Chapter XVI: Preface: iii (15)

Shake the bottle and apply a little of the liquid to the place. Horseback riding and walking are good for nervous girls and women.

NEURALGIC HEADACHE.--This commonly comes periodically, usually, one- sided. It may occur at the same hour for several days in succession. The pains are of all kinds. It may start in the morning or at any time. It involves more especially the eyes, side of the head, face, and goes into the teeth and neck. It comes in persons subject to neuritis in other parts or neuralgia.

Treatment.--Build up the system with tonics in the interval. Lead a quiet restful life. Acetanilid in five-grain doses frequently relieves it. This is a dangerous medicine to use, except under a doctor's supervision. Spigelia in doses of one-twelfth of a drop of the tincture is good for left-sided attacks; two doses are enough, one-half hour apart.

STOMACH OR GASTRIC HEADACHE.--This, as the name indicates, is due to some acute or chronic trouble with the stomach. It is caused by over-loading the stomach, or eating food that does not agree, such as fat meat, gravies, starchy food, warm bread, pastry, etc., or it may be due to dyspepsia. The tongue is generally coated, the mouth tastes bitter. If it is acute and the stomach is full, take a common emetic like warm water, salt water or mustard water. If it is due to decomposed food, drink lots of warm water and take an enema and also a dose of salts. If there is much gas in the stomach, take some baking soda in a glass of warm water; one drop doses of tincture of nux vomica every half hour for three hours often relieves.

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HEADACHE FROM CONSTIPATION.--This is frequent. There is generally a dull, heavy feeling in the forehead, the head feels full and sometimes dizzy, the patient feels blue and morose, the tongue is coated on its back part, mouth tastes bitter, patient is drowsy and stupid and work goes hard. A free passage from the bowels relieves the headache.

Treatment.--Cure the constipation as directed in another part of the book. Take a good full enema of warm soap suds and water, and one drop of tincture of nux vomica every hour for six hours during the attack.

BILIOUS HEADACHE.--This is so-called because the bilious symptoms are the most prominent. It may be caused by violent anger, disputes, excessive eating causing congestion of the liver; abuse of spirits; some persons are of a bilious constitution and the least error in diet and habit produces such an attack. The pain may be violent or dull, the head may throb terribly; the whites of the eyes have a yellowish look, and the face may be of a dark brown hue, the patient may vomit bile. The vomiting causes more brain distress. The mouth is bitter, the tongue coated yellowish, the breath smells badly. Bowels may be irregular.

Treatment.--A free movement of the bowels often relieves. First take an enema and then one-half ounce of epsom salts. Do not eat anything but drink all the water you may wish. A tea made of blue flag is often of benefit. The diet should be regulated so as not to overload the stomach and liver and the bowels should move freely daily.

WOMB HEADACHE.--Women who suffer from womb troubles such as leucorrhea, torn cervix, falling womb displacements and diseases of the inner womb, ovaries and tubes, suffer from all kinds of headache. The pain may be in the nape of the neck, the back part of the head and on the top behind (occiput). It may come on suddenly when the womb is displaced by a sudden fall or over-lifting, etc. The woman should then go to bed and lie down with her arms crossed over her chest, with the knees drawn up and weight resting upon them and chest with the buttocks elevated, (knee-chest- position). This replaces the womb. The other troubles should be corrected or these headaches will keep on. The womb and its appendages are the cause of many kinds of headaches, neuralgias, dyspepsia, and constipation; correct the troubles and the headache will disappear.

MENSTRUAL HEADACHES.--These are very common. They may be regular every month, and they are then caused by some trouble with the womb or ovaries, or may be due to a run-down condition or heredity. It comes sometimes from suppression of the menses as a consequence of some violent emotion, fright, anger, grief, or by exposure to wet, draughts of air, privations, over-fatigue, etc. It may last for several days. The headache may be mild or severe.

Treatment.--A foot bath or sitz bath is very good, with free drinking of pennyroyal tea after the bath, and when in bed. Place warmth to the feet, moist heat over the abdomen, such as a hot water bag or fomentations. Remain quietly in bed. If constipated, take an enema. Frequently a free bowel movement gives much relief in this trouble. During the interval doctor the patient for the trouble causing the headache for which see another part of this book, "Diseases of Women."

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MOTHERS' REMEDIES, 1. Headache, Paregoric and Soda for.--"A teaspoonful of paregoric, with one-half teaspoonful of baking soda in a tumbler of water, May be taken all at once or sipped slowly."

2. Headache, Hops Good for.--"Make a strong decoction of hop tea, and take a wineglassful every half hour until relieved." This is an old tried remedy and a good one.

3. Headache, Mustard Excellent for.--"Place a mustard plaster on the back of the head, also bathe the feet in mustard water and stay in a darkened room, and avoid all excitement and noise." The one essential thing is to get the nerves quieted; take as little food as possible for twenty-four hours, giving the stomach an opportunity to rest, as most of the headaches come from a disordered stomach.

4. Headache, Peppermint Beneficial for,--"Bathe the head in strong peppermint. Then apply cloths wrung from water as hot as can be endured." Hot or cold applications are known to be very beneficial. After the cloths are taken off, the soothing effect can be further enhanced by gentle rubbing of the forehead.

5. Headache, Cold Application in Case of.--"Apply cold applications on the forehead and over the eyes." These cold applications have been known to give relief in a very few minutes to many people suffering with severe headaches. It is well to continue the treatment; even after relief has been obtained, for at least a half hour. Gentle rubbing of the head is very good, also.

