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.
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:
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.
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.
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.
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."
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 ValerateIron ValerateAmmonia 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 grainsAlcoholic extract of Sumbul 20 grainsAsafoetida 10 grainsArsenious acid 1/2 grain
Mix thoroughly and make twenty pills, one after each meal.
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.
Causes.—In a large proportion of cases the disease begins before puberty. It rarely begins after twenty-five. It is more liable to attack females than males. Heredity is thought by some to play a big role. Dr. Osler says: "In our figures it appears to play a minor role." Another doctor says: "Heredity plays an important role in the production of the disease. Besides epilepsy, insanity, migraine, alcoholism, near relationship of parents (consanguinity) and hysteria are among the more common ancestral taints observed." All factors which impair the health and exhaust the nervous system are predisposing causes. Injury to the head often causes it. Teething, worms, adherent foreskin and clitoris, closing of the internal opening of the womb, delayed menstruation, are sometimes the cause.
Symptoms.—There are two distinct types. The major attacks—or "grand mal"—in which there are severe convulsions with complete loss of consciousness, etc.; and the minor attacks or "petit mal," in which the convulsive movements are slight and may be absent, and in which the loss of consciousness is often but momentary or practically absent. In some the attacks occur during the day; in others during the night, and they may not be noticed for a long time.
Characteristic paroxysm of the Major attacks.—This may be ushered in by a localized sensation, known as the Aura, in some part of the body; but it may come without any warning and suddenly. The convulsions begin suddenly and at first are tonic, that is, it does not change but holds on. Thc patient falls unconscious regardless of the surroundings, and the unconsciousness may be preceded by an involuntary piercing cry. The head is drawn back and often turned to the right. The jaws are fixed (tonic spasm). The fingers are clenched over the thumb and the extremities are stiff. The breathing is affected and the face looks blue. The urine and bowel contents may escape; but this occurs oftener in the next stage. This tonic spasm usually lasts from a few seconds to a half minute when it is succeeded by the clonic spasm stage.
Clonic spasm stage.—In this the contraction of the muscles is intermittent. (Tonic spasm is the opposite condition.) At first there is trembling, but it gradually becomes more rapid and the limbs are jerked and patient tosses violently about. The muscles of the face are in intermittent motion, the eyes roll, the eyelids are opened and closed convulsively. The jaws move forcibly and strongly, and the tongue is apt to be caught between the teeth and bitten. The blue look now gradually decreases. A frothy saliva, which may be bloodstained from the bitten tongue, escapes from the mouth. The urine and bowel contents may escape involuntarily. The length of time of this stage is variable. It may last two minutes. The contraction becomes less violent and the patient gradually sinks into the condition of deep sleep, when the breathing is noisy and stertorous, the face looks red and swollen, but no longer bluish. The limbs loose their stiffness and unconsciousness is profound. The patient, if left alone, will sleep for some hours and then awakes and complains only of a dull headache. His mind is apt to be confused. He remembers nothing or little of what has occurred. Afterwards the patient may be irrational for some time and even dangerous.
The minor attack or "petit mal."—There is a convulsion; a short period of unconsciousness, and this may come at any time, and may be accompanied by a feeling of faintness or vertigo. Suddenly, for example, at dinner time the person stops talking and eating, the eyes are fixed and staring and the face is slightly pale. The patient usually drops anything he may be holding. The consciousness returns in a moment or two and the patient resumes conversation as if nothing had happened. In other instances there is a slight incoherency or the patient performs some almost automatic action. He may begin to undress himself, and on returning to consciousness find that he has partially disrobed. He may rub his beard or face, or may spit about in a careless way. An eminent physician states: "One of my patients, after an attack, was in the habit of tearing anything he could lay his hands on, particularly books; violent actions have been committed and assaults made, frequently giving rise to questions which come before court. In the majority of cases of "petit mal" (light attacks) convulsions finally occur, at first slight, but ultimately the grand mal (major attacks) becomes well developed, and the attacks may then alternate."
Recovery.—The authority above goes on to say: "This may be given today in the words of Hippocrates: 'The prognosis in epilepsy is unfavorable when the disease is congenital (that is, existing at birth), when it endures to manhood, and when it occurs in a grown person without any previous cause. The cure may be attempted in young persons but not in old.' '' Death rarely occurs during the fit, but it may happen if the patient is eating. If the attacks are frequent and the patient has marked mental disturbance the conditions are unfavorable. Males have a better outlook than females.
PHYSICIANS' TREATMENT.—What to do during the Attack of Epilepsy.—Keep the patient from injuring himself, loosen the clothing, take off the collar or anything tight about the neck. Place a cork or spool or tooth-brush handle between the teeth to keep the patient from biting his tongue, but attach a stout cord to the object and hold it in that way.
Preventive and general treatment.—In the case of children the parents should be made to understand that in the great majority of cases epilepsy is incurable. The patients need firm but kind treatment. It does not render a person incapable of following some occupations. "Julius Caesar and Napoleon were subjects of epilepsy." The disease causes gradual impairment of the mind, and if such patients become extremely irritable or show signs of violence, they should be placed under supervision in an asylum. A person with this disease should not marry.
Diet.—Give the patient a light diet at regular hours, and the stomach should never be overloaded. There are cases in which meat is injurious, and it should not be eaten more than once a day and at noon time. A vegetable diet seems best. The patient should not go to sleep until the digestion is completed in the stomach.
