m
NERVE WASTE
NERVE WASTE
PRACTICAL INFORMATION CONCERNING
NERVOUS IMPAIRMENT IN MODERN LIFE
ITS
CAUSES, PHASES AND REMEDIES,
WITH ADVICE ON THE
HYGIENE OF THE NERVOUS CONSTITUTION
BY H. C. SAWYEft, M.D.
SECOND EDITION
SAN FRANCISCO
THE BANCROFT COMPANY
1889
H
S3
WOLOGt
UBRARV
Entered according to Act of Congress in the Year 1889, by
H. C. SAWYER
In the office of the Librarian of Congress at Washington
PREFACE TO THE SECOND EDITION
The second edition of this little book has been wholly
re-written and considerably enlarged in an effort to make
it more practically useful.
The author shall be glad if this effort to improve upon
his first work will be considered, in one sense, a grateful
response to the kind words of the press and to the appre-
ciation of the public toward the earlier edition.
BAN FRANCISCO, JAOTARY, 1889.
1320 MARKET STREET.
260169
INTRODUCTION
The true scope as well as the powers and the limita-
tions of the medical man are often imperfectly under-
stood ; the various functions of the physician cure, alle-
viation, prevention, teaching are better defined by the
L,atin cura, care, than by its derivative, cure, in its modern
sense. To care for the health of the whole community
is a far wider field of usefulness than to cure the sick in-
dividuals in it.
In his work of curing, the physician is too often viewed
as a kind of sorcerer, and he is invoked to use the mys-
terious chemical substances which he is supposed to have,
or which he ought to have ; many persons imagine that
if they could get hold of the doctor's prescription-book,
they could do without the doctor.
There are drugs whose action is so sure, and surgical
and other procedures whose results are so radical, that
they appear almost magical, but, in the large proportion
of cases, the physician is far from being a magician, and
has no absolute power over disease. He is simply one
learned in the science, and experienced in the manage-
ment of sickness ; he is one factor, the chief of all the
forces operating for life and against death ; the patient,
his surroundings, his friends sometimes his ancestors
influence the result for good or for evil.
The power of the physician against disease and death
lies in his trained faculty of observation, in his superior
insight, in his comprehensive grasp of principles, in his
(vii)
VIII INTRODUCTION.
profound knowledge of all the conditions which are for
and against life, in his wiser judgment, and in the author-
ity or the influence which he is able to excercise in any
particular case. These qualities often enable him to
nurse the flickering flame of life into health and strength
where a less skillful hand would extinguish it forever.
lyike the architect, the ship-master and the general, the
doctor is a director of forces, a supervisor, an exerciser
of good judgment; his equipment is intellectual more
than physical; his power to cure is oftener in his head
than in his satchel.
It is to be feared that the physician has sometimes per-
mitted or encouraged an exaggerated estimate of his
power; he is human, and when the case gets well he has
not the heart to dispel the illusion which inspires such
grateful praises. Perhaps he feels that these are, in
some measure, his due to offset the unjust criticism which
all physicians receive. But, in the end, any mistaken
idea of his power is apt to react upon the physician.
When he fails to save a case, which no power on earth
could save, he is at fault; he did not understand the case;
he did not know, as he ought, the specific for this
particular disease. The interests of both the physician
and his clients are best served by an intelligent compre-
hension of the scope, the powers and the limitations of
medical science.
The cure of disease will always be an important ele-
ment of the physician's work, and in the incurable sick,
the alleviation of pain, the prolonging of life, the affording
of euthanasia are priceless services; but the most valuable
services which scientific medicine is capable of rendering,
lie in the direction of disease-prevention in the family,
in the state and in the nation.
At this time the policy of preventing disease rather
than curing it is not generally understood nor appre-
ciated, but the world is rapidly growing too wise to neg-
INTRODUCTION. IX
\V r
.
lect a great conservative power in its midst, and in the
future this function of the medical profession will be more
and more utilized. A ship drifts under full sail upon a
tropic sea, a glimmering cloud appears upon the horizon,
nothing is done; the cloud grows, but is still unheeded;
soon the storm bursts with terrible fury, a wild rush is
made to take in sail, but it is too late. This would be
criminally bad seamanship, but it is an illustration of what
occurs every day upon the uncertain sea of life.
The efficiency of medical men will be immensely in-
creased when their relation to their families is more or
less constant, instead of intermittent and irregular. The
doctor should come and go like the clergyman and the
priest. Instead of being a necessary evil whose visits are
avoided as long as possible, and which are a source of
uneasiness when necessarily multiplied, he should be a
minister and guardian of health, an officer of the family
upon whose special wisdom free, early and constant
reliance is placed. His counsel should have great weight
in a hundred personal and family questions which influ-
ence the most symmetrical development of the child and
the preservation of the man.
The eradiction of inherited tendencies to disease, the
direct improvement of the physical and mental measure
of stocks, the development of a hardy constitution in
weak children, the recognition and arrest of many fatal
organic diseases in their incipiency, before they are too
old to be controlled, the arrest of acute inflammations at
a time when this is possible, the insuring of longevity
and a sound old age these are some of the things which
the physician of to-day is able, but which he is not often
permitted, to do.
Teaching is an important function of the physician;
every earnest medical man is ' 'doctor' ' in deed as well
as in name. Medical advice in the abstract is often barren
of influence; medical teaching, which conveys clear ideas
X INTRODUCTION.
of pertinent physiological and scientific facts, is far more
impressive and fruitful. As in all teaching, the living
voice is effective in a greater degree than the printed page
can ever be; the talent which some physicians have for
clearly illustrating a subject or emphasizing a fact is an
important element in their success.
Most medical men, according to their tastes and ex-
periences, come to have a peculiar interest in certain
diseases; such an interest the author has long felt toward
functional diseases of the nervous system.
Nervous impairment is one of the most common de-
partures from health; it is a subject upon which consider-
able teaching has been expended, some of it true, much
of it false. The experience of the author is that the
popular ideas at least upon the subject of remedies are
frequently vague or erroneous; he is constantly meeting
with persons, in the field of his daily work, to whom a
realization of some of the facts attempted to be explained
herein would be priceless; and he has thought that this
short statement from the point of view of a working phy-
sician might, in some degree, serve a useful purpose.
SAN FRANCISCO, DECEMBER, 1887.
1320 MA.RK.ET STREET.
CONTENTS
Page
I. THE PHYSIOLOGY OF NERVE FORCE I
II. THE CAUSES OF NERVOUS IMPAIRMENT 6
III. THE CAUSES OF NERVOUS IMPAIRMENT ( Conj'cT) 1 6
IV. TYPES OF NERVOUS IMPAIRMENT 21
V. SURFACE SIGNS 27
VI. MENTAL SIGNS 32
VII. CIRCULATION SIGNS 37
VIII. SENSATION SIGNS 4!
IX. MUSCULAR SIGNS WRITER'S CRAMP 49
X. MUSCULAR SIGNS THE CONVULSIVE DISORDERS 53
XI. RESPIRATORY SIGNS HAY FEVER AND ASTHMA 58
XII. ABDOMINAL SIGNS NERVOUS INDIGESTION.... 6l
XIII. RECTAL SIGNS CHRONIC CONSTIPATION 67
XIV. REPRODUCTIVE SIGNS SEXUAL NEURASTHENIA 69
XV. SEXUAL NEURASTHENIA IN THE FEMALE .... 78
XVI. NERVE WASTE AND LONGEVITY 8 1
fxi)
XII CONTENTS.
Page
XVII. THE CURE OF NERVOUS IMPAIRMENT 84
XVIII. REST AS A REMEDY 90
XIX. THE OUTING CURE 98
XX. BRAIN AND NERVE FOODS IO6
XXI. TEA, COFFEE, TOBACCO AND ALCOHOL 115
XXII. NERVINES AND NERVE TONICS 119
XXIII. DRUG VICE AND MEDICINE HABIT 129
XXIV. ELECTRICITY AS A REMEDY 140
XXV. SURFACE REMEDIES BATHS, HEAT AND COLD,
COUNTER-IRRITATION, MASSAGE, CLOTHING. . 145
XXVI. THE SURGICAL TREATMENT OF NERVOUS IM-
PAIRMENT 155
XXVII. APHORISMS IN NERVOUS IMPAIRMENT.. 158
THE PHYSIOLOGY OP NERVE FORCE
THE NERVOUS SYSTEM. The central nervous system
consists of the brain, a soft mass of gray and white tissue,
which fills the cavity of the skull, and the spinal cord, a
white cord* sixteen inches in length and about the thick-
ness of a lead pencil, which is enclosed in the bony spine.
To the anatomist and microscopist this nerve tissue ap-
pears exactly alike in all human beings, but the invisible
physical differences which undoubtedly exist constitute
the difference between the mind of a Napoleon or a Crom-
well and that of some contemporary simpleton. This
central nervous system communicates with every other
part of the body by means of long, white conducting nerves
of varying thickness. The term ' 'nerve-cell' ' is used quite
frequently in this book and it is important to understand
what it means. The cell is the anatomical basis of human
flesh ; it is a minute mass, spheroidal, ovoid, cylindrical,
sometimes shapeless. A typical cell consists of an outside
membrane, and an enclosed mass of protoplasm, which
may or may not include certain germinal spots, the nu-
cleus and the nucleolus. These cells are extremely small ;
it is estimated that the spinal cord alone contains many
millions of them. An aggregation of these cells is called a
nerve-center, and these nerve-cells and nerve-centers, bound
and woven together by fibres, and the crevices packed
with fat and connective tissue, make up the structure
known as the brain and spinal cord. Besides this central
nervous system, a vast number of nerve-cells and nerve-
(i)
*
2 NERVE WASTE.
centers have been placed in the head, in the neck, and in
the cavities of the chest, abdomen and pelvis ; these cells
are independent of the will but are dependent upon the
central nervous system for their vitality. They control,
regulate, and supply power to the vital organs within the
body ; they act as reservoirs of nerve-force, and with their
connecting nerves make up what is known as the sympa-
thetic nervous system.
THE FUNCTIONS OF THE NERVOUS SYSTEM are:
i. Mind, Perception, Intelligence, Bmotion, Will.
2. Instinctive Action^ inherited ability; a new-born in-
fant almost without mind does many acts instinctively.
3. Automatic or habitual action. Many acts come by
repetition to be automatic, done without the consciousness
of the individual, or participation of mind; thus, in writing,
the mind of an adult is not often concerned in the spelling
of the words, nor in the penmanship they have become
automatic acts; or, one may play correctly a tune upon a
musical instrument while the mind is absorbed in some
other subject. This principle of habitual action has an
important bearing in nervous diseases. Every repetition
of any act makes a certain impression upon the nerve-
centers in the brain or cord which renders subsequent
acts, more and more easy; this is the history of all skill,
from learning to walk to the most difficult performances
of the musician or the professional gymnast.
Thus by repetition bad habits as well as good ones
become established or fastened upon us, and certain
diseases, as epileptic fits or St. Vitus' dance in children,
tend to become more and more a habit, or easily per-
formed act of the nervous system.
4> Reflex Action. By this we mean that a sensation
in any part is carried to the spinal cord or brain by the
nerves, and thence reflected to some other organ or part
by instinctive action or otherwise. A man touches a hot
iron and draws his hand away almost before he is con-
THE PHYSIOLOGY OF NERVE FORCE. 3
scious that the iron is hot; the painful impression is
telegraphed to certain nerve-centers in the spinal cord,
and instantly they telegraph back to certain muscles,
which withdraw the hand from the iron. The mind
may not be concerned at all in this process; when a person
is tickled during sound sleep he may make a great variety
of reflex motions, without being at all conscious of them.
5. The Nutrition and Growth of every tissue and
organ is under the direct control of certain nerve-centers
in the brain and spinal cord; every tissue is believed to
have its "tropic center" and, if this becomes diseased,
the nutrition of the parts dependent upon it suffers,
partial or complete atrophy results. Many obstinate
diseases of the skin and of the joints depend upon disease
of their nourishing nerve-centers.
6. Certain areas of the nervous system directly control
and regulate the circulation of the blood; this vaso-
motor function of the nervous system will be more fully
described in a future chapter.
7. The processes of secretion and excretion are directly
maintained and regulated by the nervous system; this
excito-secretory function explains why the mouth of a
hungry man waters at sight or thought of savory food,
how tears well up under the stimulus of emotion, and
why the secretion of the digested juices, and the conse-
quent appetite and digestion, is influenced by good or bad
news, or why the skin and mouth sometimes become dry
and parched under the influence of any intense emotional
excitement.
8. The nervous system acts as a battery to gener-
ate and give out force to every part where there are
muscular fibres ; the muscles, arteries and veins, stomach
and bowel walls, and every organ that contains muscular
fibres, gets that quality which we call tone, from the
steady, gentle force-supply from the nervous system.
Muscular exertion involves the expenditure of nerve-force;
4 NERVE WASTE.
the power is manifested in the muscles, but it comes from
the nerve-cells, just as the power which is manifested in
the ringing of an electric bell comes from the cells of the
galvanic battery ; the champion oarsman is not the man
with the largest or hardest muscles, but he whose nervous
system can supply the largest amount of force and main-
tain it the longest in the race.
9. The brain receives, assorts, distributes to its differ-
ent parts, and registers, impressions and sensations from
every part of the body, but although the brain feels for
the whole body, it cannot feel for itself; surgical operations
upon the brain-tissue cause no pain. When a pin is
thrust into the finger the pain is really felt in the brain ;
the proof being that if the nerve which connects the finger
with the brain be cut, the pin can cause no pain ; the
finger is numb and paralyzed. The nerves may be com-
pared to telegraph wires; they transmit nervous impulses
from, and impressions to, the brain and spinal cord.
THE SOURCES OF NERVE-FORCE. The power that is
expended with every thought and movement comes from
food and oxygen. The blood liquefied and digested
food circulates through every tissue and brings to every
cell and fibre the chemical materials with which it may
renew itself; it also brings oxygen in little red sacs, which
unites chemically with the worn-out elements of the
tissues, burns them up, or oxidizes them ; in this body-
combustion heat is evolved, and this heat, by a
mysterious vital process, is converted into force, with
which every brain and nerve-cell is more or less charged.
This force may be cempared to electricity and the nerve-
cell to a Leyden jar.
THE RELATION OF SLEEP TO NERVE FORCE. During
the day the expenditure of brain and nerve force in
thinking, moving, working, is greater than the capacity
of the nervous system to store it from the blood, so, after
sunset, a halt is called for sleep. During sleep the ex-
THE PHYSIOLOGY OF NERVE FORCE. 5
penditure of nerve- force is reduced to a minimum, and
income is far in excess of outgo; man awakens after a good
night's sleep with his nerve-cells charged with an abun-
dance of force for the labors of the day. Sleepless nights
quickly exhaust the reserve force and a time comes when
the individual must sleep. A young, strong person
quickly recuperates from the effects of prolonged loss of
sleep because his vigorous young brain and nerve-cells
have the power of rapidly absorbing new force; in the
old or enfeebled, this power of creating nerve-force is slow,
and recuperation correspondingly so.
CONSEQUENCES OP EXCESSIVE NERVE-WASTE. Thus
the nerve-cells are constantly the seat of two processes
nerve-waste and nerve-repair. When these two processes
are proportionate in the individual, all goes well. But
when nerve-waste habitually, or for a time, exceeds repair
certain changes take place within the nerve-cell; it be-
comes weakened, not only in its capacity to put out force,
but also in its capacity to attract nourishment and create
force from the blood; it becomes irritable ', over-sensitive
to impressions, its power of enduring is diminished.
When these two conditions of weakness and irritability
become established in the nerve-cells, other parts of the
body suffer ; the whole physiology of the individual may
become disordered, weakened, unsteady. Nervousness,
nervous debility, nervous prostration or exhaustion, are
names in common, used to describe the consequences of a
continued predominance of nerve- waste over nerve-repair.
II
THE CAUSES OP NERVOUS IMPAIRMENT
The causes of nervous impairment are of two kinds :
those which originate without, and those which are de-
veloped within the individual. In the first class may be
placed Environment and Heredity ; in the second class all
those countless forms of nerve- waste which are so common
in modern life, and which may be pretty completely sum-
med up in two words, Overwork and Dissipation.
THE EPOCH. Modern life is hard upon the nervous
system. The age of electricity, of complicated machin-
ery, of intricate business methods, is upon us. ' * The rail-
road brain ' ' and ' ' the railroad spine ' ' are beginning to
be talked of in medical meetings. The roar, the jar, the
ceaseless eye and ear stimulation, the tyranny of~"the
clock, and the increasing sunlessness of cities did not act
upon the fathers. The endiess memory-weakening suc-
cession of ideas in newspaper and review tittillates rather
than exercises, superficially burnishes rather than solidly
strengthens the organ of mind. The factors which pro-
duce nervousness are probably more numerous and ac-
tive among Americans than among any other people the
^American diathesis is becoming more and more distinctly
jieryous. The possibilities of man in America are great
and they excite ambition to become rich, to rise in the
social scale, to accomplish objects which involve struggle ,
sacrifice, anxiety. The American is new, unsettled, unlo-
cated, in a state of insecurity and unrest, which is unfavor-
able to health. The climate of much of the United States
(6)
THE CAUSES OF NERVOUS IMPAIRMENT. 7
is bracing, and permits and encourages a greater amount
of nervous expenditure than is possible in any other part
of the civilized world. The American is not yet used to
his environment; many a man overboard has sunk in strug-
gling, who, with less exertion, could have kept afloat.
THE NERVOUS CONSTITUTION In the nervous temper-
ament of the old writers, strength and endurance of the
nervous system was the salient feature. By reason of
this very strength and endurance the nervous tempera-
ment, in the stimulating environment of modern life, is
apt to undertake too much, to work unceasingly or to
dissipate to excess. Thus it conies about that the nervous
temperament develops an irritable and weakened con-
dition of the nervous system instead of the endurance
which was one of its original characteristics. "Neurotic' '
is a word which has come into common use in modern
medical literature to designate this state of more or less
nervous weakness, and susceptibility to some form of
nervous disorder.
OVERWORK. The elements of overwork which involve
excessive nerve-waste are over- activity, tension, over-
excitement and monotony.
Full exercise of the brain is favorable to health and
longevity; it inhibits the emotions, strengthens the will
and acts as a moral, mental and physical tonic. Kven
prolonged brain-work is not necessarily injurious when
unattended by hurry, anxiety or excitement, a fact which
is illustrated in the biographies of innumerable long-lived
brain-workers, and mental idleness, plus the dissipation
which it is apt to engender, is one common cause of ner-
vous impairment.
An incessant mental and nervous over-activity seems to
be inseparable from many vocations. Some men are
habitually stimulated or goaded by circumstances into
working beyond their strength; they regularly work at
high-pressure.
8 NERVE WASTE.
The exigencies of life often necessitate spurts of work;
the lawyer works almost night and day for weeks on an
important case; the inventor pursues some promising idea
for days, neglecting sleep and even food. In many com-
mercial houses there are periodically recurring busy times,
when the closure of the doors at evening does not end the
day's toil, the wear and tear goes on by gaslight till late
at night or early morning.
The young and the strong have a large reserve fund of
nerve-force and pass through these periods of excessive
work without permanent injury. But the individual
whose nervous system is his weak part is subject to laws
that do not apply to others, just as the man in straightened
pecuniary circumstances is obliged to forego expenditures
r that are scarcely felt by his well-to-do neighbors. The
relation of over-activity to nervous disease is as simple as
suFtractionr The man puts out more than he takes in,
and sooner or later, according to the extent of_hjs nerve-
capital, he becomes embarrassed, crippled or fails j^njirely
in his vital power.
Many occupations, for example type-setting, sewing
machine running, or vocations which require prolonged
standing, involve an over-activity of certain muscles; as
a result a worn and iritable condition of that portion of
the spinal cord which controls the nutrition of, and sup-
plies the power to these muscles may be established.
The spinal cord is a highly important part of the
nervous system, having many similarities of structure and
function to the brain; it is in fact a continuation of the
brain, and some physiologists look upon it and the brain
together as a single complex organ. When local irritation
is once established in the spine it may irritate and depress
the whole nervous system and give rise to many distress-
ing symptoms.
The tenison of anxiety so common among manu-
facturers, merchants and men holding responsible
THE CAUSES OP NERVOUS IMPAIRMENT. 9
positions, is an element of work that is in some respects
worse than mere over- activity, and the two often go
together.
If a long, flexible finely tempered sword be supported
at its extremities and subjected to a moderate weight at
its middle, it will bend, and, as often as the weight is
lifted from it, will fly back to its natural shape, though
this act be repeated a million times; if an excessive
weight be brought to bear upon the steel it is snapped in
twain; if the blade be subjected to the strain of a lesser
but still too heavy weight, it will yet respond up to a
certain point of strain; if the too heavy weight is
maintained during months and years, the resiliency and
elasticity of the blade is impaired, the sword becomes
crooked, inelastic, lifeless. So it is with human vitality;
a man may sustain heavy day strain throughout a long
life, if the succeeding night hours are periods of true
relaxation; it is the carrying of business cares and
worriments over night that impairs the fibre of the delicate
and high-strung nervous organization of the nervous
constitution.
With certain workers, as locomotive engineers, bank
tellers, dentists, the largest experience and the most
practised skill can never dispense with an abnormal vigi-
lance, an over-alertness, which kept up day after day,
and year after year, is wearing in the extreme, and which
not unfrequently proves a strain that breaks.
Over-excitement is excessively rapid nerve-waste; it is
tying down the safety valve and burning lard in the fur-
nace. A measure of excitement is good for the brain and
nerves, it stirs up the nutritive processes, cleans out the
cobwebs, and leaves the mind clearer and stronger for it.
But excessive excitement has burned the youth out of
many a brain and left its possessor an old man at forty.
The stock-boat d and the street are notorious fields of
shattered nerves and softened brains, and every year the
IO NERVE WASTE.
excitement of political campaigns makes overdrafts upon
the vitality of thousands.
There are men whose work involves no great over-
activity nor anxiety nor excitement, and yet they suffer
from the monotonous repetition of one set of acts and im-
pressions. The whole brain is not uniformly exercised by
any act nor set of acts, but only certain parts of it. So
certain impressions, as sights and sounds, do not impress
the whole brain, but only small areas of it whose function
it is to receive and take cognizance of this class of impres-
sions. By a constant harping on one string it wears out
before the others. By a continuous exercise of one set of
brain-cells to the comparative exclusion of others, they
become tired, then exhausted and incapable of further con-
tinuance in this particular groove without suffering to the
individual, Thus the book-keeper, dealing with figures
and nothing but figures year after year, becomes tired,
listless, inelastic and finally incapable of work. A vaca-
tion trip to the seaside or the mountains benefits him
immensely, partly by the power of pure air and exercise,
but largely because the overworked areas of the brain are
rested, and because a new set of acts and impressions ex-
ercises other brain-cells that needed exercising.
The physiological history of every man is that he grad-
ually matures, then for a few years is at the maximum of
his strength, then gradually fails to old age. The time
when a man is at his best, is limited to a few years
champion athletes seldom maintain their supremacy ten
years. Such men may appear to be as strong or stronger
than ever before, but the invisible fountains of power, deep
in the nervous structures, have begun their retrograde
change, their day is passed, and in the race some fresher
man wins the prize. The amount of work which a man
can easily do between thirty and forty should not be his
standard of achievement in later years; when he has started
to descend the hill of life, his work should become easier
THE CAUSES OF NERVOUS IMPAIRMENT. II
and his holidays and vacations should become more and
more frequent. Unfortunately this is not often possible;
sometimes an acquired inability to enjoy anything else in
life but work is one of the bitter elements in the cup of
success, but more often stern duty to others, and the grind-
ing competition of young and tireless rivals keep the older
man to a pace beyond his failing strength. At this stage
of our national development overwork seems to be an
inevitable condition of existence, but it is to be hoped
that increasing prosperity and increasing wisdom will
reduce the exactions and lessen the often terrible price
which men pay for decent success, and that the "gospel
of relaxation," preached by Herbert Spencer, may become
fashionable in the land.
SOCIAL NERVE-WASTE. Nervous men and women are
apt to be fond of amusements, and of the excitements of
social life; these seem like recreation after a day of toil,
and, in some degree, they are such. But when they are
carried to excess, or when they involve undue excitement,
or encroach upon the hours of sleep, in a person whose
nervous system is weakened, they draw steadily upon the
diminished fund of vitality. There are many forms of
social duty, as those incident to church, lodge and politics
which require night work without being in any degree
recreative, and which become auxilliary causes of nervous
impairment.
WORRY. There are minds that no trouble can injure
it glides off as water does from a duck's back ; it does not
sink in and corrode ; but nervous people are seldom phil-
osophical or phlegmatic enough for this. Domestic trou-
ble often aggravates nervous weakness, and instances
where the thinning and rapidly ageing face are the only
signs of silently borne grief are within the range of every-
one's experience ; the skeleton in the closet is oftener re-
vealed to the physician than to any other, and his skill to
heal often stand helpless before its power to wreck.
12 NERVE WASTE.
Success or failure in life, whether accident or sequence,
has much to do with the health of the individual. Suc-
cess brings friends, favors and pleasant words, a thousand
little amenities that smooth the road of life. The con-
sciousness of being somebody, of cutting a good figure in
the world, is exalting and sustaining ; it buoys and enables
many a weak man to accomplish a long life journey that he
never could have accomplished had the way been rougher.
Failure depresses and irritates ; the sensitive mind of the
man who has failed poorly withstands the rebuffs, the
harsh words, the neglect or the scarcely concealed con-
tempt of his fellows. The depressing influence of disap-
pointed ambitions and a hopeless future is sometimes a
powerful obstacle to recovery.
SCHOOL-LIFE Anyone who is often abroad at the hours
when the children are going to and from school, must have
noticed that a certain proportion of them are very thin,
pallid, and as far as possible from the normal standard of
plump, rosy, healthful childhood. During the past twenty
years there has been no lack of protest against what Hux-
ley vigorously designated "precocious mental debauchery"
and ' 'book gluttony and lesson bibbing, ' ' but it would seem
that the teacher and the parent can not often be made to
see this subject from the point of view of the physiologist.
Over-pressure and over-application are relative terms
what is overwork for one child may be easy work for
another. From the standpoint of the physician, the
routine method of teaching which goads every one of fifty
children, of widely varying physical and mental strength,
to a high standard of accomplishment, under penalty of a
certain disgrace at school and at home, is pernicious in
the extreme.
The idea that exercise strengthens the brain and mind
is true up to the boundary line in the individual where
exercise becomes overwork. The long lessons, the
struggle to keep up, the cramming for examinations, all
THE CAUSES OF NERVOUS IMPAIRMENT. 13
mean the expenditure of brain-force. This force must come
from somewhere ; the brain draws upon the blood-current
to a greater extent than the physiological economy of the
child provides for ; the result is that certain chemical
elements of the blood, which ought to be, and naturally
would be, converted into bone, muscle and nerve tissue,
are diverted from this course, by the demands of the brain ;
the bones and muscles are poorly nourished, and the
child is stunted in growth and never becomes the man,
physical or mental, that he might have become. This is
the story of the undeveloped muscles, the short stature,
the physical insignificance of thousands, whose parents
before them were large and handsome specimens of
humanity.
Many intelligent educators recognize these facts, but
the teacher is no more able than other men, to work a
revolution within the sphere of his duty ; the unwise
ambition of parents is as often responsible as the zeal of
the teacher for the nervous disorders arising out of school-
life. The father who has begotten a nervous child owes
it to that child to exercise more than ordinary care in its
education ; school honors and study must be subordinated
to physical development, which includes the physical
brain and nerve tissues as well as bone and muscle tissues.
If such a child cannot keep up with other children who
have inherited strong nervous systems, without abnormal
thinness, headaches, " nervousness, " then let him stay
behind. The parent should never encourage such a child,
by rewards or by reproaches, to become first in his class.
Many nervous children are extremely bright; they learn
quickly and with an apparent ease which gains them
praises and honors, and leads the parents to expect and
to exact great things; unfortunately, experience shows
that this mental precocity is not often maintained in after
life.
14 NERVE WASTE.
Instead of ( ' The mind is the measure of the man, ' ' it
might be said in these days that nerve-force is the measure
of the man, so important a part does this quality play in
the battles of life. The man who at thirty finds himself
with a strong nervous system has in it a possession of
appreciable coin value. Modern life demands not only
fine work but a quantity of it, and many a fine worker
has been obliged to abandon a lucrative position to some
one less skillful, for lack of the necessary staying powers.
SEDENTARY HABITS. A principle of physiology is that
"a functional act is a nutritive act;" in other words, an
organ is nourished, within certain limits, in proportion
as it is used. An organ to be healthy must be used, but not
over-used. Sedentary man over- uses one organ the brain-
and-spine and under-uses all the others. This dispropor-
tionate activity or strain upon the organ of vitality is one
effect of sedentary habits. The overworked city man be-
comes indolent and luxurious in his hour of ease. He rides
rather than walks, he seeks to habitually breathe a warmed
air, chews succulent food, wears hard hats, glazed shirt-
fronts and garments which fulfil his idea of elegance and
dignity of appearance rather than permit grace and sup-
pleness. Suppleness scarcely exists among us, and if an
Olympian athlete could see a hundred average Americans
in running costume, it is to be feared that their partially
bald heads, filled teeth, flat chests, thin limbs, stiff joints,
and deformed feet, would excite his derision or his pity.
LUXURY e-nervates as effectually as overwork and
strain. That combination of indolence, self-indulgence,
over-eating, jinder-breathing and nervous excitement,
which may be observed in certain sons and daughters of
wealth, leads to nervous impairment^ An under-used
brain-and-spine comes to be poorly nourished, to have a
flabby fibre, and to seek stimulants to c 'pull itself together. ' '
A brain-and-spine whose activity takes the form of excite-
ment rather than of work, becomes irritable and craves
THE CAUSES OF NERVOUS IMPAIRMENT. 15
the soothing influence of narcotics. No observation of
medical practice is more constant or more striking than
that those who persistently seek comfort and pleasure
are the very ones who find annoyance and pain. L,ike the
princess in the fairy tale whose tender flesh was irritated
by a crumpled rose-leaf under twenty mattresses, self-
indulgence acquires sources of suffering of which hardier
mortals are ignorant.
The clergyman can teach more eloquently than the phy-
sician how excess of comfort makes us selfish ; how men
who have never striven , and women who have never suffer-
ed, have lacked the most potent force in human character ;
how luxury and moral hebetude go hand in hand, and how
those who have been given every opportunity for symmet-
rical growth and instructive example, are commissioned,
and ignobly, if at all, neglect their chances in the circean
isle. But the physician, with his records of cases, and his
offensive specimens gathered from the dead-house can more
forcibly, if rudely, demonstrate how sloth and sensuality
lead to decay and death.
Ill
CAUSES OF NERVOUS IMPAIRMENT (Continued)
OCULAR DEFECTS, near-sight, and far-sight causing
imperfect perception, and astigmatism (corneal asymme-
try) causing faulty refraction, are common unsuspect-
ed exciting or aggravating causes of nervous symptoms in
school children, students and others. No phase of nervous
disorder is more pathetic than that in which a child is held
to its work, spite of headache, eye- tire, incompetency and
strange feelings which it cannot itself describe and which
are not understood by others.
Dr. H. P. Allen of Columbus, O., was recently appointed
by the Board of Education to examine the eyes of the
children in the public schools of that city. His report
states that of 4, 700 children examined i , 1 75 were found
to have defective vision in one or both eyes. Near-sight-
edness increased from none at all in the primary schools
to 13 per cent in boys, and 17 per cent in girls in the senior
class of the high school ; according to age it increased from
none at six years to i i T s ff per cent at 17 years. Of all chil-
dren who needed correcting glasses, only about 10 per cent
had them. In the Polytechnic school of France, the pro-
portion of myopia has increased from 30 to 50 per cent,
and 80 per cent of all the students have to wear glasses.
