Part 37

Symptoms.--These are varied. The most prominent symptom is fatigue. The patient feels so tired and complains of being unable to do any mental labor. It is almost impossible to put the mind on one subject for any length of time. There are headache, dizziness, want of sleep, and there is great depression of spirits; patient is gloomy, irritable in temper with manifestations of hysteria. Sometimes there are marked symptoms of spinal trouble. Pain along the spine with spots or areas of tenderness. Pains simulating rheumatism are present. There is frequently great muscular weakness, great prostration after the least exertion, and a feeling of numbness, tingling, and neuralgic pains. In spinal symptoms, there is an aching pain in the back, or in the back of the neck, which is a quite constant complaint. Then there are the anxiety symptoms in many cases. There may be only a fear of impending insanity or of approaching death, or of apoplexy, in simple cases. More frequently the anxious feeling is localized somewhere in the body, in the heart region, in the head, in the abdomen, in the thorax (chest, etc.). In some cases the anxiety becomes intense. They are so restless they do not know what to do with themselves. They throw themselves on the bed, complain, and cry, etc. Sometimes the patients become so desperate they commit suicide. Some patients do not wish to see anyone. Some patients cannot read, reading wearies them so much, or they get confused and dizzy and must stop. Some are very irritable. They complain of everything. Remember they cannot help it, usually. Some are easily insulted and claim they are misunderstood. The circulation may be disturbed in some cases. Then there is palpitation of the heart, irregular and very rapid pulse, pains, and feeling of oppression around the heart, cold hands, and feet. The heart's action may be increased by the least excitement and with the fast pulse and palpitation there are feelings of dizziness and anxiety and such patients are sure they have organic disease of the heart. No wonder. Flashes of heat, especially in the head, and transient congestion of the skin are distressing symptoms. Profuse sweating may occur. In women, especially, and sometimes in men, the hands and feet are cold, the nose is red or blue, and the face feels "pinched." Nervous dyspepsia is present in many cases. The digestion is poor and slow and constipation accompanies it. Sometimes there is neuralgia of the stomach. The sexual organs are seemingly affected, many men are "almost scared to death" and they use all sorts of quack remedies to restore their sexual vigor. Spermatorrhea is their bugbear. They usually get well if they stop worrying. In women there is the tender ovary and the menstruation may be painful or irregular. The condition of the urine in these patients is important. Many cases are complicated with lithaemia (sand-stone in the urine). It is sometimes also increased in quantity.

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PHYSICIANS' TREATMENT for Nervous Prostration.--The patient must be assured and made to believe that the disease is curable, but that it will take time and earnest help on the part of the patient. Much medicine is not needed, only enough to keep the system working well. Encouragement is what is needed from attendants. Remove the patient from the causes that produce the trouble, whether it be business, worry, over-study, too much social duties, or excesses of any kind. The patient must have confidence in the physician, and he must be attentive to the complaints of the patient. It is the height of foolishness and absurdity for a physician to tell such a patient before he has thoroughly examined him or her that the troubles are imaginary. I believe that is not prudent in the majority of cases. I have heard physicians talk that way to such patients. I thought, what fools! The patient needs proper sympathy and sensible encouragement. You must make them believe they are going to get well. If you do not wish to do this, refuse such cases, or you will fail with them. If there are any patients that need encouragement and kindly, sympathetic, judicious "cheering up," these patients are the ones, and they generally are "laughed at and made fun of" by people who should know better. Remember their troubles are real to them, and are due to exhaustion or prostration of the nervous system and this condition, as before described, produces horrid feelings and sensations of almost every part of the body. The patient must be made to believe that he may expect to get well; and he must be told that much depends upon himself, and that he must make a vigorous effort to overcome certain of his tendencies, and that all his power of will will be needed to further the progress of the cure.

