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Ear Affections in Scarlet Fever ............
Nerve Apparatus Appearing Suddenly..... 392
ulenta, on Account of Complicated Mas-
Surgical Interference in Tuberculosis of
Treatment of Suppurative Middle Ear Dis-
eases by Bier's Method of Hyperemic
Pharmacologic Action of Digitalis, Squills
ganic and Organic, including Urinary
and Prescription Writing. with Especial
in ...S in De
Harden Rulean and Disa est Diet
W. T. CORLETT. M. D.. Cleveland.
REYNOLD W. WILCOX, M. D., N ew York.
Papers for the original department must be contributed ex symptomatio neurasthenia. While neurasclusively to th's magazine, and should be in hand at least one month in advance. French and German articles will be trans thenia is not as common an affection as many lated free of charge, if accepted.
A liberal number of extra copies will be furnished authors, and suppose, it is a distinct clinical entity whose reprints may be obtained at cost, if request accompanies the cause is overfunctioning or undue expendi. proof.
Engravings from photographs or pen drawings will be fur ture of nervous energy, and whose manifestanished when necessary to elucidate the text. Rejected manuscript will be returned if stamps are enclosed for this purpose.
tions are symptoms and signs wbich indicate
nervous weakness and nervous irritability. It COLLABORATORS.
is true fatigue neurosis and the expression ALBERT ABRAMS. M. D., San Francisco. M. V. BALL, M. D., Warren, Pa.
"'irritable weakness,” often used, is one FRANK BILLINGS, M. D., Chicago, Ill. CHARLES W. BURR, M. D., Philadelphia.
fairly descriptive of its chief characteristics. C. G. CHADDOCK, M. D., St. Louis, Mo.
This reference to neurasthenia as a psycho. S. SOLIS COHEN, M. D., Philadelphia, Pa.
sis and a symptom of disease outside of the ARCHIBALD CHURCH, M. D., Chicago. N. S. DAVIS, M. D., Chicago.
nervous system suggests a word or two at the ARTHUR R EDWARDS, M. D., Chicago, Ill.
outset about the treatment. While it is true FRANK R. FRY, M. D., St. Louis. Mr. REGINALD HARRISON, London, England.. that the insane may be neurasthenic or the RICHARD T. HEWLETT, M. D., London, England. J. N. HALL, M. D., Denver.
neurasthenio become insane, the terms neuHOBART A. HARE, M. D., Philadelphia.
rasthenia and psychosis are not interchangeaCHARLES JEWETT, M. D., Brooklyn. THOMAS LINN, M, D., Nice, France.
ble; nevertheless a psycbio element which FRANKLIN H. MARTIN, M. D., Chicago. E. E. MONTGOMERY, M. D., Philadelphia.
has its underlying cause in heredity is present NICHOLAS SENN, M. D, Chicago.
in most cases of true neurasthenia. FERD C. VALENTINE, M. D., New York.
From EDWIN WALKER, M. D., Evansville, Ind.
first to last the body as well as the mind of H. M. WHELPLEY, M. D.; St. Louis.
the neurasthenic should be treated, suggesWM, H. WILDER, M. D., Chicago, Ill.
tion and encouragement, which is continuing suggestion, being potent factors in the suc
cessful management of the disorder. Another LEADING ARTICLES fact which has some bearing upon the ques.
tion of the existence of genuine, uncompli.
cated neurasthenia is that in symptomatic THE TREATMENT OF NEURASTHENIA.* neurasthenia, unless the neurasthenio ele
ment is recognized in the therapeutio measCHAS. K. MILLS, M. D.
ures adopted, the treatment instituted with
only the primary causal conditions in mind, PHILADELPHIA, PA.
will probably meet with little success. The Professor of Neurology in the University of Pennsylvania. proper method of treatment in symptomatio
It is necessary in order that my views with neurasthenia is one which takes into consid. regard to the therapeutics of neurasthenia eration both the neurasthenic and the undershould be clearly presented, to say a few words lying non-nervous disease. Whatever is done about its definition and nature. Recently for heart, stomach, liver, kidneys or blood, some tendency has been shown to return to the patient needs also mental and physical the views which prevailed before Beard, in rest and the inspiration of well-directed sug1880, impressed the profession and the com. gestion. munity with the idea that neurasthenia or
A single illustrative case may be of value nervous exhaustion de served separate recog.
in this connection. A young married man nition in our nosology. Dana, for instance,
caine to me from a distance to be treated for in a paper significantly entitled “The Pass. neurasthenia. He had gradually become more ing of Neurasthenia," would relegate the ma.