Causes.—Should be removed if possible. Circumcision should be done, especially in the young. In case of a female child the "hood of the clitoris" should be kept free. Undue mental and physical excitement should be avoided. Systematic exercise should be taken. Baths in cold water in the morning, if possible, as the skin should be in good working condition.
Medicines.—The bromides are the best, and should always be given under proper supervision of a physician or nurse.
Caution.—I wish to add that parents should always attend to the seemingly harmless "fits" in their young children. It will not do to say they are due to teething or worms. If they are, the worms at least can be treated and that cause removed. They may be due to too tight opening in the penis. If that opening is small, or if the foreskin is tight it will make the child irritable and cause restless sleep. Attend to that immediately. The same advice applies to female children. The "cover" of the "clitoris" may be tight, making the little one nervous; loosen it. If your child keeps its fingers rubbing its private organs there is reason for you to have the parts examined and the cause removed as masturbation often starts in that way. The parts itch and the child tries to stop the itching. These little things often cause "big things" and I am sure "fits" can be stopped very often by looking after the private organs in both sexes.
SHAKING PALSY. (Paralysis Agitans).—This is a chronic affection of the nervous system, characterized by muscular weakness, trembling and rigidity.
Causes.—It usually occurs after the fortieth year, and is more common in men than in women. The exciting causes are exposure to cold and wet, business worries, anxieties, violent emotional excitement and specific fevers.
Symptoms.—The four prominent symptoms are trembling, weakness, rigidity, and a peculiar attitude. It generally develops gradually, usually in one or the other hand. There is at first a fine trembling, beginning in the hands or feet, gradually extending to the arms, the legs and sometimes the whole body. The head is not involved so frequently. This trembling (tremor) consists of rapid, uniform "shakings." At first it may come in spells, but as the disease advances it is continuous. Any excitement makes it worse. It is very marked in the hands. The trembling generally ceases during sleep. The muscles become rigid and shortened; the head is bent and the body is bent forward; the arms are flexed (bent) and the thumbs are turned into the palms and grasped by the fingers; the legs are bent, movement soon becomes impaired and the extremities show some stiffness in motion. There is great weakness of the muscles and it is most marked, where the trembling is most developed. There is no expression on the face, and the person has a slow and measured speech. The walk is very peculiar, and in attempting to walk the steps are short and hurried. The steps gradually become faster and faster, while the body is bent forward and the patient must keep on going faster to keep from falling. It is difficult to go around in a short circle. The patient cannot change his position in bed easily. The mind is rarely affected.
Recovery.—It is an incurable disease. It may run on for twenty years or more. There may be times of improvement, but the tendency is to grow, gradually worse.
PHYSICIANS' TREATMENT for Shaking Palsy.—This is simply to make the patient as comfortable as possible. Regulate the diet. The patient should not worry or have much exercise. Frequent warm baths are sometimes beneficial with gentle massage of the muscles.
APHASIA.—A partial or total inability to express thoughts in words or to interpret perceptions.
Varieties.—Motor and sensory aphasia.
Causes.—Softening of the brain, tumors of the brain, lesions in syphilis especially, hemorrhage in the brain, blows on the head, and inflammation of the brain and its covering.
Symptoms of Motor Aphasia.—The patient cannot make the muscles of the larynx, tongue, palate and lips perform their functions and produce speech. The patient knows what he wishes to say, but cannot pronounce it. This may be complete or partial. Complete, when the patient can only utter separate sounds. Partial, when the words are only slightly mispronounced and when some certain words cannot be pronounced at all. In some cases, nouns only or verbs cannot be pronounced. Agraphia, means inability to write down the thoughts. Sensory aphasia: word deafness. This is an inability to interpret spoken language. The sound of the word is not recognized and cannot be recalled; but sounds such as that of an engine whistle, or an alarm clock, are heard and recognized. Word-blindness: the person cannot interpret written language. Pharaphrasia: cannot use the right word in continued speech; the patient uses words but misplaces them.
Recovery depends a great deal upon the cause.
Treatment.—Treat the cause. If from syphilis, iodide of potash and mercury. If from an injury or tumors, operate if possible. Teach the patient how to speak, read and write. The result of this often gives you a pleasant surprise.
[Illustration: Hand Nerves.]
WRITERS' CRAMP. Causes.—This occurs much oftener in men than in women, and usually between the ages of twenty-five and forty. The predisposing causes are a nervous constitution, heredity, alcoholism, worry, etc. The chief exciting cause,—excessive writing, especially when it is done under a strain.
Symptoms.—It usually begins with fatigue, weight, or actual pain in the affected muscles. In the spasm form the fingers are seized with a constant or intermittent spasm whenever the person grasps the pen. The neuralgic form is similar in symptoms but severe pain and fatigue comes with writing. The tremulous form: In this the hand when used becomes the seat of the decided tremor. The paralytic form: The chief symptoms are excessive weakness and fatigue of the part and these disappear when the pen is laid aside.
Recovery.—If taken in time and if the hand is allowed perfect rest, the condition may improve rapidly. There is, however, a tendency to recur.
PHYSICIANS' TREATMENT for Writers' Cramps.—There must be absolute rest of the hand. General tonics, such as iron, strychnine, arsenic, and cod-liver oil may be needed to tone up the system.
