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Impaired Health Its Cause And Cure by J. H Tilden, M.D.

(Shaking Palsy)

   This is a chronic affection characterized by weakness and tremor, also rigidity.

   Etiology.--This disease develops in men oftener than in women. It is a disease that rarely develops under forty to forty-five years of age; yet cases have been reported under twenty-five years of age. In all probability, however, these were choreic in nature.

   The exciting causes may be exposure, cold, wet, worries and anxieties of all kinds. In some cases it is brought on from mental shock or an injury. Any toxins may produce this disease in those who are predisposed to it. Not everyone will take on paralysis agitans. It belongs to those of neurotic diathesis who have intensified their nervousness by the use of all kinds of stimulants, alcoholics, tobacco, coffee, tea, etc. There is no question but that Parkinson's disease is only one manifestation of arteriosclerosis, or old age, disease. I never have met with a case yet that did not present most pronounced symptoms of arteriosclerosis. In those who are predisposed to take on the disease it is liable to develop in middle life. Some authors declare that it is not a neurosis. Why is it not? The blood vessels are controlled by the nervous system; arteriosclerosis is built by over-stimulation; and, certainly, if there were not nerves to be over-stimulated, it would be a very difficult matter to stimulate the organism, or produce all the diseases that come under the head of sclerosis.

   Symptoms.--The disease begins gradually with an unsteady hand. The tremor may be constant or intermittent. With this may be associated weakness or stiffness. Indeed, such cases are inclined to have rheumatism. This will account for the stiffness. When a slight rheumatism takes place in the joints of the hands, the appearance is that there is a great loss of power, This, however, is not true; for if the sensitiveness is taken out of the hands, they can grip or show evidence of power equal to that of any time previous to the development of the disease.

   The four leading symptoms are tremor, weakness, rigidity, and an attitude.

   Tremor.--The tremor may develop in all four of the extremities, or it may be confined to the hands or to the feet. The head is not so inclined to take on the affection; yet the disease is met with seemingly confined to the neck, where there is a choreic jerk of the head. The trembling is often decidedly marked in the hands, the thumb and forefinger displaying the peculiar motions that are likened to rolling a pill. When the tremor has been developed for a long time in the hands and legs, or feet, there is an inclination for an unsteadiness of the head to take place.

   Weakness.--All cases lack power. This, however, belongs to the last stages.

   Rigidity or Stiffness.--This may be expressed in the slowness of movements. The time comes when all voluntary movements are made slowly, but with considerable effort. The actions become very deliberate.

   Attitude or Gait.--The head leans forward; the back is bowed; the arms stand from the body and are somewhat fixed. The face is expressionless. The motions of the lips are slow. The whole expression is masklike; indeed, it is called Parkinson's mask. The voice is often shrill and piping. Sometimes the disease is confined to one side, or often to just one limb. However, before the patient dies, unless some intercurrent affection takes him away, he will live to become generally paralyzed.

   Treatment.--The leading authorities declare that there is no treatment that is satisfactory, but they recommend arsenic, opium, hyoscyamin, and other drugs that act on the nerve centers. I should expect cases to grow worse on drugging. Indeed, there is nothing to do except to correct the errors of life, whatever they are. Overstimulation must be gotten rid of. Patients must be induced to live on just barely enough food to keep soul and body together; otherwise they stimulate and build this disease. Everything that is of a stimulating or shocking nature must be kept from such patients. Disagreeable people, domestic and all other irritations, must be got rid of; for such patients are often very excitable, and all excitement is stimulating, and all stimulation brings on more and more enervation.


II. ACUTE CHOREA (St. Vitus' Dance)

   This disease appears oftener in children. It is characterized by irregular, involuntary twitching or contraction of the muscles. Authors recognize the liability of these cases to develop endocarditis.

   Etiology.--Children are oftener affected between five and fifteen years of age than at any other age. It is said to be rather rare among negroes and the native races of America. The reason for this is that only neurotic temperaments develop the disease. It is a disease of civilization. Putrefaction, with systemic infection by the toxins absorbed from this putrefaction, is the exciting cause. No one would believe that negroes and aborigines are less liable to putrefactive processes than the type of children who develop chorea; but when they develop enough toxin poisoning to cause a nervous temperament to develop chorea, these lower types will develop convulsions, paralysis, tuberculosis, scrofula, rheumatism, and kindred affections. Authors usually recognize a causal relationship between rheumatism and chorea. The basis on which chorea. rests is the same as that on which rheumatism rests. If a child does not develop rheumatism, it will be because it has not enough of the gouty diathesis, and the toxin poisoning will manifest in some other way. A child of a gouty diathesis will certainly develop rheumatism instead of chorea. The neurotic temperament will develop chorea and not rheumatism. In cases of chorea presenting a complication of arthritis there will be found the gouty diathesis, with a decided neurotic tendency. In all cases that I have seen of this nature the painful affections of the neurotic temperament have been more on the order of neuralgia than rheumatism. In some cases the affection has presented a state of neuritis rather than rheumatism. I have not seen a true inflammatory type of rheumatism complicating chorea, or vice versa.

