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 No. 
 
NERVOUS BREAKDOWN 
 
 ITS CONCOMITANT EVILS ITS PREVENTION 
 
 AND CURE A CORRECT TECHNIQUE 
 
 OF LIVING FOR BRAIN WORKERS 
 
 BY 
 
 ALBERT ABRAMS, A.M., M. D., (Heidelberg) F. R. M. S, 
 
 SAN FRANCISCO 
 
 THE HICKS-JUDD COMPANY 
 
 Publishers, 23 First Street 
 
 IQOI 
 

I. 
 INTRODUCTION; 
 
 There are many persons who suffer from obscure symptoms 
 without any evident cause. Their enjoyments of pleasure and 
 the comforts of life cease and they become indifferent to subjects 
 which were formerly of interest to them. Presenting no evidence 
 of ill-health, their relatives and friends are unsympathetic and 
 suggest that the patient go to work or * ' throw off the imagin- 
 ary feeling" or "use more will power." They run the 
 gamut of physicians who, finding them healthy in appearance 
 and physically sound, tell them "you are only nervous," 
 " there is nothing the matter with you," and, after a desultory 
 conversation, dismiss them with a prescription for a nerve 
 tonic. There are physicians, but they are fortunately few, 
 who are inclined to regard symptoms of a vague nature as 
 imaginary, or that the individual thus suffering is a hypo- 
 chondriac. Now the term hypochondriasis, as employed by 
 the physician, means a groundless fear of disease which has 
 no real existence, but exists only in the imagination of the 
 patient. Imagination may be responsible for a few diseases, 
 but I contend that an imagination which can create a disease 
 is in itself not in a state of health. ' ' No one can be a hypo- 
 chondriac at pleasure, ' ' says L,avkgne. 
 
 These unfortunates are acutely susceptible to any imputa- 
 tion on the honesty of their statements and, fearing that 
 none suffer as much as themselves, and obtaining no relief, 
 they gradually sink into the ''slough of despond." The 
 heads of such patients never feel just right. Their sleep is 
 disturbed and they feel depressed in the morning. Their 
 memory becomes defective, and they apprehend a loss of reason. 
 Sexual disturbances, indigestion and constipation supervene to 
 add to their misery. They show less endurance and become 
 irritable. There are no objective signs of their suffering, for 
 their symptoms are wholly subjective. Such cases have been 
 
described variously as hypochondriasis, nervousness, brain 
 strain, nervous waste, nervous prostration, nervous exhaustion 
 and nervous breakdown. Physicians designate the symptoms 
 by the Latin word, NEURASTHENIA, which means nerve 
 weakness, and the sufferer is called a neurasthenic. It was 
 Beard, of New York, who, in 1869, first directed general 
 attention to a condition marked by irritable weakness, and 
 adopted for it the term neurasthenia. In Europe, it was at 
 first derisively called Beard's disease, or the American disease, 
 and some even referred to it as Americanitis. Herbert 
 Spencer regarded the trouble as essentially American, a view 
 which is decidedly incorrect insomuch as it is a disease of 
 the whole civilized world. Very often the cause of neuras- 
 thenia may be resident in some organ of the body. It may 
 be the sexual apparatus, the nose, throat, or digestive tract, 
 hence all neurasthenics should willingly submit to a thorough 
 examination by their physician, for without a removal of the 
 cause, all treatment will prove ineffectual. The strides made 
 in diagnostic medicine have been enormous, and with the 
 wonderful X-rays at our command, who can gainsay the 
 Biblical quotation, "For there is nothing covered that shall 
 not be revealed, and hid that shall not be known." We have 
 medical as well as social fads. To call every disease with 
 nervous symptoms, neurasthenia, is essentially wrong. 
 Neurasthenia is unaccompanied by any tangible evidence of 
 organic disease. Therefore the diagnosis of neurasthenia is 
 only warranted, when, after a systematic and thorough ex- 
 amination of the body, no evidence of organic disease can be 
 elicited. A careful examination of the bodily functions is a 
 tedious and painstaking act, and necessitates considerable skill 
 on the part of the physician. Patients coming to the physician 
 for advice and relief do not understand this. They presume 
 that feeling the pulse, looking at the tongue, and tapping the 
 chest constitute the sole diagnostic aids of the physician. The 
 real skill of a medical man lies in his diagnosis of the case. 
 Diagnosis is the goal of a physician's erudition, and justifies 
 the Latin aphorism, "He who diagnoses well, cures well." 
 
The cure of disease will always be an important duty 
 of the physician, but the trend of modern medicine is in the 
 direction of preventing disease. The efficiency of the physician 
 will be greatly enhanced when his services to his patients 
 are less intermittent and more constant. The public may yet 
 regard as commendable the Chinese custom of paying the 
 physician only during the period health is maintained, all 
 emoluments ceasing during sickness. There is a well-known 
 Italian epitaph ' ' I was well wished to be better read 
 medical books took medicine and died." Pope's maxim, 
 "A little knowledge is a dangerous thing," pertains in all 
 cogency to matters medical. The most dangerous dilettan- 
 teism is that of medicine. The object of this brochure is to 
 inculcate the grand precepts of hygiene whereby disease may 
 be prevented. Any book tending to make " any man his own 
 physician" should read "every man his own executioner." 
 Without an intelligent conception of disease by the layman 
 and his hearty co-operation, the physician finds much difficulty 
 in the rational treatment of his patient, and this is especially 
 true of the neurasthenic. Credulity is belief without reason, 
 and scepticism, reason without belief, but all patients are 
 neither credulous nor sceptics. Neurasthenia is a demoralizing 
 disease, producing depression, irritability and unreasonable- 
 ness, and no disease warrants more fitly the remark of Johnson, 
 "Every man is a rascal as soon as he is sick." A neuras- 
 thenic should never be his own physician, for, like a lawyer 
 who conducts his own case, "he has often a fool for a client." 
 This little volume is dedicated to all those who are liable to, 
 or suffer from nerve exhaustion, with the hope that it will 
 rescue the former and help the latter to recover. 
 
 Southwest corner Van Ness Avenue and California Street, 
 
 San Francisco, Cal. 
 
II. 
 
 THE CAUSES OF NERVOUS BREAKDOWN. 
 
 Every individual is endowed at birth with a definite 
 amount of nerve capital. The amount allotted to each 
 individual can never be the subject of computation ; some 
 have more, others less. Every mental act leads to brain waste, 
 but there is also repair of this waste, and when this equilibrium 
 of waste and repair is maintained, normal brain vigor continues. 
 L,et this health equilibrium be disturbed and at once the 
 foundation is laid for an irritable weakness of the entire 
 nervous system. Neurasthenia rarely develops before the age 
 of twenty or after fifty. It is a nerve disorder arising at a 
 time of life when the struggle for existence is most pro- 
 nounced, a time of life when the greatest demands are made 
 on the nervous system, hence, a period between the third 
 and fifth decades furnishes the greatest number of cases. 
 Both sexes suffer, but not equally, the males preponderat- 
 ing. Extremes of climatic conditions favor the develop- 
 ment of the disease. All races are victims. Hebrews and 
 Slavs are susceptible to it, and the Scandinavians in this 
 country furnish a large contingent. The law of heredity does 
 assert itself most emphatically as a factor in nervous break- 
 down. "The world is beginning to perceive," says Galton, 
 " that the life of each individual is, in some real sense, a con- 
 tinuation of the lives of his ancestors." Holmes, the poet 
 physician, observes that "we are omnibuses in which all our 
 ancestors ride. " ' ' The Gods visit the sins of the fathers upon 
 the children." 
 
 NEUROTIC HEREDITY. There are a number of nervous 
 diseases of direct hereditary character, transmitted from gen- 
 eration to generation. Aside from the transmission of an 
 unstable nervous system, there is a law of heredity known as 
 the law of sanguinity. Two parents may have normal 
 organisms, and yet produce offspring with defective nervous 
 
8 
 
 constitutions. The perfect organization pf the progeny is the 
 result of three factors the quality of the germ ( which brings 
 matter), the quality of the sperm (which brings force) and the 
 suitability of the one to the other. The following are some of 
 the laws of heredity : 
 
 1. The child may inherit the attributes of either parent 
 solely. 
 
 2. It may inherit the qualities of one parent in some res- 
 j)ects and of the other in other respects. 
 
 3. It may inherit the father's attributes for one period 
 of existence and the mother's for another. 
 
 4. Attributes tend to appear in the progeny about the 
 same time of life at which they became manifest in the parents. 
 
 5. Attributes of the father tend to be inherited by the 
 sons and of the mother by the daughters. 
 
 6. Attributes may be transmitted in latent form from one 
 generation to another, to reappear in a third or fourth or still 
 more remote generation a phenomenon called " reversion." 
 
 There is a variation in the degree of hereditary taint. 
 Thus neurasthenia is not so serious a heritage as epilepsy, 
 imbecility or insanity. The taint in a family is greater the 
 larger number of members afflicted. The indications of a 
 neurotic heredity, known as stigmata, may be manifested by 
 defects of moral sense, of memory, attention, will, or judg- 
 ment. It is heredity which makes the nervous organization 
 so unstable as to collapse under strain. 
 
 The stigmata of the degenerate may be physical, psychic 
 or both. Many notable writers who have made a psycho- 
 anthropologic study of degenerates do not attach the same sig- 
 nificance to physical stigmata as does L,ombroso. The chief 
 physical stigmata are : cranial and facial deviation, recession 
 of the lower jaw, large or small mouth and thick lips, abnor- 
 mally shaped and misplaced ears, defective and misplaced teeth 
 and high palate. Criminal anthropologists find such deform- 
 ities very common, although there are a class of occasional 
 criminals who show no peculiarities, a type called by Lombroso 
 "the criminal man." Unless the physical stigma has attained 
 such a degree of structural anomaly as to impair the normal 
 
function of a part, no great importance is to be attached to it. 
 Some of the psychic stigmata are the following : 1 Precocity 
 or retarded evolution of intellect. 2 Extreme changeableness 
 and irritability. 3 Exaggerated consciousness and a fanatical 
 religious zeal or great moral depravity. 4 Intense egotism with 
 no regard for the feeling of others. 5 Extravagant and cranky 
 motives and desires. 6 One-sided talents and disproportionate 
 development of mental faculties. 
 
 While recognizing the undoubted influence of heredity, 
 we are inclined to go too far in ascribing to Nature the many 
 inflictions of individuals, for instead of being "more sinned 
 against than sinning," it is just the opposite, for man is often 
 the victim of his own vicious habits. Ingersoll was asked on 
 a certain occasion whether he thought he could have made 
 things better if he had had the creation of them. His reply 
 was " I would have made health catching instead of disease." 
 He was unquestionably wrong, for the gift of every living 
 thing is usually health, and for most diseases man is generally 
 to blame for having violated at some time or other a natural law, 
 and transgression has brought the penalties with it. No disease 
 exemplies more aptly the Scriptural text, "The way of the 
 transgressor is hard," than does nervous exhaustion. "To be 
 of any use at all," says Balfour, " we must put ourselves in 
 Nature's place and work as Nature works." 
 