APOPLEXY. (Cerebral Hemorrhage). (Brain Hemorrhage). Causes.—Bleeding (hemorrhage) into the brain substance is almost always due to an affection of the walls of the large or small arteries of the brain, producing rupture and subsequent bleeding. Persons of fifty or over are more subject to it, and it is more common in men than in women. Any disease that will cause degeneration of the arteries, helps to cause it, such as nephritis, rheumatism, syphilis, gout and alcoholism. Nephritis is one of the most certain causes, because arterio-sclerosis (hardening and decaying of the walls of the arteries) and hypertrophy of the heart are associated with nephritis, etc.
Direct Causes.—Straining at stool, heavy lifting, anger, rage, fright, etc.; paroxysm of whooping-cough or convulsions may cause it in children.
Symptoms.—Sometimes the patient experiences headache, dizziness, paleness or flushing of the face, fullness in the head, ringing in the ears, etc., temporary attacks of numbness or peculiar tingling in one-half of the body. When the bleeding takes place there is usually loss of consciousness. In the attack:—If the bleeding is extensive the patient falls suddenly into coma, and this may soon prove fatal. If the bleeding is slight at first and gradually increases, the patient is delirious at first, then one arm, then one side, and finally the whole body may become paralyzed, and unconsciousness, and even death may come from the paralysis of the heart and breathing nerve centers. In many cases the patient falls unconscious without previous warning. The face is red, the eyes injected, the lips are blue, the pulse is full and slow, and the breathing is slow and deep. The head and eyes may be strongly turned to the injured side. The pupils may be unequal. The paralysis may not be noticed while the patient is unconscious and is quiet. The urine and the bowels contents may pass involuntarily or the urine may be retained. Sometimes when the case is very grave the patient does not awake from his deep sleep (coma); the pulse becomes very feeble, respiration becomes changed, mucus collects in the throat, and death may occur in a few hours or days. In other cases the clot in the brain is gradually absorbed, and the patient slowly returns to consciousness. Sometimes relapses occur. In mild cases instead of deep coma, there may be only headache, faintness, nausea and vomiting.
Subsequent Symptoms.—When the patient improves, consciousness returns, but there remains a half-side paralysis, hemiplegia, on the side and opposite to that of the seat of the injury in the brain. It may not take in the whole side, only a part. The gait is peculiar. In walking the patient supports the paralyzed arm. In many cases the paralyzed parts gradually regain their functions in a few weeks, but not always complete. The leg improves more than the arm. There is danger of other attacks. When the sleep (coma) is very deep, the breathing is embarrassed, with vomiting and prolonged half-consciousness and extension and complete paralysis, the danger to life is great.
What can I do at once? Loosen the clothing around the neck and waist. Raise the head and shoulders and put cold to the head (ice bag if you have it) and warmth to the feet, legs and hands. Watch the bladder closely. The urine must be drawn frequently in this disease, especially if there is much paralysis. It may dribble away, but that is not enough. Look out for bed sores, especially if the sickness is a long one.
APOPLEXY. 1. Mothers' Remedies, Simple yet Effective Remedy for.—"Place the feet of the patient in hot water and mustard," This is a very simple treatment for such a serious disease, but very often will relieve as the hot bath will cause a reaction, take the pressure of blood from the brain and by this means has been known to save many lives.
2. Apoplexy, Simple Injection for.-"Place dry salt on the tongue and give an injection as follows:
Warm water 1 quartCommon salt 2 teaspoonfulsBrandy 1/2 ounce
This injection is recommended for any kind of a shock which affectsthe circulation."
The injection of the bowels will relieve the congestion by drawing theblood away from the brain.
Medical treatment must be to regulate the diet, bowels, kidneys, and stomach. Restore the general health.
Caution.—A person who has had an attack of this kind may have another. The mode of life must be changed in most cases. The patient must take things easy. The bowels, kidneys, stomach, and liver must work naturally and the stomach must not be overloaded. Too much meat must not be eaten; alcohol must be let alone; rich foods are prohibited. Hurry, worry, anger, fright, excitement, etc., are bad. Be lazy, take life easy, do not get over-heated, and sleep, sleep, SLEEP,—in a room where there is plenty of good air. Do not lift or strain to have a passage of the bowels. Stooping is injurious. The blood must be kept from the head. Take proper care and you are likely to live years longer. And now you may wonder why I give such cautions. Apoplexy is directly due to a breaking of the wall of a blood vessel, large or small; due to a weakening, or decay, or degeneration of the wall. This lets the blood into the substance of the brain and presses upon the nerve centers, causing the trouble and paralysis. Any wrong action tends to fill the blood vessels very full and the weakened wall bursts.
PALSY. Paralysis.—A loss of movement, entire or partial, in the voluntary muscles of the body. When this loss of power is complete it is called paralysis; when it is not complete, paresis.
Causes.—Inflammation of the brain and spinal cord, tumors in these parts, accidents and injuries, poisons, apoplexy, etc.
Symptoms.—The patient cannot make all the usual motions of the part. The affected muscles may waste after a time.
Different Varieties.—
(a) Paralysis of the ocular (eye) muscles.—The vision becomes double, the eyelids do not act normally, may droop. The eye may not move in every direction as it should.