   Endocarditis, which is common in these cases, is an early development of inflammation due to toxin in the blood. Unless the cause is controlled, the disease will extend to the arteries, developing arteritis. Then, if the condition continues without interruption, there is nothing impossible about embolism, convulsions, and paralysis as the sequel of the diseased condition of the endocardium and the inside membrane of the arteries. It is not strange that, preceding chorea, such diseases as scarlet fever, measles, whooping-cough, and chicken-pox develop. As regards a tendency for the disease to develop in certain families, there is no question but that families of the neurotic type are subject to this and other nervous affections. Children are high-strung and easily excited. Too frequently mothers have no self-discipline, and their influence on children is to drive them into such diseases, rather than to steer them clear of chorea as well as other nervous affections. Children of this temperament find musical education very hard on their nerves, The strain of taking the lessons is often quite enough to develop chorea in decided types of this temperament. Such children are easily worried. They come to grief with lessons. They are hurt very badly by criticism. If teachers find fault with them, or scold them, or give them bad marks, it means indigestion and a day of nervousness--probably a headache. The average schoolteacher is unfit to take care of children of this type. Indeed, such children should be sent to institutions where they can have the proper feeding, and where they may be understood and disciplined in keeping with their needs. So far as the mind is concerned, these children belong to the brightest and most active. If their physique will hold up, they can outstrip all other classes. Very nervous children are liable to be thrown into chorea by a shock or an injury of any kind, or a surgical operation.

   For the purpose of commenting on it, I shall give a part of a paragraph from Osler: "There are instances without endocarditis and without, so far as can be ascertained, plugging of cerebral vessels; and there are also cases with extensive endocarditis in which the histological examination of the brain, so far as embolism is concerned, was negative."

   These facts are explained when it is recognized that children have been brought into a high state of toxin infection from decomposition in the bowels, and this infection has gone to such an extent as to create inflammation of the lining of the arteries as well as of the heart. A case might escape developing endocarditis, yet there would be sufficient inflammation in the arteries to furnish the emboli required to develop the infarctions necessary to account for the disease.

   Symptoms.--There are mild and severe types. The severe types are sometimes called maniacal. In mild cases the affection of the muscles is slight. Speech is not necessarily interfered with to any great extent, and the general health, so far as the appearance of the child is concerned, would pass for being all right; but no physician will recognize a child with ever so slight choreic development as a normal or healthy child. There is always indigestion, creating gastro-intestinal irritation sufficient to account for the unsteadiness of movements and the involuntary movements which such children develop. I am persuaded to believe that children who are kept largely on fruit and vegetables, with cereals, are more inclined to develop the lighter forms of this disease. The more severe types require the more toxic poisoning that comes from putrefaction of animal proteins. Children who have the mild type are pronouncedly nervous, and they are accused of having the fidgets. They have crying spells, and frequently scream out in the night. Some of them walk in their sleep. Stuttering, stammering, and awkwardness in speech are mild types of chorea.

   The extreme or severe cases--those that are called maniacal--have truly a terrible disease. This disease develops more often in grown people or adults than in children. It first begins in the hands and arms; then the face is affected, and subsequently the legs. The movements are confined to one side. It is then called hemi-chorea. It is thought that it is more often developed on the right than on the left side. Its decidedly prominent symptom is muscular weakness. There will be a visible dragging of the legs, or limping, and a tendency for falling forward. Patients will took as if they were going to fall, but they save themselves. Sometimes there is a dragging of one leg. In some cases there is extreme paresis. These cases have a regular but rapid pulse.

