Part 36

Causes.--It is frequently hereditary, and it has occurred through several generations. Women and members of nervous families are usually attacked. Many of the headaches from eye-strain are of this type, It is often inherited, and may last from puberty to the menopause. Some authors claim that decay of the teeth without toothache will cause it. Adenoid growths in the pharynx and particularly abnormal conditions of the nose will cause it. Many of the attacks of severe headaches in children are of this nature, and the eyes, nose and throat should be examined when children or older persons suffer from this complaint. Mental emotion, physical or mental fatigue, disorders of the female genital organs, eye-strain, etc., loud noises, toothache, act as predisposing causes. Some think it a poisonous condition due to the absorption of poisons from the stomach and intestines, and others regard it as a nervous condition due to anemia and all conditions which weaken the resistance of the nervous system.

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Symptoms.--The premonitory symptoms, which may last a few hours or a day or more, are sleepy feelings of discomfort, uneasiness, weariness, chills, vertigo (dizziness), disturbance of the sight or disturbances of the senses. The real attack may follow quickly, beginning with the characteristic headache, at first one sided, located in one spot in the temple, eye or back of the head, but spreading, as it increases in severity, until it involves all of one side of the head and occasionally both sides. The pain is usually constant and of great severity and it is increased by motion, noises, light, or mental strain. The skin over the painful part is very sensitive. There are loss of appetite, nausea and vomiting. If the stomach has a great deal of food in it, vomiting relieves the pain sometimes. In the spasmodic form the affected side is painful, the skin is cool, the pupil is dilated, and the flow of saliva is increased. In the paralytic form the affected side is flushed, hot, the vessels are dilated and the pupils are contracted. There is great weakness, prostration and depression. The urine may be abundant or suppressed, temporarily. The results of treatment in this disease are uncertain, as the attacks are likely to occur in spite of treatment. They usually cease in old age, and in women they may stop after the menopause. The attacks in women are likely to occur at or near the menstrual periods.

First Thing to do in Sick Headache.--It is well to remain in a darkened room away from noise, etc. If the head throbs and beats very hard, either a cold ice bag or hot applications often bring relief. A mustard plaster at the base of the brain with a hot foot-bath often helps. Some people by stroking the forehead and temples have the power to ease the pain, producing quiet and sleep. If the bowels are costive, salts should be taken to move them, or they can be moved by an enema, if salts are not at hand. If the stomach is full, or tastes sour, drink a lot of warm water and vomit, or produce vomiting by tickling your throat with your finger, after having taken a large quantity of warm water for sometimes warm water thus taken fails to cause vomiting. If there is no food in the stomach, but there is sour and bilious vomiting, the warm water will frequently help. For a sour stomach or when it is full of gas, a teaspoonful of baking soda in some hot water will often feel very pleasant and grateful. The patient should keep absolutely quiet after these are done, and often they fall into a refreshing sleep.

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EMERGENCY MEDICINES.--If anemia is the cause, give tonics such as iron and arsenic. If the patient feels faint and nauseated, a small cup of strong hot coffee gives relief, sometimes. Antipyrin, given early in doses of two and one-half grains often relieves. Take another dose in one-half hour if necessary. But such remedies are hard on the heart.

