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allow the victim to sleep for an hour or two - a boon usually denied more
from fear of recurrence than lack of sympathy, it is better than taking him
home. If not, let someone call a cab, and deliver the victim safely to his
friends.

Every epileptic should carry always with him a card stating his full name
and address, with a request that some one present at any seizure will
escort him home.

If the victim wakes with a headache, give him a 10-grain Aspirin powder, or
a 5-grain Phenalgin tablet; _never patent "cures"_.

If possible, the patient should lie abed the day after a fit, undisturbed,
taking only soda-and-milk and eggs beaten up in _hot_ milk.

* * * * *

CHAPTER VII

NEURASTHENIA

"Some of your hurts you have cured,
And the worst you still have survived;
But what torments of mind you endured
From evils which never arrived."
- Lowell.

To-day, the need to eat forces even sensible men to live - and die - at a
feverish rate. In bygone days the world was a peaceful place, in which our
forefathers were denied the chance of combining exercise with amusement
dodging murderous taxis; knew not the blessings of "Bile Beans", nor the
biliousness they blessed either; they did not fall victims to
"advert-diseases"; and they left the waters beneath to the fishes, and the
skies above to the birds.

Withal they were sound trenchermen, who called their few ailments "humours"
or "vapours" and knew what peace of mind meant. Sixty years ago there was
one lunatic in every six hundred people; to-day there is one in every two
hundred.

At the same time, the "neurasthenic temperament" is not altogether a modern
product, for Plato described it with great precision, and declared such
people to be "undesirable citizens" for his ideal republic.

Neurasthenia is due to exhaustion and poisoning of the nervous system, the
chief symptoms of which is persistent _neuro-muscular fatigue with general
irritability_. Its minor symptoms are almost as numerous as the various
activities possible in mind and body.

The Predisposing Cause of neurasthenia is inherited nervous instability,
but among nervous diseases, neurasthenia seems the least dependent on
heredity, this factor playing a less important part than

Exciting Causes which are the sparks that fire explosive trains laid by the
living, and often by the dead.

Worry in any form (especially when accompanied by excess of brain-work),
Accident-shock,
Sexual abuse,
Abuse of drink, drugs or tobacco,
Lack of exercise,
Exhausting diseases,
Menopause, and diseases of the womb,
"Society life",
Retirement,

are the commonest exciting causes of neurasthenia; hard brain-work, unless
accompanied by worry, not being injurious.

The disease is more common in men than women (because of the more active
part played by them in the struggle for existence), in cities than in the
country, in mental than in manual workers, in the "idle rich", and in races
which live feverishly, like the Americans. It is rare in old age.

Ambition, the race for "success", the struggle to carry out projects beyond
the reasonable capacity of one man, and the ceaseless work and worry with
little sleep and no real rest which mark life to-day are responsible for
this disease.

Competition has increased in all conditions of life; free course is given
to ambition, individuals impose on their brains a work beyond their
strength; and then comes care and perhaps reverse of fortune; and the
nervous system, under the wear and tear of incessant excitation, at last
becomes exhausted,

The basic symptom is an inability to stand a normal amount of mental or
physical strain, and shows itself in seven marked ways:

1. Muscular Fatigue, which is often most marked in the morning. The
patient rises reluctantly, feeling as if he had not slept, is listless and
"lazy", and can neither work nor play much without getting unduly tired.
This weariness may pass off as the day wears on.

2. Backache is often constant and annoying. It may be a pain, or a general
discomfort, and may be felt anywhere in the back, the nape of the neck and
down the spine being common places. The legs often "give way", and, in
severe cases, patients believe they cannot stand, and become bed-ridden.
Under sudden excitement they may walk again, becoming "miracles of
healing". These _spinal symptoms_ are common in neurasthenia following
accident.

3. Headache is more often an abnormal sensation than an intense pain.
Pulsations, feelings of distress, of lightness, fullness, heaviness and
pressure are common, or a band may seem to be drawn tightly round the head
across the forehead.

