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quent consequences. One's life should be so sidering too much the time of completion of regulated, not only by bimself, but with the the task before them. assistance of those by whom he is constantly
The mode of rest treatment pursued with. surrounded, that unnecessary anxiety and
out taking patients from their homes is usuworry are as far as possible eliminated.
ally spoken of as the partial rest treatment. Passing now to a consideration of the
The method of carrying it out necessarily treatment of neurasthenia, before taking up
varies somewhat with the conditions in which the different therapeutic methods and meas.
the patient is placed. Some matters are of ures, attention must be directed to the fact
first importance. The hours of sleep should that at least two sets of neurasthenic patients
be largely increased. Many men and women need to be recognized in considering plans of
' who are in the habit of being in their beds treatment. One set must be treated at home
only eight hours, or even less, can readily in. or not at all, because of financial or other
crease the time to twelve or fifteen hours reasons, and another, the patients included
without really interfering with their work. in which can be removed from home and
Fourteen to sixteen hours of recumbency out their usual environment and undergo a com.
of the twenty-four should be taken whenever paratively expensive form of treatment. The
it is possible to accomplish this result. It methods to be employed in the two classes
is best brought about by going to bed at of cases are fundamentally the same, but
eight or nine in the evening, and by taking differ in their manner of application and
one or two hours during the day, preferably in the degree in which particular measures
late in the morning or early in the afternoon. can be carried out. The general practi. tioner, is often confronted with the problem A ll disturbing iniluences should be elimin. of what to do with a neurasthenic patient
ated during the periods of day and of night wbo cannot undergo an expensive rest treat. rest. The woman should know nothing of ment, and wbo indeed may be unable to se.
household cares or of her children; nor og even of a short jour. should the man be troubled with anything ney or change of climate and surroundings. either within or outside of his immediate
Whether the patient is treated at his household. home or in a house or hospital where the With regard to the use of food, electricity, so-called rest cure is undertaken, the most bathing, diversions and medicine, the remarks important measures of treatment will be the which will be made later when discussing same. These are rest, regulated diet, recre. the full rest treatment are almost equally apation, change, massage, electricity, exercise, plicable in discussing the partial rest treatwork and medicinal and special therapeutio ment either at home or elswehere. Some measures. The keynote of the treatment in modifications of the suggestions given when all cases is rest. As fatigue due to over-func. considering the full rest treatment as regards tioning is the most important element in the the administration of food and the use of ex. development of true neurasthenia, it is a nec. ercise, diversions, etc., of course, will be essary corrolary that prevention of the over necessary, but these are chiefly such as expenditure of nervous energy demands first would be so apparent as to need no detailed consideration as a therapeutic measure. The consideration. It might be well, however, first thing that the physician should do is to to say something with regard to massage used look into the exact manner of life led by the at the homes of patients. For business men patient, man or woman. This can often be and for women who are much engaged with so readjusted as to bring about a less wear. domestic and other duties during the day, a ing existence.
good plan is tc buve the supper between six A word might be said here about under and seven, to spend the time between this rest, which is not quite the same as overwork. meal and 8:30 or 9 o'clock in quiet conversaEven with time and opportunity at their dis- tion, reading or amusement, then to have genposal, many business and professional men, eral massage for forty-five minutes to an and in fact many in all walks of life, do not hour. This treatment may prove not only know how to rest even when they have time restful to the patient, but may add in the and opportunity. They worry and drive them. bringing on of sleep when insomnia is pres. selves even in their efforts at diversion and ent. Careful arrangement should be made recreation; in all things they unnecessarily so that the patient will not be disturbed at waste energy. They should be taught to do the conclusion of the treatment. General their tasks and duties with less mental and faradization may sometimes be alternated physical output; to sit when they would or with massage to the advantage of the patient, dinarily stand, to talk quietly instead of with although on the whole it will prove less useundue excitement, to substitute complacency ful in the home treatment than massage and for anxiety, and to work steadily without con. Swedish movements.