TREATMENT. Preventive in Sick Headache.--The patient is often aware of the causes that bring on an attack. Such causes should be avoided. A great many people who are afflicted with this trouble are not only careless in their eating, eating anything and everything and at all times--at meal time and between meals--but also careless in their habits of life. Patients should avoid excitement, like card parties, etc., staying up late, or reading exciting books. The meals should be regular, no food taken that is hard to digest. Pies, cakes, puddings, gravies, ham, pork, sausage, and fried foods must be avoided. Rich, greasy foods will not do for such persons to eat. Strong tea and coffee are bad. Plenty of water should be taken between meals. At meals it is better to take no water unless it is hot water. Every morning on arising it is well to drink a large quantity of either cold or hot water. This washes out the stomach, bowels and kidneys, and stimulates them to better perform their functions. The bowels must be kept regular, one or more passages a day and at a regular hour. Sometimes, especially in younger persons, the eyes are at fault and may need glasses. Frequently it is caused by overwork in school in young girls, especially during their menstrual periods. Social duties cause them in many women, and then strong tea or coffee, or headache powders, or tablets, are taken to keep up or to stop the pain, making the patient more liable to the attacks in the future; and then still more tea, coffee, and headache remedies are taken until the patient is a slave to the remedies taken to help her. A great many of these headaches can be helped by simple measures, and the time between the attacks, in about all cases, made longer if the patient will but work with the physician, not only at the time of the attack, but in the interval. The clothing should be comfortable. The feet should always be kept dry. This applies especially to neuralgia. In fact the above measures of prevention and care apply to all kinds of headaches and neuralgias. Prevention is worth more than the cure.

MOTHERS' REMEDIES. 1. Sick Headache, Hop Tea Will Relieve.--"Hop tea is very good if a good strong decoction is made. A wineglassful may be taken every half hour or hour until relieved." This is very easily prepared, as the hops may be purchased at any drug store.

2. Sick Headache, a Favorite Remedy for.--"Aconite liniment or aconite rubbed on the forehead will relieve the pain in the head almost instantly. One drop of the tincture of nux vomica in a teaspoonful of water every five or ten minutes will quickly relieve." Nux vomica is good only when the headache comes from constipation and stomach trouble and too high living.

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3. Sick Headache, Aromatic Spirits of Ammonia for.--"For a nervous headache there is nothing better for immediate relief than fifteen or twenty drops of the aromatic spirits of ammonia." This relieves the pain and quiets the nerves and stimulates the heart.

4. Sick Headache, Camphor Application for.--"A very simple but effective remedy is a cloth wet with spirits of camphor and sprinkled with black pepper applied to the head gives almost instant relief."

5. Headache, Soda and Peppermint for.--"One teaspoonful (level) of soda in two-thirds glass of hot water, add five or eight drops of oil of peppermint and a little sugar. Drink quite warm. This has been often tried and proven to be a success." The soda will relieve any gas in the stomach and the peppermint aids digestion and relieves sickness of the stomach.

6. Sick Headache, Lemon Good for.--"One lemon before breakfast will help to keep off sick headache. Have never found a remedy to cure sick headaches. A sack of hot salt will always help the pain." The lemon will help to tone up the stomach and the salt applied to the head will help the pain by relieving the congestion. It is always well to take a good cathartic after a spell of sick headache.

PHYSICIANS' TREATMENT for Sick Headache.--

1. Antipyrine 25 grains Citrate of Caffeine 10 grains Bromide of Potash 25 grains

Mix and make into five powders. One powder as needed. (You might take second one in three hours.) This is not good when it is bilious sick headache. In fact, it would make it worse. It is good for sick headache and neuralgia due to eye or nerve strain, but then the first remedy, antipyrine, can be left out. It is not needed. I would then put twice as much of the bromide of potash, fifty grains, and take a powder every two hours until better.

2. Citrate of Caffeine 1/2 dram (30 grains) Phenacetine 60 grains Bicarbonate of soda 60 grains Aromatic powder 12 grains

Mix and make twelve powders. Take one every three hours. This is good. Sometimes it is depressing on the heart for some people, due to the phenacetine. Acetanilid can be substituted in same dose.

(The homeopathic treatment is very successful in relieving spells of sick headache. See chapter on Homeopathy.)

3. Sodium Phosphate, taken every morning, about one-half to one teaspoonful in hot water. It is good for the bowels and liver.