6. Headache, Castor Oil Will Relieve.--"One tablespoonful of castor oil. Have used this and found relief." This remedy gives relief as the castor oil carries off the food that is distressing the stomach. It is well to take two tablespoonfuls of lime-water in a glass of milk three times a day for about a week after the castor oil has operated.

SICK HEADACHE. (Migraine. Hemicrania).--Migraine is a peculiar form of severe paroxysms of unilateral (one side) headache often associated with disorders of sight.

Causes.--It is frequently hereditary, and it has occurred through several generations. Women and members of nervous families are usually attacked. Many of the headaches from eye-strain are of this type, It is often inherited, and may last from puberty to the menopause. Some authors claim that decay of the teeth without toothache will cause it. Adenoid growths in the pharynx and particularly abnormal conditions of the nose will cause it. Many of the attacks of severe headaches in children are of this nature, and the eyes, nose and throat should be examined when children or older persons suffer from this complaint. Mental emotion, physical or mental fatigue, disorders of the female genital organs, eye-strain, etc., loud noises, toothache, act as predisposing causes. Some think it a poisonous condition due to the absorption of poisons from the stomach and intestines, and others regard it as a nervous condition due to anemia and all conditions which weaken the resistance of the nervous system.

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Symptoms.--The premonitory symptoms, which may last a few hours or a day or more, are sleepy feelings of discomfort, uneasiness, weariness, chills, vertigo (dizziness), disturbance of the sight or disturbances of the senses. The real attack may follow quickly, beginning with the characteristic headache, at first one sided, located in one spot in the temple, eye or back of the head, but spreading, as it increases in severity, until it involves all of one side of the head and occasionally both sides. The pain is usually constant and of great severity and it is increased by motion, noises, light, or mental strain. The skin over the painful part is very sensitive. There are loss of appetite, nausea and vomiting. If the stomach has a great deal of food in it, vomiting relieves the pain sometimes. In the spasmodic form the affected side is painful, the skin is cool, the pupil is dilated, and the flow of saliva is increased. In the paralytic form the affected side is flushed, hot, the vessels are dilated and the pupils are contracted. There is great weakness, prostration and depression. The urine may be abundant or suppressed, temporarily. The results of treatment in this disease are uncertain, as the attacks are likely to occur in spite of treatment. They usually cease in old age, and in women they may stop after the menopause. The attacks in women are likely to occur at or near the menstrual periods.

First Thing to do in Sick Headache.--It is well to remain in a darkened room away from noise, etc. If the head throbs and beats very hard, either a cold ice bag or hot applications often bring relief. A mustard plaster at the base of the brain with a hot foot-bath often helps. Some people by stroking the forehead and temples have the power to ease the pain, producing quiet and sleep. If the bowels are costive, salts should be taken to move them, or they can be moved by an enema, if salts are not at hand. If the stomach is full, or tastes sour, drink a lot of warm water and vomit, or produce vomiting by tickling your throat with your finger, after having taken a large quantity of warm water for sometimes warm water thus taken fails to cause vomiting. If there is no food in the stomach, but there is sour and bilious vomiting, the warm water will frequently help. For a sour stomach or when it is full of gas, a teaspoonful of baking soda in some hot water will often feel very pleasant and grateful. The patient should keep absolutely quiet after these are done, and often they fall into a refreshing sleep.

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EMERGENCY MEDICINES.--If anemia is the cause, give tonics such as iron and arsenic. If the patient feels faint and nauseated, a small cup of strong hot coffee gives relief, sometimes. Antipyrin, given early in doses of two and one-half grains often relieves. Take another dose in one-half hour if necessary. But such remedies are hard on the heart.

TREATMENT. Preventive in Sick Headache.--The patient is often aware of the causes that bring on an attack. Such causes should be avoided. A great many people who are afflicted with this trouble are not only careless in their eating, eating anything and everything and at all times--at meal time and between meals--but also careless in their habits of life. Patients should avoid excitement, like card parties, etc., staying up late, or reading exciting books. The meals should be regular, no food taken that is hard to digest. Pies, cakes, puddings, gravies, ham, pork, sausage, and fried foods must be avoided. Rich, greasy foods will not do for such persons to eat. Strong tea and coffee are bad. Plenty of water should be taken between meals. At meals it is better to take no water unless it is hot water. Every morning on arising it is well to drink a large quantity of either cold or hot water. This washes out the stomach, bowels and kidneys, and stimulates them to better perform their functions. The bowels must be kept regular, one or more passages a day and at a regular hour. Sometimes, especially in younger persons, the eyes are at fault and may need glasses. Frequently it is caused by overwork in school in young girls, especially during their menstrual periods. Social duties cause them in many women, and then strong tea or coffee, or headache powders, or tablets, are taken to keep up or to stop the pain, making the patient more liable to the attacks in the future; and then still more tea, coffee, and headache remedies are taken until the patient is a slave to the remedies taken to help her. A great many of these headaches can be helped by simple measures, and the time between the attacks, in about all cases, made longer if the patient will but work with the physician, not only at the time of the attack, but in the interval. The clothing should be comfortable. The feet should always be kept dry. This applies especially to neuralgia. In fact the above measures of prevention and care apply to all kinds of headaches and neuralgias. Prevention is worth more than the cure.

MOTHERS' REMEDIES. 1. Sick Headache, Hop Tea Will Relieve.--"Hop tea is very good if a good strong decoction is made. A wineglassful may be taken every half hour or hour until relieved." This is very easily prepared, as the hops may be purchased at any drug store.

