It will thus be seen that nervous prostration may exist independently of pelvic lesions, or, conversely, pelvic lesions may exist independently of nervous prostration. Nevertheless, the two are frequently associated, and this fact ought, I believe, to be kept in mind in dealing with the affection known as neurasthenia. Hysterical manifestations nearly always come to the surface in nervous prostration, and they also frequently attend pelvic lesions.
Indeed, the term “hystero-psychosis” has been coined for the purpose of defining certain psychical disturbances of presumably pelvic origin, and in the broadest sense neurasthenia is not uncommonly an hysteroneurosis. It is the frequent association of these three conditions which, it seems to me, makes it more practicable to study them conjointly.
The special symptoms of nervous prostration are most variable. Introspection, as Dr. Wesselhoeft has pointed out, makes of the patient a nosomaniac. The anaemic nerve centres are unduly impressionable, and a mental shock which would not seriously affect a stronger and more rugged woman falls with crushing force upon one whose nutrition is already depraved.
In this way are developed disorders of sensibility, alternations of mobility, circulatory disturbances, anomalies of secretion and exertion, disorders of the gastro-intestinal canal, dermatoses, and general and psychical disturbances of all kinds. Many of these affections start from pelvic lesions, and are nearly always associated with depravity of nutrition and more or less nervous prostration.
Some of the worst symptoms of neurasthenia with which I have had to contend have been hyperaesthesia of the articulations, giving rise to the so-called “hysterical joint.” Here the prostration is usually not profound, and it is possible to apply the somewhat energetic treatment recommended by Dr. Wesselhoeft. I remember one case very distinctly, the detailed history of which I shall give in another place, which brought me much reputation because of the “remarkable” cure I was fortunate enough to make.
The patient, a beautiful girl of eighteen, had been bed- ridden for three years with supposed hip-joint disease. She was in college before assuming the ride of an invalid, and worried much over her studies and work. She sustained a fall a short time previously to taking to her bed, and to this fall the injury to the hip was attributed. She had been from physician to physician and from sanitarium to sanitarium without receiving benefit. All of the numerous medical men under whose care she had been, directed their attention to the hip and applied the classical treatment for morbus coxarius without avail.
The patient had finally reached a point where introspection was her chief occupation and her mind dwelt almost continually upon a “diseased hip.” She was finally brought to me, coming in an invalid’s chair and looking the very picture of dependency. There was a slight degree of anaemia, though this was not marked. Notwithstanding the expression expression of abjectness the girl did not look seriously ill. The hip was excessively tender upon pressure, but there was no local increase of temperature, no evidences of fever and suppuration, and forcible apposition by striking the heel was not very painful.
More less spastic contraction of the flexor muscles of the affected side existed, which gave to the limb an appearance of actual shortening, which was very deceptive. Hysterical symptoms were common. On examination I found the left ovary exquisitely tender. Compression of the ovary increased the pain in the hip most decidedly and gave rise to much nervous agitation. I did not, therefore, deem it wise to recommend local treatment other than the daily use of the hot douche. She had long been a victim of ovarian dysmenorrhoea.
I placed upon the ankle of the affected limb three pounds of bar-lead, prescribed a pair of crutches and insisted upon her walking. The lead was used to overcome the spastic contraction as well as for its moral effect. I did not deem the joint lesion of such a character as to used extension. In two months’ time this patient discarded her crutches for a cane. Six weeks later she put up the cane and is now perfectly well.
This was a case in which somewhat harsh measures were eminently appropriate.
In marked contrast to the case just recorded is the following: Mrs.-, aet. 47, widow for twenty years. She is a devoted church-woman, and for years was a leader in all charitable work done in the community in which she resided. Through friends she was urged to consult me, and I think that the call to the neighboring town in which she lived was countermanded at least four or five times before the finally mustered up courage and strength enough to see me. Upon reaching the bedside I found my patient in a room made dark by closed blinds, over which were hung heavy blankets to shut out every ray of light. The mirror was turned toward the wall for fear a ray of light might strike it and flesh throughout the darkened room.
Nor did the patient rest under these extreme precautions, for the eyes were protected with two pairs of colored glasses with side attachments. Hyperaesthesia of the sense of hearing was equally marked and the noise was excluded from the room by double doors whose keyholes were stuffed with cotton. She l so had her ears filled with cotton, over which she wore ear-mufflers. She was emaciated to an extreme degree, and had been reduced to her miserable condition by a series of events which frequently precede profound neurasthenia. Her husband was killed during the war, and she was left childless. Twelve months previous to taking to her bed she nursed her mother through a long and fatal illness.
This greatly prostrated her, yet she kept up until a favorite brother-in-law was thrown from a carriage and killed. This was the last straw, and the shock compelled her to take to her bed. In due time loss of appetite with irritability of the stomach developed, which, of course, led to marked depravity of nutrition. With the anaemia came hyperaesthesia of the special senses, spinal irritation, headache, hysterical manifestations, etc.
There was no series pelvic lesion, although she had been much treated for an alleged uterine displacement with congestion. Unfortunately, she was encouraged, instead of discouraged, in her invalidism, and she soon became a nosomaniac of the worst type. She had written down her symptoms one at a time, and the record is such a typical one that I should like to give it in full, but time forbids.
With great difficulty the patient was moved on a cough to a private hospital and placed under the Weir Mitchell treatment. I ignored the pelvic trouble entirely. It is unnecessary to give in detail the progress of the case from day to day after this treatment was inaugurated. Suffice it to say that the improvement was of the most marked character, and in six weeks from the time she entered the hospital she walked to her carriage with her eyes and ears unprotected. She soon resumed her church and charitable work, in which she again takes much delight.
This woman wanted to get well. She was a woman of pure motives and high ideals. She had, in the language of Dr. Wesselhoeft, the wish, but, unaided, not the will. She required the aid of an intelligent, strong-minded, nurse who could bring to her exercise applied in such a way as to enable her to assimilate food without the expenditure of nerve force. She co- operated with her physician and nurse in every possible way, and as soon as the anaemic nerve cells became flushed with new blood she began to improve.
To have commanded this patient “to take up her bed and walk” before improving her nutrition would have been as unscientific as to have placed the first patient in bed with extension and counter-extension applied to the limb. I know of no class of cases requiring for their successful treatment more tact and discrimination than that under consideration.
I feel confident that I have many times cut the affection short in its prodromal stage by removing the girl from college work and insisting upon open-air exercise. Static electricity has, in my hands, proved exceedingly useful both during the prodromal stage and that of convalescence.
I will conclude by saying that I have been impressed with the frequency with which an hereditary history of epilepsy has been met with in the cases of neurasthenia passing under my observation.