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First, then, is rest.--Both mental and physical diversions, nutritious though easily digested food, and removal of baneful influences as far as possible. Physical exercise for the lazy. Rest for the anemic and weak. For business or professional men the treatment is to get away and far off, if possible, from business. It will often be found best to make out a daily programme for those that must remain at home, something to keep the mind busy without tiring, and then times of rest. The patient, if it is possible, should be away from home if home influences and surroundings are not agreeable. Dr. S. Weir Mitchell, of Philadelphia, has devised and elaborated a cure, called a rest cure, for the relief of this class of patients, and it is wonderfully successful especially in thin people. "Be the symptoms what they may, as long as they are dependent upon nerve strain, this 'cure' is to be resorted to, and if properly carried out is often attended with surprising results." "A bright, airy, easily cleaned, and comfortable room, is to be selected, and adjoining it, if possible, should be a smaller one for an attendant or nurse. The patient is put to bed and kept there from three to six weeks, or longer as may be necessary, and during this time is allowed to see no one except the nurse and doctor, since the presence of friends requires conversation and mental effort. The patient in severe cases must be fed by the nurse in order to avoid expenditure of the force required in the movement of the arms. No sitting up in bed is allowed and if any reading is done it must be done by the nurse who can read aloud for an hour a day (I have seen cases where even that could not be done). In the case of women, the hair should be dressed by the nurse to avoid any physical effort on the part of the patient. To take the place of ordinary exercise, two measures are employed, the first of which is massage or rubbing; the second, electricity. By the kneading and rubbing of the muscles and skin the liquids in the tissues are absorbed and poured into the lymph spaces, and a healthy blush is brought to the skin. This passive exercise is performed in the morning or afternoon, and should last from one-half to an hour, every part of the body being kneaded, even the face and scalp. In the afternoon or morning the various muscles should be passively exercised by electricity, each muscle being made to contact by the application of the poles of the battery to its motor points, the slowly interrupted current being used. Neither of these forms of exercise call for any expenditure of nerve force; they keep up the general nutrition. The following programme for a day's existence is an example of what the physician should order:

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7:30 a. m.--Glass of hot or cold milk, predigested, boiled or raw as the case requires.

8:00 a. m.--The nurse is to sponge the patient with tepid water or with cold and hot water alternately to stimulate the skin and circulation, the body being well wrapped in a blanket, except the portion which is being bathed. After this the nurse should dry the part last wetted, with a rough towel, using some friction to stimulate the skin.

8:30 a. m.--Breakfast. Boiled, poached or scrambled eggs, milk toast, water toast, or a finely cut piece of mutton chop or chicken.

10:00 a. m.--Massage.

11:00 a. m.--A glass of milk, or a milk punch, or egg-nog.

12:00 m.--Reading for an hour.

1:00 p. m.--Dinner. Small piece of steak, rare roast beef, consomme soup, mutton broth, and any one of the easily digested vegetables, well cooked.

3:00 p. m.--Electricity.

4:30 p. m.--A glass of milk, a milk punch or egg-nog.

6:30 p. m.--Supper. This should be very plain, no tea or coffee, but toast and butter, milk, curds and whey, or a plain custard.

9 :30 p. m.--A glass of milk or milk punch.

In this way the day is well filled, and the time does not drag so heavily as would be thought. If the stomach rebels at over feeding, the amount of food must be cut down, but when all the effort of the body is concentrated on respiration, circulation, and digestion a large amount of nourishment can be assimilated by the exhausted body, which before this treatment is undertaken may have had its resources so shattered as to be unable to carry out any physiological act perfectly. For the treatment to be successful the rules laid down should be rigidly followed, and the cure should last from three to six weeks or longer."

HYSTERIA.--A state in which ideas control the body and produce morbid changes in its functions.

Causes.--It occurs mostly in women, and usually appears first about the time of puberty, but the manifestations may continue until the menopause or even until old age. It occurs in all races. Children under twelve years are not very often affected. A physician writes: One of the saddest chapters in the history of human deception, that of the Salem witches, might be headed, "Hysteria in Children," since the tragedy resulted directly from the hysterical pranks of girls under twelve years of age. During late years it has been quite frequent among men and boys. It seems to occur oftener in the warm and mild climates than in the cold. There are two predisposing causes that are very important--heredity and education. Heredity acts by endowing the child with a movable (mobile) abnormally sensitive nervous organization. Cases are seen most frequently in families with marked nervous disease tendencies, whose members have suffered from various sorts of nervous diseases.

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Education.--The proper home education is neglected. Some parents allow their girls to grow up accustomed to have every whim gratified, abundant sympathy lavished on every woe, however trifling, and the girl reaches womanhood with a moral organization unfitted to withstand the cares and worries of every-day life. And between the ages of twelve and sixteen, the most important in her life, when the vital energies are absorbed in the rapid development of the body, the girl is often "cramming" for examinations and cooped in close schoolrooms for six or eight hours daily; not only that, but at home she is often practicing and taking lessons on the piano in connection with the full school work. The result too often is an active bright mind in an enfeebled body, ill-adapted to subserve the functions for which it was framed, easily disordered, and prone to act abnormally to the ordinary stimuli of life.

Direct Influences.--Those influences that directly bring on the attack are fright, anxiety, grief, love affairs, and domestic worries, especially in those of a nervous nature. Diseases of the generative organs and organic diseases in general, and of the nervous system especially, may be causes of hysteria.

