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Nervous Exhaustion - Neurasthenia.The affection seems usually to proceed from an improper degree of activity of some part of the nervous system, more especially in the exercise of the mental faculties. It seems also to be subject to certain hereditary influences ; the children of parents who have suffered from chronic diseases of the nervous system, such as epilepsy, hysteria and insanity, are especially prone, to the manifestation of nervous exhaustion. Physicians, especially those who practice in large cities, are often consulted by individuals who, although manifesting no well-defined disease, are evidently not in good health. It is possible that these cases do not receive as much attention from friends of the person, or even from the physician himself, as they deserve ; for the tendency to complain, to exaggerate slight indisposition, is so common, that unless there is some definite and tangible derangement of the body, the tendency is to ignore and make light of the symptoms presented. In nervous exhaustion, moreover, the indications of the difficulty are of a subjective rather than of an objective character ; that is, they are symptoms which the patient can himself feel, but which no one else can perceive. The subjects of nervous exhaustion complain of lassitude, a want of buoyant feeling, an indisposition for exertion, mental depression, and sometimes wandering pains and aches are felt in various parts of the body. Such individuals are wakeful at night, and arise with a sense of fatigue and a feeling that their sleep has not refreshed them. When stimulated by some unusual excitement they are capable of the usual exertion, but when the excitement has subsided they feel exhausted. Such patients usually fancy that they have some serious disease, and often become melancholy at the thought that their powers are being undermined and that they are " in a decline. " A careful examination of the different organs usually fails to disclose any evidence of disease. The heart, lungs, kidneys, etc., are healthy. The physician is apt to regard such patients as the victims of their own imagination. Yet this condition is in many cases real, not imaginary. By a little inquiry it becomes manifest that such patients have been usually long harassed by the cares and responsibilities of business, by excessive devotion to study, or by some similar strain on the nervous system. In many cases this overwork is combined with carelessness and neglect in diet and habits of life. This disease is essentially and pre-eminently an affection of modern society, and is found in its most aggravated type in the United States. For the causes that stimulate the mind to excessive exertion are especially active in this country. The inducements to active effort are so great, that the business of life is assumed here at an unusually early age and with extreme zeal. This condition of nervous exhaustion is by itself a serious affection, and may indirectly induce or aggravate numerous other ills; for it favors the development of diseases to which the patient may be predisposed, and aggravates the effects of 'such ailments as he may acquire. It would be impossible to detail all the symptoms which may be caused by this condition of nervous exhaustion. Some of the more important ones will be, however, briefly discussed. Spinal irritation is a manifestation of nervous exhaustion which afflicts many of those engaged in active mental effort, and is especially common among women who are subject to diseases of the womb. In this condition there is extreme tenderness all along the spine ; there are usually flying pains, especially in the chest and abdomen ; and the occurrence of hysteria as well as of convulsive spasms of the limbs is a frequent symptom. This condition of spinal irritation is usually periodical, and is especially apt to occur after over-exertion or excessive emotion. In nervous women it occurs particularly during the period of menstruation. There are also conditions which seem essentially the same as spinal irritation, though there is no tenderness on pressure along the back bone. The condition is manifested by unpleasant and annoying sensations in different parts of the body. Some individuals suffer from neuralgic pains in the limbs ; others have throbbing sensations in the chest and in the head. Another symptom is itching, which may occur in any part of the body without apparent cause, and may be quite intense and persistent. One of the most distressing symptoms is the wakefulness of such patients. They lie awake and toss about for hours and perhaps fall into a heavy sleep toward morning, from which they awake without feeling much refreshed. This condition is obstinate and may not yield even to the bromide of potassium or to chloral, unless taken in excessive doses. Another manifestation of nervous exhaustion is dyspepsia, which is rarely so distressing as those forms of dyspepsia which result from organic disease of the stomach, but is nevertheless a source of much annoyance and uneasiness to the patient. The special senses are also liable to derangements. Among the most common of these are specks before the eyes, which appear especially when the individual feels exhausted. Another occurrence is noise in the ears, which sometimes takes the form of a continual humming, and sometimes appears as sudden and loud noise. One of the symptoms of nervous exhaustion, which is brought to the notice of the physician with especial frequency, is derangement of the sexual functions. This may take the form of impotence, partial or complete. This is often manifested by a loss of sexual power before the appetite disappears. Under these circumstances the patient is extremely depressed and despondent, as a result of which the symptoms ar£. aggravated. Sometimes this sexual weakness takes the form of seminal emissions. These are of course natural and in perfect accord with health and those who are continent; but in conditions of nervous exhaustion these emissions are apt to occur w¼n far more frequency than in health. These emissions when excessive are of themselves 'somewhat exhausting, but they are especially important as indications of nervous prostration. The popular idea ascribes to seminal losses the symptoms which occur in the individual at the time ; in other words the emissions are assumed to be the cause of the patient's prostration. As a matter of fact they are the result rather than the cause of the condition, and the patient's despondency should be relieved by the assurance that when his general health shall be improved, this sympton will disappear, provided there be no organic disease of the sexual organs. In females nervous exhaustion is manifested by pain and unusual prostration at the time of the menstrual