4. Prescription for the Liver and Bowels in Sick Headache.--

Sulphate of soda 30 grains Salicylate of soda 10 grains Sulphate of Magnesia 1 grain Benzoate of Lithia 5 grains Tincture of Nux Vomica 3 minims Distilled water 4 ounces

This mixture should be made up in large quantity and placed in a siphon by one of the concerns which charge soda water, and from one-quarter to one-half a glass of this water, at ordinary temperature, is to be taken every morning at least one-half an hour before breakfast; enough being taken to insure an adequate bowel movement during the forenoon. This ought to be a good combination to use regularly.

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5. Dr. Hare gives the following recommendations. Probably no single source of pain compares in its frequency to headache, chiefly because it is essentially a symptom of diseases or functional disturbances.

It may come from constipation or eye strain, from brain disease, anemia, uremia, too much blood in the head, etc. In many cases a mild laxative to thoroughly empty the bowels is necessary. Sometimes the urine will be deficient in solids and liquids, so that the effete and poisonous material are retained in the blood, which produce headache. For such cases if the urine is acid, the frequent use of Vichy water, to which is added a little bicarbonate of potassium, about five grains to a drink, as a diuretic will prove of great service. If the urine is alkaline (and this you can tell by using a red litmus paper which will turn blue if it is alkaline) ten grain doses of benzoate of ammonium three (3) times a day are often useful.

NERVE TUMORS (Neuroma).--A morbid increase in the tissue-elements of the peripheral (the external surface) nerves.

Varieties. True and False Nerve Tumors.--True nerve tumors (neuromata) are composed of nerve-fibres provided with a medullary (marrow) sheath or of nerve tissue; false nerve tumors are composed of other structure than nerve tissue, are usually of secondary origin, extending to the nerve from nearby structures.

Symptoms.--The true nerve tumors may be hereditary or due to wounds or blows and amputation. They may give rise to no symptoms, or may cause intermittent pain. Pressure increases this pain, when the condition of the nerve fibre is interfered with. Loss of local sensation and power may develop. It is sometimes possible to feel the little nodular growths, and they can be seen when they are superficial. They may give no pain, or they may become very sensitive. They may become chronic and they are very liable to do so. Some of them may disappear.

PHYSICIANS' TREATMENT for Nerve Tumor.--The severe forms should be cut out; others can be let alone.

NEURITIS (Inflammation of the Nerves. Neura-Nerves; Itis-Inflammation. Inflammation of the Bundles of Nerve Fibres).--Nagel describes it as "an inflammation of the nerves of an acute or chronic nature, associated with more or less degeneration, change in the nerve fibrils of the affected nerves."

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Causes.--An injury to the nerves, frequent muscular strains, exposure to cold. Inflammation can extend to the nerve from adjacent inflamed structures. Pressure can cause it. Fractures of bones cause it by compression and it is also caused by infectious diseases, such as rheumatism, typhoid fever, syphilis, etc. In some cases it simply appears without apparent cause.

When the disease process involves the nerve sheaths and connective tissue structures in particular, an interstitial neuritis results; when the disease locates itself in the nerve fibrils it gives rise to "parenchymatous neuritis" (main part of the nerve is inflamed).

Simple Neuritis.--This means that a single nerve of a group of adjacent nerve trunks is affected. If a number of nerves are affected at the same time it is called Multiple Neuritis or Polyneuritis.

Causes.--(a) Exposure to cold. This is a very frequent cause, as for example, in the facial (face) nerve. (b) Traumatism,--that is, wounds, blows, injuries caused by fractures and dislocations; pressure from tumors, sleeping with the head resting on the arms. Pressure from crutches, "crutch paralysis." (c) Diseases involving the nerves due to extension of inflammation from nearby structures, as in neuritis of the facial nerve due to decay of the temporal bone.

