1--Diseases of the Spinal Chord
C--Herpes Zoster (shingles)
2--Diffuse and Focal Diseases of the Brain
B--Affections of Blood Vessels of the Brain
2--Cerebral Hemorrhage (apoplexy)
C--Tumors of the Brain
D--Inflamation of the Brain
3--Diseases of the Peripheral Nerves
B--Neuritis in metallic poisoning
4--Diseases of the Cerebral Nerves
A--Lesions of the Retina
5--General & Functional Diseases
B--Acute Chorea (St. Vitus Dance)
To introduce this subject, I desire to say a little about the influence of functional derangement of the nervous system on our daily lives. This subject is not considered in the average textbooks, nor by the average physicians in their general practice. Full nerve energy indicates full nutritive power. This means that metabolism will be carried on normally, that secretions and excretions will be balanced, and that the body will be in as near a normal condition as it is possible for a human being to be. It should be understood that full health is a state which only approximates the ideal; and this state is always in keeping with the nerve energy. To maintain nerve energy at a normal state, it is necessary for man to be adjusted to his environment, and his everyday experiences in that environment must be of such a character as not to overtax and draw too heavily upon his nerve energy. In other words, man's body must be adjusted to its environments. Any influence, it matters not what, that draws too heavily upon the nerve energies, weakens this energy to just that extent. If man uses up too much nerve energy, if he uses a little beyond his creation of nerve energy, each day, it is obvious that he must be gradually running out of this power, Overwork, over-enjoyment, exposure to the elements, physical influences, eating, clothing, etc., all have their influence in using up the nerve energy.
Where nerve energy is used beyond the recuperative power for a time, we have enervation following. This causes an interruption--retarding--of secretions and excretions. Add to this retention of excretions the toxins that evolve when the eating is beyond the digestive power. This toxic state brings about functional derangement of the nervous system, and also functional derangement of various organs of the body.
Much more on this subject will be found in [Tilden's book] Toxemia Explained.
I have explained above how enervation is brought about. Special tracts are affected by local injuries. An injury to any part of the body is liable to set up for the time being an enervated state of the nervous system supplying that particular part. Waste products fail to be eliminated, but are deposited, causing irritation. We have whole systems of healing based upon this derangement of the nervous system. Where the nerves pass out of the spine they are liable to become cramped or impinged because of slight deposits, luxations, or displacements. When this is true, the osteopath and chiropractor are almost invariably successful in giving relief and cure. Where the condition is due entirely to a slight misplacement, the readjusting and righting of the anatomy must necessarily bring a cure; but where nerves are passing out through small foramina or openings between bones or other points, deposits are liable to take place when there is such a state of the blood as toxemia, plethora, scurvy, or gout existing. In these constitutional states there is a certain amount of deposit taking place in different parts of the body, and if a certain part of the anatomy is exposed to irritations--if muscular energy is expended over a certain locality, causing a freer flow of blood to the part than is normal--deposits will take place. If these deposits take place in small bony openings, where nerves and arteries pass out, the nerves will be impinged upon, then cause pain--neuralgia or rheumatism--and, when continued, arteritis and endocarditis. To overcome nerve impingement, there must be absorption. Manipulation and exercise will often bring temporary relief by causing absorption of the present deposits; but so long as the constitutional derangement remains, there will be a redeposit, and all tender points throughout the organism--all points where discomfort is once developed on account of this state of the blood--will reappear. There can be no permanent cure until the habits of life are corrected to such an extent that the organism will no longer keep up its manufacture of toxins and pathological deposit.
It is obvious that manipulations of all kinds will be beneficial. Electricity, vibratory treatment, massage, and certainly osteopathy and chiropractic adjustments, will be followed with positive relief. But such relief will often make the patient and doctor believe that a cure, has followed, when, if what I say is true, it is absurd to believe that a cure can be brought about in this way. In addition to the so-called cure, the righting of the system, by correcting disease-producing habits, will remove the cause; and then a cure may be had that can be depended upon.
In injuries of all kinds there is a tendency for a deposit to take place, because nature rushes there with surplus material to make repairs. But after there has been a restoration to the normal of the parts destroyed, and surplus material is, left--for instance, in the healing of bones--after the bone has been thoroughly united there is a great quantity of debris, not unlike joints made by plumbers; and these extra deposits must be absorbed in the course of time, especially the soft structures. A bony deposit that has taken place will to a certain extent be absorbed, but there will always remain an extra amount, which is for bracing purposes. In injuries, however, where there is no need of this surplus material, and where the surplus material impinges on a nerve structure, either a painful state will remain at that point, or the irritation will be reflexed to other parts of the body. This will be the invariable experience, and will require a treatment which will overcome this condition.
Manipulation will cause absorption; but if there is a slight irritation at the locality, which will bring a surplus amount of blood, there will be redeposits and a return of the discomfort. In all subjects where there is a scrofulous or gouty diathesis, and where there is a general toxemic state of the blood, the redeposits will continue until the toxemia is overcome and the system is readjusted to the original or normal state. It should be kept in mind, in treating the sick, that whatever is necessary to be done to bring them back to the normal should be done; and it should be obvious to all intelligent people that where there are irregular habits or bad habits--where the life is not up to the normal--in any respect, these perversions must be righted. There can be no hope of a readjustment and a bringing back to a normal state without correcting the errors of life.
This disease is characterized by disturbances of sensations and incoordinations of the muscular system. Nutritive changes are also in evidence. There is also found degeneration of the root fibers of the dorsal columns of the cord. The disease means hardening of the posterior columns of the spinal cord. This hardening is on the order of arteriosclerosis. It is really a changing, so to speak, of the spinal cord--a premature aging of the nervous system. The symptoms all point to more or less degeneration of the brain, especially that part related to the cord.
Etiology.--This is a very common disease--more common in cities than in the country. Men are more inclined to have the disease than women; the proportion is estimated at ten to one. It is a disease of adult life, the majority of cases developing between forty-five and fifty. Occasionally cases are seen in young men. I think all authorities agree that syphilis is the cause. My experience--which has not been small--is positively contrary to this opinion. The disease is strictly an old-age disease, and so are most of the chronic symptoms attributed to syphilis; but there is good reason for young men thirty-five to fifty years of age being brought down with locomotor ataxia, for the disease is certainly an index to imprudent life from a sex standpoint. The general opinion about the cause is approximately right, yet absolutely wrong. By "approximately right" I mean that it is a disease brought on oftener from sex abuse than from any other cause. However, anything that will use up nerve energy and break down the nervous system is liable to develop locomotor ataxia. But in all cases that I have ever seen there has been a history of early self-abuse, beginning as early as eight years of age and continuing with either the practice of onanism or excessive venery to forty years of age and the full development of incoordination; and in the majority of these cases I have found that there was not a reliable history of any kind of venereal disease. Where the diagnostician starts out with the assumption that syphilis is the cause, he will convert every sort of pimple or blister around the reproductive organs, lips, mouth, or throat, which would hardly be noticed, into a syphilitic infection. Where trouble is sought for it is exceedingly easy to find; this is true in the search after the etiology of locomotor ataxia. In the majority of cases, so far as I have seen, it requires an exceedingly strong imagination to ferret out an excuse for syphilis; but it does not by any means require a sleuth hound to discover sex abuse to such an extent that it is a wonder that some of these people are left to tell the story. To add to this one cause, there are many others, such as deranged digestion, overwork, worry, anxiety, overworked emotions, exposure to cold and wet, the excessive use of alcohol, tobacco, coffee, and tea.
In all subjects of middle age and over, prostatic enlargement with the accompanying symptoms must be kept in mind by the diagnostician. I am satisfied from years of experience that often first-class physicians pay little attention to prostatic enlargement with its varying symptoms, when reckoning up a diagnosis of any kind, and especially in diagnosing ataxia. I never pass up a patient over thirty-five years of age without an examination of the posterior urethra and neck of the bladder, for a possible pathology, caused by enlarged prostate gland. It is almost as common among men over thirty-five years of age as enlarged tonsils in children, but strange to say, it is criminally neglected and overlooked by many clinicians. For years such patients have been coming to me after getting the last word on diagnosis--the clinic not even hinting that there might be such a condition existing.
The symptoms of locomotor ataxia and those accompanying enlarged prostate gland, inflammation of the urethra and urinary bladder, often parallel each other so that sometimes the symptoms would be summed up as locomotor ataxia when they really belong wholly and entirely to prostate gland enlargement and its varying symptomatology; which symptom complex is very much more simple to treat and more amenable to treatment than the complex of locomotor ataxia.
The latter disease is one of a general giving down of the entire nervous system. The patients of the former may be brought back to very good health if they are willing to follow a rigid regimen for life. Men of no self-control will find the cards stacked against them at every turn, with either of these so-called diseases. The straight and narrow path is the only road to travel. The ataxia subject can do much for himself--not by drugging--not by any curing scheme, but by learning how to conserve every bit of nerve energy. "Regular" medicine has nothing to offer that will not hasten the end.
Doctoring always comes to the end of palliation--either death of the patient, or the patient senses that he has been paying for a benefit he never gets, but, instead, a hurry all to eternity. All cures end in premature demise, the contention of medical superstition to the contrary notwithstanding.
Symptoms.--There are three stages--namely, incipient, ataxic, and paralytic. Symptoms in the incipient stage, which is sometimes called the pretoxic stage, differ very widely. There will be pains of an indefinite character, which may be treated for rheumatism or neuralgia. Sometimes a very great discomfort will occur in the rectum, which may be treated as hemorrhoids or proctitis, or even stricture, when the irritability is wholly reflex and in reality there is absolutely nothing pathologic about the rectum. Some will complain about an irritability of the urethra. I had a case with one tormenting symptom--namely, a feeling as though there were a hair in the throat.
This man had kept first-class specialists in New York, Philadelphia, Baltimore, Pittsburg, Chicago, and Denver in meal tickets before he came into my hands. After having a long talk with him, I told him to return home. He lived in Pittsburg. I told him that if he would forget his trouble he could live a number of years yet. I explained to him that it was simply a nervous irritation, indicating the development of tabes dorsalis. No treatment would be of any avail. So long as he annoyed himself by going from place to place, expecting to be cured, and then being disappointed, he would be annoyed so much that life would not be worth the living; but if he could manage to forget it, and think of something else, his life ought to be made fairly comfortable by living correctly, and he should live for a number of years.