The sensations are usually located in the back of the head, and may be
accompanied by dizziness, noises in the ears, or dimness of sight. There
may be a feeling of unsteadiness when walking, or a sense of being in
motion when at rest. The headache varies in intensity; it is worst in the
morning, is increased by thinking, diminished after eating, often improves
at night, and never keeps the patient awake.

4. Stomach and Bowel Disorders. The victim is indifferent to food, though
dainties often tempt him, when he cannot face a square meal. He has a
feeling of general well-being after a meal, but within an hour signs of
imperfect digestion arise; he feels oppressed, and has flatulence. Later,
there are flushes of heat, palpitation, drowsiness, and a craving for food.
Constipation is usually obstinate, while diarrhoea may cause great
weakness.

5. Sleeplessness. Some patients go to sleep readily, but after some
instants wake suddenly, in a state of excitement that persists despite
their efforts to calm themselves, and only at an early hour in the morning
do they sleep again. Other patients go to bed with the conviction they will
not sleep, and are kept awake by incessant cogitation, their minds being
harassed by a rapid flow of images, ideas and memories. In some cases the
person is calm, his mind is at rest, yet he cannot sleep.

6. Circulatory Disturbances. More blood flows to an organ at work than to
one at rest. In health we do not notice these changes, but in neurasthenia
these internal tides are exaggerated as rushes of blood to the head,
flushings of various parts, and coldness of hands and feet.

Heart palpitation is alarming but not dangerous, and the distended
blood-vessels of the ears may set up vibrations in the drum, so that at
night when the head is on the pillow, every beat of the heart is heard as a
thump, which banishes sleep, and works the victim into a state of high
tension. A pain in the chest, arms and elbows is often felt, limbs may
swell (shown by the tightness of rings, collars, etc.) while the hands and
feet are usually moist and clammy. The patient may have to empty the
bladder every half-hour. Disorders of menstruation are common.

7. Mental Fatigue. Hundreds of pages would be needed to describe all the
symptoms due to mental fatigue, the morbid belief that the victim has a
fatal disease being very common, though his "disease" rarely makes him lie
up; in the day he works, at night describes his symptoms to the home
circle.

The inability of most men to apply themselves steadfastly to any one set of
ideas is seen in the immense popularity of music halls, cinemas, and
short-story magazines, which offer a change of interest every few minutes.

In normal people there is a slight consciousness of mental processes, but
the mind rarely watches itself work; the neurasthenic is unable to
concentrate, and gets charged with inconstancy and shiftlessness.

His ideas are restive, continuous thought is impossible, and when talking
he has to be "brought back to the point" many times. Memory and attention
flag, and he listens to a long conversation, or reads pages of a book
without grasping its import, and consequently he readily "forgets" what in
reality he never laboured to learn. Trembling of limbs is common.

He lacks initiative, and whatever course he is forced to take - after much
indecision - he is convinced, a moment later, it would have been wiser to
have taken the opposite one.

All his acts are done inattentively. He goes to his room for something, but
has forgotten what when he gets there; later, he wonders if he locked the
drawer, and goes back to see. At night he gets up to make sure he bolted
the door, put out the gas, and damped the fire.

Regret for the past, dissatisfaction with the present, and anxiety for the
future are plagues common to most people, but they become acute in a
neurasthenic, who reproaches himself with past shortcomings of no moment,
infuriates himself over to-day's trivialities, and frets himself over evils
yet unborn.

Such a patient is often greatly upset by a trifle, yet little affected by a
real shock, which by its very severity arouses his reactive faculties which
lay dormant and left him at the mercy of the minor event. He will fret over
a farthing increase in the price of a loaf, but if his bank fails he sets
manfully to.

Duty that should be done to-day he leaves to be shirked to-morrow; he is
easily discouraged, timid, and vacillating. Extremely self-conscious, he
thinks himself the observed of all observers. If others are indifferent
toward him, he is depressed; if interested, they have some deep motive; if
grave, he has annoyed them; if gay, they are laughing at him; the truth,
that they are minding their own business, never occurs to him, and if it
did, the thought that other people were _not_ interested in him, would only
vex him.