Symptoms.--The constitutional or general symptoms are usually slight. The pain is the most important symptom, being of a boring in the parts to which it is distributed. This pain may be very distressing, or of a stabbing character, and is usually felt in the course of the nerve; or it may cause little inconvenience. Sometimes the skin is red and swollen over the affected parts. There is impaired nerve function and as a result of this the muscles supplied by these nerves become weak, and occasionally paralyzed. In severe cases they may become atrophied and an eruption often appears along the course of the nerve. Sometimes the hair and nails are not properly nourished, causing falling out or grayness of the hair and loss of the nails. This neuritis may extend from the peripheral (external) nerves and involve the larger nerve trunks or even reach the spinal cord. This rarely occurs in neuritis from cold, or in that which follows fevers; but it occurs most frequently in neuritis caused by blows, wounds, etc., (traumatic).

Duration.--This varies from a few days to weeks or months. If the primary cause can be remedied it usually ends in full recovery. Sometimes it is followed by the chronic form.

PHYSICIANS' TREATMENT for Neuritis.--The first thing to do is to try to remove the cause. Then absolute and continued rest of the affected part. If one has a sore hand it will be rested, if possible; so it must be with the sore and inflamed nerve.

For the Attack.--After having placed the part in absolute rest, moist heat applied to it frequently brings great relief. Sometimes a mustard plaster applied along the sore part does good. This produces a counter irritation and thus draws some of the congestion from the congested, inflamed nerve. Ice is more effective in some cases than heat. The bowels should be kept open daily with salts. Build up the general health with tonics; no alcohol can be used. If it shows a tendency to become chronic, use massage, electricity or change of climate. Atrophy (shrinking) of the muscles is likely to follow if the disease continues long and for this massage and electricity must be given.

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Treatment. Preventive.--A person who has once had neuritis must exercise all care to keep from taking cold or exposing themselves to severe cold winds and storms. Wet clothing will be apt to cause its return. Damp houses are bad. The climate should be dry and not changeable. There should be enough and proper kind of clothing to keep the body heat at the normal point. Plenty of rest and sleep are required. These cautions also apply to rheumatism and neuralgias.

Multiple Neuritis.--Other names: Polyneuritis, Disseminated Neuritis, Peripheral Neuritis. Meaning--Multiple neuritis is an inflammatory disease of the peripheral (toward the end of the nerves or external nerves) nervous system. It varies much in extent and intensity and affects symmetrical parts of the body.

Varieties.--These arise from differences in the nature, causes, severity and location of the disease process.

Causes.--They are many. (1.) The poison that comes from infectious diseases such as typhoid fever, diphtheria, smallpox, leprosy, la grippe, etc. (2) From poisons such as alcohol, lead, arsenic; phosphorus, mercury, coal gas, etc. (3) From anemia, cancer, tuberculosis, syphilis, septicemia, diabetes. (4) From cold, over-exertion, etc.

Symptoms.--Acute febrile multiple neuritis. A typical case: This comes on from exposure to cold, over-exertion, or in some cases spontaneously. There are chills, headaches, pains in the back, limbs and joints, and the case may be called rheumatism. Loss of appetite, coated tongue, constipation, and other symptoms of stomach and bowel trouble. The temperature rises rapidly, and may go to 103 to 104 degrees. The limbs and back ache, but intense pain in the nerves are not always constant. The pain is usually sharp, severe, and located in the limbs, and is worse from moving and pressure. There are tingling feelings in the hands, feet and body, and a feeling as if ants or insects were crawling over them, and there is also increased sensitiveness of the nerve trunks or entire limb. There is loss of muscular power, first marked, perhaps, in the legs, and it extends upwards and reaches the arms. Sometimes it first begins in the arms. In typical cases the extending muscles of the wrist and ankles drop. (Wristdrop and foot-drop). In severe cases there is a general loss of muscular power, producing a flabby paralysis. This may extend to the muscles that control speaking, swallowing and hearing resulting in impairment of these functions. The muscles soften and waste away rapidly. Disorders of nutrition are frequent, like watery swelling (oedema), glossy looking skin, sweating, hives, etc.