In view of the wide-spread and great increase of myopia
in all civilized countries, it becomes the duty of parents
to give their children's eyes the same watchful care that
they now do their teeth. Dr. Dennett of New York has
made the excellent suggestion that a test-type placard be
hung in every class-room in the land; the card which he
proposes is simple, consisting of a series of letters and
(16)
CAUSES OF NERVOUS IMPAIRMENT. 17
characters with directions concerning the distance at which
each size should be read by the normal eye.
The muscles of the orbit which control the movements
of the eye-ball may become weakened, asthenic, and the
disagreement between these and the internal accommo-
dating muscles of the eye maintains a constant eye-strain.
These eye-strains are very wearing upon the brain, and
are capable of causing a high degree of nervous impair-
ment, persistent headaches, and even epilepsy. Some re-
markable results in the cure or alleviation of epilepsy, by
the operator of ocular tenotomy, thus removing hurtful
eye tension, have lately been obtained.
The manner in which eye-muscle weakness and eye-ball
defect harass and injure the brain may be thus stated.
When a visual impression strikes the eye-ball, it is refracted
through the various media within and focused upon the
sensitive membrane (the retina) which lines its posterior
wall. Thence it is transmitted along the optic nerve to
the great central receptive ganglion of the brain (the
central home-office for sensation) the optic thalamus, which
lies near the bottom of me brain. Thence it is radiated
to, and received by those brain-cells in the surface of the
brain which are concerned in the particular impression.
(This outer gra}' substance of the brain the cortex, or
peeling, bears a similar quantitative relation to the rest of
the brain that a three-quarter section of a peach does to its
stone.) With a normal visual apparatus a clear impression
is received at the central home-office and distributed to the
out-lying brain-cells with facility. With a faulty appara-
tus, the image formed upon the optic thalamus is not
distinct; it is blurred; the higher brain-cells recognize it
with an effort, and here lies the strain. What should be
an automatic act is converted into a voluntary one. So, in
our great post-offices the immense effort and strain of re-
ceiving and distributing letters is largely due to the fact
that so many of them are illegibly addressed.
1 8 NERVE WASTE.
Ear-strains may cause or aggravate nerve-weakness in
the same way that eye-strains do. A plug of wax in the
external ear, a chronic inflammatory condition of the mid-
dle ear, and other conditions may impair hearing and cause
an indistinct auditory impression to be received at the
optic thalamus, the recognition of which puts a strain
upon the brain.
REPRODUCTIVE MISFORTUNES AND MALPRACTICES are
active and powerful causes of nervous impairment. Ex-
cessive child-bearing or prolonged nursing, combined
with household drudgery, reduces many a mother to a
serious condition of nerve-weakness. On the other hand,
those parents who refuse to accept the trials of parentage
are often injured by such a course. All those ingenious
perversions of the natural physiological relations of mar-
riage, aimed at the prevention of conception, which,
judging from my observations, are by no means rare,
prove a dangerous strain, and make serious overdraft upon
the vitality of thousands. Worse still, the practice of
criminal abortion, or induced "miscarriage," when it
does not cause death, may bleed out a woman's vitality
beyond the power of nature to restore it, or it may leave
scars and disease in the delicate reproductive tissues,
which, acting backwards, persistently harass and weaken
the nervous system.
Sexual abuse and excess are to be expected in our
American life. We have noted that the American, by
reason of his constitution, his climate, the transition
period in which he lives, is essentially nervous, his brain-
and-spine over-active, over-sensitive, unstable, loving ex-
citement, craving new things. Especially the city boy
and man, under-using all extra-neural tissues and over-
using the brain-and-spine, deteriorates in hair, teeth,
muscle, skeleton, and develops a morbid sensibility in
nerve-tissue everywhere. 'This state of nervous erythism
craves all sorts of morbid excitementTand quickly responds
CAUSES OF NERVOUS IMPAIRMENT. 19
to erotic suggestion, and becomes the victim of sexual
vice^ Sexual vice has operated against health since the
beginning of history, but probably it has never been so
injurious to vitality as it is in the nineteenth century
American. I am constantly obliged to note how the
neurotic diathesis', sedentary habits, erotic suggestion and
igSonmceTb'f fiienaws~or^exjial^hy^ien^^ct together to
produce mental and nervous disease.
REFLEX IRRITATION. The central nervous system,
within its bony case of skull and spine, communicates
with every other part of the body by means of nerves.
These nerves constantly conduct nervous impulses from
the brain- and-spine to other parts of the body, and con-
stantly transmit nervous sensations from every other part
of the body, generally through the spine to the brain.
An impression made upon one part of the body may
influence some distant part by influencing nerve-centers
which are common to both. Thus, a hot application to
the abdomen relieves intestinal colic, not by ' ' striking in, ' '
but by producing a relaxing influence upon the bowel
through the spine and sympathetic. Slight, persistent
morbid impressions are capable, by their cumulative action,
of producing very serious diseases. Thus, the back-acting
irritations of teething, of indigestible food and of worms
are frequent causes of convulsions in infants. The irri-
tating impression of a tight foreskin has often caused con-
vulsions or paralysis in children. The irritating presence
of dried secretions in the nose or throat, reflected upon
an over-sensitive nervous system, is a common cause of
asthma, hay-fever and deafness.
The principle of reflex action is the basis of a certain
proportion of cases of nervous impairment which might
be described as back-acting, reflex, afferent or inverse
neurasthenia. In this form the nerve-weakness is second-
ary to local disease in some other part of the body. A
long series of irritating morbid impressions reacting upon
2O NERVE WASTE.
brain-and-spine, harass, irritate, depress these parts, and
ultimately impair their nutrition and lessen their capacity
for creating and supplying vital force.
Nasal catarrh may be instanced as a purely local dis-
ease which often develops a high degree of secondary
mental and nervous disorder. ' ' Spinal irritation ' ' is often
maintained by disorder of womb or rectum. Kpilepsy,
St. Vitus' dance, lock-jaw and every form of persistent
convulsive disorder may result from such apparently
inadequate irritations as eye or ear strains, from hardened
wax in the ear, or from chronic constipation. The first
thing an expert in nervous diseases does with a new case
of "fits," of which the cause is not obvious, is to over-
haul the patient from head to heel in the search for possi-
ble sources of reflex irritation. The mental symptoms of
chronic dyspepsia may be studied in almost any house-
hold. Diseases of the womb and ovaries in the female,
diseases of the male reproductive organs, and rectal
diseases, all develop a long train of mental and nervous
symptoms in certain cases.
In many cases of chronic local disease, the secondary
impairment of the brain-and-spine comes to be by far the
most important element. As between two crippled organs,
the nose or the rectum, on the one hand, and the brain-
and-spine on the other, the latter is certainly by far the
most important, even though the former is the primary
disease. Thus, the physician who fixes his attention nar-
rowly upon a disease-process in eye, ear, nose, stomach,
womb, prostate, or rectum, and ignores the secondary
brain-and-spine complications, greatly limits his use/ul-
ness. This is a danger to which the specialist, who
comes to his work without broad training, is liable. In a
purely local interest in the physical or mechanical problems
of a case, it is possible to neglect the often graver second-
ary mental and nervous symptoms; one may forget the
patient in studying the disease.
IV
TYPES OF NERVOUS IMPAIRMENT
THE NEUROTIC DIATHESIS. A diathesis is an inher-
ited morbid tendency; thus we notice the gouty, the
scrofulous and the tuberculous diatheses. The neurotic
diathesis is the foundation of a large proportion of cases
of nervous impairment. It becomes established in ner-
vous stocks as a result of the nervous strain and over-
draft of civilized life ; city Americans of the second and
third generation are apt to be more or less neurotic.
Persons of this diathesis live and work with a very
small reserve fund of nerve-force. They are like a mer-
chant doing business upon limited capital; every little
loss and waste embarrasses them and a large one threatens
to bankrupt them completely. They are always trying
to keep even. On those days in which they live within
their nervous income they may be pretty well, but when
they exceed it they suffer to some extent ; a slight
indiscretion may precipitate very disagreeable symptoms.
A man in a strange land with a hundred dollars in his
purse may be very happy in expending ninety-nine dol-
lars and very miserable in expending one hundred and
one. Such men and women may be ' ' all broken up, ' ' as
they say, by an indigestible supper, a bad night's sleep,
a piece of bad news, a seminal loss, or a few days of over-
work. They envy persons of great vital resources, whose
large reserve fund of nerve-force enables them to expend
in every direction with impunity, and which seems to
exempt them for a time from obedience to the laws of
health.
The nervous diathesis is not always a misfortune ; in
many cases it is a blessing in disguise. The nervously
(21)
22 NERVE WASTE.
poor come early to understand the science of vital econ-
omy and to be obedient subjects of the goddess Hygeia,
and so are rewarded by fairly long life. The fact of
limited vital-surplus keeps many a man in the straight
and narrow path of virtue who would otherwise stray.
Neurotic men are apt to beget bright, beautiful and
interesting children and to make the best parents. Much
of the world's work is being done to-day by men who are
more or less crippled in their vital resources. Altogether
I believe that neurotic persons who are not too unfortu-
nate, or too reckless, perceive more, feel more, accomplish
more, enjoy more and get more out of life than those of
any other diathesis.
NERVOUSNESS is only the manifestation of a greater or
less degree of nerve-weakness, inherited or acquired.
In some persons any emotional perturbance or excite-
ment, or any mental effort which rapidly uses up a large
amount of force, leaves the whole muscular system weak
and trembling, and periods of activity and vivacity are
apt to be followed by periods of depression and wretched-
ness ; these phenomena indicate the smallness of the
nervous resources, and the inconstant, unstable out-flow
of nerve-force. So the intolerable annoyance which some
persons feel at certain creaking noises, the sudden starting
at slight, unexpected sounds, the excessive peevishness,
the lack of self-control, the losing presence of mind at
nothing "going all to pieces" are signs of the abnor-
mal susceptibility and lessened endurance of the nervous
tissues.
PROSTRATIONS is an abrupt failure of the life-
forces ; it may be partially recovered from in a few days,
or it may keep the patient hovering between life and
death for weeks, according to the degree of the vital over-
draft.
A serious case of nervous prostration is as impressive a
health lesson as can be imagined. The active man of a
TYPES OF NERVOUS IMPAIRMENT. 23
few days before is now a helpless inert mass ; in his face
every vestige of youth, health, and mental power is
replaced by a worn, prematurely aged appearance painful
to look upon. The strong, quick intelligence familiar to
his friends is degraded to a stupid indifference, or inco-
herence ; in some cases visions or delirium occur ; the
pulse beats quickly and feebly, thin as a thread under the
finger, and almost feels as though it might at any moment
die away forever. Muscular strength is at its lowest ebb ;
slight exertion causes trembling ; the subject is unable to
rise ; he is forced by outraged nature to permit a remedy
that was long ago her due rest. Fever, persistent sleep-
lessness, headache, vertigo, congestion of the brain,
alarming sinking sensations are common symptoms.
In some cases the sick man never reacts from this col-
lapse, but after lingering for days or weeks, dies a real
suicide ; but the larger proportion of cases slowly respond
to rest, judicious medication and feeding. A careful
nursing of the remnants of life recalls the subject from
his graveward course ; although, after passing through
such an experience, the patient is seldom or never again
the man he was.
J -The symptoms of uncomplicated
nerve-weakness have been long familiar to physicians,
but it is only in late years that their full import has
come to be well understood. The comprehensive mental
vision of Dr. George F. Beard collected the straggling
objective and subjective signs of nervous impairment,
classified them, appraised them, and practically created
them into a new disease, which he called Neurasthenia
literally, nerve- weakness. The scientific propriety of
recognizing neurasthenia as a distinct disease has been
denied, but in practice there is no other disorder, whose
history is more clear and symmetrical, and none whose
treatment is more clearly indicated. The neurasthenic is
a nervous cripple. If the history of this disorder were
24 NERVE WASTE.
required to be written in three words, these would be
weakness, irritability, unsteadiness.
(CEREBRAL NEURASTHENIA^ Cerebrasthenia, Brain Kx-
Brain Fag, is most often seen in men be-
tween the ages of thirty and sixty, whose duties and
responsibilities are greater than they can bear and the
strain of whose work falls chiefly or wholly upon the
brain. Politicians, manufacturers, professional men and
merchants contribute yearly a certain number to the list
of those who are killed or crippled by this form of neur-
asthenia. Mental symptoms of irritability or weak-
ness are generally marked in these cases. The sleepless-
ness and circulation derangements of acute brain exhaus-
tion are capable of developing insanity .
SPINAL NEURASTHENIA is the type most likely to be
developed when strain has been brought to bear upon the
spinal cord more than upon the brain. Telegraphers,
compositors, type- writers, penmen, railroad men and
house-wives may be instanced among those liable to this
form of nerve- weakness. There is no clear-cut difference
between cere oral and spinal neurasthenia ; their symptoms
are much the same, but are apt to present certain differ-
ences in degree.
SEXUAL NEURASTHENIA is a term used to describe
those cases in which nerve-weakness is partially or entirely
manifested, and, in many cases, originated, in the repro-
ductive apparatus. This class of cases has been variously
designatea by the names Spermatorrhoea, Seminal Weak-
ness, Irritable Prostate, Impotency, Sexual Hypochon-
driasis, according as different physicians fixed their atten-
tion upon one or another of the symptoms which char-
acterize it.
NERVE-WEAKNESS MANIFESTED BY OTHER ORGANS
THAN THE BRAIN AND SPINE. A common phase of city
life is a large family whose only resource is a moderate
salary earned by the father. The daughters approaching
TYPES OF NERVOUS IMPAIRMENT. 25
womanhood, the sons at college, or a sick child have the
most pressing needs and absorb an undue share of the
slender income. There is not enough to go round, and
some one, too often the mother, must manifest poverty for
the whole family. So it often is with the central nervous
system the great vital source and the other organs and
tissues of the body, which, as we have seen, are dependent
upon it for vitality. Many men and women have some
organ or tissue that is, by inheritance or by acquisition,
weaker than the others it is their vulnerable point.
When excessive brain or muscle work or strain uses up a
disproportionate amount of the available nerve-force the
supply is not enough to go round, and the weak part is
very apt to suffer. When the brain and spinal impoverish-
ment is manifested principally in the digestive apparatus
we have the type gastric neurasthenia, to the various
symptoms of which the names oxaluria, lithaemia, lithiasis,
liver insufficiency, enteroptosis (falling of the bowels),
nervous indigestion, nervous chills and cramps are applied.
In other cases the muscular system is chiefly or solely
affected in the form of tremor, or of writer's cramp, while in
still others the eye, the voice, the heart or the reproduc-
tive organs suffer most.
THE FUNCTIONAL NERVOUS DISORDERS a large fam-
ily are manifestations of insufficiency or impairment of
the brain-and-spine. Mental Disorders of every degree
of severity from simple crankiness to violent mania
or profound melancholia or dementia often consist, or begin
in, brain-and-spine weakness. In certain stocks the brain
is an organ of less resistance than the spine and nervous
over-draft or nervous strain may result in mental aliena-
tion; the "insane neurosis" is the great predisposing
cause of insanity. Inebriety, the diseased appetite for
alcoholic liquors, uncontrollable because of enfeebled will-
power, is now distinguished from the vice drunkenness
and treated as a mental and nervous disease. Insomnia
r?6 NERVE WASTE.
is one of the most constant symptoms of nervous impair-
ment. The Convulsive Disorders, Kpilepsy, St. Vitus'
Dance, Hysteria and others, which are manifested by
paroxysmal and irregular discharge of nerve-force, depend
upon instability (one element of weakness) of the central
nervous system, and are only radically cured by improv-
ing the vitality and stability of this part of the body.
Spermatorrhoea is often a symptom of cerebro-spinal insta-
bility as of local reproductive disorder. Over-sensitive-
ness of nerve-centres (another element of weakness,)
is the predisposing cause of many forms of Headache and
of Neuralgia. As in the convulsive disorders, the great
aim in the radical treatment of these pains is to improve
the integrity of the nervous structures Hay-fever, in a
large proportion of cases consists in an over-sensibility oi
the nervous centres connected with the nerve-ends in the
upper air-passages, plus the excitant or irritant, whatever
it may happen to be. Spasmodic Asthma has a similar
condition of the respiratory nerve-centres for its primary
causation.
SURFACE SIGNS
Some years since a distinguished English visitor, Her-
bert Spencer, in the course of a New York address, said:
" Everywhere I have been struck with the number of faces
which told in strong lines of the burdens which had to be borne.
I have been struck, too, with the large proportion of gray-haired
men, and inquiries have brought out the fact, that with you the
hair commonly begins to turn some ten years earlier than with us.
Moreover, in every circle, I have met men who had themselves
suffered from nervous collapse due to stress of business, or named
friends who had either killed themselves by over-work, or had been
permanently incapacitated, or had wasted long periods in endeav-
ors to recover health.
The changes which excessive nerve-waste produces on
the surface of the body may be studied everywhere in
American business and social life.
Good looks depend more upon health than upon
symmetry. Every sound, wholesome, fresh country boy
and girl is good looking, but many society beauties will
not bear inspection in the morning. The difference
between the plump, firm, rosy cheek of youth and the
withered flabby one of age is fundamentally a difference
of vitality of nerve-force.
EXTREME THINNESSS, sometimes even to emaciation
often occurs because the fatty tissues are not sustained by
the blood the excessive demands of brain and nerve
lead them to appropriate the fat-forming elements of the
blood for force creation, and thus leave little or none to
be deposited ds fat. This thinness is sometimes limited
to certain parts of the body, as the face; in other cases
28 NERVE WASTE.
the face remains the only plump part. A peculiar sunken
and aged appearance of the tissues lying immediately
about the eye is a sign which I have frequently noted in
victims of overwork and of sexual excesses.
BALDNESS, which is said to be increasing among Amer-
icans, is one of the most common results of over-activity
of the nervous system.
The three conditions of hair-growing are a blood-cur-
rent containing a sufficiency of certain chemical sub-
stances, its free circulation in the vessels of the scalp
and sufficient vigor in the hair-follicle to attract the
blood-stream and assimilate from it.
In cases of excessive nerve-waste the demands of other
organs upon the blood are imperative; they tax its
nourishing and force-supplying capacity to the utmost
molecule. Thus when the hair follicles are, hereditarily
or otherwise, somewhat weak organs, they are robbed of
their food. In sedentary man the lazily acting heart
does not freely pump the blood as far as the hair follicle,
and the blood which is pumped there is often obstructed
for hours at a time by the pressure of hard hats upon
the nutrient arteries of the scalp.
Non-exercise of the scalp is one great cause of bald-
ness. "A functional act is a nutritive act; " that is, exer-
cise of an organ calls the blood into it and thus the organ
is nourished, within certain limits, in proportion as it is
used. The function of the hair is to protect the scalp. In
animals the hair follicles are active; they erect the hairs in
hot weather and apply them closely to the skin in cold.
Sedentary man covers his head with hats, keeps the scalp
at a hot-house temperature, or subjects it to the enervating
climate of rooms. He relieves his hair follicles from all
duty in protecting the head, and so they degenerate or
perish as any other organ would from non-use.
In extreme thinness the absorption or the absence of the
layer of fat which naturally lies between the scalp and
SURFACE SIGNS. 29
the bony skull subjects the hair follicle to pressure and
thus favors atrophy. An impaired nervous system poorly
innervates or vitalizes its dependent organs; the hair folli-
cles become unable to attract the blood current or to
assimilate from it as it circulates through their tissues;
thus they become enfeebled beyond the power of stimulus
to rouse them, or die altogether.
These ideas accord with the natural history of baldness.
This defect is rare among non-sedentary peoples as
the Indian to whom nervousness is unknown, and in
women who do not interfere with the circulation of the
scalp, nor maintain it at a debilitating temperature, by
their head-gear, and who are not often subjected to the
same degree of nervous strain that men are. Thus, too, we
may understand the inefficiency of all the popular methods
of treating baldness. It is easy to bring the blood into
the scalp by friction or by stimulating lotions, but an
enfeebled hair-follicle cannot use this blood more than a
dyspeptic's stomach can use food. We may lead a horse
to water but we cannot make him drink. The treatment
of the baldness of nervous insufficiency consists chiefly in
improving the vigor and resources of the nervous system,
as advised in the later chapters of this work, more than
in the use of local measures.
THE TEETH of civilized man are not very enduring;
there are comparatively few Americans who are not com-
pelled to seek the services of the dentist to rescue some of
these organs from premature decay. The teeth, like the
hair follicles, often deteriorate because they are not used
sufficiently. Teeth were meant for biting, but civilized
man does but little real biting. His food is soft, succu-
lent, soaked in liquids, and the dental roots do not receive
that nutritive stimulus which frequent firm pressure in
their sockets provides. Impoverished blood is another
cause of decay in teeth. There is only a certain available
quantity of phosphates in the blood-stream, and if these
3O NERVE WASTE.
are appropriated by an overworked brain, little is left with
which the teeth may nourish themselves. Debility of
the tegumentary trophic nerve-centres those centres
which vitalize teeth, skin and nails, and enable them to
attract the blood stream and to assimilate from it the
chemical substances which they require is still another
element in dental caries.
Brittleness and slow growth of the nails is a sign of
which the causation is similar to that of decay in teeth.
ATONY. The firmness of muscle, of artery and vein,
and to some extent of surface flesh depends upon a steady
stream of nerve-force from the central nervous system.
When this nervous outflow is limited the tissues may
become lax and more or less flabby; the flesh lacks tone;
the veins may be relaxed and dilated, even to the degree
of varicosity or of varicocele, the face develops hard
lines or wrinkles, and a general atony may prevail at a
time of life when the tissues should be firm and solid.
ANOMALOUS APPEARANCE. While nervous impairment
is very apt to leave its mark upon the surface, it does not
always do so, and it is a fact that a high degree of brain-
and-spine weakness may exist in persons who are, to a
casual observer, the healthiest of men. This is most
strikingly exemplified in individuals of a mixed nervo-
sanguine temperament, having fine thin skins and plenty
of red blood. Such persons are sometimes pictures of
rosy health, their digesting and blood-making organs
being perfect while the central nervous system is weak
and irritable in the extreme. These persons have a rather
uncomfortable time of it. Their sufferings are alto-
gether subjective and cannot be demonstrated. They
are often unable to make any one believe that they are
sick, and finally cease to try and learn to bear their
troubles in silence. Relatives who would overflow with
compassion for a cut finger have no sympathy at all for
a lame brain-and-spine because they cannot see it. It
SURFACE SIGNS. 31
sometimes happens that such persons are unjustly blamed
for laziness or mental irritability or moral delinquency
when they should be cured (i. e., cared for).
The youthful appearance of many nervous invalids is a
phenomenon which I have repeatedly noted; one is sur-
prised to hear a patient who looks not more than twenty-
five state his age at thirty-five or forty.
THE NEURASTHENIC VOICE is an objective symptom
which may be noted here. The quality and quantity
of the voice is apt to be temporarily enfeebled after
fevers, or any acute disease which seriously involves
the nervous system. In chronic nervous impairment the
voice may become permanently altered. A huskiness or
hoarseness, a soft quality, a lack of timbre and of power,
and especially unsteadiness or unreliability, make up what
is called the neurasthenic voice. These changes are
caused by a flabbiness or lack of tone in the vocal cords
and their adjacent muscles, and in some cases by a re-
laxed congested state of the mucous lining of the larynx.
The nerves which run to these muscles, as well as the
nerve-centers or batteries in the brain which supply them
with force, are in a state of chronic depression, either as
a part of a general brain depression, or as a result of per-
sistent reflex irritation from the stomach, reproductive
organs or elsewhere.
The neurasthenic voice is sometimes supposed to be
due to chronic laryngitis or some other condition of the
larnyx, but purely local treatment never cures it. It may
seem strange to treat a husky voice by medicating the
stomach or womb; but as I write I recall a case of per-
sistent huskiness of voice in a young lady, which com-
pletely disappeared as soon as a displacement of the womb
was cured. She had been a fine singer and her husband
had spent considerable money upon specialists in diseases
of the throat without any great benefit.
VI
MENTAL SIGNS
The central nervous system is trie seat and source of
character. The difference between a chief-justice and a
sneak-thief consists in the changes which heredity and
discipline have wrought in the plastic brain-and- spine.
And the physical condition and the blood supply of "the
organ of mind" largely determine those traits and char-
acteristics which make up a man's individuality.
MENTAL IRRITABILITY is a frequent manifestation of
the physical irritability and weakness within. A fretful,
peevish manner, an increasing irascibility, a tendency to
become angered at slight provocation or without provoca-
tion, an abnormal suspiciousness or jealousy; in woman,
an abnormal emotional sensitiveness, sometimes approach-
ing hysteria these are trouble-creating traits which may
be developed in the most amiable individual as a result of
nervous impairment.
These exhibitions are apt to be looked upon as moral
failings, and met with reproach and censure, when medical
advice or treatment is what is needed.
DEPRESSION OF SPIRITS is a common phase. Poorly
nourished brain-cells cannot be expected to put forth a
strong, hopeful, joyous quality of mind. The gloomy
forebodings and the morbid fears of nervous impairment
become in some cases a true insanity, and may even lead
to suicide, but more often this phase takes the form of
repeated fits of the blues, or of hypochondria. In this
latter condition the subject feels that he is sick, and his
attention once fixed upon his condition, develops into a
morbid habit of introspection; he exaggerates the mean-
ing of all his symptoms and fears the worst consequences.
(32)
MENTAL SIGNS. 33
Thousands of medical vampires deliberately do all in
their power to cultivate this wretchedness, and derive
large incomes by playing upon this phase of nervous
impairment.
PATHOPHOBIA means "fear of disease." An irritated,
over-sensitive, or impoverished brain-and-spine is apt to
be uneasy about itself. It watches, notes symptoms,
worries. This morbid sensitiveness about health has
become an American trait. No other people swallow so
much medicine, nor support so many physicians, nor
become the prey of charlatans to such an extent as
Americans. This trait is not wholly imagination; it is a
sign manifested by nervous systems irritated by the rest-
less, disproportionate activity of American life.
IMPAIRMENT OF MEMORY. The process by which ex-
ternal impressions become fixed forever in the mind has
been compared to photography the highly sensitive
particles of brain matter corresponding to the highly sensi-
tized plate in the camera. Every impression is brought
to the brain through the special senses of sight, hearing,
taste, touch and smell; and every thought and imagina-
tion of the mind is supposed to be registered that is, to
produce certain molecular changes in the brain-cells.
But, since these brain-cells are being constantly worn out
and destroyed, and the life of the individual cell is
transient, how is it that this registration is permanent ?
This is explained by applying the law of heredity to cell-
life. Within every cell is a spot or germ, which, as the
cell itself is passing through the various terms of its
existence, gradually develops, and eventually takes the
place of the parent cell, carrying on all the molecular
peculiarities of the parent cell.
The vigor of the memory is apt to be in direct pro-
portion to the vigor of the brain-cell. In youth, memory
is keen, and many of the impressions registered in the
substance of the brain during that period of life are
34 NERVE WASTE.
remembered vividly in extreme old age, while impres-
sions brought to the comparatively blunted and enfeebled
brain-cells of old age are forgotten in a week or a day.
This illustrates how it is that an enfeebled condition of
the brain-centers is apt to be manifested by a failing mem-
ory. The cells, poorly nourished by thin blood, or
impoverished by an excessive expenditure of their reserve
force, become sluggish, blunted, unimpressionable at any
age, just as they do in the natural failing power of
extreme old age. Many degrees of impairment of mem-
ory are met with. Of course, the capacity of the brain
to register impressions has its limits. A three weeks'
tour of Kurope is apt to leave indistinct and confused
memories. A man whose business involves the remem-
brance of a vast number of details, may have a very poor
memory for things outside the range of that business,
without having any degree of brain or nerve impairment.
Closely related to this impairment of memory is an
IMPAIRMENT OF THE FACULTY OF SPEECH. The power
of speech requires a more or less normal condition of
the vocal organ in the throat the larynx, of the mus-
cles concerned in articulation those of the tongue and
lips, and of the resounding chambers or cavities in and
adjacent to the throat and nose. But, in addition, it
requires the more or less healthful condition of certain
brain-cells, the speech-centers, in which reside the faculty
of language, or that part of intelligence which associates
certain words with certain ideas.
A fluent speaker is one in whom the speech-center in
the brain is, by heredity or by cultivation, highly devel-
oped. This instinct for words may be extraordinary in
persons who are not fluent talkers ; some of the most
famous authors have been comparatively stupid compan-
ions, or have been totally unable to make a speech in
public. Children born deaf, or becoming deaf from early
sickness, remain dumb, not because the vocal organs
MENTAL SIGNS. 35
are at fault, but because the speech-center in the brain
cannot be sufficiently educated without hearing. When,
as a result of over brain-work, the vigor of the cells of
the speech center, in common with other parts of the brain,
becomes impaired, the subject may be noticed to fre-
quently mis-use words, or syllables, or even single letters,
generally the initial letter of words ; and he may be often
at a loss for a familiar word. This impaired fluency of
speech is not constant ; the individual may be a strong
and eloquent speaker under the stimulus of certain sur-
roundings, but in his enervated, listless moments, when
the brain is more or less off duty, this phase may be very
conspicuous.
IMPAIRMENT OF WILL POWER. Volition is the rarest
and most valuable quality of mind. There are a hun-
dred men who are wise for one who is strong, and the
man with a strong will is apt to control his fellows. In
many cases of nervous impairment, weakening of the
will power is very noticeable. A patient lately informed
me that he had left home immediately after breakfast to
have an aching tooth drawn, but, though he had fully
decided that the tooth must be removed, he could not
bring himself to enter the dentist's office ; he passed and
repassed the door innumerable times, and it was noon be-
fore he could force himself to enter and submit to the
momentary operation. This incident by itself is not
proof of an impaired will, but when such a peculiarity
developes, as it did in this case, in a man to whose known
character it is utterly foreign, then it is so. My patient
had visited the dentist many times before without shrink-
ing, and his acquired enfeeblement of will was manifested
in other directions. Fickleness, inconstancy, wavering,
and inability to concentrate the mind, or to long apply it
to study or work, are often the manifestations of an
acquired enfeeblement of will, and may seriously affect
the business or social interests of the individual. The
36 NERVE WASTE.
patriarch's "Unstable as water, thou shalt not excel"
well describes some of these cases. This impairment of
will power is not unfrequently exhibited in old and
wealthy families, where the stock is retrograding from a
lack of earnest work, combined with dissipation, and it is
one of the serious consequences of several of the drug
habits, notably of morphine and of chloral addiction.
UNEVENNESS is one of the characteristic phases of ner-
vous impairment, which often renders the subject an
enigma to his friends. Not only the state of mind, but
all the subjective sensations of the disorder are liable to
sudden and frequent changes. One day such a man may
be active and enthusiastic, the next fatigued and de-
pressed. One day he may be cheerful, or even vivacious;
the next silent, inelastic, listless. The functions of
digestion and reproduction are liable to sudden break-
downs, or to periods of enfeeblement. Thus the neu-
rasthenic invalid is apt to be in business and in society
a noticeably uneven man.
VII
CIRCULATION SIGNS
The vessels, by means of which the blood circulates
through every part of the body, are not rigid and unyield-
ing tubes, but have the property of dilating and contract-
ing. These changes of calibre occur under a great variety
of circumstances. In the moment of sudden fear the blood
recedes from the skin and rallies around the vital organs
within as if to protect them the face is <( blanched with
terror ;" under the stimulus of another emotion the ves-
sels of the skin dilate, and the blood rushing in to fill
them causes the blush of shame ; when the body is
exposed to cold, the blood-vessels of the skin contract and
the blood is partially withdrawn from the surface, in
order that it may be kept hot, and not radiate its heat too
rapidly into the cold air ; under the influence of heat the
blood is led into the skin, that, by radiation and by evap-
oration of sweat, the body may lose part of its super-
fluous heat ; during study or earnest thought the blood-
wave is attracted to the brain ; during and after digestion
to the stomach and other digestive organs.