2. Sick Headache, a Favorite Remedy for.--"Aconite liniment or aconite rubbed on the forehead will relieve the pain in the head almost instantly. One drop of the tincture of nux vomica in a teaspoonful of water every five or ten minutes will quickly relieve." Nux vomica is good only when the headache comes from constipation and stomach trouble and too high living.

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3. Sick Headache, Aromatic Spirits of Ammonia for.--"For a nervous headache there is nothing better for immediate relief than fifteen or twenty drops of the aromatic spirits of ammonia." This relieves the pain and quiets the nerves and stimulates the heart.

4. Sick Headache, Camphor Application for.--"A very simple but effective remedy is a cloth wet with spirits of camphor and sprinkled with black pepper applied to the head gives almost instant relief."

5. Headache, Soda and Peppermint for.--"One teaspoonful (level) of soda in two-thirds glass of hot water, add five or eight drops of oil of peppermint and a little sugar. Drink quite warm. This has been often tried and proven to be a success." The soda will relieve any gas in the stomach and the peppermint aids digestion and relieves sickness of the stomach.

6. Sick Headache, Lemon Good for.--"One lemon before breakfast will help to keep off sick headache. Have never found a remedy to cure sick headaches. A sack of hot salt will always help the pain." The lemon will help to tone up the stomach and the salt applied to the head will help the pain by relieving the congestion. It is always well to take a good cathartic after a spell of sick headache.

PHYSICIANS' TREATMENT for Sick Headache.--

1. Antipyrine 25 grains
Citrate of Caffeine 10 grains
Bromide of Potash 25 grains

Mix and make into five powders. One powder as needed. (You might take second one in three hours.) This is not good when it is bilious sick headache. In fact, it would make it worse. It is good for sick headache and neuralgia due to eye or nerve strain, but then the first remedy, antipyrine, can be left out. It is not needed. I would then put twice as much of the bromide of potash, fifty grains, and take a powder every two hours until better.

2. Citrate of Caffeine 1/2 dram (30 grains)
Phenacetine 60 grains
Bicarbonate of soda 60 grains
Aromatic powder 12 grains

Mix and make twelve powders. Take one every three hours. This is good. Sometimes it is depressing on the heart for some people, due to the phenacetine. Acetanilid can be substituted in same dose.

(The homeopathic treatment is very successful in relieving spells of sick headache. See chapter on Homeopathy.)

3. Sodium Phosphate, taken every morning, about one-half to one teaspoonful in hot water. It is good for the bowels and liver.

4. Prescription for the Liver and Bowels in Sick Headache.--

Sulphate of soda 30 grains
Salicylate of soda 10 grains
Sulphate of Magnesia 1 grain
Benzoate of Lithia 5 grains
Tincture of Nux Vomica 3 minims
Distilled water 4 ounces

This mixture should be made up in large quantity and placed in a siphon by one of the concerns which charge soda water, and from one-quarter to one-half a glass of this water, at ordinary temperature, is to be taken every morning at least one-half an hour before breakfast; enough being taken to insure an adequate bowel movement during the forenoon. This ought to be a good combination to use regularly.

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5. Dr. Hare gives the following recommendations. Probably no single source of pain compares in its frequency to headache, chiefly because it is essentially a symptom of diseases or functional disturbances.

It may come from constipation or eye strain, from brain disease, anemia, uremia, too much blood in the head, etc. In many cases a mild laxative to thoroughly empty the bowels is necessary. Sometimes the urine will be deficient in solids and liquids, so that the effete and poisonous material are retained in the blood, which produce headache. For such cases if the urine is acid, the frequent use of Vichy water, to which is added a little bicarbonate of potassium, about five grains to a drink, as a diuretic will prove of great service. If the urine is alkaline (and this you can tell by using a red litmus paper which will turn blue if it is alkaline) ten grain doses of benzoate of ammonium three (3) times a day are often useful.

NERVE TUMORS (Neuroma).--A morbid increase in the tissue-elements of the peripheral (the external surface) nerves.

Varieties. True and False Nerve Tumors.--True nerve tumors (neuromata) are composed of nerve-fibres provided with a medullary (marrow) sheath or of nerve tissue; false nerve tumors are composed of other structure than nerve tissue, are usually of secondary origin, extending to the nerve from nearby structures.

Symptoms.--The true nerve tumors may be hereditary or due to wounds or blows and amputation. They may give rise to no symptoms, or may cause intermittent pain. Pressure increases this pain, when the condition of the nerve fibre is interfered with. Loss of local sensation and power may develop. It is sometimes possible to feel the little nodular growths, and they can be seen when they are superficial. They may give no pain, or they may become very sensitive. They may become chronic and they are very liable to do so. Some of them may disappear.

PHYSICIANS' TREATMENT for Nerve Tumor.--The severe forms should be cut out; others can be let alone.

NEURITIS (Inflammation of the Nerves. Neura-Nerves; Itis-Inflammation. Inflammation of the Bundles of Nerve Fibres).--Nagel describes it as "an inflammation of the nerves of an acute or chronic nature, associated with more or less degeneration, change in the nerve fibrils of the affected nerves."

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Causes.--An injury to the nerves, frequent muscular strains, exposure to cold. Inflammation can extend to the nerve from adjacent inflamed structures. Pressure can cause it. Fractures of bones cause it by compression and it is also caused by infectious diseases, such as rheumatism, typhoid fever, syphilis, etc. In some cases it simply appears without apparent cause.

