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J. A. (Joel Asaph) Allen.

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three may become tired out, and this tiring out may occur repeat-
edly time and again without exhaustion resulting ; and the classi-
cal symptoms, as given by Beard and corroborated by so many
other observers the world over, which apply to nerve exhaustion,
may appear in a modified form in the victim of nerve weari-
ness, and suggest to the alarmist, or he who is given to form-
ing extreme conclusions, that the case before him is one of
exhaustion.

Michael Foster, the great physiologist, in a recent address
delivered before the members of the University of Cambridge,
apropos to this subject of weariness, says :

Observations and reasonings, into the details of which I cannot
enter now, have led physiologists to the conclusion that a muscle, not
only in the body but also for a measurable time out of the body, is con-



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tinually undergoing change of substance ; that the complex groupings
of atoms, molecules and particles, by virtue of which it is alive, are
continually being made and as continually being unmade ; the living
complex muscle is always being built up out of, and always breaking
down again into, simpler substances. Did we possess son>e optic aid
which should overcome the grossness of our vision, so that we might
watch the dance of atoms in this double process of making and unmak-
ing in the living body, we should see the commonplace, lifeless things
which are brought by the blood, and which we call food, caught up
into and made part of the molecular whorls Of the living muscle,
linked together for a while in the intricate figures of the dance of life,
giving and taking energy as they dance, and then we should see how,
loosing hands, they slip back into the blood as dead, inert, used-up
matter. In every tiny block of muscle there is a part which is really
alive, there are parts which are becoming alive, there are parts which
have been alive but are now dying or dead ; there is an upward rush
from the lifeless to the living, a downward rush from the living to the
dead. This is always going on, whether the muscle be quiet and at
rest or be moving ; some of the capital of living material is always
being spent, changed into dead waste ; some of the new food is always
being raised into living capital. But when the muscle is called upon to
do work, when it is put into movement, the expenditure is quickened,
there is a run upon the living capital, the greater, the more urgent the
call for action. Moreover, under ordinary circumstances, the capital
is, during the action, spent so quickly that it cannot be renewed at the
same rate ; the movement leaves the muscle with an impoverished
capital of potential stuff, and a period of rest is indeed in order so that
the dance of atoms of which I just now spoke may make good the loss
of capital and restore the muscle to ita former power.

In considering muscular weariness, we, at the same time, must
keep in mind weariness of the nerve centers, for, after all, the weari-
ness of the whole body from muscular work is, to a very great degree,
in fact chiefly, a weariness, speaking broadly, of the brain.

When we have excessive muscular exertion, the weariness may
take a form of distress, and, if the effort be continued, the distress may
become so great as to cause complete exhaustion, and even death may
result. In excessive work, of whatever kind it may be, in order for
the work to be accomplished, there is made a greater demand upon the
blood for oxygen. Difficult breathing, or panting, results from the
changing quality of the blood. There are many things besides carbonic
acid which are swept into the blood as the result of the activities of
the body ; in other words, the product of work in the human body is a
poison which must needs be eliminated through the medium of the
lungs and the other excretory organs.



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Foster again well expresses it :

As the breath of man is poison to bis fellow-man» so the outcome of
the life of each part of the body, each tissue, be it muscle, brain, or
what not, is a poison to that part and its fellows, and may be a poison
to yet other parts. Of each member, while it may be said that the
blood is the life thereof, it may with equal truth be said the blood is
the death thereof ; the blood is the channel for food, but it is also a
pathway for poison.

It would seem saperflaons to draw attention to these well-
known physiological facts, but I do so only to emphasize the point
which I make, and that is, that by neglect upon the part of the
individaal of certain necessary laws, — involving rest, opportunities
for oxygenation, proper attention to elimination through the
various draining channels of the body, — excessive work, whether
bodily or mental, in repeated cases, produces such a degree of
weariness and poisoning of the nerve centers as to mislead us in
the direction of interpreting the symptoms present as those of
neurasthenia.