The duty of managing these complicated circulation
changes belongs to a certain part of the nervous system of
organs known as the vaso-motor system. This system
consists of central collections of nerve -cells and innumer-
able thread-like nerves which run along in the walls of
every blood-vessel in the body. In health all goes well,
but when the nerve-cells of the central nervous system
become weakened or irritable, the action of the dependent
vaso-motor nerves is apt to become deranged and un-
steady, the abnormally susceptible blood-tubes are not
I 37)
38 NERVE WASTE.
properly controlled, and certain circulation derangements
result. One of the most common of these is partial con-
gestion of the brain. Brain exercise attracts a large
quantity of blood into the brain-vessels, which, when the
brain exercise is at an end, should be made to recede
from the brain by the contraction of the blood-vessels ;
but if the supply of nerve-force to these blood-vessels is
insufficient, they are sluggish, lack tone, and cannot con-
tract; the brain remains engorged with blood, and we may
have a Congestive Headache, or perhaps a persistent Sleep-
lessness. Or, the blood-flow to the brain may be too
small, causing An<zmic Headache, vertigo or dizziness,
and a variety of sensations referable to the head, eyes and
ears. The Excessive Blushing which so annoys some
patients, and the Hot Flashes experienced by many
women about the change of life, are examples of this
unsteadiness of the circulation resulting from a weakened,
or an irritated nervous system.
There may be constant coldness of the feet and hands,
or, on the other hand, the extremities may be warm and
perspiring, according as the blood-current is over or
under the normal supply to these parts. Almost any
organ in the body may be affected by these irregularities
of blood supply. A congested and abnormally sensitive
condition of the spinal cord, with or without some dis-
order of the reproductive organs, is a common symtom
among women, known as Spinal Irritation, or the Irri-
table Spine. The Irritable Ovary and the Irritable Uterus
are terms which imply an irritable, congested and relaxed
condition in those organs. In the male a relaxed, con-
jested and hyper-sensitive state of certain deep-seated
parts the uretha, the prastate gland, and parts adja-
cent are often the conditions keeping up Spermatorrhoea
and Impotency. One form of weak and irritable eyes
depends upon a state of chronic congestion in the mucous
membrane of the eye the conjunctiva.
CIRCULATION SIGNS. 39
THE IRRITABLE HEART Palpitation of the heart is
one of the most common symptoms of nervous debility,
and one which sometimes causes much uneasiness or alarm.
The heart is a hollow muscle, swung somewhat freely in
the chest, whose business it is to keep the blood in motion.
It acts as a pump, receiving the dark blood from the veins
and forcing it into the lungs, where it is purified and red-
dened by contact with oxygen; thence it again receives
this red oxygen-laden blood and pumps it to every organ
and tissue, through hundreds of elastic tubes the arte-
ries.
The power or force that keeps the heart moving, day
and night, comes from the nervous system, just as the
force that vibrates the hammer of an electric bell comes
from the galvanic battery. While this supply of nerve
force flows out to the muscular fibres of the heart in
proper quantity, that organ beats strongly, steadily, and
with a certain rhythm. But if the nerve-cells, or batteries,
of the nervous system, become weakened by over-expen-
diture, two things may happen, first, the nerve-cells can
not give out a strong current of force to properly main-
tain the beating of the heart; second, one certain nerve,
whose duty it is to maintain the rhythm of the heart, by
keeping it to a certain number of beats per minute, par-
tially loses its governing power, and becomes more or less
unreliable. These two conditions of nerve weakness
cause palpitation of the heart, a weak action of the
heart because of a feeble outflow of nerve force, and a
rapid, irregular action because of the inability of the
pneumogastric nerve to properly do its duty. Palpitation
of the heart, in the great majority of cases, is not a
symptom of heart disease, as that term is used by medical
men; it is not, in itself, dangerous to life, and never
results in, or causes sudden death.
I have met men and women suffering from this symp-
tom, who firmly believed themselves to be the victims of
4O NERVE WASTE.
heart-disease, and over whose heads the fear of sudden
death had hung for months or years. They had obtained
this idea from the representations of some patent medicine
advertisement, or from the statement of some ignorant or
unscrupulous physician. It is a sad fact that there are men
who, in order to extort a petty sum, will subject a fellow
human being to a mental misery which may endure as
long as life itself. There is no more terrible news to hear,
and no heavier burden for the sick to bear, than the con-
viction that they have incurable disease of the heart.
Palpitation of the heart is cured by gradually building up
the nervous system, and by the use of medicines having a
direct tonic action upon the heart, of which medical
science has several of great value.
Closely related to the unstable circulation of nervous
impairment are certain
DISORDERS OF SECRETION AND EXCRETION. The skin
contains immense numbers of sweat-glands whose function
it is to excrete, or separate from the blood, certain waste
substances in solution; so, too, the pink, shining mucous
membrane lining those cavities of the body which com-
municate with the air, and which is a kind of internal
skin, is studded with innumerable follicles which secrete,
or separate from the blood, a thin fluid mucus. This mu-
cus serves to protect the parts, to keep them moist and
pliable, and, by being constantly removed and changed, it
keeps the parts clean . Both these sets of glands are under
the direct influence of certain nerve-cells, and in nervous
impairment, this excito-secretory office of the nervous
system may become disordered, unsteady, over or under
the normal degree of activity, causing Excessive Perspira-
tion of the hands or feet, or of the whole body; or in other
cases an Unnatural Dryness of the Skin, or an Abnormal
Dryness of the Mouth and Throat.
VIII
THE ACHES, PAINS AND FEELINGS OF NERVOUS
IMPAIRMENT
The apparatus of sensation includes : i . The brain,
which is the great central receptive organ. 2. The nerves,
which conduct impressions from every part of the body
'to the brain. 3. The nerve-ends in eye, ear, tongue,
nose, skin and elsewhere, which are the perceptive part
of the apparatus. Healthy, nervous tissue perceives,
conducts and receives natural impressions without pain or
discomfort, but weakened, poorly nourished, morbidly
sensitive nervous tissues do not always do so.
HEADACHE. The head may ache from a great variety of
causes, and the headache of nervous impairment is only
one of a large family. Thus the head may ache :
1 . When the brain is irritated or pressed upon by some
foreign substance, as a brain tumor, abcess or meningitis.
2. When the blood pressure within the brain is in-
creased by any derangement of the circulation. This may
be the result of exposure to cold, of over brain- work, of
heart disease, of kidney disease, or of the unsteady cir-
culation of nervous impairment.
3. When the brain is harassed by any continuous
morbid impression brought to it from distant parts; thus
the disordered stomach of the dyspeptic sometimes irri-
tates his brain into aching.
4. When the blood is charged with unnatural or
with poisonous substances; a large dose of quinine causes
headache in most persons ; the blood-poisoning of Bright's
disease often gives rise to terrible head pains. Exposure
to cold acts partly in this way ; the function of the skin,
(41)
42 NERVE WASTE.
an important excretory organ, being suppressed for a time,
various poisonous substances are imprisoned in the blood.
5. When the brain is chronically tired, as in eye-
strain and ear-strain, or in regular over brain- work it may
ache just as a muscle would.
6. When the brain is imperfectly nourished by poor
quality of blood.
The headaches 01 nervous impairment are variously de-
scribed as a feeling of fullness, or a tight band-like feeling
about the temples, or a heavy tender feeling at the crown
of the head or in the back of the neck. They are ex-
plained by the unsteady circulation of the blood described
in a preceding chapter, by the over-sensibility to reflect-
ed irritations, which is a characteristic of weakened nerve-
cells, and in some cases by brain-tire from strain and over
brain-exercise.
MIGRAINE, OR SICK HEADACHE, is a peculiar form of
headache to which many nervously impaired persons are
periodically subject. A typical sick headache is ushered
in by brow uneasiness, or by painful disturbances of vision,
and chilly sensations which continue for a time, varying
from a few minutes to several hours. These disorders of
sensation gradually pass into headache, often limited to
part of the head, and often attended by nausea or vomit-
ing. The stage of headache is apt to last several hours
and leave the patient weary and depressed, though after
the immediate effects have passed away many persons
feel better than usual a fact probably explained by the
enforced rest, abstinence from food, and vomiting. The
attacks may occur every few days or as rarely as once in
several years, or even once in a lifetime.
Neurologists are not agreed upon the real nature of
sick headache. It was formerly supposed to be due to
liver or stomach derangements, but these are now known
to be only exciting causes, bearing the same relation to
the brain that an ignited fuse bears to a mine of powder.
SENSATION SIGNS. 43
Dr. lyiveing has written an exhaustive work on this
form of headache, in which he asserts that it is a pain-
storm traversing certain tracts in the brain. The theory
most commonly held refers migraine to the sympathetic
nervous system. This system, which consists of chains
of nervous ganglia in the head, neck, chest, abdomen and
pelvis, is controlled by the brain-and-spine. In a weak-
ened brain-and-spine this controlling or inhibiting influ-
ence is impaired, and the sympathetic system runs riot.
The sympathetic system controls the blood-stream, and
it at first contracts the blood-vessels in its uncontrolled
excitement, causing the visual and other disordered sen-
sations of the first stage. Later, its excitement is followed
by temporary exhaustion or paralysis, whence results dila-
tation of blood-vessels, brain-fullness and headache.
Migraine is a disorder of the first half of life ; after
thirty or forty the attacks diminish in frequency ^nd
finally cease.
In many cases of impending sick headache, temporary
seclusion and rest, or, it may be, cheerful change, will
ward off the attack. In others warmth, a hot mustard
foot-bath (if the feet are cold), or hot- water rubber bottles
to spine and neck, a. cup of strong coffee, a little hot
bouillon or a glass of wine internally, and an evaporating
lotion, or cloths wrung in ice- water, may be added, and
will suffice. Purgatives are of great use in the beginning
of sick headache; five grains of calomel, mineral waters,
two or three teaspoonfuls of Tarrant's seltzer aperient, or
a dose of the individual's favorite "liver pill," maybe
used upon the first warning of the approach of migraine.
S.ilicylate of soda has a reputation for preventing migrain-
ous attacks, which it sometimes realizes; it is not without
danger to the kidneys, and is not suitable for self-treat-
ment.
VERTIGO, OR DIZZINESS. The physiology of equipoise
is quite intricate. First, our perceptive organs (of vision,
44 NERVE WASTE.
hearing, and touch) give us evidence of our relation to
outside objects. The evidence of these various impres-
sions is transmitted by the nerves to the cerebellum, or
little brain, which is the co-ordinating centre, or home
office, of equilibration. The cerebellum acting upon this
evidence sends out nervous impulses to various muscles,
chiefly those of the head, neck and spine, by the proper
contraction of which we are able to maintain our equi-
poise. When any of the three parts perceptive, co-ordi-
nating or motor of this mechanism is disordered we may
have vertigo. It occurs in certain diseases of the eye and
of the ear, because it is largely by the aid of these organs
that a man unconsciously takes his bearings. It occurs
in several organic diseases of the brain and of the spine,
in epilepsy, in certain diseases of the stomach, and in
gout. It frequently complicates sick headache and some-
times replaces it. It occurs in simple nervous impair-
ment from an unsteadiness of the entire nervous appa-
ratus of equilibration.
SPINE PAINS and morbid sensations are among the
most common symptoms of nervous impairment, espec-
ially of spinal neurasthenia.
The back of the neck and the region of the spine, ex-
tending from the hair to a point just below the shoulder
blades, is the most common seat of sensations variously
described as a sore, tender feeling "deep in," a dull ache,
or an uncomfortable, irritating, burning sensation in the
skin ; a dull ' ' headache in the back ' ' may be experienced
at any point along the spine,
Spinal Irritation, a sensation of pain or of irritability,
usually located in the lower part of the back, is a some-
what common symptom among women. It indicates con-
gestion and over-sensibility of the spinal cord at the cor-
responding point; and is in most cases due to the harass-
ing, depressing influence of ovarian or uterine disease.
SENSATION SIGNS. 45
Similar sensations are sometimes met with in the male in
cases of sexual debility and exhaustion.
NERVE PAINS. -Neuralgia has been cleverly called
"the prayer of a starved nerve for food." But this is
not always the case, and nerves may ache from a variety
of causes, e. g. :
1. Exposure to cold, resulting in congestion and
pressure about the nerve.
2. Poisoning; the impure blood stream of gout, rheu-
matism, lithaemia, malaria, or of any metallic poisoning
may irritate the nerves and set them to aching.
3. Organic nervous diseases, as inflammation of the
nerve itself, or disease of the spinal cord.
4. Reflex irritation, as when one decaying tooth lights
up a neuralgia of half the face.
5. Over- worked and under-nourished nerve-centres are
more sensitive to all the exciting causes just mentioned,
but they may ache without any discoverable exciting
cause whatever. The neuralgias of nervous impairment
are common in the face (brow-pains and tic), in the head,
in the chest- wall, in the leg (sciatica), and may occur in
any nerve.
Tic DOULOUREUX, Facial Neuralgia, Prosopalgia, is
peculiar in the rapidity of its approach and in the abrupt-
ness of its departure, in the intensity of the pain, in the
muscular spasm which it often induces and in the obsti-
nacy with which it resists treatment. Hither or all of the
three divisions of the tri-facial nerve may be attacked.
The term ' ' brow-ague ' ' supposes a malarial (exciting)
causation. The opthalmic variety of tic is sometimes con-
founded with migraine, but falls far short of migraine.
The sudden spasmodic contractions of the facial muscles
which attend certain cases of tic douloureux have caused
the term ' ' epileptiform neuralgia " to be applied to it ;
the muscles about the eye, those of the face, and in some
cases those of all the face and neck may be involved in
46 NERVE WASTE.
spasm. The hair is very apt to turn gray about the seat
of pain, and between attacks superficial ansethesia in some,
exquisite sensitiveness in others, may be marked.
There may be a dull aching sensation along the course
of the nerves of the arm or leg not amounting to actual
pain, or a feeling of numbness may be experienced in
some part. These limb sensations are sometimes sup-
posed to be forerunners of paralysis, and are thus the
cause of much unnecessary uneasiness or alarm. They
merely indicate the impoverished state of nerve nutrition
and are never followed by paralysis. Electricity often
removes these symptoms, as well as those located in the
spine, as if by magic, and neuralgia itself is often quickly
cured or greatly benefited by proper treatment.
The avoidance of neuralgic attacks involves especially
two things, viz., the avoidance of cold, and of the blood-
poisoning, lithsemia, which results from over-eating and
under-breathing. Urinary deposits are a sign that some-
thing in diet or in habits needs adjustment.
NERVE-END PAINS. Paraesthesias, or morbid sensa-
tions on the external or the internal surfaces of the body,
are very common in nervous impairment. Tenderness in
the scalp, tenderness about the teeth and gums, or at
almost any point ; creeping or crawling sensations ; itch-
ing of the skin ; exaggerated sensations of heat or of
cold ; feelings of numbness ; ' ' burning in the nerves ' ' of
the face or any part of the surface ; smarting in the womb
or vagina or rectum ; soreness in the muscles; a sore,
tender feeling and sense of relaxation in the joints of knee,
elbow or jaw; a feeling of tenderness or soreness in the
heels, are among the subjective signs, described by differ-
ent patients.
VISCERAL NEURALGIAS. The nerves which innervate
the internal organs may ache as well as the superficial
nerves. Angina Pectoris^ " breast-pang," is a terrifying
combination of spasm and pain in the region of the heart,
SENSATION SIGNS. 47
of which each attack is said to bring the fear and suffer-
ing of death itself. It is like migraine, an uncontrolled
action of the sympathetic nervous system, and in many
cases depends upon organic disease of the heart. Gastral-
gia (gastrodynia, cardialgia, gastric colic) ranges all the
way from uneasy sensations in the stomach on taking food
to severe paroxysms of stomach pains. Enteralgia, neural-
gia of the bowels, is somewhat common in abdominal
neurasthenia. Hepatalgia, neuralgia of the liver, occurs,
but rarely. Uterine and Ovarian neuralgias are common
and often develop without any discoverable local causa-
'tion; I have seen cases of neuralgia of the urethra and
of the testicles. Neuralgia of the rectum and of the anus
are occasionally met with.
AN UNNATURAL FATIGUE may be, for a time, the only
indication of failing nerve-power. The accustomed duties
of life may become excessively irksome, and a constant
feeling of weariness may be experienced. In some cases
work is well done under the stimulus of duty, but after-
noon or evening brings an intolerable feeling of fatigue.
Or the best sleep may be insufficient to repair the over-
drawn nervous system, and the individual arises from his
bed, after having slept soundly eight or nine hours, unre-
freshed, inelastic and languid, and it may be several
hours before he becomes braced up for the day's duties.
When this abnormal tiredness occurs in an apparently
healthy man he is apt to be suspected of laziness and to
get but little sympathy.
SPECIAL SENSE SIGNS. The visual apparatus with its
exquisite perception, and its delicate adjustment, is liable
to several disorders in nervous impairment.
The mucous membrane lining the front of the eye and
orbit the conjunctiva may become congested, red and
watery as one of the results of a disordered circulation.
The perceptive part of the apparatus the retina, optic
nerve, and in the brain the great central sensory ganglion,
48 NERVE WASTE.
the optic thalamus, may participate in the general nervous
weakness and irritability. Floating specks and wavy lines
in the field of vision, running together or blurring of the
letters in reading, momentary blindness, and a feeling of
fatigue on using the eyes are common symptoms of ocular
neurasthenia.
An unnatural dilation of the pupil is often noticeable
in nervous impairment. It is explained by weakness of
the motor oculi nerve-sources (whence pupillary contrac-
tion) plus unrestrained action (inhibition failure) , of those
sympathetic fibres of the opthalmic ganglion which dilate
the pupil.
The ear may become the seat of various annoying
sensations, indicative of feeble and unsteady nervous out-
flow. Ringing, buzzing, tapping and roaring sounds in
the ear are occasionally complained of. These noises are
sometimes very persistent. In one case a patient had
hardly been free from a ringing in the ear for more than a
year; at first, as she said, it almost drove her crazy, but
she finally became accustomed to it.
The nerve-ends for smell in the nose, and those for taste
in the tongue, are liable in rare cases to functional perver-
sions, and the individual is annoyed by unnatural odors
or tastes. In other cases the acuteness of these senses is
greatly diminished.
The treatment of neurasthenic pain is palliative or tem-
porary and curative or permanent; the former is accom-
plished by stimulation and sedation, the latter by the
whole hygiene of the nervous constitution. Electricity
is the most valuable single remedy in both the palliation
and cure of neurasthenic pain.
IX
MUSCULAR
The muscles everywhere are directly dependent upon
the brain-and-spine, not only for power but for growth.
When the electric bells of a dwelling-house ring faintly
or cease to ring, and the bell-rnan is summoned, he turns
his first attention, not to the bell, but to the batteries
hidden away in the attic or cellar. In paralysis of
muscles it is, in most cases, the nervous tissue back of
the muscle that has gone wrong. A strong nervous
system is the foundation of muscular agility and power.
The pugilist Sullivan has probably no heavier or harder
muscles than thousands of other men, but a superior
quality of nerve tissue enables him to use heavy muscles
with the rapidity and cat-like agility, and the concen-
tration of power in a single blow, that makes him so
effective as a pugilist. An irregular, dissipated life would
soon ruin this fine quality and reduce him to the level
of other men. Hanlan, for many years the champion
oarsman of the world, has not very large muscles, but
his superior quality of brain and spine tissue gives him
a high and sustained power which few men can equal.
The common gymnastic feat of raising one's self a
number of times on the horizontal bar is one in which
neurasthenics never succeed very well ; they lack reserve
power.
The relation of the nervous system to the muscular
apparatus is often illustrated in professional athletes.
When a man is trained too fine, i. <?., when his muscles
are developed out of proportion to the capacity of his
nervous system to create and supply force, and of his
heart and lungs to supply blood and oxygen, he lacks stay-
4 (49)
5O NERVE WASTE.
ing power and is apt to be defeated in a contest. Readers
of Wilkie Collins' novel " Man and Wife " will remember
the fate of Geoffrey Delamayne. Dr. Winship, a one-
time celebrity of Boston, who trained himself from a puny
college boy to a Hercules in lifting heavy weights, suf-
fered from palpitations and faintings during his public
exhibitions. Many large muscled men suffer severely from
nervous symptoms.
Trembling of fingers and hands is a common phase of
nervo-muscular impairment ; it may be more or less con-
stant, or may only be manifested when an unusual de-
mand is made upon the nervous system, as during
sudden emotional excitement, or after any great muscu-
lar effort.
A sudden twitching or starting of the muscles of one
limb or the entire body, generally on going to sleep, and
a twitching of the muscles about the eyelids in reading
or in any work requiring eye strain, are symptoms that
are frequently described by neurasthenic patients. These
tremblings and twitchings indicate the unsteady inter-
mittent character of the nerve-current from brain-and-
spine to muscle.
WRITER'S CRAMP, or writer's palsy, is an example of
the exhaustion of certain groups of nerve-cells. This
is one of a family of nervous disorders known as ' ' occu-
pation neuroses," which is seen among telegraphers,
musicians, dancers, engravers and others, who habitually
use one set of muscles to do more or less fine work. The
individual partially or completely loses the ability to
make the familiar movements of his craft, while in other
respects the limb is but little impaired. Thus the pen-
man may become unable to write or even to grasp his
pen, while his ability to play ball or row a boat, or do
any coarse movement, may be as good as ever. The
cell combination in the nervous system which directs the
complex act is exhaust ,d. The fact that the symptoms
of writer's cramp are chiefly manifested in the extremi-
ties leads many to suppose that it is a purely local affec-
tion ; but if the subject attempts to use the left hand in-
stead of the right the disease soon appears there as well.
Cramp or palsy is only- one of many symptoms ex-
hibited in the occupation neuroses, and even these may
be absent in well-defined cases of writer's cramp. Three
types of these disorders have been described, viz.: the
spasmodic, the paralytic and the tremulous, according as
cramp, weakness or trembling is the most marked symp-
tom in the case. One of the earliest and most constant
symptoms is a sense of unnatural fatigue in the hand,
arm or shoulder, which may grow into a dull aching
pain during work. Sometimes this pain implicates the
whole limb from the fingers to the spine, and is so great
as to compel the individual to cease work. Other symp-
toms frequently described are stiffness and tightness of
the fingers or arm ; trembling or twitching unsteadiness
of the limb ; cramp, spasm, or jerking or tightness of the
muscles ; soreness and tenderness ; loss of power; various
morbid sensations in the limb, as a sense of itching,
burning, tingling, creeping, prickling, numbness on the
surface; binding about the wrist; feelings of heat or cold-
ness; neuralgia; a tendency to grasp or clutch the pen
too tightly, and to bear down heavily upon the desk.
Victims of writer's cramp often suppose that they have
rheumatism and treat for this disease.
Many cases of writer's cramp are cured quickly and per-
manently without abandoning work. These are gener-
ally cases in which the disorder has not become too chronic.
In some cases a more or less prolonged vacation is nec-
essary, and in certain old cases, especially existing in
thoroughly broken-down patients, no treatment will do
more than lessen the evil. The treatment of this, as of
all similiar disorders, is a combination treatment. It
includes among other things:
52 NERVE WASTE.
1. Change in work. The patient must endeavor to
do his work by means of motions as opposite to those to
which he has been accustomed as possible ; in the style
of the pen and holder, in holding the pen, in standing or
sitting at work, in lifting Heavy books, many changes
may be made which will throw part v of the strain of work
upon other nerve-cells and rest those which have been
over-drawn.
2. Training. When an athlete wishes to get himself
into the best possible condition, he goes into training for
a time. So the victim of writer's cramp who wishes to
hold his position must often reform his habits of eating,
drinking, smoking, sleeping, and perhaps deny himself
many things in which he takes comfort.
3. Klectricity in the form of local and central galvan-
ism i.3 the most efficacious single remedy. It generally
relieves pain at once and substitutes a grateful glow for
the feeling of fatigue and stiffness so often complained of.
Its permanent effect is equally valuable and I have never
seen a case of writer's cramp that was not distinctly
benefited by this remedy.
4. Massage. Kneading and various passive exercises
of the affected muscles are useful measures, as is also hot
bathing.
5. Hypodermic injections of various medicines into the
affected limb are, next to electricity, the most potent meas-
ure, though not adapted to all cases.
MUSCULAR SIGNS THE CONVULSIVE DISORDERS
Convulsion and spasm are italicized signs that some-
thing is wrong with the brain-and-spine. In many cases
of convulsive disease search discovers a cause therefor in
some irritation of the gray brain-cortex, whether existing
in the brain itself or transmitted thither from without by
sensory nerves. But in other cases no cause can be dis-
covered; if death occurs from accident, necropsy shows no
morbid change, and the microscopist with ever so high a
power can detect nothing abnormal in the nervous struc-
tures. An unstable, a weakened, an over-sensitive, or all
three of these conditions of the brain-and-spine, may man-
ifest itself in convulsive muscular movements of various
kinds. Chorea, Hysteria, and Epilepsy can hardly even
be alluded to in the few pages that can be spared here,
but a few facts may serve as introduction to a statement
of the important principles of treatment which apply to
all three.
IN ST. VITUS' DANCE, irregular and more or less violent
convulsions, involving single muscles or groups of mus-
cles, which are exaggerations of natural movements rather
than convulsions, occur; the term ' ' insanity of the mus-
cles," has been applied to it. In the fourteenth and fif-
teenth centuries an endemic nervous disorder prevailed in
the region of the Rhine and the Moselle, and it was cus-
tomary to lead victims to the chapel of St Vitus at Stras-
burg, where they were supposed to be cured by religious
ceremonies and invocations. The various forms of chorea
which are now popularly known as St. Vitus' dance have
no similarity to the nervous epidemics of the middle ages.
(53)
54 NERVE WASTE.
Chorea has been traced to various physical changes in the
brain, and to various irritations, poisonous or reflex. The
chorea of nervous impairment is apt to develop in children,
more often in girls, between the ages of seven and fifteen.
Habit and imitation sometimes develop and establish this
disorder. Chorea is the most easily .curable of the con-
vulsive disorders, though it occasionally runs a course of
a year or more, and may become chronic.
HYSTERIA is the most protean of all diseases; convul-
sive seizures are but one phase of it, and they are
sometimes absent. The entire apparatus of perception
may be deranged; morbid sensations, aches, and pains,
which are true cerebral hallucinations, are complained of.
The motor apparatus may be periodically agitated by
convulsive movements, or may remain paralyzed in one
limb or another for five, ten, or even twenty years, to be
miraculously cured in a week or a moment by the faith
cure, or a bottle of the water of gourdes. The mind often
distinctly deteriorates in its moral element; hysterical
patients are sometimes mendacious, deceitful, egotistic,
selfish, and painfully lacking in moral stability. Some of
the most remarkable instances might be related of the
deep-laid and ingenious tricks which have been resorted
to by hysterical patients to obtain the notoriety or the
attention they crave.
The fact that typical hysteria is almost confined to the
female long led to the supposition that it has its origin in
the womb, but hysteria is occasionally observed in the
male, and the exaggerated emotional susceptibility pe-
culiar to this disorder is not so very rare in man. Hysteria
varies in type in different countries and at different ages.
France develops a type of hysteria, hystero-epilepsy or
hysteria major of Charcot, that is seldom seen in England
or America. Hysteria mimics all diseases; hysterical in-
sanity, hysterical unconsciousness, hysterical amblyopia,
deafness, paralysis, convulsions, pain, asthma, dyspepsia,
MUSCULAR SIGNS THE CONVULSIVE DISORDERS. 55
joint-disease, ovarian and uterine disease, and even hys-
terical pseudo-pregnancy occur.
EPILEPSY, "the falling sickness," is a very ancient
disease. In ancient times one having it was supposed to
be "possessed of a devil," and religious formulas were
resorted to to drive out the unclean spirit. The essential
features of epilepsy are sudden loss of consciousness and
convulsions, but many subtle and masked phases of this
disorder have been noted. In severity an attack varies
all the way from slight, almost imperceptible, uncon-
sciousness to tragic fits, and even to violent homicidal
mania. Epilepsy is most common between the ages of
ten and twenty puberty is a comparatively unstable
period of life but may occur at any age. The frequency
of attack varies from once in one or two years to even one
hundred and fifty seizures in twenty-four hours; the
larger proportion of cases outside the asylums have well-
defined attacks once in two or three weeks. The two
factors in this disease are intrinsic instability (hereditary
or acquired) of the higher brain-cells plus an irritation.
The irritating impression may consist in blood-fullness,
in a blood-poison, or may be reflected from a distance.
Recent observations render it probable that ocular defects
are a frequent irritating cause, among others. Habit has
much to do with the development and maintenance of
epilepsy. Each fit renders subsequent ones more probable
and more easy. Thus the reflex convulsions of childhood
sometimes merge into epilepsy, and thus in the adult, fits
which are only epileptiform may gradually become epilep-
tic. The tendency of this disorder is to weaken body and
mind, although it does not always do so. It is probable
that the epileptic seizure is a sign of various conditions
which we are unable to differentiate in the present state
of our knowledge. Thus the epileptic fits of Napoleon
did not express the same condition of brain deficiency
that those of the idiot epileptics of our asylums do. In-
56 NERVE WASTE.
stability is the prominent defect of the one, abject weak-
ness of the other.
The curative treatment of the convulsive disorders in-
cludes three great principles:
1. Elimination. The search for and removal of out-
lying irritations, which may be acting backward to irritate
and depress the brain, is of the first importance; in an ob-
scure case every organ and cavity of the body may have
to be interrogated.
2. Brain-and-spine peace rest. This may require re-
moval of a precocious child from school, or in adults a
change of occupation or of environment. Sleep, quiet,
uneventful, unirritating surroundings are desirable in
every case; in children, a year of "quiet country life and
sunshine, away from city sights and sounds, will succeed
where the great city specialist in nervous diseases will
fail. In a few cases the principle of securing absolute
peace for the central nervous system must be carried to
the length of secluding a patient in a darkened room for
weeks, shutting out even the stimuli of light and sound;
the oculist can testify to the value of this procedure in
his department of nervous disorder.
3. Brain-and-spine nutrition building. Food and
oxygen are the material; electricity, counter-irritation,
heat, cold and drugs, are the forces; as with all the forces
which man converts to his uses, these act beneficently in
proportion as they are guided wisely.
There is no magical cure for most cases of convulsive
nervous disease. It is a matter of earnest, faithful per-
sistent adherence to the principles which physiology and
experience alike teach us. It is a careful, continuous,
vigilant, never-relaxing care and attention to numerous
details. I am convinced that many uncured cases of con-
vulsive nervous disease are so because treatment has
never gone deep enough nor far enough, and has not been
characterized by the extreme thoroughness which is es-
MUSCULAR SIGNS THE CONVULSIVE DISORDERS. 57
sential to success. We have many other and more pow-
erful forces than drugs which act upon the human tissues,
and the cure of these disorders is a matter of wider scope
than the prescription of bromides or of phosphorus. It is
a pathetic fact that the enthusiasm, the pluck, the faith-
fulness, the wisdom, which is more than sufficient to cure
nervous disease is often lacking in parents, and that the
medical man sometimes finds his feebly-aided efforts in-
sufficient to rescue a child from a future which is, in some
cases, worse than death. In these disorders, if the neces-
sary care is great and the details tedious, the end for
which we strive is great, and even the prospect of success
justifies great effort.
XI
RESPIRATORY SIGNS HAY FEVER AND ASTHMA
The respiratory apparatus, so far as hay fever and
asthma are concerned, may be described as consisting of
first, the mucous lining of the nose, throat, voice-box,
windpipe, and lungs; second, the nerves, nerve-ends, in-
going sensation-bearing nerve-fibers, out- coming impulse-
bearing fibers and vaso-motor (blood-current regulating)
fibers; third, the respiratory nerve-centers in the medulla,
(between brain and spine) ; fourth, the unstriped muscular
fiber which constitutes the middle wall of bronchial tube,
wind-pipe, and of artery and vein everywhere.