Two years afterward I received a letter from his wife, thanking me for my help to him. She declared that he had overcome his tendency to dig into his throat to such an extent that he would forget it for days at a time; at least he would forget it long enough to attend to a certain amount of business, and would pass days without making any remark about the discomfort or annoyance; for, as he declared himself, it did not amount to a discomfort, but he felt that, if he could just get hold of the hair and pull it out, he would be fully relieved.
The pains that precede this disease are of a sharp, darting character. They may show in almost any part of the body. They do not last long. Their tendency is to appear around the belt region. However, there will be darting pains occasionally in the intestine and in the sensitive spots, and a very wise physician will probably advise that there should be an operation for appendicitis. In some cases there is started up a numbness in the feet--a tingling sensation; and then in others there will be a feeling of constriction about the waist, as though the clothing were too tight. In a small percentage of cases there will be an atrophy of the optic nerve. This causes blindness to come on very early in the disease. This atrophy comes on very gradually, and ultimately leads to total blindness.
There is ptosis of the eyelids. The pupil is sometimes exceedingly small, due to spinal myosis. The Argyll-Robertson pupil indications, with the darting pains and ptosis, are considered diagnostic. The character of the pupil is a contraction, with loss of reflex to light. To show how very specific is the idea that syphilis is the cause of this disease, I will repeat a few lines from a well-known authority: "The time between the syphilitic infection and the occurrence of the symptoms of locomotor ataxia varies within a wide limit. About one-half the cases occur between the sixth and the fifteenth year, but many begin even later than this."
Ataxic Stage.--The first symptom that the patient experiences is inability to get around in the dark, or inability to stand with the feet together and the eyes closed. Patients in this condition are wholly incapable of standing on one foot. The walk of the patient suffering from ataxia is very characteristic. There is a decided inability to control the movements. The feet come up with a jerk, and are pushed forward in an irregular way, and while clear of the ground there is more or less of a tendency to fall about either to the right or left. Coordination is almost entirely lost; that is, the power to control the movements is apparently not strong enough to do anything more than lift a projected foot and leg, but where and in what direction the movement will be made is conjectural. The patient evinces strength, but nevertheless there is this lost power of controlling the movements. The push and pull of the legs are strikingly strong, showing that incoordination is choreic rather than paralytic. There is paralysis to just the extent that the joints are more than usually relaxed, so that there can be a hyperextension and a hyperflexion.
Sensory Symptoms.--Lightning pains may continue. These pains, however, vary greatly in different patients. Some patients will not complain very greatly. Others will complain a very great deal, and the pain is so persistent in certain localities that it is sometimes mistaken for rheumatism. Tingling sensations, described as pricks of pins and needles, are present in the feet. Sometimes patients have a sensation as though there were something between the feet and the floor--when the naked foot is put on the floor, as if there were cotton between the floor and the foot. These, of course, are symptoms of lost sensation--or perhaps I would better say incoordinate sensations.
Sometimes there is lost power of localizing pain. A prick on one limb may be felt on the other, or a pin prick on one foot may be felt on both. In these cases a time comes when the patient loses power to recognize in what position the leg is. It may be extended far to the side, yet, so far as the consciousness of the patient is concerned, he will not know but that both feet are together and the legs parallel to each other.
Reflexes.--Lost knee-jerk, or patella reflex, is an early symptom; in fact, this often exists when there are scarcely any other symptoms. But in all such cases I have found chronic, granular inflammation of the urethra. Almost invariably these cases have shown one or more strictures of the urethra, bearing out the belief I have had for a number of years that the disease is brought on from excessive venery and irritation of the reproductive organs, more than from any other one cause. Continuous subacute reflex irritation from stricture of the urethra--or what is sometimes called gleet--is capable of breaking down the nervous system and bringing on tabes dorsalis. This, however, will require a certain amount of toxin poisoning--toxemia--to hasten the development. There is nothing that so breaks down the nervous system and prepares it for taking on tabes dorsalis as venereal shocks and where these shocks are excessively frequent, and continue over a number of years, patients are liable to go down and out with locomotor ataxia before the chronometer has tolled off half the years that should come to man.
Deafness is not uncommon as one of the early symptoms of this disease; yet it cannot be recognized as characteristic, for people who develop ataxia have in all probability been more or less troubled with catarrh all their lives, and the deafness may be wholly catarrhal.
Vertigo is another symptom that does not necessarily belong to this disease, because it may be a symptom of indigestion and liver derangement. The irritations that cause such patients to consult physicians--such as laryngeal, gastric, nephritic, rectal, or urethral irritations, etc.--are what are in ataxia called crisis symptoms; but they belong to arteriosclerosis as well, and are brought on by hyperemia. As stated before, they are purely reflex. The most common, or gastric and laryngeal, both may be found in chronic irritation of the stomach of dyspeptics, tobacco-users, and those given to excessive use of any stimulants; hence such symptoms will be of no importance, unless they are found existing without the usual symptoms of gastric derangement due to improper living.
One of the early symptoms of locomotor ataxia is a retarded, or rather a hesitating or halting, expulsion of the urine, The desire to, urinate will be present, but the patient will experience difficulty in starting the stream. Almost any kind of symptoms of a cerebro-spinal nature, due to degeneration, may be looked for in subjects of this disease.
Paralytic Stage.--In time these cases arrive at paralysis, where there is no power to walk. Then, of course, they become bedridden. At this time, or before, such patients are often carried off with some intercurrent affection, or a hyperemia, or apoplexy, of a vulnerable organ, brought on from an indiscretion that in health would scarcely be noticed.
Diagnosis.--Lightning pains, inability to stand with the eyes closed, etc., are considered almost diagnostic.
Treatment.--There is only one cure, and that is prevention--removing the causes before the disease is developed. The habits of life must be corrected. A very foolish manner of treating such cases is for the physician to permit the patient to continue the use of tobacco, coffee, tea, or other stimulants, and prescribe such so-called remedies as strychnin, tonics, etc. Patients must be kept away from all stimulation, and they should be kept out of the atmosphere of them as much as possible. For instance, they should not be confined to offices where there is tobacco smoke, or in homes where the odor of coffee is in the air two or three times a day. It must be remembered that the farther down the nervous system is driven--enervated--the more easily it is affected, and patients may become so susceptible that the inhaling of tobacco smoke for a few seconds will produce as much irritation as two or three cigars would produce several years before the breakdown came. In this respect patients frequently do themselves great harm. They know what they have been able to do; they are quite willing to believe that they can indulge a little, compared with the old supply; and they treat the subject of overstimulation and bad habits in the same way all along the line; and too frequently physicians concur with the patient in this matter. Such patients should be impressed with the necessity of doing absolutely THE RIGHT THING ALL THE TIME; they should be made to see that there is everything to gain and little to lose, and that that little is more easily lost than even average physicians can be made to believe. Thus no one is justified in going on the principle that he has nothing to gain, that everything is lost; for nature is more than willing to meet all patients half-way--yes, nine-tenths of the way. Hence those who wish to get any benefit--continue in life and enjoy much comfort--must pay the price, which means absolute continence, complete abstinence from all stimulation, and a very simple diet, made up of fresh, uncooked fruits for breakfast; salad, cooked, non-starchy vegetables, and wholewheat bread, potatoes, or some one of the decidedly starchy foods, once a day for a second and last meal; and abstinence from strong meats, such as beef, pork, etc. Lamb, chicken, fish, or eggs may be indulged in once or twice a week, dropping the starch; but it is my opinion that those patients will live longer and enjoy better health if they do not indulge in animal albuminoids at all; for decomposition of the protein in the intestine is one source of toxin poisoning in this tragic disease.
Definition.--A progressive disease of the brain and meninges, associated with mental and motor disturbances.
Etiology.--All nerve disturbances of a degenerative form are looked upon by a stereotyped medical mind as originating from syphilis. It is the consensus of opinion of the medical profession that syphilis is the cause of all degenerative cerebro-spinal affections in seventy to ninety per cent. I may be lacking in gray matter, but I do not believe that this is true; for the disease can be found in country districts, affecting people who have lived far from the centers, and who have never had syphilis or anything of a venereal character. The answer to that statement by those who advocate the syphilis idea, is that it has been inherited. It is necessary to make this assumption; for the theory would break down without it, and, according to the experiences I have had, it is not necessary to bolster an assumption with a fallacy to know the cause of the majority of diseases ending in cerebro-spinal degeneration. As stated under locomotor ataxia, excessive venery, plus toxin poisoning developed by putrefaction from imprudent eating--from a haphazard style of living--is quite enough to account for seventy to eighty per cent of the cases attributed to syphilitic infection. Heredity is said to be a very important factor; obviously, however, only to the extent that we inherit a tendency to take on certain lines of disease.
In general paralysis, next to syphilitic heredity as a cause, it is said that an important predisposing cause is a life spent in ambitious projects that require strong mental effort to realize. Business propositions which require great nerve strain are in this class. This I accept, with the addition of a haphazard daily life for there is nothing that will harden and age the nervous system like a continuous strain or worry. But overstimulation is necessary to worry successfully. Such people take their business to bed with them, adding worry at night, and coffee, tobacco, and often alcoholics during the day, to hard work and this conglomeration of causes leads to enervation. No nervous system can long stand up under a continuous strain--under continuous hard work and bad habits--if there is worry added to it.
Symptoms.--Irritability; inattention to business, amounting to apathy. Previous to the development of the degeneration, subjects may work night and day, when all at once they decide to have a little vacation and pleasure. They will take interest in affairs of life which before had never even drawn their attention, and friends who are close to them will be surprised to see them leave their desks, and the work that they had pursued so intensely, and go off for an hour, seemingly without anything to do, with the mind on subjects entirely out of keeping with their business. When anyone acts in this way, it is quite safe to assume a failing mind, and if dementia follows, friends should not be surprised. It is simply a giving-down of an overworked brain and nervous system. It is obvious that such people are profoundly egotistical and self-centered before, and even after, the mental degeneration.