The same author, in his admirable paper referred to, says :

The loss of living^ capital, or the presence of the products of work
which would have do appreciable effect on a muscle, may wholly annul
the work of a piece of nervous machinery. If an adequate stream of
pure blood, of blood made pure by the efficient cooperation of organs of
low degree, be necessary for the life of the muscle, in order that the
working capital may be rapidly renewed and the harmful products
rapidly washed away, equally true, perhaps even more true, is that of
the brain. * As physical and mental efforts are continued, the eliminat-
ing capacity, unless carefully guarded, is marred, the resulting poisons
are more and more heaped up in the system, poison the muscles, poison
the brain, poison the heart, poison, at last, the blood itself, starting
in the intricate machinery of the body new poisons in addition to them-
selves. The hunted hare run to death dies, not because he is choked
for want of breath, not because his heart stands still, its store of energy
having given out, but because the poisoned blood poisons his brain,
poisons his whole body. So, also, the schoolboy, urged by pride to go
on running beyond the earliest symptoms of distress, the mere loss of
wind, struggles on until the heaped up poison deadens the brain, and
he falls dazed and giddy as in a fit, rising again it may be and stumbling
on unconscious, or half conscious only, by mere mechanical inertia of
his nervous system, on, only to fall once more, poisoned by poisons of
his own making.

I quote liberally from the thoughts of the physiologist, Foster,
for the purpose of making more clear the position taken. If con-



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tinned effort, withont rest, will poison to the extent of producing
death, sarely many repeated efforts which are not so much in
excess with conditions favorable to accumnlation of lencomaines,
— namely, a tied-ap state of the secretions, inattention to the proper
diet, accamulations of undigested and unassimilated food, which
undergoes fermentation and decomposition, developing ptomaines,
thus adding to the reserve of poison in the system, keeping in
mind the fact that the neglect of hygienic laws, failure to secure
proper ventilation of rooms and the proper clearing out of the
alimentary canal at proper times, surely we may have weariness
and poisoning to the point of distress, and even to that point
which would suggest nervous exhaustion. Men who are greatly
absorbed in their work have no time to think about the laws of
health, but the family physician, and the neurologist as well,
should realize, in these cases, the importance of " clearing the
decks for action.'' They should promptly turn on the batteries
which will scatter the accumulated poisons, open the windows, put
the patient out of doors, anywhere, so that the purest air may be
breathed and elimination of the accumulated poisons hastened.
In his essay, read before this society a few weeks ago. Dr. Bremer
said :

There is no class of sufferers that is more persistently and vigor-
ously maltreated than the neurasthenic. The cause of this lies in the
fact that there is no organ, member or tissue, in the body, which has
not been held up as the chief offender in neurasthenia by some or
another specialist. The worst of it is, that since specialism is still on
the increase, the number of offending parts of the body is steadily
multiplying, and however much legitimate specialism may have done
for the advancement of the medical sciences, it must be admitted that
the abuse of specialism has assumed the proportions and significance
ef a nuisance. There is today no specialist who does not consider
neurasthenia a legitimate and fruitful field for its work, in a few
instances to the advantacre, but much more frequently to the detriment
of the patient. Broadly stated, the medical profession of today may
be divided into two classes : the peripherists, comprising almost all
specialists, and the centralists, found principally among the general
practitioners and the neurologists. It has been said of the latter, that
whenever they do make a right diagnosis, as a rule, nothing can be done
for the patient. This is unfortunately true in a measure, but in this
sense, that the patient has already gone the round of the peripherists,
the specialists of the various organs, who mistook ihi case for being a
local trouble, causing general symptoms, and tinkered at irrelevant



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flymptoms, until the precious time for rational general therapeutics was
grone. Had they looked upon the disorders of the various organs with
a **oentraP' light, interpreting the local trouble as being due to a
general central disturbance, the result of their therapeutic efforts
would probably have been entirely different.