When the disease process involves the nerve sheaths and connective tissue structures in particular, an interstitial neuritis results; when the disease locates itself in the nerve fibrils it gives rise to "parenchymatous neuritis" (main part of the nerve is inflamed).

Simple Neuritis.--This means that a single nerve of a group of adjacent nerve trunks is affected. If a number of nerves are affected at the same time it is called Multiple Neuritis or Polyneuritis.

Causes.--(a) Exposure to cold. This is a very frequent cause, as for example, in the facial (face) nerve. (b) Traumatism,--that is, wounds, blows, injuries caused by fractures and dislocations; pressure from tumors, sleeping with the head resting on the arms. Pressure from crutches, "crutch paralysis." (c) Diseases involving the nerves due to extension of inflammation from nearby structures, as in neuritis of the facial nerve due to decay of the temporal bone.

Symptoms.--The constitutional or general symptoms are usually slight. The pain is the most important symptom, being of a boring in the parts to which it is distributed. This pain may be very distressing, or of a stabbing character, and is usually felt in the course of the nerve; or it may cause little inconvenience. Sometimes the skin is red and swollen over the affected parts. There is impaired nerve function and as a result of this the muscles supplied by these nerves become weak, and occasionally paralyzed. In severe cases they may become atrophied and an eruption often appears along the course of the nerve. Sometimes the hair and nails are not properly nourished, causing falling out or grayness of the hair and loss of the nails. This neuritis may extend from the peripheral (external) nerves and involve the larger nerve trunks or even reach the spinal cord. This rarely occurs in neuritis from cold, or in that which follows fevers; but it occurs most frequently in neuritis caused by blows, wounds, etc., (traumatic).

Duration.--This varies from a few days to weeks or months. If the primary cause can be remedied it usually ends in full recovery. Sometimes it is followed by the chronic form.

PHYSICIANS' TREATMENT for Neuritis.--The first thing to do is to try to remove the cause. Then absolute and continued rest of the affected part. If one has a sore hand it will be rested, if possible; so it must be with the sore and inflamed nerve.

For the Attack.--After having placed the part in absolute rest, moist heat applied to it frequently brings great relief. Sometimes a mustard plaster applied along the sore part does good. This produces a counter irritation and thus draws some of the congestion from the congested, inflamed nerve. Ice is more effective in some cases than heat. The bowels should be kept open daily with salts. Build up the general health with tonics; no alcohol can be used. If it shows a tendency to become chronic, use massage, electricity or change of climate. Atrophy (shrinking) of the muscles is likely to follow if the disease continues long and for this massage and electricity must be given.

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Treatment. Preventive.--A person who has once had neuritis must exercise all care to keep from taking cold or exposing themselves to severe cold winds and storms. Wet clothing will be apt to cause its return. Damp houses are bad. The climate should be dry and not changeable. There should be enough and proper kind of clothing to keep the body heat at the normal point. Plenty of rest and sleep are required. These cautions also apply to rheumatism and neuralgias.

Multiple Neuritis.--Other names: Polyneuritis, Disseminated Neuritis, Peripheral Neuritis. Meaning--Multiple neuritis is an inflammatory disease of the peripheral (toward the end of the nerves or external nerves) nervous system. It varies much in extent and intensity and affects symmetrical parts of the body.

Varieties.--These arise from differences in the nature, causes, severity and location of the disease process.

Causes.--They are many. (1.) The poison that comes from infectious diseases such as typhoid fever, diphtheria, smallpox, leprosy, la grippe, etc. (2) From poisons such as alcohol, lead, arsenic; phosphorus, mercury, coal gas, etc. (3) From anemia, cancer, tuberculosis, syphilis, septicemia, diabetes. (4) From cold, over-exertion, etc.

Symptoms.--Acute febrile multiple neuritis. A typical case: This comes on from exposure to cold, over-exertion, or in some cases spontaneously. There are chills, headaches, pains in the back, limbs and joints, and the case may be called rheumatism. Loss of appetite, coated tongue, constipation, and other symptoms of stomach and bowel trouble. The temperature rises rapidly, and may go to 103 to 104 degrees. The limbs and back ache, but intense pain in the nerves are not always constant. The pain is usually sharp, severe, and located in the limbs, and is worse from moving and pressure. There are tingling feelings in the hands, feet and body, and a feeling as if ants or insects were crawling over them, and there is also increased sensitiveness of the nerve trunks or entire limb. There is loss of muscular power, first marked, perhaps, in the legs, and it extends upwards and reaches the arms. Sometimes it first begins in the arms. In typical cases the extending muscles of the wrist and ankles drop. (Wristdrop and foot-drop). In severe cases there is a general loss of muscular power, producing a flabby paralysis. This may extend to the muscles that control speaking, swallowing and hearing resulting in impairment of these functions. The muscles soften and waste away rapidly. Disorders of nutrition are frequent, like watery swelling (oedema), glossy looking skin, sweating, hives, etc.

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Recovery.--The course of the disease varies considerably. In mild cases the symptoms disappear very soon. In the worst form the patient may die in a week or ten days. As a rule, in moderately severe cases after persisting for five or six weeks, the condition remains about the same for a few months, and then improvement slowly begins and recovery takes place in six to twelve months. In neuritis from alcohol drinking there is a rapid onset as a rule, with delirium and delusions. The result is usually favorable and after persisting for weeks or months improvement gradually begins, the muscles regain their power, and even in the most desperate cases recovery may follow. The mental symptoms are very severe in alcoholic cases. Delirium is common. It takes much longer for such cases to regain what they call their normal condition.