Symptoms.--These may be divided into two classes: 1. Interparoxysmal or time between the paroxysms (spells). 2. Paroxysmal. During the time of the attack. First variety--The will power seems defective. In bad cases self-control is lost. The patient is irritable, and easily annoyed by the slightest trifle; is very excitable and easily moved to laughter or tears without any apparent cause for either. Easily discouraged and despondent. She wants lots of sympathy. Second--Loss of sensation is frequently present, and it is most commonly one-sided; it may involve certain parts, as one or two limbs, the trunk escaping, or part of one limb. Various spots of want of sensation (feeling) may exist. The skin of the affected side is frequently pale and cool and a pin prick may not cause bleeding. In some cases they feel the touch of the hand, but there is no feeling from heat. There may also be oversensitiveness to pain and of the skin. It may be one-sided or both, or only in spots. The left ovarian region is a common sensitive point; also over the breasts, lower positions of the ribs, on top of the head and over many portions of the backbone. Pain in the head is a very common and distressing symptom, and is usually on the top. Pain in the back is common. Abdominal pains may be very severe and the abdomen may be so tender as to be mistaken for peritonitis. Various parts of the body may have neuralgic pains. There may be intense pain around the heart. There may be complete blindness, the taste and smell may be disturbed or complete loss of hearing. Third--Paralysis is frequently present. It may be one-sided or only of the lower extremities, or only one limb. The face is usually not involved when it is on one side. The leg is more affected than the arm. Sensation is lessened or lost on the affected side. Paralysis of the lower extremities is more frequent than one-sided paralysis. The power in the limbs hardly ever is entirely lost; the legs may usually be moved, but the legs give way if the patient tries to stand. The affected muscles do not waste. The feet are usually extended and turn inward. Sudden loss of voice occurs in many cases. The paralysis is generally paroxysmal, and is frequently associated with contractures, shortening of the muscle. The contractures may come on suddenly or slowly, and may last minutes, hours, or months, and some cases even years. Movements of the hands, arms, etc., like the motions in chorea are often seen in the young. A trembling (tremor) is sometimes seen in these patients. It most commonly involves the hands and arms, more rarely the head and legs. These movements are small and quick. Fourth--Swallowing may be difficult on account of spasms of the muscles of the pharynx. The larynx may be involved and interfere with respiration. Indigestion in some form is often present. The stomach and bowels may be very much bloated with gas. There may be a "phantom tumor" in the intestine (bowel). Constipation may be very obstinate, vomiting may be present and persistent and hiccough present. The action of the heart may be irregular, and rapid heart action is common. The least motion may cause difficult breathing and false Angina Pectoris (heart pang); the urine is retained not infrequently in female patients.

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Symptoms of the Paroxysms.--Convulsive seizures are common manifestations of hysteria, and frequently present a great similarity to epilepsy. The prodromal (fore-running) symptoms are frequently present and may begin several days before the convulsion occurs. In milder forms, in which the cause may be due to a temporary physical exhaustion, or emotional shock, the fore-running symptoms are of short duration. The patient may become very nervous, irritable, impatient, have fits of laughing and crying, alternately, or have a feeling of a chill rising in the throat. The convulsion follows these symptoms. The patient generally falls in a comfortable place; consciousness is only apparently lost, for she frequently remembers what has taken place; the tongue is rarely bitten, In the milder forms the movements are apt to be disorderly. In the severe forms the movements are apt to be a lasting contraction of the muscles and the patient may have the head and feet drawn back and the abdomen drawn front. There then may follow a condition of ecstacy, sleepiness, catalepsy, trance, or the patient may show symptoms of a delirium with the most extraordinary sights of unreal things. These convulsions may last for several hours or days. Firm pressure over the ovaries may bring on a convulsion, or if made during a convulsion may arrest it. The disease is rarely dangerous to life, yet death has followed exhaustion induced by repeated convulsions or prolonged fasting. The duration of hysteria is very uncertain.

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DURING A CONVULSION. The first thing to do is not to be frightened. A patient in a convulsion from hysteria very seldom injures herself during the convulsions. If you are sure it is hysteria, give a nasty tasting medicine, asafoetida is a splendid remedy, but not in pill form, for there is no taste or smell to them. Sometimes a convulsion may be arrested by the sudden use of ice to the backbone or abdomen or by dashing cold water in the face and chest, or by pressing upon the ovaries. When the hysteria is of a mild form it is sometimes a good plan, when the convulsion comes on, to place the patient in a comfortable position and then leave her, and when the patient comes to and finds herself alone and without sympathy, the attacks are less likely to be repeated. Sometimes if you watch a patient closely when she is seemingly unconscious, you will see, if you look at her very guardedly, that one eyelid is not entirely closed, and that the patient really sees much that is occurring around her. I am writing of real genuine hysteria, in which the patient is not quite right, not only physically but mentally,--especially the latter,--during the attack at least. For that and other reasons such patients should not be treated cruelly.