As a matter of fact, it must be stated that social strata do not
make any difference in the frequency of Beard's disease. Rich and
poor are indiscriminately affected by it. The only difference is in
name, not in fact. For while the well-to-do neurasthenic, especially he
that has an inkling of the ailment from his reading on the subject, is
apt to apply to a neurologist for relief, and get from him the true name
of the disease, the poor man has to be satisfied with the diagnosis of
biliousness, dyspepsia, catarrh and similar diagnostic incongruities,
and is allowed to worry through his collapses as best he can, with the
aid of quinine, calomel and tonics.

It is fortunate for humanity that the general pathologists and
the other specialists of the world have had this note of warning
given them by a neurologist. Possibly they will in future leave
the domain refen'ed to entirely to those who look upon all the
disorders of the various organs with a <' central*' light and in-
terpret all local troubles as being due to a general central disturb-
ance. However positive this dictum may seem, practitioners and
specialists will more than likely still go on recognizing the fact
that over-eating, with too little defecation and accumulated leuco-
maines and ptomaines and peripheral irritation, — a figurative thorn
in the flesh, — all may, if left unrelieved, create all of the symptoms
of so-called neurasthenia, and that when relieved those symptoms
will disappear as if by magic.

Commencing with the teething child which is thrown into
reflex convulsions as the result of an erupting tooth, all along the
line to the second childhood, when an unrelieved pruritis or eczema
drives its victim mad with discomfort, we have evidences in favor
of the thought that peripheral irritations are the prime cause
in many cases of so-called neurasthenics. Every general worker
and specialist in diseases of the rectum has found patients on the
border line of nervous exhaustion and almost madness, all pro-
duced by a fissure of the anus. There are probably those within
the sound of my voice who have seen numerous cases presenting
many of the symptoms of neurasthenia, all occasioned by an
obstructing spur upon one side or the other of the nasal septum,
oocasianing accumulations above, up to the frontal sinuses, and at
times the sufferings approaching the agonies of the damned.



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These oases, together with others which might he mentioned, the
offending organs never haying heen interrogated, have ran the
gauntlet of neurological treatment for months and eyen years, and
are finally relieved quickly and precisely hy the removal of the
peripheral disturhanoe. We all know that excruciating pain, home
even for a short time, or pain of any kind wherever located if
long continued, will heget a general demoralisation of the nervous
centers, simulating nervous exhaustion. Surely all of us, whether
specialists or workers in the general field, should try to save our
patients pain, with a view to the hushandmentof their nerve force.
From infancy, the growing child should have its teeth guarded
with a view to prevent toothache and the consequent nerve disturh-
anoe. The mothers of the world should he placed in the hest
, possible condition for the pangs of maternity, remembering the
element of poisoning, how susceptible the nervous centers are to
being poisoned. Thus elimination, cleansing of all the emuncteries
should be the rule, particularly during the pregnant period, and
then every possible pain should be prevented. More rapid recov-
eries would follow and parturition would result in less loss of
nerve force.

Indeed, there is no special line of study which the worker in
general medicine or the family physician should apply himself to
more assiduously than the nervous system. Just insofar as he
can, this particular laborer in the medical vineyard should be a
neurologist, for it is a fact, that all will admit, that after all the
nervous system represents our main capital. All that will develop
it and maintain it and prolong its usefulness, should be known
and made a part of the armamentarium of the general practitioner.
The neurological author of Current Fallacies about Neuras-
thenia, previously quoted, read a tirade in this society a few years
ago against gynecology, (which, by the way, was never answered,)
but may we not say that the criticism which may justly be directed
toward the specialist who runs too much in grooves, will apply in
a most pronounced way to the neurologist who dwells too much
upon his particular line of thought ?