Neuritis following diphtheria and other infectious diseases. The outlook in cases from these diseases is usually favorable, and except in diphtheria, fatal cases are uncommon. It is most common from diphtheria. Recovery, in neuritis from diphtheria, takes place in about three months, but some cases are fatal.

Neuritis from lead.--The first symptoms are those of intestinal colic, lead line on the gums, "dropped-wrist." The recovery is quite gradual and the poison may be cast out in three to four months.

In Neuritis from Arsenic.--We have disturbance of the stomach and bowels first, then the legs and arms are about equally affected, weakened; may recover in two to six months.

Treatment for acute kind.--The first thing to do is to rest in bed and control the pain and acute symptoms. Hot applications help to relieve the suffering. Patient must be kept comfortably and constantly warm and quiet. Hot applications of lead water and laudanum.

Medicines.--It may be necessary to use morphine to control the pain. Remedies such as antipyrine or aspirin are often used. A physician must be called. When the disease is caused by arsenic and lead and alcohol, of course you must remove the cause before you can hope for any improvement.

Caution.--Any one can readily understand from reading this description that the thing to do is to be careful not to needlessly expose yourself to taking cold. One subject to rheumatism or neuritis, even in small degree, should take care not only not to take cold but not to overdo in laboring; cold, wet and over-exertion cause the majority of the acute attacks. But some are caused by diseases, such as diphtheria, typhoid fever, etc., and a great many cases of neuritis following these and other infectious diseases can be avoided if proper care is taken during and after these diseases. Such care can easily be taken. Keep your rooms warm and comfortable, and the patient in bed or in a comfortable room until all danger is past. How often I have heard a doctor blamed for such results when in most cases it is the patient's or nurse's fault. Certain results will follow certain diseases and only proper care can keep such results from following. Dropsy frequently follows even a light case of scarlet fever. Why? Simply because, on account of being a light case, the child is left to roam at will about the rooms and catches cold, takes la grippe. If people would only take care of themselves this disease would not leave so many lifelong victims. I have seen men and women who have just recovered from this disease stand on the street corners on a cold, damp day, and talk an hour, and the next day they wondered how they could possibly have taken cold. We cannot disobey the laws of nature safely. Persons who are subject to neuritis or rheumatism should be especially careful on cold, damp, wet days and of over-exertion.

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GENERAL AND FUNCTIONAL BRAIN DISEASES. NERVOUS PROSTRATION. NERVOUS EXHAUSTION. NEURASTHENIA.

NERVOUS PROSTRATION.--Is a condition of weakness or exhaustion of the nervous system, giving rise to various forms of mental and bodily inefficiency.

Causes. 1. Hereditary causes.--Some children are born of parents who are weak themselves, and who have led fast lives through business or pleasure and these parents have given their offspring a weakened body, and the children are handicapped with a nervous predisposition and furnish a considerable proportion of "nervous" patients.

2. Acquired.--It is acquired by continual worry and overwork, sexual indiscretion, excesses, irregular living and indiscretion in diet. A great many business men, teachers and journalists become "neurasthenics." It may follow infectious diseases, particularly influenza, typhoid fever and syphilis. It also follows operations sometimes. Alcohol, tobacco, morphine may produce a high grade of the disease, if their use is abused.

Symptoms.--These are varied. The most prominent symptom is fatigue. The patient feels so tired and complains of being unable to do any mental labor. It is almost impossible to put the mind on one subject for any length of time. There are headache, dizziness, want of sleep, and there is great depression of spirits; patient is gloomy, irritable in temper with manifestations of hysteria. Sometimes there are marked symptoms of spinal trouble. Pain along the spine with spots or areas of tenderness. Pains simulating rheumatism are present. There is frequently great muscular weakness, great prostration after the least exertion, and a feeling of numbness, tingling, and neuralgic pains. In spinal symptoms, there is an aching pain in the back, or in the back of the neck, which is a quite constant complaint. Then there are the anxiety symptoms in many cases. There may be only a fear of impending insanity or of approaching death, or of apoplexy, in simple cases. More frequently the anxious feeling is localized somewhere in the body, in the heart region, in the head, in the abdomen, in the thorax (chest, etc.). In some cases the anxiety becomes intense. They are so restless they do not know what to do with themselves. They throw themselves on the bed, complain, and cry, etc. Sometimes the patients become so desperate they commit suicide. Some patients do not wish to see anyone. Some patients cannot read, reading wearies them so much, or they get confused and dizzy and must stop. Some are very irritable. They complain of everything. Remember they cannot help it, usually. Some are easily insulted and claim they are misunderstood. The circulation may be disturbed in some cases. Then there is palpitation of the heart, irregular and very rapid pulse, pains, and feeling of oppression around the heart, cold hands, and feet. The heart's action may be increased by the least excitement and with the fast pulse and palpitation there are feelings of dizziness and anxiety and such patients are sure they have organic disease of the heart. No wonder. Flashes of heat, especially in the head, and transient congestion of the skin are distressing symptoms. Profuse sweating may occur. In women, especially, and sometimes in men, the hands and feet are cold, the nose is red or blue, and the face feels "pinched." Nervous dyspepsia is present in many cases. The digestion is poor and slow and constipation accompanies it. Sometimes there is neuralgia of the stomach. The sexual organs are seemingly affected, many men are "almost scared to death" and they use all sorts of quack remedies to restore their sexual vigor. Spermatorrhea is their bugbear. They usually get well if they stop worrying. In women there is the tender ovary and the menstruation may be painful or irregular. The condition of the urine in these patients is important. Many cases are complicated with lithaemia (sand-stone in the urine). It is sometimes also increased in quantity.