HAY FEVER is a curious disorder in many respects. It
attacks almost exclusively the sedentary, brain-working,
well-to-do population or their descendants. It recurs
annually with singular exactness; some persons are at-
tacked at the same hour of the same day each year. It
amounts, in some cases, to no more than a bad cold in the
head; in other cases the coryza is followed by bronchitis,
cough, and asthmatic seizure of the most intense descrip-
tion. These asthmatic attacks are the most dreaded
feature of hay fever, and sometimes prolong the attack
for weeks or months, though the usual duration of an at-
tack is about a month. The law of habit has consider-
able to do with this, as with all functional nervous dis-
orders; each attack favors a recurrence.
The nature of hay fever has been the subject of much
discussion. It has been called a purely local (nasal and
bronchial) disorder, a purely nervous (vaso-motor) disor-
der, and a purely toxic (pollen-poisoning) disorder. The
(58)
RESPIRATORY SIGNS HAY FEVER AND ASTHMA 59
prevailing theory now is that hay fever is a respiratory
neurosis, in which irritated nerve-ends, over-sensitive
respiratory nerve-centres, unstable respiratory vaso-motor
innervation act in different proportion in each case.
NEUROTIC ASTHMA is that variety of spasmodic difficult
breathing which cannot be traced to any physical cause.
In many cases there is no bronchitis nor heart, stomach,
kidney or skin disease nor blood poison to explain the
paroxysm, and we can only suppose over-sensibility of
nerve-end and nerve-centre to irritants which are often
trivial, and which are not noticed by ordinary persons.
Asthma and epilepsy occur in the same individual with
sufficient frequency to suggest a kind of relationship be-
tween them. Eczema and other skin diseases involving
imperfect secretion through the skin, and thus blood
poisoning, is a somewhat common accompaniment of
neurotic asthma. Asthma, epilepsy and eczema have
occurred together in several persons who have come
within my observation. A paroxysm of asthma lasts from
half an hour to several days and tends to recur at more
or less frequent intervals. Chronic asthma is capable of
inducing certain physical changes in the structure of the
lungs and heart emphysema, dilatation of the pulmonary
vessels and of the right side of the heart.
THE TREATMENT of hay fever and that of neurotic asthma
are similar: it includes preventive palliative and curative
measures.
Change of climate is the best means of avoiding an
attack of hay fever, and is often the best in asthma. For
hay fever the White Mountains, several sea islands, and
at sea, out of sight of land, are famous asylums. The long,
dry summer season of California, in which flowers and
pollens play but little part, is favorable to both hay fever
sufferers and asthmatics. The tonic influence of change
and rest probably have something to do in this means of
warding off an attack.
60 NERVE WASTE.
The palliative treatment of both hay fever and asthma
utilizes every stimulant and sedative on the list and then
sometimes fails. Of stimulants caffeine, strong coffee,
acholic liquors, Indian hemp and nux vomica are the most
common in use. Of sedatives, belladonna, hyoscyamus,
stramonium, duboisia, Hoffman's anodyne, grindelia, nitrite
of amyl inhalations, eucalyptus, and the nauseants tobacco,
lobelia and ipecac succeed and fail. Morphine, ether and
chloroform will give temporary relief. Solutions of
cocaine locally applied have a power of reducing engorge-
ment in mucous membrane, which is of great use in the
beginning of hay fever.
Various inhalations afford relief in asthma, that of
oxygen, the smoke of stramonium leaves and of saltpetre.
The most efficacious smoke is that from powdered lobelia,
powdered stramonium leaves, powdered saltpetre, and pow-
dered black tea, of each two ounces, mixed, sifted, burned,
or smoked, and the smoke inhaled. Powerfully impress-
ing and diverting the blood-current from the nervous cen-
tres is a principle which acts well in many cases; the hot
mustard foot-bath, a mustard plaster or dry cupping
between the shoulders, ice bags to the base of the brain,
to the back of the neck, and to the spine are all made to
accomplish this indication.
Galvanism of the pneumogastnc nerve, and of the
neck greatly modify the paroxysm of asthma.
The curative treatment of the respiratory neuroses is
sometimes surgical, and always hygienic. Surgery, in
the form of the galvano-cautery, the snare, the knife or
caustics is sometimes successful when there is obvious
local disease within the nasal passages. The cure and
the treatment against hay fever and neurotic asthma
involves the whole subject of nervous hygiene. Cod liver
oil and arsenic are the great remedies. The most effica-
cious treatment against the respiratory neuroses would be-
gin two or three generations before the individual is born.
XII
ABDOMINAL SIGNS, NERVOUS INDIGESTION.
Before food can become blood it must go through sev-
eral processes :
1. Prehension, or the act of getting it into the mouth.
2. Mastication, or chewing.
3. Deglutition, or swallowing.
4. Digestion, or the reduction of food to a liquid, and
the conversion of it into chyle.
5. Absorption of this digested food-stream from stom-
ach and intestines.
6. Liver action upon albumens, starches and sugars.
The abdominal organs do not maintain their tone,
secrete their juices and nourish themselves by their own
inherent vitality, but they are enabled to do these things
because they are innervated, vitalized or supplied with
nerve- force by the brain and spine through the sympa-
thetic nervous system.
That portion of the sympathetic system which di-
rectly supplies the vital (breathing, circulating, digest-
ing) organs with power, is placed for protection and
convenience in the great cavities of the chest and abdo-
men. Here the sympathetic centres with their con-
necting nerves form a double chain in front of the spine,
extending from the neck to the pelvis. This outlying
dependency of the brain and spine is independent of the
will, is 011 duty day and night ; its nerve-cells are kept
charged with nerve force by the central nervous system,
and act as reservoirs of vitality for the internal organs.
POOR APPETITE AND INDIGESTION. The digestive
juices which attack the food, soften it and change it
(61)
62 NERVE WASTE.
chemically so as to reilder it fit for absorption are
secreted by innumerable follicles in and adjacent to
stomach and bowels. These follicles depend directly for
their power of secreting upon the nervous system. This
excito-secretory function of the nervous system is pow-
erfully affected by mental influence. When any intense
emotion, as terror or anger, or any great excitement,
rapidly uses up a great amount of nerve-force the diges-
tive secretions may be almost suspended for hours, or
even for days. So, when the brain or the muscles are
over-worked the nervous allowance of the great sympa-
thetic system is reduced, and the quantity and quality of
the digestive juices suffers from this impoverishment.
After a day of severe toil a man may feel ' ' too tired to
eat," which means that the nervous system has been
overtaxed, and the stomach lining, lacking its accus-
tomed stimulus, does not secrete its juices feels no appe-
tite.
ATONY IN STOMACH AND BOWEL WALLS. Of the three
coats or layers which make up the stomach and bowel
walls, the middle one is composed of contractile muscu-
lar fibres, and, by the elasticity and resiliency of these
muscular fibres, the shape and tone of these organs is
maintained. As has been explained, this muscular tone
depends directly upon a steady supply of nerve force
from the cells of the sympathetic nervous system. When
the force-creating and force-supplying capacity of these
cells is impaired, the muscular coat of the stomach loses
tone, becomes more or less relaxed, the gases of slow
digestion distend it, the subject describes his stomach as
" bloating."
A French physician, M. Glenard, has lately described
a peculiar condition which I have noted. He gives it
the name Enteroptose, which means a " falling of the
bowels. ' ' In this condition the contents of the abdomen
are not firmly supported, but drag upon their ligaments.
ABDOMINAL SIGNS, NERVOUS INDIGESTION. 63
The changed position of the parts which thus results
gives rise to changes in the calibre of both stomach and
intestines dilatations and constrictions occur at various
points, which interfere with the proper performance of the
digestive function.
This condition may affect the entire abdominal mass,
but M. Glenard reports that the most frequent form of
enteroptosis is a displacement or falling of the right arch
of the large intestine. This arch normally lies at a
point in the abdomen just to the right and a little above
the navel, and helps to support the stomach above, and
when it becomes prolapsed the stomach in its turn, sinks,
drags and is weakened.
Gastro-ectasis, or bloating and prolapse of the abdo-
minal mass, sometimes occur in the same subject.
DIGESTIVE BREAKDOWNS. In some over-worked men
the digestion remains pretty good, but is liable to sud-
den break-downs. On certain days without any appar-
ent cause the subject finds that his dinner rests like a bar
of lead upon his stomach; or sour risings, heartburn and
belchings indicate plainly enough that the meal is being
slowly and imperfectly digested. Or, after a hard day's
work, or after some trifling indigestion in eating, the
individual may be attacked by violent colic or cramps,
with nervous chills, which in some cases prostrate and
incapacitate him for several days.
Such attacks may occasionally be traced to pieces of undi-
gested food no larger than the little finger nail. At such
a time a piece of cheese, of preserved fruit, or of walnut
may be too tough for the deteriorated gastric and intesti-
nal juices. Again, the intestinal gases, which are always
present in larger quantities during and after slow diges-
tion, accumulate in the bowel, the tired relaxed bowel-
wall has not the tone to contract upon them, move them
along and properly distribute them in the intestine, and
colic results. In other cases the irritable and weakened
64 NERVE WASTE.
nerves of the abdomen become the seat of paroxysms of
pain and of a variety of unnatural sensations, which are
independent of any exciting cause that can be discovered.
Soreness, dragging, fluttering, burning, or a feeling of
weakness are among the sensations described by different
patients. These and other sensations are frequently lo-
cated somewhere about the navel.
THE LIVER TYPE OF NERVOUS INDIGESTION. Many
years ago it was first noted that in certain cases of dys-
pepsia, torpid liver, as well as in cases of nervous strain
or over-work, the urine is scant, high colored, of a high
specific gravity and deposits certain substances on cool-
ing. Of these, uric acid crystals, urates of soda and other
urates forming a reddish brick-dust deposit, which clings
tenaciously to the sides of the vessel, oxalate of lime
whitish, thick and often very abundant one or all
together are found in different urines. The relation
between oxaluria (oxalic acid or oxalate of lime in the
urine), lithsemia (lithic acid in the blood), and lithiasis
(the lithic acid diathesis or tendency) to nervous impair-
ment is now well understood.
The liver weighs from three to four pounds, and is one of
the most complex and important organs in the body.
One of its functions is to stand between the blood-stream
of the digestive organs and that of the rest of the body.
At the gates of the portal or abdominal circulation, it
exercises a prudent discrimination, as St. Peter is reputed
to do at the gates of heaven, and only admits such and
so much of the often impure or gross stream, which results
from digestion, as is good. It would not do to allow
all that every man eats to get into his general circulation.
A gross surplusage must be gotten rid of, and this is part
of the work known in physiology as excretion. When
the heavy nitrogenous elements of the portal circulation
representing meat, eggs, the caseine of milk and other
heavy foods, are brought to the liver, it admits some and.
ABDQMINAL SIGNS, NERVOUS INDIGESTION. 65
in hearty feeders, it restrains some. That which is kept
back is subjected to the action of oxygen, oxidized, disin-
tegrated or split up into urea, carbonic acid and water
and borne to the kidneys, which filter it from the blood.
When the liver is imperfectly innervated or vitalized by
the sympathetic nervous system it become "insufficient."
It is unable to do its work thoroughly. It fails to form
urea, and forms lithic or uric acid. Urea is soluble in
water and gives a clear urine; the substances substituted
for urea by a tired liver, uric acid, its resulting salts, the
urates, and its later products, oxalic acid and the oxalates,
are not very soluble in cold water and so form a variety
of urinary deposits. Thus "the neurotic with lithiasis"
(Fothergill) is apt to pass turbid urine, or urine which be-
comes turbid on cooling; to notice that the bottom and
sides of the vessel are sometimes stained with a brick-dust
deposit; to be troubled with "biliousness" and constipation,
and to find that he cannot digest fats easily.
THE TREATMENT OF ABDOMINAL NEURASTHENIA.
When this form of nervous impairment develops in one
who is not used to sickness, much precious time may be
lost before the stern laws which pertain to it are realized,
and the troublesome regime, which experience has found
essential, is submitted to. Often this disease is consid-
ered to be, and treated as, dyspepsia, but purely local
treatment is unavailing. Drugs alone have no permanent
power in this disorder. Merely local treatment is trim-
ming at the branches, and leaving the roots untouched.
Sometimes it is only after ignoring or resisting the dis-
ease for months or years, and after trying every patent
medicine, pathy, and marvellous cure, that the victim
mellows into a wise and painstaking patient. Then the
true cure begins. General nervous hygiene is the founda-
tion; a careful adaptation of diet in each case imperative,
and then drugs and electricity can help. A system of
partial or complete liquid feeding has done me good
66 NERVE WASTE.
service. The diet in abdominal neurasthenia needs to
be generous, and as soon as we can get our nervous dys-
peptic a little out-of-doors it can usually be made so, to a
greater or less extent. The English physician puts his
gouty dyspeptic and lithaemic patients on a reduced diet
and gets them well. The American practitioner finds
that his nervous lithsemics do best on a diet rich in nitro-
genized matter and fats on beef, eggs, butter, cream and
wine. In abdominal neurasthenia the man is not dyspep-
tic or bilious because he eats indigestible food so much as
because his digestive organs do not regularly receive their
nervous remittances. Behind the unreliable stomach or
the insufficient liver is the insufficient brain and spine;
we are curing a nervous system rather than a liver.
In some cases we have to face two hostile facts. First,
nitrogenized foods and fats are essential to create stability,
endurance, staying power in the nervous structures; sec-
ond, the individual is unable to digest these substances.
He is unable to liquefy and emulsify them into absorbable
chyle, in stomach and intestine (primary digestion), or, if
able to do this, is unable to elaborate the food- stream in
the liver, through which digested meat, eggs, milk-casein,
and similar foods must pass before they can become blood
(secondary digestion). But the greater the difficulty the
greater the opportunity of the physician to show whether
he is any more clever at curing than other people. By a
system of food selection, cooking, masticating, vigilance
in avoiding the beginnings of evil and a knowledge of
certain timely precautions we can generally manage.
The pedagogic or supervising function of the physician is
perhaps more important in nervous indigestion than in
any other form of nervous impairment.
XIII
RECTAL SIGNS CHRONIC CONSTIPATION
Chronic constipation is not always a sign of nervous
impairment, but only very often. Then it depends upon
deficient moisture in the motions (deficient intestinal
secretion) or upon debility (poor innervation) of the un-
striped muscular fibre, which constitutes the middle wall
of the lower bowel. Constipation is both an effect and a
cause of disease. Sir Andrew Clark has recently applied
the term ' * fecal anaemia' ' to a class of cases, in which the
elements of disease are retained accumulation in the lower
bowel, chemical decomposition with formation of poison-
ous matters, absorption into the blood and chronic blood-
poisoning. All pelvic and reproductive morbid conditions
are especially aggravated by chronic constipation.
The hygiene of the lower bowel proper food, a regu-
lar habit of going to the closet among other things is
the best treatment of constipation. Of foods those which
afford a comparatively large remainder of waste to stimulate
the lower bowel rolled oats, rolled pearled wheat, Indian
meal may be taken when they agree with the stomach.
Ripe fruits in summer, stewed prunes, baked apples, figs,
cranberries, in winter, are valuable. But sometimes med-
icines are temporarily useful. The salines unload the
bowels with less disturbance than any other class of drugs.
Seidlitz powders, Rochelle salts in soda-water, or any of
the popular mineral waters may be occasionally relied
upon. A very convenient and portable preparation is
"Tarrant's seltzer aperient," of which one or two tea-
spoonfuls in a glass of cold or warm water before break-
fast will be sufficient. A regular glass of simple water
on rising is sufficient to regulate some persons. The
(67)
68 NERVE WASTE.
habit of tippling mineral waters, and especially hot water,
is to be condemned for reasons which there is not space
to explain.
A very good pill against neurasthenic constipation
for temporary use, is the following.
Take Extract of Nux Vomica 8 grains
Extract of Belladonna 4 grains
Resin of Podophyllum 4 grains
Oleo-resin of Capsicum 2 drops
Aloin 8 grains
Powdered Ipecac 2 grains
Extract of Dandelion to make... 64 grains
Mix ; divide into thirty-two pills. Dose one to three at bed-time
till the desired effect is produced; then continue with one-half or
one-quarter of a pill at bed-time for a week.
It often happens that the lower bowel is the only point
at fault in chronic constipation, and then it may be best
not to use any medicine at all. Any drug that influences
the lower bowel must also stimulate, to some extent, in
passing through, the whole intestinal tract, which is not
always desirable. In such a case a daily injection of a half-
pint of cold water into the lower bowel will accomplish
all that drugs can, and will have a tonic effect beside.
In sexual neurasthenia this is the best method; the deep
urethra and the prostate are in close anatomical rela-
tion to the lower bowel, and it makes a great difference
in these organs whether the rectum is clogged and heated,
or whether it is clean, cool and unirritated. Mild galvan-
ization of the spine, the abdominal sympathetic and of the
rectum itself will sometimes cure obstinate constipation
when all else has failed.
XIV
HEPRODUCTIVE SIGNS SEXUAL NEURASTHENIA IN THE
MALE
An apparatus in physiology is a collection of organs
charged with the performance of a particular function.
Thus we speak of the visual, vocal, respiratory and
digestive apparatus. The reproductive apparatus, viewed
thus comprehensively, includes not only the external
organs of generation, but also certain portions of the
spinal cord and brain, without which there can be no
reproductive activity. The spinal cord and sympathetic
are reproductive organs as far as they contain erigerent,
trophic and excito-secretory nerve-centres. The brain is
a reproductive organ as far as certain of its cortical cells
inherit erotic instincts, and receive, react to and remem-
ber erotic impressions.
REPRODUCTIVE SIGNS OF GENERAL NERVOUS IMPOVER-
ISHMENT. When the sum total of the nervous resources
is reduced, the reproductive apparatus is very apt to
manifest weakness or unsteadiness. Seminal secretion
may be scant or may fail altogether, and the individual
may remain without sexual desire for months or years.
Krection may be feeble and poorly sustained, and prema-
ture and feeble emission, on attempting coitus, is a com-
mon symptom of the nervous irritability and weakness of
this type of neurasthenia. In some cases, without there
being any actual loss of power, there is an uncertainty
and unreliability, with respect to the sexual function,
which renders the individual practically impotent. A
sense of unnatural or intolerable fatigue after temperate
intercourse is another common phase of this condition,
70 NERVE WASTE.
and many apparently healthy men with perfectly healthy
sexual organs are obliged to practice the greatest care-
fulness in this part of their economy. As one man
expressed it, ( ' that thing tears me all to pieces. ' '
Involuntary morbid seminal emissions are an annoying
symptom which may occur in nervous paupers without
any foundation of excess, or any local weakness, or any
cause whatever, excepting the unstable condition of the
spine. This form of spermatorrhoea is a neurosis, a
purely nervous disease, belonging to the family of ex-
plosive or convulsive disorders, which includes epilepsy,
St. Vitus' dance and hysteria. The emission is often
started or set off by anything which irritates the nervous
system in the slightest degree, as an indigestible supper,
an evening cigar, coffee or emotional excitement.
SEXUAL NEURASTHENIA. There are several ways in
which civilized man is injured through his reproductive
apparatus. The abuses of childhood and boyhood, the
strain of celibacy in an environment of erotic suggestion,
the folly of excess often added to overwork (thus burn-
ing the candle at both ends), and the frauds against con-
ception, all act extensively in our midst to produce a
type of disease, which is widespread and important.
The unity of sexual neurasthenia is not at present
thoroughly recognized outside of neurological literature,
although the prominent part played by the nervous sys-
tem in functional reproductive disorders long since led
some eminent authorities to classify them among ner-
vous diseases as the "The Sexual Neuroses." But in
general, sexual neurasthenia still goes by a variety of
names ; its symptoms are treated as distinct diseases by
many practitioners, and are so described in many stand-
ard medical works. Sexual hypochondriasis, spinal irri-
tation, spermatorrhoea and impotence are often functional
disorders of the same apparatus, having the same causa-
tion and requiring the same plan of treatment.
SEXUAL NEURASTHENIA. 7 1
The elements of sexual neurasthenia may be briefly
described as follows :
CEREBRO-SPINAL IMPAIRMENT. No function involves
the output of so large a quantity of nerve-force in so
short a time as the reproductive. Sexual excess empties
the nerve-cells most quickly and effectively of their
nerve-force, and if persisted in establishes a chronic irri-
tability and weakness in the central nervous system.
Here is nerve-waste at its worst.
REFLEX IRRITATION. The repeated and other pro-
longed engorgements which attend sexual excitement, and
the succession of irritating impulses transmitted from the
brain to the sexual organs in habitual mental erotism, are
capable of producing certain morbid changes in the deep,
reproductive tissues. These consist of congestion, in-
flammatory patches, irritable points, thickening and strict-
ure of the urethra, of irritability and congestion or even
chronic inflammation of the prostate gland and of an
over-active, over-sensitive condition of all the reproductive
tissues. 1 Certain eminent authorities have denied that
!jean Jaques Rousseau was a victim of sexual neurasthenia, if we are to
judge from his famous " Confessions." Concerning his case, MM. Grimaud de
Caux and Martin Saint-Ange (Histoire de la GneYation de 1'Homme. Paris, 1847J
ay: "Lastly, we have to admit the existence of another form of stricture of
the urethra that caused by a nervous state of the passage, which becomes so
greatly contracted that its calibre is wholly obliterated and its sides brought
into contact. Such an obstacle to urination is only temporary, lasting at most
an hour or two, but, by its frequent repetition, causing much suffering to those
who are its subjects. It was such an affection that rendered J. J. Rousseau so
unhappy, and so insupportable to himself and to others. He was supposed to
suffer from stone in the bladder. Morand, however, could never discover it by
Bounding, so Rousseau had recourse to Frre C6me, who, having penetrated
to the bladder, found nothing. This examination quieted him fora time, but
the urethral spasm reappeared, and hypochondria supervened to darken the
mental horizon of the philosopher, and to disgust him, as every one knows,
with all the objects of his love and friendship. If the author of " Emile " had
lived in our day, with its scientific progress in the treatment of diseases of the
urinary passages, it is more than probable that the greater part of his life, espe-
cially the close, would have felt the full power of his character and genius,
which, being of late development, would have illumined his old age." This
symptom is so common that one of my stock questions in sexual neurasthenia
is, " Are you able to make water without embarrassment in a public urinal?"
In twenty per cent, of aH cases the answer will be, i: No."
72 NERVE WASTE.
stricture of the urethra can result from sexual excitement
alone and claim that it must depend upon venereal disease
or upon injury. Nothing is more common in my experi-
ence than thickened, blotched or strictured urethras in men
who have never had gonorrhea or even sexual intercourse.
These changes, once established, persist. They act back-
ward upon spine-and-brain, transmitting a continuous
harassing impression which irritates and depresses the
vitality of these vital organs. Spinal irritation, spinal in-
stability, spermatorrhoea, impotence, are, in alarge propor-
tion of cases, directly dependent upon these deep-seated
morbid conditions.
SPINAL IRRITATION. Unsteady circulation, congestion,
impaired nutrition and over-sensitiveness of the spinal
cord, is a common symptom in all forms of sexual
neurasthenia.
SPERMATORRHOEA. The unnatural losses of sexual im-
pairment are the features which are apt to give the patient
most anxiety, but they are by no means the most important
element in the case. In some cases, these losses result
chiefly from local irritability and weakness ; in others,
more from a habit of excessive secretion which the parts have
been gotten into; and in others, more upon spinal instabil-
ity; and in some cases all three of these conditions operate.
The seminal fluid is in no sense a vital fluid as the blood
is, and its loss is, intrinsically, not very debilitating.
Many husbands expend seminal fluid almost daily for
years, or a life- time, without apparent injury; and in chil-
dren before there is any secretion to lose, and in females,
bad habits may produce all the nervous symptoms of
chronic spermatorrhoea. But in the powerfully depressing
mental effect which this objective symptom often produces,
it is worthy the most earnest effort on the part of the physi-
cian. The excessive nerve-waste, the reflex irritation of
deep reproductive disease, the depressing emotions of
anxiety and remorse are the most potent factors in sex-
SEXUAL NEURASTHENIA. 73
tial neurasthenia and all together make up a peculiarly
distressing form of disease.
THE URINARY DEPOSITS, which are common in all
varieties of nervous impairment, are a source of great
anxiety to sexual neurasthenics. Influenced by false
statements of advertising charlatans tens of thousands of
"young, middle-aged and old" men believe that their
life-force is being drained by spermatorrhoea. It is a
great comfort to many such men to see their turbid urine
clear up in a second on the application of suitable chemi-
cal tests.
IMPOTENCE may be temporary or permanent ; partial
or complete. It may consist in unstriped muscular-fibre
atony (relaxation of vein, scrotum, imperfect erection or
failure of erection), in excessive irritability, local, or uni-
versal throughout the whole apparatus (premature ejacu-
lation), in atrophy (diminution in size of the external
parts), or in excito-secretory failure (deteriorated seminal
secretion sterility), or in all together. Behind this
symptom is the great fact of the spinal cord and sympa-
thetic. The external genitals are the instrument, the
spine is the source of sexual vigor (tone, erection, ejacu-
lation) and of sexual life (nutrition and secretion). Dis-
eases of the spinal cord, implicating the centres of sexual
life, are attended by impotence. If the nerves which con-
nect nerve-centre and generative-organ could be severed all
sexual life (growth, secretion, vigor) would cease. Thus,
when the spine and sympathetic have been overdrawn by
excess, or when they have been depressed for years by
morbid urethral and prostatic impressions, they poorly in-
nervate or vitalize the external parts and sexual impair-
ment debility or exhaustion results. Thus, the spine is
the ultimate organ of sexual life, and the great objective
point in any scientific treatment of this symptom, and
thus impotence is pre-eminently a nervous disorder.
74 NERVE WASTE.
SEXUAL HYPOCHONDRIASIS SEXUAL PATHOPHOBIA.
The mental depression and anxiety of sexual neuras-
thenia is often itself a symptom of central nervous im-
pairment. Poorly nourished and irritable brain-cells are
apt to manifest an anxious or gloomy quality of mind.
Reproductive impairments and especially discharges, of
every kind, cause a mental depression in nervous persons
that is in striking contrast to the cheerfulness of graver
diseases. In tuberculosis, the patient is often cheerful
and hopeful to the last ; the lungs do not exert the same
influence over the brain that the reproductive organs do.
A large proportion of sexual neurasthenics labor under
false or distorted conceptions of the nature and gravity
of their disease, and in some these false beliefs attain to
the gravity of real insane delusions. One of these delu-
sions is in relation to the intrinsic effect of an occasional
seminal loss. The tons of cheap printing which are cir-
culated throughout the land will compare favorably with
any disease germ, in the amount of mental and nervous
disorder which they produce. The policy of these books
is to frighten, and to this end, symptoms and conse-
quences of sexual abuse are distorted and exaggerated
with great ingenuity.
A common statement is that the loss of a single drop
of seminal fluid is equal in vital waste to forty ounces of
blood. The invalid, ignorant of physiology and of path-
ology, knows that he is sick, and that he feels a wretched
lassitude and weakness after such a loss, and this state-
ment strikes him with all the force of truth. He becomes
morbidly watchful, and every evidence of loss depresses
him greatly. I have lately treated a young man weigh-
ing one hundred and sixty pounds, and presenting every
external evidence of health, who was for years com-
pletely unfitted for his day's work by a weekly emission;
and have in my possession numbers of letters which ex-
press a degree of mental wretchedness, amounting to
SEXUAL NEURASTHENIA. 75
agony, because of this single symptom and without an-
other obvious sign of disease. Of the three elements of
a seminal emission in nervous individuals (the seminal
loss, the nervous discharge, and the subsequent mental
depression) the last is far the most potent. In certain
patients it may be elicited that during several years of
sexual abuse they retained good health, but that upon
discovering the awful consequences from some advertise-
ment, and upon the natural appearance of seminal emis-
sions, habitual worry quickly made them nervous in-
valids. If we could persuade sufferers from chronic
nasal catarrh that every drop of mucus lost from the nose
is equal to forty drops of blood, and that this disease is
bearing them to the insane asylum or the grave, we
could thus frighten and worry thousands of these
patients to death. In most cases of sexual neurasthenia,
sexual abuse is only one of several causes among hered-
ity, over- work or sedentary habits. But these patients are
apt to attribute all their weakness to their own folly, and
to suffer much unnecessary misery. The fact that sexual
sufferers must generally bear their troubles in secret,
with no strong arm to lean upon and none to instruct or
advise does much to develop morbid notions.
The importance of these mental states of sexual neuras-
thenia does not always receive the consideration it needs.
Many physicians, estimating this disorder upon its ob-
jective and pathological features alone, look upon it as a
trifling matter. Thousands of young men, who every
year seek help from their family physician, are met with
indifference or brusqueness, or receive some medicinal
treatment which is entirely inadequate in the case ; then
the patient remains miserable, the physician misses one of
his greatest opportunities for doing good, and the char-
latan thrives.
Remorse for the past and anxiety for the future are
terrible forces in human life, and the fact that there is
76 NERVE WASTE.
often no true foundation for these emotions does not
lessen their power. Chronic worry is capable of killing
the strongest man, and many a pale-faced boy is carry-
ing about a secret which is a serious matter to him, and
which, of itself, depresses his vitality, retards his growth
and distinctly interferes with his success in life.
It is wiser to recognize the importance of the mental
phases of sexual troubles, and to set to work sympathiz-
ingly and kindly to remove them. It requires a much
higher order of medical skill to treat a disorder which
has its seat in the mind than in any other function of the
body. With earnestness in both physician and patient sex-
ual neurasthenia is one of the most certainly curable of all
nervous disorders. A little pains taken to instruct these
patients in the elements of sexual physiology and patho-
logy, will achieve a success in practice which is not always
granted in other directions. In very many cases the fav-
orable prognosis, which can conscientiously be made by
the physician who is equipped for this kind of work, in
substituting bright prospects for anxiety, is a powerful
remedy to begin with. And if in his intercourse with his
patient the physician be imbued with a broad charity, a
kindly sympathy, and an earnest desire to relieve a con-
dition which is, in some respects, peculiarly unhappy, this
fact will often be as truly remedial, in its way, as med-
icines, electricity or any tangible remedy.
THE TREATMENT OF SEXUAL NEURASTHENIA varies
according as general nerve weakness, mental depression,
spinal weakness, irritability and instability, deep-seated
urethral and prostatic changes, or local debility or ex-
haustion are the most important elements in the case.
Eliminative treatment is essential where deep-seated
morbid processes are acting to keep up the symptoms.
Modern instruments and procedures render the deep
reproductive tissues perfectly accessible to the surgeon,
and disease therein can be exactly located and thoroughly
SEXUAL NEURASTHENIA. 77
treated. Teaching giving the patient clear and correct
ideas of the nature of his trouble, and instructing him in
its hygiene is often the most valuable service which the
physician is able to render in sexual neurasthenia. Re-
storation, or building up of brain and spine, or of the
spine alone, and in many cases of the external parts, is
accomplished by a careful hygiene, electricity and a wise
use of every force which can be included under the word
"tonic."
XV
SEXUAL NEURASTHENIA IN THE FEMALB
The reproductive system is deficient in civilized
woman. Our American families seem to be decreasing,
in size, and it is fortunate that the Republic is not
wholly dependent upon its city daughters for soldiers
and statesmen. Child-birth is a simple process in primi-
tive woman, and becomes difficult, or complicated or dan-
gerous, in proportion as the woman is civilized. The
great development of the baby-food industry in the
United States testifies how the mammary glands, a part
of the reproductive system, are failing. It is getting
somewhat' rare to find a mother in the higher walks of
life who can nurse her child without systematic stimula-
tion.
Heredity and education operate extensively to weaken
brain-and-spine, and dwarf dependent tissues. A pretty
large proportion of American women are slender, and
have clear-cut, intellectual faces, and expressive eyes.
They are interesting or delightful, clever or brilliant in
conversation, altogether charming as companions, and
plucky or noble as wives. But the physiologist notes
that they are flat-chested, narrow-hipped, that their flesh
is not firm, that they lack suppleness and endurance, and
he knows that they will not make good physical wives
and mothers. In an address on The Modern Tendency
of Disease, the late Dr. Fothergill gave an ingenious
account of the manner in which the strain and over-
draft of civilization stunts the purely sexual element of
women, and tends to reduce her to a neuter.
