Excerpt from Charlotte Medical Journal, 1892
Neurasthenia is usually defined as a condition of nerve exhaustion or nervous debility.
Neurasthenia may be due to many causes. In some cases it results from severe infections disease; this is especially true in tuberculosis; it may be due to some general organic condition, diabetes, nephritis, constipation and auto-intoxication, pelvic disease in women, etc.; it may follow severe traumatism, overwork and mental strain, or emotional strain. But in addition to these immediate causes, Hartenberg says, "there must exist another factor, deeper-lying, more hidden which allows the exciting cause to become pathogenic. This deeply-rooted, hidden factor can not be looked for elsewhere than in a special predisposition on the part of the nervous system."
One of the most constant symptoms of neurasthenia is constant fatigue, disinclination for effort either physical or mental, loss of will power and the power of concentration. There is also nervous irritability, hyperactivity of reflexes, insomnia, etc., headache, vertigo, ringing in the ears, and heart palpitation and common physical symptoms. In many patients there 19 marked mental depression, this may alternate with periods of abnormal gaiety or hilarity without cause.
Hartenberg says:
"Fatigue is one of the essential symptoms of neurasthenic states. All patients complain with this emphasis of this invincible lassitude which overtakes them as soon as they wake in the morning and remains with them the entire day."
In the treatment of neurasthenia each case must be studied carefully; careful examination should lie made for any physical or organic condition causing or complicating the neurasthenia, and if such conditions are found, they should be given proper treatment, - which sometimes may be surgical.
With organic causes eliminated, the treatment of neurasthenia. Dr. Ferebee says, "should embrace rest and isolation, massage, electricity and hydrotherapy superalimentation and drugs. The personality of the nurse in charge of such a case is important. A tactful, resource nurse, one who can preserve an equable, cheerful demeanor and can divert the patient from his gloomy forebodings and autoclinical observations, is a great desideration. The physician should impress his patient with confidence, make him believe that he understands the ease, that he is going to get well, and when the setbacks come, as come they will, allow the patient to see that the physician is not discouraged, that he had counted them in advance, and that his opinion is unchanged."
Dr. F. Beach, discussing the educational treatment of neurasthenia, refers to the necessity of rest, at least for a time, saying that in the ease of a woman, she must be relieved from all household cares and worries, while a perfectly hygienic life must be led with strict attention paid to diet. This latter should be good, plain, and abundant, milk, cream, eggs, farinaceous food, fruit and vegetables being given at first, and when the patient is stronger the ordinary diet may be resumed. but "no alcohol should on any account be permitted." A change of air in connection with moderate exercise may be prescribed later.
While many physicians advocate some form of rest cure, at least in beginning treatment. Dr. Riggs does not approve of the absolute rest in most cases, he says:
"On'y for complete physiological bankrupts should rest be at all an important item. and. even in these eases, I have never continued it at an aggregate of over three hours daily, exclusive of the night, for more than a week or ten days. Rests, though short, should be made as perfect in quality as possible; that is. patients should be taught how to rest."
Dr. Riggs outlines the important part of his treatment for neurasthenia as follows:
"Fundamental re-education of the patient is the weapon in which I put my greatest trust. To teach the neurasthen. Это и многое другое вы найдете в книге Charlotte Medical Journal, 1892 (Classic Reprint)