Affections of the Brain and Nervous System

AFFECTIONS OF THE CEREBRAL MEMBRANES

CHRONIC CEREBRAL LEPTOMENINGITIS

Definition: Chronic inflammation of the pia mater.

Symptoms: These are persistent, dull headache, mental deterioration, vertigo, muscular weakness, low grade optic neuritis, occasionally nausea, vomiting, and ringing in the ears.

Etiology: Injury, alcoholism, sunstroke and “syphilis” are given as causes. It sometimes accompanies brain abscess and brain tumor and follows acute leptomeningitis.

Prognosis: Early care may result in recovery, although the outlook is always uncertain.

Care of the Patient: These cases need rest and fasting more than anything else. All stimulation and excitement should be avoided. A diet of fruits and vegetables should follow the fast for a prolonged period.

CHRONIC CEREBRAL PACHYMENINGITIS

Definition: Inflammation of the dura mater.

Symptoms: Same as for chronic cerebral leptomeningitis.

Etiology: Seen in severe anemia, chronic affections of the blood vessels, sunstroke, alcoholism, Injury to the bead and insanity.

Prognosis: This is unfavorable.

Care of the Patient: Same as for chronic cerebral leptomeningitis.

HEMORRHAGIC PACHYMENINGITIS

Definition: A blood-tumor of the dura mater.

Symptoms: In some cases no symptoms are present during life. If the pathology is marked, headache, failure of memory, impairment of intellect, stupor, contracted pupils, local convulsions, or palsies are seen. These symptoms may alternately improve and grow worse over a long period. In severe cases with extensive effusion of blood, the symptoms resemble those of apoplexy.

Prognosis: This is very unfavorable.

Care of the Patient: Same as for leptomeningitis.

TUBERCULOUS MENINGITIS

Definition: This is inflammation of the membranous coverings of the brain of a tubercular nature.

Symptoms: These are the same as those for chronic leptomeningitis plus tubercular symptoms.

Etiology: It is secondary to tuberculosis elsewhere.

Prognosis: Unfavorable.

Care of the Patient: Same as for tuberculosis.

APHASIA

Definition: This is inability to express or to comprehend ideas in speech or equivalents of speech. Two varieties – motor and sensory – each of which are subdivided into cortical and subcortical, are recognized. Sensory aphasia is again divided into visual and auditory forms.

Symptoms: Motor aphasia is inability to express thought in words. When the brain lesion is in the third frontal convolution (cortical motor aphasia) the power of silent talking and reading are lost as well as power of articulate speech. In the most common forms of aphasia, the lesion is in the adjacent tracts which carry the speech impulses to the articulatory muscles (subcortical motor aphasia) and only the power of speech is lost.
Sensory aphasia is inability to understand written or printed words (word-blindness, or visual aphasia), or to understand spoken words (word-deafness or ‘auditory aphasia). The lesion is in that portion of the brain known as the angular gyrus, where visual word memories are stored, or in the first temporal convolution, where auditory word memories are stored, or in one of the incoming (subcortical) tracts of special sense.
In cortical visual aphasia the patient is unable to read aloud or to himself, nor can he write (agraphia) spontaneously or from dictation. In subcortical visual aphasia he can write spontaneously and from dictation, but is unable to read what he or others write.
In cortical auditory deafness he cannot understand spoken words or write from dictation, and, being unable to understand his own speech, he misplaces words (paraphasia) or talks jargon. Though word-deaf, the patient can speak spontaneously, read aloud and write in subcortical auditory aphasia.

Etiology: may be a transient condition due to sudden fright, brain congestion, migraine, hysteria, epileptic convulsions, and may appear in convalescence from fevers; or, it may be due to organic changes in the brain such as tumor, gumma, abscess, pressure by a depressed fracture, softening of the brain, embolism, thrombus, apoplexy, etc.

Prognosis: In softening of the brain the case is hopeless; after apoplexy, recovery frequently follows; recovery may follow removal of depressed fracture; it follows aphasia due to fright, hysteria, migraine and epileptic convulsions. The outlook is more hopeful in young, individuals.

Care of the Patient: Attention should be given to the causes of the primary pathology. Care for as directed under epilepsy, migraine, apoplexy, etc.

ACUTE ENCEPHALITIS

Definition: This is inflammation of the brain substance – usually of the gray matter.

Symptoms: The symptoms are not well defined and the condition is sometimes mistaken for typhoid fever. The common symptoms are headache, inability to sleep, coma, delirium and vomiting. Paralysis may follow recovery. It is often followed by brain abscess.

Etiology: See Suppurative Encephalitis. .

Care of the Patient: See Suppurative Encephalitis.

APOPLEXY – Cerebral

Definition: This is hemorrhage into the brain followed by the formation of a blood-clot. It is popularly known as a “stroke.”

Symptoms: Such prodromal symptoms as headache, vertigo, disturbed sleep, ringing in the ears, and, perhaps, a sense of numbness or weakness on the affected side, often precede the hemorrhage. In many cases, however, the patient falls suddenly without previous warning.
The face is flushed, the eyes injected, the, lips blue, breathing stertorous, the pulse full and slow, the temperature, at first subnormal from shock, later rises from irritation and the urine and, feces may be passed involuntarily. Convulsions are frequent and paralysis of some parts of the body accompanies. Even while the patient is comatose, the paralysis may be detected.
The head and eyes may be strongly rotated toward the side on which the hemorrhage occurs (conjugate deviation); one cheek often flaps more than the other, the pupils may be unequal, movements are made only on the unaffected side, when the affected arm is raised and allowed to fall, it drops lifeless; and occasionally the temperature is higher in the axilla of the paralyzed side.
In grave cases the subject does not awake from coma, the pulse grows feeble, respiration assumes the Cheyne-Stokes type, the reflexes cease, mucus collects in the throat producing a rattling sound, the temperature rises to 103° or 104°F. and death follows in a few hours to one or two days.
In some cases either consciousness is not lost or else its loss is very transient; in others paralysis develops immediately but unconsciousness does not become complete for twenty-four hours.
If death does not result, consciousness is usually regained in from twelve to forty-eight hours, and hemiplegia (paralysis of one side) remains on the opposite side of the body. Usually the muscles of the face and upper chest escape the paralysis. The tongue tends to deviate toward the paralyzed side when protruded. There is no tendency to rapid wasting of the affected muscles, and sensation is usually unimpaired. In walking the patient supports the paralyzed arm and swings the leg forward in a rotary movement from the trunk.
In very light cases not all of the above symptoms develop.

Etiology: Degenerative changes in the blood vessels and plethora, due to overeating, or high blood pressure from any cause, result in rupture of a vessel in the brain. Affection of the blood vessels is the immediate cause of apoplexy. Toxemia covers the ground of cause quite thoroughly. Any sudden increase in blood pressure from anger, excitement, a cold bath, stimulation, effort; or any great enervating influence such as alcohol, loss of sleep, fatigue, etc., may precipitate a hemorrhage.

Prognosis: A “stroke” is not always fatal. Many people have two or more “strokes” before they result fatally. Even in the very aged, if the hemorrhage is small, the outlook for improvement is often good. Many cases recover their powers of locomotion and speech and other faculties that have been impaired, and even outlive the average expectancy. If the clot is, small, the paralysis may completely disappear. More frequently recovery is only partial. Six months to two years are required for all the improvement possible.
Prevention: People who know they are in line for apoplexy should adopt a very moderate regimen of living and lead a very quiet life. The diet should be largely of fruits and vegetables; excitement, great effort and all stimulation, should be avoided.

Care of the Patient: Even in the mildest cases the patient should not get out of bed for two or three weeks and no food but water should be given during most or all of this period. Weger says:
“If a fast is instituted at once and a hands-off policy tactfully pursued, the chances of stopping the hemorrhage and causing absorption of the blood-clot are greatly enhanced. In fact the life of the patient may depend on early treatment of the right kind.”
After the fast, the food should be principally fruits and green vegetables. The patient should be fed very little and he must be content to live with a reduced arterial pressure and reduced weight.
What Tilden says about treatment will be of advantage to prevent recurrence. He says: “The treatment should begin months and years before the disease manifests. Those who are heavy eaters, continually carrying a large quantity of blood in the brain, evidenced by flushed face and enlarged veins over the forehead, and other signs of too much blood, such as ringing in the ears, head swimming, etc., should take a hint and reform their manner of living. The time to cure this disease is several years before it manifests. No one can be fooled into knowing he is headed in that direction; for all he needs to do is to look at himself in the glass, and he will find he is altogether too stout and too plethoric-looking, and the face is usually quite flushed. He should know what his habits are. A man who uses stimulants to excess must know, or should know, that he is bringing upon himself degeneration of the blood-vessels and that the time must come when apoplexy will result. It does not necessarily need to be found in the brain. Apoplexy may take place in the kidneys or any other vital organ.”

CEREBRAL ANEMIA

Definition: A lack of blood in the brain. It may be acute or chronic.

Symptoms: Acute. Pallor of the face, vertigo, confusion of ideas, ringing in the ears, dimness of vision, dilatation of the pupils, nausea, a tendency to yawn, sometimes fainting, and, occasionally, in extreme cases, convulsions and coma are seen.

Chronic. Vertigo, headache, irritableness, disturbed sleep, failure of memory, lack of ability to concentrate, intolerance to light, a tendency to faint, and extreme lassitude characterize chronic anemia of the brain. These symptoms improve when the patient lies down.

Etiology: Acute cerebral hemorrhage is seen in fainting or syncope following shock, great loss of blood, after sudden withdrawal of fluid from the abdominal cavity, and, in surgical cases, after ligation of the carotid artery. Chronic anemia of the brain is seen in heart affections, especially in aortic stenosis, hardening of the arteries that prevents the blood from reaching the brain, and in general anemia.

Prognosis: This depends on the cause. Most cases of acute anemia are quickly recovered from. Recovery from the chronic form depends on recovery from the heart and arterial pathology and from general anemia.

Care of the Patient: In acute cerebral anemia rest and fresh air are the great needs. Stimulants should not be employed. Care for the chronic case according to whether he has hardening of the arteries, heart affection or general anemia.

CEREBRAL EMBOLISM AND THROMBOSIS

Obstruction of the arteries of the brain by an embolus or thrombus rarely occurs before the age of fifty. Paralysis and aphasia often result. Embolism may give rise to sudden and severe immediate symptoms, such as headache, vertigo, disorders of intelligence and sometimes complete insensibility. Emboli occur in hardening of the arteries, aneurysm, heart affections, etc.