and more nervous, irritable and depressed. jority of cases so diagnosticated to the psy. He occupied an important commercial posichoses, and of the cases left he believes that tion, but not one sufficiently calling upon his many should be regarded as illustrations of energies to entirely account for his breaknervous disorder dependent upon the disease down. He suffered from an annoying vitre. of non-nervous organs. I do not, however, ous opacity and an old orchitic trouble; also accord with the view that all cases, or nearly from a congenital, partial arrest of developall cases, come either under tbe psychiatric
ment of one lower extremity. His mind bad pale or are to be regarded as instances of
become concentrated on the symptoms and
conditions which were not in themselves suffi. *Read before the Philadelphia Neurological Society, No
cient to cause any serious apprehensions. He
Tember 8, 19.5.
had worried himself into a state of extreme work are full of unrest. Of two business men neurasthenia because of affections easily who have equal amounts of work to do, and cured, or at least relieved. The first thing are practically equal in physical strength and necessary to do in this case as in so many mental capacity, one goes about his tasks others, was to remove the patient from his with a steadiness and system that do not environment and to put bim on as complete wear either upon himself or those with whom rest as possible, and to forcibly impress him he comes in contact; the other with such with the idea that all his annoying symptoms restlessness and unnecessary output as to were transient, or at least could be remedied, keep himself in a half exhausted state and and that no reason existed why he should not those around him disturbed and disquieted. in a short time be in as good health as be had Perhaps bis unrest is shown in the unnecbeen one or two years before. Proper atten. essary steps that be takes, or the unnecestion was given to his eyes, to his somewbat sary rapidity with which he takes them; in crippled limb, to his genitalia, but at the talking too long or too excitedly; in driv. same time he was placed upon a thorough ing when leading would do better;-in brief, rest treatment, at first pearly complete and in expending more energy tban is necessary later made partial. Isolation, massage, elec- even for the full accomplishident of the work tricity, hydrotherapy and other measures, in hand. The feelings of those compelled by bereafter to be referred to, were used, and as fate to keep oompany with these useful but they were gradually withdrawn, systematized irritating mortals is best expressed by the exercises and increasing occupation were sub- slang expression, “Give us a rest;”, but as stituted. The man made a good recovery in a rule they neither rest themselves or let less than three months.
anyone about them rest. One man does bis Before taking up special measures for the work with smoothness and with only that treatment of neurasthenia, a few words should loss of vitality which is easily repaired by be said about its prophylaxis, and it would his daily food and sleep, the other is always be time saving to include in these remarks giving out more than can thus be supplied. suggestions regarding not only the methods One saves his forces at the same time that he of preventing its occurrence, but also of its uses them, the other is wasting much that he recurrence after recovery through time or might easily save. One physician is worn treatment. The age is strenuous. Notwith out before his hours of work are half expired; standing the pace whiob is set in almost all the other goes evenly and quietly through walks of life, however, many succeed in pass. the hard day's work. The work that nags and ing to middle life and later, and then suo. harrasses one man scarcely ruffles the other. cumb not to neurasthenia, but to arterioscler. Probably no one thing is more important osis or some other degenerative disease. The in the prophylaxis and treatment of neuras. predisposd neurasthenio who tends to early thenia than the avoidance or prevention of exhaustion of bis nervous system may, in worry. . Genuine neurasthenia seldom occurs spite of his neuropathic heredity, have within in one with a healthy inheritance, simply him great possibilities in sone directions, through persistent and severe mental work. and it is well worth while to conserve and The biographies of scholars, technologists, develop his powers. The physical and men and professional men who have obtained tal endowments and limitations of the child celebrity afford ample evidence of the truth should receive the close attention of the par- of this statement. On the other hand, it is a ent and the educator. The seeds of neuras. matter not only of bistory, but of common thenia may be sown in the preparatory school experience, that anxiety and worry, whether or in the college, and especially in the latter, caused by domestic disturbances or embarwhere so often a false standard, or at least one rassments and purplexities in business and that is not suited to the average members of professional life, are fruitful sources of the a class, is set. After the general education exhaustion and irritability which are the sign or training of the youth is completed, another manual of neurasthenia. Probably no one greut step towards the prevention of neuras. factor is more important in the production of thenia is that which is taken when care is the neurasthenic state than the worries of do. exercised, both by the individual and his mestio life. Res angustoe domi. The stuadvisers, in the choice of an oucupation dent of mathematics, of law, of medicine, or which is suited to his inherited endow- of any vocation requiring intellectual capacments.
ity and presistent labor may continue his Passing now to the question of the preven work through long hours for many weeks or tion of neurasthenia in those engaged in ac- months with no more visible result than nortive pursuits, it should be remarked that not mal mental and physical fatiguo. But add to a few of those who suffer from nervous or this an embarrassing or nagging doinestic other breakdown do so because their lives and life, and neurasthenia is one of the most fre.