(b) Paralysis of the muscles of mastication (eating). Symptoms.—If paralysis is only on one side, it is difficult to chew; if on both sides, chewing is impossible. The jaw hangs down.
(c) Paralysis of the facial (face) muscle.—This is a rather common occurrence, and is due to exposure to wet, and cold, diseases of the middle ear, tumors, etc. Symptoms:—The eyelids do not close tightly, and tears are continually trickling over the cheek; the corner of the mouth droops and the saliva runs out, etc. The mild cases last two or three weeks; the severe form from four to six weeks; the worst cases usually recover in a long time.
(d) Paralysis of the muscles of the upper extremity.—There are various and many symptoms, but with all there is the same loss of the usual motion. That particular muscle does not do its special work; for instance, if the paralysis is of the deltoid muscle of the arm and shoulder, it is not possible to raise the arm, usually pain in the shoulder. The muscle soon wastes and the head of the arm bone (humerus) falls away from the shoulder, etc.
(e) Paralysis of the muscles of the lower extremities.—Paralysis of the "Gluteus Maximus and Minimus." (Hip muscles). Lifting up of the thigh is difficult and so is walking up hill or rising from sitting position. The toes are turned out. The other muscles may be paralyzed and simply cannot do their usual duty.
(f) Toxic (poison) paralysis. Lead paralysis.—It is hard to extend the fingers. The lead line is shown on the gums.
PHYSICIANS' TREATMENT for Palsy.—Remove the cause. Give salts and iodide of potash. Paralysis from arsenic, mercury, zinc or copper:—The symptoms are those of neuritis and are greatly similar in each kind. The spongy gums show mercury; the puffy face and diarrhea show arsenic poison. Remove the cause.
CONGESTION OF THE BRAIN. (Diseases of the Cerebral (Brain) Circulation).(Hyperaemia).—The brain is too full of blood.
Causes. For Active Congestion.—Over-exertion in study, etc.; chronic pletbora (too much blood in the blood vessels); from constant use of alcohol, tobacco, amyl nitrite, and from the stomach.
For passive congestion.—Local obstruction to the return of blood from the brain. Prolonged mental and physical exertion with excesses and irregular living may cause it.
Symptoms of active kind.—Head feels warm, face is red, the arteries in the neck beat hard, violent headache, ears ringing, very restless and does not sleep well.
Symptoms of the passive form.—The headache is not so great; there may be stupor, drowsiness and dull intellect and very sleepy.
Recovery.—Favorable if the cause is removed.
Treatment for active congestion.—Keep the patient absolutely quiet in a dark, well aired room, with the head and shoulders raised, an ice bag or cold cloths to the head and warm applications to the hands and feet. A warm foot bath will aid in drawing the blood away from the head. Give salts (salines) to move the bowels. These take away a great deal of water from the blood and aid in relieving the congestion of the head.
Treatment for passive congestion.—Remove the cause if possible. Give a light nutritious diet; prohibit alcohol in any form; keep the bowels regular.
CEREBRAL ANEMIA. (Too little blood in the brain). Causes.—Heart disease, general anemia, and mental excitement.
Symptoms.—"Fainting spells," dizziness, the ears ring and there are spots before the eyes; nausea and vomiting may go ahead of the fainting spells. The face is pale, the pupils are dilated, the pulse is small and feeble, and there may be cold sweating on the body. If you can remove the cause the result is favorable.
Treatment.—For the fainting fits:—Place the patient in the "lying down" position and this frequently restores consciousness; loosen any tight clothes, corset, waist, collar, etc. Give plenty of fresh air and do not crowd. Keep quiet yourself; do not get excited. In mild cases, mild stimulants may be necessary. Let the patient smell of camphor, put a cloth with camphor or ammonia near the nose. In other cases amylnitrite and strychnine may be necessary. Small doses of whisky or brandy frequently help. Remove the cause. Give tonics for general anemia.
TUMORS OF THE BRAIN AND INFLAMMATION, Abscess, etc. Abscess.
Causes.—This is always secondary and comes from some other part of the body. It comes often in young and middle life and is more common in males than in females. The most frequent cause is inflammation of the ear and the next is from fracture of the skull bones. It may be large or small.
Symptoms.—May come slowly or quickly. After an injury to the head the symptoms may come on suddenly such as intense headache, delirium, vomiting, chills, high fever, and sometimes convulsions, and a very deep seeming sleep (coma). In chronic cases the symptoms are not so severe.
Treatment.—An operation if the abscess can be reached. If not, an ice bag should be applied to the head; quiet the distress with narcotics.
TUMORS OF THE BRAIN.—Varieties in order of their frequency. Gumma, tuberculous tumors, glioma, sarcoma, cancer, etc.
Causes. Predisposing.—Men are about twice as often affected as women until fifty and then it is about equal. It is more frequent in early adult life. The exciting causes are blows and severe emotional shock.
Gumma (in third stage of Syphilis) appear as a round, yellow, cheesy mass, usually beginning in the membranes and are usually seen between thirty and fifty. They come from syphilis.
Tuberculous tumors. These appear as hard masses and vary in size. They may be single or many, and are situated in any part of the brain. More than half of the tumors appearing in children are of this variety.
Glioma. "Glue-tumor." They come from tissue forming the basis of the supporting framework of the nervous tissue. This kind occurs often in the young.