Care of the Patient: Same as for apoplexy.

CEREBRAL HYPEREMIA

Definition: This is an excess of blood in the brain – congestion of the brain. It may be either acute or chronic.

Symptoms: Acute. The chief symptoms of acute congestion are intense headache, and sleeplessness, or sleep is disturbed by unpleasant dreams.
Chronic. This is characterized by dizziness, dull headache, irritability, disturbed sleep, failure of memory and inability to concentrate. The symptoms grow worse when the patient lies down. The ophthalmoscope reveals hyperemia of the retina. In extreme cases there may be exacerbations resembling apoplexy, in which unconsciousness is followed by paresis. Indeed a common sequel to cerebral congestion is apoplexy which is often preceded by many warnings that pass unheeded.

Etiology: Acute congestion is seen in sunstroke, and often follows the use of alcohol, nitroglycerine, destructive emotions and even prolonged intense mental effort. Chronic cerebral congestion may result from some obstruction to return of blood from the brain, (as by a tumor in the neck), increased heart action, prolonged anxiety, overwork, excesses, etc.

Prognosis: This is good if cause can be removed.

Care of the Patient: For acute congestion, immediate rest and relaxation in a darkened and well ventilated room are essential. The head and shoulders should be slightly elevated. No food but water should be given until complete comfort has returned. In chronic cases find and remove the cause if possible. Avoid all overstimulation, stop or cut down on the food, and institute correct habits.

CEREBRAL PARALYSIS IN CHILDREN

Definition: Hemiplegla, diplegia, or paraplegia appearing at birth or in the first few years of life, and usually associated with wasting and hardening of certain portions of the brain. The condition is also known as spastic paralysis of infants.

Symptoms: Hemiplegia (paralysis of a lateral half of the body) comes on suddenly and is, frequently accompanied by fever, convulsions or coma. These severe symptoms subside after a few hours or days and the child is left paralyzed on one side.
Diplegia (paralysis Involving similar parts on both sides of the body) and paraplegia (paralysis from the waist down) usually date from birth and are characterized by rigidity and loss of power in the arms and legs, or in the legs alone. Children thus affected are generally idiots or imbeciles and are often afflicted with epilepsy.

Etiology: The cause in prenatal cases is not known; in congenital cases meningeal hemorrhage induced by difficult labor is thought to cause the paralysis. Infantile cases result from acute encephalitis, hemorrhage, thrombosis, or embolism.

Prognosis: This is not favorable. In rare cases hemiplegia ultimately disappears and the child regains health, but in most cases it is followed by secondary rigidity and commonly by imbecility, epilepsy, and movements resembling those of chorea, or continuous movements of the fingers and toes follow. The other forms are hopeless.

Care of the Patient: During the convulsive stage no food but water should be given. After convalescence is advanced educational exercises may be helpful. The whole life of the child should be well regulated.

HYDROCEPHALUS

Definition: An excessive accumulation of fluid in the ventricles of the brain – “water on the brain.” Two forms are described – acute and congenital or chronic.

Symptoms: Acute. This is a rare condition developing usually in children between the first and fifth years and characterized by an effusion of serous fluid into the cerebral interspaces and ventricles.
It is divided into simple, convulsive and comatose types. Injuries to the head, poor hygiene and eruptive fevers are listed as causes. Teething is also said to cause it, perhaps in the same way that growing hair on the chest at a later age causes acne of the face.
Congenital: This may develop before birth and interfere with delivery; or the child may appear normal for several months before the swelling of the head attracts notice. The head becomes globular, the fontanels and sutures remain open, the face becomes relatively small, the eyes protrude and are directed downwards, the scalp is thin and stretched, the superficial veins are distended, the hair may be scanty. The head becomes so heavy in some cases that the neck cannot support it and it falls forward.
Generally, intelligence is much impaired, but in rare cases there is precocity. Paralysis, exaggerated reflexes, convulsions, etc., may develop.

Etiology: In some cases the effusion appears to result from inflammation of the ventricular ependyma, in others it seems to result from occlusion of the communicating passage’s between the ventricles or between the ventricles and sub-arachnoid space.

Prognosis: This is very unfavorable. Congenital cases often die early, but a few cases live for years.

Care of the Patient: Favorable results were reported from Russia a few years ago by fasting. This should cause absorption of the fluid, clearing up of inflammation and, possibly, even removal of occlusion. We have had no experience with the condition.

SUPPURATIVE ENCEPHALITIS

Definition: This is an abscess of the brain.

Symptoms: Acute. High fever, rigors, headaches, delirium, convulsions, vomiting and coma are the constitutional symptoms.
Chronic. The general symptoms are headache, tenderness of the head to percussion, irritability, vertigo, vomiting, stupor, pallor, loss of flesh and strength, and mental impairment. Temperature is variable.
What are called focal symptoms vary with the location of the. abscess. These may be blindness, deafness, word-blindness, rolling of the eye-balls, incoordination, muscular weakness. These are present in both acute and chronic cases.

Etiology: Acute abscess follows injury to the brain. Chronic abscess is secondary to suppurative inflammation of adjacent parts such as caries of the bone following otitis media, or it may result from distant suppuration as in the liver, lungs, or heart, or it may follow “infectious fevers.” Chronic abscess is an end-point in a long drawn-out pathological process resting on toxemia.

Prognosis: This is rarely favorable.

Care of the Patient: If the focal symptoms indicate its location in an accessible area of the brain, surgical drainage may help. Otherwise rest and fasting followed by a frugal diet of fruits and vegetables may be helpful.

TUMORS OF THE BRAIN

A brain tumor is a growth in the brain tissue, the membranes or blood vessels. It produces pressure. Many kinds of tumors develop in the brain and their symptoms depend upon their location and size. Headache is rarely absent; it is sometimes localized and associated with tenderness on pressure. Vomiting is often unattended by nausea and fails to relieve the associated headache. There is often marked vertigo; convulsions, local (Jacksonian epilepsy) or general, occur in approximately fifty per cent, of cases. Failure of memory, depression of spirits, irritability of temper and emotional states are frequent mental symptoms. Sleeplessness, sugar in the urine and an excessive amount of urine are present.
What are called “focal symptoms” depend upon the location of the tumor and the parts of the brain involved or pressed upon. These need not be discussed here as they are of value only to the expert.

Etiology: This is said to be obscure, but it seems likely that brain tumors are due to the same causes that produce tumors in other parts of the body. Injury, prolonged worry, intense and prolonged mental effort may predispose.

Prognosis: It is a grave condition in which much may often be accomplished or nothing can be done.

Care of the Patient: All errors of life must be corrected. Tobacco, alcohol, tea, coffee, drugs, sexual indulgence, overeating, etc., must be given up. All stimulants must be abandoned. Rest is necessary. I quote the following from Weger:
“A case of brain tumor came under our observation several years ago. The patient had been totally blind for about seven years. The diagnosis was first made by one of the most eminent brain specialists in this country and was confirmed at several of the most renowned American clinics where it was decided that the case was inoperable. After a prolonged fast, succeeded by a very limited diet for several weeks, vision was restored and the patient was able to read the finest news print without the aid of glasses. Two years after recovery, vision remained unimpaired and no other untoward symptoms have been reported. One can rely entirely upon nature in many such cases and sometimes obtain the most startling results when all other methods of treatment have failed. It is cases such as this that justify the assumption that fasting is a therapeutic agent of the first order. Obviously, it is impossible to predict such a favorable outcome in any given case. However, the end will many times justify the means in cases that seem otherwise hopeless.”

INSANITIES

Time was when the lunatic was considered a separate being, wholly apart from all the regular members of society. Slowly the world is catching up with Sylvester Graham, who declared over a hundred years ago that “even in the worst kinds of madness, the mind is still strictly true to the same general laws that always govern the human mind in all conditions.” Insanity is not a definite and fixed state as different and distinct from sanity as black is different from white. It is no more possible to fix upon a precise boundary line between sanity and insanity than it is to place one’s finger on the line of demarkation between health and “disease.”
The imbecile and the neurotic who becomes insane still possess mind. The behavior of the “abnormal” man is but a lessening or an exaggeration of the behavior of the “normal” man. No man loses his mind. Insanity introduces no new principle of action into the processes of mind. The principle of unity does not forsake us here. And, just, as the evolution of pathology from simple to complex, may be watched in the liver, so may it be watched in mental affections.
Having partially recognized the fundamental unity of nervous and mental “disease,” it is now incumbent upon neurologists, psychologists, etc., to recognize the unity of so-called physical “diseases.” Once this fact is clearly recognized it will become apparent that these neuropathological conditions depend upon the same cause for their genesis, development and continuity as does pathology of the heart, or lungs, or liver or kidneys. The evolution of pathology in one organ or part of the body is identical with the evolution of pathology in another organ or part.
Various classifications of insanity have been made, but like all other efforts to classify “diseases” these are not satisfactory. Whichever system of classification is employed we never find any definite lines of cleavage dividing these classes into distinct groups. Maudsley writes: “Insanities are not really so different from sanities that they need a new, special language to describe them, nor are they so separated from other nervous disorders by lines of demarkation as to render it wise to distinguish every feature of them by a special technical nomenclature. The effect of such a procedure can hardly fail to make artificial distinctions where divisions exist not in nature and thus to set up barriers to true observation and inference.”

Etiology: Retrograde changes in the mental life of the adult are due to injury to the brain, pathology of the brain, and to reflex irritations in other parts of the body. Shock, mental suffering, emotional stress, etc., may enervate the brain and lower its resistance to the causes of brain pathology. Insanity is seen in certain glandular dysfunctions as shown in the chapter dealing with affections of the ductless glands.
Inflammation and degeneration of the brain tissue is due to the causes of inflammation and deterioration in the liver, lungs, kidneys, heart, or other organ. Hardening of the arteries of the brain, by cutting off the blood supply to the brain, results in a gradual softening and deterioration of its tissues.
A potent source of reflex irritations of the brain is pathology in the sex organs. Inflammation of the uterus or prostate gland or of the ovaries and testicles, or tumors of these same organs, often results in insanity.
Another great cause of insanity is drugs – tobacco, tea, coffee, morphine, heroin, bromids, serums, etc. The habitual or’ “medicinal” use of drugs, especially hypnotics, anodynes, narcotics, etc., plays havoc with the brain and nervous system.
Changes found in the brain at death represent the endpoint of the pathological process and are not the cause of insanity. Enervation and toxemia and their many emotional, sexual, physical, dietetic, etc., causes constitute the true cause of insanity.
If dementia, for instance, represents the end-point in a long drawn-out pathological evolution, what are its connections with the other pathological conditions of the body which precede it, develop concomitantly with it, and which succeed it? They are all parts of the same pan-systemic pathological evolution and all arise out of the same basic causes. The pathology of the brain and nerves does not differ in its essential character from the pathology found in the other tissues of the body. Nervous and mental affections are all of a piece with all other affections of the body. They are not set apart from the rest of the pathology of the body.