The Argyll-Robertson pupil is present, and often optic atrophy, which is liable to lead to total blindness. The facial symptoms--the peculiar stolidity of the features, tremulousness of the muscles of the face, and inability to protrude the tongue--are characteristic. It is said that those who lead a very active life and do a great deal of hard work are more liable to have tabes than paralysis. The truth of the matter is that hard work is blamed for what sensuality does. It has been my experience that office men--those leading sedentary lives, writers, etc.--are more inclined to develop tabes. Both diseases are remediable, if taken before organic degeneration has advanced too far. Some cases of tabes show topical paralysis early.
Treatment.--Correcting the life is the only thing to do that will bring relief, and it is the only thing that is necessary. Stimulants must be tabooed, and eating should be light. Stimulating food, such as meat and bread three times a day, must be given up. Take bread about once a day, meat not at all in the summer time, and two or three times a week in the winter time; fruit for breakfast; a combination salad, meat, cheese, or nuts, with cooked vegetables, for dinner. Abstain from all stimulants.
Definition.--An acute inflammatory disease of the skin, which consists of vesicles on a reddened base, the lesions being distributed in relation to the course of the cutaneous nerves, and as a rule unilateral. The outbreak of the eruption is usually preceded by severe neuralgic pain.--Gould.
The latest opinion is that this disease is an acute hemorrhagic inflammation of the dorsal roots of the spinal nerves; that it is an acute affection of the nervous system and localizes on one side of the body. One peculiarity of the breaking-out on the skin is that it will not cross the median line either in front or behind. This disease takes its name from the locality. When it is on the face it is herpes facialis; when it is on the lips, it is herpes labialis, etc.
Herpes is a most disagreeable disease. The eruption is sensitive, and the rubbing and chafing from clothing, bandages, and dressings contribute to make the disease--affection is a better term--very disagreeable.
Etiology.--Herpes is a reflex irritation. The real cause is intestinal putrefaction, causing toxin poisoning. Because of nerve inhibition, that part of the surface which is involved cannot eliminate through the natural channels; hence there is forced elimination by the cutaneous emunctories, with topical infection and consequent inflammation.
Treatment.--Rest in bed when possible, and a fast of sufficient duration to establish full elimination. When the affection is controlled, then feeding should be fruit at first; then fruit and salads; then a dinner of starch, vegetables, and salad daily, with fruit for the first meal.
In people over fifty years of age it is quite common to find hardening of the arteries of the spinal cord. In all probability this is due to the fact that in the majority of people the spinal cord is allowed to become very inactive. Very few men keep up any very great amount of exercise after thirty years of age. What little they do does not bring into activity the spinal column. This naturally will lead to stiffening and hardening of the parts involved.
This is a disease interfering with speech. Where symptoms of aphasia begin to manifest, it points to a lesion of the nervous system, especially a chronic derangement of the brain located at the lower part of the fissure of Rolando. Patients beginning to show signs of this derangement will have difficulty in making themselves understood. They will say words that have entirely different meanings from the words which they have in mind or wish to use. The derangement may spread to and affect the speech centers, the facial centers, and also the auditory centers. Aphasia is rarely simple. It will not exist very long before other symptoms develop. It is almost impossible to, draw the line between the various derangements of this part of the brain. There is a great deal written on this particular disease; but, inasmuch as no patients are ever benefited, but all of them travel slowly but surely to the grave, a minute history and description of the disease is worthless to anyone except those who desire the novelty of knowing all about it. Many family physicians will find it necessary to be thoroughly informed on the subject, in case patients suffering from this disease have large legacies to leave and the families are divided against themselves.
Where the disease occurs in youth, the probabilities are that, if proper care is given, the patients will get well. Aphasia may start up in very young children, who will be very slow to have command of language until they are ten, or even fourteen or fifteen, years of age. Youth is a wonderful restorative. Where men begin to show symptoms of aphasia after forty to fifty years of age, it is only a question of a few years when paralysis will develop. The patient then will remain speechless, though capable of understanding everything, and he may even attempt education. A stay in the progress of the disease may take place, and the patient remain in a semi-invalid state for several years.
Misplacing words is very common and very annoying to those who are afflicted in this way. The fact of the matter is that imperfect speech or misplacing words will not continue many years without being accompanied by impairment of the power of expression, and certainly reasoning will be affected more or less.
Hope may be given to parents of children troubled in this way; but in the case of those past middle life physicians should be very guarded about promises of betterment. Of course, the prospects of betterment in such cases will depend largely upon the past life. If the individual has gone the pace, he certainly will not be brought back to anywhere near the normal. The rule is that when this disease develops it means that the subject has been excessive in indulging himself sensually. In children the cause may be convulsions. By feeding children in such a way as to produce gastro-intestinal irritation--especially in children of a decidedly nervous temperment--they may be forced into epileptic seizures that will cause more or less paralysis of different parts of the body. Special brain centers are sometimes involved; and, if organic change has taken place, a cure is impossible.
In ordinary health the circulation of the blood in the brain follows in order the general circulation. Anything that increases the flow generally will increase the flow of blood in the brain. Anything that excites the heart action increases the amount of blood passing through the brain. Active hyperemia must occur under many circumstances and conditions, and there are no symptoms further than prominent veins on the forehead and temples and a full feeling of the arteries. When this is brought about by a plethoric habit--from eating rather more than is necessary--there will be no symptoms until the habit of overeating has been maintained for several years. Then, when such subjects lie down, there will be a purplish appearance of the skin around the eyes, nose, and ears; and when they stoop, over, the face gets very full of blood and quickly turns purple at different points. Such subjects may boast of excellent health and lots of strength; but they are developing such a state of dilation of the blood vessels of the brain, and perhaps the upper part of the spinal cord, that apoplexy is invited. If their blood is suddenly reduced by an accident which opens the blood vessels and allows a great loss of blood, there is danger of a sudden collapse. By this I mean that a surplus amount of blood is drawn off so quickly that it leaves the brain anemic, and the shock may be so sudden as to cause death long before the patient has lost sufficient blood to account for it.
If such patients are prostrated on a bed of sickness until quite anemic, there is danger of death coming from anemia of the brain. In truth, it would be a case of bleeding oneself to death in his own veins. It is dangerous for any one organ of the body to be kept in a state of hyperemia running over a long period of time.
Consciousness is kept in evidence by a continuous supply of blood to the brain. When the brain is suddenly made anemic, patients fall in a faint. When patients suffer from oxygen starvation, brain efficiency is lost. It requires a full amount of rich arterial blood to keep up mental efficiency. Under the influence of emotion, the action of the vasomotor nerves is cut off, and, as a consequence, the abdominal blood vessels become distended with blood. The blood pressure falls and the heart falls; in other words, the heart empties, the circulation of the brain falls, and unconsciousness occurs. This will happen when a large ovarian cyst is removed from the abdomen, or a large accumulation of dropsical fluid is drawn off suddenly. Where these accumulations are removed suddenly, patients are liable to bleed to death within their own bodies. The blood vessels of the abdomen have been pressed upon until paralyzed; then, when the pressure is removed, they are filled, with no power to empty.
When using chloroform on patients, it is necessary to have them in a horizontal position; otherwise the anesthesia is liable to kill them. The reason for this is that the chloroform partially paralyzes, or in truth does paralyze, the muscular coats of the arteries. The blood empties into the abdomen from the brain, and the patient dies from fatal syncope. Only the foolhardy would attempt to give chloroform to patients in a sitting posture. A half-sitting position is dangerous, This is often the position that patients are in when dentists work upon the teeth. I have had considerable to do with anesthetizing patients, but I have always insisted upon the horizontal position. If, however, this is not possible--if the dentist is not expert enough to operate upon his patient in that position--then the chloroform should be given according to my hasty method; namely, have the patient breathe deeply and rapidly, with the face under a towel, for about two minutes. Then add chloroform, and allow the patient to inhale rapidly for about one minute. Then remove the chloroform, and let the operation take place. If the dentist is expert, he should pull several teeth before the patient has any real sense of pain. Under such circumstances there is no danger of collapse or heart failure. A weak heart--made so by various causes--may have the influence of keeping the brain anemic. I have found that patients who have a very slow pulse, running from thirty to fifty to the minute, usually carry a state of hyperemia at the base of the brain, which will not be suspected. It is a condition brought on from overeating, causing more or less plethory. If these patients are fasted for three or four days, the volume of blood is let down; there will be a feeling of dizziness in the head on account of the loss of pressure from the hyperemia, and they will complain of a feeling of heaviness, closely bordering on dizziness--all due to the fact that there is a sort of collapsed state of the blood vessels.
If such a patient is fed very carefully, and not enough to raise the blood pressure--just enough to keep body and soul together--an adjustment will take place in the blood vessels of the brain, so that after a while--in the course of a few weeks--the food may be increased in amount, and eventually the patient can eat all that is necessary, and continue to have a pulse at from sixty-eight to seventy-four--the normal pulse-rate; whereas for perhaps ten years or more before there had been a pulse never rising as high as sixty. If this condition is not recognized and corrected, such patients will die of apoplexy; or there will be an increasing hyperemia that may continue to inhibit the circulation until there is death from heart paralysis.
Heart weakness may be brought on from any habits that overstimulate and bring on enervation. Some people are more liable to take on heart weakness than others. There is a predisposition--or it would be better to say a special diathesis--and they take on derangements more easily than others. The gouty diathesis will develop rheumatic heart trouble.
Etiology.--Those conditions of the body that pervert the blood vessels--a plethoric state of the body, rheumatism, gout, acidosis or scurvy--when known to exist, will account for any symptoms there may be of cerebral hemorrhage. Anything that produces a degeneration of the vessels is liable to bring on this affection. Men who abuse themselves with alcohol are predisposed to this trouble. Men are more subject to this disease than women--in all probability due to the fact that they are more licentious and indulgent in the line of stimulation. There is no such thing as inheriting a disease, but there is a tendency to take on this affection which may be called predisposition. It is a disease that is more liable to develop in the gouty subjects than in any other class of people. It is very liable to develop in the course of rheumatism and fevers of various kinds, Apoplexy may develop, caused by embolism.