 The immortal Darwin says, "Our lives are but a bundle 
 of consequences ; our present is but the outcome of the past." 
 It is by trifling advantages momentarily minute that Nature 
 either worsens or improves the status of our vitality, and it is 
 by securing these trifling advantages and turning them to the 
 good of our patient that vital declension is averted and chronic 
 ailments remedied when that is possible. A recent writer, 
 Prof. Putnam, introduces the personal equation as a factor in 
 disease, and limits the responsibility to the individual and not 
 to heredity. He attempts to explode the pessimistic fatalism 
 attached to heredity and assures us that a just regard for the 
 laws of hygiene will help to avert disease. He says that " for- 
 tunately for the educational outlook, the evidence has begun 
 to accumulate that a morbid inheritance is not the inevitably 
 
10 
 
 crushing and baneful thing that it has been thought. We 
 come into the world, each one a being of limited capacity, 
 but, in other respects, free to become what circumstances make 
 us, and responsible, to the extent of our capacity, for our lot. 
 We bring no ticket-of-leave which stamps us as drunkards or 
 maniacs on probation, but we do bear, in the histories of our 
 ancestors, a certificate that hints by what efforts and by what 
 avoidances we can make ourselves reasonable successes in our 
 respective lines. There is no original sin and not even as it 
 seems to me, original propensity, but only original capacity and 
 original limitation, and even limitation is only another name 
 for latent capacity." 
 
 PARESIS It is an every-day observation to hear of men of 
 keen perception and ambition who excel in zeal and energy as 
 business or professional men falling victims to paresis. The slow 
 and earnest plodder who goes through life leisurely without 
 scintillations of genius is the man to be truly envied. The am- 
 bitious man, with limited nerve capital and no reserve force, 
 who lets loose his wings and soars to lofty heights, will be 
 certain to emulate Icarus, whose wings were composed of wax. 
 The predisposing cause of paresis is sententiously expressed by 
 Mickle, "A life absorbed in ambitious projects with all its 
 strongest mental efforts, its long-sustained anxieties, deferred 
 hopes, and straining expectation." "It is the pace which 
 kills ' ' and ' * burning the candle at both ends ' ' are popular 
 expressions of the same conditions which lead to paresis. To 
 the foregoing causes must be added syphilis and excess in the 
 use of alcohol. Statistics show that sixty-five per cent of all 
 paretics have had syphilis. The relation of syphilis and paresis 
 is essentially this : The poison of syphilis weakens the consti- 
 tution and vitiates the blood and prepares the brain for its final 
 dissolution by exciting causes like alcoholism, excessive venery, 
 brain strain and excitement. " Once syphilis, always syphilis" 
 said the erudite Ricord. Syphilis is, however, a mild disease 
 with our present methods of continuous treatment. It is only 
 when treatment has been inefficient or when the individual 
 gives himself over to excesses, that the virulency of its tertiary 
 manifestations is provoked. It behooves syphilitics, and they 
 
11 
 
 unfortunately constitute a large proportion of our population, 
 to live a life free from the glittering promises of ambition, with 
 all its concomitant evils, and above all, to abstain from the use 
 and abuse of alcohol . 
 
 Alcohol is responsible for at least twenty per cent of all 
 cases oi paresis. 
 
 OCCUPATION L,abor of whatever kind demanding mental 
 or physical over-work will cause neurasthenia. Merchants, 
 teachers and professional men furnish large numbers of neu- 
 rasthenics. 
 
 The chief causes of neurasthenia are mental overwork asso- 
 ciated with anxiety, worry or excitement. To these must be 
 added the abuse of alcohol, tobacco \ coffee, tea, bodily disorders, 
 physiologic factors and moral causes. 
 
 MENTAL OVERWORK Brain activity is always associated 
 with an increase in the amount of blood in the brain, hence it 
 frequently happens that brain workers, who pursue their intel- 
 lectual work after meals, suffer from indigestion, for the blood 
 so essential to digestion is attracted to the brain. The greatest 
 amount of work that the brain can do without fatigue is during 
 the early morning hours, for sleep has served to recuperate a 
 fagged brain. From the early morning hours the ebb of nerve 
 force begins, attaining its maximum discharge in the middle 
 of the afternoon, a time when the nervously exhausted are 
 most weak. The evening meal temporarily stimulates the brain 
 functions, masking as it were the depressed state of the nervous 
 system. Then follows sleep. This is nature's method of regu- 
 lating waste and repair. The brain worker requires more sleep 
 than the laborer, and if he deprives himself of the requisite 
 amount of sleep, he is laying the foundation for a protracted 
 siege of nervous prostration. Nature's preventive and cure of 
 disease is sleep. The ancients spoke of sleep as the half brother 
 of death. Insomnia or sleeplessness is the forerunner of severe 
 mental disturbances. The truism "laboring art can never 
 ransom nature from her inaidable estate," can aptly be applied 
 to inspmnia. 
 
12 
 
 WORRIMENT Dr. H. C. Sawyer, of San Francisco, in 
 his admirable work on " Nerve Waste," expresses himself as 
 follows regarding worry: " If a long, flexible, finely -tempered 
 sword be supported at its extremities and subjected to a mod- 
 erate 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 ma}^ sustain heavy day strain 
 throghout 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 fiber of the delicate 
 and high strung nervous organization of the nervous consti- 
 tution." 
 
 There is a ' ' Don't Worry Society ' ' among whose mem- 
 bers are hundreds of brain workers. An English writer 
 of prominence asserts that the majority of people kill them- 
 selves by lives of indolence of mind and body. Mental inac- 
 tivity is injurious to physical health, and it is rare to find the 
 idler among the list of centennarians. Healthy brain activity 
 is essential to life and iustifies the aphorism that it is not work 
 but worry that kills. That enviable man whom nothing worries 
 is the kind, considerate and patient man whom we occasionally 
 meet in this busy world. The ill-tempered, irritable and 
 pessimistic individual, with deranged digestion, is the man 
 with an unbalanced nervous system who has disregarded the 
 natural law of waste and repair. We know but little of the 
 changes undergone by the brain in nerve exhaustion, although 
 investigations made on animals suggest many things which are 
 applicable to the human being. When, for instance, intense 
 fatigue is induced in animals by stimulation with electricity or 
 by the exercise of normal functions to the point of exhaustion, 
 
13 
 
 the nerve cells of animals become altered in shape, and appear 
 shrunken, and it is only after hours of rest that the cells 
 resume their normal appearance. 
 
 PHYSICAL OVERWORK This results in bodily fatigue, 
 which is really fatigue of the nervous system. This fatigue is 
 brought about by the development in the body of poisons 
 which exercise a paralyzing influence on the delicate nerve 
 centers. 
 
 THE ABUSE OF ALCOHOL One of the greatest scourges 
 of the nervous system is alcohol. Alcohol in persons of a 
 nervous temperament, even when consumed in the smallest 
 amounts, induces organic changes in the nerve tissues like 
 those of old age. Alcohol is essentially a medicine, and not 
 a substance for habitual consumption. The habitual use of 
 alcohol stands foremost, after heredity, as a single indepen- 
 dent cause of insanity. The psychic degeneration of alcoholism 
 is characteristic, and consists of gradually weakening memory 
 and will, slowness of perception and judgment, loss of the 
 moral and esthetic sense, with paroxysms of depression, anger 
 and irritability. There is no organ of the body which is not 
 implicated in chronic alcoholism, but it is as a nerve intoxicant 
 that its most pernicious effects are manifest. A moderate 
 indulgence in alcoholic beverages at meal times is certainly 
 not harmful to persons active in mind and body, but in those 
 with a neurotic heredity their use is always injurious. 
 
 TOBACCO Tobacco like alcohol is a drug. When used in 
 moderation by those accustomed to its effects it is generally 
 harmless. Some are soothed by its use, whereas others are 
 intoxicated. The temperament of the individual is the only 
 real index of its action, for, "what is one man's meat is 
 another man's poison." Excessive smoking results in throat 
 irritation, dyspepsia and a peculiar affection of the heart known 
 as the ' ' tobacco heart. ' ' Oculists describe a partial blindness 
 known as toxic amblyopia as a result of the excessive use of 
 tobacco, yet when the habit is discontinued, vision is, as a 
 rule, restored. The cigarette is more dangerous than the 
 cigar, not only because it is used to excess but because the 
 smoke is inhaled. 
 
14 
 
 COFFEE, TEA AND COCOA These substances while not 
 essential are nevertheless indispensable to many persons. 
 Like all luxuries and it is well to specify them as such, the 
 harm arising from their use is the result of overindulgence. 
 Taken in excess, they retard the digestion of starchy foods. 
 A single cup of coffee at breakfast must be regarded as a 
 stimulant, while taken at night it is often the cause of insom- 
 nia. There is a device known as the ergograph by which 
 muscle force is measured. It has been shown by the ergo- 
 graph that coffee will increase muscular power and so will 
 small doses of alcohol, yet, when taken in large quantities, 
 they depress muscle vigor. There are .many nervous affections 
 wholly attributable to tea and coffee. Some of the ill effects 
 of excessive coffee drinking are, headache, palpitation of the 
 heart, vertigo and confusion of the intellect. The most impor- 
 tant signs from which habitual coffee drinkers suffer are those 
 affecting the nervous system, which a foreign medical corre- 
 spondent thus describes : 
 
 "Sleep disappears, or is accompanied by terrifying 
 dreams. In an upright position the patient complains of a 
 sensation of vacuum in the head and often of vertigo. At this 
 period of the intoxication there is very marked trembling of 
 the upper and lower limbs, and also fibrillary trembling of the 
 lips that may spread to all the muscles of the face and to the 
 tongue. Painful cramps also make their appearance in the 
 muscular masses of the calf and thigh, particularly at night, 
 preventing sleep." 
 
 Similar evil effects follow from the use of too much tea. 
 And for these reasons physicians have for a long time warned 
 their patients against the chronic intoxication and other severe 
 ills incident to the free use of coffee and tea as beverages. 
 
 BODILY DISEASES Syphilis is an important cause. 
 There are some persons who once having contracted the 
 disease, invariably interpret every bodily derangement as a 
 manifestation of syphilis. These unfortunates can however 
 be given the positive assurance, that a case of syphilis properly 
 and continuously treated rarely leads to bad results. Whenever 
 the nutrition of the body suffers from whatever cause, the 
 nervous apparatus in some persons is the first to suffer. 
 
15 
 
 PHYSIOLOGIC FACTORS Puberty in both sexes, and the 
 puerperal state and change of life in women, as well as the tis- 
 sue changes peculiar to old age {senility}, are periods in life 
 when the delicate nervous system is subject to excessive strain 
 which increases its vulnerability. Puberty takes place between 
 the thirteenth and twentieth years, resulting in remarkable 
 physical and mental changes. The evolution of the sexual 
 characters and development of reproduction, give rise to en- 
 tirely new sensations and powerful emotions. In the boy, the 
 mind becomes occupied with emotional, sentimental, amatory 
 and fantastic imaginings, and it is at this time that the vicious 
 habit of masturbation is likely to be formed. 
 
 In the piterperal state, pregnancy diminishes the vitality of 
 woman, debilitating and weakening her entire system, thus 
 rendering her a prey to the many disorders of nervous break- 
 down. 
 
 The change of life> known as the menopause, in women 
 between the ages of forty and fifty, is another period fraught 
 with mischief to the nervous system, and it is rare to find in 
 this period of involution a woman who is free from nervous 
 manifestations. The disequilibration associated with the ces- 
 sation of ovulation and menstruation is a menace to mental 
 integrity. 
 
 During the senile period of life the tissue involution is 
 likely to be attended by numerous mental disorders. A con- 
 spicuous sign is loss of memory for recent events and the 
 individuals interest becomes centered in his physical comforts 
 and needs. 
 
 BRAIN CHANGES IN NEURASTHENIA Physiologic experi- 
 ments demonstrate that in fatigue of the nervous system, the 
 nerve cells, which in health are plump, become shrunken, and 
 become restored to their original shape and size only after 
 prolonged rest. 
 