Care of the Patient: The present care of the insane is not much advanced over that of two thousand years ago. Although much cruelty is still practiced it is not as common nor as open as formerly. Nerve and mind destroying drugs are used and dope has largely supplanted chains, night sticks and strait jackets. Psycho-analysis promised much but failed to make good; indeed many neurologists assert that many patients are made worse by being psychoanalyzed.
It is most important to remove and correct all causes of enervation and give these patients a good physiological house cleaning, after which a diet of fruits and vegetables should be employed. All hygienic factors are important and all drugs should be avoided.
Dementia: This is insanity characterized by more or less complete loss of intellect. Several forms are described, as primary, secondary, terminal, senile and praecox, but these distinctions are of minor importance.

Imbecility: An imbecile (idiot) is one born without normal mental equipment. Perhaps injury at birth or arrest of development after birth account for some causes. There are various forms and degrees of imbecility, ranging from mild cases in which the individual is regarded as backward, to pronounced cases in which the unfortunate is unfitted for anything, is a mere burden on society which, in a more enlightened age, will not be borne by its healthy members.

Insanity: Or a lack of mental soundness, integrity, is divided into acquired, affective, circular, cyclic, climacteric, communicated, confusional, doubting, emotional, epidemic, hereditary, homicidal, ideational, ideophrenic, impulsive, menstrual, moral, perceptional, and periodic forms. These distinctions are of no practical value.

Mania: This is violent insanity with wild excitement. It is divided into alcoholic, a Potu, Bell’s, dancing, epileptic, puerperal, religious and transitory manias. Again these distinctions are unimportant.

Psychosis: This is any mental “disease.” Anxiety psychosis, exhaustion psychosis, toxic, maniac depressive psychosis, etc., are described. For all practical purposes these distinctions may be ignored.

DEMENTIA PRAECOX

Definition: This is an adolescent insanity developing usually between the ages of fifteen and thirty.

Symptoms: it is characterized by mental deterioration, emotional apathy, hallucination, delusions, and finally dementia.

Etiology: Hereditary neurotic diathesis, or neurosis resulting from larval deficiencies form the foundation for this condition. Emotionalism, improper food, sexual excesses or repressions, etc., lead to enervation, toxemia and, finally, dementia.

Prognosis: Our experience leads us to believe that proper care from the first will assure recovery in practically all cases.

Care of the Patient: “Patience and time must be stretched to the limit by those who hope to effect a cure.” Each case must be thoroughly studied and cared for intelligently. All causes of enervation must be eliminated, even while the fast is in progress. These cases must be gently but firmly disciplined and should be kept busy doing those things they like to do. Rest and a general health-building program are essential. Recovery may be expected in from six months to two years.

MELANCHOLIA

Depression: This is a depression of spirits. Eight or nine distinct types are classified, each with special outstanding characteristics.

Symptoms: This presents a variety of symptoms not unlike those included under the term neurasthenia. In melancholia all impressions seem exaggerated and there is most profound mental depression. An abnormal self-consciousness exists and there are delusions and hallucinations. There is, mentally, a state of abject misery and anguish without apparent cause. There is always insomnia, although these cases all sleep more than they think. Duties are neglected and the sufferer is unable to explain his worries or his lack of interest in everyday affairs. Gloomy foreboding and a sense of impending calamity, to himself and family, are present. The sufferer is filled with suspicion, distrust and insane jealousy, though he may retain his usual reasoning faculties. His emotions are easily disturbed and he generally tends to retire within a carapace of reticence and uncommunicativeness, with either extreme restlessness or apathetic and quiet indifference.

Etiology: Many of these cases are due to organic changes in the brain or nervous system or in other organs of the body. Others are purely functional and are due to the usual causes of functional impairment.

Prognosis: Cases due to organic changes rarely recover. Other cases usually run a protracted course that ends in recovery. The outlook in delusional melancholia is not so favorable, these cases commonly terminating in a pronounced type of insanity.

Care of the Patient: The profound enervation evident in these cases calls for prolonged rest. The evident failure of the gastro-intestinal tract makes attention to feeding most important. A fast not only rests the greatly debilitated digestive system, but permits elimination of toxins. Toxins must be kept low. The environment must be changed and the mind diverted. The whole mode of living must be ordered in conformity with the laws of life. All enervating influences require correction and much patience and time are required.

PARETIC DEMENTIA

Definition: This is a chronic inflammation of the cerebral cortex characterized by a change of disposition, failure of memory, mental exaltation, delusions of grandeur, tremors, epileptiform convulsions and paresis. It is also known as general paralysis of the insane,’ general paresis, and chronic meningoencephalitis.

Symptoms: Usually beginning “insidiously” with a change in disposition – the industrious becoming slothful; the ambitious, apathetic; the chaste, dissolute; the liberal, parsimonious; the complaisant, churlish; and the truthful, false – there follow loss of energy, failing memory and weakened judgment. A peculiar egotism and mental exaltation accompanies the impairment of the faculties; the sufferer becoming boastful, talkative and easily provoked to furious outbreaks. The use of wrong letters and suppression of syllables in writing reveals failure of memory.
At this stage motor symptoms begin to manifest. The pupils are often unequal, the tongue trembles when it is protruded, the speech is slow, hesitating and indistinct, and the gait is somewhat shuffling.
The most characteristic mental symptom of fully developed paretic dementia is the delusion of grandeur manifested in the subject’s magnified estimate of his social or political status, wealth, strength or power of intellect. Although the mind is usually serene and cheerful, periods of profound depression are frequent. The sensibilities are blunted, and the “animal nature” is ascendant. The mind becomes progressively involved; there develops extreme indifference to all that goes on; there is voracious appetite, with bolting of food, and soiling of the clothes with food.
The tremor of the tongue grows, the lips and other parts of the face begin to tremor, speech grows indistinct and “scanning,” the pupils fail to respond to light, though still accommodating to distance (argyll-Robertson pupil) ; and there is usually an increase in the reflexes, though these may be lost. Epilepsy-like and apoplexy-like convulsions are common.
In the final stage the mental power is almost obliterated, health fails, the bladder and, rectum empty themselves involuntarily, the gait is unsteady, and finally, the subject becomes unable to leave his bed. Death closes the scene.
Paresis shows occasional, sometimes continual symptoms throughout all stages of its advancement. In its early stages there are usually “unmistakable signs of queerness.” This goes on to “gradual mental break down.” The victim’s manners, customs, and habits are likely to strike off at odd tangents. He may become egotistical and develop a troublesome attitude toward others. Delusions of grandeur, with extravagance as a likely outstanding characteristic, may develop. Criminal tendencies may result in forgery, embezzlement, murder, revolting sex crimes, etc. Accompanying the odd mental quirks, and varying in, intensity and variety in some cases, are severe, recurring headaches, dizziness, insomnia, memory lapses, nervousness and numerous types of convulsive seizures and paralysis.

Etiology: It is said to be due to “syphilis” and that “the disease centers its attack upon the centers of the brain” while the brain, involvement is supposed to begin “at the very time of the first general invasion of the spirochetes.”
Tilden says: “the mental derangements are brought on from venery and fear.” He should have added, plus drug poisoning. There can be no doubt that paresis, like all other troubles, is time summation of multiple causes.
The symptoms described are not “specific.” They are common in people in all walks of life who eat to excess of deficient and stimulating foods, imbibe alcoholics, tea, coffee, soda fountain slops, indulge in tobacco, practice excessive venery, who overwork, worry a lot, secure insufficient rest and exercise and who palliate their symptoms with drugs. I cannot see the need for a disease called “syphilis” to produce these symptoms and to finally produce degeneration of the brain. Hardening of the arteries of the brain from any cause may easily produce these symptoms.

Prognosis: This is a form of insanity with paralysis that we get little opportunity to care for; first, because our institutions are not designed to care for the insane; and, second, because these cases are usually sent to asylums. I have had opportunity to care for but two cases, and these in the terminal stages, when there was nothing to do except watch them die. It may be possible to restore these sufferers to health if Hygienic methods are employed in the early stages of the trouble. I know of no logical reason why the early stages of paresis will not yield as readily to Hygienic care as does ataxia.

Care of the Patient: Nothing can be done in the late stages. In the early stages, if fear and drugs are eliminated and all enervating practices are discontinued and a general health-building program carried out, recovery may be possible. A fast will aid in eliminating accumulated toxins.

BULBAR PARALYSIS

Definition: An affection rarely occurring before the fortieth year, due to chronic degenerative changes of certain neuclei in the medulla oblongata, and characterized by paralysis of the lips, tongue, pharynx and larynx.

Symptoms: It begins “insidiously” with difficulty in speaking and gradually evolves into paralysis and wasting of the tongue, lips, palate, larynx, and pharynx. Difficulty in swallowing is alone considered. enough to make a diagnosis.

Etiology: An acute form is seen that results from hemorrhage or from acute poliomyelitis of the medulla. The chronic or progressive form is a chronic poliomyelitis of the bulb and is usually a part of amytrophic lateral sclerosis.

Prognosis: Acute forms end fatally in a few days. Chronic forms last four or five years, but the cases seem hopeless.

Care of the Patient: General care to build up the general health, is all that can be done. The condition should be prevented by right living.

CHRONIC ANTERIOR POLIOMYELITIS

Definition: A chronic affection (atrophy) of the nerve cells in the anterior gray horns of the spinal cord, and characterized by progressive wasting of the muscles and a corresponding loss of power, hence its other name, progressive spinal muscular atrophy.