Symptoms.--The patient is seized in apparent good health, while in the performance of some duty--occasionally an action requiring strain. There may be a sensation of numbness, or tingling, or pain, in the limbs; or there may be choreic movements of the muscles of the side opposite to that in which the affection is most intense. The onset of the hemorrhage may be sudden loss of consciousness and complete relaxation of the extremities. The disease is liable to occur at the close of a meal, or after excitement, or after a speech that has brought up the arterial pressure. It is not infrequent that a speaker will fall forward and down unconscious with apoplexy before he has gone very far with his address.
Anything that will temporarily increase the arterial pressure is liable to precipitate hemorrhage. Those cases that do not die will have more or less paralysis following. It is called a stroke. If the hemorrhage is not very large, the blood-clot may be absorbed, and the patient may gradually regain the use of a hand or leg, or both arm and leg of the side paralyzed. A paralysis is more often that of hemiplegia--half the body--than confined to the lower limbs. In severe cases the unconsciousness is very profound; the patient cannot be roused; the face is turgid; the skin has a cyanotic (bluish) appearance, The pupils of the eye are dilated, and sometimes unequal. The patient may remain in a state of coma for several hours before dying; or the coma may last for from several hours to one or two days before consciousness will return. Where the paralysis is not great--where the hemorrhage has not been profound--the symptoms will not be so profound; but there is no assurance that the patient will not have another attack before he has fully recovered from the first and second strokes. Often, however, the strokes are months apart. The location of the hemorrhage varies very widely. Necessarily symptoms coming from this disease must vary a very great deal. The sort of paralysis brought on must depend entirely upon the location of the blood-clot. For example, pressure on the speech center will cause word-deafness.
Treatment.--The treatment should begin months and years before the disease manifests. Those who are heavy eaters, continually carrying a large quantity of blood in the brain, evidenced by flushed face and enlarged veins over the forehead, and other signs of too much blood, such as ringing in the ears, head swimming, etc., should take a hint and reform their manner of living. The time to cure this disease is several years before it manifests. No one can be fooled into knowing he is headed in that direction; for all he needs to do is to look at himself in the glass, and he will find he is altogether too stout and too plethoric-looking, and the face is usually quite flushed. He should know what his habits are. A man who uses stimulants to excess must know, or should know, that he is bringing upon himself degeneration of the blood vessels and that the time must come when apoplexy will result. It does not necessarily need to be found in the brain. Apoplexy may take place in the kidneys, or any other vital organ of the body. It means a ruptured blood vessel from a distention of the vessel. So far as the treatment is concerned, it should be preventive. However, when the disease has developed, the patient must be fed very little, so as to reduce the quantity of blood; also the weight must be gradually reduced, and he must consent to live with a reduced arterial pressure and a largely reduced weight. The food should be principally fruit and salads. Very little meat may be taken once or twice a week, but no bread, or anything made from grain, until the weight is brought down to a point where the patient is made safe. Then two or three times a week a little toast bread or baked potato may be given. Sugar in all forms must be tabooed.
Symptoms.--The most important symptom is headache--either dull and continuous, or sharp, stabbing, or lancinating. The pain may be made to diffuse itself all over the head. Sometimes it is limited to the front, and sometimes to the back. When it is in the back of the head it extends down the spine. Occasionally the pains are decidedly localized, with a sensitiveness to the touch.
Treatment.--In cases where constitutional syphilis is suspected, there may be a growth known as gummata. These cases are treated by iodid of potassium, mercury, etc. I should expect to accomplish as much by proper dieting and proper general care of the system. There is nothing that will increase the elimination equal to a proper combination of foods and the restricting of food to systemic requirements.
This means inflammation of the brain substance--usually of the gray matter. Inflammation may be brought on by an injury, by intoxicants, food poisoning, gas poisoning, etc. It is a disease that follows infections. It frequently is a sequel or an accompaniment of meningitis in such diseases as cerebral spinal fever. It has been known to develop in exophthalmic goiter and in some forms of malignant diseases, mastoiditis, ulcerations in the ear, etc.
Symptoms.--The symptoms of this disease are not well defined. Sometimes it is taken for typhoid fever. Indeed, I see no reason why it may not be an accompaniment of typhoid fever; for the malpractice that causes the so-called typhoid fever to run on for weeks, developing septic poisoning, may develop inflammation of the brain just as readily as toxins generated in any other way. The common symptoms are headache, inability to sleep, coma, delirium, vomiting. Paralysis may follow the disease where patients recover.
Treatment.--When the disease is due to injury, the treatment must be surgical. Where there has been depression of bone, it must be lifted. If there is headache or delirium, it must be treated in the usual way: perfect quiet, hot baths to complete relaxation, enemas to clear out the bowels, and positively no food until all symptoms are under control. Where cases extend to the formation of abscess, if the diagnosis can be positively determined, the surgeon is needed to operate and remove the pus.
This disease may be confined to a single nerve, or it may involve a large number of nerves. When many nerves are involved it is known as multiple neuritis.
Etiology.--Local neuritis may be caused by what is called a cold--whatever that means. A cold is something that everybody knows all about and no one knows anything about. It is a blanket term that covers a great deal of ignorance. Those who are decidedly toxin-poisoned, and those who are inebriates, morphine fiends, or given to the excessive use of food and stimulants, will be subject to this disease. When the nervous system is made sensitive, as it is in all chronic poisoning, as above hinted, a bruise, an injury, or an exposure to cold when lying heavily on one cheek, with the crease of the bed-clothes pressing against the side of the face, or any unusual pressure, will start up an aching or an inflammation. This is what is called localized neuritis; it is sometimes called rheumatic neuritis, and it is also called neuralgia.
Neuralgia or inflammation of the sciatic nerve may be brought on by the constant pressure of sitting in an uncomfortable chair. There is no difference between localized neuritis and multiple neuritis, except in degree, and the fact that in multiple neuritis a greater portion of the nervous system is involved.
Symptoms.--Local neuritis is usually confined to the one nerve, and, as a rule, the constitution is not so broken down as in the other form. The most important symptom is pain. The character of the pain is on the order of pressure or bearing, sometimes stabbing; and when the pain is on, the nerve is usually sensitive to pressure along its course. Sometimes the skin is slightly reddened over the nerve; and again cases are edematous. The pain varies considerably, being sometimes intense and distressing, and at other times simply a soreness that will almost subside, and then return.
In localized affections of this character, if the nerve involved is the supraorbital and the patient is of a hysterical temperament, she may put the muscles of the eyebrow in a state of onguard and cause herself very much more suffering than she need have. Any pain protected by putting the part in a fixed position with the surrounding muscles puts everything on a strain, and in the course of a day the patient will have a great deal of suffering from the onguard state of the muscles--really more than from the pain which the fixation was assumed to relieve. In headaches of a nervous character many people build a continuous headache by knitting the brow and putting the whole front of the forehead in a corrugated, cramped position, instead of allowing the muscles to relax. It does not relieve a pain to corrugate the brow, but it intensifies it, and people who would suffer very little from headache will develop a type that will run on indefinitely, caused by cramping the brow, and otherwise developing the headache habit. Physicians must be very careful about mistaking this form of headache for neuritis or tumor of the brain.
The duration of the disease varies from a few days to weeks, but sometimes months. A slight neuritis from injury may pass off in about a day or two, while in severe cases, in unreduced location of bones, or in fracture of bones, where nerves are pressed upon, the relief will not come until the cause is discovered and removed.
This disease is liable to be set up in the course of metallic poisoning.
Treatment.--Rest in bed and a pint of hot water every three hours until comfortable. Then fruit morning; salad at noon; teakettle tea in the evening, for about a week. Then gradually increase, but avoid overeating. Hot baths to relieve excessive pain. Certainly no drugs for these subjects; for they have already been poisoned to death. I think the majority of physicians will give hypodermics of morphine to remove pain, but it is not necessary. If a hot bath can be had, the patient should be kept in water as hot as he can bear for half an hour, or an hour, if necessary to bring relief; and then he should return to the hot bath when the pain becomes troublesome. Of course, the excessive heat in bathing is enervating, but no more so than drug administration and the pain for which the bath is given. Strychnine is recommended, but, to my mind, it is the very worst kind of malpractice to overstimulate a patient in this condition with drugs that act so powerfully on the nervous system as strychnine. Indeed, drugs are not necessary at all.
These lesions are not rare, and must be recognized by the physician. A systematic examination of the eye, to find out the condition of the retina in certain diseases, is necessary.
This disease occurs as a symptom in Bright's disease of the kidneys, syphilis, leukemia, and anemia. The common symptom in all cases is the occurrence of hemorrhage and the development of opacities. Where hemorrhage occurs there is a diffused cloudiness. This is due to an effusion of the serum. The hemorrhage takes place between the layers of the nerve fibers. When recent, the color is bright red; but as times goes on there is a change. In old hemorrhages the color is almost black. The white spots are due to exudates of a fibrous character, or fatty degeneration. The most important form of retinitis is albuminuric retinitis. This occurs in patients suffering from kidney disease, particularly that variety known as interstitial nephritis. The percentage of cases of nephritis presenting this peculiar condition of the retina ranges from fifteen to twenty-five. This disease, when associated with granular kidney, occurs at a stage when the amount of albumin may be slight or even absent. Arteriosclerosis often accompanies this affection. There is a hemorrhagic form, where hemorrhages are repeated, with very slight signs of inflammation; and then there is an inflammatory form, in which there is much swelling of the retina. This latter variety obscures the disk, and in some instances the inflammation of the optic nerve predominates over the retinal changes. This frequently throws one in doubt as to whether the condition is really associated with the retinal changes.
Retinitis in Anemia.--After large hemorrhages, it is not infrequent for a patient to lose the sight of one or both eyes temporarily. Sometimes the lost sight will be permanent. In such cases there is usually a retinitis of sufficient severity to account for the symptoms. There is also a malarial retinitis, and then a retinitis due to leukemia.
Treatment.--There is no special treatment of any importance for these affections. The real derangement, which the retinitis represents as a symptom, must be corrected; hence the treatment must be for those diseases. Certainly all stimulants must be given up, including coffee and tea, with an absolute fast until all discomfort is gone, then fruit and vegetables until health is established.
Where the fifth nerve is involved, sensation and motion are apparently interfered with. Where the seventh is involved, facial paralysis is marked.