There are several forms of nervous strain which act
through the reproductive apparatus to depress and
(78)
SEXUAL NEURASTHENIA IN THE FEMALE. 79
weaken the brain-and-spine. Medical men alone realize
the extent to which woman's dependency upon man sub-
jects her to abuses, and renders her liable to misfortunes
in this part of her economy. The strain of enforced
celibacy, that of excessive and unwelcome exercise of the
reproductive apparatus, which are widely suffered by
women, would not be endured by man. The strain and
shock of unphysiological manoeuvres against conception
has repeatedly been pointed out by eminent authorities,
but the existence of such things is largely ignored in
medical practise. In addition to these strains child-
bearing, nursing, child-rearing, household drudgery and
domestic worry too often strain and wear upon the nervous
centres from several directions at once.
Uterine and ovarian diseases are very common among
American women, and are due to a long list of accidents
and mistakes. Perhaps no class of cases of nervous
symptoms is more common than that in which a congested
and bent womb, or a misplaced ovary or some other
local disease, is the chief cause. These local conditions
often continue to act backward along the nerves, through
months and years, and irritate and depress the vitality
of the brain-and-spine as a splinter in the foot might, by
its disturbing influence, cripple the entire leg. Hysteria
and the exaggerated emotional phenomena, so common
among delicately reared women, are generally the effect
of an abnormally sensitive nervous organization, plus some
irritating process about the reproductive organs.
Nervous impairment in woman may manifest itself in
the reproductive organs. In woman, as in man, the re-
productive system is vitalized, through the sympathetic
nerve-centres, by the great vital source, the brain-and-
spine, and the tone of these tissues is apt to fluctuate
with the general health. The ill-regulated, unsteady
circulation of the blood, which so often accompanies de-
ficient nerve-power, may include a congested and over-
80 NERVE WASTE.
sensitive state of the spine, womb or ovary. In these
cases the irritable spine, the irritable womb, and the irri-
table ovary are best considered not as local diseases, but
as local symptoms of a general nervous deficiency,
lyocal treatment alone is only palliative ; cure must come
in caring for the nervous system.
In over- worked women menstruation may be entirely
suppressed for considerable periods when the reproductive
system is defrauded of its nerve-force by the brain-and-
spine. In a class of 114 young women who were study-
ing midwifery, Prof. Schroeder found that 65 were thus
affected. In most of these cases menstruation failed soon
after beginning the course of study.
In the treatment of associated nervous and reproduc-
tive disorder in the female, the first thing to be accom-
plished is elimination, abrupt or gradual, of everything
that is working for the disease. The laws of sexual
hygiene must be obeyed ; chloral, morphine, alcohol, if
they are in the case, must go out of it. Irritating impres-
sions of every kind must be removed as far as possible,
which will often necessitate a change of environment.
If ovarian or uterine disease is acting backward to irri-
tate and depress the brain and spine, an earnest effort
must be made to remove it. In this local treatment for
nervous disease modern surgery has achieved some of its
most brilliant successes. After the enemies have been
ousted let us set the beneficent forces of nature at work
in the case, and they will not disappoint us. The suc-
cessful treatment of nervous disease in woman requires
an earnest physician, an earnest patient, and favorable
circumstances ; this is why so many curable diseases
remain uncured.
XVJ
NERVE-WASTE AND LONGEVITY
A completed lifetime is a measure of nerve-force. If
the brain is the organ of mind, and the spine the organ
of varied functions, the brain-and-spine together is the
organ of vitality. Every child inherits a vital store
which may be conserved to fourscore, or so lavishly ex-
pended or so severely strained that literal death of old
age may occur at forty.
Flourens (De la Longevite humaine. Paris, 1855)
taught that in man, as in animals, the period of growth is
to the period of life as one is to five. He fixes the termina-
tion of growth in man at 20 years, when the epiphyses
have united with the main bones. ' * Man grows for 20
years and lives five times twenty years; that is to say,
100. The goat grows for 8 years and lives to 40; the
horse grows for 5 years and lives 25 years, and so with
others, ' ' We now know that man does not come to the
end of growth at 20, but continues to develop to 30 and
beyond; but it is true that with a fair start, and a favor-
able environment, man may, and often has, lived 100
years.
We may distinguish two qualities of any stock of
vitality quantity and tenacity. Some men of appar-
ently large vital resources lack resistance, and die from
slight causes; others, frail, nervous, halting, live through
every strain to three score and ten. Certain swords will
bend double under a weight that will break a bar of pig
iron ; endurance is a better quality than abundance.
In a large proportion of cases chronic nerve-weakness
does not threaten life ; it cripples and incapacitates the
6 (81)
82 NERVE WASTE.
subject and may render him more or less miserable
through a long life. It has even been stated that the
neurasthenic condition in some degree protects the indi-
vidual against acute inflammations, and, as a fact, acute
diseases, as pneumonia, are not very common among this
class of persons ; then the neurasthenic individual gets
into the habit of taking care of himself after he becomes
an invalid and this habit protects him against many
causes of acute disease. So with many nervous invalids,
especially those in whom the digestive powers remain
fairly good, the chances are that they will outlive many
of their more robust acquaintances.
Within a few years some authorities have stated that
certain organic diseases, as Blight's disease, and dis-
ease of the blood-vessels of the brain which precedes apo-
plexy, are sometimes the direct result of chronic ner-
vous impairment ; the prolonged ill nourishment of the
tissues is believed by these observers to result in actual
changes, or degenerations, in certain organs.
We can demonstrate that brain-and-nerve weakness
alters the nutrition and character of surface organs hair,
skin, nails, and reproductive organs; we know that brain
and spinal disease often precipitates disease in joint,
muscle and bone ; and it is fair to suppose that this
trophic function of brain-and-spine is universal reaching
to blood-vessel, lung, heart and digestive organs.
In case of a blighted grape-vine one might examine
curiously the yellow leaves and say, * ' this vine has the
blighted leaf," or since leaves are the breathing organs of
plants " its lungs are diseased." But the vine-dresser
knows that far down at the roots the insidious phylloxera
is sapping the life of the vine, and that the diseased leaf
is a result, and not a cause.
Nervous impairment is the chief cause of death in
many cases described by other names. When a physi-
cian is called to a diphtheritic child, or to a pneumonitic
NERVE WASTE AND LONGEVITY. 83
adult, he knows that his duty and his power lies largely
in nursing his patient's vitality. The danger is lest the
poison in the one case, or the acute local inflammation in
the other, against which our science has as yet no speci-
fics, shall depress the brain-and-spine to death. With
strong (or better) enduring patients he has promising
material, and with these he most easily makes his cures.
With many men who have been slowly dying, (brain-and-
spine exhausting) for five, ten or fifteen years, a pneu-
monia or a typhoid fever is merely the last act of the
drama. The enfeebled brain-and-spine is unable to endure
or to rally, it cannot be stimulated there is nothing to
stimulate, and it succumbs to a sickness which an unim-
paired man would easily endure, and safely recover from.
When such is the case it is a pity that the fact cannot be
stated, (for the lesson there is in it), " this man was
worked to death."
XVII
THE CURE OP NERVOUS IMPAIRMENT
Cure is care. Curing a chronically impaired brain-
and-spine consists in taking care of it. As with horti-
culturists, viticulturists and pisciculturists, the man who
knows most about his subject and the forces which influ-
ence it, can take the best care of it. This cure requires
the co-operation of many different remedies in proper
proportion.
The realization ( in time ; that one has a chronic
nervous disorder is an important pre-requisite to cure.
This realization is often difficult to bring about. The
carelessness or the obstinacy of many persons in estimat-
ing the importance of nervous symptoms, until it is too
late, are facts of constant observation in medical practice.
Symptoms are nature's warnings that her laws are being
violated, or that something has gone wrong. A nervous
symptom is a sign that something is wrong with the
most important organ in the body, the very fountain
of life, the brain and spinal cord. When such a sign is
given it is the part of wisdom to heed it, though every
other sign be ignored.
This failure to realize the meaning of nervous signs is
pathetic when its consequences fall, as they often do,
upon some helpless and dependent member of a family.
The author was once consulted by a woman whose little
girl was having several epileptic fits daily. The father
of the child refused to allow her to receive medical treat-
ment, because, as he said, "it is nothing but a habit."
This was strictly and scientifically true, but what worse
habit could a father wish his child to have ? Another
(84)
THE CURE OF NERVOUS IMPAIRMENT. 85
parent whose little boy was developing the first symp-
toms of St. Vitus' dance, declined to take him out of
school, "because he would lose his examinations, and
besides he was always a nervous child, and this is noth-
ing but nervousness. ' ' The physician stands dismayed
before what must seem to him criminal egotism and
neglect. Of course such persons, who so confidentially
place their knowledge and judgment of disease above
that of the physician, come in due time to see their
error, but then, too often, is too late. The writer can
point to a half dozen cases at any time, where indifferent,
stolid, brutal or parsimonious neglect to heed nervous
signals is ruining a young and innocent life, crippling a
wife and mother beyond repair, or hurrying a whole
family toward want or dependence.
One reason why nervous symptoms are so lightly thought
of especially when they occur in others than ourselves is
that they are largely subjective and not material. It is one
thing too see, and another to recognize the significance of
what we see. A broken bone or a burned skin speak for
themselves, inspire sympathy and aid. A crippled spine
is infinitely more serious that a broken arm, but it is out
of sight and manifests its inability only by subtle signs,
which do not appeal to the senses. But when we hear a
person spoken of as being ' ' only nervous or hysterical or
' ' queer, ' ' we must remember that these are signs that
something is wrong with the most important organ in
the body. Especially, mental symptoms are the most
important of all disease signs, signifying as they do that
a brain is being irritated or starved, or is some way out
of order.
Earnestness in the patient is essential. Very many
persons, on applying to a physician for aid, have not yet
arrived at that stage in the history of their disease where
they are willing to make earnest effort to get well. We
hear much about good doctors, but less about good
86 NERVE WASTE.
patients; to become a good patient^ as to become a good
doctor, often requires several years of bitter experience.
A long period of suffering is sometimes necessary to
create a wisdom that will not scorn true remedies, nor
rebel against the inevitable.
A physician was once consulted by a lady for certain
nervous symptoms. Pains were taken to explain how
the unnatural and unwholesome way of living, to which
she had become accustomed, was at the bottom of all
her trouble, and that this must be radically changed
before any permanent benefit could be expected. It
afterward transpired that she had not been favorably im-
pressed with that doctor's ability. As she reported,
"Oh, he don't know anything; he told me a lot of stuff
about diet and exercise, but he said he couldn't cure
me. ' ' Now this lady, who is simply a type of thousands,
may become a very good patient for some doctor in the
future, when her symptoms have become intolerable, and
when cruel experience has taught her that there is no
royal road to health. A physician cannot cure an indiffer- '
ent or a passive patient in chronic disease, more than a
teacher can instruct an idle, careless or rebellious pupil.
One is very unfortunate to have a chronic disease, which
is often both troublesome and expensive to cure, but
having it, one ought to do the best he can. The cure
of chronic disease may be considered somewhat in the
light of penalty for hygienic sins. It would even be a
misfortune if all chronic diseases could be quickly, safely
and pleasantly cured; the habits of men and women
would become too bad.
Persistence is a quality which is essential in many
cases of nervous impairment. A chronic disease is one
which has become slowly established in the system, and
is even in some cases more or less naturalized there.
Patients sometimes remark that they would not feel
natural without their aches and pains. Such a disease
THE CURE OF NERVOUS IMPAIRMENT. 87
cannot be forced or hurried out. In most cases of ner-
vous impairment, the cure is a matter of slowly tearing
down old diseased tissue and building up new, vigorous
tissue, just as an old ship might be taken on the stocks
and rebuilt, by replacing each rotten plank and rusty
bolt, piece by piece, with new ones. The pedagogic func-
tion of the^physician often operates to hold the patient
to his course. Of the boys who every year begin their
studies with enthusiasm, a large number would not per-
severe unless they were held to it by some power out-
side themselves, and so it is with chronic invalids. A
burly athlete will train for months that he may win a
contest ; the nervous cripple must often train for years,
or even a lifetime, that he may work well and live
happily.
The individuality of the physician is sometimes an im-
portant element in the cure. Over and above purely
scientific attainments, the peculiar characteristics of a
physician may make him of priceless value to one class
of patients, and of no use at all to others. In general,
the physician is most successful who is able to inspire
confidence in his patient, to exert a certain amount of
influence and authority over him, to encourage and in-
spire him to earnest effort. And if he have a large
vitality, a scientific enthusiam, an interest in his patient,
and a pluck which rises with difficulty and leads him to
exhaust the resources of his art before acknowledging
himself baffled, these will often prove saving qualities.
Trained senses, special wisdom, trained judgment, earnest-
ness, honesty, are the qualities which make a physician;
of these, skill and honesty, are, it is to hoped, common.
But earnestness, enthusiasm, a keen sense of responsi-
bility, anxious thought, are not always possible. These
are qualities which are often given by physicians, but
which cannot be bought. They are often inspired or
repelled by the patient himself. An earnest patient stimu-
88 NERVE WASTE.
lates the physician to his best work ; the careless throw
cold water upon enthusiasm, and cool it to duty, and we
all know the difference between the two.
PRINCIPLES OF TREATMENT. An eminent authority,
the late Dr. Beard, wrote :
' ' Each case of neurasthenia is a study of itself. ... If
two cases are treated precisely alike in all .-the details
from beginning to end, it is probable that one of them is
treated wrong."
But while this is true, there are certain broad princi-
ples which must be followed in every case :
1. Certain adverse symptoms which act as direct
obstacles to improvement must be allayed or removed ;
among these are sleeplessness, neuralgia or headache,
worry, indigestion, etc.
2. I^ocal disorders which are maintaining or aggra-
vating the nerve weakness must be radically cured; such
are eye-strains, irritations about the nasal passages, stom-
ach disorders, irritations, congestions, and relaxations
about the reproductive organs in either sex. Many of
these local disorders are obvious ; others are unsuspected
or masked, and are only ferreted out by the comprehen-
sive knowledge of the physician.
3. Brain and nerve nutrition. The central nervous
system must be reinvigorated, or recharged with vitality.
This renewal of vital force is not affected by stimulation,
which is temporary and injurious, but by gently and
surely toning and building up the tissue and capacity of
the nerve-cells, to stay so. This last result is often pos-
sible only after the other two principles of treatment have
been effected.
The available vital resources existing or remaining in
any case largely determine the result of caring for the
brain-and-spine. When a business house suspends, and
examination shows merely a temporary entanglement, or
disproportion of immediate assets and liabilities, the
THE CURE OF NERVOUS IMPAIRMENT. 89
creditors breathe freely, there is a straightening out, a
realizing, and after a time business is resumed. But
when speculation or bad management has exhausted the
capital, the only course is to go out of business, or to
recommence in humble style. In nervous impairment
the prospects are generally good in persons under thirty-
five, since up to this age or beyond man is yet maturing,
still on the up-grade, and nature is capable of great
things at this time of life. Later in life the pros-
pects are not so uniformly good, though some of the
most satisfactory results of care, which I have seen, have
been in elderly persons.
To accomplish these results, the physician has choice
of a great variety of remedies, and is offered a wide field
for the exercise of his judgment. The remedies used
against nervous impairment may be ranged in two
classes : First, hygienic remedies, the healing power of
nature, when nature is given a chance. Second, the
medicines and procedures which scientific medicine has
learned in centuries of experience and study. In most
cases both classes of remedies are needed to effect the
cure. In some cases health is restored by means of
hygienic remedies alone, without the use of drugs or of
surgical skill, but it is seldom that the reverse is true, and
that medicine and local treatment cure without some
obedience to those natural laws which rest, immutable
and inexorable, upon every human life.
XVIII
REST AS A REMEDY
The "rest cure " in some form or in some degree is an
essential factor in the treatment of nearly every case of
nervous impairment ; it is the foundation remedy. Rest
for brain-and-spine means economy in action and peace
from passion. 1
ECONOMY IN ACTION is a simple proposition, but, simple
as it is, the inability or refusal of many persons to realize
it is the one thing that renders their cure impossible.
When a patient becomes well impressed with this prin-
ciple of brain-and-nerve saving, of the prudent manage-
ment of his or her particular nervous resources, he has
made a long stride toward health.
The comparison of nerve-force with money has long
been a favorite one with physicians, and " nerve income,"
' ' nerve expenditure, " ' ' nerve failure, " ' ' physiological
bankruptcy," "below par," are phrases in common use as
illustrations. Most men are careful of their money ; they
realize that when their capital is slowly and surely dimin-
ishing, they are in a bad way. When the merchant's profits
fall below expenses, he does not buy a lottery ticket and
continue, but reduces expenses and practices a careful econ-
omy until business is better. But when the same mer-
chant finds his health becoming injured from over- work,
he is not apt to practice a like wisdom in respect to his
life-force that he does in respect to his money. It is hard
to get him to cut down expenses at a time when he should;
1 " Passion. L,atin passio, from patior, to suffer. 1. The impression or effect
of an external agent upon a body ; that which is suffered or received." Web-
ster.
(90)
BEST AS A REMEDY 9!
he demands a ' ' tonic, ' ' and relies on that. Brain and
nerve economy is not usually popular with patients ; it
interferes with their plans, and involves sacrifices, efforts,
trouble ; the hypophosphite and the nerve-food man seem
to offer a much pleasanter means of cure.
A few weeks of rest from work, worry and irritating im-
pressions, is the most rational treatment in cases of simple
nervous impairment from over-work, and one which will
often be real pecuniary, as well as vital economy.
Victims oi over- work might be divided into two classes ;
those who can take a vacation and those who cannot.
Unfortunately, a large proportion of cases belong in the
latter class; they cannot leave their posts; they must
work, and cannot help worrying.
. In these cases it is often possible to suggest ways in
which the evil may be lessened, and in which careful
economy, outside of work, may enable a man to about
keep even. The lodge, church, and other forms of night
and Sunday work, or the worrying and scheming out of
work-hours, which is habitual with many men, may be
the straw that breaks the camel's back. Those social
obligations which are not recreations may be advantage-
ously sacrificed, and the amount of sleep increased. If
such a man can habituate himself to sleep ten or twelve
hours, for a time, so much the better; sleep is nerve-
income.
Worry, as the reader knows, is seldom suppressible by
effort of the will; this evil must be met by a method of
substitution or displacement; it must be kept out or
crowded out; to this end, cultivate a hobby.
In every large city there are men who find the fight too
bitter, or the burdens too heavy. Many a man has
found peace and happiness for himself and his, in retir-
ing once and for all from the ceaseless wear-and-tear of
city life, and in making a home, however humble, in the
country.
92 NERVE WASTE.
REST FROM IRRITATING IMPRESSIONS is often more diffi-
cult to command than economy in action. An injured
thumb is apt to be surrounded by a bandage, held in a
certain position, and protected with excessive carefulness
against touches and jars until it gets well. Man will
' ' favor ' ' a sprained ankle for months or years if need be.
The oculist secludes certain patients in darkness for
weeks or months, to protect a diseased eye from the stim-
ulus of the most subdued light. A similar protection
must sometimes be thrown about a crippled brain-and-
spine. Years ago Dr. Mitchell in a great, little book 1
told how he managed certain cases, chiefly women in
gpoclcircumstances. who had been under-worked and
over-doctored into a condition of chronic nervous exhaus-
tion. ie exacted implicit obedience, isolated them from
relatives and friends, put them to bed, and by a combi-
nation of continuous rest, peace, forced feeding, massage
and electricity, without medicine, returned many of these
hopeless cases to their friends, plump and rosy.
The principles of brain-and-spine protection and saving,
involved in Dr. Mitchell's rest cure, are now everywhere
practised in suitable cases, though it is not always nor
often that the laity understand or submit to such a
strange proceeding. When a nervous person is mani-
festly irritated by his surroundings, he should be re-
moved out of them if possible. Here is one beneficial
effect of change. Where change is not possible, such
persons should receive a good deal of consideration from
those about them. It often happens that nervous suffer-
ers, irritable and fretful, arouse the hostility of others, and
that the social atmosphere in which they live is seldom
calm. In these cases the doctor is able to explain the
inwardness of things, and to secure some degree of tran-
quility for a household.
In cases of reflex nerve- weakness, where eye, ear, nose,
1 " Fat and Blood and How to Make Them." Philadelphia. 1877.
REST AS A REMEDY. 93
womb or prostate is acting backward to irritate brain-
and-spine, the removal of these conditions is only one
step toward securing rest for the organ of vitality. The
interdiction of stimulants and narcotics, and all unwhole-
some excitements, has the same purpose.
SLEEP is the most valuable form of brain-rest. During
the hours of sleep the out-put of nerve-force is reduced to
a minimum, and at the same time the blood is busily
repairing the wear and tear of the day. The oxygen of
the blood unites with the worn-out tissues, and heat is
evolved in this process. This heat is converted into vital
force, as the heat of an engine may be converted into
electricity for lighting or other purposes, which vital
force is stored up in the brain-cells for use the next day.
Thus, each morning we awaken with our brain and nerve
tissues charged with the vigor of life. Sleep, which the
poet long ago described as "tired nature's sweet re-
storer, ' ' has in these days become a remedy ; and in the
great asylums and hospitals where nervous and mental
disorders are treated, the value of prolonged sleep is
understood and utilized.
The essential phenomenon of sleep is lessened blood-
flow to the brain. But whether this nightly recurring
ebb-tide in the brain is the cause of sleep, or whether (as
some assert) the brain-cell itself originates the impulse
(by inherent law, or established habit, or by both) which
slackens heart-beat, slows blood- current, and leaves the
brain in peace, physiologists differ.
SLEEPLESSNESS. The nineteenth century worker needs
often to pray, ' 'give us this night, our nightly rest' ' more
than "give us this day our daily bread." Insomnia is
an increasing symptom in medical practice.
There are two elements in a good night's sleep, getting
to sleep and staying there; one may fail in either of these:
i. When the circulation is badly managed and un-
steady, as explained in a preceding chapter.
94 NERVE WASTE.
2. When the brain remains engorged with blood, be-
cause enfeebled blood-vessels (their middle wall of un-
striped muscular fibre being feebly innervated by an
insufficient sympathetic system) cannot contract upon,
and empty themselves of their surplus.
3. When irritable brain- cells easily attract the blood-
stream to the brain, whence enfeebled vessels are enabled
to remove it.
Many schemes and recipes against sleeplessness are
in circulation, but the only one that is applicable to all
cases is, Discover and eliminate the cause of it. Nature
is uncompromising when her laws are disregarded, and
her penalties are not easily softened or escaped. The
devices in vogue for this purpose of lessening the penalty
of brain mis-use may be classified as follows :
i. Those which act by soothing an irritated brain,
and by breaking off the current of the day. A half-hour
of light reading or of cheerful conversation, or a cigar at
bedtime, may so tranquilize the brain-cells that sleep is
possible. The hop-pillow of our ancestors perhaps acts as
much through the imagination as by any subtle emanation
of lupuline. But twenty to forty drops of the fluid extract
of lupuline in a dessert-spoonful of the syrup of lettuce is
excellent for the sleeplessness of advanced life and is free
from danger.
I believe that music can be made a valuable remedy
in many cases of nervous impairment. I know a man
who, when evening finds him harassed, anxious, excited
by the experiences of the day, takes out his violin and
soothes his irritated brain, and allays the tension of his
strung nerves by the simple melodies which he is able to
play. An hour of cheerful, agreeable music before retir-
ing is worth the trial of any victim of nervous insomnia;
the fact that the invalid has no skill or ear in music need
not deter him from a trial of this advice. He must re-
member that the purpose of learning and performing is
REST AS A REMEDY.
95
not so much the edification of others as the soothing
of his irritable nerve-cells, and the keeping out of worry
and care. We read in the Old Testament that ' ' David
took a harp and played with his hand ; so Saul was
refreshed, and was well, and the evil spirit departed from
him.'' Martin lyUther wrote " Next to theology I give
the highest place to music, for thereby anger is forgotten,
the devil also ; melancholy and many tribulations and
evil thoughts are driven away." The future may bring
the primitive minstrel once more upon the scene, and
weird chant or plaintive melody may, in some cases, take
the place of chloral.
Some such quiet method of diversion is suitable when
the theatre or even a social evening away from home
would be too exciting or too tiresome.
The plans of counting, or imagining a flock of jumping
sheep, or a dripping icicle, or reading a dull book,
sometimes succeed by displacing other thoughts, and by
the soothing influence of monotonous impressions. The
somniferous influence of a dull sermon is well-known.
Many impressions acting upon the nerves-ends of the skin
soothe the irritated nervous tissue; riding in the wind
will make many persons sleepy, and the hot bath and
massage act in part thus.
2. Gentle stimulus often soothes the brain perhaps
counter-irritates it, as scratching allays an irritation of
the skin, or, in other cases, enables it to rid itself of
blood. A small glass of beer, or one of the wine of coca
and even the nightcap of whisky, which I do not advise,
will often favor sleep. Dr. I^auder Brunton recently re-
ported that a small dose of strychnia (a powerful nerve-
tonic) at bedtime is often efficacious against the sleepless-
ness of brain-tire; a half grain or more of quinine will
sometimes act in the same way. A patient who has tried
all the common plans against sleeplessness informs me
that a dozen or twenty deep inspirations are effectual.
g6 NERVE WASTE.
This loading the blood with excess of oxygen acts as a
a stimulus to brain cell, and to the circulation. The
electrical procedure, known as central galvanization, is
very efficacious, and acts by stimulating the sympathetic.
3. Many plans succeed in withdrawing blood from
the brain. A light supper of raw oysters, or a crust of
bread, with, perhaps, a glass of beer at bed-time may
divert the blood- wave from brain to stomach, and thus
induce sleep. A short walk in the open air, a brisk rub-
bing with a flesh brush, or a coarse towel may be useful.
All but complete immersion in a hot mustard bath (only
the nostrils and mouth remaining above the surface) has
served me well, and acts not alone by calling the blood
to the surface, but by exerting a universal soothing influ-
ence (through the nerve-ends) upon the brain. Massage
acts in a similar manner.
Habit has much to do with certain cases of sleepless-
ness ; many physiologists consider sleep to be largely a
brain-habit. Some persons get into a habit of lying
awake, or of regularly waking at some unseasonable
hour ; in such cases a complete, abrupt change of en-
vironment and action will often break the bad brain-habit
and restore the ability to sleep.
When simple plans do not succeed, and sleeplessness
becomes habitual, the aid of the physician must be in-
voked. Prolonged insomnia may lead to the gravest
results; it is sufficient of itself to produce not only com-
plete nervous exhaustion, but even mania and other
forms of true insanity. The careful physician of to-day
only makes use of chloral and other hypnotic drugs as a
last resort, and then confidently, because he knows his
tools. It sometimes happens that a habit of sleepless-
ness can be broken by a wise use of drugs, and that four
or five nights of drug sleep will establish a habit of
natural sleeping. The genius of modern chemistry has
placed in the hands of the physician certain drugs against
REST AS A REMEDY. 97
sleeplessness, which have the advantage of being (as
we now believe) comparatively harmless. Paraldehyde,
diaethysulphondimethylmethan, mercifully abbreviated to
"sulfonal," urethan, antipyrin, acetanilide and amyl-
ene-hydrate are brain sedatives of the highest value in
suitable cases. But by means of the hot bath, the Turk-
ish bath, electricity, massage, and in some cases certain
mechanical contrivances, it is often possible to manage
insomnia without the use of drugs.
In those callings requiring night work and day sleep,
the day sleep can never be made to yield the same restor-
ation of nerve-force, nor to afford the same rest to the
brain-cells that night sleep does. The nervous organs
are very susceptible to the stimuli of light and sound,
and thus a degree of tension is maintained even in appar-
ently sound day sleep ; but even where a perfectly quiet
and darkened room is available for day sleep, some ele-
ment of natural sleep seems to be wanting.
7
XIX
THE OUTING CURE
We have noted the part that oxygen, the essential ele-
ment of the air we breathe, plays in the production of
nerve -force. Oxygen reddens the blood; when the dark,
almost black, blood of the veins is exposed to the air in
the lungs, it instantly takes on the vivid scarlet hue of
arterial blood. A daily full supply of out-door air is the
most valuable tonic and vitalizer for the nervous system
in existence without any exception. One to six thou-
sand lungfuls (not sniffs) of out-door air taken daily for
a few months, will accomplish more toward restoring the
vigor of an impaired nervous system than will phospho-
rus, hypophosphites, iron, quinine, strychnine, coca, or
any of the other substances classified as nerve tonics, and
more than the wisest combination of these medicines can
accomplish, without this remedy.
Oxygen exerts a direct, positive, certain influence upon
the nutrition and life of the nerve-cells ; under its influ-
ence nerve-force is made more rapidly and in larger
quantity, and a larger amount of food is able to be assim-
ilated; it is a tonic in the best sense of that much-abused
word. For these reasons, nervous invalids should spend
as much time as possible in the open air. It is not
meant to advise an indiscriminate exposure to all airs for
feeble persons. Oxygen, like all good remedies, may be
so unwisely used as to do harm, and weather and climate
are the correctives in an oxygen prescription.
SUNSHINE is a disinfectant; how it sweetens out a foul,
sick room ; it is both tonic and sedative to the nervous
system ; the bracing and cheering influence of fine
(98)
'
THE OUTING CURE. 99
weather is familiar to everyone. Nervous invalids should,
if possible, sleep in an air which has been warmed
sunshine in a southern or western chamber.
MUSCULAR EXERCISE quickens the blood-current, equal-
izes the circulation, stirs up the nutritive processes, im-
proves appetite, digestion and assimilation, helps excretion
' and favors sound and refreshing sleep. The use of exercise
as a remedy in nervous impairment is not muscle-build-
ing, but brain-and-spine building, and to this end it must
be modified in three ways:
1. It must take place as much as possible in the open j
air. These oxygen inhalations from nature's reservoir ,
are, for most nervous persons, the most beneficial element
of exercise.
2. It must be agreeable. Brain-rest, or brain-change,
is an element of exercise which is the most important in '
certain cases and essential in all. Muscular exercise, to
which one must drive himself, or be driven, is still work
and not play, nervous out-put and not income. "I am
alarmed," wrote Thoreau, " when it happens that I have
walked a mile into the woods bodily without getting there
in spirit. In my afternoon walk I would fain forget all
my morning occupations and my obligations to society.
But it sometimes happens that I cannot easily shake off
the village. The thought of some work will run in my
head, and I am not where my body is I am out of my
senses. ' '
3. It must be proportionate to the strength of the in- \
dividual like a bottle of medicine, exercise has its dos-
age and directions for use. Exercise of the muscular
system has long been looked upon as a kind of antidote to
ill-effects of sedentary life, and muscular development has
been confounded with health. By systematic training, a
man may build up large muscles and still be far from
well, and it is a fact that professional athletes are, as a
class, short-lived. Muscular exercise involves the expen-
100 NERVE WASTE.
diture of nerve-force, and he whose nervous resources are
limited, should be careful not to expend too much in this
direction. A half-hour at tennis may leave a man glow-
ing and invigorated, when two hours of it will fag and
injure him. For the comparatively strong, who are suf-
fering from some of the minor forms of nervous impair-
ment, long days of hunting or fishing, mountain-climb-
ing, which, according to Tyndall, ' ' rescues the blood from
that fatty degeneration which a sedentary life is calculated
to induce, ' ' or even regular labor in the orchard or vine-
yard may be of great benefit; but for more or less enfeebled
persons, some light form of exercise, as walking, riding
or sailing, is best. Solitary exercise in the gymnasium is
of little benefit to the nervous; the putting up of dumb-
bells, the use of the health-lift, the "parlor gymnasium,"
and the various devices resorted to from a feeling of duty
are, so far as a weak nervous system is concerned, far
inferior to merely sauntering in the open air. Frequent
holidays, vacations and Sundays spent out-of-doors will
enable many an over- worked and worried city man to hold
his own in the face of very adverse circumstances.