Symptoms: These are said to develop “insidiously.” The muscles of the hand commonly suffer first. The muscles atrophy and lose power. The hands assume a claw-like position which is characteristic. Fine tremors or twitchings are almost invariably present in the affected muscles of the shoulder and arm, and then the neck and trunk. The legs are seldom involved until late, and often are not involved at all. Occasionally, however, the first symptoms develop in the lower extremities or back. In the late stages the patient may be reduced to a mere skeleton. Four types are recognized: hand-type, juvenile, infantile facial, and peroneal. ,
Symptoms of bulbar paralysis develop when the degeneration involves the medulla. The paralyzed muscles are flaccid, the deep reflexes are lost in the affected limb, sensation is unimpaired, though there may be complaints of dull pain or coldness. The sphincters are not involved.

Etiology: Inherent weakness of the cells (abiotrophy) is thought to predispose these to early degeneration as it develops frequently between the ages of twenty and fifty, most often in males. Its real cause is the same as that which causes all other nerve degeneration
– enervation and toxemia growing out of wrong life. Sexual excesses and alcoholism doubtless are the real predisposing factors.

Prognosis: The course of the degeneration is very slow and marked by occasional remissions. These indicate that the degeneration is often not as great as the symptoms indicate and that recovery is possible.

Care of the Patient: “Treatment is of no avail,” say medical authorities. We agree, but we do not agree that the removal of all the causes of enervation and the elimination of toxemia through physiological rest is of no avail. The Hygienic mode of living offers the best prospect of arresting the degeneration and prolonging life and usefulness.

HEREDITARY ATAXIA

Definition: A “family affection” characterized by symptoms resembling those of locomotor ataxia, and due to hardening of the posterior columns of the spinal cord; known also as Friederich’s ataxia.

Symptoms: This affection develops in children and young people up to the twenty-fifth year of life. It sometimes develops in several members of the same family, which indicates a hereditary predisposition to its development. The essential features are ataxia, paraplegia and irregular jerky movements of the head, impaired speech, disorders of vision, and loss of muscular power. Pain is seldom present.

Etiology: “Some cases can be traced to heredity; in others no cause can be ascertained” say medical authorities. It must be due to the usual causes of nerve degeneration, with perhaps inherent weakness of the spinal cells.

Prognosis: “The disease is slowly progressive and treatment is of no avail,” say medical authorities.

Care of the Patient: Same as for locomotor ataxia. A Hygienic mode of living offers the best prospect of arresting the degeneration and prolonging life and usefulness.

HYPERTROPHIC CERVICAL PACHYMENINGITIS

Definition: This is a chronic thickening of the spinal membranes in the neck region with compression of the spinal cord and nerve roots.

Symptoms: Sharp pain in the neck, radiating to the shoulders and arms, muscular weakness, wasting, impairment of sensation, and the peculiar deformity called “clawhand,” are the chief symptoms. Later, spastic paralysis with exaggerated reflexes and interference with the sphincters may result from pressure on the, cord.

Etiology: “Syphilis” is given as the most “important etiological factor.” This can only mean that mercury and arsenic plus fear and sensuality constitute its chief cause. Some cases follow injury.. Some are said to be due to over-exertion and exposure to cold. These last two “causes” merely represent the “last straw” that, added to the many previous straws, ‘break the camel’s back.”

Prognosis: The condition often persists for years. Where injury is slight and in cases said to be due to “syphilis,” recovery is possible.

Care of the Patient: Correct all enervating influences. Cut out all stimulants. A prolonged rest in bed will be essential to nervous recuperation. Fasting will not only serve to relieve the body of its toxic load, but will serve better than the counterirritation commonly employed to relieve the spine of its hyperemia.

MYELITIS – Acute

Definition: This is inflammation of the spinal cord. It may be limited to the gray matter chiefly, or to the gray and white matter together. The term is also applied to ischemic (deficiency of blood) softening of the cord. The two conditions present the same symptoms.

Symptoms: Several forms are described as follow:

Acute ascending myelitis is characterized by progressive loss of motion and sensation beginning in the legs and rapidly ascending until the muscles of respiration are affected. Death often occurs at the end of a few days from asphyxia, or at a later period from hypostatic pneumonia.

Compression myelitis is characterized by deep-seated, localized pain in the back, rigidity of the spinal column, angular deformity. stabbing pains radiating to the limbs or around the trunk, spastic paralysis below the level of the cord lesion, impairment of sensation and disturbances of the sphincters.

Disseminated myelitis is a rare condition in which palsy of isolated groups of muscles develops and there are irregularly distributed areas of anesthesia. In its later stages this form may resemble multiple sclerosis.
• Transverse myelitis: This form begins with acute symptoms:
chilliness, malaise, fever and vomiting. There is numbness in the limbs and sometimes pain iii the back and a. girdle sensation. Motor paralysis and paralysis of all the sensations quickly develop in the parts below the level of the spinal lesion. The paralysis is flaccid and atrophic in the muscles supplied by the affected segments and flaccid and spastic in the muscles enervated by segments below the level of the pathology, according as the affection completely or partially interrupts the conductivity of the cord. Even though the paralysis is flaccid at first in the lower limbs, it usually becomes spastic in a week or two if the patient lives. The sphincters of the bladder or rectum are nearly always affected, sexual power is lost, bed sores frequently develop rapidly over the buttocks and heels. The muscles supplied by the nerves arising from the affected spinal segment undergo atrophy and give the reaction of degeneration.

Etiology: Many cases follow injury to the spine, either from fracture of the spine or from a severe concussion. It is doubtful if any save the very worst injuries will so result in any save enervated subjects. Some cases follow smallpox, measles, typhoid fever and other infections indicating that sepsis or suppression may be the chief factors of causation. Exposure to cold is given as a cause. This we discount.

Prognosis: Any form of myelitis is grave and more or less disability usually remains after the subsidence of the acute symptoms. In mild cases complete recovery may occur. Death is frequent.

Care of the Patient: No food whatever should be given until all the acute symptoms have subsided. The patient should be left alone as much as possible and allowed to rest. If pain is severe, hot applications or hot baths may be employed for relief but these should not be pushed to the point of enervation or exhaustion.
After the symptoms have subsided, fruits and vegetables may be fed and, as soon as the patient is able to exercise, educational exercises will help to restore control of the paralyzed parts.

PSEUDO-HYPERTROPHIC MUSCULAR ATROPHY

Definition: This is a condition that usually develops in childhood in which the atrophic changes of the muscle are superseded by the deposit of fat and connective tissue. No remedy is known.

SPINAL HYPEREMIA

Definition: Congestion of the spine. It may be active (arterial) or passive (venous).

Symptoms: It is characterized by pain in the back with more or less pronounced disorders of sensation or motion. The symptoms vary from a dull pain in the lumbar region, radiating to the hips, to very alarming symptoms such as rigidity, pain in the abdomen, tingling in the hands and feet, jerking of the limbs, exaggerated reflexes and incomplete loss of power. It may last from a few hours to several days. If prolonged it evolves into myelitis.

Etiology: Cold and exposure, arrested menses, habitual hemorrhoidal discharge, tension from protracted erect posture, and injuries are listed as causes. Most of these can act only as exciting causes in the greatly debilitated and toxemic.

Care of the Patient: Rest, lying in any position except on the back and fasting are the prime needs. Gentle rubbing may afford relief.

SPINAL PACHYMENINGITIS

Definition: This is inflammation of the inner surface of the spinal dura mater with an exudate upon the inner surface.

Symptoms: It develops slowly and gradually with feverishness, chills, stiffness, violent pains in the head and neck, and various disturbances of sensation.

Etiology: Injury is the most frequent cause. The causes listed under spinal hyperemia also produce the condition.

Prognosis: “Recovery may be confidently anticipated,” says Weger, “provided the treatment throughout the course of the disease conforms to a conservative rather than a do something policy.”

Care of the Patient: See Meningitis.

SPINAL SCLEROSIS

Definition: This is myelitis with an increase of the connective tissue of the spinal cord. Four types are recognized, as follow:

Ataxic Paraplegia: This is a combined lateral and posterior sclerosis of the spinal cord.

Symptoms: It develops slowly as the structural changes in the cord gradually become more and more extensive. The paralysis affects muscles higher up than in locomotor ataxia and there is also a tendency to spasms in the lower extremities. Sensation is unimpaired, neuralgic pains are absent, the knee jerk is exaggerated and the affection may easily be mistaken for tabes dorsalis.

Prognosis: This is not very favorable, but there is every reason to believe that the tissue degeneration is not always as great as the symptoms indicate and function may be re-established in many cases that appear to be hopeless.

Cerebrospinal sclerosis: This is a multiple sclerosis affecting both the brain and cord. It is also known as disseminated sclerosis and insular sclerosis.

Symptoms: It is characterized by pains in the back, disorders of sensation, loss of coordination, tremor on motion, scanning speech, and varying degrees of mental impairment. In well-developed cases. there are increasing weakness in the lower limbs with exaggerated tendon-reflexes, involuntary oscillation of the eye-balls, defective vision and optic atrophy, headache, giddiness, numbness or tingling in the limbs and various other symptoms that are not constant.

Prognosis: This is not favorable. Our experience has demonstrated that the sclerosis may be checked if Hygienic care is instituted early and that improvement may be obtained, even, in advanced cases.

Lateral sclerosis: A rare condition, known also as Charcot’s “disease,” Erb’s palsy, amytrophic lateral sclerosis, and anteriolateral sclerosis.

Symptoms: Bilateral paralysis of the legs with muscle contractions and exaggerated reflexes characterize this affection. Loss of power is the first symptom. There is a gradual increase of weakness and heaviness in the limbs. The knees are drawn together, the legs drag behind and move forward rigidly as a whole with no knee action and the toes catch against the ground often causing falling.

Prognosis: Complete recovery is rare. Much may be accomplished in its early stages.

Posterior spinal sclerosis: This is a degenerative affection of the sensory neurons of the spinal cord, often involving, also, the sensory neurons of the cranial nerves, and characterized by incoordination, loss of deep reflexes, disturbances of sensation and nutrition and various ocular phenomena. It is also known as locomotor ataxia and tabes dorsalis.

Symptoms: These are divided into three stages as follow:

Pre-ataxic (or early) stage: The symptoms of this stage are sharp, shooting pains in the lower half of the back and legs, severe backache, numbness and tingling of the feet, a sense of constriction about the body, disturbances of the urinary and sexual systems (usually of a paretic type), deficiencies of vision, loss of deep reflexes, paroxysms of intense pain in the stomach, and isolated areas of hyperesthesia or anesthesia.