Paralysis may be the result of disease of the pons, particularly hemorrhage or patches of sclerosis. It may result from injury or disease at the base of the brain. It does not occur because of fracture, but meningitis produced by an Injury, or caries of the bone, may extend to and produce paralysis of this nerve.
Symptoms.--Paralysis of the fifth nerve may cause loss of sensation of the parts supplied, including half the face and the corresponding side of the head. Patients suffering from this will have the features turned to the opposite side, and the eyelids only partially close. The tongue will draw to that side, and when the patient undertakes to spit, it goes to one side. The loss of sensation will extend to the conjunctiva, lips, tongue, and soft palate, with that portion of the nose which is on the side where the paralysis has taken place. The loss of sensation may be preceded by a tingling. The muscles also lose their sensibility. The sense of smell is lost--said to be due to the dryness of the mucous membrane. In all probability it is due to just what causes the loss of sensation of the other parts to which this nerve is distributed. The secretions are lessened from the lachrymal and salivary glands of the side of the face paralyzed. It is perfectly natural and reasonable that a gland which is partially or wholly paralyzed should also lose its power of secretion. The inflammation and ulceration that occasionally take place in the eye in all probability are due wholly to the exposure. The eyelid, not closing, allows dirt to accumulate, which, of course, must irritate. Inflammation will follow continuous irritation, and ulceration will follow the inflammation. Paralysis has nothing at all to do with the eye complication, further than that, on account of lost control of motion, the eye cannot be kept free from dust, etc.
Herpes (skin inflammation) may be developed in the region supplied by this nerve, especially the upper branch and region of the temples. It is accompanied by much pain. This derangement is inclined to run on for years. Herpes accompanying this derangement is often complicated with a brain lesion. I have known a few cases ending their lives in the insane asylum. Probably the nervous system was so unbalanced from continuous suffering that the mentality gave out, and the disease may have extended to the brain. The most pronounced diagnostic symptom is the loss of motor power--the inability to use the muscles of the side of the face.
Treatment.--Drug physicians usually resort to morphine; and where there is a suspicion of syphilis, which is very common, anti-syphilitic treatment is given. There is but one proper treatment for this disease, the same as for all others; namely, correct whatever is necessary. If the patient has many bad habits--such as indulging in intoxicants, using tobacco, coffee, and tea, eating excessively of starches, and being sensual to the point of exhausting his nerve energy through venery--these habits must be stopped. A fast should be taken for one week, or longer if necessary; followed by fruit morning, noon, and night for the second week; and then, for the third, fruit twice a day, and salads, with non-starchy vegetables, for one meal a day. After that fruit for one meal, starch for one, and vegetables and salad for another.
This disease is often called sciatica, neuralgia, sciatic rheumatism, and sciatic inflammation. It is neuritis of the sciatic nerve. It is not impossible to have a functional derangement of the nerve, due to pressure, cold, or injury; but where the pain is pronounced it is inflammatory or a true neuritis.
Pressure on the nerve is the commonest cause. Frequently people will select as a writing-chair one that presses upon some point of the sciatic nerve. Where this is true there is no hope of getting rid of the disease, after it is once established, so long as that particular chair is used. Those who use office chairs or writing-chairs should select one that will pitch forward, so that when the feet are on the floor the knees and legs will be sufficiently elevated to avoid pressure on the back of the leg by the edge of the chair. No one should use a chair that presses on any one particular point of the back of the leg more than on another. Workmen who use lathes, and are compelled to spend many hours in treading a lathe, are very liable to develop this disease. The class of people more inclined to develop sciatica than others are those who are sensual in their natures. As a rule, men have been alcohol, tobacco, coffee, and tea habitues; and where the nervous energies have been drawn upon heavily because of excessive venery, such subjects will be hard to cure, when the disease is once established. Persistence, however, in a correct life will bring a permanent cure.
Physicians should be on their guard in diagnosing a given case of pain in the region of the sciatic nerve as sciatica. In fact, such a diagnosis should not be made until a thorough examination has proved that there are no such derangements as urethral stricture, irritable prostate, stricture of the rectum; or, in women, metritis, ovaritis, displaced womb, or some derangement of the reproductive organs, sufficient to account for the reflex irritation.
Symptoms.--The pain is almost constant, and of a character that wears the patient out. There is nothing that will cause one to feel so hopeless as weeks of suffering from this disease. The pain is not so acute as it is tormenting and continuous. It may extend from the spine to the footeven to the toes. The posterior of the thigh, so to speak, is probably a point that is more troublesome than any other in the course of the nerve, because of its being injured more than any other point from sitting on chairs, benches, etc. Keeping absolutely quiet gives the patient the most comfort. A very short walk will often throw him into great distress. The tendency is for the patient to walk on his toes, which relieves the tension. Where the disease has lasted for months and years, off and on, there is more or less perishing-away of the muscles of the leg. Herpes may develop. When it does, it is very intractable.
Treatment.--First prove whether it is neuritis or a reflex pain. If reflex, of course the disease from which the reflection is made must be corrected. A true sciatica must be taken care of about as follows: The patient should be put to bed, and given a hot bath as often as necessary to bring full relief. If necessary for him to take a thirty- to forty-minute hot bath every three hours, this can be done. Absolutely no food should be given until comfortable--a pint of hot water every three hours. When comfortable give a little fruit--something that is not too acid, on the order of pears, cantaloupe, or any other sweet fruits. The bowels may be cleared out by enema, The patient can use what water is desired while going without food. When eating begins, water-drinking may end.
Prunes, onions, and spinach should be in the daily menus, because of their laxative influence on the bowels.
A general rubbing-down twice a day, with a coarse towel or flesh brush or friction mittens, should be given the sciatic patient.
Many things have been resorted to in the line of drugs--deep injections of chloroform, alcohol, or ether; nerve-stretching, cauterization, etc.; all of which I know to my perfect satisfaction are worthless. The more the patient is abused by such remedies, the longer he will stay sick.
This is a chronic affection characterized by weakness and tremor, also rigidity.
Etiology.--This disease develops in men oftener than in women. It is a disease that rarely develops under forty to forty-five years of age; yet cases have been reported under twenty-five years of age. In all probability, however, these were choreic in nature.
The exciting causes may be exposure, cold, wet, worries and anxieties of all kinds. In some cases it is brought on from mental shock or an injury. Any toxins may produce this disease in those who are predisposed to it. Not everyone will take on paralysis agitans. It belongs to those of neurotic diathesis who have intensified their nervousness by the use of all kinds of stimulants, alcoholics, tobacco, coffee, tea, etc. There is no question but that Parkinson's disease is only one manifestation of arteriosclerosis, or old age, disease. I never have met with a case yet that did not present most pronounced symptoms of arteriosclerosis. In those who are predisposed to take on the disease it is liable to develop in middle life. Some authors declare that it is not a neurosis. Why is it not? The blood vessels are controlled by the nervous system; arteriosclerosis is built by over-stimulation; and, certainly, if there were not nerves to be over-stimulated, it would be a very difficult matter to stimulate the organism, or produce all the diseases that come under the head of sclerosis.
Symptoms.--The disease begins gradually with an unsteady hand. The tremor may be constant or intermittent. With this may be associated weakness or stiffness. Indeed, such cases are inclined to have rheumatism. This will account for the stiffness. When a slight rheumatism takes place in the joints of the hands, the appearance is that there is a great loss of power, This, however, is not true; for if the sensitiveness is taken out of the hands, they can grip or show evidence of power equal to that of any time previous to the development of the disease.
The four leading symptoms are tremor, weakness, rigidity, and an attitude.
Tremor.--The tremor may develop in all four of the extremities, or it may be confined to the hands or to the feet. The head is not so inclined to take on the affection; yet the disease is met with seemingly confined to the neck, where there is a choreic jerk of the head. The trembling is often decidedly marked in the hands, the thumb and forefinger displaying the peculiar motions that are likened to rolling a pill. When the tremor has been developed for a long time in the hands and legs, or feet, there is an inclination for an unsteadiness of the head to take place.
Weakness.--All cases lack power. This, however, belongs to the last stages.
Rigidity or Stiffness.--This may be expressed in the slowness of movements. The time comes when all voluntary movements are made slowly, but with considerable effort. The actions become very deliberate.
Attitude or Gait.--The head leans forward; the back is bowed; the arms stand from the body and are somewhat fixed. The face is expressionless. The motions of the lips are slow. The whole expression is masklike; indeed, it is called Parkinson's mask. The voice is often shrill and piping. Sometimes the disease is confined to one side, or often to just one limb. However, before the patient dies, unless some intercurrent affection takes him away, he will live to become generally paralyzed.
Treatment.--The leading authorities declare that there is no treatment that is satisfactory, but they recommend arsenic, opium, hyoscyamin, and other drugs that act on the nerve centers. I should expect cases to grow worse on drugging. Indeed, there is nothing to do except to correct the errors of life, whatever they are. Overstimulation must be gotten rid of. Patients must be induced to live on just barely enough food to keep soul and body together; otherwise they stimulate and build this disease. Everything that is of a stimulating or shocking nature must be kept from such patients. Disagreeable people, domestic and all other irritations, must be got rid of; for such patients are often very excitable, and all excitement is stimulating, and all stimulation brings on more and more enervation.
This disease appears oftener in children. It is characterized by irregular, involuntary twitching or contraction of the muscles. Authors recognize the liability of these cases to develop endocarditis.
Etiology.--Children are oftener affected between five and fifteen years of age than at any other age. It is said to be rather rare among negroes and the native races of America. The reason for this is that only neurotic temperaments develop the disease. It is a disease of civilization. Putrefaction, with systemic infection by the toxins absorbed from this putrefaction, is the exciting cause. No one would believe that negroes and aborigines are less liable to putrefactive processes than the type of children who develop chorea; but when they develop enough toxin poisoning to cause a nervous temperament to develop chorea, these lower types will develop convulsions, paralysis, tuberculosis, scrofula, rheumatism, and kindred affections. Authors usually recognize a causal relationship between rheumatism and chorea. The basis on which chorea. rests is the same as that on which rheumatism rests. If a child does not develop rheumatism, it will be because it has not enough of the gouty diathesis, and the toxin poisoning will manifest in some other way. A child of a gouty diathesis will certainly develop rheumatism instead of chorea. The neurotic temperament will develop chorea and not rheumatism. In cases of chorea presenting a complication of arthritis there will be found the gouty diathesis, with a decided neurotic tendency. In all cases that I have seen of this nature the painful affections of the neurotic temperament have been more on the order of neuralgia than rheumatism. In some cases the affection has presented a state of neuritis rather than rheumatism. I have not seen a true inflammatory type of rheumatism complicating chorea, or vice versa.