   Treatment.--When children begin to develop signs of chorea, they should be taken from their studies and put to bed. The first few days they should not have anything to eat. Then for a few days they should be fed nothing but fruit morning, noon, and night. After the first week of fasting and fruit, then two fruit meals should be given each day, with a combination salad and one or two cooked, nonstarchy vegetables for the dinner. Nothing else is to be given until the choreic symptoms have entirely disappeared. But it is cruel to allow these children to stay out of bed. They must be kept there until they are well. Cases that have been allowed to develop extreme types may require a long time in bed before they get control of themselves; but they certainly should not be allowed to go out, unless they are carried either in the arms or in a go-cart. They are not to be allowed to use their limbs. After the child has been restored, it is necessary for the family to change its mode of living. Indeed, such families should employ a physician to go into the home and see what is wrong. I often think it would be a good thing for a physician to go and board for an entire week with such families, eating at the same table and learning all their peculiarities. No doubt there will be a great deal to do by way of straightening out the psychology of such a family. They are to be taught poise. Certainly they must be well balanced in the treatment of nervous children, or cures will not come to stay. After such children have been restored, they ought never to be given meat, eggs, fish, or any other animal foods, except very sparingly: eggs and lamb or chicken once or twice a week. Perhaps cheese and milk will take the place of meat or fish. A dish of cottage cheese at a dinner, or an ounce or two of ordinary commercial cheese, or an egg or two, not more than twice a week in the dinners. The other dinners should be built around one decidedly starchy food, such as baked potatoes, either Irish or sweet, or a dish of navy beans, butter beans, corn bread, whole-wheat bread, etc. The rest of the dinner will be one or two cooked, nonstarchy vegetables and a dish of salad. These children should always have a dish of salad with the dinners, whether they eat anything else or not. The severely chronic cases--those that have become organized, so to speak--may be improved by correcting their lives, and they may not. It stands to reason, however, that if they are put on the proper lines, they will certainly do better than where they are living wrongly each day. Incorrect living cannot help but make even a bad case worse, whereas correct living certainly ought to modify the worst cases and do them a certain amount of good. There is no special treatment for them, except to teach them to live normally.



   To say that there are infantile convulsions which are not epileptiform is to make a distinction without a difference. A convulsion is a convulsion. It is said that the difference between infantile convulsions and epilepsy is that the convulsions stop when the cause is removed, and there is no tendency for the fits to recur, but that convulsions in children sometimes continue and develop into true epilepsy. It has been my experience that, when the cause of convulsions--either those in infants, which may be called infantile convulsions, or true epilepsy--is removed, either form of convulsions, if there is any difference, stops.

   EtioIogy.--Convulsions may be brought about by many causes, Children who develop convulsions, or those who develop epilepsy, are predisposed to convulsive seizures. Their nervous system is unstable and easily thrown out of balance. Probably ninety per cent of convulsions in children are brought on from gastro-intestinal irritation. Indigestion is the rule, rather than the exception, in all children, as disagreeable as the statement may be. I am not exaggerating when I say that there are no laymen, and very few medical men, who really know anything about how children should be fed. The result of all this ignorance is gastro-intestinal derangements galore. Children are only a few hours old when they begin to show indigestion; and certainly they begin to show evidences of improper feeding within the first two or three days. This being true, there is nothing strange in the amount of sickness so common to infantile life. A common so-called cause of infantile convulsions is debility. But what causes debility? Gastrointestinal disturbances. And what causes gastro-intestinal disturbances? Feeding beyond a child's digestive power. And, of course, when continued, the acidity which takes place from the fermentation of the food creates so much gastro-intestinal irritation that children are often thrown into convulsions.

   Peripheral Irritation.--It is common to recognize dentition in children as the cause of convulsions when a nursing child is thrown into this nervous state. I do not believe that this is true. Away back in the beginning I knew no better than to believe what I was taught regarding this matter, namely: that teeth in their eruptions caused nerve irritation and produced cholera infantum and other gastro-intestinal derangements of children. I knew no better then, but I know better today. I know that children will not have any trouble teething, and they will not have convulsions, if they are fed properly--if they are fed within their digestive capacity. When a child is fed in a way to produce great acidity of the stomach and bowels, and there is a decided indigestion, with acid stools of a diarrheal nature, bordering on entero- or muco-colitis or dysentery, then it will be exceedingly nervous, and, if it is cutting teeth, the gums will be very sensitive, as the nerves generally are sensitive; but the real cause is toxin poisoning from decomposition of food in the alimentary canal.