Milk and eggs should form the standby in attempt the partial rest treatment with an bringing food to the maximum in the home hour or two in bed during the day and ten or as well as in the full rest treatment of neu- twelve from evening until murning, allowing rasthenia.
the patient to be up and doing during the Walking, horseback riding, golf and tennis rest of the day, than to attempt the complete playing are among the most useful outdoor rest cure by what is supposed to be isolation exercises and diversions for neurasthenios, in some part of the patient's own house. It but when used the greatest care should be is better, on the other hand, to have the taken not to bring on undue fatigue. All treatment elsewhere than at home, even in modes of exercise should be used sparingly those cases in whiob good judgment seems at first.
to dictate that the patient should be allowed Automobiling is, in my experience, a nerve occasionally to see some member of her fam. exhausting method of taking exercise and ily. . diversion. The reason for this is that those It may seem unnecessary to say that the who resort to this method of transportation rest should be in bed, but it happens someand exercise usually show little judgment in times that patients, as well as others, believe regard to speed and keep themselves over ex. that rest in bed is necessary for only portion hilarated and in a state of nervous tension of the day, the recumbent position on a couch
Let us next take up the subject of the com- or sitting taking its place in part. For the plete rest treatment, a method of great value first weeks of the treatment, at least, the rest for a large percentage of cases of neuras. should be in bed and as absolute as possithenia. I might be permitted to say here a ble. Whether the patient is allowed to feed few words about its indiscriminate use. The berself can only be decided by the peculiar. mistake is not infrequently made of putting ities of the cases; in most instances she patients upon this treatment without due can, and the taking of food should be done consideration, and as a consequence it falls in the half sitting position in bed, using a into unmerited disrepute. Many cases of table. After several weeks, or a week or two, melancholia, for instance, are not well if the treatment is of short duration, the paadapted to this therapeutic measure; in other tient can be placed upon a couch for a porinstances of this disease one or two weeks tion of the day, and still later upon a couoli of the treatment is sufficient, other meas. and in a obair. This change should not be ures being introduced rapidly, including made until after a certain definite time is moderate exercise out of doors. A purely allotted for walking in the room. Even the hysterical case is not always helped by the position in bed is at times somewhat imporrest treatment. Symptomatic neurasthenia tant; usually the head should not be too high often does well under this treatment, which, and the patient should be encouraged to lie as a rule however, must be modified somewhat in different positions, that ia, on the back or according to the nature and peculiarities of on either side and always with as complete the case.
muscular relaxation as possible. The main features of the complete rest One of the chief objects of the treatment is treatment are: (1) isolation, (2) rest in bed, to rapidly or slowly improve the general nu(3) regulated diet, (4) massage and Swedish trition of the patient by the skillful use of movements, (5) faradic eleotricity, (6) syste. diet; I follow no fixed rule. Sometimes I matized respiratory exercises, (7) bathing, begin with a complete milk diet, increasing (8) diversion and recreation, (9) medicines. in frequency and in amount, slowly or rapid
Without isolation this treatment will fre. ly accoording to what seems to be the requently be complete failure. Again and quirements of the individual case; cases, howagain, because of the difficulties surrounding ever, which do well on milk alone for more the removal of a patient from home, I than a few days are not in my experience nu. have tried the experiment of isolating merous. In some cases the diet may still be a patient in some portion of his or her kept one largely of milk, adding only a few own house; usually it is a flat fail. articles as raw or slightly boiled eggs, albuure. A woman who remains anywhere in a min water, Horlick's malted milk or some house in which she is accustomed to direct one of the forms of beef extract. In the maor attend to the wants or needs of others can jority of cases of neurasthenia the diet can never thoroughly relax mentally and physi. soon be made mixed. In all cases, however, cally for periods of days ur weeks. She may certain artioles should be