Ataxic stage: As the nerve degeneration progresses there is a want of certainty and precision in the movements of the legs especially in the dark, and a gradual loss of control of the muscles. The walk becomes a peculiar heavy shambling, futile attempt to direct the feet. If the patient stands erect with his eyes closed and his feet in juxtaposition he sways and tends to fall; or, if the upper extremities are affected the ataxia becomes evident when he attempts to touch his finger to the tip of his nose. If placed in a recumbent position with his eyes closed he is usually unable to recognize the position in which his limbs are placed.
The steps are awkward and jerky, the foot is raised high, projected forward and outward and brought down forcibly with a thud. The body is bent forward, and the eyes are directed to the floor. Although there is not great loss of muscular power in this stage, the muscles are abnormally flaccid.
Such trophic abnormalities as perforating ulcer in the sole of the foot, abnormal brittleness of the bones, and painless swellings of the large joints, with effusion, atrophy of the bones and cartilages, and ultimately dislocation (Charcot’s joint) develop.

Paralytic stage: This develops in from ten to twenty years if the patient lives. This stage is characterized by inability to walk, progressive muscular weakness, inability to retain the urine, cystitis, bed sores, and increasing marasmus.
In a small percentage of cases symptoms of paretic dementia develop and the condition is called tabo-paralysis.

Etiology: We assume that the cause of the hardening in the different parts of the cord that gives rise to these different “forms” of spinal sclerosis is the same. We are usually told that the cause is obscure, which means it is unknown. Locomotor ataxia is said to be caused by “syphilis” and cases are treated accordingly; hence the uniform failure in these cases.
Dr. Alsaker says “the tendency of late years is to blame syphilis for more and more of the nervous disorders from which people suffer.
Some medical men claim that this disease causes all cases of locomotor ataxia. It is true that many of the ataxias have had syphilis, but by no means all of them. Many of them have also had measles and corns.
Locomotor ataxia has as varied a causation as other diseases have, and to blame one previous disorder is either mental laziness or perversion of the truth.”
Many cases of ataxia give no history of “syphilis” and do not react positively to the Wassermann test. These are treated for “syphilis” anyway.
A little investigation of the past lives of every one of these sufferers will reveal enough of sensuality and gross living to cause their troubles without dragging in an imaginary “disease” called “syphilis.” These people have been living in a manner that weakens and debases their bodies. Years of gluttonous eating, late hours, excessive venery, drinking, tobacco using and other forms of sensuality and dissipation, eroticism in thought, and, added to these, the drugs that are taken by such men and women for their aches and pains, are enough to produce in them any one or more of the mental and nervous and other “diseases” which are referred to as the third stage of a “disease” called “syphilis.” Tilden says, “I know from sixty-five years of experience that * * * locomotor ataxia is the result of excessive venery and is curable.” Alcoholism, injury to the cord, vascular and nervous sclerosis from toxemia are undoubtedly causes. Perhaps the drugs given for “syphilis” are the most potent causes.
Tilden also says that a cause for locomotor ataxia “need not be looked for beyond the daily lives of subjects. Everyone has abused himself sexually; indeed the history of such cases usually runs about as follows: ‘I began at eight years of age to masturbate, and kept it up one to half dozen times a day until I began visiting women, and, have had intercourse once to four times every twenty-four hours for the past twenty years.’ Does such an individual require syphilis to paralyze him? Add to this abuse wrong eating, tobacco and often alcoholics, coffee and tea, then can any sane man believe that syphilis is necessary to add to all that crime against health, to make a successful ataxia?”

Prognosis: In the early stages, this is favorable. In advanced stages, the case is hopeless.

Care of the Patient: We care for all of these cases alike and a description of our care for locomotor ataxia will suffice. The care of locomotor ataxia cases should have no reference to a “disease” called “syphilis.” All causes of impaired health should be corrected and every health-building measure employed. Tilden says, “when cases of locomotor ataxia apply to me for treatment, I treat the individuals for what their symptoms represent. If they have any stimulating habits, these have to be given up at once. Their wrong eating habits are corrected immediately. When it is possible for them to go to bed, they are sent to bed, and kept there until the coordination has been restored.” He tells us that he has treated many cases of locomotor ataxia with plus four Wassermanns, whose symptoms cleared up within sixty to ninety days, and adds, “where they have given up their bad habits and continued living in the right way, they have continued to remain well.”
To be able to bring about resolution of hardening in the cord in locomotor ataxia and a consequent restoration of normal movement is something so-called “regular medicine” hardly dares hope for.
Dr. Weger reports that “several tabetic cases advanced to the cane and crutch stage have been able to discard these aids to locomotion within a few months and have improved sufficiently to carry on extensive enterprises, play golf, and live normal lives for six or eight years, only to have the tabes reassert itself and become progressively worse. These cases were those of men past middle life whose habits were exemplary and who could be depended upon to do much better than the average person in carrying out instruction.”
I have had no such experiences and Dr. Weger is the only Hygienic practitioner who reports such recurrences. I incline to the opinion that the habits of these men were not as exemplary as they had led Dr. Weger to believe, and that they had not carried out instructions well. Unless we abandon all rational views of the trouble and accept the delusions that cluster around the spirochete, we must know that something in the lives of these patients caused the recurrences.
We often see an almost complete clearing up of all symptoms in multiple-sclerosis during a long fast only to have some of them return in milder form as soon as eating is resumed.

SYRINGOMYELIA

Definition: A rare affection of the spinal cord, occurring chiefly in males between the ages of ten and forty, characterized by the formation of cavities within the cord, and by atrophy of certain muscles, peculiar disturbances of sensation and various trophic changes.

Symptoms: The affection usually involves the upper extremities, the chief symptoms being wasting of the muscles (atrophy of both hands and arms) fibrillary tremors, loss of sensations of pain and temperature, but with well preserved or but slightly affected tactile sensation, lateral curvature of the spine, and such trophic disturbances as fissures, ulcers, gangrene and affections of the joints. Such eye symptoms as continuous rolling of the eye-ball, inequality of the pupils, and narrowing of visual field are frequently seen. The affection is nearly always bilateral.

Complications: In many instances symptoms of lateral sclerosis, posterior sclerosis or bulbar pathology are superadded.

Morvan’s “Disease” is thought to be a form of syringomyelia but differs from the above description in that there are loss of tactile sense and the development of painless felons.

Etiology: Injury and “acute infectious diseases” are mentioned as causes. Acute “infectious diseases” cause nothing. They are caused by toxemia and sepsis and these are the causes of syringomyelia.

Prognosis: Syringomyelia is considered incurable but not fatal and patients may live in comparative comfort for many years and eventually die of other affections.

Care of the Patient: We believe that proper care at the beginning would arrest the progress of the pathology in this condition and prevent the development of the helplessness described above. The care would not differ from that given for neurasthenia or myelitis.

SPINAL TUMORS

Tumors (neoplasms) sometimes develop in the cord and its membranes. The meningeal tumors may be either inside or outside the dura mater. They may be located anywhere along the cord, producing compression or pressure wherever located; and if prolonged the pressure interferes with the ascending and descending functions of the cord.

Symptoms: These vary with the location. Persistent neuralgic pains and slow progressive paralysis may be the chief signs. Pain in the legs, with gradually extending paralysis is diagnostic. Weakness is the first sign. There is pain upon pressure along the spinous processes.

Etiology: See Tumors.

Prognosis: Very unfavorable.

Care of the Patient: Rest and a long fast are essential. Correct all errors of life.

AFFECTIONS OF THE NERVES

DIVER’S PARALYSIS

Definition: A condition of motor and sensory paralysis with other nervous symptoms observed in divers and others subjected to increased atmospheric pressure; known also as Caisson “disease,” and “bends.”

Symptoms: These may appear immediately on reaching the surface or after the passage of several hours. Pains in the joints followed by motor and sensory paralysis in the lower extremities are, the chief symptoms. Sometimes the bladder and rectum are involved. The paralysis may sometimes take the form of hemiplegia or monoplegia instead of paraplegia. Gastralgia and vomiting are common symptoms.

Etiology: It usually requires a pressure of more than two hundred atmospheres to produce the paralysis and the time required decreases as the pressure increases. Congestion hemorrhage and softening in the cord result from the pressure.

Prognosis: As a rule recovery ensues in a few days or weeks. In a few cases the paralysis is permanent. In severe cases coma develops and death occurs in a few hours.

Care of the Patient: A gradual transition from a high to a low pressure will usually prevent the paralysis. If symptoms develop the patient should be returned to the high pressure and then subjected to gradual decompression. Severe cases should be cared for as described under acute myelitis.

EPILEPSY (Falling Sickness)

Definition: A nervous affection with loss of consciousness and tonic and clonic convulsions.

Symptoms: The common form of epilepsy is divided into two general types. The more severe form is known as Epilepsia Gravior, or grand mal. In this form the patient falls without sufficient warning to protect himself. These are the cases where consciousness is wholly lost and the convulsions are usually severe; although there are cases where consciousness is wholly lost and convulsive movements are slight – more of a stiffening of the muscles – and there are cases where consciousness is not lost. These patients may fall on the street before a car or other passing vehicle, or in some other place that may cause them severe injury. One form of this severe type of epilepsy is the nocturnal type. This is the safer form, for the patient has his convulsions at night while asleep in bed.
The light form of epilepsy is known as Epilepsia Mitior, or petit mal. Convulsions in these cases may be very mild, last less than half a minute, the momentary loss of consciousness not being enough for the patient to fall, if standing, nor to lose the trend of conversation. Or this form may be characterized by staggering and confusion and the sufferer may not be able to resume the conversation in which he was previously engaged until he is reminded of the subject. The light form may gradually develop into the severer form if its causes are not removed.
There is nothing resembling regularity in the development of epileptic convulsions. In some cases they often occur in “bouts,” one, or two or three taking place every few days, or they may be separated from each other by weeks, sometimes by months, and occasionally by years. A patient may have two or three sets of fits in a week or in a month and have none the following week or month.
It is said that the light and severe types of the affection may exist at the same time. But this does not mean that the patient has two “diseases,” two epilepsies. It only means that he has both light and severe paroxysms. The light form may exist for years without a severe “seizure,” or the severe form may persist for years without a severe paroxysm or light and severe convulsions may alternate.
In the light form, petit mal, the patient may have a half-dozen or a dozen convulsions in a day. Indeed he may become so intensely sensitive that he has as many convulsions in an hour. He may be so sensitive that the slightest shock or irritation out of the regular routine may cause a momentary loss of consciousness. Such a patient may suffer a severe convulsion every two to four weeks, or at shorter and longer intervals.