In the language of the present president of this society, the
brainy and brilliant Outten, << the psychiater, whose curious art is
oft too finely wrought, syllogizes mind oft whilst his own is
pathologized by thought." In other words, the neurologist is in
danger of laying too great stress upon his particular part of the
anatomy and is tempted to misinterpret symptoms and dislocate



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disease. To him, unless he have a care, every victim of safferiDg
or discomfort is a handle of nerves gone wrong. The most sac-
oessfal workers in this field are those whose emotional centers
have been kept in reserve, and whose intellectual centers have been
most strongly developed from the beginning, and who base
their work upon a foundation of broad, general practice. The
neurologist, like all the rest of us, should remember that every man
becomes largely the crystallized result of all that he has seen, of
that which he has associated with, and of that with which he has
been brought most closely in contact. The psychiater, then, should
constantly guard himself against exaggerating the neurological
phenomena which present themselves to his view. He and the
rest of us should remember that it is all very well to declaim
against the specialist who interprets all headaches as being due to
a necessity for eye-glasses, or the one who prefers to glide over and
always, only in gynecio grooves, but some of our neurological
brethren, God bless them, have often been known to misinterpret
and exaggerate symptoms. Admitting for the sake of argument
that many a woman suffering from a sore brain or a sorrowing
heart has received treatment for a sore womb, that the womb of
the world has been twisted and twirled in excess, that the docile,
gentle and inoffensive ovary has not often enough been permitted
to blush unseen knd waste its sweetness upon the silent air, but
all too oft has been rudely snatched from its sacred lair when it
never had been guilty of doing anybody harm, still the fact
remains that gynecology has relieved more sorrows, brightened
more homes, saved more precious lives, and will go on saving more
millions of lives that exist now only in the womb of the future,
than all of the other surgical specialties combined. It is the
novices only who rush in where angels fear to tread and act upon
the idea that a woman's anatomical, physiological and pathological
world is her womb. We should none of us, however, throw stones
at each other, for the bulk of those in the medical profession (and
out of it too, for that matter ) this side of Heaven, have their
houses composed chiefly of glass.

I have in my records a half dozen cades of men of affairs ap-
proaching the fair, fat and forty age, where success has come to
them after many weary years of labor ; leisure, responsibility,
overeating and constipation followed ; then came headache, brain
pressure, anxiety, insomnia, morbid fears followed by neurological
opinions suggesting nervous exhaustion, which in its turn was



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followed by a frenzy of anxiety and dread of the future, all
relieved within a few weeks by brisk* pnrging, flnsbing of the
kidneys, diaphoretics, fresh air, proper diet, a few nights of good
eleep, and last, but not least, the insCmctm to boy and wear
number sixteen collars instead of fourteen-and-a-half sise which
had been worn for years. Busy men when nearing the middle mile-
post of life as they increase in weight, often fail to realize that
their necks grow more rapidly than their girth, and, as a result,
they suffer from plain every-day tight-collar headaches.

In a discussion on the subject at a recent meeting of this
eociety, a prominent member cited his own case of neurasthenia as
one produced by prolonged loss of sleep and anxiety on account
of sickness in his household, and that he was practically cured by
many long continued hours of sleep. Here was a case of extreme
fatigue diagnosticated as nervous exhaustion, which was relieved
by hours of sleep. Fancy, if you can anyone, the picture of intel-
lectual health and animal vigor that he presents after having had
oeur:a&tlfiBnia an«Ubeen cured of it inside of a few weeks.

Constipation, excessive eating, lack of exercise and absence oi
proper exposure to fresh air upon the part of one of the strongest,
most healthy looking and most robust members of our profession,
resulted in a collapse, which was interpreted as neurasthenia,
treated as such, kept under treatment for several years, and
the victim is not well yet, and the question may well be asked
whether he ever will be. His neurologist flattered his vanity by
telling him that he had neurasthenia as the result of overwork.
Overwork forsooth ! A practical all-around physician would have
inquired into his habits of life and ascertained the fact that he
was a gourmand, that he ate as much of the richest food, being
possessed of epicurean tastes, as would have been sufficient for
three men. Being a specialist, with his work confined almost
•entirely to ill-ventilated offices in an old styled, illy plumbed
house on one of the prominent thoroughfares of the down-town por-
tion of the city, the conditions were favorable to an accumulation
of poisons. He was in the position of a furnace supplying force
to a mechanism wherein the fuel was shoveled in in enormous
^juantities, a poor draft was given, the amount of oxygen was not
sufficient, the ashes of combustion and clinkers were not properly
removed, and as a^result there was an explosion upon the part of
the outfit. Had the doctor referred to fallen into the hands of an
all-around •'many-skted^^ physician, he Tv:ould probably have been