The taste for out-of-door life (often wanting in the city
neurasthenic) must be cultivated. As boys we have this
taste, and lose it when we become possessed with the
thirst of ambition or gain. " In every man there is born
a poet who dies young. ' '
Fortunate the man who has early acquired a taste for
landscape and color; or that " taste for weather as such,"
which one New England man claims to have acquired,
and who is amused and pleased by the flora and fauna,
the rocks and the stars ; or for whom some little knowl-
edge of geology makes all the ground a vast and in-
teresting book, which he who runs may read. For a
nervous system, weakened and irritated by the experi-
ences of city life, gardening, or the calm intellectual
diversions of the amateur naturalist, botanizing, sketch-
THE OUTING CURE. IOI
ing, collecting, and the walking and climbing which
they involve, are the perfection of exercise and change, as
Tyndall's Hours of Exercise in the Alps was the perfec-
tion of those recreations for healthy men.
' ' The moral sensibilities which make Edens and Tempes
so easily may not always be found, but the material land-
scape is never far off," says Emerson, and many who
would appreciate and enjoy out-of-door sights and sounds
must be taught, and must begin with the primer. A
score of charming out-door books teach the possible * ' har-
vest of a quiet eye." Clarence King's Mountaineering in
the Sierra Nevadas, and the whole fascinating literature
of mountain-climbing, Tyndall, Whymper, and the rest,
can hardly fail to inspire the most inappreciative with a
new interest in life. Before going to the seaside, there
may be obtained any one of half-a-dozen primers of ma-
rine zoology, which will convert a common-place sea-
beach into a fairy-land abounding with objects of interest
and beauty especially if such a book as Charles Kings-
ley's " Glaukus " happens to be the one selected.
CLIMATE IN NERVOUS IMPAIRMENT. Experience shows
that certain nervous invalids cannot hope to be cured at
home. Weather or social environment hinders, or busi-
ness and social cares will obtrude. A change is neces-
sary, and the question of climate becomes interesting.
The climate cure of nervous impairment is a combination
cure. It includes rest, peace, sleep, oxygen, sunshine,
comfortable shelter, suitable food, and (if any society at
all) agreeable society. This combination is not common
from home, as any traveller knows.
The trip to Europe, the tour of the great cities, or of
the fashionable watering places, and other trips involving
much railroading, which many nervous invalids begin to
plan at once when change is advised, are not permissible.
The excitements of travel act as stimulants, and may
cause one to feel better for a time, but the sight-seeing is
IO2 NERVE WASTE.
generally overdone; the expenditure of nerve-force is
kept up, and no permanent benefit is obtained.
In general, it may be said that any climate which is
good for the consumptive is good for the nervous. The
great remedy in lung trouble, pure, .equable, balmy air,
is also a great remedy in nervous impairment.
Where choice is to be had I prefer the sea-coast.
There is something in the salt, inoist ocean atmosphere
that both soothes and braces. An hour of walking in
the thick, salt night-fog, which occurs at certain seasons
in San Francisco, is, one gentleman finds, the most effi-
cient hypnotic in his case. Indeed, the opposite high,
dry climate seems to produce nervousness. I not rarely
see men from the high altitudes of Colorado, Arizona
and other places, whose nervous symptoms cannot be
traced to any other cause than the prolonged, over-stim-
ulating influence of their climate. A few months of resi-
dence at the coast almost invariably benefits these cases,
and they often feel better from the first day. The choice
of climate is best made for any individual by the physi-
cian who knows him best ; but whether he gets his
oxygen and sunshine from sea air, with its medication of
sea-salts and iodine, or from the balsamic ozone-laden air
at the mountains, benefit will be likely to result,
Of old world climates, Madeira, the Riviera, and
the Mediterranean health resorts generally may be in-
stanced as suitable climates for nervous impairment,
though a place which is famous, and has a vogue is not
one I should select for an over-worked patient.
Dr. Hutchinson, in a valuable paper on "Climate Cure
in Nervous Diseases" (N. Y. Medical Record, 1879),
then stated that the Bermudas, the Bahamas, and the
Windward islands are the most available winter climates
for residents of the Eastern United States.
The mild and equable climate of California, in permit-
ting a full and continuous use of out-of-doors as a
THE OUTING CUBE. 103
remedy, is as valuable to the nervous as to the consump-
tive. Especially is this true of the coast region from
L,ake and Sonoma counties to San Diego.
San Francisco has some claims to being a winter city.
Its mean annual temperature ranges between 52 and
60. Its winter is pleasanter than its summer; and three
of its months, between August and December, are al-
most perfect free from wind, fog and rain, which are
liable at some other times, and from heat and cold, which
are never known. For residents of the interior, in winter,
this city with its miles of dry sidewalks, its cable cars,
and the innumerable mental diversions to be found
therein, make it a good place to seek a change of cli-
mate. The city is a delightful play -ground, though it is
apt to be a hard workshop.
The Santa Cruz region, forty to seventy miles due
south of San Francisco, is all that can be desired. From
Pescadero to Monterey many a sandy beach stretches at
the feet of a landscape, picturesque or beautiful, a region
restful and invigorating. In the Santa Cruz mountains
one finds an exquisitely clear atmosphere, where the
smell of the sea is mingled with the spicy fragrance of
the redwoods, and where, within the radius of a few
miles, a great variety of charming scenery encourages
the stranger to walk or climb.
The Santa Barbara and Ventura region is one of the
halcyon spots, not alone of California, but of the world.
Such a combination of ever-blue ocean, ever-blue sky,
hard, sandy beaches, mountains full of character, pictur-
esque canons and road-bits, and perennial fine weather
must be rare on earth.
Santa Barbara, now a town of 5,000 people, lighted by
electricity, and affording several first-class hotels, and
unique in its large proportion of cultured gentlefolk, lies in
a nook open to the sea, and is a trifle less uniformly mild
than Pasadena for instance. But the early morning fogs
104 NERVE WASTE.
and the mild winds, which sometimes occur at Santa
Barbara, are an advantage, rather than a drawback to
the nervous. For probably three hundred days or more
in the year Santa Barbara nestles between ocean ex-
panse and mountain height, as perfect a haven of rest as
humanity has any need of, or right to. In the health
resources of its vicinage, in the tempting and varied ex-
cursions which its back country affords, Santa Barbara is
for the nervous, perhaps, the most desirable objective
point in the South. 1
The whole South is a natural vacation-land, and the
people who possess it, realizing this fact, have gone ex-
tensively into the way of entertaining. Klegant (and
better still), comfortable, clean and moderately expensive
hotels abound.
The Sandwich Islands, eleven in number, two thou-
sand miles and seven or eight steamer-days from San
Francisco, are perfect sanitaria for certain cases of over-
work and worry. The mean temperature of these islands
is about 75, the thermometer varying between 90 and
60, and falling to 40 on the mountains. The moist,
balmy, regular climate, while somewhat relaxing for a
permanent residence, is perfectly adapted for a few weeks
or months of brain-and-spine rest. Packet steamers and
small schooners ply between the islands, and the ascent of
IA little work, "Santa Barbara and Around There," by Edwards Roberts,
(Boston, 1886), perfectly suggests the charm of this earthly paradise. See also
Harper's Magazine, November, 1887, for some admirable illustrations.
The charm of out of doors in California has inspired some agreeable books.
"Southern California," by Theodore S. Van Dyke (New York, 1886), is more
appropriately shelved with Thoreau, Burroughs and Kingsley than among
the guide-books, though as a guide-book it is admirable. The people of the
South can never be over-grateful to the memory of Mrs. Jackson, whose
"Ramona," among other writings, realized and vivified the traditions of a
land where tradition alone is lacking. "California of the South," by Drs.
lyindley and Widney, (New York 1888), has peculiar value for invalids in that it
is the work of physicians who are long residents of that land. Admirers of
Mr. Stevenson will remember his "Silverado Squatters" (to come north).
Some of the best descriptions of vacation California have been swept out of
sight in the swift current of periodical literature.
THE OUTING CURE. IO5
the volcanoes (ten thousand to fourteen thousand feet
high) affords an exciting break in the monotony of life on
a trade-wind island.
There is much to be said for, and some things against
a long sea voyage. In the rest that it enforces, in the
absolute isolation from care, and from temptation and
goading to work, or dissipation of any kind, and in the
ocean air and change of air, it is good. In that stormy
weather and the exigencies of sea-life may necessitate con-
siderable imprisonment in an ill- ventilated cabin, and in
the poorer food supply, it is not so good. One is more
dependent upon luck in a sea voyage than he would be
ashore. Still, there are cases where, all things con-
sidered, a long sea voyage is best. 1
Seeking health away from home has its drawbacks.
Some men are everywhere at home; they are citizens of
the world; they easily make acquaintances and enjoy
themselves. Others, retiring by nature, or inelastic from
sickness, grow homesick and depressed, mope, worry,
and remain unbenefited in the most perfect climate. An
invalid should leave home in company, if possible, and
cannot come to his destination with too many letters, or
too many preparations for quiet amusement. One whose
life is supposed to be in the slightest danger from any
disease, should hesitate long before venturing far away
from home alone.
iThe Ocean as a Health Resort, by Wm. S. Wilson ^ Philadelphia, 1880), is
an admirably thorough and instructive hand-book.
XX
BRAIN AND NERVE FOODS
Chemical analysis shows that the brain is composed
chiefly of water, fat, albumen and phosphorus. The nu-
trition of brain and nerve tissue may be analyzed into
three elements: First, the food; second, the digestion
of it; third, the picking up from the blood by the brain
and nerve tissues of those substances which they require
the assimilation of it. Thus the mere swallowing of any
substance is at most only one-third of the way to brain
and nerve feeding.
When the cells of the nervous system become weakened
from any cause, this weakness involves their whole physio-
logical life. Not only is their function of giving out force
impaired, but their power of attracting and appropriating
nourishment from the blood-current is also impaired.
The vigorous young nerve-cells of a country boy will ex-
tract from even a poor diet an abundance of nerve-force,
which is exhibited in his firm flesh, toned muscles and
tireless activity. The enfeebled nerve-cells of an aged
millionaire cannot extract from the most succulent and
nutritious diet a similar amount of force; his flesh is
flabby, his muscles unsteady and his powers limited. In
many bald-headed men the blood-stream is of the richest
quality, but the debilitated hair follicles are unable to
make hair from it.
This may serve to illustrate why nervous invalids de.
rive no great benefit from preparations of phosphorus and
substances supposed to be " nerve-foods. ' ' If these drugs
were far more nutritious than they really are, and if the
blood of the man with weakened nerve-cells were loaded
with phosphorus, benefit would not necessarily result.
(106)
BRAIN AND NERVE FOODS. lO/
The weakened nerve-cells can only assimilate a limited
quantity of phosphorus, and when this substance is
brought to them in unusual amount by the blood, it is
unused, carried away again and excreted from the system.
The brain and nerves feed upon the blood, and a rich,
pure blood, well charged with oxygen, is the best nerve-
food. This quality of blood is best made from natural
foods; it is hard to improve upon the Creator's method of
blood-making.
Whenever the reader feels that he needs a nerve-food,
the wisest thing he can do is to put himself in the hands
of his physician, but if he is not quite wise enough for
this, some suggestions will be of value to him.
A full daily supply of out-door air is of the first im-
portance in brain and nerve feeding. This oxygen must
be taken every day, and the more the better, for it is one
of the few remedies that is not apt to be abused. If the
reader have no respect for, nor confidence in a remedy so
cheap and simple, the oxygen can be had of certain manu-
facturers in rubber bags at so much per gallon. This
roundabout way of using oxygen is not nearly so effica-
cious in nervous exhaustion as the out-door plan, but it
seems to suit some persons better. L<est I be suspected of
being more enthusiastic than sound upon this subject, I
will attempt to explain, briefly, the relationship which
exists between oxygen and nerve nutrition; to make this
explanation complete necessitates the repetition of a state-
ment, but repetition is said to be one of the essentials of
good teaching.
i . Oxygen is the most efficacious known tonic for the
nervous tissues ; it comes into direct contact with the
brain and nerve-cells, vivifies them, and helps them to
help themselves ; by improving the vigor of the nerve-
cells it improves the digestive power which depends upon
these nerve-cells, and thus insures a better quality of
blood.
IO8 NERVE WASTE.
2. The reduction of food in the stomach and intes-
tines to a liquid is not the whole process of blood-making.
Before this nourishing fluid, chyle, reaches the general
circulation a large part of it must pass through the liver,
where it is subjected to some important modifications.
Of this food-stream, the starches, sugars and alcohol are
partially burned up by chemical union with the oxygen
of the blood they are oxidized, and in this process
animal heat is evolved; we have alreaded noted that heat
is convertible into nerve-force. The peptones, which
represent the more hearty foods, the meats, etc., are
also subjected to the action of oxygen. These nitro-
genous foods, or peptones, are usually eaten in larger
quantities than the body has any need of, and one of the
uses of oxygen in the body is to dispose ol this surplus
to so change it that it can be excreted from the system.
It does this by oxydizing the excess of meat-food, and
gradually converting it into a substance called urea.
This urea, the product of perfect oxidation, is unirritat-
ing and soluble in the blood, and thus is able to be fil-
tered out through the kidneys without injury ; the urine
is largely a solution of urea. When the amount of oxy-
gen in the blood is not proportionate to the amount of
food, either as a result of sedentary habits or of over-
eating, or of both together, this process of oxidation is
imperfect; the resulting waste substances fall short of
urea; they are more irritating; they are not very soluble
in the blood, and hence are not easily removable by the
kidneys. In short, they act as unnatural and poisonous
substances in the blood. These abnormal products of
imperfect oxidation are known as uric acid, lithic acid
and oxalic acid, 1 and the condition in which they are
1 Strictly oxalic acid does not exist in the blood. It is formed in urine (whether
in the urinary passages or outside the body) by the decomposition of uric acid
and the urates, or by that of oxaluric acid (which is oxidized lithic acid) into
oxalic acid and urea. Thence oxalate of lime and " oxaluria."
BRAIN AND NERVE FOODS. IOQ
present in the blood is called lithsemia, or lithiaisis, and
is at the bottom of some of the gravest diseases. ,
These substances may assist to form an abnormal and
excessive quantity of bile ' { biliousness, " ' ' bilious
colic;" they may be laid down in the joints or attack
almost any tissue in the body gout ; they may irritate
and eventually cause disease in the blood-vessels through
which they are borne apoplexy, aneurism ; they may
irritate and set up a chronic inflammation of the kidney
Bright' s disease ; they may form collections in the
urinary passages stone in the bladder
Nervous, overworked men are often great consumers
of meat ; they eat it by instinct to repair the waste of
excessive work. When such a man spends most of his
time indoors, breathing with only the upper half of his
lungs, his oxygen supply is not likely to be great enough
for perfect excretion, and he may eventually suffer from
some of the various forms of lithaemia.
There is a class of people who are not nervous, in
whom a rich diet, a poor oxygen supply, and a free use
of alcoholic drinks sooner or later produce some of the
graver forms of lithaemia most often Bright 's disease.
Alcohol uses up oxygen very quickly, and leaves little
behind to attend to the oxidation of surplus meat foods,
and in addition, alcohol is itself irritating to the kidneys,
liver and blood-vessels. L,ithaemia in some of its forms
is the national disease of the beef-eating and spirit-drink-
ing gouty Englishman, as neurasthenia is the national
disease of the over-worked, neurotic American.
But no theory or science is needed to convince us of
the value of oxygen in nerve-feeding if we will recall our
experience. Most of us know that we can eat, digest,
and use up a much larger amount of food when our days
are spent in the open air, than when they are spent in a
stuffy office or workshop.
110 NERVE WASTE.
Coming now to actual foods, the fats stand highest on
the list for the nervous cream, fresh butter, the fat of
roast beef and of beefsteaks ; the brain is rich in fatty
substances, and fat goes to make heat and force. Fats,
while highly nutritious to the nerves, are not so easily
digested as lean meat, but, by keeping up his oxygen,
the nervous invalid will find himself able to manage
more and more of these substances.
Cod-liver oil is the most valuable nerve-food when it can
be managed by the digestive organs. 1 I prefer the plain oil
to any of the numerous emulsions and compounds. Taken
in ' ( sandwich ' ' cod-liver oil is not in the least disagree-
able to swallow. Fill a small glass two-thirds full of
beer, moisten the sides to the brim by a rotary motion of
the glass, float the oil on the top of the beer, cover with
an inch of froth. Thus, the oil may be tossed off without
ever coming in contact with the sides of the glass, or the
tongue or the throat, and without being tasted. Another
method of swallowing oil without tasting it is to pour a
tablespoonful of beer into the bottom of a glass, then
add the oil, then pour half a glass of beer upon the oil
from a height, and toss off the perturbed contents, as
one remarked, ' ' before the oil knows where it is. ' ' The
beer is a valuable addition, as it assists the stomach to
manage the oil ; it is not rare to see nervous persons gain
*A drawback to the use of cod-liver oil is the difficulty, or rather the uncer-
tainty, of getting a pure oil. Cod-liver oil is as variable in quality as butter.
Where the oil is made from putrefying livers, by dirty workmen, in dirty uten-
sils, it is as certain to be rancid as is butter made under similar circumstances.
The author has been informed that " cod-liver oil " is made on a large scale by
soaking burnt herrings in various cheap oils. A rancid or a spurious oil is
likely to do as much harm as a pure oil is to do good. Among the oils which
maybe relied upon are "Burnett's," marketed by T. Metcalf & Co., of Boston,
"Marvin's," by John Wyeth & Co, of Philadelphia, "Peter Holler's, and
Allan & Hanbury s, an English oil. The dose of cod-liver oil should not be
too large, especially on beginning. The "tablespoonful" advised by many
manufacturers and druggists is injudicious. I generally begin with ten drops,
and gradually increase to a dessert-spoonful three times a day. In most cases
there is no advantage in going beyond the latter dose. I have begun with three
dre^s where the stomach did not take kindly to the oil.
BRAIN AND NERVE FOODS. Ill
five, or even ten pounds, in a few weeks, on this oil and
beer.
Children of nervous parents may be given a semi-annual
course of cod-liver oil from early childhood to through
puberty with great benefit ; it improves the nutrition and
development of the nervous structures and to a great
extent insures stability; it is putting nerve-force in the
physiological savings bank. Cod-liver oil and out-of-door
life would convert many a thin peevish child into a
sturdy, steady one.
There is probably nothing subtle or specific about cod-
liver oil; it is simply the most assimilable form of fat, and
when it does not agree it is best avoided; then cream is
the next best nerve-food. The breakfast coffee may be
made a valuable nerve-food to most persons. To a half
or a third of a cup of pure fresh cream add coffee hot
enough and strong enough to bear the dilution without
making the drink cold and weak. This makes a rich,
smooth, elegant beverage, which is superior in restora-
tive power to a whole bottle of hypophosphites. The
cream excuses the coffee, the coffee helps the digestive
organs with the cream, and many persons who ' ' cannot
drink coffee ' ' can drink this coffee-cream with benefit.
Dinner may be terminated by a small cup of hot coffee
one-third each of cream, milk and coffee. The breakfast
cereals may be enriched with cream; potatoes may occa-
sionally be served ' ' mashed ' ' with milk and cream ;
many ripe fruits will not quarrel with cream ; in winter
ripe bananas and cream make a delicious dessert ; ice-
cream home made with fresh strawberries, may be per-
mitted to some as a dissipation.
Cocoa seeds, as variously prepared by different manu-
facturers, are a useful addition to the dietary of nervous
invalids. These seeds contain nearly fifty per cent, of &,
fixed oil or fat, besides an alkaloid, theobromine, which
is analagous to the caffeine of coffee; burning, develops
112 NERVE WASTE.
an agreeable aroma, and when ground into a paste and
mixed with various flavors, we have chocolate. Choco-
late is too rich in fat, and thus too heavy, for most nervous
persons, although highly nutritious.
Baker's breakfast cocoa is a light preparation which
can be heartily recommended; it contains only so much
fat as can be digested by almost anyone; and is peculiar
in not cloying or palling after a time, as so many cocoa
preparations do. Such a beverage is far more wholesome,
and more agreeable, after one becomes used to it, than
tea, which is so much over-used. It is especially useful
for children; our little boy has drunk it since he was a
year and a half old, has become inordinately fond of it,
and has kept as ' ' fat as a pig, " as we say.
All these liquid preparations serve a very useful pur-
pose in cases of nervous impairment where the digestion
is weak. Belchings, slow digestion, sour risings, heavy
sensations or pain in the stomach, are plain signs that
solid food ought to be sparingly taken or withdrawn
altogether. They indicate that the digestive juices are
too poor in quality to properly disintegrate and reduce
masses of more or less solid food to liquid chyle. Hot
bouillon (which some cooks flavor deliciously with a
little celery and spinach) is a good thing for such persons.
When a man comes to his luncheon without an appetite }
or to his dinner too tired to eat, and yet feels that he
needs something to ' ' stay his stomach, ' ' one of the best
things he can do is to take a plate of hot bouillon and a
little bread, and nothing else. In many cases of nervous
indigestion the immediate symptoms may be quickly
removed by limiting the patient for a few days to hot
bouillon and bread as often a day as he wishes it. A
plate of hot bouillon, with or without a little bread, at
bedtime, is effectual in many cases of sleeplessness; a
glass of milk, warm and slightly sweetened, will favor
sleep and increase weight. .
BRAIN AND NERVE FOODS. 113
Koumyss sparkling milk, milk in which fermentation
has been induced is a valuable food in many cases.
The neurasthenic can hardly eat too much fresh, sweet
butter ; it may be swallowed in large quantities with warm
corn-bread; upon soft-boiled eggs; in mashed potatoes.
Next in value to the fats are the unbolted cereals; first
of all, wheat, then oats and corn. Cracked wheat and
cream is an ideal nerve-food. The preparation known
as ''Aunt Abbie's rolled oats " is easily cooked and alto-
gether excellent. Corn-bread, the " johmry-cake " of
New Kngland, made of corn meal, eggs and flour, thick,
light, warm and soaked with fresh butter, is a better
nerve-food than can be found on the druggists' shelves.
Though highly nourishing, cereals are not the most
easily digestible of foods, and even prove too coarse and
irritating for a few stomachs. Some children who are
forced to eat oatmeal, because of its reputation as a
healthy food, suffer from indigestion and skin eruptions,
and recover when the too coarse food is withheld. The
digestibility of cereals can be greatly increased by care-
ful cooking.
Roast beef and juicy steaks are rich in the elements of
brain nutrition, the phosphates of lime and soda, and the
fats, "besides yielding a larger amount of force to the
mouthful than any other food. The preparations of phos-
phorus that are put up by the Creator in such inimita-
ble packages, in the germ of wheat, oats and corn, and
in meats, have great advantages over the artificial pro-
ducts of the laboratory; they are more easily soluble in
the digestive juices, and more easily assimilated by the
tissues, because they are natural. Fresh fish and shell fish
are light, easily digested foods when properly cooked
but they have no special value as brain and nerve foods.
Celery, it may be remarked, since the physician is often
asked concerning it, has no value whatever in nerve-
nutrition, but boiled celery, served immersed in milk and
114 NERVE WASTE.
butter, is another thing ; L,ima beans have a high nu-
tritive value, and may be served in the same way. The
man with any stomach at all who cannot make brain and
nerve tissue and force upon the diet I have indicated, will
not be likely to find it in any product of the chemist's
skill; but I again insist that the food supply must be
sustained by, and proportionate to, a proper oxygen
supply It would never do for an indoor neurasthenic to
attempt this diet, in whole; and when rainy weather or
other cause keeps the outdoor one indoors, he must come
down to sedentary diet.
One of the most difficult things to find, away from home, is wholesome, well-
cooked food. Some of my neurasthenic patients, though living in elegant
hotels, have not been able to get enough to eat. When the homeless neuras-
thenic finds a table where, the following bill of fare may be selected, among
other things, he is advised to cherish it :
Breakfast. Fruit in season, baked apples, stewed prunes; coffee-cream,
well-cooked cracked wheat and cream, rolled oats and cream, corn bread and
fresh butter ^two butters for one bread), soft-boiled eggs, fresh butter ad
libitum,
Luncheon. Chicken soup, hot bouillon, bread; properly made breakfast
cocoa; fresh, warm sweet milk ad libitum', raw oysters, beer, bread.
Dinner. Soup, roast beef, broiled porterhouse steak, mashed potatoes (made
with butter, milk and cream), stewed celery, stewed fresh lima beans, bread,
fresh butter ad capacitatem, claret, sauterne or burgundy, ripe bananas and
cream, custard and preserved raspberries, ice cream home made of pun
cream and fresh strawberries (rarely), small coffee-cream.
Supper (night-cap for certain cases) .Breakfast cocoa, bread; hot bouillon,
bread; sweet milk; raw oysters, beer, bread.
The neurasthenic will do well to confine himself to the wholesome, nour-
ishing solid dishes and not dissipate his digestive pqwer upon greasy fish, meats,
gravies or entrees, or upon dessert.
XXI
TEA, COFFEE, TOBACCO, AND ALCOHOL.
Concerning these substances it is not possible to make
one rule for the whole human race ; used temperately
they add a great deal to the comforts of life; used intem-
perately they may create great mischief ; thus a danger
lurks in their moderate use. Coffee and tea are both
stimulants to the nervous system, and their habitual use
probably increases the sensitiveness of the nervous tis-
sues; used intemperately these substances may induce a
high degree of " nervousness," manifested in trembling
fingers, palpitations, disordered vision, or indigestion.
A habit of excessive tea drinking may be gradually
displaced by sipping hot water barely flavored with
orange peel, or lemon juice, or any agreeable substance.
When tea is drank for its stimulative effect more than
for sociability, very hot milk or breakfast cocoa may be
substituted.
TOBACCO in small quantities is a stimulant to the ner-
vous system of the habitual smoker; it promotes the flow
of ideas, increases digestion and circulation by its stimu-
lant effect upon certain nerve-centers in the brain, and it
slows the processes of tissue waste. Used in excess it
becomes an irritant to the nerve-centers ; the heart may
become irritable, the digestion may fail, the eyes may be-
come weakened, and trembling fingers betray the irri-
tated and weakened condition of the nerve-cells within ;
1 ' tobacco amblyopia, " ' ' smokers vertigo, " ' ' smoker's
heart," are constantly used terms in medical practice.
Gently rubbing a flea-bite soothes the irritated skin ; pro-
longed scratching may destroy it, or set up an inflammatory
Il6 NERVE WASTE.
skin disease. So, tobacco, used in moderation, by its
gentle stimulant effect counter- irritates and soothes the
brain and nerves excited by the experiences of the day ;
prolonged or excessively used, it becomes an irritant. It
is one of the principles of physiology, that persistent irri-
tation over stimulation of any part eventually ends in
exhaustion. The fact should be remembered, that per-
sons of a nervous constitution, and persons living a sed-
entary, indoor life, are more susceptible to the action of
stimulants and narcotics than others, and that they are
more liable to abuse, and to be injured by them. With
respect to the use of tobacco by children and immature
youths, there can be but one opinion ; it is an evil so
great and so important in its relation to the public health
as to justify its suppression by legislation.
ALCOHOL in small quantities is a gentle stimulant to
stomach, heart and brain ; used in excess it is one of the
surest and most efficacious brain and nerve poisons that
we know.
Many conservative men, who have had opportunity of
observing the alcohol question from every point of view,
believe that the popular use of light wines as food would
conduce to national temperance. However this may be,
there is no doubt of the value of light wines in nervous
impairment. Used wisely, as food, with meals, and
never as beverages between meals, one to two gills of
pure, light wine warms the stomach, assists digestion,
gently soothes away weariness from the tired brain, and
furnishes in easily assimilable form the elements of force
and heat. Some persons are offended at the statement
that alcohol is under any circumstances a food, but phys-
iology demonstrates (not theorizes) that it is. Truth is
truth whatever bearing it may have upon social questions,
and the firmest faith is that which has conviction that
truth can never be used to injure mankind.
TEA, COFFEE, TOBACCO, AND ALCOHOL. II 7
Heretofore, when a pure, soft, agreeable, light wine
has been indicated, in sickness, the physician has been
obliged to recommend an imported article, but I should
like to call the attention of medical men at a distance to
some facts concerning the wines of California. The
sunny slopes of this State produce grapes which are un-
surpassed in any land. At first, and for a long period,
California wine-growers lacked a science in planting, and
art in making. Now, after years of effort and loss, the
more intelligent of them produce light wines that are
mild, smooth, of agreeable aroma and of delicate flavor,
and in case of the red wines, of fine color. Certain speci-
mens even have in them much of that velvety softness
and seductive bouquet which crowns the wines of the
Gironde. The Cabernet, Cabernet- Sauvignon, Sauvignon
Vert, Gutedel, Sauterne and Riesling, of the best Cali-
fornia vineyards, can hold up their heads in any com-
pany. The Zinfandel, so extensively planted in this
state, is a good (at its best, excellent), ordinary wine, but
is by no means to be considered the best that California
is capable of. When a heavier wine is indicated, as it
sometimes is in elderly patients, the California Burgundy,
Port and Sherry will often be found superior for medici-
nal purposes to much of that imported. 1
The habit of drinking whisky between meals is a bad
one for a healthy man, and is highly injurious to him
whose nervous system is his weak part. Without con-
sidering the irritant effect of the alcohol upon the delicate
1 Some of California's early wines gave her a reputation that is undeserved to-
day. It is unfortunate, too, that there is still much thin, sour, astringent,
bad "California wine" on the market. Some of this has been made from
unsuitable grapes, and some unskillfully from suitable grapes; much of it has
been made from no grapes at all in cellars far from California. Some of Cali-
fornia's own sons, I regret to say, are the worst enemies of her wine industry.
Not a few wine-sellers, hotel-keepers and restauranteurs find it profitable to
supply the stranger with a wine that is cheap (to them) because it is bad. The
California State Viticultural Commission has established a permanent exhibi-
tion at 216 Montgomery street, San Francisco, where the best vineyard pro-
ducts of the State are to be seen and tasted.
1 1 8 NERVE WASTE.
stomach lining and liver tissue, that proportion of alcohol
which escapes unoxidized through the liver, in circulating,
passes through the finely organized brain and nerve tis-
sues, upon which it exerts a distinctly poisonous effect.
Neither wine nor whisky should ever be used as ' ' bracers,''
or stimulants to the nervous system. The plan of work-
ing, or "keeping up" on stimulants so common is dis-
astrous; no one can long follow it without paying some,
often a severe, penalty.
Many of the patented preparations, to be found in so
great variety in the drug-stores, with the seductive names,
* * tonic, " ' ' restorative, " ' ' rejuvenator, " " nerve-food, ' '
are simply stimulants, alcoholic or drug, and do the harm
that all stimulants do. " The ladies' tipple " is a phrase
which a recent writer has applied to that omnipresent and
taking mixture "beef, iron and wine." The composi-
tion of this compound varies with the consciences of the
druggists who make it, but it generally contains a good
deal of wine, and a very little of iron and beef. The
popularity of this mixture is a good illustration of the
superstitious faith that people are apt to put in drugs.
One would suppose that when a man had decided to take
beef, wine and iron, he would prefer juicy steaks and
roasts, with a quality of wine of his own choosing, and
the iron by itself; but the mixture representing the
virtues of dog-meat and cheap wine, manufactured to
reap as great a profit as possible, has, in his eyes, ac-
quired some strange power in passing through the hands
of the apothecary.
XXII
NERVINES AND NERVE TONICS
Drugs do not occupy the place in modern medicine that
they once did. The development of the scientific method
in observing and in thinking has infused a skepticism into
medicine as it has in many other departments of thought.
Experienced and scientific men come forward with such
subversive statements as that quinine is of little value in
typhoid fever, that strychnine never cured paralysis, and
that phosphorus is worthless as a brain-tonic.