In the severe form, Grand Mal, the convulsion is preceded by a short cry or shriek, like a cry of distress. The patient usually falls forward on his face, which is often injured. It is no uncommon thing for these patients to fall on a stove and be badly burned. Due to the spasmodic contractions of the muscles of the jaw, these patients often severely bite the tongue. In frequent cases the tonic contractions of the jaw muscles is so severe that the jaw is set, and, due to the setting or spasmodic contraction of the muscles of the chest, breathing is suspended for half a minute.

Due to suspended respiration and even circulation, the face, which at first is pale, turns red, livid, then purple, and, at times, almost black. The pulse becomes very rapid and the pupils dilate. Indeed there is over-dilatation of the pupils in all forms of epilepsy, as in many other nervous affections.

Because the muscles on one side of the body are affected more than those of the other side, the head is turned to one or the other shoulder in a jerking way. The eyes roll and have a wild expression. The cheeks as well as the tongue are often severely bitten. In severe cases there is always foaming at the mouth, the foam being tinged with blood from tongue or cheek. Breathing is stertorous and these cases are often mistaken for apoplexy or drunkenness. There have been cases in which bones were broken or dislocated, so severe were the muscular contractions. Often the sphincters relax and there is involuntary emptying of the bladder and colon.
The paroxysm may last from a few seconds to a halt-hour. One, two, or three dozen convulsions may be required before calm is restored to the nervous system. In cases where dozens are required the patient may die due to rupture of blood vessels in the brain (apoplexy), rupture of the heart, uremic coma, shock, or from too long suspension of the vital functions by the prolonged tonic spasm, so that vital activities cannot be resumed after it has passed off.

When the convulsion subsides, the body relaxes, consciousness returns and the patient may fall into a deep sleep which may last for several hours. Upon awakening, if the convulsions have not been too prolonged, the patient may appear quite well, and except for a tired feeling and muscular soreness, may feel well. Indeed many cases recover from the convulsions in a few minutes and immediately resume their regular activities, as though nothing had occurred.

In cases where the convulsions last several minutes the patient is worn out and, even though he sleeps heavily for some time after the spasms cease, he may be tired and his muscles be stiff and bruised and his tongue sore, for several days afterward. In the more severe cases the patient may recover from the convulsions very excited and lapse into a severe form of mania, which lasts one or two days, ending in death; or he may go on living but requiring constant attention and attendance, due to the mental derangement.

One form of epilepsy known as “Jacksonian,” is conceded to be due to injury (trauma). This type is characterized by being confined to one-half of the body; either the right side, or the left side. The muscular spasms are more or less severe, but the patient does not lose consciousness. He is a witness to his own spasms. This type of epilepsy is rare.

Etiology: Epilepsy belongs to that group of maladies called neuroses. It is characterized by periodic convulsive paroxysms, due to functional derangements of a reflex nature. Pathologists have sought the cause of epilepsy in post-mortem studies of epileptics, but have not found it, due to the fact that the examination of an organ after death does not show functional derangement and cannot show the reflex irritations that throw the patient into convulsions.

The functional characteristic in all forms of epilepsy is a lack of nervous stability. The man with a normal nervous system is able to perform the functions of life – walking, thinking, eating, digesting, eliminating, etc. – to mingle with people and amicably adjust himself to society. In actual life we meet with all degrees of nervous coordination or balance, ranging from a solid, stable state to one of marked instability – one easily thrown off balance.

In the epileptic we see a nervous system that is very unstable, one that is very sensitive to irritations and is thrown out of balance by things that the normal nervous system easily adjusts itself to or successfully resists. Epileptics are all neurotic. They lack strong central nervous control. When their nerve energy is drawn upon beyond a certain variable limit, they lose coordination and control. The whole motor nervous system becomes “insane.”

Epilepsy is said by many to be hereditary, while others claim that only the neurotic diathesis (tendency to nervous “diseases”) is hereditary. In view of our present knowledge of heredity, it is probable that both of these views are wrong. It is more probable that the nervous deficiency that constitutes the neurotic diathesis is the outcome of nutritive deficiencies before and after birth. Stable nervous systems cannot be built out of inadequate nutrition and we have enough clinical and experimental evidence to show that certain food deficiencies in the young, growing organism produce impairment and convulsions. Unfortunately, most of the old ideas about hereditary “disease,” which were developed before we knew nothing about either hereditary or the effects of dietary deficiencies, persist in spite of our increased and, increasing knowledge of these subjects.

Convulsions in infants and children with unstable nervous systems are frequently seen. Slight irritations, such as indigestion, a heavy meal, too much exercise, or being chilled, may bring on convulsions in some children. Undoubtedly, these are the children that give us most of our cases of epilepsy.

In all cases of epilepsy, except the few in which injuries to the head have caused depressed fractures and other anatomical defects, there are enough errors of life practiced to account for the “disease” without calling in predestination or election to help explain the pitiable plight of the sufferer.

To develop epilepsy there must first be a very unstable nervous system, one easily thrown out of balance. The individual must, then, & subjected to influences that bring on a pronounced type of enervation – lowered nervous energy. Enervation checks elimination, producing toxemia. This rapidly forces the nervous system into a pronounced state of lost resistance. It is then that it becomes so sensitive that unusual irritations of any nature or a slight increase of an accustomed irritation, may cause a breaking-up of nerve balance, a temporary loss of co-ordinating power.

The epileptic subject may be thrown into convulsions by overeating, improper eating, toothache, earache, or any pain, sexual indulgence, anger, sorrow, joy, overwork or overplay, excitement, adenoids, colds; in fact by any undue nervous strain. One case I cared for was thrown into a violent fit of convulsions by the application of an electric needle to the roots of some superfluous hair on the face.

Once the epileptic habit (reaction pattern, to employ a psychological term) is established, very little more irritation than one is accustomed to in daily life is enough to throw the subject into a fit. Often an unaccustomed harsh sound, a sharp word, or a slight disappointment is enough to overcome the slight resistance and bring on a convulsion.

Emotional over-irritation and lack of emotional control quickly impair the nervous system and these may also precipitate a convulsion. Psychic shock and lack of emotional poise contribute to the production and continuance of practically all so-called “diseases.”

Perhaps the commonest cause of epileptic convulsions is poisoning or putrefaction generated by gastro-intestinal decomposition. Too much sugar or meat often cause enough decomposition and poisoning to bring on epileptic convulsions.

The nervous tension produced by gambling, or by bucket-shop operations, is enough to produce epilepsy and, if these things are continued, to prevent recovery. The petty thief, the smuggler, the hypocrite, the juggler of accounts, the liar, and the cheat, all, if subject to epileptic convulsions, pay for their dishonesty by fits.

Prognosis: This is favorable if the case is not based on an incurable organic pathology.

Care of the Patient: That reflex irritations from abscessed teeth, adenoids, ovarian and uterine abscesses and fibroids, phimosis, enlarged prostate, bony growths, eye-strain, etc., may precipitate convulsions has been emphasized above, but these are only local outgrowths of the same nervous impairment and toxemia which form the basic cause of epilepsy; and unless the basic causes of all of these troubles is removed the patient will continue to have epilepsy. Hence, the failure of surgery in epilepsy.

Only by going back of these minor ailments and correcting all of the causes of ill health can we ever hope to succeed in remedying epilepsy. It is necessary to get rid of the enervation and toxemia and to remove all the causes of these. The whole body must be put in a state of health and maintained in this state.

As a matter of physical and mental economy, there must be a general reform in all physical and ‘mental habits. The epileptic must stop all abuse of the body and mind. All enervating habits must be discontinued at once and permanently. Doctors who attempt to cure “disease” without correcting enervating habits and who treat patients for “specific diseases,” while ignoring a manner of living that makes cure impossible, will never succeed in remedying epilepsy or any other affection in their patients.

It is necessary in all cases to avoid the causes of enervation. Since the cause of epilepsy is often subtle, uncertain and obscure, both the doctor and the patient should attempt to find and remove or correct all and every enervating habit or influence, however insignificant it may appear. The plan of living should be put upon a rigidly economic basis and nerve energy conserved as much as possible.

Sensualism must be controlled. Sex abuse, both mental and physical, must be given up forever. Libertines and masturbators cannot be cured of epilepsy until cured of their wasteful sex habits. Those who constantly excite their sex functions mentally, even if they do not resort to overt sexual acts, will also fail to recover until they have educated themselves out of this bad habit. –
Tobacco, tea, coffee, alcohol and like poisons lower nerve-tone and help to produce and perpetuate epilepsy. Until all poisonous habits are completely abandoned, the sufferer need not expect to recover. Gross eating habits must be broken. Gluttony, irritating foods and condiments and too “rich” foods help to produce enervation and toxemia and are often the causes of the irritation that precipitates a convulsion. The putrefaction and constipation that grow out of
gross eating habits are recognized as “causes” of epilepsy.

Since gastro-intestinal derangements are so nearly uniformly precedent to epileptic “seizures,” it is folly to look for, good results in these cases without giving due attention to the amount, kind, and combination of food eaten.

Everything capable of producing reflex irritation must be overcome in order to overcome the convulsion habit. This is not to be done by cutting off a tight prepuce, saddling the nose with eye-crutches, removing the gall-bladder, or womb, etc., and by taking cathartics; but by restoring the whole body and all of its parts to good health.

It is often necessary to get away from family influences, for the epileptic who is pampered and indulged and weakened by misdirected sympathy cannot get well. He must learn to stand on his own.

Among the treatments employed by the ancients in the care of epileptics were fasting and prayer. On one occasion, when the disciples of Jesus, wanted to know why they had failed in their effort to cast out the “devil” from an epileptic, he told them “this kind cometh not out save by fasting and prayer.” There is nothing of more immediate benefit to the epileptic patient than fasting, while the mental calm often produced by prayer is a great aid to restoration of poise.

Every case of epilepsy should be given a long fast as the surest and most rapid means of freeing the body of excess food and of its toxic overload. This will also quickly remedy nearly all the common sources of reflex irritation. Since the most common source of irritation is the digestive tract, nothing can more speedily benefit these patients than a properly conducted fast.
It has been shown that excess nitrogen (protein) increases the frequency of paroxysms in epilepsy; whereas, an increase in bases (alkaline salts) reduces them. One egg added to the daily diet of children predisposed to spasmodic affections will give rise to spasms. When the eggs are removed from the diet the child promptly becomes normal.