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parged early and often for at least a week, for it would have taken
that length of time, however energetic his doctor might have heen,
to have cleared oat the accamalations in that alimentary canal. At
the same time his kidneys wonld have been flashed with a view to
the more complete removal of poisons which are eliminated
through this channel. The activity of the skin would have been
encouraged, and during this time the poisoned nerve centers hav-
ing unfitted him for exercise, he would have been famished muscular
exercise through the medium of massage. I venture the opinion
that he would have been rid of his leucomaine and ptomaine poison-
ing within a very short time, and having been placed upon a proper
diet and instructed to take proper exercise, both in walking and
horseback riding, he would have been in shape for work promptly.

Malaria, cold and rheumatic conditions are often potent factors
of so-called cases of neurasthenia. Chilling of the surfaces, too, even
if malaria be ruled out, and certainly where the system is below par,
no matter what the case wejoay have uftder our care, malaria cannot
often be ruled out of our philosophy, particularly in the Mississippi
Valley. But even though it be not considered, with the nervous
system ( which, after all, is our power of resistance against
disease ) below par, the suspectibility to cold, so-called, is great.
Chilling of the surfaces, driving the blood inwardly and interrupt-
ing the equilibrium of the circulation, still further adds to the
difficulties which confront us, and begets a condition of disease
which has been long considered under the term of rheumatic, to
which Dr. Hans Froelich, in a paper recently presented to the pro-
fession, has given the name of lymphostasis.

Dr. Froelich says, "That with such patients there is always too
rich a supply of food with too little combustion, caused by in-
sufficient peristaltic and voluntary motion. These circumstances,
single or combined, then, cause an engorgement of the concentrated
lymph, which condition is first noticed in the fissures and tissue
spaces, the source of the lymph system."

It will thus be seen that the rheumatic and gouty elements, the
presence of uric acid and the deposit of fibromous materials along
the track of nerves, in other words a lymphostasis, should be con-
stantly kept in mind, and so too the fact that in proper regulation
of diet, massage and flushing of eliminative organs, lies relief.

In closing, I desire to emphasize the following points :

1. The naajeclty of cases of so-called neurasthenia are either vic-
tims of nerve weariness, dependent upon misdirected energy without



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proper rest at proper intervals ; and nerve poisoning, the result
of constipation, improper food and accamalation of the ashes of
combustion, leucomaines and ptomaines ; a disposition to use the
stomach too much and the rectum too little, and a failure to appre-
ciate the importance of pure air as a rejuvenator of tired and
poisoned nature ; or else nerve demoralization resulting from
unrelieved peripheral irritations.

2. There is less harm in the victim of disease directing his atten-
tion to special organs and peripheral points as the offenders of his
<;omfort, than there is in having his mind absorbed in the
contemplation of his nervous apparatus. In other words, it is an
evil day for anyone, man, woman or child, when the attention is
concentrated upon the nerve centers, when the energiesr are directed
toward watching nervous symptoms ; in fact, it would be well for
them if they never had a knowledge of the anatomy and functions
of .their nervous system, and that knowledge should be the last
presented to them for consideration. The best way to cure the
discomforts occasioned by nerve weariness and nerve poisoning,
and even those of nervous exhaustion, which are far more serious,
is to prevent them ; and it should be our constant desire to impress
upon the families with whom we come in contact the importance
of building up the nerve capital of the child from the day of its
birth, and even before its birth, indirectly through the mother.
We should endeavor to teach the burden-bearers and battle-wagers
of the world that the fruit-bearers have a nervous system more



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 52 of 78)