Endocarditis, which is common in these cases, is an early development of inflammation due to toxin in the blood. Unless the cause is controlled, the disease will extend to the arteries, developing arteritis. Then, if the condition continues without interruption, there is nothing impossible about embolism, convulsions, and paralysis as the sequel of the diseased condition of the endocardium and the inside membrane of the arteries. It is not strange that, preceding chorea, such diseases as scarlet fever, measles, whooping-cough, and chicken-pox develop. As regards a tendency for the disease to develop in certain families, there is no question but that families of the neurotic type are subject to this and other nervous affections. Children are high-strung and easily excited. Too frequently mothers have no self-discipline, and their influence on children is to drive them into such diseases, rather than to steer them clear of chorea as well as other nervous affections. Children of this temperament find musical education very hard on their nerves, The strain of taking the lessons is often quite enough to develop chorea in decided types of this temperament. Such children are easily worried. They come to grief with lessons. They are hurt very badly by criticism. If teachers find fault with them, or scold them, or give them bad marks, it means indigestion and a day of nervousness--probably a headache. The average schoolteacher is unfit to take care of children of this type. Indeed, such children should be sent to institutions where they can have the proper feeding, and where they may be understood and disciplined in keeping with their needs. So far as the mind is concerned, these children belong to the brightest and most active. If their physique will hold up, they can outstrip all other classes. Very nervous children are liable to be thrown into chorea by a shock or an injury of any kind, or a surgical operation.
For the purpose of commenting on it, I shall give a part of a paragraph from Osler: "There are instances without endocarditis and without, so far as can be ascertained, plugging of cerebral vessels; and there are also cases with extensive endocarditis in which the histological examination of the brain, so far as embolism is concerned, was negative."
These facts are explained when it is recognized that children have been brought into a high state of toxin infection from decomposition in the bowels, and this infection has gone to such an extent as to create inflammation of the lining of the arteries as well as of the heart. A case might escape developing endocarditis, yet there would be sufficient inflammation in the arteries to furnish the emboli required to develop the infarctions necessary to account for the disease.
Symptoms.--There are mild and severe types. The severe types are sometimes called maniacal. In mild cases the affection of the muscles is slight. Speech is not necessarily interfered with to any great extent, and the general health, so far as the appearance of the child is concerned, would pass for being all right; but no physician will recognize a child with ever so slight choreic development as a normal or healthy child. There is always indigestion, creating gastro-intestinal irritation sufficient to account for the unsteadiness of movements and the involuntary movements which such children develop. I am persuaded to believe that children who are kept largely on fruit and vegetables, with cereals, are more inclined to develop the lighter forms of this disease. The more severe types require the more toxic poisoning that comes from putrefaction of animal proteins. Children who have the mild type are pronouncedly nervous, and they are accused of having the fidgets. They have crying spells, and frequently scream out in the night. Some of them walk in their sleep. Stuttering, stammering, and awkwardness in speech are mild types of chorea.
The extreme or severe cases--those that are called maniacal--have truly a terrible disease. This disease develops more often in grown people or adults than in children. It first begins in the hands and arms; then the face is affected, and subsequently the legs. The movements are confined to one side. It is then called hemi-chorea. It is thought that it is more often developed on the right than on the left side. Its decidedly prominent symptom is muscular weakness. There will be a visible dragging of the legs, or limping, and a tendency for falling forward. Patients will took as if they were going to fall, but they save themselves. Sometimes there is a dragging of one leg. In some cases there is extreme paresis. These cases have a regular but rapid pulse.
Treatment.--When children begin to develop signs of chorea, they should be taken from their studies and put to bed. The first few days they should not have anything to eat. Then for a few days they should be fed nothing but fruit morning, noon, and night. After the first week of fasting and fruit, then two fruit meals should be given each day, with a combination salad and one or two cooked, nonstarchy vegetables for the dinner. Nothing else is to be given until the choreic symptoms have entirely disappeared. But it is cruel to allow these children to stay out of bed. They must be kept there until they are well. Cases that have been allowed to develop extreme types may require a long time in bed before they get control of themselves; but they certainly should not be allowed to go out, unless they are carried either in the arms or in a go-cart. They are not to be allowed to use their limbs. After the child has been restored, it is necessary for the family to change its mode of living. Indeed, such families should employ a physician to go into the home and see what is wrong. I often think it would be a good thing for a physician to go and board for an entire week with such families, eating at the same table and learning all their peculiarities. No doubt there will be a great deal to do by way of straightening out the psychology of such a family. They are to be taught poise. Certainly they must be well balanced in the treatment of nervous children, or cures will not come to stay. After such children have been restored, they ought never to be given meat, eggs, fish, or any other animal foods, except very sparingly: eggs and lamb or chicken once or twice a week. Perhaps cheese and milk will take the place of meat or fish. A dish of cottage cheese at a dinner, or an ounce or two of ordinary commercial cheese, or an egg or two, not more than twice a week in the dinners. The other dinners should be built around one decidedly starchy food, such as baked potatoes, either Irish or sweet, or a dish of navy beans, butter beans, corn bread, whole-wheat bread, etc. The rest of the dinner will be one or two cooked, nonstarchy vegetables and a dish of salad. These children should always have a dish of salad with the dinners, whether they eat anything else or not. The severely chronic cases--those that have become organized, so to speak--may be improved by correcting their lives, and they may not. It stands to reason, however, that if they are put on the proper lines, they will certainly do better than where they are living wrongly each day. Incorrect living cannot help but make even a bad case worse, whereas correct living certainly ought to modify the worst cases and do them a certain amount of good. There is no special treatment for them, except to teach them to live normally.
To say that there are infantile convulsions which are not epileptiform is to make a distinction without a difference. A convulsion is a convulsion. It is said that the difference between infantile convulsions and epilepsy is that the convulsions stop when the cause is removed, and there is no tendency for the fits to recur, but that convulsions in children sometimes continue and develop into true epilepsy. It has been my experience that, when the cause of convulsions--either those in infants, which may be called infantile convulsions, or true epilepsy--is removed, either form of convulsions, if there is any difference, stops.
EtioIogy.--Convulsions may be brought about by many causes, Children who develop convulsions, or those who develop epilepsy, are predisposed to convulsive seizures. Their nervous system is unstable and easily thrown out of balance. Probably ninety per cent of convulsions in children are brought on from gastro-intestinal irritation. Indigestion is the rule, rather than the exception, in all children, as disagreeable as the statement may be. I am not exaggerating when I say that there are no laymen, and very few medical men, who really know anything about how children should be fed. The result of all this ignorance is gastro-intestinal derangements galore. Children are only a few hours old when they begin to show indigestion; and certainly they begin to show evidences of improper feeding within the first two or three days. This being true, there is nothing strange in the amount of sickness so common to infantile life. A common so-called cause of infantile convulsions is debility. But what causes debility? Gastrointestinal disturbances. And what causes gastro-intestinal disturbances? Feeding beyond a child's digestive power. And, of course, when continued, the acidity which takes place from the fermentation of the food creates so much gastro-intestinal irritation that children are often thrown into convulsions.
Peripheral Irritation.--It is common to recognize dentition in children as the cause of convulsions when a nursing child is thrown into this nervous state. I do not believe that this is true. Away back in the beginning I knew no better than to believe what I was taught regarding this matter, namely: that teeth in their eruptions caused nerve irritation and produced cholera infantum and other gastro-intestinal derangements of children. I knew no better then, but I know better today. I know that children will not have any trouble teething, and they will not have convulsions, if they are fed properly--if they are fed within their digestive capacity. When a child is fed in a way to produce great acidity of the stomach and bowels, and there is a decided indigestion, with acid stools of a diarrheal nature, bordering on entero- or muco-colitis or dysentery, then it will be exceedingly nervous, and, if it is cutting teeth, the gums will be very sensitive, as the nerves generally are sensitive; but the real cause is toxin poisoning from decomposition of food in the alimentary canal.
The greatest mortality from convulsions is within the first year, because children's nervous systems are exceedingly tender and easily thrown into a state of degeneration. As children grow older, they will have more resistance. The rule is that they have more indigestion the second year, and, indeed, are more inclined to have cholera infantum the second summer than the first year; but they are stronger and can resist the degenerating influence of convulsions. I have seen children so sensitive from gastro-intestinal indigestion that they would have a light form of epilepsy from teething time on to five and six years of age, when the "petit mal" would be supplanted by true convulsions. When this state of the nervous system is maintained because of malpractice and abominable nursing and dieting, the mind fails to develop, because the brain does not develop. The children from this time on begin to show degeneration--show that they are doomed; and unless they are taken hold of by someone who will correct the errors in the care and nursing, they will be doomed to idiocy.
These children respond to kindly treatment, proper diet, and proper nursing, if taken in time, as quickly as if they had never been abused by malpractice.
Rickets.--When children are abused as above stated, they are liable to develop rickets. (See "Rickets.").
Fevers are frequently ushered in by convulsions. The toxin poisoning that has brought on the fever has so completely overstimulated the nervous system that the child is thrown into convulsions.
Congestion of the Brain.--This may be one of the symptoms of fever.
Infantile Hemiplegia.--This is one of the results of infantile convulsions. In all the cases I have met with I have found sufficient gastro-intestinal derangement to account for the disease. A few I have traced to septic poisoning of the mother, causing infection of the child through the milk.
Symptoms.--Convulsions may come on without warning. However, if the mother is very watchful of her child, she should know that it has been feeling more or less ill for several days. If the proper attention has been given to the bowels, there will be indications of indigestion. All mothers should be taught the importance of this symptom. Young children cannot carry the evidences for any great length of time without a smash-up in the general health. Just what the symptoms will be will depend upon the inclinations and peculiarities of the child.
