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NERVOUS PROSTRATION

Categories: 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
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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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