A reading of some of the standard treatises upon ma-
teria medica might easily lead a layman to suppose that
all diseases are curable or relievable by drugs, but the
chronic invalid knows better. The best medical thought
of to-day tends toward a less and less use of drugs and a
greater and greater reliance upon the healing power of
nature, when this is encouraged by hygiene and good
nursing. Medical men have come, or are coming, to ap-
preciate that there are many forces beside chemicals which
act upon a diseased organ or an impaired vitality. In
late years an impetus has been given to the study of vital
economy, of medical physics, of diet in disease, of clima-
tology and of nursing, and a system of individual hygiene
for individual diseases is being perfected.
But although drugs have been dethroned and degraded,
they are by no means exiled nor in contempt. They are
useful, often indispensable. It is only that they are not
omnipotent. They do not so much cure as assist to cure;
they are not now the first forces thought of by the wise
physician, nor the ones upon which main reliance is placed.
(119)
120 NERVE WASTE.
In practice there is a great pressure brought to bear
upon the physician to use drugs, and many physicians
yield to this pressure against their best judgment. People
do not understand curing without medicine, and, what
often influences the physician more, they are not willing
to pay for such treatment. There is a feeling that with-
out the prescription nothing has been done, and (will the
reader believe it) there are persons who, even when the
life of a loved one is at stake, are too selfish, too careless,
or too unintelligent to carry out the necessary nursing;
in such cases the physician must do the best he can with
drugs.
Drugs used in nervous impairment may be divided into
two classes those designed to alleviate some symptom
or to have a temporary influence, and those designed to
have a permanent effect. The first class consists chiefly
of stimulants and sedatives, the second of tonics.
NERVE STIMULANTS AND SEDATIVES. Many of the symp-
toms of nervous impairment are unbearable or disagree-
able, and are best alleviated at once. Pain and spasm are
always thus treated. A habit of sleeping may often be
made to replace a habit of sleeplessness by a judicious
use of stimulants, or of sedatives, and then these serve a
beneficent purpose. The feeling of fatigue is often so
disagreeable and intolerable that we are justified in tem-
porarily removing it. An insufficient liver, indicated by
heavy urinary deposits, may be gently stimulated until
the urine is clear. Thus the wise use of stimulants and
sedatives is very useful in nervous impairment.
But certain facts need to be remembered in connection
with the use of these drugs. Pain, headache, morbid
fatigue, sleeplessness are not diseases but symptoms; they
are signals hung out by a distressed brain-and- spine.
Stimulants and sedatives do that which they do quickly
and have no absolute lasting good effect; they are palli-
ative, not curative; they temporarily remove the symptom,
NERVINES AND NERVE TONICS. 121
but leave the disease; wisely used they are a lesser evil,
unwisely they may be a greater evil than the symptom
which they temporarily remove. The chemist can tem-
porarily deodorize an offensive spot, but he knows that
removal of the putrefying organic matter is essential to
sanitary safety. And it is slovenly doctoring to rest con-
tent with covering a symptom by a stimulant or a sedative,
and not dig about the roots of it.
The first recommendation with respect to stimulants
and sedatives is to avoid them when possible. We have
all gotten into a habit of resorting too quickly to these
things they act so nicely. But the hereditary neuras-
thenic, whose nervous system is his weak point, and who
must needs be doctoring or caring for it through a long
life can afford to take some trouble to escape the tyranny
of these substances. In what has been called "the most
sensible medical book ever written," Mr. Hilton 1 has
dwelt upon a law of universal application that pain ap-
peals for rest, quiet, peace. Thus in sick headache or in
neuralgia, one should pause in a whirl of excitement or
activity and temporarily seek a subdued environment.
Heat to various points on the surface will often do all
that morphine will. Hot drinks internally milk, cocoa,
water or even black coffee or hot weak whisky punch
are often capable of doing all that caffeine or coca can.
Of stimulants, caffeine (the active principle of coffee),
coca, and its active principle, cocaine, guarana powder,
Indian hemp (whence the "hasheesh" of the orient), cam-
phor, valerian, and the preparations of ammonia are essen-
tially brain stimulants. The pupil-dilators, belladonna,
hyoscyamus, stramonium, and duboisia, first stimulate
the spine and sympathetic and incidentally relax spasm
and paralyze secretion. Of heart stimulants digitalis,
strophanthus, sparteine, lily of the valley may all be so
1 Rest and Pain, by John Hilton, F. R. S. ; F. R. C. S. ; Condon.
122 NERVE WASTE.
gently used as to be justly called tonics; coca and caffeine
stimulate the heart through the brain.
Of sedatives, alcoholic liquors, opium and its alkaloids,
(morphine, narceine, thebaine, papaverina and codeine)
chloroform, ether and nitrous oxide first temporarily
stimulate the brain and then stupefy it; they are our
greatest medicines against pain. The bromides, chloral,
croton chloral, hops act directly upon the brain tissue,
soothing it and withdrawing blood from it without stupe-
fying. Paraldehyde, sulfonal, amylene hydrate, urethan
hypnone, recent products of the German laboratories, cause
sleep by a direct influencing the brain cortex which we
do not as yet understand. Antipyrine and acetanilide,
also produced in the laboratory, from aniline, were first
introduced as remedies against fever, but are now more
famous as nervous sedatives; in many cases of migraine,
neuralgia, insomnia, the power of these remarkable drugs
is complete. The depressants, conium, (the cup of hem-
lock drunk by Socrates), Calabar bean, jaborandi, gel-
semium (the pretty yellow jasmine), aconite, all have
terrible power. Hydrocyanic acid and the cyanide of
potassium paralyze the centers of life in less time than it
takes to tell it. Nitrite of amyl inhalations and nitro-
glycerine have a power of instantly relaxing arterial
tension, which serves a useful purpose in certain diseases.
It is an interesting fact that many of the symptoms of
nervous impairment are relieved by both stimulants and
sedatives by drugs which have a directly opposite action
upon brain and nerves.
NERVE-TONICS A. tonic is a force which tones, or acts
with some degree of permanence in opposition to a relaxa-
tion and weakness. In a narrower sense it is a medicine
which tones. Tone is nerve-force manifested. It maybe
manifested in mental or muscular activity, or in the con-
traction of tightness of unstriped muscular fibre or other
tissue. The brain-and-spine is the ultimate source of all
NERVINES AND NERVE TONICS. 123
nerve-force, and thus it must be the great objective point
in any attempt at toning.
The kindly forces of nature rest, sleep, oxygen, sun-
shine, food, exercise, cheerfulness are incomparably the
best tonics. Unfortunately, a large proportion of nervous
invalids are not able to make the best use of natural
tonics; they are too expensive; often they are impossible.
Thus certain artificial tonics have their place ; electri-
city is one of the best of these ; drug tonics have their
field of usefulness, and the doctor himself sometimes
acts as a tonic.
With respect to the organs chiefly influenced by tonic
treatment, in different cases, we speak of nerve-tonics,
voice-tonics, digestive-tonics, heart- tonics, reproductive
tonics, blood-vessel tonics, tissue tonics, but all these
forms of toning are produced through and by the central
nervous system.
TONICS AND STIMULANTS. A careful distinction must
be noted between a tonic and a stimulant. A tonic acts
more or less slowly in improving the nutrition of brain
and spine, and thus the vital resources. A stimulant acts
more or less quickly in exciting the brain and spine into
increased activity, and after its influence has passed
leaves the brain and spine no stronger, or less strong,
than before. A tonic may be compared to a slow saving
of money which accumulates into a bank account. A
stimulant may be likened to a mortgage, which procures
immediately a large sum of money, and is thus highly
gratifying in its immediate results, but which has a day
of accounting. But with careful financiers a loan is often
made the means of ultimately increasing capital, and
stimulants may be so judiciously used as to permanently
improve the vital resources. The abuse of stimulants is
one of the sanitary evils of to-day; their use is a science
that is too little understood or managed even by medical
men.
124 NERVE WASTE.
ARSENIC is easily first among nerve-tonics. For a long
period it was known that arsenic had an almost specific
power in certain indolent chronic diseases of the skin. Its
action was alterative, i. <?., it produced a change in the
nntrition of the diseased tissue, slowly tearing down old,
and slowly building up new skin, until a healthy surface
resulted. I^ater it came to be known that arsenic has a
similar effect upon a brain and spine that it has upon skin,
It slowly re-creates by modifying nutrition, by tearing
down and building up. To-day this remedy has the con-
fidence of neurologists everywhere as the greatest of nerve-
tonics. Its action is slow, and the remedy requires in
some cases to be taken for months. In some cases in
which the action of arsenic is eventually the most marked,
no effect at all is perceptible for two or three months,
when all at once the patient begins to improve rapidly.
It improves the appetite and digestion from the start. It
sometimes markedly improves the health of the skin, hair
and nails. While arsenic in small doses, wisely used, is one
of the most beneficient of remedies, in large doses, or un-
wisely used, it is a powerful poison. For this reason it
should never be meddled with by others than medical men.
There is opportunity for much wisdom in giving
arsenic. The preparation, the special dose at different
stages, the way of taking, the frequency and length
of the intermissions, are important points. The physi-
cian by wise management is able to extend the good
effects of the drug over months. A patient is liable to
exhaust the power of arsenic in his case in two or three
weeks, and to poison himself beside.
Nux VOMICA, and its alkaloid, STRYCHNIA, are the most
active nerve tonics. They stimulate nutrition in nerve-
tissue, and especially in the spine. As in case of arsenic,
strychnia may be so gently used as to heal and renovate,
or so clumsily as to poison to death.
NERVINES AND NERVE TONICS. 125
PERUVIAN BARK, and its alkaloid, QUININE, is a power-
ful nerve-stimulant, in large doses, and a gentle one, a
true tonic, in small. The hydrochlorate of quinine,
much used in Europe, is far superior to the sulphate,
which is almost universally used in America for three
reasons; it has greater alkaloidal strength, is more solu-
ble in water (one in thirty-four), and the hydrochloric
acid, of which it is made, corresponds to the hydrochloric
acid of the gastric juice.
PHOSPHORUS exists in the body of an adult to the
amount of about i x 6 6 pounds; this occurs chiefly as phos-
phate of lime, phosphate of soda, and is found in the
brain and nerves in peculiar compounds, the secret of
which even the wonderful chemistry of to-day is not able
to entirely discover.
The diet in daily use by even poor American men and
women contains more than enough phosphorus, in a
natural form, to maintain the needs of the body. If, dur-
ing excessive nerve-waste from overwork, or any cause,
the supply of phosphorus is artificially increased, it acts
for a short time as a stimulant. Under the stimulus of a
strong, rich food supply the tired nerve-cells are enabled
to do their work more easily ; the individual feels better.
But, very soon, the capacity of the nerve-cells to assimi-
late an unnatural quantity of nutriment becomes ex-
hausted ; they get dyspeptic, as it were, and, as the
unnatural phosphorus supply is brought to them by the
blood-current, they refuse it, are unable to use it, and it
is borne away again to be excreted from the system.
Thus, in the end, much of the expensive bottle of hypo-
phosphites finds its way to the water-closet. If the course
of phosphorus be wisely managed, if the patient's nerve-
waste be cut down, and natural remedies be brought to
cooperate with the medicine, it may produce permanent
benefit. But if the patient has continued his nerve-
expenditure, or perhaps increased it under the stimulat-
126 NERVE WASTE.
ing influence of the drug, the result is that when the
nerve-cells have cloyed upon their high-pressure diet of
phosphorus, they are less able than before to manage the
natural phosphorus supply of food. These remarks
apply particularly to phosphorus pills and the hypophos-
phites. It is my opinion that the reader may use the
phosphate of lime and phosphoric acid ad libitum, for the
reason that they do not reach the nervous system at all,
the former becoming insoluble in the digestive juices,
and the latter forming phosphates that are likewise not
absorbed. Phosphoric acid, however, has some value in
other directions.
The late Dr. G. M. Beard of New York, who probably
treated more cases of nervous exhaustion than any other
man, wrote :
"Of phosphates this can be said, that, like iron and quinine,
they belong to the list of over-praised and over-used remedies, at
least in their relations to neurasthenia These
phosphates and phosphoruses and phosphites are good remedies
in nervous troubles, but if they had anything like the specific
power claimed for them, there would be little need for treating
these cases ; most of the patients that I see have taken them in
abundance. All these stock remedies have a certain power which,
in very many cases, they soon expend. They reach the limit of
effect, beyond whicli they cannot be forced."
Dr. Samuel Wilks, whose opinions are received with
respect by the medical profession on both sides of the
Atlantic, in a recent address, says :
" I never remember seeing more than one patient the better
after taking phosphorus, and therefore I am bound to look upon
this as a coincidence. In my private pharmacopoeia I have at-
tached to the word phosphorus, the name ' humbug.' "
My own faith in phosphorus is greater than that of Dr.
Wilks, but I quote him for the benefit of such of my
readers as may care to compare the conclusions of an ex-
perienced and scientific physician with the statements
of some of the many shrewd advertisements, with which
NERVINES AND NERVE TONICS. I2y
the journals of the day abound. The ignorant use of
phosphorus may occasionally have serious results, and a
case was recently reported in which a woman had taken
a phosphorus pill three times a day for two years, to
strengthen her brain, with the result of causing a chronic
inflammation and partial destruction of one of the bones
of the face.
One of the worst cases of nervous break- down that I
have ever seen was in a young married man, aged thirty -
three, a victim of overwork and other excesses. He in-
formed me that he had been taking a preparation of the
' ' hypophosphites of lime, potash, manganese, iron, qui-
nine and strychnine," which I found by his bedside,
daily for over a year. It had been recommended to him
by a neighboring druggist, "and my patient informed me
that it had done him a great deal of good. This young
man, with his emaciated figure, sallow cheek and lustre-
less eye, was a picture of premature old age. One great
injury which patent medicines do by their fine promises
is in encouraging the nervous to rely on them to the
neglect of other and wiser measures.
COCA is a remedy which is being widely advertised as
a powerful nerve tonic. It is really a sedative-stimulant,
and as such is very valuable in many forms of nervous
impairment. The active principle of the coca-leaf is the
alkaloid cocaine, whose power of paralyzing sensation in
mucous membrane nerve-ends makes it one of the bless-
ings of modern surgery. This anaesthetic power of
cocaine extends, to some extent, to nerve-tissue every-
where brain, spine and nerves. In addition, coca has
stimulant and excitant properties similar to those of>
strong coffee. In these two properties of coca reside its
remarkable action. It soothes away the intolerable feel-
ings of nervous or muscular fatigue, experienced by many
after a hard day's work, into a feeling of comfort, or even
of mild exhilaration. It promotes the flow of ideas, and
128 NERVE WASTE.
gives an artificial sangfroid, which is a great satisfaction
to nervous and diffident public speakers and others, and
which, if not repeated too frequently, is harmless. It
temporarily strengthens the voice, and has quite a repu-
tation for this purpose among singers and actors. It is
the best remedy against mental depression. It is often
successful against the sleeplessness which comes from
brain and nerve tire. In certain cases it is the best heart
tonic. It is useful in slow convalescence from any debili-
tating disease, and is able to comfort and sustain the aged.
But we must not make the mistake of abusing this
medicine. Used regularly in full doses it is not a tonic
in the sense that it builds up the brain-and-spine. It
modifies sensation and increases power, not by adding
anything to the sum of vital force, but by calling forth
existing resources; in other words, it is a pure stimulant.
Coca, like many other stimulants, maybe, and often is so
gently and judiciously used as to permanently improve the
nutrition of the brain-and-spine, and thus act as a true tonic.
THE ARITHMETIC OF TONICS. In a large proportion
of cases tonic medicines accomplish but little good. If
we suppose a bottle of hypophosphites, holding 96 tea-
spoonfuls to represent ninety-six units for vitality, over-
work, worry, sleepless nights or any continous brain-and-
spine strain will counteract this twenty fold and leave a
large vital loss at the end of a month. Taking a tonic
under certain circumstances is like paddling up Niagara
river with a lath or fighting a conflagration with a
syringe. But if brain-and-spine depressors, devitalizers
and impoverishes are eliminated from the case the month-
ly balance will be all on the side of gain. Ninety phos-
phorus pills, reinforced by 90 hours of oxygen inhala-
tion (out of doors), 90 hours of extra sleep, 90 hours of
recreation, 90 good appetites and 720 hours of brain-and-
spine peace, will almost realize the promises of the nerve-
food man.
\
XXIII
DRUG VICE AND MEDICINE HABIT
THE BRAIN AND NERVE POISONS. Since morphine,
chloral and the bromides became well known to the peo-
ple, three new nervous diseases have been added to the
list, books are written on the treatment of morphino
mania, chloral and bromide addiction, and asylums are
built to accommodate the increasing number of victims.
The new nervines, cocaine, antipyrine, acetanilide, and
others still newer, are becoming popularized with alarm-
ing rapidity.
Dr. Warren-Bey writes to the Virginia Msdical Monthly, that
the extent to which antipyrine is employed in Paris is incredible.
The average French doctor prescribes it for all the ills that flesh is
heir to ; it has become as necessary an article in every lady's bou-
doir as her perfume-bottle ; scarcely a man can be found who has
not some of it carefully stored away in his pocket-book ; children
are raised on it, and cry for it as for their biberons ; and, in fact,
they all take it, and for all things, but especially for migraine,
which, as you know, is pre-eminently the malady of those who in-
dulge in social dissipation. " That you may form an idea of the
extent to which it is the rage, I will give you an incident as it was
told me by the party immediately concerned : Mrs. P. was
dining out recently in the Faubourg St. Germain, when she
chanced to mention that she had suffered with headache during
the day. Instantly, from the pockets of thirteen of the fifteen
guests who were present, antipyrine was produced in capsules,
wafers, powders, and elixirs and she was compelled to take a
dose then and there, noth withstanding her earnest protest, and
her assurance of entire relief before starting from home." N. Y.
Medical Record.
Although the recent nervines are not yet seen to be
very injurious (as chloral was not at first), yet our expe-
rience justifies us in formulating a law that the habitual
9 (129)
I3O NERVE WASTE.
use of any drug which quickly and powerfully influences
the nervous tissues is injurious to their nutrition.
If we seek the causes which have led to the wide-spread
and spreading drug-intemperance, we note first of all the
example of the physician. The great use of stimulants
and sedatives by medical men suggests the idea that there
is virtue in them, and in action the drugs speak for them-
selves. The patient does not always realize that that
which is simply a tonic or a stimulant of* a sedative in
skillful hands may easily become a poison in unskillful
ones, and thus he is often betrayed into tampering with
dangerous agents. We do not give our patients the best
service of which we are capable when we resort too readily
to palliative drugs. Probably we should more often
teach that pain, sleeplessness, headache are beneficent
warnings, reminders that something needs adjusting,
rather than evil spirits to be cast out by chemicals. But
weak as we are, and desirous to please, we find the magi-
cally acting drug a greater triumph, at the time, than any
ascetic doctrine of vital economy. When these drugs
must be given, it would be better if patients remained in
ignorance of what they are taking; such ignorance could
do no harm, and here very often, " a little knowledge is a
dangerous thing."
The enterprise of certain manufacturing pharmacists has
of late become active in cultivating the use of powerful
drugs among the people. Seizing upon the labors of the
physiologist and the clinician these gentlemen devise com-
binations of the most potent drugs and exhaust their
fertile imaginations in advertising them ostensibly to the
medical profession, but practically to the people.
To our shame, there is no lack of physicians who, in
ignorance, or for the paltry gratification of seeing their
names on a proprietary medicine wrapper, laud these
preparations to the skies. Some of what should be the
most honored names in American medicine are flaunted,
DRUG VICE AND MEDICINE HABIT. 13!
million fold, in the face of the public, and given the ap-
pearance of recommending this man's " powerful tonic,"
or that one's remedy for headache. 1 With unique impu-
dence many manufacturing pharmacists have undertaken
the education of the medical profession, and from among
their boxes and barrels issue books and circulars on the
art of curing disease which have no little influence upon
those of our 90, ooo physicians who are ignorant, or feeble-
minded, or who have no other source of information.
One of over a hundred physicians' testimonials to the
virtues of a certain widely advertised sedative is so illus-
trative, so suggestive and withal so naive, that I quote
it; the italics are mine.
Dr. , , writes: " gives more relief in cases of
headache than any remedy I have used before. In two cases of
nervous prostration where other remedies failed to give relief,
both ladies being married, and great sufferers from almost contin-
uous headaches, your gave permanent relief without any bad
effects. In some cases, I find the remedy has to be persisted in
before permanent cure is effected. To my certain knowledge^ I
have now six families on my list who ate never without a bottle of
in the house. It is a welcome medicine to my suffering
patients."
We may safely suppose that the * * permanent cure ' ' will
continue until the "bottle in the house" has lost its
power, and that the gentleman can give his two patients
(both married) better care than dosing them with bro-
mides is.
1 Many proprietary preparations, it is fair to say, are more elegant, convenient
and portable than any prescription of the same ingredients could be made;
specialism in pharmacy, as in medicine, excels in some respects. But " good
wine needs no bush" is not an axiom with the manufacturing pharmacist, and
the specious, ignorant or false statements which some manufacturers see fit to
supply with their bottles make them infinitely mischievous. Having some ac-
quaintance with the proprietary preparations on the American market (which
differ from patent medicines in being 1 non-secret, often meritorious, and in
being ostensibly at least addressed to the medical profession) I can at this
moment scarcely recall two whose advertisements state the truth, the whole
truth, and nothing but the truth, and do not, designedly or otherwise, suggest
a false idea of their real power and uses.
132 NERVE WASTE.
ABUSE OF TONICS. Sufferers from any chronic disease
are apt to become addicted to self-drugging. There seems
to be a tendency in human nature to search for some mys-
terious substance to charm away disease, or to renew the
vigor of youth; the history of Ponce de L,eon is daily re-
peated in every drug store in the land. We prefer to find
health rather than try for it, just as we prefer winning a
fortune to saving it. Marvellous cures, faith-cures and
every novelty in cures that promises restoration of health
without penalty for hygienic sins, and without the price of
effort, are welcomed by the people ; false teachers in the
gospel of health flourish. Remedies about which there is
no mystery sunshine, pure air, proper food and correct
habits are not very popular; though their value is felt
and admitted; they are too homely and slow. In spite
of repeated disappointments the sick turn again and again
to the druggist. The druggist, in his turn, does not use
much medicine; for him the element of mystery is lacking.
PATENT MEDICINES. Since the time that men first saw in
the misery, the ignorance, the vain wishes and the credu-
lity of the sick a fine field for commercial enterprise, and
assumed the responsibility of advising and treating them
by wholesale, self-drugging has increased until it has now
reached the proportions of a national evil. More than
twenty- two million dollars are annually expended in the
United States for patent medicines alone, and between
five and eight million dollars are paid for advertising
them. Before the abolishment of the stamp-tax a few
years ago, patent medicines brought the government an
annual income of one million eight hundred thousand
dollars. The advertisements of patent medicines are nearly
as great an evil as the medicines themselves are, since
their artful descriptions and sensational appeals influence
hundreds of thousands of well persons into believing
themselves sick.
DRUG VICE AND MEDICINE HABIT. 133
The universal habit of medicine swallowing immensely
increases the aggregate of medical pratice, and it is not
exactly worldly-wise in a physician to rail against these
aids to his business. But here I may be pardoned an
observation : there is a wide difference between the true
physician and those merchants who reach after and treat
the sick upon strictly business principles. The medical
profession has its faults, but one of its glories is that the
traditions of centuries, and a powerful professional opinion
lead even a selfish man to place the welfare of his patient
above his own pecuniary interests. What a contrast
between this attitude and that of those pretenders who
" sell what never can be bought," or of those renegades
who realize the words of the great Abernethy , ' ' Medicine
is the noblest of professions, but the meanest of trades. "
Professional egotism is a fault from which medical
men are not exempt, but it is not so unfounded nor so
dangerous as lay egotism. There is no other scientific
subject in which the people feel so much ableness as in
therapeutics. Men and women who would not meddle
with a watch or a piano do not hesitate at the human
body. Not a few persons even distrust physicians, seem-
ing to think that a medical education warps or stunts, or
in some way unfits a man to care for disease. I remem-
ber being called many years ago to the bedside of a
young woman, who had been treated without much suc-
cess for three days by her mother. The good lady
wished no more from me than the name of the malady ;
"we have Dr. Gunn's Family Physician in the house,"
said she, "and we always treat by that." I had lately
to envy the complacent completeness of a system of medi-
cine, propounded by a man who is wise enough in his
own trade. Said he, " all diseases come from the blood ;
all you have to do to keep well is to thicken it up in the
fall with a little sarsaparilla, and thin it down in the
spring with a little blue mass." The lay egotist observes
134 NERVE WASTE.
one case, and makes rules for all the world ; the scientific
physician observes twenty cases and is silent.
The most pathetic (and of late too frequently reported)
instances of lay egotism are those in which a deluded
mother, convinced of her supernatural healing power,
permits a helpless child to die without earnest skillful
effort to save it.
AMATEUR PHYSICIANS. The popularizing of knowledge,
which is one characteristic of the mental activity of our
time, has drawn the veil from all the sciences, and from
none more completely than the medical sciences. The
reading public feels some familiarity with medical theo-
ries, and is more or less informed in new remedies. This
is desirable, for intelligent men make the best patients.
But a certain proportion of intelligent, imaginative and
self-confident persons make the mistake of practising
medicine upon this imperfect "knowledge. The amateur
doctor is everywhere about, and manages his own ills
and advises in those of his friends with a confidence
which the oldest physician might envy. Such a man is
above patent medicines ; he reads standard medical
treatises, and uses the tools of the educated physician.
Many invalids enter upon this amusement as they would
upon amateur photography, or bicycling, and I have
known a gentleman to spend large sums of money on
books and apparatus, and treat himself for months, be-
fore discovering that he was treating the wrong disease.
New drugs as fast as they appear are known to the ama-
teur doctor, and used by him perhaps more extensively
than by physicians. Coca, cocaine, antipyrin, antifebrin,
caffeine, and other drugs are to-day largely in the hands
of the laity.
There are three good reasons why amateur drugging
is not wise, and why it seldom permanently benefits :
i . It is based upon unskillful diagnosis. The art of
knowing how, and how far any man varies from the nor-
DRUG VICE AND MEDICINE HABIT. 135
mal standard is the finest in medicine, and is essential to
wise treatment. A sick man's mind is not to be trusted to
decide upon the nature and degree of his disease. It is
apt to be biased by its own fears and wishes. Physicians
know this, and when sick, rely upon some professional
brother.
2. It lacks wisdom in selecting remedies. Wisdom is
something more than intelligence ; it is intelligence plus
experience. The girl of fourteen and the matron of forty
may read the same novel, but how different are the pic-
tures which its pages suggest to each. Physicians have
constant examples of the fact that the judgment of the
most intelligent man is worth little outside the range of
his own immediate experience.
Intelligence without experience is misled by taking
theories. Immense sums are spent annually in this
country to persuade that certain drugs have a specific
power over nervous weakness. The plausible logic of
the nerve-food and nerve- tonic man commends itself,
not only to the ignorant, but to the most intelligent.
But, in medicine, good logic is not always good prac-
tice. The literature of medicine is full of good theories
that cannot be made to work in the sick room. There
are good chemical theories for the cure of diphtheria,
consumption, diabetes; but the working physician is not
able to realize their promises. The chemist can formu-
late a perfect theory for making thin people fat, and fat
people thin, but it has a very limited use in real life.
3. It lacks judgment, proportion, discretion, in apply-
ing medicines. Degree is everything in therapeutics.
Every drug, indeed every force, which has real power
against disease, has a certain action and produces a cer-
tain reaction in the tissues ; the management of these
actions and reactions is an important part of the physi-
cian's skill. It is very easy for stimulation to become
Over-stimulation (irritation and exhaustion) and for seda-
136 NERVE WASTE.
tion to become depression. A few facts may serve to
indicate that drug-giving is a more intricate science than
many suppose.
1. The effect of most medicines varies greatly with the
dose in which they are given; quinine in small doses is a
very good remedy in certain headaches; in large doses it
often causes terrible headache; opium in small doses
strengthens the heart ; in large doses it weakens it to
death; ipecac is one of the surest emetics; it is also one
of the best medicines to arrest vomiting; arsenic, in large
doses, poisons to death by its irritant effect upon the
stomach; in small doses it is successfully used to soothe
the stomach and to allay vomiting; calomel is a powerful
purgative it is used extensively, in small doses, to soothe
the irritated stomach lining.
2. The length of time any drug is continued affects the
result. All the ' ' bitters ' ' and stomachic tonics, which at
first increase the digestive power if used too long, cause
dyspepsia. Over-stimulation ends in exhaustion. The
same principle applies to purgative pills. Here is one of
the ways in which unwise drugging does harm. Many
persons reason that if one bottle is good, twelve bottles
are twelve times as good; they pass in the dark the point
where the medicine ceases to be of any use, or becomes an
injury in their particular case. This over- doing is a
characteristic of domestic treatment. It is not uncommon
to meet persons who have been having some prescription
refilled for years, not knowing that the fact that it did
them much good at one time, does not prevent it doing
them much harm later. The "tonic" habit, the "bit-
ters," and the purgative pill habits, are as injurious in
their way as the morphine, chloral and alcohol habits.
For many years the liver was a favorite talisman with
those persons who live by playing upon the fears of the
sick, but lately the kidneys have become a favorite organ,
as affording even a greater scope for business enterprise.
DRUG .VICE AND MEDICINE HABIT. 137
Most of the ' ' kidney-cures " advertised so freely, are to
the kidneys what a drastic purgative is to the bowels
they "scour them out." Some kidneys need a drastic
influence, and the individual feels better after using these
compounds; but their continued use, or their use in per-
sons whose kidneys happen to be irritable, sensitive,
congested from exposure to cold, or some other cause, or
in persons who have inherited a tendency to inflammation
of the kidney may easily result in incurable Bright' s dis-
ease.
j. The combination of drugs, so that certain powerful
ones are modified, corrected, assisted, is a principle of
drug-using that has made great progress in modern medi-
cine; this principle is especially valuable with ' ' neurotics, ' '
that class of medicines used to affect the nervous system.
/. Age, temperament, inherited tendencies, climate, occu-
pation and many other circumstances influence the choice
and the dosage of drugs; twin brothers having the same
disease might require altogether different medicines and
directions.
It would be a great blessing if a safe and sure method
of home treatment for every disease could be perfected
and taught; tens of thousands of the sick poor are unable
to secure adequate medical aid, and only a small portion
of the sick are treated by physicians.
But skill comes only by practice. A novice in rifle-
firing sees the target and has intelligence to estimate the
distance and point the gun, but he cannot hit the mark.
The inexperienced young housewife may study the recipe
and measure the ingredients ever so carefully, but the
bread is a failure. Dr. Holmes, speaking of physicians,
says, " The young man knows the rules, but the old man
knows the exceptions;" and before reaching the wisdom
to effectually use drugs, the brightest intelligence must
be qualified by years of observation in the sick room.
Most of the advertised remedies against nervous impair-
138 NERVE WASTE.
inent are manufactured to sell, and have no relation to
scientific treatment. But if a physician were to lay before
his patient a carefully selected stock of instruments and
medicine, in many cases he would injure rather than
benefit himself with them. A set of watchmakers' tools
may be used to ruin a watch as effectively as a crowbar.
There is no work in which trained perceptions, the
habit of study, solid thought go for more than in
the work of curing disease. So let not my reader ever
imagine that the prescription of some famous physician,
written for another, will necessarily be of use in his case,
for the most important thing about a prescription for the
patient, is the wisdom which directs its use. The knowl-
edge that decides what remedy to use, how long to use it,
when to modify or combine it with other remedies, when
to stop its use for a time, and when not to use it at all
can never be conveyed within the limits of a patent
medicine circular.
Many cases of nervous debility are best cured without
the use of any medicines whatever; all they need is good
advice, and the wisdom to follow it, to get well. There
is a class of patients which comes to the physician with a
history of prolonged and copious ' ' medicine-bibbing and
drug- tippling " as it has been termed. They have ' ' tried
everything " and doctored for every chronic disease, with
physicians of every school, including magnetic healers
and the faith-cure, and the physician feels that he is in
the presence of a very experienced patient indeed. It is
not always that this class of patients can be sufficiently
controlled to get well; but when they can be, it is remark-
able what results can be produced by a course of treat-
ment which may not include a single teaspoonful of med-
icine.