eschewed and promise to give up servants, visitors, friends, others should be given particular favor. children and husband during the allotted Much depends upon the manner in which period of treatment, but in spite of herself, food is prepared; broiled and roast meats are in nine cases out of ten, will not be able to to be preferred. Oysters should be given carry out her promise. It is far better to raw, broiled or dry panned. Green vegetables such as lettuce, spinach and celery can my hands as a supplementary treatment to be used with considerable freedom. It is not rest, massage and other measures, is slow necessary to exclude potatoes altogether as is respiratory exercises, either indoors or out of sometimes advised, but they should be used doors. For the indoor exercises I bare for sparingly either roasted or mashed. Peas years made use of those given in a little book and rice thoroughly well cooked, may be used by Blaikie, entitled "Sound Bodies for Boys and fruits not too freely. The ligiter forms of and Girls.” It was intended originally for a dessert like tapioca, corn starch, spanish school book, but the prescribed lessons corcream, cream puffs and ico cream may be in respond so well to wbat is required that they troduced after a time. The main object in afford an easy method of ordering exercises. the use of food is its increase to the point of The physician or nurse can vary the exer. full, or what would ordinarily be, over-feed. oises as seems best suited to the needs of ing without disturbance of the digestion of the patient. the patient. I find raw eggs a valuable addi. While bathing is useful in the home treat. tion to the ordinary diet list. They may be ment of neurasthenia, it can be employed taken in numbers varying from four to twelve to greater advantage in the complete rest a day according to the circumstances and to cure where time and attendants are at full the amount of other food taken. Beef ex command. A daily sponge bath, with or tract gives a variety to the diet, but does not without the addition of alcohol, is perbaps add much to its real value.
the best all around bydriatic measure. Most Massage and Swedish movements cannot neurasthenios will not stand cold sponge be dispensed with in the rest treatment. I bathing, at least not at first, and those who, can only give a few suggestions. As a rule, ill-advised or of their own initiation, resort tbe massage can be given by the nurse who suddenly to cold sponge bathing, or spraying has charge of the patient; it is not always or immersion in the hope of bardening and best that this should be done. The intro. strengthening their pervous systems, may duction of a masseuse from the outside may find that they have made a serious mistake. be either a useful measure or a disturbing The cool or cold sponge, the spray, the douche element. Which it will be depends upon the and the immersion bath may prove beneficial patient sometimes, but more frequently on the to the neurasthenic, but usually a patient masseuse Massage at first should be given must be educated to them. With regard to for a comparatively short time, thirty or the time of day when baths are taken, it is with thirty-five minutes, but later can be in. sufferers of neurasthenia as it is with those in creased to forty, fifty or sixty minutes. health, that the best time for one patient may
Electricity used only in the form of general not be that for another. Warm baths are faradization with a slowly interrupted current usually best taken in the evening, tepid or is less useful than massage, but often should cold baths in the morning, but there are be employed. Here again the method of its many exceptions to these rules as to time. use is important. In not a few cases, the In the daily schedule of a patient under the purse who attempts to give faradio electricity rest treatment diversion in the form of read. to a patient is unskillful or irritating in her ing, conversation, games and light work like method of doing this. On the whole, I pre- knitting are usually of use early or late in the fer the method of direct muscular faradize. . course of treatment. Considerable judgment tion supplemented with gliding or labile cur- may be necessary in the selection of suitable rents applied to the entire limb or part. The books and suitable games, but no rules can nurse holding two moistened electrodes in one be laid down to govern this matter. The hand, passes from cne muscle to another; judgment and good taste of both physician then placing one electrode to the spine or in and nurse, combined with the experience the neighborhood of the nerve plexus, the soon gained with the patient, will serve 'to electrode is passed from point to point down guide in this part of tbe treatment. the limb.