 Brain cells, when quite fresh and vigorous, may be likened 
 to small balloons inflated ready for an ascent. They are round 
 and full, and when seen under the microscope they give evi- 
 dence of being distended. The cells of the tired brain, on the 
 other hand, are seen to be shrunken, as an air ball or toy 
 balloon from which most of the air or gas has escaped. 
 
16 
 
 When our brains begin to work after a refreshing rest or 
 sleep they are, says a recent writer, full of nerve fluid, which 
 the absorbents of the body and brain have stored up there like 
 bees fill their cornb. So soon as work begins, this vital force 
 is sapped to meet the demands upon the brain, and the process 
 that goes on during the whole time it is working may be 
 described in the following way: 
 
 Imagine that these cells are small goblets filled with 
 liquid, and that they have a tiny stem, through which runs a 
 tube or opening; the liquid in the goblet is drained by the 
 demands of mind and body, and slowly trickles through the 
 opening, drop by drop, until either the work ceases or the 
 goblet is exhausted. 
 
 This latter condition is not often reached, for the simple 
 reason that the owner of the brain is very much more likely to 
 collapse. When the cell has yielded half its vital fluid you 
 begin to experience a feeling of fatigue, and if you go on 
 drawing the contents of the cells you are doing yourself injury 
 in a proportionate degree, and nature will make you pay for it 
 in some way or other. 
 
 But all the cells are not involved in any kind of mental 
 work, which means that one part of the brain may be very 
 actively at work while the other is resting and storing up 
 nerve fluid. Thus it is that a man suffering from brain fag 
 may leave his books and go golfing or cycling and feel that he 
 is really resting; other cells are being called upon for work 
 now, while the tired ones those required for mental activity 
 are enjoying repose. 
 
 But it follows that the part of the brain which is called 
 into activity for bodily exercise is now getting tired, while the 
 other part of the brain is still at work to some extent, and so 
 the whole of our brain cells become fatigued, and total rest in 
 the shape of sleep, is absolutely essential. 
 
III. 
 
 THE GENERAL SYMPTOMS OF NERVOUS 
 BREAKDOWN. 
 
 GENERAL SIGNS These may be divided into 1 motor 
 disorders. 2 sensory disturbances. 3 disturbances of the special 
 senses. 
 
 MOTOR DISORDERS Muscular fatigue is a constant sign. 
 Effort in walking is exhausting and leads to prostration. 
 Sustained effort is impossible. The slightest muscular effort 
 is attended by trembling. So characteristic is this sign that 
 Lemarcq found it in 85 per cent of neurasthenics. Some patients 
 complain of trembling knees and shaking hands or the tremor 
 only becomes evident in the handwriting. There may also 
 be muscular twitchings in the lips and face. 
 
 SENSORY DISTURBANCES Headache is a common sign. 
 It may be constantly present or invoked by any mental or 
 muscular effort or some emotion. The headache is usually 
 confined at the base of the brain or it may be located on the 
 top or front of the head or at the temples. Some describe 
 the headache as a heavy weight or constriction about the 
 head. Some describe the sensation of a closely fitting lead 
 cap on the head. Some experience a heaviness or throbbing 
 and a sensation as if wind or water were running under the 
 scalp. 
 
 Backache, confined to the small of the back or ac- 
 companied by pain running up between the shoulders or 
 through the loins and down the limbs, is a frequent sign. 
 
 Spinal tenderness is common, and may be so pronounced 
 as to interfere with sitting or lying down. A favorite location 
 for the tenderness in women is at the extreme end of the spine. 
 There may be sensations of hot flushes, cold, numbness, 
 stiffness, soreness, etc., in any and all parts of the body. 
 
18 
 
 EYE SIGNS An early sign is a blurring of the vision 
 on using the eyes for any length of time which may become 
 so pronounced that the person becomes unable to perform 
 any work requiring the use of the eyes for any length of time. 
 Often the vision becomes veiled arid things look strange and 
 unreal. 
 
 OTHER DISORDERS OF THE SPECIAL SENSES Abnormal 
 ringing, singing, whistling and roaring sounds are heard 
 although the hearing itself is never seriously impaired. Taste 
 is often impaired. Nothing tastes exactly right or there is a 
 bitter taste in the mouth even when no food is taken. 
 
IV. 
 
 THE SPECIAL SYMPTOMS OF NERVOUS 
 BREAKDOWN. 
 
 The signs may be confined to single organs like the brain, 
 heart or the stomach and intestines whereas in reality, they 
 are mere manifestations of a general breakdown of the nervous 
 system. 
 
 BRAIN SYMPTOMS The capacity for mental work becomes 
 lessened. Any mental effort is attended by a sense of fatigue 
 and distress. Fixing the attention on anything is difficult and 
 often impossible. There is loss of Memory. Ideas do not 
 occur with the usual vigor and patients often affirm that "they 
 cannot think straight." The fear of insanity is common with 
 such persons. Attracted by their symptoms, they become 
 introspective, misconstrue their sensations and develop phobias. 
 Becoming morbidly self-watchful they pass into a condition of 
 hypochondriasis. It is rare for the morbid fears to become 
 insane delusions. Fear in neurasthenics developes as a result 
 of weakness and loss of courage. Some fear to be alone, some 
 fear darkness, others narrow or high places, etc. Some fear 
 dirt or infection by disease. A neurasthenic recognizes the 
 absuridity of his fears and is able to dispel them whereas the 
 hypochondriac regards such fears as actual conditions and can- 
 not be convinced to the contrary. Diminished affection for those 
 dear to him is another sign which often distresses the patient. 
 He becomes irritable, fault-finding and resentful. He dreads 
 meeting acquaintances or people. He approaches his daily 
 task with a sense of weariness. He becomes emotional and 
 lachrymose on the slighest pretext. He recounts the history 
 of his illness to everyone who will listen and often seems to 
 delight in so doing. As a rule, he regards the future with 
 disgust He cannot bear to read the morning papers lest some 
 accident, murder or sudden death may distress him. 
 
20 
 
 Sleeplessness is one of the earliest signs. Sometimes there 
 is difficulty in falling asleep, or the sleep is constantly dis- 
 turbed. Occasionally the sleep is sound and deep, yet the 
 patient awakens in the morning unrefreshed and often feels 
 more depressed than upon retiring. On closing the eyes in 
 bed, there is, at times, sudden jerking of the legs, or a feeling 
 as of falling. When dreams disturb the sleep, it indicates that 
 the latter is not sound, but partial. In dreams, the brain is in 
 part awake ; the will is dormant and the imagination runs riot 
 with incongruous and fantastic images. When many brain 
 centers are active, dreams are consistent and coherent, while, 
 when few centers are working, they are unreal and extrava- 
 gant. Dreams are evidence to the physician of unsound sleep. 
 The dreaming period, in health, rarely occurs until the time 
 for awaking approaches. If the dreaming period comes on 
 early, there is some disorder present in the body which retards 
 the complete rest of the brain. Attempts have been made to 
 classify dreams, but such classifications, from a psychologic 
 standpoint, are purely arbitrary. 
 
 HEART SIGNS Heart palpitation is a frequent symptom. 
 Palpitation means that the patient is conscious of his heart's 
 action. A conscious knowledge of any organ constitutes dis- 
 ease of that organ, not necessarily organic, but more often 
 functional disease. A person with a healthy heart is not con- 
 scious that he has such an organ. In the mild forms of pal- 
 pitation only a fluttering or sinking feeling is experienced. In 
 the more severe forms, the heart beats violently against the 
 chest, the arteries throb and the action of the heart is increased 
 to as many times as 150 pulsations per minute. In nervous 
 palpitation, the face becomes flushed, and after the attacks, 
 large quantities of urine are passed. An attack may last only 
 a fewjminutes or may continue for hours. Palpitation is most 
 often caused by some digestive disturbance or maj^ result from 
 emotions or prolonged muscular or mental efforts. 
 
 Ruskin has truly said : " No great intellectual thing was 
 ever done by great effort ; a great thing can only be done by a 
 great man, and he does it without effort. The body's work 
 and the head's work are to be done quietly, and comparatively 
 
21 
 
 without effort. Neither limbs nor brain are ever to be strained 
 to their utmost ; that is not the way in which the greatest 
 quantity of work is to be gotten out of them ; they are never to 
 be worked furiously, but with tranquility and constancy. We 
 are to follow the plough from sunrise to sunset, but not to pull 
 in raceboats at the twilight ; we shall get no fruit out of that 
 kind of work only disease of the heart. ' ' 
 
 Irregularity of the heart is another sign. An evidence ot 
 enfeebled circulation is shown by cold hands and feet. Sudden 
 flushings and sweats and pulsations of the large artery of the 
 abdomen are exceedingly frequent to the great annoyance of 
 the patient. 
 
 STOMACH SIGNS The more I observe dyspeptics, the 
 more certain is my conviction that nervousness is responsible 
 for the majority of cases. We are a nation of dyspeptics 
 owing to our ceaseless and intense living methods. Repair is 
 not commensurate with waste and there comes a time to many of 
 us when our functions must suffer. All the organs of the body 
 in health work harmoniously; one is dependent on the other for 
 the normal performance of its work. If one suffers they all 
 suffer, yet some one organ, it may be the heart, the stomach or 
 the liver, usually bears the brunt of nerve exhaustion. Why 
 this is so, is difficult to say, other than by supposing that every 
 person like Achilles has some vulnerable spot. Some persons 
 when they have a "nerve storm" center all their abnormal 
 sensations in the heart, others in the stomach, others in the 
 head, etc. 
 
 Nervous indigestion is a freqent complication of nerve 
 strain. The appetite may be unimpaired and even voracious. 
 At other times, the mere thought of food is repugnant. Often 
 the food eaten lies like a heavy weight. The patient belches 
 and is apt to bring up a sour fluid giving rise to heartburn. 
 The tongue may be perfectly clean throughout the disturbances 
 of digestion. The day has waned when the physician, after 
 casting a furtive glance at the tongue, feeling the pulse and 
 asking a few desultory questions about the stomach, proceeds 
 to prescribe what has been facetiously called a "shotgun" 
 prescription; embodying pepsin and acid to increase digestion, 
 
22 
 
 an alkali to correct acidity, a tonic to promote digestion and 
 a purgative to move the bowels. Such a prescription is as 
 much a contradiction as the ' ' whisky cocktail ' ' described by 
 the perturbed Frenchman, "a little whisky to make it strong, a 
 little water to make it weak, a little lemon to make it sour, a 
 little sugar to make it sweet, and then you say, here's to you, 
 and you drink it yourself." The scientific physician of to-day 
 takes nothing for granted. He places the patient on a " test 
 meal" after which, he withdraws the contents of the stomach 
 and subjects it to chemic analysis. Having ascertained the 
 ingredients of the gastric juice, he is ready to fulfil his duties 
 as an up-to-date practitioner, and prescribes accordingly. In 
 the majority of cases of nervous dyspepsia, chemic analysis 
 shows no anomaly, and digestion is found to have been com- 
 pleted within the normal time limit. The latter facts are alone 
 characteristic of nervous dyspepsia. Were the digestive 
 trouble of a nature other than nervous, there would be decided 
 changes in the gastric juice and in the character of the digestion, 
 It is strange how soon nervous dyspeptics discover that it is 
 not wise to eat too much when nervous or excited, for it is at 
 such a time when the gastric signs predominate. Prof. 
 Bouchard has written a learned treatise on "Auto-intoxication 
 in Disease." He clearly shows that man is constantly standing 
 as it were on the brink of a precipice; every moment of his life 
 he runs the risk of being overpowered by poisons generated 
 within his system. The healthy and unhealthy body is a recep- 
 tacle and a laboratory of poisons. Self-poisoning is only inhibi- 
 ted by the activity of the skin, kidneys and bowels. Now 
 these poisons are normally manufactured in our intestinal 
 canal, and were it not for the action of the bowels, kidneys and 
 skin, many of us would succumb to auto-intoxication. In 
 indigestion, these poisons are generated by stagnant food, and 
 give rise to blood poisoning. 
 