Sarcoma and Cancer are rare.
Symptoms.—The most of the growths start in the membranes of the brain, and by compressing a certain part of the brain they produce their special symptoms such as headache, vomiting, inflammation of the nerves of the eye, double vision, blindness, the memory impaired, dullness and apathy, an irritable temper, and sometimes become demented. There is often vertigo or a sense of giddiness. There may be convulsions, and paralysis of some muscles. A general tuberculosis tendency or history of syphilis will help to make the diagnosis. In children it is more likely to be tuberculous. The result is more favorable in tuberculous growths in children and syphilitic tumors in adults. It may last from a few months to three years in a bad case.
Treatment.—For gumma, caused by syphilis, iodide of potash and mercury should be given. In both kinds, syphilitic and tuberculous, a nutritious diet and general tonic treatment, such as cod-liver oil, iron, arsenic, and quinine should be given. The bowels must be kept open and special attention given to the digestion.
For headache.—Ice bags, cold to the head, mustard to the nape of the neck.
For Vomiting.—Mustard over the stomach. Surgery is necessary for some tumors that can be reached. You will naturally depend upon your attending physician for advice and treatment.
SYPHILIS OF THE BRAIN. Causes.—The symptoms of syphilis of the brain, belong to the third stage of the disease, and are rarely ever observed until at least one year or longer from the time of the first lesion (chancre). It may be from ten to twenty years coming on. Both sexes are equally liable, and it may come at any age. Syphilis may produce a circumscribed tumor, a disease of the arteries or a general hardened infiltration of the brain. The tumors are small, yellowish, and cheesy in the center. They originate in the "Dura Mater" (covering) and spread to the brain structure proper. The disease of the arteries causes a thickening of these vessels, a narrowing of the blood channel in them, thus producing a clot.
Symptoms.—Of gumma (syphilis tumors) at the base of the brain, are persistent headache, worse at night; sleeplessness, depression of the mind, memory impaired, vertigo, sometimes vomiting and paralysis of some of the nerves (third and sixth pairs). Violent convulsions, like epilepsy, appear in some cases.
Symptoms when arteries are diseased.—Temporary loss of speech, numbness or weakness in one limb, the sight is disturbed, or vertigo; and, when the clot (thrombus) appears, symptoms of apoplexy, This is a common variety of syphilis of the brain.
How to tell what the disease is.—The history of the patient will help. An apoplexy in a young person would suggest syphilis.
Recovery.—The chances are better when the disease forms gumma (tumors) than when the blood vessels are diseased.
Treatment.—Should be begun and properly carried on when the person has the primary sore (chancre), and then these after troubles may not follow. This is one of the diseases where the victim reaps a big harvest on account of the sexual sin, and in order to escape the bad results for himself, etc. he should go through a regular course of treatment when he first contracts the disease, perhaps for a year or more, This treatment should last as a rule for some years. It is late to begin when the brain symptoms show brain involvement. For this there must be radical and careful treatment with mercury and iodide of potash; with tonics and general building up treatment, and then even if the patient lives he may be a nuisance to himself and others.
GENERAL PARESIS. (Paretic dementia. General Paralysis of the Insane. Softening of the Brain).—This belongs under diseases of the mind, but there are so many cases that a description of this disease may be instructive and interesting. One author says: "General paresis is a chronic, progressive, diffuse, encephalitis (inflammation of the brain), resulting in structural changes in the cerebral (brain) tissue, with involvement of the cortical, and meningeal, (covering) blood and lymph vessels, presenting characteristic symptoms, with progressive course and fatal termination usually within three years." There are three stages:—1. The period of incubation (the prodromal stage). 2. A stage of pronounced mono-maniac activity with symptoms of paralysis. 3. Stage of extreme enfeeblement with diminution and final loss of power. These stages run into each other. First stage in a typical case:—There are tremblings and slight trouble in speech and expression of the face. The mind has exalted and excited spells, etc.
Symptoms.—The patient is irritable. The mental and moral character is unstable. His affairs are in confusion. He uses bad language, neglects his family, goes with drunkards and bad women, makes indecent proposals to respectable women of his acquaintance without realizing that it is improper. He cannot keep his mind on one thing. Speech is a little thick, indistinct and hesitating. Syllables are dropped or repeated, speech finally becomes undistinguishable. He is very excited; he thinks he is persecuted. He is a big fellow generally. He is a king, he is rich and mighty. This is the usual run. As the disease progresses he becomes feeble-minded more and more so continually. Persistent insomnia comes on early and frequently recurring, one-sided headache often goes with it. Sometimes there is an uncontrollable desire to sleep. Loss of consciousness is an early symptom. After severe attacks there may be one-sided paralysis (hemiplegia) which usually disappears in a few hours or days. Convulsions like epilepsy may appear early, but usually occur in the later stages. The pupils are mostly dilated, rarely contracted, and they are often unequal and react slowly to light. When the tongue is protruded it trembles and is put out in a jerky manner. The hands tremble, in the advanced stage. The speech is jerky and slow. Syllables are dropped and repeated. One early symptom is retention of the urine. There is another annoying symptom—a constant grinding of the teeth. The walk is very spasmodic, but in advanced stages it becomes slouching or dragging. The skin may be red or blue. When the feeble-mindedness is fully developed the mind does not perceive anything accurately. He sees imaginary things, and things that he does see do not appear to him as they are. Finally he has no mind.