A few words might be said in conclusion, Generally I begin the use of systematized about seasonal vacations, resorts, climate and respiratory exercises early; sometimes after travel. These remarks are of course, appli. the second or third week and while the pa. cable to patients convalesoing under the in. tient is still in bed. These are, in the first fluence of rest treatment or to others in place, movements of the upper and lower whose cases it seems advisable to resort to limbs and of the trunk accompanied by deep change of climate and location rather than to breatbing. Later when the time comes for indoor measures. Business and professional the patient to be taken out of bed for a period men and women whuse manner of living calls of half an hour, five minutes of this time can for undue expenditure of nervous force, should be given up to systematized exercises. One have at least two periods of vacation during mode of exercise whioh has proved useful in the year. One of these should be taken pre
ferably at the usual time of such vacations, tient's condition is one of general nervous. namely, between the first of June and the ness and great irritability. In the majority first of October. The number of weeks taken of cases alcoholic preparations should not be must, of course, be regulated by the circum- used. Next, perhaps, to the suffer stances and opportunities of the individual. migraine and from bypochondria, the neuras. Physicians and the community at large have thenio man or woman is the most frequent come to recognize more and more the import. victim of the advertising pharmacy of the ance of the summer vacation, but the same is day. He turns in every direction for the not true of the short vacation of late winter nostrums which will take away his feelings or early spring. It is a well-known fact that of fatigue, discomfort and depression, and nervous disorders are more numerous and too often resorts to such vicious stimulant more severe in the early weeks of spring. If narcotics as Vin Mariani and coco-cola, or to the busy man or woman could so arrange the too relieving sedative anodynes like an. matters as to allow of a holiday of from two tikampia and cocain combinations. These to three weeks late in February or early in stimulant tonics, these sedatives, anodynes March, in the most congenial climate accessi. and narootios of alluring name are among the ble, it would be found that this would do al. worst enemies of neurasthenios as they are most as much in maintaining health and vigor of other members of the community. as the usual longer summer vacation. Un. fortunately February and March are usually a time of hard work and high tension, and yet much could be done to make a short vacation at this time popular if its value was GONORRHEA AND SOME OF ITS REfully recognized by members of the medical
SULTS. * profession. The short vacation in late winter or early spring is usually best spent by
E. G. BALLENGER, M, D. going to some quiet and healtbful resort in a climate less taxing than that in which the
ATLANTA, GA. overweary man habitually dwells. For Amer. Lecturer on Genito-Urinary. Diseases, Atlanta School of icans north of the Maryland border, the springs of Virginia, or of North Carolina, the
GENTLEMEN :- Before beginning our regusouthern seaside resorts, the Bermudas. Tar course I desire to present to you a few Nassau, Cuba or Jamaica will be found de. facts which I have taken some pains to col. sirable. Continuous travel is not usually a lect, to show you from the start the im. good therapeutic measure for neurasthenia. portance of gonorrhea as a causative factor In exceptional cases, however, a trip to the of many diseases not only in this branch, Mediterranean or to Japan or elsewhere may but all through your medical course and in prove useful, but in all cases the journey your practice in after life. should be made under conditions which do Of course it is natural for every professor not tax. Much sight-seeing and hurrying and lecturer to think that his own branch is from place to place should be avoided. Very one of the most important, I believe though high altitudes do not agree with neurasthen. if you will consider carefully the facts I have ics, although they may do well at resorts not collected to show the far reaching effect of higher than one to three thousand feet. gonorrhea, you will be willing to admit that
I have said little about the use of medi. the time you devote to this subject will cines in the treatment of neurasthenia, and not be entirely misspent. this is because there is comparatively little I also will touch briefly upon a few points to say. Attention should always be directed as to the education of the public, and espeo. to the digestive tract; stomacbic tonics, di- ially the young men in regard to the dangers gestapts and mild cardiac or metallic tonics and the methods of prophylaxis. and even the antispasmodios hare some So common is gonorrhea and so mild are place. Among the remedies of most value many of the cases, that not only the laity, but are preparations of strychnin with lactopep. a large per cent of physicians and surgeons tin, nux vomica and gentian, cascarilla, cac. have developed an indifference that is almost tus, preferably in the form of the fluid ex. criminal. tract, arsenous acid, sodium and gold chlorid, Neisser holds that gonorrhea with perhaps zino valerinate, and in some cases prepara. the exception of measles, is the most widetions of iron like the albuminate or sulphate. spread of all diseases (1). Morrow asserts Veronal and trional are among the most val. that it is even a more potent factor of depopuable hypnotics. Bromids should, as a rule. ulation than syphilis, and that a large per be avoided, but can be used in moderation in cent of involuntary childlessness is due to it. particular instances, especially when the pa- Opening lecture at the Atlanta School of Medicine.