 Auto-intoxication from indigestion does not always mani- 
 fest itself by the classic signs of indigestion, and it is not infre- 
 quent that the physician fails to elicit from the patient subjec- 
 tive evidence of indigestion. 
 
THE INTESTINAL SIGNS The chief sign is consti- 
 pation. Torpidity of the bowels may run in families. Seden- 
 tary habits, coupled with excessive eating and a disregard 
 to the call of nature as well as the character of the food eaten, 
 are common causes of constipation. In neurasthenia the mus- 
 cular tone of the bowels suffers and it becomes incapable of 
 moving the fecal matter onward into the rectum. There are 
 some persons who are persistently constipated without suffering 
 any inconvenience. A patient once told me, in detailing his 
 symptoms, that as far as his bowels were concerned, they 
 were in perfect condition, as they moved regularly once -a 
 week. The majority of persons, however, complain that 
 unless they have a daily evacuation they suffer from languor, 
 headache, loss of appetite and depression. So potent an 
 influence does a free evacuation have on the condition of well 
 being that even Voltaire was induced to write: "Those per- 
 sons who are in good position . . . whose bowels are freed 
 by an easy regular peristaltic movement every morning as soon 
 as they have breakfasted . . . those who are ttius favored by 
 nature are mild, affable, gracious, kind. A no from their 
 mouth comes with more grace than a yes from the mouth of 
 one that is constipated." 
 
 A recent German writer has collected a large number of 
 cases of neurasthenia dependent wholly on constipation and 
 the evil results thereof. He contends and his contention 
 cannot be questioned that the bowels normally manufacture 
 poisons which, when absorbed, influence the delicate nervous 
 system. Hypochondriacs are usually constipated, and so are 
 the insane. One of my patients, who is an habitual sufferer 
 from constipation and has periodic nerve storms, finds immedi- 
 ate relief after taking a saline purgative. The physiology of 
 defecation is practically as follows: The fecal matter formed 
 in the large intestine sets up a motion known as peristalsis, 
 which moves the fecal mass through the large bowel, dropping 
 it into the rectum. At the latter point "a call of nature" 
 takes place and an evacuation is the result. If no response is 
 made to this "call" by the individual, whether through 
 laziness or attention to other duties, the watery portion of ' 
 
24 
 
 the fecal mass is absorbed, passes into the circulation and 
 intoxicates the nervous system. Persons who suffer from this 
 auto-intoxication have a muddy skin, dark rings under the 
 eyes, cold extremities and an unpleasant taste in the mouth, 
 dark, offensive and insufficient bowel movements and a heavy 
 urine, which leaves a deposit on standing. 
 
 SECRETORY DISORDERS The urine is scant and dark, or 
 it may be abundant and light colored. During or after a 
 nerve storm it is usually of the latter character. Often there 
 is some bladder irritation and the urine is passed frequently. 
 Perspiration is usually profuse, especially after the slightest 
 mental or physical exertion, and the " cold, clammy hand " 
 is a common condition. 
 
 The sexual disorders will be considered in the chapter, 
 SPECIAL FORMS OF NEURASTHENIA. 
 
V. 
 
 THE GENERAL TREATMENT OF NERVOUS 
 BREAKDOWN. 
 
 RELIEF FOR MENTAL OVERWORK Sleep is without 
 doubt the natural restorative of a fagged brain. The writer, 
 when suffering from brain tire, finds more relief by three days' 
 absolute rest in bed than by a sojourn of two weeks in the 
 country after the conventional manner. Sleep is, however, a 
 restorative that cannot always be summoned at will. The 
 inventor, speculator, student and business man must seek mental 
 recreation. The brain worker who seeks diversion and does 
 so constrainedly defeats the objects of such diversion. The 
 diversion adopted must be agreeable. Travel is often suggest- 
 ed as a method of mental recreation but it is often done in such 
 a perfunctory way that the victim returns to his habitual 
 routine work more exhausted than recuperated. They may 
 change their skies but not themselves. Indulgence in extra- 
 neous literature, the cultivation of a fad, some regulated 
 exercise like golf, bicycling, hunting, etc., are excellent means 
 of diversion. Employment prevents melancholy it is restful 
 to the body. Inaction, idleness and the constant pursuit of 
 pleasure, for the sake of pleasure, simply encourage prema- 
 ture old age. Above all things in seeking physical exercise as 
 a means of diversion, be sure to avoid physical overwork. 
 Physical exhaustion is naught else but nervous fatigue, for 
 every physical act is the result of nervous energy. The limit 
 of physical exercise is fatigue. Rational exercise is never 
 exertion but a gradual and progressive use of muscles diverting 
 the blood from the overtaxed brain throughout the entire body. 
 Neurasthenics who overexercise, develop poisons equally as 
 injurious as those generated by brain strain. 
 
 RELIEF FOR WORRIMENT " Worry, not work, kills." 
 Worry in persons previously unaccustomed to great respon- 
 sibilities is one of the greatest factors in the premature loss of 
 
26 
 
 health and life. Worry, grief, passion and fretting are power- 
 ful nervous shocks. They arrest the functions of digestion and 
 impair the bodily functions. Self -control is the palladium against 
 nervous prostration. I have never met nervous prostration 
 in individuals who have acquired a knowledge of self-govern- 
 ment. We are all competent to construct for ourselves a 
 philosophy of complacency. Such philosophy need not resolve 
 itself into indolence and apathy nor need it assume the aspects 
 of stoicism. When misfortune or disaster overtakes the Turk 
 he attributes it to the will of God or more often to fate {Kismet ) 
 and he piously ejaculates: " It is fate {Kismet dir) or God will 
 provide" (Allahkerim). The cultivation of some belief which 
 inculcates the doctrines of contentment should be encouraged. 
 It may be a difficult matter to control the emotions but 
 mastery can be attained by training. I know many neuras- 
 thenics who suffer relapses whenever exposed to some intense 
 emotion. When self-control is difficult, individuals must avoid 
 conditions which introduce them to such influences. They 
 must avoid going to funerals, reading death notices and the 
 newspapers, cultivate the companionship of people who may 
 dream of unhappiness but wake up laughing. The worries of 
 some people are often so ridiculous that they must be regarded 
 as the emanations of a diseased mind. I know one woman, 
 who, after a rest cure for nervous prostration, suffered only one 
 inconvenience and that was, that she had heard that recovery 
 from a "rest cure" lasted only five years, and at the end of 
 that time she feared she would suffer a relapse. My patient 
 was very much like the woman whose doctor asked after her 
 health replied dolefully: "I feel very well; but I always feel 
 bad when I feel well, because I know I am going to feel worse 
 afterward. ' ' 
 
 ELIMINATION OF FACTORS CONDUCIVE TO NEURASTHE- 
 NIA Knowing that the perennial unrest of body and mind, 
 continuous emotional excitement like grief, worry and anxiety, 
 make up the causative elements of nerve waste, our primary 
 object is to eliminate the cause. We must guard ourselves 
 from drifting upon the shoals of nervous degradation. Re- 
 member that when nervous breakdown once occurs, recovery is 
 
27 
 
 only possible to a certain extent, and relapses are frequent. As 
 Courtney puts it : * ' Hardly any of them come out of the con- 
 flict unscathed, and though many recover sufficiently to cope 
 with the ordinary duties and trials of life, they are never quite 
 capable of weathering its real storms." 
 
 THE REST CURE In a little book, ' ' Fat and Blood and 
 How to Make Them," Dr. Weir Mitchell has created a new era 
 in curative medicine, and the victims of nervous prostration 
 and hysteria are his debtors. He has simplified a task here- 
 tofore almost impossible of attainment, viz : the cure of a pro- 
 nounced case of nervous prostration. It would be ridiculous 
 to affirm that all cases can be cured by the rest cure, any more 
 than to say that any method of treatment, yet devised, will 
 cure all cases of the disease to which it is adapted. This much 
 one can conscientiously and conservatively say it cures and 
 benefits a greater percentage of cases than any other known 
 method of treatment. The cardinal points of the rest cure are 
 isolation of the patient, rest with exercise and over-feeding. A 
 rest cure attempted at the patient's home is rarely attended 
 with success, hence the necessity of absolute isolation that is, 
 the execution of the cure away from home to obtain the 
 necessary control of the patient. The most important element 
 of treatment is moral control. Loving and sympathetic rela- 
 tives can never appreciate the nature of the patient's symp- 
 toms. There are some patients who thrive poorly on absolute 
 isolation, in which instances they are occasionally permitted to 
 see at intervals their friends and members of their family. An 
 intelligent nurse is indispensable a poor nurse is worse than 
 useless. The details of the method are essentially as follows : 
 The patient is confined to bed, and under no circumstance is 
 allowed to get up, to read, or write. The patient is even fed 
 by the nurse, the object being to secure perfect passivity of 
 mind and body. Absolute rest is not always enforced, the 
 method being modified to suit the individual case. It is the 
 rule for patients to affirm that it is impossible for them to re- 
 main in bed continuously, and it is but natural that they 
 should make this statement, for their extreme restlessness only 
 announces the instability of their nervous system. Contrary 
 
28 
 
 evidence is soon forthcoming after absolute rest in bed and the 
 manifestations of nerve irritability are subdued. It is then 
 that they share the enthusiasm of the poet when they pro- 
 claim: " O bed ! O bed ! delicious bed ! That heaven upon 
 earth to the weary head !" 
 
 After rest in bed for several weeks the patient is allowed 
 to sit up. To facilitate digestion and build up nutrition during 
 the rest cure, massage and electricity are employed daily. 
 Massage and electricity give exercise to the unused muscles, 
 improve the circulation and promote the absorption of 
 nourishment. Insomuch, as all neurasthenics suffer from in- 
 digestion, and consequently imperfect body nourishment, diet 
 is a most important factor in the rest treatment. Great dis- 
 cretion is exercised by the physician in the selection of the 
 proper diet, and when this is accomplished, it is surprising 
 what prodigious quantities of food can be taken by the patient 
 undergoing the rest cure. The improvement in nutrition is 
 manifested by increase in weight which may be all the way 
 from 10 to 40 pounds. In many individuals hydropathic treat- 
 ment is employed with water of varying degress of temperature, 
 and it is surprising to note the sedative and tonic influences of 
 cold water when the patient is accustomed to its use. Of late, 
 hypnotism or treatment by suggestion has been employed in the 
 treatment of neurasthenia, and it must be confessed that its in- 
 telligent employment is capable of marvelous effects in ridding 
 the patient of morbid ideas and in inducing sleep, which, even 
 with drugs, is often times impossible. 
 
 Healthy suggestions made by the physician, I regard as 
 indispensable in the treatment of many cases. The dangers of 
 hypnotism are exaggerated, for no one can be hypnotized 
 against his wish. Prof. Bernheim, the apostle of hypnotism, 
 has this to say : ' ' It is the duty of the physician to select 
 what is useful in suggestion, and to apply it for the benefit of 
 his patients. When, in the presence of sickness, I think that 
 therapeutic suggestion has a chance of success, I should con- 
 sider myself to blame, as a physician, if I did not propose it to 
 my patient, and if I did not even make a point of getting his 
 consent to its employment." The influence of mind on body 
 
29 
 
 is every day illustrated by the introduction of some new fad or 
 delusion in the treatment of disease. It is difficult to conceive 
 that such results are effected by the mind as a simple thinking 
 organ; on the contrary, the mind must be regarded as a force 
 like light, heat and electricity which operates for good or evil on 
 the bodily functions. Strong mental impressions may actuate 
 disease, and even death, or they may act by curing disease. 
 Joy and hope stimulate, whereas grief and despair depress 
 the bodily functions. Sutton, a recent writer, presents the 
 following facts : 
 
 First That mental emotion may induce sickness or death 
 within a brief space of time, or even immediately, and in per- 
 sons of robust health. 
 
