeable to others towards whom the patient acts as she has for months or years. This is the time for action, too often delayed from motives of misplaced sympathy on the part of relatives and friends.
The affections is in many instances limited to the spine, the mind becoming only secondarily tired. In other cases it is spinal and cerebral; in others again chiefly cerebral. The line between this and insanity is always clearly definable. Though a neurasthenic patient may become insane, and probably the reverse, yet both are distinct conditions.
Books speak of this disease at common to men and women. Yet in this region in small towns as well as in large cities the cases of neurasthenia in women are preponderatingly great.
Hypochondriacs and hysteria stand in peculiar relation to neurasthenia. They maybe regarded as different species of the same genus; that is, more or less deeply seated disturbances of the cerebro-spinal system in which the sympathetic system is probably indirectly involved, as many functional disturbances presided over by the great sympathetic system often testify. Hypochondriasis, pure and simple as occurring in men, is easily distinguishable by its striking characteristic of introspection and despondency, occasioned by abnormal sensations, without marked physical weakness and tiredness.
Pure hypochondriacs are often energetic, conscientious workers. In hysteria there is neither great tiredness nor tendency to introspection, but a paroxysmal or prolonged absence of the power of self control, in grave cases associated with tonic or clonic muscular spasm and loss of consciousness. While neurasthenia in its uncomplicated forms is free from these symptoms, but, as ample experience teaches, often complicated with both of the preceding forms to such an extent that it is often very difficult to tell which is primary and which secondary. The symptoms known as introspection, hysterical aberrations of the emotions, and neurasthenic sense of exhaustion are in their distinctive manifestations most important and constitute indications in the selection of remedial and dietetic measures.
The following are some observation of peculiarities observed in a large number of cases and peculiar to all:.
Introspection.-The neurasthenic patient in variably expresses her desire for relief, not so much in a direct appeal as in a supplicating, subdued tone of voice and manner. She rarely asks, “What can you do to relieve me?” but almost invariably, “What is the cause of” this or that sensation? If she is introspective, that is, hypochondriacal, she becomes a nosomaniac, watching acutely every one of her numerous distressing sensation, on the unremitting analysis of which her mind dwells.
In marked cases she is quite unable to think of anything outside of herself, and in many cases dislikes to do so, preferring to river her attention on herself. Attempts to divert her annoy or anger her. Friends and relatives implore the physician to divert the patient, but all their attempts are in vain because quite misdirected.
Positive and Negative Will.-It seems sometimes as if the patient delights in her self-inspection, and that she prefers her condition to speedy recovery. This is not the case, for the patient will always assure the physician of her wish to get well. During the acute stage-a long yet definable period-this wish and longing cannot well be utilized, but the long and ill-defined period of convalescence must first be awaited.
Here we shall always discover that the wish and the will of the patient are two very different mental conditions. The desire or wish for recovery is entirely unattended by any will effort to accomplish the desired end. The injunctions and directions of the physician are resisted by the same unconquerable power of negative power, or vis inertiae. The patient having been unable to exert her will, now thinks herself unable to use it.
Numerous Symptoms of Patients.-To physicians in search of indications for medicines each statement of patient concerning a sensation is apt to be considered as a symptom. Many years ago, when resolved to get at the keynote of a patient’s case, the writer determined to allow the patient to detail all her symptoms as long as she chose and to take accurate notes of each one till the right one should be disclosed; and this was to be done regardless of time and exertion.
The patient, one who needed no urging to describe her “symptoms,” began in an almost inaudible voice, detailing one sensation after another with an unrivalled degree of clearness and vividness of expression; as she proceeded the voice became stronger, her face slightly flushed, and the most perfect descriptive language flowed in an endless stream. Each word was written down, page after page was filled; still she went on with unmistakable signs of satisfaction at being able to pour her pent-up emotions into willing and sympathetic ears. If, for a moment, the flow of language was interrupted, a simple question would re-animate her to proceed with renewed energy.
Feelings seemed to beget feelings; their complexity gave the patient no trouble; her intellect was equal to the action of unraveling the most complicated sensation, separating them into their component parts and spreading them out before the mind of the listener. A glance at the watch showed that nearly two hours had passed, during which the feeblest of neurasthenic patients had talked incessantly. The note-book was full, the keynote was found. It was this: neurasthenic patients have innumerable sensation and exhibit no sings of fatigue after talking incessantly for nearly two hours.
Great Endurance of Neurasthenics.-The instance just related, which is one of many, illustrates two things. One is, that it is not the kind of sensation described but the fact that neurasthenics have innumerable sensations, that constitute the symptoms. The other thing is that many neurasthenics are capable of great exertion without suffering disagreeable after- effects from fatigue.
This is illustrated by other cases of which I have notes. A highly neurasthenic young lady consented to camp out for her health near a lake. She was induced to join a party for a short walk along the lake. By trying what they thought a shorter road the party lost their way and took a very long walk of about four hours, through bogs and over forces. The neurasthenic was less fatigued than some of the others. The interesting observation was subsequently made that the patient had become interested in a young man of the party. She recovered her health within a year from that time. Other cases of this kind will appear under the head of therapeutic suggestions.
Neurasthenic Patients Crave Sympathy.-This is one of the most formidable obstacles to the curative management of such cases, for the kind of sympathy such patients crave is expressions of condolence and more or less deep affliction at so much suffering as the patient expresses. Such sympathy is most natural and does honor to the feelings of parents, sisters, brothers and husbands, but it is unfortunate that the deeper their expression of affliction so much the more profound will be the mental dejection and weakness of the patient.