The story of one case may be instructive. The patient
was a very intelligent young man, a college student.
Some six months before coming to me he began to treat
DRUG VICE AND MEDICINE HABIT. 139
himself for nervous debility. He avoided all advertised
nostrums, and procured standard medical treatises, which
he studied carefully, yet the conclusions which he drew
from these did him considerable injury. During most
of this time he was taking phosphorus pills with other
drugs, such as strychnine and quinine, which he had
learned were powerful nerve- tonics. He subjected him-
self to a daily cold shower bath as prolonged as he could
bear; he exercised beyond his strength; he purchased an
electric battery and used it for several months; but, con-
cluding that it did him no good, he gave up its use. He
thought and worried constantly about his condition.
When he first came under my notice he was quite thin,
visibly nervous, unable to study, his appetite capricious,
and altogether he was considerably worse than when he
began to treat himself. Upon taking charge of his case I
abolished all medicines ; his cold bathing I changed to a
hot salt water bath every other day, and devoted myself
to curing certain local conditions of the reproductive sys-
tem which were at the bottom of his trouble. When
this was nearly accomplished his vacation came on, and I
sent him to the country ; he spent six weeks in the Santa
Cruz mountains, and returned thoroughly well, having
gained sixteen pounds in weight, and he has remained
so since. One of the most important factors in the cure
of this patient was the mental load which he got rid of in
thoroughly understanding his condition and prospects,
and in shifting the responsibilities of his treatment from
his own shoulders to those of a physician.
XXIV
ELECTRICITY AS A REMEDY
Electricity is one of the modes of molecular motion like
heat, light, and sound, and is convertible into these forces.
Three kinds of electricity are used in medicine: i, the
Galvanic, or constant current, obtained from chemical
action in a number of cells, from one to sixty; 2, the
Faradic, or interrupted current; this is an induced or
secondary current, obtained by the magnetizing and de-
magnetizing of a rod of soft iron, around but not through
which a galvanic current from one to four cells is made
to pass; 3, Static or Frictional electricity, developed by
friction between large revolving plate-glass wheels and
rubbers; in using this kind of electricity the patient is
insulated and charged, like a Ley den jar, and then, by
touching his body in various places with metal rods, the
electric force is drawn out at any desired point. With a
good machine it is possible to draw sparks from one to
twelve, or even more, inches long from certain parts of
the body.
The two first mentioned forms of electricity are of the
most value in nervous impairment. The galvanic current
gives merely a superficial sensation; it is a silent current of
great quantity but of low intensity. The Faradic current,
on the other hand, is readily felt within because of its high
degree of intensity. The constant current has been com-
pared to a mighty, slowly moving river ; the interrupted
current to a rapid, leaping, noisy mountain brook. The
current of frictional electricity has a high tension, but
this form of electricity collects chiefly upon the surface of
the body, and never penetrates very deeply below the
skin.
(140)
ELECTRICITY AS A REMEDY. 141
When the electric current is passed through the body
several effects are produced, according to the kind of cur-
rent used ; the particular nerves it is made to traverse,
the quantity or the intensity of it ; the direction it is made
to take, whether toward or away from the central nervous
system ; the length of time it is used at each sitting ; the
peculiar susceptibility of the patient, and the dosage of it.
It is only within a few years that physicians have prac-
tised the measurement of the electric current, but this
assistant to the remedial use of a powerful agent is .most
important ; the battery differs on different days ; ten cells
on Monday may represent a different amount of electricity
from ten cells on Tuesday ; again the patient's suscepti-
bility and conductibility may differ on different days. In
many cases in which electricity is used it is highly im-
portant to have a uniform, or slightly increasing dose at
each sitting, and this result can only be attained by
means of a delicate instrument called the milliampere-
metre. A recent writer remarks : "I can as easily
imagine a drug store without scales as a medical battery
without a metre."
The electrical procedures used in nervous impairment
are :
1 . ' ' Galvanization of the Neck " or ' ' of the Cervical
Sympathetic." In this operation the circuit is made to
pass through certain nerve-centres which have an impor-
tant influence upon the circulation and upon the nutri-
tion of the whole body.
2. Central Galvanization, in which the negative
pole is placed over the stomach (and thus over the great
solar plexus of the sympathetic) and the positive pole at
various points upon the spine and neck. This procedure
powerfully influences the circulation, excretion in skin,
and nutrition in brain-and-spine.
3. Spinal Galvanization, in which the entire spine is
subjected to the galvanic current.
142 NERVE WASTE.
4. Abdominal Galvanization, includes the spine and,
in turn, the various digestive organs within the circuit.
It is a powerful stimulus or tonic (according to degree),
increasing liver-action, bile-flow and in some cases re-
moving chronic constipation.
5. Genito-Spinal Galvanization subjects the entire
reproductive apparatus, including the lower spine, to the
galvanic current. In sexual neurasthenia this operation
has the power of allaying irritability and improving nu-
trition in a remarkable degree, and in functional pelvic
disorders of women it is one of the most efficacious
remedies.
6. General Galvanization subjects the entire body,
from neck to feet, to the action of the galvanic current.
7. General Faradization consists in subjecting the
whole body, from neck to feet, to the induced current.
It is useful, but less so, in my hands than central or gener-
al galvanization.
8. The Electrical Bath, much thought of by some, has
in a large proportion of cases no advantages over less trou-
blesome methods. It diverts, instead of concentrating
the current a disadvantage where local organs are to be
influenced. I^ocal forms of electrical bath are, in some
cases, very useful.
The various remedial uses of electricity may be summed
up as follows :
1 . It is a powerful stimulant and tonic, not because it
adds anything to the tissues in passing through them,
but because it rouses them, stirs them up, revivifies or
puts new life into them, and thus enables them to assim-
ilate and make new tissue and force.
2. It may be made to exert a sedative or soothing
effect upon internal organs that can be reached in no
other way ; this it does by a gentle stimulant or counter-
irritant action just as we rub a flea-bite to soothe the
irritated skin ; and in congestions of deep-seated parts it
ELECTRICITY AS A REMEDY. 143
acts by contracting the relaxed and flabby tissues, and
emptying them of surplus blood.
3. It can produce an alterative effect, /. e. , cause a
wholesome change in organs, the seat of some morbid
process, in a manner which we cannot explain.
4. It can be made to counter-irritate and powerfully
impress superficial nerve-ends, and thus, through them,
the central nerve-cells.
The power of electricity to influence nutrition in brain-
and-spine constitutes its greatest usefulness in nervous
debility. In the treatment of all the functional nervous
disorders epilepsy, St. Vitus' dance, hysteria, writer's
cramp, neuralgia, sick headache this tonic influence of
electricity is one of our chief resources. In the various
local phases of nervous impairment in the irritable
spine, the irritable ovary, the irritations and weaknesses
about the male reproductive organs, the most gratifying
results are often obtained with this remedy. The stimu-
lant and the sedative action of both the galvanic and
faradic currents is sometimes efficacious against the
paroxysms of sick headache and neuralgia.
The use of electricity as a remedy requires a thorough
knowledge of the anatomy of the nervous system, of the
exact location of the nerve-centers to be treated, and of
the geography of the various nerves. It is perhaps need-
less to say that the passing of a current from one hand to
another, through the arms, has no value in the treat-
ment of nervous impairment ; as well might one rub an
internal medicine upon the hands and expect benefit. To
do good electricity must be made to pass through the
diseased parts.
The electric belts, electric corsets, electric brushes, and
other cunning baits for inexperience, are useless in ner-
vous impairment, though the purchaser sometimes gets
his money's worth in experience ; these toys have no
effect other than that which they occasionally produce
144 NERVE WASTE.
upon the imaginations of certain persons. A proposal to
use electricity is not unfrequently met with some such
remark as this, " Oh ! I have tried that ; it is of no use
in my case," and questioning develops the fact that the
patient has worn an electric belt, or that he is the owner
of a Faradic battery. The calm self-confidence of many
persons in their ability to use tools which it has taken
him years of labor to learn to use is sometimes a little
piquing to the physician ; a truer way to put it would be
that an unskillful use of a good remedy has failed, as
unskillful attempts in any direction are very apt to do.
Scientific electricity has other resources beside those
used in the cure of nervous debility. As a means of
diagnosis it is very valuable to the neurologist ; the gal-
vano-cautery enables the surgeon to remove many dis-
eased growths, and to perform many operations without
the loss of a single drop of blood. Probably the most
remarkable action of electricity in the human body is
that known as electrolysis, by which abnormal growths
and tissues are made to disappear by being decomposed
into their chemical elements. Two highly important
applications of electrolysis have been established within
the past few years the removal of fibroid tumors of the
womb, and the melting away of strictures of the male
urethra, and in each of these cases electrolysis replaces
dangerous surgical operations.
XXV
SURFACE REMEDIES
The skin is not popularly thought of as an organ, but,
with its 2,500 square inches of surface, its 7,000,000 folli-
cles, its 1,750,000 inches (28 miles) of perspiratory chan-
nel, its unnumbered nerve-ends, it is one of the most
wonderful and important organs in the human body. It
serves as a tegument to protect the internal parts ; it is
an excretory organ second only to the kidneys ; it is an
organ of perception by the tactile sensibility of the skin
man largely, unconsciously, estimates his relation to the
outside world.
The great extent of this superficial organ, its sensi-
bility, its extensive communication through nerves with
brain-and-spine, all enable us to powerfully influence the
organ of vitality through the skin.
BATHS may be made of great value to the nervous.
The cold sponge bath (which requires only a large bath
sponge, a bowl of water, and a piece of oil-cloth) taken
immediately on getting out of bed, and lasting perhaps a
minute, is a valuable tonic, and is as strong a form of
cold bathing as is advisable in many cases. In persons
who have plenty of blood, the cold shower, or the plunge
bath, taken in early morning or in mid-forenoon, may be
better.
Many persons make too long a use of the cold bath. A
half minute, or a single minute, spent in passing the
sponge over the limbs, chest and spine, followed by
vigorous rubbing with a coarse towel, will often result in
a fine reaction and a warm glow, when five, or even two
minutes would be too long. The danger in the cold bath
10 ( 145 )
146 NERVE WASTE.
is in cooling the body below the normal (98.6) tempera-
ture, and thus depressing. When the body temperature
has been raised above the normal, cold may be applied
without danger down to 98.6. We read that the Russian
will emerge from his hot vapor bath and roll himself in
the snow.
This question of cold bathing is to be decided by the
effects which it produces; if the individual comes to the
breakfast table after his sponge, sheet, or shower bath,
warm and glowing, the bath has done good, but if the
flesh is cooler than before the bath, or if a feeling of slight
chilliness is experienced, the cold bath has done harm.
There are doses of cold bathing, as well as of other
remedies, which must be regulated by the powers of the
individual. In some, generally thin persons, any form of
cold bathing has a depressing effect, and is inadmissible.
Sea Bathing, as a remedy, ranges all the way from a
powerful tonic to a powerful depressant, according to cir-
cumstances; as a rule it is not adapted to thin or to weak
persons. By the robust it is often overdone and made to
produce depression rather than elevation of the vital
powers. I advise my reader to be guided by medical
advice before resorting to this form of bathing. The hot
sea-water baths, to be found at most -seaside resorts, are
much more useful, in a large proportion of cases, than
open sea bathing.
The warm (96 to 104) or hot (lof to nf} bath is
safer for the thin and the enfeebled than the cold bath; they
do not abstract heat from the body as the cold bath does.
The popular impression is that warm baths are weaken-
ing, and this is true if they are too prolonged. But a five
minutes' hot bath, to which two tablespoonfuls or more
of salt or mustard has been added, acts as a tonic, and
produces better effects in many persons than the cold bath.
Artificial hot sea-water baths may be improvised at
home by adding 3 per cent of salt to the bath nine
SURFACE REMEDIES. 147
pounds of salt to thirty gallons of water. Ditman's Sea
Salt may be had of the druggist in five-pound boxes ;
ordinary rock-salt will do very well, though it is more or
less dirty and the resulting water needs straining.
Various substances are added to the hot bath for the pur-
pose of rendering it stimulating or tonic instead of weaken-
ing. Chopped sea-weed or a decoction of sea- weed makes
the Fucus bath or, as it is called in England, the Ozone
bath. The Pine bath, prepared by dissolving one half to
one pound of the extract of pine-needles in warm water
is in use in the German institutions. The essence of pine-
needles added in small quantity to a warm bath floats on
the surface of the water and clings to the person on leav-
ing the bath, enveloping it in an agreeable aroma. The
extract of aromatic herbs (one pound to a bath), chamo-
mile, gentian, calamus, mint, juniper, marjorurn, clover-
blossoms, etc. , is also used in Germany to render the warm
bath stimulating.
The alternating Hot and Cold Salt Sponge Bath is one
that I frequently recommend. A large bath sponge is
alternately loaded with hot and with cold salt water
and expressed over limbs, trunk, and especially over the
spine. Begin with the hot water and end with either hot
or cold, as most agreeable. This bath, lasting two to five
minutes, is a powerful tonic.
All but complete immersion in a hot bath, to which a
handful of powdered mustard has been added, has served
me well against sleeplessness. In a half or two- thirds full
bath-tub one may so arrange himself that nostrils and mouth
or the nostrils alone are the only parts of the surface out of
water; the extensive sedative and blood-diverting influ-
ence of this bath powerfully calms an irritated nervous
system. Two to five minutes is long enough. Of course
such a bath would not be advisable in cases of weak or
fatty heart, and is not to be made use of alone by very
debilitated persons.
148 NERVE WASTE.
The Vapor (Russian) and the Hot-Air (Turkish) baths
are useful in certain cases as a powerful remedy against
sleeplessness, but these baths. have their dangers, and
more than any other form of bathing need to be directed
by the physician. In them the body is subjected to a
heat of from 113 to (in some cases) 140 or more. A va-
por bath may be taken at home by placing a shallow ves-
sel of boiling water under a chair, adding one or two hot
bricks and enveloping the body seated upon the chair
with blankets. Vapor baths are sometimes rendered more
stimulating or agreeable by passing the steam through
bunches of fresh aromatic herbs or by adding pine-needle
extract or Canada balsam to the water.
Local Bathing of various kinds is a remedy of the
highest value in the various phases of nervous impair-
ment ; as a means of local treatment hot water is greatly
superior to cold.
In the various weaknesses and congestions about the
female reproductive organs, the local use of medicated
hot water is more efficacious than any other single rem-
edy ; and in the various irritations and relaxations about
the male reproductive organs I use hot medicated solu-
tions, externally and also internally, by means of certain
contrivances, with the best results. Weak and irritable
eyes are generally more benefited by hot or warm washes
than by the cold ones so often recommended. When a
weakened nervous system includes among its other
enemies, some chronic inflammatory process about the
nasal and other upper air passages, hot medicated solu-
tions and sprays form an important element in the treat-
ment.
In certain catarrhal conditions of the stomach, as well
as in other forms of dyspepsia, washing out the stomach
with various medicated waters by means of a long flexible
tube is of great benefit; this lavage is more used by Euro-
pean physicians than by Americans.
SURFACE REMEDIES. 149
HEAT AND COLD are forces of great power in many of
the symptoms of nervous impairment. One who is liable
to any form of neurasthenic pain should have, and es-
pecially carry with him when he goes from home, two
large rubber bottles for hot water which may be applied
to feet, abdomen, spine or face in different cases. Heat
to the small of the back is a powerful stimulus to the cir-
culation and may be employed against ' 'a cold' ' or any con-
dition of depression. A small can of powdered mustard,
with which and a handkerchief a powerfully sedative ap-
plication can be made in half a minute, and an alcohol
lamp should form part of the armamentarium of the neu-
rasthenic on his travels. Pain can sometimes be ironed
out of a face, neck or limb by means of a hot flat-iron
and a piece of flannel. Kvaporating lotions of any alco-
holic liquid and water, so commonly used in headache,
are only a means of producing cold; cloths wrung in ice-
water are preferred by some. A hollow helmet filled with
ice-water is part of a plan of treatment of St. Vitus'
dance recently praised by Dr. Corning of New York;
this refrigeration of the scalp, used in connection with the
galvanic current, contracts the brain- vessels and secures
the brain rest for which Dr. Corning has long been so able
a pleader. Ice-bags over brain-and-spine, gradually con-
tracting and expelling blood from the vessels of the cen-
tral nervous system, constitutes a successful treatment of
many nervous symptoms, of which the philosophy has
been ably taught by Dr. John Chapman of Paris. The
permanent arrest of neuralgic pain by means of intense
cold (produced by the application of chloride of methyl)
is reported by certain French physicians. Cold, locally
applied, is sometimes of great service against deep re-
productive congestions in either sex; thus the "psy-
chrophor," or cold carrier, of Winternitz of Vienna, a
hollow blind tube, through which a current of ice- water
150 NERVE WASTE.
is passed from a high reservoir, is a powerful measure
against deep urethral and prostatic congestion.
COUNTER-IRRITATION, influencing the nerve sources by
means of stimulants applied to the nerve-ends, has been
in use from the dawn of history, and is practised by the
most primitive peoples. A mustard poultice, a spice-
bag or a plaster which relieves deep-seated pain, conges-
tion, or inflammation, is popularly supposed to act by
"drawing out" the soreness or the inflammation. In
this, as in hundreds of other medical phenomena, inex-
perience observes correctly enough, but deduces incor-
rectly. The physiology of counter-irritation includes
the stimulated nerve-end, the in-going sensation-bearing
nerve, the ultimate receptive and reactive nerve-centre,
the out-coming impulse-bearing nerve-fibre, and the deep
tissues relaxed or contracted, soothed or stimulated
according to circumstances. The essential factors in
counter-irritation are the nerve-centres of brain-and-spine
and sympathetic. In deep-seated irritations, congestions,
relaxations, inflammations, counter-irritation is still one
of the most efficacious procedures. Rubefacients, the
galvano-cautery, and the thermo-cautery, never pushed
so far as to injure the skin or to cause much pain, are
especially useful in certain spinal and deep reproductive
disorders
Counter-irritation is one of the oldest procedures against
pain. Equal parts of camphor and chloral-hydrate rubbed
together will form a liquid, which is of great service as a
liniment in neuralgia. L,iniments containing chloroform,
aconite, alcohol, tincture of cayenne-pepper, menthol and
alcohol are much used. A mustard plaster, or spongio-
piline wrung out in hot water and sprinkled with the
compound liniment of mustard, and even flying blisters not
larger than a quarter of a dollar over the painful point are
often highly effective.
SURFACE REMEDIES. 15!
MASSAGE is a word derived from a Greek word, signi-
fying to press, knead, or handle. Massage is one of the
oldest remedies in existence ; from time immemorial,
shampooing, rubbing, flagellation, and other manual pro-
cedures have been used in the orient, and among various
uncivilized races. Modern medicine makes a considerable
use of this agent. The chief procedures of massage are a
gentle stroking toward the heart effleurage ; a vigorous
rubbing massage a friction; a pinching of the muscles
petrissage ; and a tapping or percussion of the muscles
and flesh tapotement.
The effects of these various operations may be sum-
marized as follows :
1. They increase the circulation and activity of the
skin, thus enabling it to better perform its function of
sweating out excrementitious substances from the blood.
2. They improve the nutrition of the tissues lying
immediately under the skin; this fatty layer is increased,
and thus the body improves in weight and appearance.
3. They equalize the circulation, drawing blood away
from the brain or from internal organs, thus relieving in-
ternal congestions.
4. They produce a distinct sedative or tonic effect
upon the terminations of the nerves, the end organs of
the nervous system, and thus exert a good effect upon
the central nervous tissues.
Massage will often induce sleep in the sleepless, or
replace the intolerable feeling of fatigue of which some
patients complain, by a feeling of warmth and comfort.
It is sometimes possible to stroke away a headache or
neuralgia as though by magic. In various affections of
the joints and muscles, as rheumatism, massage is the
most valuable remedy. The effects of massage described
above are part of the secret of the ' 'magnetic healing' ' so
much in vogue. The magnetic healer is generally a
152 NERVE WASTE.
person who makes an ignorant and unscientific use of
massage; they often overdo it and thus produce injury.
There are at the present day, in all large cities, a class
of men and women who have been trained in this art,
and the services of these masseurs and "masseuses are often
utilized by the physician, and not a few physicians make
personal use of massage as adjuvant to other remedies.
In thin, badly -nourished infants, a daily rubbing with
cod-liver, or some other oil, for half an hour, will produce
great benefit ; they improve in weight and appearance
almost immediately.
CLOTHING has an important bearing on nervous impair-
ment. Those whose vitality is diminished, whose resis-
tant or re-active powers to cold are deficient, easily "take
cold' ' . My neurasthenic patients are constantly taking
cold. Taking cold is a purely nervous (vaso-motor)
phenomenon. A draft strikes the surface, or a cold damp
air chills it; the nervous mechanism of the sympathetic
contracts the vessels of the skin temporarily suspend its
function of excreting (perspiration) and throw a dispro-
portionate part of the blood stream upon certain internal
organs. The blood thus precipitated internally is not a
pure blood; it is a blood which has failed in relieving
itself, in the skin, of certain excrementitious substances.
Perspiration is, to some extent, an excretion like urine;
it is one of the fluids in which the body washes out its
waste materials. Every household produces a certain
quantity of garbage, which is promptly and regularly re-
moved; when, as recently happened in this city, the
scavengers go on a "strike," a short accumulation is of-
fensive and unwholesome. The function of perspiration,
to which modern physiologists attach the greatest im-
portance, is regulation of the bodily heat. It is largely
by evaporation of sweat that the body is steadily main-
tained at a uniform temperature. When sweat fails the
internal heat point is raised above the normal and internal
SURFACE EEMEDIES 153
fever occurs. In temperate weather an adult perspires
about two pints in twenty-four hours. In a Turkish bath
the body can lose two pints of sweat in a single hour.
* 'Sensible" perspiration occurs when drops appear upon
the skin: insensible perspiration is going on, in places,
continuously. The physiologies used to record the story
of a child who was gilded all over, to represent an angel
in a papal festival at Rome, and who died in four hours,
from suppression of this excreting and heat-evaporating
function.
When a cold drives back an excess of impure blood
from the surface it is not accommodated by all internal
organs equally, but largely by certain tissues which
seem to have a compensatory or complementary relation
to the skin. The blood-wave rejected from the skin by a
cold does not often "settle" in bone or ligament or brain,
but is very apt to engorge nasal, bronchial or intestinal
mucous membrane. Any internal mucous surface which
has been diseased, and thus weakened and rendered less
resistant, is liable to feel the effects of a cold; even the ure-
thra in certain chronic cases is a perfect barometer; in
others the spine is very sensitive to cold.
For several reasons the nervous should wear woolen
under-garments. Wool protects against draughts, it
absorbs moisture (perspiration), it absorbs odors, keeps
the flesh sweet-smelling, and exerts a gentle stimulating,
derivative influence on the surface which favors excre-
tion and softly counter-irritates brain-and-spine. Those
who are subject to bronchitis may advantageously
wear a second woolen under-garment in the form of a
vest: this complete chest-protector is perfect where the
front, or front and back, (side neglecting) protectors ordi-
narily sold are very imperfect. In spinal irritation and
other spinal disorders, a broad band of flannel about the
loins gives great comfort and wards off many an ache; I
have known such a band to cure chronic diarrhoea. There
154 NERVE WASTE.
is no such thing as medicated flannel: red flannel has no
advantage and some disadvantages over white or gray.
The heaviest men's gray Scotch wool under-garments to
be had at men's furnishing stores, re-inforced, in delicate
persons, by an undervest of Bulle flannel, are excellent.
Better are the garments of the Jaeger Sanitary Woolen
System Co. (N. Y.), which are now to be had in most
large cities. Dr. Jaeger would have us discard cotton,
linen and silk and dress altogether in wool, from hat to
boot, and even sleep in woolen sheets, under woolen
blankets and counterpanes. This idea, which seems ex-
treme at first sight, is supported by good reasons and by
experience.
The little plug of cotton in the ears when one is
driving in the wind or has a sore throat wristlets, felt
slippers and cork-sole shoes all afford protection or com-
fort in certain cases.
XXVI
THE SURGICAL TREATMENT OF NERVOUS IMPAIRMENT
The fact lias been more than once noted, that in certain
cases of nervous impairment the skill of the surgeon must
accompany the wisdom of the physician. When a chronic
i.e., thoroughly established, disease-process is acting back-
wards to irritate and depress the brain-and-spine, its
removal is the first thing in order. Sometimes this may
be effected by hygiene and medication ; more often it
requires direct local treatment.
When hurtful tension of one or more of the ocular mus-
cles involving eye-strain, and thus brain-strain tenot-
omy division of the taut muscle has produced brilliant
results in epilepsy.
In hay fever, asthma, and chronic nasal catarrh irrita-
tions about the nose and upper air passages can sometimes
only be cured surgically. The five indications in the local
treatment of chronic nasal catarrh are cleansing of the dis-
eased surface, disinfection, soothing or stimulating the
mucous membrane, reduction of engorgement and conges-
tion, and removal of redundant and diseased tissue. When
the last of these indications exists some surgical procedure
^the cautery, the galvano-cautery, the snare, the curette
or the knife is the only certain resource. As an eminent
rhinologist, in summing up the modern treatment of
chronic catarrhal disorders, recently said: " The sooner we
cease to be throat doctors and become throat surgeons the
better will be our success in the management of diseases
of the upper air passages. ' '
The surgical treatment of neuralgia is all that remains
in some cases. It includes acupuncture thrusting
(155)
156 NERVE WASTE.
needles beneath the surface the injection of various solu-
tions deep into the tissues and alongside the nerve, nerve-
stretching, and nerve-section. All these operations are
successful in certain cases, but the result cannot be posi-
tively promised in any single case.
It is a singular fact that a surgical operation of itself,
without any special indication, will sometimes arrest ner-
vous disorders for years, or even cure them altogether.
The operation of trephining the skull for epilepsy under-
taken in the supposition that depressed bone is irritating
the brain-surface, is often successful in curing the disease
when no depression is found. The operation of ocular
tenotomy in epilepsy, and the operations against neuralgia
probably act in the same way, in a few cases, by the pro-
found impression, or the counter-irritating effect which is
thus produced upon the central nervous structures.
In many cases of nervous disease in children the opera-
tion of circumcision, or, what I often prefer, that of prepu-
tial dilation, will effect a radical cure. It seems supererog-
atory to assert that a natural oigan, placed by the Creator,
is superfluous, and should be removed. But no fact in
neurology is better established than that the foreskin in
sedentary neurotic children may be an irritant, and a cause
of extreme nervous disease. In sexual neurasthenia,
when urethral and prostatic morbid changes are present,
but little progress can be made until these are removed.
In every large community there is a certain proportion
of ca"ses~of ovarian jlisease which have exhausted the
ordinary resources of medicine and surgery, without
benefit, and in which life has become a burden. It was
in. this class ot cases that removal ot the offending organs
_was first practised with brilliant results. Since that time
the operation of ablation of the ovaries has been abused
(what good thing has not ?} and medical men are ranged
pro and con. This operation has not yet become estab-
lished among the medical profession at large, but has
THE SURGERY OF NERVOUS IMPAIRMENT. 157
so among specialists in abdominal surgery. There is
abundant proof that this operation is a blessing in suitable
cases, but there is also, unfortunately, abundant proof
that the good judgment which confines operating to
suitable cases is not common.
In all surgery good judgment must precede skill;
indeed, if one must be lacking I should in my own
person, prefer less skill and more judgment. The readi-
ness, even eagerness, of surgeons as a class to operate
leads the laity to suspect some secret anatomical paranoia
akin to that of ' 'Jack the Ripper, ' ' but man loves to do
that which he can do skillfully and this penchant leads to
much needless operating .
An immense amount of local treatment is conceived and
carried out in dishonesty. Every physician has seen
patients who have been subjected to long and expensive
courses of local treatment for which there was, to say the
least, no legitimate indication. Some patients even de-
velop a kind of mania for local treatment; "folic gyna-
cologique" broadly "womb-doctoring foolishness," is a
French term which might be paraphrased and become
useful in America. An eminent surgeon recently re-
marked, "the favorite hunting ground of quackery is an
obscure, mysterious, mucous canal" where disease may
be imagined but cannot be demonstrated. The urethra,
the rectum and the womb are constantly treated for
imaginary diseases, and an imaginary disease is often
more injurious to vitality than a real one.
XXVII
APHORISMS IN NERVOUS IMPAIRMENT
1. The brain-and-spine is the organ of vitality.
2. The brain-and-spine may be crippled by any form
of functional over-activity wear, tear, strain, wrench, or
over-draft as certainly as the ankle-joint may be.
3. The manifestations of brain- and-spinal impairment
are partly objective, but largely subjective.
4. The signs of distress which a crippled brain-and-
spine hangs out are the most heed-worthy of all morbid
signs.
5. Many cases of nervous impairment are incurable in
their earlier stages, but become curable in a later stage,
after the subject has gotten very much worse; a period
of suffering is sometimes necessary before true remedies
will be permitted.
6. The cure of nervous impairment is a combination
cure, including many forces in proper proportion. It is a
chain of which one broken link throws the whole to the
ground.
7. Natural remedies rest, sleep, food, out-of-door air,
cheerfulness are more efficacious than drugs.
8. Rest nerve economy in large or in small doses,
is in most cases an essential remedy.
9. Oxygen gas in the form of out-door air is incom-
parably the most powerful known tonic and vitalizer to
the nervous tissues in the quickness and certainty of its
action, and in the permanence of its results.
10. Nerve nutrition requires a rich blood-stream, and
hungry, unfagged, actively assimilating nerve-cells. The
(158)
APHORISMS IN NERVOUS IMPAIRMENT. 159
four factors of assimilative (force-creating) and force-
supplying vigor in the nerve-cells are daily food, daily
oxygen, daily work and daily rest, in proportions that
vary with circumstances. Oxygen is the essential ele-
ment of the fire of life as it is of all fire; a blood- stream
fully charged with oxygen gas by deep-breathing, full
and free lung-play, is from ten to an infinite number of
times more nourishing to brain and nerves than a blood-
stream loaded with hypophosphites and lacking in oxy-
gen.
11. Brain and nerve foods are useful as far as they
are assimilated by brain and nerve-cells, and not farther.
12. Of the three great classes of foods starches and
sugars, fats and albumens or nitrogenized foods the last
two are essential to develop and maintain stability, endur-
ance and reserve power in the nervous structures of the
nineteenth century American.
13. A nervous cripple with a thoroughly imcompetent
liver is like a steam boiler which has been condemned;
both can only run at very low pressure.
14. Medicines are valuable remedies in nervous im-
pairment, but their place is secondary and assistant. Of
themselves, and without a foundation of other remedies,
they are, in most cases, powerless to cure.
15. The nervous system, like the eye, is not a good
part of the body for amateur prescribers to experiment
with; unskillful drugging is apt to be useless or worse.
1 6. When a chronic, local morbid process is at the
bottom of, or complicates, nervous impairment, the affec-
tion may resist every kind of general treatment until the
local disorder is removed.
17. Electricity used according to the principles, the
nerve-routes, and the dosage of modern electro- thera-
peutics is one of the most efficacious remedies against
both the general and local phases of nervous impairment.
1 8. Rest, change, sleep, out-of-door air, baths, food,
I6O NERVE WASTE
phosphorus, strychnine, quinine, iron, alcohol, electricity,
massage, and every other remedy which experience has
shown to be good in nervous impairment, may be, and
often is, so used as to aggravate the disorder and make
the patient worse.
19. Rest, feeding, trouble, sacrifice, expense must be
proportionate to the needs of the case; if these fall short
or over-reach the cure is apt to be, so far, a failure.
20. Proportioning the adaptation of restorative forces
to morbid needs and authority the vis externus which
maintains proportion often constitute the great power
and use of the physician in nervous impairment.
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