 Second The physical phenomena induced by such cause 
 indicate a deep perturbation vibration of the nervous system, 
 and are generally of a dynamic character. 
 
 Third Thought strongly directed to any part tends to 
 increase its vascularity and consequently its sensibility. 
 
 Fourth Thought strongly directed away from any part 
 diminishes vascularity and lessens sensibility. The more so 
 when associated with powerful emotions. (A key which un- 
 locks Christian science and other "fads.") 
 
 Fifth The emotions may cause sensations, either by 
 directly exciting the sensitory ganglia and the central extrem- 
 ities of the nerves of sensation, or by inducing vascular changes 
 in a certain part of the body, which excite the sensitive nerves 
 at their peripheral termination. 
 
 Sixth There is no sensation, whether general or special, 
 excited by agents acting on the body from without, which can 
 not be excited also from within by emotional states affecting 
 the sensory ganglia, such sensation being referred by the mind 
 to the point at which the nerve terminates in the body. (Tuke.) 
 
 Christian science is suggestion plus absurdity; divine 
 healing, suggestion plus faith in God; Dowieism, suggestion 
 plus prayer and holy terror; Weltmerism, suggestion plus 
 imagination, pure; magnetic healing, suggestion plus imagina- 
 tion, also; osteopathy, suggestion plus massage; homeopathy, 
 suggestion plus nothing; allopathy, suggestion plus tubfuls of 
 
30 
 
 drugs that either kill or cure; regular or rational medicine, 
 suggestion plus the best common horse sense available, or 
 suggestion and medicine mixed with the best quality of brains 
 obtainable. No suggestion in this that the quality of brains is 
 indisputably good in all cases or perhaps in any. Yet that is 
 the scientific principle at the base, and it may be used with 
 telling effect in all cases of sickness, and is infinitely better 
 than the delusions of the day by so much as it substitutes in- 
 telligence for ignorance and does not produce that disaggrega- 
 tion of personal consciousness and temporary insanity that is 
 the sine qua non in Christian science, etc . 
 
 THE PARTIAL REST TREATMENT In cases of mild neuras- 
 thenia^ and for patients who cannot give up their entire time to 
 the full rest treatment, which is often the case in men, the fol 
 lowing partial rest treatment may be employed : On waking 
 in the morning, a cup of cocoa is taken and the patient should 
 remain in bed twenty minutes longer ; after this, the patient 
 rises and takes a cool or cold sponge or shower bath, after 
 which the skin is vigorously rubbed with a rough towel ; fol- 
 lowing the bath, breakfast is taken, after which the patient 
 should lie down for an hour and remain at absolute rest, with- 
 out reading. At 10:30 a glass of milk is taken, when the 
 patient may go out for a walk or drive or attend to business. 
 At 1 o'clock luncheon or dinner is taken, after which meal the 
 patient should lie down for an hour. In the afternoon any 
 recreation may be taken, or attention paid to business until 
 6:30, when dinner or supper is taken, followed by rest for an 
 hour. At 9:30 the patient should retire for the night. 
 Massage should be taken once a day; before rising in the 
 morning, after the morning cup of cocoa, or in the evening be- 
 fore retiring. A wineglassful of malt should be taken with 
 each meal, and if the patient has impoverished blood, some 
 simple iron preparation should be taken. In conclusion, ' ' It is 
 reiterated," says Courtney, ''that affections of the brain and 
 nervous system are in greater measure preventable than those 
 of other parts ; consequently the mental and nervous salvation 
 of the individual is, practically speaking to a very marked ex- 
 tent, within his own hands, and may be worked out by him 
 through rigid attention to the guidance of hygienic laws." 
 
VI. 
 
 THE SPECIAL TREATMENT OF NERVOUS 
 BREAKDOWN. 
 
 INSOMNIA. 
 
 THE THEORIES OF SLEEP The anemic theory supposes 
 that during sleep there is a decreased amount of blood in the 
 brain. The toxic theory supposes that in consequence of the 
 wear and tear of the body tissues, waste products are generated 
 which have a benumbing influence on the brain cells which 
 preside over the senses. A Strong proof of the latter hypothesis 
 is adduced by the following observation of Striimpell: A 
 young man had lost all power of sensation except in the right 
 eye and the left ear. When the former was covered by a bandage 
 and the latter stopped by a plug the brain of the subject was 
 practically isolated from the outer world and the invariable 
 result was genuine sleep. "The substance of the brain," says 
 Hammond, in "Sleep and Its Derangements," "is consumed by 
 every thought, by every action of the will, by every sound 
 that is heard, by every object that is seen, by every substance 
 that is watched, by every odor that is smelled, by every pain- 
 ful or pleasurable sensation, and soon each instance of our 
 lives witnesses the decay of some portion of its mass and the 
 formation of new material to take its place." 
 
 During sleep the physical and mental functions are at rest. 
 Sleep is more essential to life than food. In sleep, muscular 
 relaxation is absolute, and the amount of air inspired by a 
 normal man is one-seventh of that used during similar periods 
 of quiet wakefulness. The pulse is less rapid and the brain 
 contains less blood. The first few hours of sleep are the most 
 valuable because they are most profound. 
 
 AMOUNT OF SLEEP NECESSARY In the time of Solo- 
 mon, the twenty-four hours were divided into three parts 
 eight hours for labor and occupation, eight hours for rest, 
 
32 
 
 refreshment and recreation and surcease of all labor, and eight 
 hours for sleep. The object of sleep is the reconstruction of 
 overworked organs and it would be too arbitrary to determine 
 the number of hours necessary for sleep, for its real value lies 
 more in the intensity of sleep than on its duration. Again, 
 the amount of sleep necessary is commensurate with the mental 
 and physical exercise of the waking hours. Bight hours of a 
 disturbed dreamy sleep is barely the equivalent of two hours 
 of a deep, dreamless sleep. For this reason, we can easily 
 understand why men of the greatest mental activity are usually 
 the briefest sleepers. Frederick the Great required only five 
 hours' sleep and Pitt only three hours. Brown says, that at 
 four years, twelve hours' sleep are needed; at fourteen years, 
 ten hours; at seventeen, nine and one-half hours; then seven 
 or eight hours during adult life. 'In old age continuous sleep 
 is rare and the necessity less; but frequent naps during the 
 day and night, make up the average. In cold countries more 
 sleep is required than in warm climates. 
 
 CONDITIONS FAVORING SLEEP A well ventilated room, 
 cool, dark and quiet. A comfortable bed with a moderate 
 amount of covering. Mental worries and intense thoughts in- 
 terfere with sleep. Sleep is a powerful habit. A person who 
 awakens at a certain hour for several successive nights, even- 
 tually establishes the habit of awakening at that hour. The 
 habit should be cultivated of retiring and awakening at a 
 definite hour. 
 
 THE CAUSES OP INSOMNIA OR SLEEPLESSNESS Prof. 
 See divides all causes of insomnia into: 1 Psychical, and 2. 
 Physical. The causes of psychical insomnia include cases of 
 sleeplessness dependent on mental emotion, to thought, worry, 
 that is, to causes not directly dependent on organic disease. 
 Young, the well known author of ''Night Thoughts," was 
 presumably thus afflicted 
 
 ' ' From short as usual and disturbed repose, 
 
 I awake. How happy those that wake uo more; 
 
 I awake emerging from a sea of dreams 
 
 Tumultuous, where my wrecked despondent thought 
 
 From wave to wave of fancied miser}' 
 
 At random drove, her helm of reason lost!" 
 
33 
 
 The worries of the student, the merchant, the speculator, 
 homesickness and disappointments are of this order. In the 
 treatment of such cases, the physician is often powerless to act. 
 " Who shall minister to a mind diseased; 
 Pluck from the memory a rooted sorrow, 
 'Rase out the written troubles of the brain, 
 And with some sweet oblivious antidote 
 Cleanse the stuffed bosom of that perilious stuff 
 Which weighs upon the heart?" 
 
 PHYSICAL, CAUSES Every deviation of health is charac- 
 terized by disturbance of sleep, but in most cases where a 
 vicious sleep habit is established, it tends to persist. Among 
 the chief causes are: 1 Brain strain. 2 Organic disease 
 of the brain and arteries. 3 Stomach and intestinal diseases. 
 4. Irritation of the sexual organs. 5 Poisonous substances 
 (toxic insomnia). 
 
 THE INSOMNIA OF BRAIN STRAIN An increase in the 
 supply of blood to the brain eventuating in cerebral congestion. 
 It is an undoubted fact, that the brain strain of severe mental 
 labor is measurably lessened by an adequate amount of physical 
 exercises. Physiologists and hygienists have shown this to be 
 true, yet we must be cautious in going to the other extreme, 
 taking too much physical exercise; for otherwise, the poison- 
 ous substances generated by muscular fatigue only tend to 
 excite the brain and tend to insomnia. 
 
 THE INSOMNIA OF ORGANIC DISEASE OF THE BRAIN 
 AND ARTERIES Whenever the nutrition of the brain is 
 compromised by actual disease, then insomnia of an aggravat- 
 ing and persistent character results. When the insomnia is 
 caused by brain congestion, there is flushing of the face, red- 
 ness of the eyes, giddiness, confusion of ideas, and sometimes 
 stupor. 
 
 THE INSOMNIA OF STOMACH AND INTESTINAL DIS- 
 EASE In indigestion, toxic substances are developed which 
 irritate the brain and prevent sleep. In many instances, the 
 accumulation of gases in the stomach and intestines by press- 
 ing on important organs, notably the heart and lungs, induce 
 sleeplessness indirectly. Some persons sleep best, if, before 
 
34 
 
 retiring they take a light repast; others, on the contrary, would 
 find such a procedure an indiscretion, certain to be followed by 
 insomnia. Sleep after eating is a salutary procedure. It draws 
 the blood from the brain to the stbrttach and thus facilitates 
 digestion. 
 
 Toxic INSOMNIA Insomnia induced by the indiscrimi- 
 nate use of poisonous substances like alcohol, coffee, tea, to- 
 bacco, etc. Not infrequently the inhibition of any one of these 
 substances will often cure an intractable insomnia. 
 
 TREATMENT OF INSOMNIA It has been truly said that if 
 sleep and hope should be taken from man he would be the most 
 miserable being in existence. Much can be attained by obey- 
 ing the laws of hygiene. Attention must be directed to a 
 minute investigation of all the bodily functions to ascertain the 
 fundamental condition, of which insomnia is a mere manifesta- 
 tion. We possess many drugs which, when prescribed by the 
 physician with discretion, may be regarded as harmless, yet 
 drugs should only be used as a last resort, for any drug which 
 induces sleeep by overpowering the body is not entirely with- 
 out danger. Generally speaking, an adequate amount of phys- 
 ical exercise is necessary in all sufferers from insomnia. Noth- 
 ing is more conducive to sleep than exercise taken in the open 
 air. Some diversion for the brain worker may be found in 
 change of scene and society. * ' Seeing that too much sadness 
 has congealed your blood and melancholy is the nurse of 
 frenzy, therefore have thought it good for you to hear a 
 play, and frame your mind to mirth and merriment which bars 
 a thousand harms and lengthens life." 
 