In all cases of nervous impairment – epilepsy, chronic melancholia, neurasthenia, etc. – “acidosis” arises more quickly and has more powerful effects. It is undoubtedly the weakness and derangement of the nervous system in such cases that permits the earlier development of “acidosis” and that explains why the “acidosis” has such a powerful effect. “Acidosis” is especially likely to precipitate an epileptic paroxysm at night, for then the reaction of the blood is physiologically less strongly alkaline than during the day.

The weakness and derangement of the nervous system in epilepsy renders care in feeding all the more necessary and makes it equally necessary to avoid shock, emotional strain, overstimulation, excesses, extreme exposure, and all other influences that tax or weaken the nervous system.

Finally, if all the enervating and irritating habits and influences enumerated above are not corrected and removed, these will keep up enough irritation, digestive derangement and excretory inhibition to prevent recovery.

It is, of course, true that the longer the causes of epilepsy have been allowed to run, the harder it is to correct. The nervous system may ultimately become so non-resistant to irritation and the habit of convulsive repetition so firmly established, that the slightest irritating influence may unbalance co-ordination and initiate convulsions. It is wise, therefore, to begin the care of these cases at the very beginning and we have a right to expect better and faster results than years later, when the “disease” is well established. Those are most benefitted by fasting whose mental state is not shattered by the long-continued use of drugs and by psychic shock.

But whether the case is taken early or late, we should not lose sight of the fact that it takes time to overcome toxemia and enervation, and still more time for the nervous system to evolve out of the habit of falling into temporary states of lost co-ordination. How can we expect this to occur during a few days of fasting?

Rest is necessary to restore nervous poise and this cannot be obtained so long as there is any nervous irritation from any source. Emotional over-irritation – worry, anger, jealousy, apprehension, fear, etc. – ; poison habits – tea, coffee, tobacco, alcohol, headache “remedies,” constipation “cures,” etc. – ; excesses – gluttony, sensuality, overwork, overplay, etc. – ; and the deficiencies – lack of fresh air, lack of sunshine, indolence, deficient diet, etc.,; all aid in building and maintaining the constitutional derangement that is back of epilepsy. Any program of care that ignores these will inevitably fail.

The patient who returns to gluttony, sensuality, inebriety, gambling, and to his former excesses, and dissipations, after he has been restored to health, will again break down his health and is likely to redevelop epilepsy. There is no cure of “disease” outside of removal of cause and there is no prevention of “disease” save by avoiding its causes.

HERPES ZOSTER (Shingles)

Definition: This is an acute inflammation of the ganglia of the posterior nerve roots, characterized by more or less intense pain and a vesicular eruption upon a red and inflamed base along the peripheral or cutaneous nerve. It is also called posterior ganglionitis.

Symptoms: Shingles may develop in various parts of the body from the face down to the legs. – The most common site is along the intercostal nerves of the chest, where it is almost always unilateral. Severe complications and organic changes are rare. Clusters of vesicles (blisters) mounted on inflammatory bases, accompanied and preceded by sharp, neuralgic pains, mark the affection. The eruption will not cross the median line either in front or behind. The fluid soon becomes turbid, dries up and forms yellow-brown crusts, which fail off in a few days.

Etiology: It is a reflex irritation; its real cause is poisoning from intestinal putrefaction. It is a common development in fevers – pneumonia, malaria, cerebrospinal meningitis – and in neuritis and neuralgia.

Prognosis: It commonly gets well quickly, though neuralgic pains may persist for some time and its development near the eye may result in permanent damage to this organ.

Care of the Patient: Rest in bed and a fast of sufficient length to result in full elimination should be employed in all cases. Drugs to “relieve” pain should be avoided. After the fast the diet should be fruits and vegetables.

FACIAL PARALYSIS

Definition: This is paralysis of one side of the face; called also Bell’s palsy.

Symptoms: The affected side is expressionless, the natural lines are obliterated, the angle of the mouth droops, the eye cannot be closed, tears flow over the cheek, and speech is affected from impaired motion of the lips. If laughing or whistling are attempted the absence of movement on the affected side is still more conspicuous.

Etiology: Many cases are due to neuritis resulting from its usual causes; other cases are due to pressure, an inflammatory exudate, upon the nerve-trunk between the brain and skull, or from a tumor, or blood clot or abscess involving the facial center; a few cases result from paralysis of the nerve within the temporal bone as a result of a fracture or an extension of Inflammation of the middle ear.

Prognosis: This is guardedly favorable in most cases. The prognosis must depend on the pathology back of it.

Care of the Patient: Remove the cause – that is, correct all causes of enervation and toxemia. Fasting for toxemia will help.

NEURALGIA

Definition: A symptom-complex characterized by paroxysms of severe pain occurring along the line of a sensory nerve-trunk, without inflammation or obvious anatomical changes in the nerve.

Symptoms: Seen almost wholly in adults, more often in women than in men, neuralgia may occur in almost any part of the body. It is characterized by sudden, sharp, darting and arresting pains. The pain is relieved by pressure; there are tender spots (points douloureaux) where the nerves emerge from bony canals or muscular coverings. The area supplied by the nerve is usually very sensitive and palpation may locate spots of extreme tenderness at points of exit of the nerve. Inspection of the part usually reveals nothing abnormal, although a slight swelling may be seen in some cases. Herpes occasionally precedes or follows a paroxysm. In some cases reflex spasms of the muscles attend the pain.
The condition is more or less chronic and the pain, which is of a sharp, stabbing character, is often intense. The pain lasts from a few moments to many hours and its subsidence may be accompanied by the passing of a large quantity of pale urine. The interval between paroxysms varies in different individuals; sometimes being several weeks or even months long. The paroxysms often tend to recur at regular intervals.
The most frequent and most important neuralgias, named according to the location of the pain and the special nerves involved, are:

Trifacial Neuralgia, or neuralgia of the fifth nerve, known also as Tic Douloureaux and prosopalgia, is characterized by pain in one or more branches of the trifacial nerve with tender points above and below the eyes, extending well down the cheek and centering, in some cases, at a point immediately above the teeth of the upper jaw. Reflex spasms of the muscles (muscular twitchings) are common. In old chronic cases the hair on the affected side may become coarse and bleached.
The real sufferer from tic douloureax presents a pathetic picture of abject misery and suffering. In the chronic form this trouble often persists for years and may utterly incapacitate the sufferer. Despair and mental apathy are common depressive concomitants and, when the affection has become a fixture, the two form an almost indissoluble union.

Cervico-Occipital Neuralgia involves the upper cervical nerves and is characterized by paroxysmal pain extending down one or both sides of the neck as far as the collar bone and upward to the cheek. A spot of tenderness may be found midway between the mastoid process and the upper cervical vertebrae. Cramps in the muscles, sensitive skin, and, sometimes a surface eruption of vesicles, may accompany this form of neuralgia. Frequently a cracking at the nape of the neck proves very annoying. Cervico-occipital neuralgia may also accompany
tuberculosis of the spine.

Cervico-Brachial Neuralgia, involving the lower cervical nerves, presents paroxysmal pain with numbness and weakness radiating down the arm to the hand, across the shoulder to the scapula, sometimes accompanied by a surface eruption of vesicles. Swelling or edema of the arm and later atrophy of certain muscles with pale, dry, harsh, and glossy skin are often seen in long-standing cases.

Dorso-Intercostal Neuralgia, following the course of the intercostal nerves, is characterized by paroxysmal pain that is usually confined to the fifth and sixth intercostal spaces. This means that the pain is felt between the ribs. It is’ frequently associated with “an eruption of herpes zoster. Spots of tenderness may be found near the spinal column, in the axilla and near the sternum.

Lumbo-Abdominal Neuralgia presents paroxysmal pain along the courses of the iliohypogastric and ilioinguinal nerves radiating from the hip to the groin and inner side of the thigh.

Sciatica, though usually a neuritis, may also sometimes be a neuralgia, the pain radiating down the inner side of the thigh and leg.

Etiology: Medical works list heredity as a cause. This is a fallacy that will soon be outgrown. Hereditary “disease” belongs to the days of our grandparents. Modern biology admits of no such thing.
Neuralgia is of toxic origin, sometimes of drug origin – chronic lead poisoning being among its causes. Eye-strain and cavities of the teeth are listed among the reflex irritants that may produce trifacial neuralgia. Nervous degeneration, gout and malaria, listed as causes, are all outgrowths of toxemia, as are other pathologies that are said to cause it. Pressure on the nerves from tumors, misplacements, and from without, help, at least to account for some cases.

Prognosis: Complete and permanent recovery may be expected in practically all cases by persistently following a strict regimen.

Care of the Patient: Weger well sums up the care of the neuralgia patient when he says of trifacial neuralgia: “All but one of the few cases we have been privileged to treat have made permanent and satisfactory recoveries by persistently following the most rigid dietetic regimen for many months. Some cases require a year or two to overcome the toxic cause and the vicious pain habit that frequently persists after the cause is removed. The psychic aspect of some cases that have had as many as fifteen ganglion injections without relief, is a. factor that is often underestimated. The power of the will must be enlisted and utilized to overcome, to endure, to ignore, and to minimize the pain consciousness. We have found a rather protracted fast or even several fasts at intervals of a few months absolutely necessary to accomplish a cure. All carbohydrate food must be withheld for several months. Sweets, condiments, and stimulants of all kinds must be absolutely avoided. The diet must be non-irritating in order to avoid reflex excitation from a sensitive gastric or intestinal mucous membrane. Food containing all of the necessary basic cell salts and vitamins should be given in proper combination. The physical and mental morale must be raised and the patient carefully guided and encouraged. The only failure we have to record was in a patient near the seventieth year who was not capable of understanding or carrying out specific instructions.”
Weger has here outlined the care of long-standing chronic cases of trifacial neuralgia. The reader will understand that milder cases, of shorter duration, will not require such long periods for recovery. All “forms” of neuralgia are to be cared for alike.

SIMPLE NEURITIS

Definition: This is inflammation of a nerve and, since nerves ramify all parts of the body, neuritis may develop in any part of the organism. The condition is almost wholly confined to the peripheral nerves. As it is often difficult to distinguish between neuritis and neuralgia, thousands who have the latter condition imagine they have neuritis. Simple neuritis is characterized by inflammation of the nerve trunks accompanied by pain, impaired sensation and motion, and atrophy.