Prognosis.--If, when the disease has once developed, the child is treated exactly right--namely, digestion corrected, and all evidences of indigestion completely overcome, either by fasting or by feeding very lightly--and if the patient is kept absolutely quiet, the very worst forms of this disease should be controlled in a week. Where the disease has come on with such virulence as to produce hemiplegia, if taken hold of carefully, and if no more toxin poisoning be allowed to develop from improper eating--wrong food combinations--the child will evolve out of the condition and the paralysis will be gradually overcome.
Treatment.--The bowels and stomach should be cleared out. If the child is vomiting, it will not be necessary to do anything for this particular symptom, except to keep water away from it as well as all food. The stomach will soon get settled. The bowels should be thoroughly cleared out with enemas two or three times a day, until there is no more decomposition in the entire tract. Then the eating should be very carefully corrected. The child may be put on its accustomed food, if a better cannot be had, but should be given not more than one-fourth the ordinary quantity. For the convulsions there is nothing better than the hot bath. Put a cloth wet in cold water on the child's forehead, and change frequently while it is in the bath. When the convulsion is past, put a little cold water into the child's mouth with a spoon. When the child is in the bath, hold the body under the water. The temperature of the water should be as hot as it is safe to make it. Keep the child in the water until complete relaxation takes place. Drugs are not needed; indeed, they are disease-builders rather than beneficial. These children are very easily managed, if they are given the proper rest, both physiological and physical--dietetically and physically.
Definition.--This is an affection of the nervous system, characterized by spasms or convulsive movements, with unconsciousness. In the lighter forms there is unconsciousness without the convulsive movements. The light forms of the disease--those that are free from convulsive movements--are called "petit mal." The loss of consciousness accompanied with convulsive seizures is known as "grand mal." Convulsive movements localized without loss of consciousness are called "epileptiform," or sometimes "Jacksonian epilepsia." It is due to disturbance of the motor center. There are very few cases of organic disease of the cerebral cortex.
Etiology.--The majority of cases start before puberty. Indeed, the convulsions of infancy are simply epileptic seizures, but they are seldom called epilepsy until they become established and recur at more or less regular intervals. This is a disease that belongs to the neurotic diathesis.
So far as sex is concerned, there are probably sixty per cent of the cases among mates. It is possible that a larger percentage of males are known to have the disease, if statistics were compiled that would be absolutely reliable. The reason for this is that the male is more active than the female--even in germ life, on through embryonic life. It is not generally known that men are more nervous and active than women, and it would be perfectly natural for them to develop more nervous diseases. Even if they were not by nature more nervous, their habits of life are such that they create nervousness. They are more inclined to take up with stimulating habits. They are decidedly more sensual; hence more inclined to develop nervous diseases. No doubt there are hereditary tendencies for epilepsy to develop in families; but no disease is hereditary in the sense that it is inherited. Children born of neurotic families, brought up in a way to develop their neurotic temperament, will certainly be more inclined to develop this disease than others.
Alcoholism is recognized as one of the leading causes for the development of epilepsy; but I think that it would be impossible to prove that alcohol causes more epilepsy than gluttony, tobacco, coffee, and tea. Indeed, it is safe to say that without gluttony there would not be nearly so much alcoholism. Overeating paves the way for all stimulating habits. And, so far as developing nervous diseases is concerned, toxin poisoning is equal to alcohol poisoning. The profession generally is of the opinion that syphilis predisposes to the disease. The life that exposes sensualists and libertine to syphilis has as much to do with developing epileptic disease, and other nervous diseases, as the socalled venereal disease.
Reflex Causes.--Dentition, worms, adherent prepuce, masturbation, venery, foreign bodies in the ear, eyestrain, any disease that is of a painful order and has a tendency to produce reflex irritations, may be the starting point of epileptic convulsions.
When developed after thirty-five years of age, the cause is wine, women, and sensuality in all forms.
Symptonms.--Preceding the convulsion there is a period known as aura. This is described differently by different patients. Some will complain of pain in the hand or finger; or there may be a disagreeable sensation felt in the stomach, or a feeling of precordial oppression, like smothering. As the disease is oftener brought on from gastro-intestinal derangement than from any other single cause, it is more probable that the aura will be that of a feeling of irritation in the stomach and bowels. The patient will utter a cry or groan, and is off in the convulsion without being conscious of having made an outcry. Those who have been accustomed to taking care of these patients know instantly, when they hear the outcry, that the convulsion is on. The patient usually falls on one side; the head is turned and drawn back; oftentimes the heels and the head jerk backward. Then again the jerking will be from side to side, so that a patient lying on the floor will pound his head against the floor, and the convulsion, when severe, will be a contraction of all the muscles from head to foot. These are called tonic spasms. The contractions and relaxations follow each other in rapid succession. It is very exciting to those who see a patient suffer convulsions for the first time. They are always anxious to do something.
Coma.--Breathing is, uneasy. The face is congested ,and becomes very cyanosed. The patient will chew his tongue, froth at the mouth, and, after the convulsion has ceased, be will lie in a comatose state for from several minutes to several hours. If left alone, he will probably sleep for several hours after the fit has passed, because he is worn out completely. Those patients who have night occurrences of this disease will know that they have passed through one when they wake up the next morning; for their tongues will be quite sore, and their muscles will be painful and feel as though they had been bruised.
The "petit mal" is the epilepsy without the convulsions. The attack consists of loss of consciousness. The patient may be passing out of a room, and, as he reaches for the door-knob, a spell of unconsciousness takes hold of him, and, instead of taking hold of the knob, his hand passes to one side of it. He will become conscious at once, and think it strange, or possibly feel vexed at his awkwardness, that he did not take hold of the knob the first move. He may think of it afterwards, and he may not; but it is something which he cannot explain.
Some of these cases will be in conversation. When an unconscious state passes over them, they lose the thread of the discourse for a moment; then come to a state of sensibility, and continue the sentence they had started; which, of course, appears strange to those who have been engaged in the conversation. The hesitancy cannot be explained.
The "Jacksonian epilepsy" is known as cortical, or partial, epilepsy. It is always distinguished from the, ordinary epilepsy by the fact that patients with this type of the disease do not lose consciousness. Irritative lesions in the motor zone are usually the cause. The spasms begin in a limited number of muscles. They may begin in the face, arms or legs, or the thumb, or the toe may twitch. It may be that the patient previous to the contraction will have a feeling of numbness or tingling in the parts. The disease may involve the muscles of one leg only or of the face. The patient may remain conscious throughout the spasm and watch the course of it with interest. The beginning may be very slow. The patient may have time to become comfortably seated before the attack becomes too severe. The location of the spasm may continue the same for years. There is always a tendency for partial epilepsy to become general. This disease is frequently found in children following partial paralysis--the so-called post-hemiplegic epilepsy. The convulsions will begin on the affected side.
Diagnosis.--The suddenness of the attack and the loss of consciousness, with contraction and relaxation following each other in rapid succession, are characteristic of the major form of epilepsy. The sphincters relax, the urine passes from the bladder, and sometimes the bowels are emptied. The convulsion caused by uremia is epileptic in character. The type of convulsion can be determined by an examination of the urine. "Epilepsy in a person over thirty who has not had previous attacks indicates organic disease of some kind." This I have not found true. I have found such persons as amendable to treatments as others. All the cases I have been called upon to treat have been curable--simply because the exciting cause was functional. Jacksonian epilepsy is distinctive, and it is hard to determine always on what the spasms depend. Irritation of the motor centers may be caused by many things. So far as I have been able to discover, all cases present toxin poisoning, and, because of this toxin poisoning, gastro-intestinal decomposition is always present. Of course, uremia may have much to do with it, but the kidneys have been brought into a state of inflammation because of the toxins in the blood.
Prognosis.--The prognosis is favorable when cases do not depend upon an organic disease that is incurable.
Treatment.--The disease is very easily controlled in children, provided the parents can be induced to take the proper care of them. They must be kept away from excitement, and fed very plainly, and at stated intervals, three times a day, and never between meals. Children must be controlled with a firm but kind hand. To indulge such children is to confirm them in their sick habit. Very strong people may develop this disease. In the adult, bad habits of eating, overstimulation of all kinds, abuse in the line of waste of energy in social affairs--indeed, anything and everything that has a tendency to bring on enervationmay be the exciting cause of convulsions in those of a pronouncedly nervous temperament. Cases running on for several years will show mental deterioration. In some there will be developed a decided irritability. If this condition continues to occur, it may be necessary to put such patients under restraint--perhaps in an asylum, People who have epilepsy should not think of getting married.
No treatment is needed in any case, further than diet and hygiene. There is talk at this time of the discovery of the bacillus epilepticus and the removal of a portion of the colon. This belongs to freak surgery, and it will not cure. The surface of the body must be taken care of, the bowels regulated, and then the eating should be specially adapted to the individual case. Those who carry considerable flesh should be kept on fruit morning, noon, and night, and nothing else until the weight is brought down to about an ideal standard; then fruit for one meal, starch and fruit for another, and meat, with cooked and raw vegetables, for a third meal. This is an outline of the diet that such patients should follow. They should be cautioned about eating when feeling uncomfortable. Our golden rule--Rule No. 1--should be observed at all times. When patients with epilepsy persist in eating heartily, there is no hope and the disease will grow worse continually.
This disease is characterized by severe headache, usually one-sided or unilateral. Often it is associated with a deranged condition of the vision. The eye affection, however, is only one symptom of the symptom complex.
Etiology.--It is said this disease is hereditary. It is no more hereditary than any other nervous affection. People who are born with a nervous diathesis may have a preponderating tendency to take on migraines, or the tendency may run in some other direction. Any of the different types of nerve derangements is liable to develop in those of neurotic temperament, but it is as impossible to inherit a headache as to inherit any other disease. Women are more inclined to this disease than men. However, both sexes do develop it. It is a house disease, brought on and kept in existence by imprudence in eating. I have seen cases of twenty years' standing cured so quickly that they did not have more than one headache after the treatment was begun. And invariably the cure was made by correcting the habits of living, especially the diet.