Treatment.—The end is sure. You can relieve the distress partly. Personal attention by a physician is needed.
INSOMNIA.—Insomnia is not a disease, but a symptom of disease. It may, however, become so active, prominent, and important a symptom as to constitute a condition which merits individual management and treatment.
Definition.—Insomnia is the term employed to denote actual or absolute sleeplessness, and also lack of fully restful sleep, which might be termed relative sleeplessness.
Causes.—Organic causes. Disease of the brain and spinal cord. Toxic causes due to poison circulating in the blood which by irritation of the brain and cord (axis) and especially of the brain, cause such diseases as nephritis (chronic), jaundice, typhoid fever and consumption.
Primary causes. Depend upon insanity.
Nervous or simplest causes.—These are present in nervous persons and comprise the two conditions of congestion and anemia of the brain. The brain congestion is typified by the nerve-tire of the student; over-study and anxiety bring too much blood to the brain and necessarily too much activity and then insomnia. Anemia of the brain acts in the opposite manner. The brain cells are not properly nourished and hence irritated, and sleeplessness follows.
SLEEPLESSNESS. Mothers' Remedies. 1. Hop Pillow Stops.—"People affected in this way will be very much benefited by the use of a pillow composed of hops, or cup of warm hop tea on retiring. The hops have a very soothing effect upon the nerves."
2. Sleeplessness, Easy and Simple Remedy for.—"On going to bed, take some sound, as a clock-tick or the breathing of some one within hearing, and breathe long breaths, keeping time to the sound. In a very short time you will fall asleep, without any of the painful anxieties attending insomnia."
3. Sleeplessness, Ginger at Bedtime for.—"Ginger tea taken at bedtime soothes one to sleep," This is a very good remedy when the stomach is at fault. It stimulates this organ and produces a greater circulation, thereby drawing the blood from the head. This will make the patient feel easier and sleep will soon follow.
4. Sleeplessness, Milk Will Stop.—"Sip a glass of hot milk just before retiring. This is very soothing to the nerves, and a good stimulant for the stomach,"
PHYSICIANS' TREATMENT.—Remove the cause and be careful in using drugs. In the organic kind the treatment is not very successful. In the toxic kind drugs must be given to correct other diseases and also tonics given. For brain congestion and anemia kind other means must be used first, and the drugs as the last resort. Treatment of the congestive insomnia.—1. Hot or warm general body-baths are very advantageous to stimulate the circulation and restore its balance alike in congestion and anemic cases. After such baths the patient must go to bed at once and not get chilled in cold rooms or by drafts. They must be properly covered and kept warm.
2. Cold spongings, cold shower baths, or cold plunge baths are given when the hot or warm bath does not produce the correct result. If this does not depress it is better than the warm bath. The person should be rubbed with warm rough towels until the skin is aglow. If he feels rested and quieted, the reaction is proper; if depressed, the treatment is too vigorous and not suitable.
3. The patient should stand ankle deep in a tub of hot water and a "drip sheet," from water at 75 to 80 degrees temperature, thrown over him. Then rub the patient's back and abdomen hard and a general brisk rub-down immediately after leaving the tub. This treatment should quiet, not excite or depress.
4. The cold abdominal pack is valuable. Flannel is wrung out in water, 75 to 80 degrees temperature and laid in several thicknesses upon the abdomen; place a dry towel over this, cover all with oiled silk, overlapping widely in order to protect the bed. Tie or bandage all this firmly. The effect of this work is first that of a cold then of a warm poultice.
5. Exercise. This should be in the open air when possible. A fast walk, horseback ride or ride on bicycle for a half hour before bedtime, followed by a rub-down will frequently give a good sleep. Dumb-bell, Indian club exercise, chest weight, are good in some cases.
Diet.—A light easily digested supper is often better than a heavy meal. Sometimes a little eaten before bed-time will give sleep. A piece of toast, for instance. It draws the blood from the brain and more to the stomach.
Medicines. If you must use them.—The bromides are the best. Sodium and strontium bromide are first choice. Twenty to thirty grains in water one-half hour before retiring. Chloral hydrate should not be used often. Sulphonal, trional, etc., should always be given with a little food-never alone. Sometimes bread pills do just as well.
ANEMIC CONGESTION. Diet.—A light supper before retiring, like hot milk, broths, milk punch, etc., will very frequently promote sleep by removing the cause and quickening the circulation. Give nutritious, easy food to digest. The baths are not so valuable for this kind of insomnia. A cold sponge bath or plunge may be of service.
Medicines.—Tonics are needed here as in regular anemia. The patient must be carefully treated, and very many of these cases can be cured. The patient must render all the aid he can give, and the physician should gain his confidence. If he does he will not need to give much medicine to put the patient to sleep, and if he does give it he can frequently use a Placebo with the same effect. Mind has an influence over mind. By "Placebo" is meant any harmless substance, as bread-pills, given to soothe the patient's anxiety rather than as a remedy.
SLEEP WALKING.—There is a tendency to sleep walking in some families, often more than one child will do this to a greater or less extent. It is very extreme in some cases, and the next morning they do not know anything about it. The person is very seldom hurt and he can do some dizzy things. Many persons walk about in their sleeping room or simply get out of bed. Fatigue, worry, poor sleep, restlessness, nervousness, a hearty late dinner are aggravating causes. As age advances and the person becomes stronger, the patient will do less of it.