He is extremely irritable (slight noises make him start violently),
childishly unreasonable, wants to be left alone, rejects efforts to rouse
him, but is disappointed if such efforts be not made, broods, and fears
insanity. The true melancholic is convinced he himself is to blame for his
misery; it is a just punishment for some unpardonable sin, and there is no
hope for him in this world or the next. The neurasthenic, on the contrary,
ascribes his distress to every conceivable cause save his own personal
hygienic errors.

A neurasthenic, if epileptic, fears a fit will occur at an untoward moment.
He dreads confined or, maybe, open spaces, or being in a crowd. When he
reaches an open space (after walking miles through tortuous byways in an
endeavour to avoid it) he becomes paralysed by an undefinable fear, and
stops, or gets near to the wall.

He fears trains, theatres, churches, social gatherings, or the office.

Other victims fear knives, canals, firearms, gas, high places, and railway
tracks, when the basic fear is of suicide. Many patients have sudden
impulses - on which the attention is focussed with abnormal intensity - to
perform useless, eccentric, or even criminal actions; to count objects, to
touch lamp-posts, to continually reiterate certain words, and so on.

The victim is fully aware that there are no grounds for his panic or
impulse, but though his reason ridicules, it cannot disperse, his fear, and
the wretched man finds relief in sleep alone, which adds to his woes by
being a coy lover.

An almost invariable stage is that wherein the patient studies a
patent-medicine advertisement and finds that a disease, or collection of
diseases, is the root of his troubles. This alarms but interests him; he
studies other advertisements, sends for pamphlets, and so becomes familiar
with a few medical terms. He then takes a "treatment", and talks of his
"complaint" and how he "diagnosed" it. He has become hypochondriac.

He borrows a book on anatomy from the public library to discover in what
part of the body his ailment is located.

He draws up (or copies) a special diet-sheet, and talks of "proteids",
notices a slight cloudiness in his urine, and underlines "The Uric-Acid
Diathesis" in one of his pamphlets. Then his heart bumps, he diagnoses
anew, and so goes on, usually ending by taking phosphorus for his "brain
fag". Then he finds he has a disease unknown to the faculty, which
discovery interests him as intensely as it irritates his unfortunate
friends.

This prince of pessimists has a conviction that, compared with him, Job was
a happy man, and that he will go insane. He does not know that it is only
when there are flaws in the brain from inheritance or organic disease that
mental worry leads to lunacy; a sound brain never becomes unhinged from
intellectual stress alone.

Books and friends are daily questioned about his "diseases", and in spite
of reassuring replies, he continues to doubt, re-question and cross-examine
endlessly, feeding his hopes on the same assurances, consoling himself with
the same sympathies, and worrying himself with the same fears.

Other folk may be "nervy", he is seriously ill; he _knows_ it because he
_feels_ it. He expects the greatest consideration himself, denies it to
others, and then complains he is "misunderstood".

"Every symptom becomes magnified; the trifling ache or pain, the trivial
flatulence, the disinclination or mere hesitation of the bowels to adhere
to a strict schedule, all minor events such as occur to the majority of
healthy men from time to time unheeded, come to be of vast importance to
the psychasthenic individual."

He keeps a record of hourly changes in his condition, and pesters his
family doctor to death. He goes from physician to physician, from hospital
to hospital. Having been induced by his friends to see a specialist, he
bores that good man - who knows him all too well - with a minute description
of his symptoms, presenting for inspection carefully preserved
prescriptions, urinary examination records, differential blood counts, and
the like. Coming away with precious advice, he feels he omitted to describe
all his symptoms, begins to doubt if the specialist really understands
_his_ case, and so the pitiful farce goes on - for years.

The extraordinary fact is that while he is suffering (_sic_) from cancer,
or heart disease, or Bright's disease, and spasmodically from minor
affections like tuberculosis, arterio-sclerosis, and liver-fluke, he is
probably running a successful business. While making money he forgets his
ills; the moment his attention is diverted from the "root of evil" he
proceeds to further "diagnosis".

In the end, he makes a pleasant hobby of his imaginary maladies, trying
each patent nostrum, and giving herbalists, electric-belt men, Christian
Scientists, and dozens of other weird "specialists" a chance to cure him.