   The greatest mortality from convulsions is within the first year, because children's nervous systems are exceedingly tender and easily thrown into a state of degeneration. As children grow older, they will have more resistance. The rule is that they have more indigestion the second year, and, indeed, are more inclined to have cholera infantum the second summer than the first year; but they are stronger and can resist the degenerating influence of convulsions. I have seen children so sensitive from gastro-intestinal indigestion that they would have a light form of epilepsy from teething time on to five and six years of age, when the "petit mal" would be supplanted by true convulsions. When this state of the nervous system is maintained because of malpractice and abominable nursing and dieting, the mind fails to develop, because the brain does not develop. The children from this time on begin to show degeneration--show that they are doomed; and unless they are taken hold of by someone who will correct the errors in the care and nursing, they will be doomed to idiocy.

   These children respond to kindly treatment, proper diet, and proper nursing, if taken in time, as quickly as if they had never been abused by malpractice.

   Rickets.--When children are abused as above stated, they are liable to develop rickets. (See "Rickets.").

   Fevers are frequently ushered in by convulsions. The toxin poisoning that has brought on the fever has so completely overstimulated the nervous system that the child is thrown into convulsions.

   Congestion of the Brain.--This may be one of the symptoms of fever.

   Infantile Hemiplegia.--This is one of the results of infantile convulsions. In all the cases I have met with I have found sufficient gastro-intestinal derangement to account for the disease. A few I have traced to septic poisoning of the mother, causing infection of the child through the milk.

   Symptoms.--Convulsions may come on without warning. However, if the mother is very watchful of her child, she should know that it has been feeling more or less ill for several days. If the proper attention has been given to the bowels, there will be indications of indigestion. All mothers should be taught the importance of this symptom. Young children cannot carry the evidences for any great length of time without a smash-up in the general health. Just what the symptoms will be will depend upon the inclinations and peculiarities of the child.

   Prognosis.--If, when the disease has once developed, the child is treated exactly right--namely, digestion corrected, and all evidences of indigestion completely overcome, either by fasting or by feeding very lightly--and if the patient is kept absolutely quiet, the very worst forms of this disease should be controlled in a week. Where the disease has come on with such virulence as to produce hemiplegia, if taken hold of carefully, and if no more toxin poisoning be allowed to develop from improper eating--wrong food combinations--the child will evolve out of the condition and the paralysis will be gradually overcome.

   Treatment.--The bowels and stomach should be cleared out. If the child is vomiting, it will not be necessary to do anything for this particular symptom, except to keep water away from it as well as all food. The stomach will soon get settled. The bowels should be thoroughly cleared out with enemas two or three times a day, until there is no more decomposition in the entire tract. Then the eating should be very carefully corrected. The child may be put on its accustomed food, if a better cannot be had, but should be given not more than one-fourth the ordinary quantity. For the convulsions there is nothing better than the hot bath. Put a cloth wet in cold water on the child's forehead, and change frequently while it is in the bath. When the convulsion is past, put a little cold water into the child's mouth with a spoon. When the child is in the bath, hold the body under the water. The temperature of the water should be as hot as it is safe to make it. Keep the child in the water until complete relaxation takes place. Drugs are not needed; indeed, they are disease-builders rather than beneficial. These children are very easily managed, if they are given the proper rest, both physiological and physical--dietetically and physically.



   Definition.--This is an affection of the nervous system, characterized by spasms or convulsive movements, with unconsciousness. In the lighter forms there is unconsciousness without the convulsive movements. The light forms of the disease--those that are free from convulsive movements--are called "petit mal." The loss of consciousness accompanied with convulsive seizures is known as "grand mal." Convulsive movements localized without loss of consciousness are called "epileptiform," or sometimes "Jacksonian epilepsia." It is due to disturbance of the motor center. There are very few cases of organic disease of the cerebral cortex.

   Etiology.--The majority of cases start before puberty. Indeed, the convulsions of infancy are simply epileptic seizures, but they are seldom called epilepsy until they become established and recur at more or less regular intervals. This is a disease that belongs to the neurotic diathesis.

   So far as sex is concerned, there are probably sixty per cent of the cases among mates. It is possible that a larger percentage of males are known to have the disease, if statistics were compiled that would be absolutely reliable. The reason for this is that the male is more active than the female--even in germ life, on through embryonic life. It is not generally known that men are more nervous and active than women, and it would be perfectly natural for them to develop more nervous diseases. Even if they were not by nature more nervous, their habits of life are such that they create nervousness. They are more inclined to take up with stimulating habits. They are decidedly more sensual; hence more inclined to develop nervous diseases. No doubt there are hereditary tendencies for epilepsy to develop in families; but no disease is hereditary in the sense that it is inherited. Children born of neurotic families, brought up in a way to develop their neurotic temperament, will certainly be more inclined to develop this disease than others.