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Recovery.--The course of the disease varies considerably. In mild cases the symptoms disappear very soon. In the worst form the patient may die in a week or ten days. As a rule, in moderately severe cases after persisting for five or six weeks, the condition remains about the same for a few months, and then improvement slowly begins and recovery takes place in six to twelve months. In neuritis from alcohol drinking there is a rapid onset as a rule, with delirium and delusions. The result is usually favorable and after persisting for weeks or months improvement gradually begins, the muscles regain their power, and even in the most desperate cases recovery may follow. The mental symptoms are very severe in alcoholic cases. Delirium is common. It takes much longer for such cases to regain what they call their normal condition.

Neuritis following diphtheria and other infectious diseases. The outlook in cases from these diseases is usually favorable, and except in diphtheria, fatal cases are uncommon. It is most common from diphtheria. Recovery, in neuritis from diphtheria, takes place in about three months, but some cases are fatal.

Neuritis from lead.--The first symptoms are those of intestinal colic, lead line on the gums, "dropped-wrist." The recovery is quite gradual and the poison may be cast out in three to four months.

In Neuritis from Arsenic.--We have disturbance of the stomach and bowels first, then the legs and arms are about equally affected, weakened; may recover in two to six months.

Treatment for acute kind.--The first thing to do is to rest in bed and control the pain and acute symptoms. Hot applications help to relieve the suffering. Patient must be kept comfortably and constantly warm and quiet. Hot applications of lead water and laudanum.

Medicines.--It may be necessary to use morphine to control the pain. Remedies such as antipyrine or aspirin are often used. A physician must be called. When the disease is caused by arsenic and lead and alcohol, of course you must remove the cause before you can hope for any improvement.

Caution.--Any one can readily understand from reading this description that the thing to do is to be careful not to needlessly expose yourself to taking cold. One subject to rheumatism or neuritis, even in small degree, should take care not only not to take cold but not to overdo in laboring; cold, wet and over-exertion cause the majority of the acute attacks. But some are caused by diseases, such as diphtheria, typhoid fever, etc., and a great many cases of neuritis following these and other infectious diseases can be avoided if proper care is taken during and after these diseases. Such care can easily be taken. Keep your rooms warm and comfortable, and the patient in bed or in a comfortable room until all danger is past. How often I have heard a doctor blamed for such results when in most cases it is the patient's or nurse's fault. Certain results will follow certain diseases and only proper care can keep such results from following. Dropsy frequently follows even a light case of scarlet fever. Why? Simply because, on account of being a light case, the child is left to roam at will about the rooms and catches cold, takes la grippe. If people would only take care of themselves this disease would not leave so many lifelong victims. I have seen men and women who have just recovered from this disease stand on the street corners on a cold, damp day, and talk an hour, and the next day they wondered how they could possibly have taken cold. We cannot disobey the laws of nature safely. Persons who are subject to neuritis or rheumatism should be especially careful on cold, damp, wet days and of over-exertion.

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GENERAL AND FUNCTIONAL BRAIN DISEASES. NERVOUS PROSTRATION. NERVOUS EXHAUSTION. NEURASTHENIA.

NERVOUS PROSTRATION.--Is a condition of weakness or exhaustion of the nervous system, giving rise to various forms of mental and bodily inefficiency.

Causes. 1. Hereditary causes.--Some children are born of parents who are weak themselves, and who have led fast lives through business or pleasure and these parents have given their offspring a weakened body, and the children are handicapped with a nervous predisposition and furnish a considerable proportion of "nervous" patients.

2. Acquired.--It is acquired by continual worry and overwork, sexual indiscretion, excesses, irregular living and indiscretion in diet. A great many business men, teachers and journalists become "neurasthenics." It may follow infectious diseases, particularly influenza, typhoid fever and syphilis. It also follows operations sometimes. Alcohol, tobacco, morphine may produce a high grade of the disease, if their use is abused.