Almost every case which has come under the writer’s observation has been much hampered if not made hopeless by this condition of things, against which no remedy suggests itself that would not be construed as “unkind”.
The origin of this very formidable and refractory nervous disease, like that of most diseases usually termed chronic, is either hereditary or acquired, as the histories of every observed case plainly testify. Either the father was a hypochondriac or the mother neurasthenic, or both parents were of unsound nervous constitution. Dipsomania on the part of parents produces neurasthenia in the children, as readily as it will be followed by any other form of nervous disease, according to the individual predisposition of the offspring.
The excessive use of tea and coffee is another very active factor in the history of neurasthenics. Where fathers inclined to alcohol, mothers are addicted to tea and coffee, which, while its immediate effects do not obtrude themselves upon our notice, are none the less insidious in their more remote consequences.
The acquired forms of neurasthenia are of utmost interest to the therapeutist, and the sources of acquisition are readily stated. They are much brain-work with insufficient food and sleep. Such conditions obtain chiefly in women (less frequently in men) of fine intellectual ability, conscientiousness and ambition. Physical overwork with unintellectual women has no such effect.
Quite analogous to the above are the conditions of care and sorrow, especially in women who are able for a long time to conceal and control their emotions. The usual consequence of such states of mind is disregard of food and insufficient sleep. Instances of acquired neurasthenia are presented in families of several girls and boys, where one or more of the former are Neurasthenic while the latter are vigorous and athletic. Boys delighting in vigorous exercise do not, as is the case with girls, lose appetite and sleep.
The effects of nervous exhaustion in boys are usually much less grave than in girls; as a rule such effects are manifested in mental, not muscular, tiredness, and they are relieved by air and exercise, while in girls and women those influences are shunned because they seem to increase the tiredness.
Predisposition-The temperament, or what in modern pharaseology is called the personal equation, plays a visible but uncontrollable part in the progress of neurasthenia, as temperament greatly determines the other imperfectly known condition known as predisposition. Where the disease is hereditary, it is easy to say that the predisposition is due to that source; where there is no history of heredity and where neurasthenia exists in the last members of a generation, it may be attributed to acquired predisposition which needed only the exciting cause to establish the disease in its most typical form.
One of the most common forms of neurasthenia, often quite intractable, results from a serious defect in our public school system, one which affects chiefly girls from twelve to fourteen years of age. The following is a brief example: The child rises late with no appetite for breakfast and no time to eat it if so inclined. The lessons, however, have been learned the evening before, and the school work is begun with an ambitions will and a crammed mind, and continues with one intermission of often not more than ten minutes or three of four hours. The pupil arrives at home ravenously hungry, eats too fast, and too much of injudiciously prepared food, too long in digesting to leave room for an appetite for even a light evening meal, or even for a breakfast the next morning.
In another case the girl or boy grows desperately hungry while at school, but being unprovided with food (lunch), goes on with the school exercises, at the end of which the sense of hunger has vanished and has been replaced by an aversion to normal food, with a possible craving for something pungent and indigestible. This observation can easily be made in many instances, and will, in as many cases, be seen to lead to nervous prostration, which is then treated by vile, patented concoctions consisting largely of whiskey, under the name of “tonics,” while the patient needs only the best that a legitimate market affords prepared in a sensible manner.
Typical Cases Ending in Rapid Recovery.-Curative results have already been indicated in what has been said above, and further indications for treatment may be gathered from a few cases of extremely rapid recovery of apparently incurable cases, to which brief allusion will here be made. A woman of forty had been a victim of grave neurasthenia for five years. In the absence of an inclination to exert himself, she had, during that period, been mostly confined to her bed or lounge, in the meantime giving birth to two children, going through gestation and confinement normally, without recovering from neurasthenic prostration which, in the course of some years more, rendered her entirely helpless.
Her condition was associated with a feeling of dropping to pieces unless supported and braced by a harness of wood, iron and leather, in which she “sat up” for several hours each day, spending the rest of the time in bed. Having left the patient in this condition, it was reported before the writer’s next professional visit that Mrs.-had been cured, and that she was able to go out like other people. A visit to the house confirmed the report. The patient came to the door herself, and in a quiet manner, entirely without the least expression of joy or wonder at her release, stated, that having heard of a famous “magnetic physician,” she summoned him, was ordered by him to arise and stand; protesting that it was impossible, she was raised to her feet and again ordered to stand, then to walk.
Fearing that she would fall, she begged the magnetic doctor to support her, which he peremptorily refused, saying she might fall if she liked. Instead of falling, she had to walk about the room, was then placed upon a lounge and subjected to a severe treatment of rolling and pummelling, and then ordered to dress and sit up until tired, to remain up and about like other people, and to call on the doctor in future, as he would not come so far to the patient again.
This happened about twenty-five years ago, and the patient has been in very fair health arrested by insisting that all professional visits by the writer or any other physician to whose sympathy the patient could appeal must cease. This injunction was carried out conscientiously with the best results by the husband of the patient. Perhaps we may learn from this that sometimes, at least, the familiar motto is reversed, and angels rush in where fools fear to tread.
Profiting by this experience, another neurasthenic woman, unmarried, but of most intractable, antagonistic temperament, confined to her bed, in and out of hospitals, for years, wearing out the strength and means of her relatives and the patience of many physicians, was at length abandoned by them. It was a case of spinal and cerebral neurasthenia complicated with hypochondriasis in its most trying form of introspective maunderings and endless description of symptoms.
She tormented her advisers by her endless tirades, the indulgence of which invariably aggravated her condition, and were there fore avoided, until once her physician yielded to the patient’s importunities for a visit, when be found her in her usual abject state of prostration. Guided by experience derived from cases like the one first described, he assisted the patient to her feet and marched her, will you nil you, up and down the room until he, at least, was thoroughly tired, and then departed with the promise never to do so again. The patient, on her part, made a number of her unnameable promises, but kept on her feet and let the doctors alone.
Though not cured of deeply-rooted morbid mental faults, the neurasthenic phase of her condition had yielded to the change of the antagonistic element of her character from passive to very practical activity. A third very serious case of this kind occurred in the person of a girl of fifteen, of selfish character, who gradually became bed-ridden with spinal and cerebral neurasthenia, and tormented with the usual multifarious painful sensations, none of which, on the most pains-taking physical examination, resulted from demonstrable organic disease of genital or abdominal organs. The patient was most tenderly cared for by her mother, who, in the course of years, became so imbued with the idea of yielding to every wish and whim of the patient, that at length remonstrance became useless.
The mother, though recognizing the importance of persuading or urging her daughter to depend more on herself, admitted that she had yielded so long that now she must continue to feed, dress and assist her charge in the most trivial things. Her food had to be placed in her mouth, the position of a hand or foot changed by some one else, although patient did so spontaneously when she chose. This went on for fifteen years, when the mother, growing old and feeble, died. Her maternal support being gone, the patient at once proved her ability to walk, to dress, to feed herself, and to seek light employment. Though far from well, she is equally far fro being a helpless, bed-ridden invalid.