Treatment.—Avoid over-eating, worry, over-study. The evening should be spent quietly. Such persons had better drop parties, late hours or anything that tends to cause worry, fatigue or nervousness.
STAMMERING.—This may be inherited to some extent; excitement, nervousness, bodily fatigue, want of rest, etc., make it worse.
MOTHER'S REMEDY. 1. Stammering, Easy Cure for.—"Read aloud in a room an hour each day. Repeat each word slowly and distinctly."
PHYSICIANS' TREATMENT.—The person should be taught early to talk slowly, and to do everything to control himself and not get nervous. There are schools for this trouble, and they seem to do good work. They teach the patients how to speak slowly, distinctly and to keep their minds off of themselves.
HICCOUGH.—This is caused by intermittent, sudden contraction of the diaphragm; obstinate hiccough is a very distressing symptom and sometimes it is hard to control.
Causes.—Inflammatory causes. It is seen in gastritis, peritonitis, hernia, appendicitis, and in severe forms of typhoid fever. Irritative causes. Swallowing hot substances, local disease of the gullet near the diaphragm, and in many cases of stomach trouble and bowel disorder, especially when associated with gas (flatus). Specific causes: Gout, diabetes or chronic Bright's disease. Nervous (Neurotic) causes. Hysteria, epilepsy, shock, or brain tumors.
MOTHERS' REMEDIES. 1. Hiccough. Vinegar for.—"One teaspoonful vinegar sipped carefully (so it will not strangle the patient) will stop them almost instantly."
2. Hiccough, Sugar and Vinegar Stops.—"A few drops of strong vinegar dropped on a lump of sugar and held in the mouth until dissolved, will stop most cases of hiccoughs."
3. Hiccough, Sugar Will Relieve Patient of.—"Place a little dry sugar on the end of the tongue and hold the breath. I have tried this remedy after others have failed and obtained instant relief."
4. Hiccough, Simple Remedy for.—"Have patient hold both ears closed with the fingers, then give them three swallows cold water while they hold their breath."
5. Hiccough, Home Remedy to Stop.—"Take nine swallows of cold water while holding the breath."
6. Hiccough. Vinegar Stops.—"One teaspoonful of vinegar thickened with sugar and eaten slowly."
7. Hiccough, Cinchona Bark in Peppermint Stops.—"Put about one-fourth teaspoonful of cinchona bark, powdered in two ounces of peppermint water, and give one teaspoonful every five or ten minutes until relieved, or three drops of camphor and aqua ammonia in wineglassful of water," These remedies are very good when the stomach is at fault, as they have a stimulating effect.
PHYSICIANS' TREATMENT.—Sudden start may check it in the light forms. Ice, a teaspoonful of salt and lemon juice may be tried. Inhalations of chloroform often relieve. Strong retraction of the tongue may give immediate relief. Spirits of camphor, one teaspoonful. Tincture of cayenne pepper one to two drops in water. Ten grains of musk by the rectum. Hoffman's anodyne one teaspoonful in ice water is very good.
INJURIES TO THE HEAD. Concussion or Laceration of the Brain.—The brain may be injured by a blow on the head, or indirectly by falling fully upon the feet or sitting down hard upon the buttocks.
Symptoms.—The person who is injured may lose his balance and fall, become pale, confused, and giddy, may have nausea and vomiting and recover. If the injury is more severe and there is a tear of the membranes of the brain or the brain itself, the patient will fall and lie quietly with a feeble and fluttering heart, cold, clammy skin, and apparent unconsciousness; he can be roused by shouting but will not reply intelligently. He will be able to move his limbs. The urine and contents of the bowels will be passed involuntarily. As he gets better he may vomit. He may soon return to entire consciousness, but still suffer from some headache, feel wearied, and tired, and not feel like exerting himself. This may continue for some time. Occasionally the results are more serious even after a long time has passed, and an abscess of the brain should be watched for, sometimes epilepsy or insanity follows. If the patient grows worse instead of recovering, either deep seeming sleep sets in or symptoms of inflammation of the covering (meninges) or the brain itself follows. Such injuries must be carefully watched, for you can not tell at first how severe they may prove to be.
TREATMENT. What to do First.—Put the patient to bed without any pillow, and put around his body hot water bottles or bags, suitably covered. He should be kept quiet and free from excitement, and sleep should be encouraged. Hot water or ice water, when awake, as is most agreeable to the patient, may be given. Aromatic spirit of ammonia, during the shock is better for the patient to take than alcohol, for alcohol excites the brain; dose, one-half to two drams; the former can be given every ten minutes in a little water for about three doses. Surgical treatment may be necessary at any time.
INJURIES OF THE SPINAL CORD. Concussion of the Spine.—A severe jarring of the body followed by a group of spinal symptoms supposed to be due to some minute changes in the cord, of an unknown nature.
Causes.—Severe concussion may result from railway accidents or violent bending of the body, fall from a house, blow on the back, jumping, etc.