   Alcoholism is recognized as one of the leading causes for the development of epilepsy; but I think that it would be impossible to prove that alcohol causes more epilepsy than gluttony, tobacco, coffee, and tea. Indeed, it is safe to say that without gluttony there would not be nearly so much alcoholism. Overeating paves the way for all stimulating habits. And, so far as developing nervous diseases is concerned, toxin poisoning is equal to alcohol poisoning. The profession generally is of the opinion that syphilis predisposes to the disease. The life that exposes sensualists and libertine to syphilis has as much to do with developing epileptic disease, and other nervous diseases, as the socalled venereal disease.

   Reflex Causes.--Dentition, worms, adherent prepuce, masturbation, venery, foreign bodies in the ear, eyestrain, any disease that is of a painful order and has a tendency to produce reflex irritations, may be the starting point of epileptic convulsions.

   When developed after thirty-five years of age, the cause is wine, women, and sensuality in all forms.

   Symptonms.--Preceding the convulsion there is a period known as aura. This is described differently by different patients. Some will complain of pain in the hand or finger; or there may be a disagreeable sensation felt in the stomach, or a feeling of precordial oppression, like smothering. As the disease is oftener brought on from gastro-intestinal derangement than from any other single cause, it is more probable that the aura will be that of a feeling of irritation in the stomach and bowels. The patient will utter a cry or groan, and is off in the convulsion without being conscious of having made an outcry. Those who have been accustomed to taking care of these patients know instantly, when they hear the outcry, that the convulsion is on. The patient usually falls on one side; the head is turned and drawn back; oftentimes the heels and the head jerk backward. Then again the jerking will be from side to side, so that a patient lying on the floor will pound his head against the floor, and the convulsion, when severe, will be a contraction of all the muscles from head to foot. These are called tonic spasms. The contractions and relaxations follow each other in rapid succession. It is very exciting to those who see a patient suffer convulsions for the first time. They are always anxious to do something.

   Coma.--Breathing is, uneasy. The face is congested ,and becomes very cyanosed. The patient will chew his tongue, froth at the mouth, and, after the convulsion has ceased, be will lie in a comatose state for from several minutes to several hours. If left alone, he will probably sleep for several hours after the fit has passed, because he is worn out completely. Those patients who have night occurrences of this disease will know that they have passed through one when they wake up the next morning; for their tongues will be quite sore, and their muscles will be painful and feel as though they had been bruised.

   The "petit mal" is the epilepsy without the convulsions. The attack consists of loss of consciousness. The patient may be passing out of a room, and, as he reaches for the door-knob, a spell of unconsciousness takes hold of him, and, instead of taking hold of the knob, his hand passes to one side of it. He will become conscious at once, and think it strange, or possibly feel vexed at his awkwardness, that he did not take hold of the knob the first move. He may think of it afterwards, and he may not; but it is something which he cannot explain.

   Some of these cases will be in conversation. When an unconscious state passes over them, they lose the thread of the discourse for a moment; then come to a state of sensibility, and continue the sentence they had started; which, of course, appears strange to those who have been engaged in the conversation. The hesitancy cannot be explained.

   The "Jacksonian epilepsy" is known as cortical, or partial, epilepsy. It is always distinguished from the, ordinary epilepsy by the fact that patients with this type of the disease do not lose consciousness. Irritative lesions in the motor zone are usually the cause. The spasms begin in a limited number of muscles. They may begin in the face, arms or legs, or the thumb, or the toe may twitch. It may be that the patient previous to the contraction will have a feeling of numbness or tingling in the parts. The disease may involve the muscles of one leg only or of the face. The patient may remain conscious throughout the spasm and watch the course of it with interest. The beginning may be very slow. The patient may have time to become comfortably seated before the attack becomes too severe. The location of the spasm may continue the same for years. There is always a tendency for partial epilepsy to become general. This disease is frequently found in children following partial paralysis--the so-called post-hemiplegic epilepsy. The convulsions will begin on the affected side.

   Diagnosis.--The suddenness of the attack and the loss of consciousness, with contraction and relaxation following each other in rapid succession, are characteristic of the major form of epilepsy. The sphincters relax, the urine passes from the bladder, and sometimes the bowels are emptied. The convulsion caused by uremia is epileptic in character. The type of convulsion can be determined by an examination of the urine. "Epilepsy in a person over thirty who has not had previous attacks indicates organic disease of some kind." This I have not found true. I have found such persons as amendable to treatments as others. All the cases I have been called upon to treat have been curable--simply because the exciting cause was functional. Jacksonian epilepsy is distinctive, and it is hard to determine always on what the spasms depend. Irritation of the motor centers may be caused by many things. So far as I have been able to discover, all cases present toxin poisoning, and, because of this toxin poisoning, gastro-intestinal decomposition is always present. Of course, uremia may have much to do with it, but the kidneys have been brought into a state of inflammation because of the toxins in the blood.