He also thinks the extent to which gonor. of men contract gonorrhea, the sophistry of rhea prevails in private life is much greater such reasoning is evident. The time to eduthan is generally supposed, and makes the cate is before the disease is contracted, for then startling statement that there is more infec- if a competent and conscientious surgeon tion among rirtuous wives than in profes- takes charge of him, his one-sided education sional prostitutes. The truth of this state will be completed, but tbink what a price to ment becomes more reconcilable, when one pay! Consider the moral degradation, the considers how much larger is the number of physcial weakness and the mental changes virtuous wives than is the number of prosti. that have been wrought as cbains of iron to tutes, and that "powerful motives lead to their handicap bis career and perbaps wreok his concealment." Unfortunately the mildness life. It is not claimed that education will of many cases gives the patient a false sense create an Utopia, but fear of impending danof the gravity of his condition, if neglected, ger would certainly save many from the mael. and his suffering is rarely sufficient punish- strom of venereal diseases if they were only ment for his sin, until some complication fol. shown the dangers in time. This education lows, or he desires to marry, but cannot, be- in addition to warning as to the peril should cacse of the uncertainty with which he is also encourage and even urge the young man barrassed, not only on account of the danger that continence is not incompatible with of infecting an innocent woman, but also as perfect bealth. The double code of moral to his future health and potenoy. Many of laws, is to be condemned, whereby a man these cases become utterly miserable neuras. may sin without offending society, and yet thenics from the profound mental impression the same sin means the woman's ruin. I made by the disease affecting the sexual or do not advocate lowering the standard for gans, for next to a man's love of life comes women, but raising it for men. that of procreation, and his sexual instinct, Morrow says thousands of young women which“ is given to man for two reasons, to suffer moral and physical shipwreck from perpetuate the species and to rivet the tie be ignorance of the fact that loss of virtue tween husband and wife by mutual endear. often carries with it the loss of health. ment” (2). Is, then, his mental anguish "The vast majority of men who carry disundatural?
ease and death into their families do so ig. This is only the history of a cer norantly” (4) Undoubtedly many disasters tain class; others are apparently oured and in married life and untold suffering could of their own accord, or upon the advice of a be averted if the patients were properly adcareless physician, who gives his consent after vised even after they have contracted the dismerely inquiring as to the general symptoms ease. Who is to blame in these cases ? Most and the discharge, the patient then niarries assuredly the physician, who is almost al. a pure woman “only to deposit in her lap— ways insufficiently trained in the methods of as a wedding gift from his first wife, the pros determining whether or not a patient can titute—the seeds of a foul disease which marry with impunity. This should be a makes her innocent wifehood a source of pain standing question in all examinations in surand misery, and often renders motherhood gery, not only in the medical colleges, but impossible. The prostitute takes a poetic re- also in the state board examinations, and in venge, and by the disease she gives her para. this way compel the student and physician mour forever seals the fountain of nature and to be prepared upon this subject. I assert restrains her supplanter from acting beyond no question could be asked that would be her own (the prostitute's) sphere, even more practical, nor one that will be of more though she be a thousand times legalized as value in preventing sterility, disease, suffera wife by church and court” (3).
ing and death. Is it right to treat so serious a matter as a Gonorrhea is the most amenable of venejoke? Should not a young man early in his real diseases to individual prophylaxis, and youth receive a certain amount of education yet one hestitates at first to advocate any upon such an important subject and one with method which might perhaps increase the such disastrous possibilities? Ought this evil by lessening the danger which undoubt. part of the education of a son be left to the edly is a great conservator of social purity. servants or his ignorant (and perhaps profli. When, however, we consider that the social gate companions, who little realize the dan. evil bas existed through all ages, and that all gerous pitfalls even if they themselves have attempts at suppression have failed, from fallen therein ?
the rigid laws of Maria Theresa at Vienna A father cannot ease bis conscience by and the Popes at Rome (5), down to the presthinking bis son will not yield to the temp. ent day, and have invariably increased the tation or will come out unscathed. With the numbers of the clandestine prostitutes (who plain fact staring him in the face, that 80% is always more dangerous), that control meas