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PHYSICIANS' TREATMENT for Nervous Prostration.--The patient must be assured and made to believe that the disease is curable, but that it will take time and earnest help on the part of the patient. Much medicine is not needed, only enough to keep the system working well. Encouragement is what is needed from attendants. Remove the patient from the causes that produce the trouble, whether it be business, worry, over-study, too much social duties, or excesses of any kind. The patient must have confidence in the physician, and he must be attentive to the complaints of the patient. It is the height of foolishness and absurdity for a physician to tell such a patient before he has thoroughly examined him or her that the troubles are imaginary. I believe that is not prudent in the majority of cases. I have heard physicians talk that way to such patients. I thought, what fools! The patient needs proper sympathy and sensible encouragement. You must make them believe they are going to get well. If you do not wish to do this, refuse such cases, or you will fail with them. If there are any patients that need encouragement and kindly, sympathetic, judicious "cheering up," these patients are the ones, and they generally are "laughed at and made fun of" by people who should know better. Remember their troubles are real to them, and are due to exhaustion or prostration of the nervous system and this condition, as before described, produces horrid feelings and sensations of almost every part of the body. The patient must be made to believe that he may expect to get well; and he must be told that much depends upon himself, and that he must make a vigorous effort to overcome certain of his tendencies, and that all his power of will will be needed to further the progress of the cure.

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First, then, is rest.--Both mental and physical diversions, nutritious though easily digested food, and removal of baneful influences as far as possible. Physical exercise for the lazy. Rest for the anemic and weak. For business or professional men the treatment is to get away and far off, if possible, from business. It will often be found best to make out a daily programme for those that must remain at home, something to keep the mind busy without tiring, and then times of rest. The patient, if it is possible, should be away from home if home influences and surroundings are not agreeable. Dr. S. Weir Mitchell, of Philadelphia, has devised and elaborated a cure, called a rest cure, for the relief of this class of patients, and it is wonderfully successful especially in thin people. "Be the symptoms what they may, as long as they are dependent upon nerve strain, this 'cure' is to be resorted to, and if properly carried out is often attended with surprising results." "A bright, airy, easily cleaned, and comfortable room, is to be selected, and adjoining it, if possible, should be a smaller one for an attendant or nurse. The patient is put to bed and kept there from three to six weeks, or longer as may be necessary, and during this time is allowed to see no one except the nurse and doctor, since the presence of friends requires conversation and mental effort. The patient in severe cases must be fed by the nurse in order to avoid expenditure of the force required in the movement of the arms. No sitting up in bed is allowed and if any reading is done it must be done by the nurse who can read aloud for an hour a day (I have seen cases where even that could not be done). In the case of women, the hair should be dressed by the nurse to avoid any physical effort on the part of the patient. To take the place of ordinary exercise, two measures are employed, the first of which is massage or rubbing; the second, electricity. By the kneading and rubbing of the muscles and skin the liquids in the tissues are absorbed and poured into the lymph spaces, and a healthy blush is brought to the skin. This passive exercise is performed in the morning or afternoon, and should last from one-half to an hour, every part of the body being kneaded, even the face and scalp. In the afternoon or morning the various muscles should be passively exercised by electricity, each muscle being made to contact by the application of the poles of the battery to its motor points, the slowly interrupted current being used. Neither of these forms of exercise call for any expenditure of nerve force; they keep up the general nutrition. The following programme for a day's existence is an example of what the physician should order:

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7:30 a. m.--Glass of hot or cold milk, predigested, boiled or raw as the case requires.

8:00 a. m.--The nurse is to sponge the patient with tepid water or with cold and hot water alternately to stimulate the skin and circulation, the body being well wrapped in a blanket, except the portion which is being bathed. After this the nurse should dry the part last wetted, with a rough towel, using some friction to stimulate the skin.

8:30 a. m.--Breakfast. Boiled, poached or scrambled eggs, milk toast, water toast, or a finely cut piece of mutton chop or chicken.

10:00 a. m.--Massage.

11:00 a. m.--A glass of milk, or a milk punch, or egg-nog.

12:00 m.--Reading for an hour.

1:00 p. m.--Dinner. Small piece of steak, rare roast beef, consomme soup, mutton broth, and any one of the easily digested vegetables, well cooked.

3:00 p. m.--Electricity.

4:30 p. m.--A glass of milk, a milk punch or egg-nog.

6:30 p. m.--Supper. This should be very plain, no tea or coffee, but toast and butter, milk, curds and whey, or a plain custard.

9 :30 p. m.--A glass of milk or milk punch.

In this way the day is well filled, and the time does not drag so heavily as would be thought. If the stomach rebels at over feeding, the amount of food must be cut down, but when all the effort of the body is concentrated on respiration, circulation, and digestion a large amount of nourishment can be assimilated by the exhausted body, which before this treatment is undertaken may have had its resources so shattered as to be unable to carry out any physiological act perfectly. For the treatment to be successful the rules laid down should be rigidly followed, and the cure should last from three to six weeks or longer."

HYSTERIA.--A state in which ideas control the body and produce morbid changes in its functions.