   Prognosis.--The prognosis is favorable when cases do not depend upon an organic disease that is incurable.

   Treatment.--The disease is very easily controlled in children, provided the parents can be induced to take the proper care of them. They must be kept away from excitement, and fed very plainly, and at stated intervals, three times a day, and never between meals. Children must be controlled with a firm but kind hand. To indulge such children is to confirm them in their sick habit. Very strong people may develop this disease. In the adult, bad habits of eating, overstimulation of all kinds, abuse in the line of waste of energy in social affairs--indeed, anything and everything that has a tendency to bring on enervationmay be the exciting cause of convulsions in those of a pronouncedly nervous temperament. Cases running on for several years will show mental deterioration. In some there will be developed a decided irritability. If this condition continues to occur, it may be necessary to put such patients under restraint--perhaps in an asylum, People who have epilepsy should not think of getting married.

   No treatment is needed in any case, further than diet and hygiene. There is talk at this time of the discovery of the bacillus epilepticus and the removal of a portion of the colon. This belongs to freak surgery, and it will not cure. The surface of the body must be taken care of, the bowels regulated, and then the eating should be specially adapted to the individual case. Those who carry considerable flesh should be kept on fruit morning, noon, and night, and nothing else until the weight is brought down to about an ideal standard; then fruit for one meal, starch and fruit for another, and meat, with cooked and raw vegetables, for a third meal. This is an outline of the diet that such patients should follow. They should be cautioned about eating when feeling uncomfortable. Our golden rule--Rule No. 1--should be observed at all times. When patients with epilepsy persist in eating heartily, there is no hope and the disease will grow worse continually.


V. MIGRAINE (Sick Headache)

   This disease is characterized by severe headache, usually one-sided or unilateral. Often it is associated with a deranged condition of the vision. The eye affection, however, is only one symptom of the symptom complex.

   Etiology.--It is said this disease is hereditary. It is no more hereditary than any other nervous affection. People who are born with a nervous diathesis may have a preponderating tendency to take on migraines, or the tendency may run in some other direction. Any of the different types of nerve derangements is liable to develop in those of neurotic temperament, but it is as impossible to inherit a headache as to inherit any other disease. Women are more inclined to this disease than men. However, both sexes do develop it. It is a house disease, brought on and kept in existence by imprudence in eating. I have seen cases of twenty years' standing cured so quickly that they did not have more than one headache after the treatment was begun. And invariably the cure was made by correcting the habits of living, especially the diet.

   Symptoms.--Patients usually can tell when an attack is coming on. Some can tell two or three days ahead that they are going to have an attack. Such cases need never develop a headache; for as soon as they are put on the proper treatment the headache will cease, never to return. The fact of the matter is that these headaches are produced by coffee, tea, alcoholics, tobacco, continual eating of an excess of starch, badly combined food, or not enough fresh fruits and vegetables. Constipation will produce them. Indeed, with a neurotic temperament, anything that uses up nerve energy and brings on enervation, with fermentation of starches in the stomach and bowels, is liable to develop this disease.

Treatment.--It is so easy that we wonder patients do not learn to know what it is that causes them to be sick, and then correct the errors of life that lead to it. Those who are in the habit of taking tea, coffee, alcohol, or of living in a house where tobacco smoke is settling on the hangings or furnishings of the room, causing an ill-smelling odor continually, must get rid of all these things; for they depres's and enervate. If patients use up their nerve energy entertaining and being entertained, this, too, must stop. Everything that causes enervation must be discontinued. Early to bed and early to rise should be the motto; and then exceedingly plain food, three times a day, at regular intervals, should be the dietetic rule. Those carrying considerable flesh should be kept on a fruit diet until brought down to a normal weight.



   Definition.--Pain in the course of a nerve, due to pressure or toxin poisoning. It is easy enough to cure. All that is necessary is to correct the life of the patient. Stop all stimulants and excessive eating, The skin should be taken care of by giving it a proper bathing and daily rubbing. If there is constipation, this of course must be overcome. Any form of neuralgia is to be treated in the same way. Exercise must be a part of the daily regime.



   Definition.--This is a condition of perverted mentality. Perverted ideas control the patient, and produce more or less morbid derangement of the different organs of the body.