 No detail should be neglected in ascertaining the cause of 
 insomnia. Tea or coffee should not be taken at the evening 
 meal and tobacco should not be used, at least some hours be- 
 fore retiring. A glass of warm milk, or a cup of hot bouillon 
 before retiring may prove beneficial in inducing sleep. Some 
 derive sleep by taking a glass of beer or malt extract before re- 
 tiring. If the sufferer from insomnia be a literary man or 
 student, all intellectual effort should be stopped at least an hour 
 before retiring, and the interval filled in with some extraneous 
 dull reading. When this fails, no intellectual work should be 
 
35 
 
 done after supper, reserving that work for the early morning 
 hours. Some cases of insomnia only yield after a complete 
 change of scene free from excitement and sight seeing. Active 
 exercise before retiring, with dumb-bells, pulley-weights or 
 Indian clubs, followed by a tepid or warm sponge bath, often 
 induces healthful and refreshing sleep. Climate is an essential 
 consideration in those who suffer from insomnia. Warm cli- 
 mates are soothing and cool climates stimulating to the ner- 
 vous system. On account of the cool nights in mountainous 
 districts, refreshing sleep can often be obtained. Some find 
 benefit by residing at the seashore. 
 
 Hydr other apy is a valuable adjunct in the treatment of 
 insomnia. Schneller's experiments proved conclusively that ice 
 applied to the head of an animal caused contraction of the 
 blood vessels of the brain which persisted for a short time after 
 the ice was removed. The brief application of cold or warm 
 water to the surface of the body is stimulating, but if prolonged, 
 depressent. A cool sponge bath, or even a cold plunge before 
 retiring, will provoke sleep. The secondary effect of cold to 
 the skin, is to dilate the blood vessels which draw the blood 
 away from the brain. Many sufferers find relief in a prolonged 
 warm bath before retiring, the effect being sedative on the 
 nervous system. Others find equal benefit in a hot foot bath. 
 Some find relief in a Turkish bath followed by general massage. 
 The wet pack has done heroic service for many nervous per- 
 sons. It is used as follows : A sheet having been wrung out 
 of cold water, is thrown over the patient from neck to ankles, 
 and over this several dry blankets, with a hot water bag to the 
 feet and a cold wet cloth to the forehead. The patient remains 
 in the pack from half an hour to an hour, and is then vigor- 
 ously rubbed with a coarse dry cloth until the skin glows. The 
 wet pack may be given every night or several times a week. 
 
 Hot compresses, consisting of flannels wrung out of hot 
 water, applied to the abdomen and covered with dry flannels, are 
 often efficacious. A hot bag may be substituted. The cold 
 douche to the head, or a shower bath to the head and spine, are 
 frequently serviceable. 
 
Massage is often of service in insomnia when every other 
 hygienic measure fails. 
 
 Some persons can induce sleep by having recourse to the 
 hop pillow, which should be moistened with spirits before being 
 placed under the head of the patient. Among drugs, bromide 
 of potash is the least harmful. For an adult, 30 grains may be 
 taken in sweetened water before retiring and repeated in an 
 hour if necessary. It is especially useful in nervous cases. 
 
 Electricity, when properly employed, especially in the form 
 of static electricity, is almost an indispensable remedy in 
 insomnia. Contrary results often follow its injudicious applica- 
 tion. The galvanic current has a tendency to make some 
 persons sleepy and is to be applied in the evening, The 
 Faradic current makes most people wakeful. Electricity is 
 especially useful in the insomnia of brain strain and alcoholism. 
 
 Hypnotism is likewise an indispensable agent when judici- 
 ously emploved. 
 
 A common procedure for inducing sleep is energetic and 
 frequently repeated opening and closing of the eyelids. 
 Auto-suggestion is often of service. The patient should 
 go to bed with the firm conviction that sleep is bound 
 to follow. One may imagine observing all the phenomena 
 incident to sleep in another person. The reading of dull books 
 or concentrating the mind on some blank and wearying picture 
 makes the mind receptive to only one suggestion, viz: sleep are 
 some means often employed. 
 
 " A flock of sheep that leisurely pass by 
 One by one ; the sound of rain and bees 
 Murmuring ; the fall of rivers, winds and seas, 
 Smooth fields, wide sheets of water and pure sky." 
 
 TREATMENT OF THE HEART SYMPTOMS. 
 
 THE TREATMENT FOR PALPITATION OF THE HEART 
 Absolute rest in bed in a large ventilated and darkened chamber 
 with the clothing removed. The application of an ice-bag to the 
 region of the heart or cloths saturated in cold water are very 
 effective agents. Swallowing small pieces of ice or drinking 
 
37 
 
 large draughts of cold water or a glass of hot water are pro- 
 cedures frequently adopted. To prevent attacks of palpitation, 
 excitement of all kind must be avoided and tea, coffee, 
 and alcohol must be discontinued or at least reduced. When 
 the palpitation is dependent on impoverished blood, iron in some 
 form is serviceable. When a stomach disturbance is at the 
 bottom of the trouble it must be cured. Electricity is an effective 
 agent. When everything else fails, the rest cure gives remark- 
 ably good results. 
 
 TREATMENT OF NERVOUS DYSPEPSIA In the majority 
 of instances, indigestion is caused by too rapid eating and the 
 consumption of too much food. Digestion begins in the mouth. 
 This is especially true of the digestion of starchy foods. Many 
 dyspeptics are cured of their evil by thoroughly masticating 
 their food. A meal should be regarded as a pastime, not a 
 necessity. It is difficult and even impossible to lay down any 
 definite rule for the kind of food to be consumed, for " one man's 
 food is another man's poison." The nervous dyspeptic is as a 
 rule, poorly nourished. It is absurd to suppose that nervous 
 prostration can be cured without increasing and making the 
 nourishment effective. An exhausted nervous system demands 
 a plentiful supply of good nutritious food. Beard maintains 
 in his classic work on ' * Sexual Neurasthenia' ' that flesh is the 
 natural food of man. His theory of diet is founded on the 
 theory of evolution and finds expression in the following three 
 propositions : 1 Living beings feed on that which is below them 
 in the scale of development. 2 The best food for man is that 
 which is just below him or nearest to him in the scale of 
 development. 3 Food is difficult of assimilation for man in 
 proportion to its distance below him in the scale of develop- 
 ment. It is undoubtedly true, that those who subsist exclus- 
 ively upon meat are capable of greater mental and physical 
 exertion than those who consume vegetable food. Animal 
 food contains the greatest variety of nutriment and is generally 
 most easily digested. Beef is more nutritious and stimulating 
 than mutton. The flesh of very young animals is less nutri- 
 tious and more difficult of digestion than the flesh of the 
 matured animal. Oysters are very nutritious and digestible 
 
38 
 
 when consumed raw. Oatmeal is a frequent cause of indiges- 
 tion in the nervous dyspeptic. Eggs, milk and fish are very 
 nutritious. When the dyspepsia is severe, an exclusive milk 
 diet for several weeks proves curative. The daily amount 
 necessary must never be less than three pints and as much as a 
 gallon. A large glassful should be drunk slowly every hour, 
 and, when toleration is established this amount may be increas- 
 ed at shorter intervals. The digestibility of the milk may be 
 increased by adding a pinch of salt or a teaspoonfui of lime 
 water to each glass. Some prefer taking the milk diluted with 
 water or seltzer. When whole milk is loathsome, it may be 
 skimmed or substituted by buttermilk. Farinaceous foods 
 should, as a rule, be excluded as they create flatulency and 
 heartburn. Too much liquid should not be taken at a meal 
 as it dilutes the gastric juice and inhibits digestion. Hygienic 
 measures, such as exercise and bathing, are indispensable, for, 
 by increasing the tone of the nervous system they indirectly 
 improve digestion. Sufferers from nervous dyspepsia will find 
 material aid by carrying out the partial rest treatment and 
 confining themselves to the following diet which excludes 
 starchy foods which are notoriously indigestible in neurasthenic 
 persons. 
 
 On waking, eight ounces of equal parts of hot milk and 
 seltzer water, taken slowly. Breakfast, steak or loin chops with 
 fat, soft boiled or poached egg, cream toast (very little), half a 
 pint of milk and a small cup of coffee. Lunch, 10 A. M., small 
 teacup of squeezed beef juice with stale bread. 12 M, rest 
 or sleep. Midday meal, 12:30 P. M., fish, chicken, scraped 
 meat ball, stale bread with plenty of butter, baked apples and 
 cream, two glasses of milk. Lunch, 4 p. M., bottle of koumyss, 
 raw scraped beef sandwich or goblet of milk. 5:30 P. M., 
 rest or sleep. Dinner, 6 P. M., meat or fresh soup, roast or 
 mutton, game, stale bread (sparingly), fresh vegetables, 
 (excepting potatoes). Eat slowly, chew the food thoroughly, 
 and never eat when excited or exhausted. Poorly prepared 
 meals are often a source of dyspepsia. Washing the stomach 
 by means of a tube is often indicated for the relief of dyspepsia. 
 Constipation is frequently a cause of dyspepsia and loss of 
 appetite. 
 
" A *K\ 
 9*rxm \ 
 
 ERSITY 
 
 f XTNIVERSITY 
 
 Personally I have observed only temporary good to result 
 from the use of such agents as pepsin, pancreatin and hydro- 
 chloric acid. To stimulate digestion strychnin is often invalu- 
 able. The addition of common salt to our food stimulates 
 digestion. Alcohol should be stopped, although there can be 
 no objection to a moderate use of some light wine taken with 
 meals. 
 
 RULES FOR DYSPEPTICS. 
 
 RULE I. Eat slowly and chew the food thoroughly. If 
 the foregoing are not observed then follow the rule of Sir 
 Andrew Clark, viz: Count the bites. For every mouthful of 
 meat thirty-two bites must be allowed, or one bite to every 
 tooth. If the meat is tough sixty-four bites must be allowed, 
 and ninety -six bites if very tough. This rule is an almost 
 positive protection against dyspepsia and will, in most instances, 
 cure the disease. 
 
 RULE II. Solids and liquids must be taken at separate 
 times. l,iquid taken with food in those with weak stomachs 
 dilutes the gastric juice and retards digestion. Then again, 
 when liquids are not taken with the food it induces the patient 
 to chew the food thoroughly or otherwise it cannot be swal- 
 lowed. If at breakfast tea or coffee must be drunk it is better 
 taken at the completion of the meal. 
 
 RULE III. Farinaceous and proteid foods should not be 
 taken at the same meal, in other words, the same character of 
 food only should be introduced into the stomach at the same 
 meal. For example: Bread and butter may be taken at 
 breakfast, but no meat, fish or eggs. L,uncheon should consist 
 of fish, eggs or meat, but no bread, potatoes or other farina- 
 ceous food. Supper should consist of the same kind of food as 
 at luncheon or farinaceous food only. Introducing the same 
 kind of food into the stomach at each meal insures the com- 
 pletion of digestion at the same time, and not at different 
 times, as would be the case if the character of the food taken 
 at a meal is different. 
 
40 
 
 RULE IV. If liquid must be taken at a meal, the best 
 drink is hot water, taken on rising in the morning, at 12 
 o'clock and again at 4 p. M. Taken at these intervals there 
 will be do dilution of the gastric juice and the contents of the 
 previous meal will be washed out of the stomach. 
 