Sexual Neurasthenia occurs chiefly in young men given to self-abuse or
sexual excesses. Erections and emissions are frequent, first at night with
amorous dreams, then in the day as a result of sexual thoughts; weakness
and pain in the back follow, and the sexual act may become impossible. The
patient usually studies a quack advertisement, and passes into the hands of
men who make a living by bleeding such wretches dry. Cold baths and the
treatment outlined in Chapter IX will cure him.

Course and Outlook. Neurasthenia is very curable. If the cause be removed,
and vigorous treatment instituted, the victim may be well in a couple of
months, but in most cases there are obstacles to radical treatment, and the
disease drags on indefinitely.

Egoism, moral cowardice, and sexual excess play a part in much
neurasthenia, but relatives must not forget, in their indignation at these
laxities, that the patient really _is_ ill; it is unkind, unjust and
useless to tell an ailing man the unpalatable truth that it is his own
fault.

* * * * *

CHAPTER VIII

HYSTERIA

"Diseased nature oftentimes breaks forth
In strange eruptions; ..."
"King Henry IV."

Hysteria, recorded in legend and law, in manuscript and marble, in
folk-lore and chronicle, right from history's dawn, is still a puzzle of
personality, and only equalled by syphilis in the protean nature of its
manifestations.

The sacred books of the East said delayed menstruation due to a devil was
its cause; the thrashing-out of the devil its cure. Chinese legends
describe it, and its symptoms were ascribed by the Inquisition to
witchcraft and sorcery.

Old Egyptian papyri tell how to dislodge the devil from the stomach, and
there were hysteria specialists in 450 B.C. All old theories fix on the
womb as the seat of the disease. The name hysteria is the Greek word for
womb, and 97 per cent of patients are women.

A few of the very numerous modern theories may be noticed.

The unconscious (or the subconscious) and the conscious are only parts of
one whole. Our "conscious" activities are those which have developed late
in the history of the race, and which develop comparatively late in the
history of the individual. The "conscious" is the product of the racial
education of the "unconscious"; the first is the man, the modern, the
civilized; the last is the child, the primitive, the savage. Between the
two there is no gulf fixed, and the Oxford metaphysician need not go to
Timbuctoo to seek a superstitious savage; he may find one within himself.

In hysteria, Janet says, the field of consciousness is narrowed, and the
patient lives through subconscious experiences, which she forgets when she
again "comes to". She journeys back into the past, back a few years
individually, back centuries or æons racially, and becomes a savage child
again.

Normally, when anything goes wrong, or we suffer from excessive emotion, we
give vent to our feelings by tears, abuse, anger, or impulsive action; in
some way we "hit back", and relieve ourselves of the feeling of oppression.
Then we forget, which heals the sore, and closes the experience.

If, at the moment, we bottle up our emotions, they obtrude later at
inconvenient times until we "get them off our mind" by confiding in some
one, when we get peace of mind. Open confession _is_ good for the soul, and
it is better to "cry your eyes out" than to "eat your heart out".

There are some experiences, however, to which we cannot react by anger or
confidence, and so we imprison our emotions, and try to obtain peace of
mind by forgetting the irritation.

Freud thinks perverted sex ideas are thus repressed, and cause hysteria by
coming into conflict with the normal sex life. If these old sores can be
laid bare by psycho-analysis, and the mental abscess drained by confession
and contrition, cure follows.

The biologists consider hysteria as an adult childishness, a primitive mode
of dodging difficulties. Victims cannot live up to the complicated
emotional standard of modern life, and so act on a standard which to us
seems natural only in children and uncivilized races.

Savill gives the following differences between neurasthenia and hysteria:

NEURASTHENIA HYSTERIA

Sex Both sexes equally. 97 per cent females.

Age Any age. First attack before
page of 25.

Mental Intellectual weakness; Deficient will power,
peculiarities bad memory Want of control
and attention. over emotions.

Causes Overwork; dyspepsia; Emotional upset or
accident; shock.
nervous shock.