Preventive Treatment of Hysteria.--In order to be successful in this line of treatment the cause must be found and treated. An English physician writes: "It is pitiable to think of the misery that has been inflicted on these unhappy victims of the harsh and unjust treatment which has resulted from false views of the nature of the trouble; on the other hand, worry and ill-health, often the wrecking of the mind, body and estate, are entailed upon the near relatives in the nursing of a protracted case of hysteria. The minor manifestations, attacks of the vapors, the crying and weeping spells are not of much moment, and rarely require treatment. The physical condition should be carefully looked into and the mode of life regulated, so as to insure system and order in everything. A congenial occupation offers the best remedy for many of these manifestations. Any functional disturbance should be attended to and a course of tonics prescribed. Special attention should be paid to the action of the bowels. The best preventive treatment is the one that is given early, when the girl is growing from childhood to girlhood. It should be begun even earlier. A weakly baby should be built up by proper food and outdoor life. Dainties should not be given to such a child. When the child is old enough, as some mothers think, to go to kindergarten school, keep the little one at home. It is plenty early enough to send such a child to school when she is seven years old. This early school work rushes the child, makes it nervous. If you should happen to listen to the heart of many young school children you would find it pounding away at a furious rate. Do not hurry a weakly child. Do not hurry or rush a young girl even though she is strong, from the ages of twelve to sixteen years. Our school system does just that. Instead of taking life easy when she is nearing the crisis (puberty) or is in that period, she is hurried and rushed and crammed with her school work; the girl frequently goes to school during this period, even when she is unwell and sits there for an hour or more with wet skirts and sometimes wet shoes and stockings. Every day I see girls of all ages go past my office here in this cultured city of Ann Arbor, without rubbers, treading through the slush and water. Is it any wonder they become sickly, become victims of hysteria and suffer from menstrual disorders? Dysmenorrhea must follow such carelessness, and the parents are to blame in many cases. Be careful of your children, especially girls at this age, care less for their intellectual growth, and pay more attention to their body development, even if it should happen to be at the expense of their intellectual development. A healthy body is better than all the knowledge that can be obtained, if it goes, as it too often does, with a body that is weak and sick. Outdoor life is necessary. Horseback riding is splendid; walking is also good exercise at a regular time each day."

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PHYSICIANS' TREATMENT for Hysteria.--If there is any womb trouble, it must be attended to. There is frequently trouble with the menses in cases of hysteria. It sometimes comes from anemia or simply comes without any special reason. Tonics like arsenic, iron, strychnine and cod-liver oil are needed for anemia. Iron valerate is good, in one grain doses, three times a day, in this disease, when the patient is not fleshy.

1. The following is recommended by Dr. Goodell:

Of each one scruple (20 grains). Quinine Valerate Iron Valerate Ammonia Valerate

Make into twenty pills. Take one or two pills three times a day.

(This is a good tonic in such cases.)

2. Fowler's Solution of Arsenic in three to five drops doses is frequently used (three times a day) and is a good lasting tonic in cases where the patient has a very pale white looking skin.

3. Asafoetida in three to five-grain pills is a splendid tonic in such cases, and in that form is pleasant to take. Take three during the day, before meals.

4. Sumbul or musk root is a good remedy. Tincture in one-half dram doses three times a day. This is good when the patient is very nervous.

5. The following is good when anemia is prominent:

Dried Sulphate of Iron 20 grains Alcoholic extract of Sumbul 20 grains Asafoetida 10 grains Arsenious acid 1/2 grain

Mix thoroughly and make twenty pills, one after each meal.

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6. Tincture of hops in doses of one-half to two teaspoonfuls is good for nervousness and sleeplessness, taken at bedtime. It can also be taken regularly four times a day in from one-half to one teaspoonful doses.

7. General Cautions.--Proper, easily digested foods must be taken. Keep the bowels open daily. Let trash and dainties alone. Pies, cakes, and rich foods are an abomination for such patients. Candy is not to be eaten. Let novels alone. Go to bed at nine and sleep until six or seven. Bathe five or ten minutes every morning or evening in tepid water or cool water. The patient should be warmly clothed. Sleep in a pleasant, sunshiny and airy room. In severe forms of the disease the "Rest Cure" and feeding described under Nervous Prostration should be used.

EPILEPSY. (Falling Sickness).--This is an affection of the nervous system, characterized by attacks of unconsciousness, with or without convulsion.

Causes.--In a large proportion of cases the disease begins before puberty. It rarely begins after twenty-five. It is more liable to attack females than males. Heredity is thought by some to play a big role. Dr. Osler says: "In our figures it appears to play a minor role." Another doctor says: "Heredity plays an important role in the production of the disease. Besides epilepsy, insanity, migraine, alcoholism, near relationship of parents (consanguinity) and hysteria are among the more common ancestral taints observed." All factors which impair the health and exhaust the nervous system are predisposing causes. Injury to the head often causes it. Teething, worms, adherent foreskin and clitoris, closing of the internal opening of the womb, delayed menstruation, are sometimes the cause.