 TREATMENT OF CONSTIPATION. Each case of constipa- 
 tion must be investigated as an individual one. Habit is an 
 important factor. The desire to go to stool must never be 
 neglected, in fact it is to be encouraged by a systematic habit 
 of going to the toilet every morning whether or not the desire 
 is present. Such a practice will often cure the costive habit. 
 Many persons find that a cigar or pipe after breakfast acts as a 
 laxative. Massage of the abdomen is constantly practiced, 
 but I confess never to have seen any good results from its use, 
 save in children and very young persons. Many persons 
 succeed in obtaining a daily evacuation by taking certain 
 articles of food. Fruit, raw or cooked, taken at breakfast, is 
 often effectual. Some find oatmeal or brown bread to have a 
 similar effect. Water should be drunk in abundance, espe- 
 cially before retiring or on rising in the morning. Others find 
 that a glass of raw milk taken before breakfast will act as a 
 laxative. Exercise is of great value, especially exercise 
 like horseback riding, which brings the abdominal muscles into 
 play. The continued use of purgatives is a dangerous prac- 
 tice. They are only temporary in action and make the bowels 
 more constipated than ever. The least objectionable agents 
 of this class are the natural purgative waters like Carlsbad 
 and Hunyadi Janos. In California we possess an effective 
 natural water called Bythinia. Suppositories of glycerin or 
 a daily enema of cold water is of great value. The same may 
 be said of olive oil. Glycerin (a tablespoonful to four table- 
 spoonfuls), thrown into the rectum is very effective. Cold 
 sponging and baths are valuable additions to the measures 
 suggested. 
 
VII. 
 SPECIAL FORMS OF NEURASTHENIA. 
 
 CONGESTIVE NEURASTHENIA. 
 
 Whittle, of London, in 1889, wrote an interesting broch- 
 ure on this special form of neurasthenia, but it seems to have 
 escaped the serious consideration of the medical profession. I 
 have repeatedly been able to confirm the observations of 
 Whittle. He describes a form of nerve depression resulting 
 from brain congestion and illustrates the remarkable efficacy of 
 blood-letting, either by leeches or venesection in its treatment. 
 The particular patients who are thus benefitted, look to the 
 uninitiated eye, the picture of health, but are really miserable 
 victims to whom actual pain or some evident disease would 
 prove an agreeable distraction. Their faces are flushed, eyes 
 watery and there is a lightness in the head with occasional 
 aching of a dull, heavy character about the forehead. The 
 majority of cases occur between the ages of 30 and 40, very 
 few under 25 or over 50. This includes the most active and 
 wearing period of life. If a man can stand the strain of this 
 period, he will be proof against anything he may encounter 
 afterward. Congestive neurasthenia occurs more frequently 
 in males than females and the most constant factor in its pro- 
 duction is continuous brain strain. 
 
 During sleep, such as it is, the body rests but not the 
 brain. As a result the brain becomes unduly charged with 
 blood, leading to congestion, which nothing seems to relieve so 
 quickly and marvelously, as blood-letting. Leeching is one of 
 the good remedies out of fashion, and while formerly it was 
 the custom to bleed too much, it is unfortunate that now we do 
 not bleed enough. I remember one congestive neurasthenic 
 who, by actual calculation, had consulted twenty-three differ- 
 ent physicians, among whom were some of the leading nerve 
 
42 
 
 specialists of Europe. In addition he had made a number of 
 sea voyages and visited many celebrated spas but with abso- 
 lutely no relief. Incidentally an eye trouble necessitated the 
 application of leeches by his oculist to the temples resulting in 
 immediate relief to his nerve symptoms which had hitherto 
 baffled all treatment. Six months later his old symptoms 
 returned but the reapplication of leeches and the withdrawal 
 of blood from the brain vessels was as successful as in the 
 primary instance, 
 
 URIC ACID NEURASTHENIA. 
 
 Brain workers often suffer from a series of per- 
 plexing symptoms which baffle the skill of their medical 
 advisers. Such sufferers are usually good livers and 
 lead sedentary lives. With such, insomnia, headache, 
 mental depression, backache and dyspepsia are prominent 
 signs. Such individuals are really sufferers from uric acid 
 poisoning. It was Alexander Haig, of London, who, in his 
 memorable work on ' * Uric Acid as a Factor in the Causation 
 of Disease," made many perplexing problems clear which had 
 heretofore remained unrecognized. Uric acid occurs in the 
 blood in traces during health. It is derived chiefly from foods, 
 and persons who eat an excess of food and take little exercise 
 produce an excessive quantity of uric acid, which accumu- 
 lating in the blood, gives rise to a train of symptoms. The 
 blood is naturally alkaline and holds the uric acid in solution, 
 but if from any cause the blood becomes acid, it can no longer 
 hold the uric acid in solution, and consequently the latter is 
 precipitated. Now the joints, muscles and ligaments are fav- 
 orable sites for the precipitation of uric acid, hence those who 
 suffer from uric acid poisoning complain of muscular pains in 
 the back and joint stiffness. The heart is also frequently 
 affected. Every time a muscle contracts, and the heart is 
 essentially a muscular pump, it produces an acid. Now an 
 acid favors the precipitation of uric acid, hence the heart 
 attracts uric acid, which, accumulating in its substance, event- 
 ually leads to inflammation and weakness of that organ. 
 
43 
 
 Headache is a frequent symptom and so is neuralgia. 
 The urine is highly acid, highly colored, and deposits a brick 
 dust sediment on standing. Chronic diseases of the liver and 
 kidneys owe their origin to the excessive formation and 
 defective elimination of uric acid. 
 
 TREATMENT OF URIC ACID NEURASTHENIA Insomuch 
 as overeating and overdrinking, combined with insufficient 
 muscular exercise, are the essential causes of uric acid poison- 
 ing, persons predisposed to this intoxication should live tem- 
 perately, abstain from alcohol and eat moderately. Any 
 hereditary tendency can be overcome by an open air life with 
 an abundance of exercise and regular hours. Meat must be 
 eaten sparingly, especially red meat. Authorities differ in 
 their recommendation of food, some advising an exclusively 
 vegetable, others an animal diet. A good rule is to diminish 
 the amount of food, especially meat, consuming the latter but 
 once a day and to get up from the table always feeling a little 
 hungry. ' ' Moderation in all things, ' ' says Balfour, * ( is a certain 
 passport to longevity. It enables us to live healthy for as long 
 as we may." Water, especially mineral water, should be drunk 
 freely, as it cleanses the blood and favors the elimination of 
 uric acid. The skin should be kept active by some form of 
 exercise sufficient to produce free perspiration. An occasional 
 Turkish bath should be taken. Care should be taken to avoid 
 chilling of the skin by dressing warmly. A large number of 
 remedies have been suggested to promote the excretion of uric 
 acid, such remedies as the lithium salts, colchicum, iodide of 
 potash, piperazin and the salicylates, but they ought not to be 
 taken without the advice of a physician. For general use I 
 can warmly recommend a preparation known as the Vita 
 Aurantii litholytica (Haber). Each tablespoonful of the solu- 
 tion, containing phosphate of soda, 30 grains ; citrate of lithia, 5 
 grains, and salicylate of soda, 2j grains. Of this solution, a 
 tablespoonful is taken in water after each meal. It has a laxa- 
 tive effect, and when this becomes too pronounced, the dose 
 may be reduced. 
 
44 
 
 SEXUAL NEURASTHENIA. 
 
 When the symptoms of neurasthenia predominate in 
 the sexual apparatus, we speak of sexual neurasthenia. 
 In neurasthenia the sexual power is usually very much 
 diminished, either by incomplete erections, premature ejac- 
 ulations or night emissions. Married men find this weak- 
 ness a source of much mental suffering, and the constant 
 fear of impotency prompts them to seek medical advice. It is, 
 without doubt, true that the majority of functional troubles of 
 the sexual organs are of a neurasthenic nature. Whatever the 
 changes may be in his sexual apparatus, the unfortunate suf- 
 ferer is inclined to exaggerate them by a vivid imagination or 
 by the perusal of o^uack advertisements. Normal ingredients 
 of the urine, such as phosphates and urates, passed by such 
 persons, is declared by charlatans, to be seminal fluid. Al- 
 though seminal fluid may be passed during urination or defeca- 
 tion, it is nevertheless a rare occurrence. 
 
 Involuntary seminal emissions in a healthy unmarried man, 
 occurring at different periods, must always be regarded as an 
 evidence of good health. It is only when the emissions are 
 followed by depression, vague pains in the head and a feeling 
 of exhaustion, that they are to be regarded as harmful. Some 
 individuals suffer no inconvenience from night emissions, oc- 
 curring even as often as several times a week, whereas in 
 others, a simple emission once a week, or even less often, is 
 attended by the signs previously noted. Seminal emissions may 
 be the cause of nerve depression, not the consequence of the loss 
 of semen, but from the nerve exhaustion following. More often, 
 the emissions are the result of nerve depression. It frequently 
 happens that sufferers from seminal emissions attribute their 
 trouble to the habit of self abuse. While the habit is unfor- 
 tunately well nigh universal among both sexes and animals, 
 and frequently attended by dire results, the latter have, no 
 doubt, been greatly exaggerated. 
 
 Spermatorrhea or the passing of semen with the urine or 
 during defecation is indicative of grave debility of the sexual 
 apparatus. It is usually the result of neglected or improperly 
 
45 
 
 treated seminal emissions. Many cases of so called sperma- 
 torrhea it must be emphasized are really urethral discharges, 
 other than semen. The microscope alone can determine the 
 nature of the discharge. 
 
 Impotence signifies one of the following conditions: 
 1. Deficiency of desire and power. 2. Deficiency of 
 power with increased desire. 3. Abnormal erectile power 
 known as priapism in which there is no discharge of semen. 
 Very often the impotence is imaginary, a form known as 
 psychical impotency. It is strange that people are not better 
 educated in regard to their sexual functions. All they learn 
 is of a suggestive nature by the reading of erotic literature 
 and quack advertisements. Among the prominent symptoms 
 of sexual neurasthenia, are: dimness of vision, back pains, 
 mental depression and defective memory, dyspepsia, palpitation 
 of the heart and dizziness. In women, sexual neurasthenia 
 presents symptoms similar to that of man, although they occur 
 with less frequency. Some suffer from nocturnal orgasms 
 accompanied by dreams and they awake feeling nervous, de- 
 pressed and exhausted. In married women, the sexual appe- 
 tite may be increased at first, but it rapidly disappears to be 
 followed very often by distaste or even disgust. 
 
 The sexual hypochondriac. This unfortunate creature, 
 boy, girl, man or woman, usually lives a life of profound 
 despondency, the result of a real or fancied disturbance of the 
 sexual organs. Such cases demand a true explanation of the 
 disorder, but when the morbid state of mind is encouraged 
 by the ^harJLatan only direful results follow. There is no 
 sufferer tcT^wtrcfln truth is more repellent than the sexual 
 hypochrondriac, in fact his morbid fear is a delusion which he 
 wishes to have verified. The sexual hypochondriac may be 
 the victim of one of the following disorders: Involuntary 
 seminal discharges, impotency, masturbation, orsyphilophobia. 
 
 Involuntary seminal discharges are quite natural and 
 occur in all persons who lead a correct and continent life and 
 are not unlike menstruation occuring in women at periodic 
 intervals. The "night emissions" are not necessarily the in- 
 voluntary discharge of semen but are often made up of a fluid 
 
46 
 
 derived from the prqstate gland. Some persons secrete a 
 larger quantity of prostatic fluid than others, hence it is quite 
 within the limits of health for such individuals to have involun- 
 tary discharges at more frequent intervals.* Then again, the 
 character of food eaten has a notable influence on the amount 
 of seminal or prostatic fluid secreted. The milky character 
 of the urine in the sexual hypochrondriac is not semen but 
 phosphates^ a fact which is made evident when a little acid is 
 added to the urine, resulting in the complete disappearance 
 of the milky character of the urine. The mucilage-like fluid 
 observed at the head of the penis after stool is often of no con- 
 sequence, consisting as it often does of the secretion of the 
 prostate gland. 
 