Course Fairly even. Paroxysms. Vary
from hour to hour.

Mental Mental exhaustion; Emotional; wayward;
Symptoms unable to study; no self-analysis,
restless; sad; living by
irritable; not rule or reading
equal to medical books;
amusement. May Fond of gaiety;
be suicidal. sad and joyous by
turns. Never
suicidal.

General Occasional giddiness; Flushing; convulsions
Symptoms fainting rare; and fainting
convulsions; common; no
headache; backache; symptoms between
sleeplessness; no attacks; local
loss of feeling. anæsthesia or
hyperæsthesia.

Termination Lasts weeks or Lasts lifetime in
months. spasms.
CURABLE. TEMPORARILY
CURABLE.

Hysteria is a disease of youth, usually ceasing at the climacteric. Social,
financial and domestic worries are exciting causes, a happy marriage often
curing, and an unhappy one greatly aggravating the complaint. It is most
common among the races we usually deem "excitable", the Slavs, Latin races
and Jews, and is often associated with anæmia and pelvic disorders.

Symptoms. Changeability of mood is striking. "All is caprice. They love
without measure those they will soon hate without reason."

Sensationalism is manna to them. They _must_ occupy the limelight. Pains
are magnified or manufactured to attract sympathy; they pose as
martyrs - refusing food at table, and eating sweets in their room, or
stealing down to the larder at night - to the same end. If mild measures
fail, then self-mutilation, half-hearted attempts at suicide, and baseless
accusations against others are brought into play to focus attention on
them.

Minor attacks usually commence with palpitation and a "rising" in the
stomach or a lump in the throat, the _globus hystericus_, which the patient
tries to dislodge by repeated swallowing. This is followed by a feeling of
suffocation, the patient drags at her neck-band, throws herself into a
chair, pants for breath, calls for help, and is generally in a state of
great agitation. She may tear her hair, wring her hands, laugh or weep
immoderately, and finally swoon. The recovery is gradual, is accompanied by
eructations of gas, and a large quantity of pale, limpid, urine may be
passed later.

Major attacks have attracted attention through all ages, ancient statues
showing the same poses as modern photographs. The beginning stage - which
may last a few moments or a few days - is one of mental unrest, the victim
being irritable and depressed. In some cases a warning aura then occurs;
clutchings at the throat, or the _globus hystericus_, palpitation,
dizziness, sounds in the ears, spots dancing before the eyes, or feelings
of intense "_tightness_" as if the skin is about to tear or the stomach to
burst.

The victim throws herself on a chair or couch, from which she slides to the
floor, apparently senseless, the head being thrown back, the arms extended,
the legs held straight and stiff. The face is that of a dreamer, and the
crucifix position is not uncommon. This stage is a gigantic sexual stretch.

Next comes the convulsive stage, but the convulsions are not the true jerky
movements of epilepsy, but are bilateral tossing, kicking, and rolling
movements, interspersed with various irregular passionate attitudes. There
is great alteration but _not loss_ of consciousness. The patient struggles
with those about her, bites them, but never her own tongue, shrieks and
fights, but never passes urine, throws things about, and arches the back
until the body rests on head and feet (_opisthotonos_). The stretching and
convulsive stages alternate, and the attack lasts a long time, being
stopped by pain or by the departure of onlookers. During this stage the
face may reflect the various emotions passing through the mind - with a
fidelity that would rouse the envy of an Irving.

The patient gradually calms down, and a fit of tears or a scream ends the
attack, after which the worn-out victim is depressed but not confused,
though memory for the events of the attack may only be partial. The patient
sometimes passes into the "dream state", described in Chapter II, for some
hours or occasionally for far longer; these are the women described with
much gusto in the local Press as being in a trance - "the living dead".

The victim of these attacks _is_ suffering from a disease, for she shows
many temporary mental symptoms which could not possibly be feigned, while
there is often a genuine partial forgetfulness of the incidents of an
attack. She says she cannot help it; candid friends say she will not. The
truth is that she cannot _will_ not to help it; for though intelligence and
memory are often good and sometimes abnormal, the judgment and will are


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