   Etiology.--This is an affection common to women. The definition should be strictly confined to an affection peculiar to women; for it probably is largely associated with irritation of the ovaries and womb. Improper early training is to blame for creating such a nervous affection. There is always a lack of moral responsibility and self-control in such cases. Such women are strictly controlled by their impulses and emotions. It may be that fear will have possession of them; it may be anxiety or jealousy.

   An unhappy love affair is quite enough to start a run of morbid processes that will ruin the life of such a woman. Many nulliparous married women, who have no domestic responsibilities, have no discipline and are not poised, and they give way to all kinds of worries. Masturbation and sexual excesses are exciting causes in a certain percentage of these cases, and eventually break them down physically. Earlier symptoms are those of indigestion. Those who are autotoxemic will look pale, showing anemia.

   Pathology.--The disease is looked upon as purely functional, with no organic lesions. Unfortunately many of these cases go through the surgical "plants" of our country and in the course of three or four operations come out minus all the organs that they can spare--not because the organs are pathologic, but because the women are willing to have something done for them, and surgeons too often allow their patients to do the diagnosing. Besides, each case operated upon swells their statistics of successful operations.

   Symptoms.--Really hysterical women will present symptoms that may be mistaken for serious functional or organic derangement. A physician who has a strong personality or a fad can change the location of the diseases of hysterical women at pleasure. If they have more trouble in the region of the apex beat of the heart than the physician is willing for them to complain of, he may discover a disease in some other part of the body--possibly a sensitive ovary. The patient, as soon as told, will put her mind upon the ovary and forget the derangement she had in the chest; and from that time on she will complain of her ovary until the physician strategically discovers she has some other disease that is more important. This may seem ridiculous, but it is true; and it is easy to see how surgical maniacs may be caught in the meshes of a hysterical woman and be induced to perform a lot of unnecessary operations. Stratagems may be used to induce these patients to think health, but it requires time and patience.

   Convulsions.--These are mild, and usually occur after some disappointment, irritation, or feeling of anger. The patient will laugh and cry at the same time, and assume a condition resembling coma. Many simulate death. A really hysterical woman can cause a great deal of disturbance, in working up sympathy in the home, or even in the neighborhood, by making people believe that she is in a dangerous condition. Such patients will often complain of a lump in the throat. This is called "globus hystericus." After a severe spell they will throw themselves into a convulsion, but it lacks a very great deal in having the true ring. Anyone who has watched epilepsy will see the lack of genuineness in the hysterical convulsion. Loss of voice is frequent. Some cases will complain of stiffness of the joints; others will complain of paralysis of the lower extremities. I remember seeing one patient who was paralyzed for three years, having to be helped from her bed to her chair in the morning and then back to her bed in the evening. It took only about three or four weeks of discipline to cure her. Physicians should always be on their guard in believing symptoms that are represented to them by nervous women as being genuine. A woman may be absolutely honest, but the physician will not be honest if he allows a patient of this type to fool him into harsh medication; and certainly it is criminal to allow such cases to inveigle the physician into a surgical operation.

   Loss of the special senses--taste, smell, and hearing--is common with these patients, There is also visual derangement--loss of perception of colors.

   Many will complain of spasms of the pharynx. There will be vomiting, loss of appetite, depraved appetite, gastric pain, flatulency, diarrhea, and also constipation.

   There may be rapid breathing, asthmatic breathing, dry cough, and a spurious type of hemorrhage from the lungs. The blood is of a pale-red color, and comes from the mouth and pharynx. Many will suck their gums for the purpose of starting a little blood. If there is anything a hysterical patient loves more than another, it is to excite, the sympathy of those about her. If she should ever work as hard for health as she does to procure sympathy, she could evolve ideal health. She looks upon a failure to convince her physician of the genuineness of her sickness as a calamity,

   There are often irritable heart, rapid pulse, pain in the region of the heart, hot flashes, cold chills, and hemorrhages in the skin. The hemorrhages are usually, if not always, fraudulent.

   These patients always complain of smarting urinating and retention of urine. They have urine of low specific gr avity. Some of them are troubled with incontinence.

   Bladder and urethral irritations are common, and frequent urination is a marked symptom, I have known of a case where the woman had the habit of pushing small pebbles into her bladder, for the purpose of eliciting sympathy and enjoying the excitement of an operation for their removal.

