NERVOUS PROSTRATION

Category: Diseases of The Nervous System

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.

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.

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.

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:

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."

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NERVOUS PROSTRATION