Causes.--It occurs mostly in women, and usually appears first about the time of puberty, but the manifestations may continue until the menopause or even until old age. It occurs in all races. Children under twelve years are not very often affected. A physician writes: One of the saddest chapters in the history of human deception, that of the Salem witches, might be headed, "Hysteria in Children," since the tragedy resulted directly from the hysterical pranks of girls under twelve years of age. During late years it has been quite frequent among men and boys. It seems to occur oftener in the warm and mild climates than in the cold. There are two predisposing causes that are very important--heredity and education. Heredity acts by endowing the child with a movable (mobile) abnormally sensitive nervous organization. Cases are seen most frequently in families with marked nervous disease tendencies, whose members have suffered from various sorts of nervous diseases.

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Education.--The proper home education is neglected. Some parents allow their girls to grow up accustomed to have every whim gratified, abundant sympathy lavished on every woe, however trifling, and the girl reaches womanhood with a moral organization unfitted to withstand the cares and worries of every-day life. And between the ages of twelve and sixteen, the most important in her life, when the vital energies are absorbed in the rapid development of the body, the girl is often "cramming" for examinations and cooped in close schoolrooms for six or eight hours daily; not only that, but at home she is often practicing and taking lessons on the piano in connection with the full school work. The result too often is an active bright mind in an enfeebled body, ill-adapted to subserve the functions for which it was framed, easily disordered, and prone to act abnormally to the ordinary stimuli of life.

Direct Influences.--Those influences that directly bring on the attack are fright, anxiety, grief, love affairs, and domestic worries, especially in those of a nervous nature. Diseases of the generative organs and organic diseases in general, and of the nervous system especially, may be causes of hysteria.

Symptoms.--These may be divided into two classes: 1. Interparoxysmal or time between the paroxysms (spells). 2. Paroxysmal. During the time of the attack. First variety--The will power seems defective. In bad cases self-control is lost. The patient is irritable, and easily annoyed by the slightest trifle; is very excitable and easily moved to laughter or tears without any apparent cause for either. Easily discouraged and despondent. She wants lots of sympathy. Second--Loss of sensation is frequently present, and it is most commonly one-sided; it may involve certain parts, as one or two limbs, the trunk escaping, or part of one limb. Various spots of want of sensation (feeling) may exist. The skin of the affected side is frequently pale and cool and a pin prick may not cause bleeding. In some cases they feel the touch of the hand, but there is no feeling from heat. There may also be oversensitiveness to pain and of the skin. It may be one-sided or both, or only in spots. The left ovarian region is a common sensitive point; also over the breasts, lower positions of the ribs, on top of the head and over many portions of the backbone. Pain in the head is a very common and distressing symptom, and is usually on the top. Pain in the back is common. Abdominal pains may be very severe and the abdomen may be so tender as to be mistaken for peritonitis. Various parts of the body may have neuralgic pains. There may be intense pain around the heart. There may be complete blindness, the taste and smell may be disturbed or complete loss of hearing. Third--Paralysis is frequently present. It may be one-sided or only of the lower extremities, or only one limb. The face is usually not involved when it is on one side. The leg is more affected than the arm. Sensation is lessened or lost on the affected side. Paralysis of the lower extremities is more frequent than one-sided paralysis. The power in the limbs hardly ever is entirely lost; the legs may usually be moved, but the legs give way if the patient tries to stand. The affected muscles do not waste. The feet are usually extended and turn inward. Sudden loss of voice occurs in many cases. The paralysis is generally paroxysmal, and is frequently associated with contractures, shortening of the muscle. The contractures may come on suddenly or slowly, and may last minutes, hours, or months, and some cases even years. Movements of the hands, arms, etc., like the motions in chorea are often seen in the young. A trembling (tremor) is sometimes seen in these patients. It most commonly involves the hands and arms, more rarely the head and legs. These movements are small and quick. Fourth--Swallowing may be difficult on account of spasms of the muscles of the pharynx. The larynx may be involved and interfere with respiration. Indigestion in some form is often present. The stomach and bowels may be very much bloated with gas. There may be a "phantom tumor" in the intestine (bowel). Constipation may be very obstinate, vomiting may be present and persistent and hiccough present. The action of the heart may be irregular, and rapid heart action is common. The least motion may cause difficult breathing and false Angina Pectoris (heart pang); the urine is retained not infrequently in female patients.

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Symptoms of the Paroxysms.--Convulsive seizures are common manifestations of hysteria, and frequently present a great similarity to epilepsy. The prodromal (fore-running) symptoms are frequently present and may begin several days before the convulsion occurs. In milder forms, in which the cause may be due to a temporary physical exhaustion, or emotional shock, the fore-running symptoms are of short duration. The patient may become very nervous, irritable, impatient, have fits of laughing and crying, alternately, or have a feeling of a chill rising in the throat. The convulsion follows these symptoms. The patient generally falls in a comfortable place; consciousness is only apparently lost, for she frequently remembers what has taken place; the tongue is rarely bitten, In the milder forms the movements are apt to be disorderly. In the severe forms the movements are apt to be a lasting contraction of the muscles and the patient may have the head and feet drawn back and the abdomen drawn front. There then may follow a condition of ecstacy, sleepiness, catalepsy, trance, or the patient may show symptoms of a delirium with the most extraordinary sights of unreal things. These convulsions may last for several hours or days. Firm pressure over the ovaries may bring on a convulsion, or if made during a convulsion may arrest it. The disease is rarely dangerous to life, yet death has followed exhaustion induced by repeated convulsions or prolonged fasting. The duration of hysteria is very uncertain.