Symptoms.--Patients usually can tell when an attack is coming on. Some can tell two or three days ahead that they are going to have an attack. Such cases need never develop a headache; for as soon as they are put on the proper treatment the headache will cease, never to return. The fact of the matter is that these headaches are produced by coffee, tea, alcoholics, tobacco, continual eating of an excess of starch, badly combined food, or not enough fresh fruits and vegetables. Constipation will produce them. Indeed, with a neurotic temperament, anything that uses up nerve energy and brings on enervation, with fermentation of starches in the stomach and bowels, is liable to develop this disease.
Treatment.--It is so easy that we wonder patients do not learn to know what it is that causes them to be sick, and then correct the errors of life that lead to it. Those who are in the habit of taking tea, coffee, alcohol, or of living in a house where tobacco smoke is settling on the hangings or furnishings of the room, causing an ill-smelling odor continually, must get rid of all these things; for they depres's and enervate. If patients use up their nerve energy entertaining and being entertained, this, too, must stop. Everything that causes enervation must be discontinued. Early to bed and early to rise should be the motto; and then exceedingly plain food, three times a day, at regular intervals, should be the dietetic rule. Those carrying considerable flesh should be kept on a fruit diet until brought down to a normal weight.
Definition.--Pain in the course of a nerve, due to pressure or toxin poisoning. It is easy enough to cure. All that is necessary is to correct the life of the patient. Stop all stimulants and excessive eating, The skin should be taken care of by giving it a proper bathing and daily rubbing. If there is constipation, this of course must be overcome. Any form of neuralgia is to be treated in the same way. Exercise must be a part of the daily regime.
Definition.--This is a condition of perverted mentality. Perverted ideas control the patient, and produce more or less morbid derangement of the different organs of the body.
Etiology.--This is an affection common to women. The definition should be strictly confined to an affection peculiar to women; for it probably is largely associated with irritation of the ovaries and womb. Improper early training is to blame for creating such a nervous affection. There is always a lack of moral responsibility and self-control in such cases. Such women are strictly controlled by their impulses and emotions. It may be that fear will have possession of them; it may be anxiety or jealousy.
An unhappy love affair is quite enough to start a run of morbid processes that will ruin the life of such a woman. Many nulliparous married women, who have no domestic responsibilities, have no discipline and are not poised, and they give way to all kinds of worries. Masturbation and sexual excesses are exciting causes in a certain percentage of these cases, and eventually break them down physically. Earlier symptoms are those of indigestion. Those who are autotoxemic will look pale, showing anemia.
Pathology.--The disease is looked upon as purely functional, with no organic lesions. Unfortunately many of these cases go through the surgical "plants" of our country and in the course of three or four operations come out minus all the organs that they can spare--not because the organs are pathologic, but because the women are willing to have something done for them, and surgeons too often allow their patients to do the diagnosing. Besides, each case operated upon swells their statistics of successful operations.
Symptoms.--Really hysterical women will present symptoms that may be mistaken for serious functional or organic derangement. A physician who has a strong personality or a fad can change the location of the diseases of hysterical women at pleasure. If they have more trouble in the region of the apex beat of the heart than the physician is willing for them to complain of, he may discover a disease in some other part of the body--possibly a sensitive ovary. The patient, as soon as told, will put her mind upon the ovary and forget the derangement she had in the chest; and from that time on she will complain of her ovary until the physician strategically discovers she has some other disease that is more important. This may seem ridiculous, but it is true; and it is easy to see how surgical maniacs may be caught in the meshes of a hysterical woman and be induced to perform a lot of unnecessary operations. Stratagems may be used to induce these patients to think health, but it requires time and patience.
Convulsions.--These are mild, and usually occur after some disappointment, irritation, or feeling of anger. The patient will laugh and cry at the same time, and assume a condition resembling coma. Many simulate death. A really hysterical woman can cause a great deal of disturbance, in working up sympathy in the home, or even in the neighborhood, by making people believe that she is in a dangerous condition. Such patients will often complain of a lump in the throat. This is called "globus hystericus." After a severe spell they will throw themselves into a convulsion, but it lacks a very great deal in having the true ring. Anyone who has watched epilepsy will see the lack of genuineness in the hysterical convulsion. Loss of voice is frequent. Some cases will complain of stiffness of the joints; others will complain of paralysis of the lower extremities. I remember seeing one patient who was paralyzed for three years, having to be helped from her bed to her chair in the morning and then back to her bed in the evening. It took only about three or four weeks of discipline to cure her. Physicians should always be on their guard in believing symptoms that are represented to them by nervous women as being genuine. A woman may be absolutely honest, but the physician will not be honest if he allows a patient of this type to fool him into harsh medication; and certainly it is criminal to allow such cases to inveigle the physician into a surgical operation.
Loss of the special senses--taste, smell, and hearing--is common with these patients, There is also visual derangement--loss of perception of colors.
Many will complain of spasms of the pharynx. There will be vomiting, loss of appetite, depraved appetite, gastric pain, flatulency, diarrhea, and also constipation.
There may be rapid breathing, asthmatic breathing, dry cough, and a spurious type of hemorrhage from the lungs. The blood is of a pale-red color, and comes from the mouth and pharynx. Many will suck their gums for the purpose of starting a little blood. If there is anything a hysterical patient loves more than another, it is to excite, the sympathy of those about her. If she should ever work as hard for health as she does to procure sympathy, she could evolve ideal health. She looks upon a failure to convince her physician of the genuineness of her sickness as a calamity,
There are often irritable heart, rapid pulse, pain in the region of the heart, hot flashes, cold chills, and hemorrhages in the skin. The hemorrhages are usually, if not always, fraudulent.
These patients always complain of smarting urinating and retention of urine. They have urine of low specific gr avity. Some of them are troubled with incontinence.
Bladder and urethral irritations are common, and frequent urination is a marked symptom, I have known of a case where the woman had the habit of pushing small pebbles into her bladder, for the purpose of eliciting sympathy and enjoying the excitement of an operation for their removal.
These cases in many instances are moral perverts. They exaggerate everything; but unfortunately they fool themselves the same as they do others. Many have been known to indulge in self-injuries by way of swallowing needles; sucking blood and then vomiting it; inflicting serious injuries to their bodies, and not allowing the sores to get well by picking them and irritating them continually. Sometimes this condition takes on a criminal aspect, such as setting fire to houses, stealing, etc. Kleptomania is a form of hysteria--or perhaps I would better say that all kleptomaniacs are hysterics.
Diagnosis.--The symptoms cannot be mistaken by a physician. Of course, these cases are liable to lead laymen and inexperienced physicians astray.
Treatment.--The treatment must be psychological. Of course, everything must be done to correct indigestion, constipation, etc. All perverted conditions of the system must be righted.
The patient must be taught to live correctly--correct eating, correct bathing, and exercise; and then the physician who is unable to control the patient, leading her into a better state of mind and giving her poise and self-will, has no business to assume the responsibility of her case.
Etiology.--Pain; poison circulating in the blood, such as occurs in Bright's disease, autotoxemia, intestinal toxins, mercurial mania, different forms of partial paralysis, nervousness, neurasthenia, The quickest and most successful cause is a belief in insomnia. The patient loses a little sleep, and at once decides that he is troubled with insomnia. He talks it, establishes it as a habit, and will continue to be troubled with insomnia until he is educated out of it. Such patients are usually more or less nervous from eating beyond their digestive capacity.
Acid stomach, from too much starch-eating or overeating, is a very common cause. Those who are troubled in this way show nervousness in their limbs. Nervous headaches are usually dependent upon an acid stomach.
Treatment.--Where there is uremia as a cause, the kidneys must be looked after. Insomnia caused by alcoholics, tobacco, coffee, or tea ran be cured by prohibiting the use of these drugs. Where insanity or light forms of mania are the cause, such patients should receive hot baths, and given only a very little food of a non-stimulating character; in fact, they should be put to bed, and kept there until the nervous system has had time to right itself. It will do so faster without food than with food. Intestinal toxemia must be overcome through correcting the diet. Those with cerebral congestion, or cerebral anemia, must be controlled according to the affection. Those with hyperemia of the brain must be fasted until the blood pressure is reduced; then the eating should be of a character to prevent a return. Where there is cerebral anemia, the heart should be looked after; and whatever congestive derangement there is present must be righted. Hot baths should be given for all cases that are irritable, followed with a gentle rubbing. Whatever else is done, the patient's mind must be set at rest; for his anxiety about his physical condition must be overcome. In all cases where there is an overworked heart, the digestion must be corrected, and the patient must be kept quiet and away from social affairs as well as business, if these tax the nervous system to any great extent. Drugs are not necessary. These patients must be fasted until normal, then fed little until the strength has returned. Fruit at first three times a day; then fruit twice a day, with salad and cooked, non-starchy vegetables for one meal. Then meat every other day, with non-starchy vegetables and a salad; the alternate days, a decidedly starchy food in place of the meat, with cooked and raw vegetables.
This is a rare disease. It is supposed to be caused by disturbances of the vaso-motor nervous system.
Etiology.--Anemia is given as the cause; also chlorosis, neurasthenia, malaria, acute infectious fevers, menstrual disorders, fright, exposure, diabetes, and syphilis. The disease comes on suddenly and affects two or three fingers or toes.
Symptoms.--There is a coldness and pallor of the extremities, with dead fingers or toes. The parts affected are stiff, and sometimes more or less painful. A pallor is the first appearance. The features look shrunken, and there is a lack of sensibility. This passes away and then returns. In time it becomes a constant condition. After the disease has been running on for a while, the fingers---or rather the parts affected--become livid and ashen. The capillary circulation becomes exceedingly sluggish. Gangrene often follows severe attacks. Rigor is common. In advanced cases echymose spots and vesicles appear. Hemorrhage sometimes occurs, and it is called purpura. Cerebral symptoms may complicate the disease.
Differential Diagnosis.--This disease has to be differentiated from frost-bite, ergot poisoning, neuritis from overstimulation, and endarteritis from toxin poisoning.
Treatment.--Avoid exposure to cold, and, if possible, spend the winters in warm climates. This is the usual prescription, but every patient is not able to change climate.
This disease would never have an existence if those afflicted were living properly. It is simply a surface manifestation of toxin poisoning, and, the same as most diseases to which flesh is heir, it originates in the gastro-intestinal canal. Hence this intestinal derangement must be righted, first, last, and all the time, by correcting the eating, and otherwise properly caring for the body.