Symptoms.—May come on suddenly, when it is due to a jar of the brain as well as the cord. Loss of consciousness, complete paralysis, small pulse, collapse, and within a few hours death may follow. In other cases improvement, though very slow, follows. Walking is difficult and the upper extremities are weak in these cases. There are pain and tenderness along the spine. Brain symptoms, such as headache, dizziness and fainting, may be present or absent.
Treatment.—Absolute rest from the beginning, stimulants if necessary, electricity is useful.
TRAUMATISM OF THE CORD. (Blows, etc.).—(Fractures and dislocations, gunshot and stab wounds, etc.).
Symptoms.—They differ according to the place where the cord is injured. The motion and feeling power may be disturbed. There may be sudden complete paralysis of the upper and lower extremities depending on how severely the cord is injured, and how high up the injury is. The bladder and rectum may not act properly. The contents may be retained or "run-away." Death follows sooner or later if the injury is extensive. In some cases the symptoms are slight in the beginning, but increase in a few days, or they may suddenly increase a few months afterwards. In other cases, bad symptoms at first may gradually abate which is due to the blood clot having been absorbed.
Recovery depends upon the extent of the injury and the constitution of the patient. It is always well to be careful about expressing an opinion about this injury.
Treatment. Immediate.—Surgical treatment is necessary. Absolute rest is a necessity, and must be had for weeks according to the severity of the case. It may seem long and become tedious, but the case must have rest for a long time.
ORGANIC DISEASES OF THE SPINAL CORD. Caisson Disease; Divers' Paralysis. Causes.—This affection occurs in divers, bridge builders, and others who are subject to increased atmospheric pressure. The symptoms develop on coming suddenly to the surface when the atmospheric pressure is greatly lessened.
Symptoms.—They usually occur on the return to the surface of the water, or after a few hours have passed. There are pains in the ears and joints and nose-bleed. The pulse is slow and strong. Neuralgia of the stomach and vomiting often occur. Paralysis of one side, or of the lower extremities may occur. Brain symptoms may develop and death may follow in a few hours. In most cases recovery takes place in a few days or weeks.
Treatment.—Persons who are engaged in such work should change very gradually from a great depth to the surface, and should not go into the outer air suddenly.
MYELITIS.—Myelitis is an inflammation of the spinal cord.
Causes.—It may occur at any age, and is more common in male than in female. The exciting causes are prolonged exposure to severe colds, too great mental and physical exertion, sexual excess, blows, bleeding into the cord, alcoholic excess, acute infectious diseases, syphilis, etc.
Symptoms.—These depend upon the location of the inflammation and the severity. The onset may be sudden or gradual—when it is sudden, there may be a chill followed by a fever of 101 to 103 degrees—general feeling of illness, loss of appetite, with coated tongue and constipation. There may be over-sensitiveness to pain and touch. Pain may radiate from the back into the limbs, with numbing and tingling of the limbs. The urine may be retained or may dribble away. Usually there is obstinate constipation. There is frequently the feeling of a band around the body. Paralysis may follow in the lower extremities and higher up, sometimes, depending upon how high up in the cord the inflammation exists. This paralysis may cause no motion of the limbs or produce an exaggerated contracting of the affected muscles, the knees being drawn up on the abdomen and the heels touching the buttocks.
Recovery.—Chances for recovery depend upon the cause. Most cases are chronic and may last for years.
Treatment.—Treatment depends also upon the cause. Rest in bed; counter-irritation, wet cupping, with care on account of bed sores. A water-bed from the first may prevent bed-sores. The urine must be drawn if it is retained. The medical treatment must be carefully given and a physician of experience should be obtained.
LOCOMOTOR ATAXIA. Tabes dorsalis. Posterior Spinal Sclerosis).—A hardening (sclerosis) affecting the posterior parts of the spinal cord and characterized by incoordination, which means a condition where a person is unable to produce voluntary muscular movements; for instance, of the legs, etc., loss of deep reflexes to bend them back; disturbances of nutrition and sensation, and various affections of sight.
Causes.—This is a disease of adult life, persons under twenty-five being rarely affected, and is more common in men than women (ten to one). Sometimes children suffering from hereditary syphilis have it. The chief predisposing cause is syphilis which precedes it in from seventy to eighty-five of the cases according to various authorities. Exposure to cold and wet, sexual and alcoholic excesses, mineral poisoning, and great physical exertion also exciting causes.
Symptoms.—These are numerous. They appear in succession and with the same regularity.
Stages.—Stages of pain; the stage of ataxia, peculiar gait; and the state of paralysis.
1. Prodromal or forerunning; the stage of pain.—This consists of lightning-like pains in the lower extremities, numbness, formication (feeling of ants, etc., crawling), sensation of dead extremities; pins and needles in the soles of the feet and fingers, coldness, itching of arms and scrotum or other parts, a sensation of constriction around the chest, headache, pain in the small of the back and loins of an aching character may occur. These symptoms may constitute the only evidence of locomotor ataxia and last for years; but sooner or later there are added absence of knee cap bone reflex (knee jerk), and immobility of the pupil. The loss of the knee jerk is always observed in time. The pupil fails to respond to light while it still accommodates for distance, called Argyll Roberston pupil. There may be imperfect control of the bladder with slow, dripping or hasty urination. Later the control is not imperfect, but it may be painful. Inflammation of the bladder may occur which is dangerous. There is usually obstinate constipation and loss of sexual power. These symptoms may last for several months and years, and then the second stage symptoms appear.