   These cases in many instances are moral perverts. They exaggerate everything; but unfortunately they fool themselves the same as they do others. Many have been known to indulge in self-injuries by way of swallowing needles; sucking blood and then vomiting it; inflicting serious injuries to their bodies, and not allowing the sores to get well by picking them and irritating them continually. Sometimes this condition takes on a criminal aspect, such as setting fire to houses, stealing, etc. Kleptomania is a form of hysteria--or perhaps I would better say that all kleptomaniacs are hysterics.

   Diagnosis.--The symptoms cannot be mistaken by a physician. Of course, these cases are liable to lead laymen and inexperienced physicians astray.

   Treatment.--The treatment must be psychological. Of course, everything must be done to correct indigestion, constipation, etc. All perverted conditions of the system must be righted.

   The patient must be taught to live correctly--correct eating, correct bathing, and exercise; and then the physician who is unable to control the patient, leading her into a better state of mind and giving her poise and self-will, has no business to assume the responsibility of her case.


VIII. INSOMNIA (Sleeplessness)

   Etiology.--Pain; poison circulating in the blood, such as occurs in Bright's disease, autotoxemia, intestinal toxins, mercurial mania, different forms of partial paralysis, nervousness, neurasthenia, The quickest and most successful cause is a belief in insomnia. The patient loses a little sleep, and at once decides that he is troubled with insomnia. He talks it, establishes it as a habit, and will continue to be troubled with insomnia until he is educated out of it. Such patients are usually more or less nervous from eating beyond their digestive capacity.

   Acid stomach, from too much starch-eating or overeating, is a very common cause. Those who are troubled in this way show nervousness in their limbs. Nervous headaches are usually dependent upon an acid stomach.

   Treatment.--Where there is uremia as a cause, the kidneys must be looked after. Insomnia caused by alcoholics, tobacco, coffee, or tea ran be cured by prohibiting the use of these drugs. Where insanity or light forms of mania are the cause, such patients should receive hot baths, and given only a very little food of a non-stimulating character; in fact, they should be put to bed, and kept there until the nervous system has had time to right itself. It will do so faster without food than with food. Intestinal toxemia must be overcome through correcting the diet. Those with cerebral congestion, or cerebral anemia, must be controlled according to the affection. Those with hyperemia of the brain must be fasted until the blood pressure is reduced; then the eating should be of a character to prevent a return. Where there is cerebral anemia, the heart should be looked after; and whatever congestive derangement there is present must be righted. Hot baths should be given for all cases that are irritable, followed with a gentle rubbing. Whatever else is done, the patient's mind must be set at rest; for his anxiety about his physical condition must be overcome. In all cases where there is an overworked heart, the digestion must be corrected, and the patient must be kept quiet and away from social affairs as well as business, if these tax the nervous system to any great extent. Drugs are not necessary. These patients must be fasted until normal, then fed little until the strength has returned. Fruit at first three times a day; then fruit twice a day, with salad and cooked, non-starchy vegetables for one meal. Then meat every other day, with non-starchy vegetables and a salad; the alternate days, a decidedly starchy food in place of the meat, with cooked and raw vegetables.



   This is a rare disease. It is supposed to be caused by disturbances of the vaso-motor nervous system.

   Etiology.--Anemia is given as the cause; also chlorosis, neurasthenia, malaria, acute infectious fevers, menstrual disorders, fright, exposure, diabetes, and syphilis. The disease comes on suddenly and affects two or three fingers or toes.

   Symptoms.--There is a coldness and pallor of the extremities, with dead fingers or toes. The parts affected are stiff, and sometimes more or less painful. A pallor is the first appearance. The features look shrunken, and there is a lack of sensibility. This passes away and then returns. In time it becomes a constant condition. After the disease has been running on for a while, the fingers---or rather the parts affected--become livid and ashen. The capillary circulation becomes exceedingly sluggish. Gangrene often follows severe attacks. Rigor is common. In advanced cases echymose spots and vesicles appear. Hemorrhage sometimes occurs, and it is called purpura. Cerebral symptoms may complicate the disease.

   Differential Diagnosis.--This disease has to be differentiated from frost-bite, ergot poisoning, neuritis from overstimulation, and endarteritis from toxin poisoning.

   Treatment.--Avoid exposure to cold, and, if possible, spend the winters in warm climates. This is the usual prescription, but every patient is not able to change climate.

   This disease would never have an existence if those afflicted were living properly. It is simply a surface manifestation of toxin poisoning, and, the same as most diseases to which flesh is heir, it originates in the gastro-intestinal canal. Hence this intestinal derangement must be righted, first, last, and all the time, by correcting the eating, and otherwise properly caring for the body.

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