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DURING A CONVULSION. The first thing to do is not to be frightened. A patient in a convulsion from hysteria very seldom injures herself during the convulsions. If you are sure it is hysteria, give a nasty tasting medicine, asafoetida is a splendid remedy, but not in pill form, for there is no taste or smell to them. Sometimes a convulsion may be arrested by the sudden use of ice to the backbone or abdomen or by dashing cold water in the face and chest, or by pressing upon the ovaries. When the hysteria is of a mild form it is sometimes a good plan, when the convulsion comes on, to place the patient in a comfortable position and then leave her, and when the patient comes to and finds herself alone and without sympathy, the attacks are less likely to be repeated. Sometimes if you watch a patient closely when she is seemingly unconscious, you will see, if you look at her very guardedly, that one eyelid is not entirely closed, and that the patient really sees much that is occurring around her. I am writing of real genuine hysteria, in which the patient is not quite right, not only physically but mentally,--especially the latter,--during the attack at least. For that and other reasons such patients should not be treated cruelly.

Preventive Treatment of Hysteria.--In order to be successful in this line of treatment the cause must be found and treated. An English physician writes: "It is pitiable to think of the misery that has been inflicted on these unhappy victims of the harsh and unjust treatment which has resulted from false views of the nature of the trouble; on the other hand, worry and ill-health, often the wrecking of the mind, body and estate, are entailed upon the near relatives in the nursing of a protracted case of hysteria. The minor manifestations, attacks of the vapors, the crying and weeping spells are not of much moment, and rarely require treatment. The physical condition should be carefully looked into and the mode of life regulated, so as to insure system and order in everything. A congenial occupation offers the best remedy for many of these manifestations. Any functional disturbance should be attended to and a course of tonics prescribed. Special attention should be paid to the action of the bowels. The best preventive treatment is the one that is given early, when the girl is growing from childhood to girlhood. It should be begun even earlier. A weakly baby should be built up by proper food and outdoor life. Dainties should not be given to such a child. When the child is old enough, as some mothers think, to go to kindergarten school, keep the little one at home. It is plenty early enough to send such a child to school when she is seven years old. This early school work rushes the child, makes it nervous. If you should happen to listen to the heart of many young school children you would find it pounding away at a furious rate. Do not hurry a weakly child. Do not hurry or rush a young girl even though she is strong, from the ages of twelve to sixteen years. Our school system does just that. Instead of taking life easy when she is nearing the crisis (puberty) or is in that period, she is hurried and rushed and crammed with her school work; the girl frequently goes to school during this period, even when she is unwell and sits there for an hour or more with wet skirts and sometimes wet shoes and stockings. Every day I see girls of all ages go past my office here in this cultured city of Ann Arbor, without rubbers, treading through the slush and water. Is it any wonder they become sickly, become victims of hysteria and suffer from menstrual disorders? Dysmenorrhea must follow such carelessness, and the parents are to blame in many cases. Be careful of your children, especially girls at this age, care less for their intellectual growth, and pay more attention to their body development, even if it should happen to be at the expense of their intellectual development. A healthy body is better than all the knowledge that can be obtained, if it goes, as it too often does, with a body that is weak and sick. Outdoor life is necessary. Horseback riding is splendid; walking is also good exercise at a regular time each day."

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PHYSICIANS' TREATMENT for Hysteria.--If there is any womb trouble, it must be attended to. There is frequently trouble with the menses in cases of hysteria. It sometimes comes from anemia or simply comes without any special reason. Tonics like arsenic, iron, strychnine and cod-liver oil are needed for anemia. Iron valerate is good, in one grain doses, three times a day, in this disease, when the patient is not fleshy.

1. The following is recommended by Dr. Goodell:

Of each one scruple (20 grains).
Quinine Valerate
Iron Valerate
Ammonia Valerate

Make into twenty pills. Take one or two pills three times a day.

(This is a good tonic in such cases.)

2. Fowler's Solution of Arsenic in three to five drops doses is frequently used (three times a day) and is a good lasting tonic in cases where the patient has a very pale white looking skin.

3. Asafoetida in three to five-grain pills is a splendid tonic in such cases, and in that form is pleasant to take. Take three during the day, before meals.

4. Sumbul or musk root is a good remedy. Tincture in one-half dram doses three times a day. This is good when the patient is very nervous.

5. The following is good when anemia is prominent:

Dried Sulphate of Iron 20 grains
Alcoholic extract of Sumbul 20 grains
Asafoetida 10 grains
Arsenious acid 1/2 grain

Mix thoroughly and make twenty pills, one after each meal.

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6. Tincture of hops in doses of one-half to two teaspoonfuls is good for nervousness and sleeplessness, taken at bedtime. It can also be taken regularly four times a day in from one-half to one teaspoonful doses.

7. General Cautions.--Proper, easily digested foods must be taken. Keep the bowels open daily. Let trash and dainties alone. Pies, cakes, and rich foods are an abomination for such patients. Candy is not to be eaten. Let novels alone. Go to bed at nine and sleep until six or seven. Bathe five or ten minutes every morning or evening in tepid water or cool water. The patient should be warmly clothed. Sleep in a pleasant, sunshiny and airy room. In severe forms of the disease the "Rest Cure" and feeding described under Nervous Prostration should be used.

EPILEPSY. (Falling Sickness).--This is an affection of the nervous system, characterized by attacks of unconsciousness, with or without convulsion.