epochs. Here also the menstrual disorders are the result rather than the cause of the nervous prostration accompanying them. There may be in various parts of the body derangements of motion and of sensation which are to be explained simply by the general condition of the patient, and not by any local disease. Thus it may happen that certain portions of the skin become quite numb, and remain so for hours or days at a time ; in other cases certain parts, such as a finger or toe, an arm or a leg, become extremely sensitive both to pain and to changes of temperature. At times too there may occur what seems to be a genuine paralysis ; the patient loses control of fingers, of thumbs, or even of the entire hand or forearm. In other instances twitchings of the muscles are constantly observed ; this is especially frequent in the muscles of the eyelids. Such patients are annoyed by the consciousness that they are constantly winking, and yet they are unable to control the eyelid. Occasionally such patients are troubled also with unusual diffidence, and even timidity, which sometimes manifests itself by an aversion to society; this is particularly apt to occur in those whose nervous exhaustion takes the form of sexual incapacity. This entire subject has been admirably summarized by a recent writer on the subject, Dr. Beard, as follows : " In regard to the above symptoms, it may be remarked that they are not imaginary, but real; not trifling, but serious, although not usually dangerous. The interchangeableness of these symptoms is also noteworthy. In nervous exhaustion, nothing is constant except inconstancy. The symptoms chase each other like the shadow of summer clouds across the landscape. The moment one leaves, another and several stand ready to take its place. In a single day one may go through the whole gamut of all these notes of disease. " The periodical and rhythmical character of some of these symptoms is of much interest. I once had under treatment a young man who had attacks of nervous depression every day about noon; they lasted but for a short time, but were as periodic as chills and fever, and, like chills, passed through definite stages. " Nervous exhaustion is compatible with the appearance of per fect health. For this reason, as well as on account of the slippery, fleeting and vague return of their symptoms, patients of this class get but trifling sympathy. Sometimes they are fat and hearty, and have a ruddy, vigorous strength, suggestive bearing; some times, also, they grow fatter as they grow worse. Noticeably the disappearance of symptoms in the stomach, and the appearance in their stead of symptoms in the brain and spinal cord, is followed by increase in weight that deceives the friend, the physician, and even the patient himself. Thus it happens that patients get the least sympathy when they most need it. " Nervous exhaustion is a modern disease, and pre-eminently an American disease, and in this country is chiefly found in the North and East. This disease must therefore be studied here ; we cannot, as in so many other diseases, look to Germany for light and information, for in Germany this condition is comparatively unknown, and in France and England is far more rare than with us. ''The diagnosis of nervous exhaustion is sometimes entirely clear, and again is quite difficult. If a patient complains of general malaise (indisposition), debility of all the functions, poor appetite, abiding weakness in the back and spine, fugitive neuralgic pains, hysteria, sleeplessness, disinclination for consecutive mental labor, severe and weakening attacks of sick headache and other analogous symptoms, and at the same time gives no evidence of anæmia or of any organic disease, we have reason to suspect that the general nervous system is mainly at fault, and that we are dealing with a typical case of nervous exhaustion. " Chronic nervous exhaustion - of which form I am chiefly speaking - may result in paraplegia, in general paralysis, in neuralgia, in uterine disturbances, in dyspepsia, in chorea, in hysteria and in actual insanity ; or under proper treatment it may go on to perfect recovery. " Chronic neurasthenia sometimes proves directly fatal without causing organic disease ; but such a termination is not usual. It is a chronic condition, and patients afflicted with it may last for half a century. " Treatment.-Nervous exhaustion usually requires, first of all, complete relief from care, anxiety and exertion. It is not desirable that the patient should entirely relinquish his occupation ; but a respite for a certain period seems absolutely necessary. Not less important is the avoidance of errors in the habits of life. The inordinate use of stimulants, excesses of any kind, etc., are of course to be avoided. The best sanitary regulations also should be observed, and one of the most efficient remedies that can be employed is a course of sea bathing. If this cannot be procured, the cold bath in the morning at least, or morning and night if the patient can bear it, is a good substitute. The diet should be generous and varied, even though the patient may already seem to have an abundance of flesh. Among the remedies to be employed, two are especially valuable-electricity and massage. Exercise should be provided for, but not taken in excess, since exercise of the body requires exertion on the part of the nervous system. In some cases severe measures have been employed to relieve spinal irritation ; small blisters and even the white-hot iron have been applied along the spine. Such measures must, of course, be used only under the advice of the physician, since in every case it is the patient and not the disease that is under treatment. The drugs that are to be used vary in different cases. In most cases strychnine, arsenic and quinine, with or without iron, will be useful. These may be given in the following prescription : Sulphate of quinine, - - Forty grains. Arsenious acid, - One-third of a grain. Reduced iron, - Twenty grains. Extract of nux vomica, - Four grains. Extract of cannabis indica, - Five grains. Mix, and make twenty pills. Take one before meals. If there be symptoms of dyspepsia it will be advisable to use in addition to the above pepsin and extract of malt, as in the following prescription : Extract of malt, - Three ounces. Wine of pepsin, - Three ounces. Mix, and take a teaspoonful after meals. If the patient be troubled with sleeplessness, the following may be administered at night: Bromide of potassium, - Two ounces. Hydrate of choral, - - - - One ounce. Syrup of orange peel, -.."-"- Two ounces. Water, ------ Four ounces. Mix, and take a teaspoonful before retiring. The dose may be repeated in an hour if needed. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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