 Impotency, or fondly called * ' lost manhood ' ' by the adver- 
 tising quack, is in most instances an imaginary condition. 
 True manhood finds no index in the vigor of the sexual appa- 
 ratus. The more man approaches the condition of brute 
 creation, the more powerful is his sexual instinct. 
 
 As man and woman ascend the scale of moral and social 
 life, there is less inclination for the performance of the sexual 
 act. Such individuals are both potent and impotent at times. 
 The best type of a married man is only potent in the presence 
 of his consort. If he demonstrates this potency toward another 
 his moral standard is as low as the negro who commits rape as 
 often as occasion permits. An indefinite number of unfore- 
 seen conditions like mental and physical fatigue, disgust, worry 
 and anger, conduce to make every man impotent at times. 
 The fear and timidity which possess the newly married are 
 evidences of morality and not sexual weakness. It has been 
 estimated by a trustworthy statistician that at least 60 per cent 
 of young husbands fail in the first sexual attempts after mar- 
 riage. There are many individuals who are impotent, owing 
 to their overwhelming fear of contracting some disease. There 
 are persons who manifest impotency toward certain women, but 
 who are fully capable of performing the act with others. 
 
 Unnatural practices are bound to be followed by impo- 
 tency. The sexual act when aroused by artificial means finds 
 no response when invoked by natural methods. Sexual 
 
47 
 
 psychopathy, or the attainment of sexual desire by unnatural 
 means, is a stigma of degeneration manifested in persons who 
 have inherited or acquired a defective nerve organization, and 
 is common among the insane. 
 
 Masturbation may conduce to severe disturbances in the 
 mental and physical health, but as the habit is stopped at an 
 early period of life, as soon as the indecency of the habit is ex- 
 plained, no possible consequences ever arise. We must all 
 encounter a period in life when there is a conflict between the 
 passions and one's better self, but the latter is usually the victor 
 in the combat. It is not an exaggeration to maintain, that, 
 in the majority of instances, the evils arising from masturbation 
 practiced moderately, and for a short period in youth, are 
 largely mental, developed from the loss of self-respect and the 
 sense of unmanliness. 
 
 Syphilophobia is the morbid dread of having contracted 
 syphilis. When other venereal diseases have, or are supposed 
 to have been acquired, the mental suffering in some individuals 
 is equally intense. The anxiety of mind conquers the entire 
 being. Sleep, digestion and nutrition are in consequence im- 
 paired, and the unending terror may last a lifetime unless 
 controlled by the conscientious physician, who is often able by the 
 modern aids of science, to make innocuous the indiscretions 
 arising from venereal disease. Often the sexual madness has 
 no real foundation; a harmless skin eruption, lax, or too 
 tightly drawn testicles, innocent pimples and the like are apt to 
 be construed as manifestations of some disease of the blood. 
 
 TREATMENT OF SEXUAL NEURASTHENIA Conjugal hy- 
 giene. Normal sexual intercourse is the most powerful passion 
 of human nature conducive to strong and vigorous health. 
 When followed by a feeling of well being, it is healthful but, 
 if on the contrary it is followed by depression, the act is harm- 
 ful. Unnatural methods of intercourse such as withdrawal, 
 use of condoms and prolongation of the act are especially 
 harmful and are often the essential cause of a protracted siege 
 of sexual neurasthenia. It must not be forgotten that the 
 health of the offspring is largely dependent on the condition 
 of the parents at the time of the conception and for this reason r 
 
Y 
 
 48 
 
 the laws of sexual hygiene should be observed most rigorously. 
 Spitzka affirms that " children begotten by a drunken father 
 have repeatedly been found to be epileptic, imbecile, deaf, 
 mute or insane." Undue repetition of the sexual act is re- 
 pugnant to the moral sense and is certain to be followed by 
 evil consequences. Sexual intercourse is intended for the pur- 
 pose of reproduction and the prevention of conception is an 
 injustice to society and results in injury to both sexes. 
 
 The treatment of seminal emissions is genga4ty a simple 
 matter when conducted by the physician. Aside from local 
 ^nTa^^es~the building up of the nervous, system is an absolute 
 essential. To arrest the emissions entirely in a continent unmar- 
 ried man is an impossibility. What can really be achieved 
 is this, to allow the emissions to continue without any detri- 
 ment to health. Marriage, while offering immunity in the 
 majority of instances, is not invariably productive of such 
 results, for there are many married men who continue to have 
 emissions. This is of course usually unnatural and often 
 indicates that the strength of the organs is imperfect, or 
 because no real pleasure is derived from the act or because 
 there still remain traces of former sexual troubles. Before 
 emissions can be controlled, sexual excitement and masturba- 
 tion must be avoided. The diet should be non-stimulating. 
 Spices, alcoholic drinks, strong coffee and tea must not be~, \/ 
 used. Before retiring very little fluid or food should be 
 taken. Sleep should not be prolonged and early rising 
 is important. The patients should never lie on the back and 
 the covering should be light and the bed hard. When patients 
 awake in the morning they should at once empty the bladder. 
 
 The treatment of sexual^neurgsthenia in general, means 
 the correction of general nerve depression. Aside from local / 
 treatment, which may be necessary when strictures or old 
 discharges complicate the trouble or when a tight prepuce 
 exists or rectal irritation from piles or retained fecal matter, 
 the essential object always, is the relief of nerve depression on 
 which the sexual disorders are dependent. Charlatans often 
 aggravate the sexual weakness and irritability by employing 
 drugs and different kinds of apparatus which temporarily 
 
49 
 
 stimulate the debilitated organs, leaving them in a worse con- 
 dition than ever before. In no other disease is meddlesome 
 treatment so disastrous as in sexual debility, and many individ- 
 uals have been /permanently injured by such measures. There 
 are no specific drugs in the treatment of sexual neurasthenia. 
 Even moral treatment, so often vaunted by medical writers, is of 
 little avail, and while the mind frequently operates to the dis- 
 advantage of the sexual apparatus, there is no affection which 
 is less amenable to moral treatment than sexual neurasthenia. 
 Patients see no results in expectancy. They want results and 
 the results which they are so eager to obtain can only be 
 achieved by a correct toning of the nervous system. 
 
WORKS OF DR. ALBERT ABRAMS 
 
 A Manual of Clinical Diagnosis 
 
 THIRD EDITION, REVISED AND ENLARGED. 
 ILLUSTRATED. 
 
 Price, $2. 
 
 The Occidental Medical Times This book contains a vast amount of 
 information ; it is, in fact, a small encyclopedia of diagnosis. In its 
 present improved and enlarged form, it will undoubtedly meet with a 
 universal and well deserved popularity. 
 
 Transactions of the Antiseptic Club 
 
 By the same author, 
 ILLUSTRATED. 
 
 IB one octavo volume, illustrated by pen and ink sketches especially de- 
 signed by Moss, Keeler and Tiers, artistically and substantially 
 
 bound in Antiseptic Dressing $1.75 
 
 Presentation Edition. First impressions, large paper, extra quality, Gilt 
 top. Uncut Edges. Half Vellum Cloth, limited to subscriptions 
 
 received and numbered $2.75 
 
 3d Edition, Cloth, Now Ready at tbo Popular Prices. Postpaid $1.00 
 
 New York : 
 E. B. Treat, Publisher, 5 Cooper Union . 
 
 Presi Comments : 
 
 Southern California Practitioner , Los Angeles, Ca/.-"We will not 
 repeat the jokes here, for we hope our readers will purchase the book 
 and enjoy it for themselves. It is full of fun and satire, and yet under it 
 all there is enough of truth to be food for thought. There is plenty of 
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 Medical Journal* Brooklyn, N. K " Is is without doubt the best 
 medical satire of the day." 
 
 The American Practitioner and News. "This volume supplies one 
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 privilege of reading." 
 
WORKS OF DR. ALBERT ABRAMS 
 
 Consumption 
 
 ITS NATURE, CAUSES, PREVENTION AND CURE. 
 
 By the same author. 
 
 San Francisco, 
 WM. DOXRY. 
 
 Price, 50 Cents. 
 
 A little volume dedicated to all those who are liable to or suffer from 
 Consumption, with the hope that it will rescue the former and help the 
 latter to recover. 
 
 A Synopsis of Morbid Renal 
 Secretions 
 
 By the same author. 
 
 A Practical Guide for Physicians and Students in the chemic and 
 microscopic examination of urine. 
 
 Scattered Leaves 
 from a Physician's Diary 
 
 Published by 
 
 THE FORTNIGHTLY PRESS Co., 
 St. Louis Mo. ,1900. 
 
 Pness Comments : 
 
 The Medical Standard, Chicago. " The readers of the STANDARD 
 are well acquainted with DR. ABRAMS' brilliant scientific work, but in 
 order to appreciate something of his remarkable versatility, they should 
 read this book of delightful sketches. Here he brings to bear the side 
 lights of his humor upon the foibles and weaknesses of the ultra-scientific 
 and makes a laughable, if somewhat tragic, picture of the absurdities of 
 quackery and its congeners. His stories are bright and brainy, brimming 
 full of scintillating wit that is sharpened by good common sense. His 
 style is perfection. DR. ABRAMS attacks the shams with a humor of the 
 practical kind that stands for straightforward honesty. Every physician 
 who has a sense of humor should buy this book aud those who are with- 
 out it should use it as a text book. 
 
 The San Francisco Bulletin. The short stories contained in this 
 little book are among the best that have been published in a long time. 
 
WORKS OF DR. ALBERT ABRAMS 
 
 Diseases of the Heart 
 
 A PRACTICAL MANUAI, FOR PHYSICIANS AND STUDENTS 
 
 Price $1.00 
 
 G. P. BNGLEHARD & COMPANY, PUBLISHERS, 
 Chicago, 111., 1900. 
 
 Medical Standard, Chicago. In this book the author discusses the 
 subject of diseases of the heart entirely from a practical aspect. His 
 most noteworthy researches in methods of diagnosis are here recorded 
 for the first time in collected form, and the latest and most practical 
 methods of treatment given in detail. 
 
 It is believed no other book yet published is so well fitted to become 
 the leading practical manual upon this subject. Dr. Abrams is one of 
 the most delightful writers now contributing to medical literature and 
 writes with a clearness and logical continuity that gives a peculiar charm 
 to his work, which is at the same time of the highest scientific value. 
 
 Diseases of the Lungs and Pleurae 
 
 A PRACTICAL, MANUAI, FOR PHYSICIANS AND STUDENTS. 
 
 Will be Published Shortly by 
 
 THE FORTNIGHTLY PRESS COMPANY 
 St. I^ouis. Mo. 
 
RETURN TO the circulation desk of any 
 University of California Library 
 
 or to the 
 
 NORTHERN REGIONAL LIBRARY FACILITY 
 Bldg. 400, Richmond Field Station 
 University of California 
 Richmond, CA 94804-4698 
 
 ALL BOOKS MAY BE RECALLED AFTER 7 DAYS 
 
 2-month loans may be renewed by calling 
 (510)642-6753 
 
 1-year loans may be recharged by bringing 
 books to NRLF 
 
 Renewals and recharges may be made 4 
 days prior to due date. 
 
 DUE AS STAMPED BELOW 
 
 AUG 3 2000 
 
 - 
 
 OCT282000 
 
 ELEY 
 
 $ 
 
 12,000(11/95) 
 
ft 
 
 
 YC 14847 
 
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