Symptoms: Three sets of symptoms are commonly described for acute neuritis, as follow:

Sensory Symptoms: These are severe pain following the course of the inflamed nerve, which is tender upon being touched. The pain is often associated with burning, tingling, numbness, etc. At first the affected part is likely to be very sensitive but later may lose sensation.

Motor Symptoms: These are impairment of muscular power, diminished or lost reflexes and tremors.

Trophic Symptoms: Herpes eruptions sometimes develop along the course of the affected nerve. The skin may become glossy, and the nails lusterless and brittle. In advanced cases the muscles undergo atrophy.

Chronic Neuritis is characterized by pain, loss of, sensation, paresis, wasting and contraction of the muscles, glossy skin, and thickening and brittleness of the nails.

Optic Neuritis is inflammation of the optic nerve and involves chiefly the intra-ocular end of the nerve.

Sciatica is inflammation of the sciatic nerve (sciatic neuritis) and is characterized by sharp, shooting pains running down the back of the thigh. It is almost always unilateral. The pain is constant; it is not so acute as it is tormenting and continuous and of a character to wear the patient out. It may extend from the spine to the foot, even to the toes. The back of the thigh is often the most troublesome of any point in the course of the nerve; apparently because it is being injured more than others from sitting on chairs and benches. Movement of the leg increases the pain. The patient tends to walk on his toes as this relieves the tension. A very short walk will often cause great distress. The pain may be evenly distributed along the course of the nerve, or there may be local spots where it is more intense. Tingling and numbness are often present. The nerve may be extremely sensitive to touch. The symptoms tend to be worse at night and upon the approach of cold or stormy weather. In long standing cases there is likely to be much wasting of the muscles and impairment of locomotion.
It is necessary not to make the mistake of believing that people have neuritis merely because they have pains in the arm, or shoulder, or thigh. Neuritis is really not as common as is generally thought. Pain is produced by many things and to mistake all acute or chronic pains in the limbs for neuritis is to make a great mistake.

Complications: Chronic inflammation may result in so much degeneration of the nerve that paralysis follows. This means loss of sensation, or motion, or both.

Etiology: Toxemia and autointoxication resulting from Impaired secretion and excretion form the basic cause of neuritis. This is the constant that is needed to prepare the groundwork for neuritis and to perpetuate it once it has developed.
Neuritis frequently follows infections, gout, diabetes and injury and may result from pressure upon a nerve by a tumor or a subluxation of the sacro-iliac joint. Poisons like alcohol, lead, arsenic, sulphonal, carbon-monoxide, etc., often produce neuritis. It is a frequent aftermath of surgical operations. Dr. Richard C. Cabot says most cases of neuritis are due to alcohol.
Injuries to the nerves – wounds, blows, pressure, etc. – are speedily recovered from if the blood is normal. If toxemia is great, instead of recovery, the inflammation produced by the injury becomes chronic.
Neuritis resulting from injury – wounds, blows, crushes of the arm or leg, operations – and from great strain upon the arm is quite common. Operations are a frequent cause of neuritis. Indeed, such cases are more common than the public is aware of.
Many of the “causes” given in medical works are not causes at all and many of the others are only complicating causes. If injury (trauma) is the cause of neuritis, this “disease” should follow every severe Injury to a nerve. If “infectious diseases” cause neuritis, all cases of such “diseases” should be followed by neuritis. If alcohol causes neuritis, all drinkers should have neuritis. A cause that needs an ally is not a cause. A cause that causes an effect once in a hundred times is not a cause.

Pressure Neuritis is due to pressure upon the nerve by tumors, misplaced parts, or by outside forces. One form of this, called “Saturday night paralysis” is seen in the drunk who sleeps all night on a bench in the park with his arm over the back of the settee and his head on his arm. The alcoholic stupor prevents him from changing positions and relieving the pressure when it becomes uncomfortable, so that when he awakes next morning his arm is paralyzed.

Prognosis: Dr. Cabot says: “The great thing about neuritis is that it gets well and that it is rare and that treatment has very little to do with it.” By this statement Dr. Cabot means for us to understand that the treatment has very little to do with the recovery. It does not follow from this, however, that it has very little to do with failure to recover; for, the treatment employed often prolongs and intensifies the “disease.”

Care of the Patient: Absolute rest is essential until the acute symptoms subside. Cause must be removed and since the factor of toxic irritation must be reckoned with, toxemia must be eliminated. The elimination of toxemia by fasting produces speedy results. In chronic cases, rest and fasting are equally valuable. Massage, heat, cold, etc., are particularly inclined to aggravate the affected nerve and should be avoided.
It is, of course, necessary to discontinue the use of alcohol and other drugs (and this covers all drugs) that enervate and impair. Nothing will be gained by substituting strychnine or opium for alcohol. It is just as essential to discontinue tobacco and coffee as to drop alcohol. All enervating indulgencies must be corrected.
After the symptoms have subsided, exercise – passive where necessary, active when and as soon as possible – plus proper food and sunbathing will promote nutrition in a manner that massage, heat, electricity and strychnine can never do. Sunbathing is of value during the painful stage, but care must be exercised not to overdo sunbathing, as this Increases the pain and suffering.

NEUROMATA

Definition: This is a tumor of the nerve made up of nerve substance proper. Sometimes the tumor is a growth from a ganglionic cell. What is called a false nerve tumor is a fibroid development in which the fibrous tissue mixes with the nerve tissue.

Multiple Neuromata are tumors of the terminal nerves or the cutaneous branches of the sensory nerves. They may be associated with tumors of the nerve trunks. They are often seen on the face, breast, or about the joints.

Amputated Neuromata are nerve tumors that develop on the ends of amputated nerves. They cause great suffering.

Etiology: These tumors result from the usual cause of tumors. See Tumors.

Prognosis: Guardedly favorable.

Care of the Patient: Care must be on general principles. Digestion must be improved and energy conserved. All stimulants must be given up.

PARALYSIS AGITANS

Definition: Known also as shaking palsy and Parkinson’s “disease,” this is a chronic affection of the nerves characterized by a gradually spreading tremor, muscular weakness and rigidity, a peculiar propulsive gait and at times mental impairment.

Symptoms: Rarely the tremors come on abruptly, but more commonly they develop “insidiously.” A tremor appears in the hand, usually in the thumb and finger (“pill rolling” movement), or in the foot or chin, and gradually spreads until it involves all the extremities and occasionally the neck and head. At the beginning, the tremor may be paroxysmal, but, as the condition progresses it becomes almost continuous. Excitement increases it, while physical effort temporarily diminishes or checks it. It ceases during sleep and complete relaxation.
Later the face becomes expressionless (mask-like), and the speech slow and measured, and there is drooling. Muscular rigidity develops, the head is, bowed, the body bent forward, the arms flexed, the thumbs turned into the palms and grasped by the fingers, and the knees are slightly bent.
At this stage the gait is characteristic. The steps, at first slow and shuffling, become progressively quicker and shorter, until the patient is forced to run or come to a stop to prevent falling forward. Occasionally a tendency to fall backward is seen. Rigidity and muscular weakness render all movements slow and stiff. Numbness, tingling and a sensation of heat are often present. Free perspiration is seen in some cases.

Etiology: Paralysis agitans develops more often in men than in women and is rarely seen under forty-five. Heredity is given as a cause. There may be a hereditary neuropathic tendency. Tendencies become affections only under the influence of enervation and toxemia. Years of wrong living are required to produce paralysis agitans. There seems to be no doubt that it is one phase of arterio-sclerosis. Tremors are commonly present as a symptom of great enervation in those in whom arteriosclerosis is well advanced. Exposure to cold, wet, worries and anxieties of all kinds are said to predispose. Cases have been known to follow shock, injury and intense mental and emotional excitement. Doubtless these cases have already evolved to the point where paralysis agitans was imminent.

Prognosis: Weger says: “In the non-traumatic type, excellent results have been obtained in a comparatively short time in most of the cases treated according to our system. When the Parkinson syndrome occurs as a late manifestation of encephalitis lethargica the prognosis is less favorable.” Our experience has been that some cases make complete recoveries while others make considerable improvement. Complete recoveries require four to eight months.

Care of the Patient: Often aged men and women with advanced hardening of the arteries and tremor consult the doctor about digestive disturbances, high blood pressure, arthritis, or other affection. The tremor is of minor importance in the list of complaints and disappears quickly when the constitutional background is improved or remedied.
Pronounced cases require longer care. We often see a first fast make the tremors worse and a second fast improve the condition greatly. Three and four fasts are often essential. Prolonged rest is made necessary by the profound enervation of these cases. All stimulation must be avoided and patients must learn to eat barely enough food to keep alive. Disagreeable people, domestic and other worries, irritations, tensions and conflicts of all kinds must be avoided. These patients are often very excitable. All excitement is stimulation and all stimulation produces more enervation. Spinal nerve pressure, as in lordosis or scoliosis, produces some cases and where this is present it should be removed.

RAYNAUD’S “DISEASE”

Definition: A comparatively rare vasomotor neurosis characterized by local anemia, congestion and symmetrical gangrene.

Symptoms: This affection “begins” in the fingers or toes and tends to become progressive, although recurrent periods of remission of symptoms are common. The affection develops most frequently between the ages of ten and thirty in those of a neurotic tendency. In its first stage the affected part – symmetric parts, as a finger on each hand, a toe on each foot, the lobes of the ears, are usually affected – becomes extremely pale, cold and anesthetic (local syncope). After a variable time the part becomes purple, livid and intensely painful (local asphyxia). Occasionally the third stage develops, in which congestion gives way to dry gangrene. Hemoglobin may appear in the urine. The condition may easily be confused with endarteritis obliterans.

Etiology: “The cause is unknown” is the statement that comes from all sides. “The disease is believed to be dependent upon spasm of the peripheral arterioles of central origin.” Spasm is supposed to occlude the blood vessel, thus cutting off nutrition to the part which consequently dies. There is every reason to believe that this affection, is an outgrowth of toxemia. Tilden says: “The disease would have no 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.”

Care of the Patient: Tilden adds: “Hence the intestinal derangement must be righted, first, last, and all the time, by correcting the eating habits and otherwise properly caring for the body.” Weger says: “I have been privileged to treat five or six cases in all of which the diagnosis had been made by well-qualified specialists, whose treatment was unavailing though it conformed to the best in medical practice. Under our supervision all made satisfactory recoveries and remained well. In one case amputation of one leg above the knee had already been resorted to and the condition of the other leg seemed to warrant the same procedure. A period of fasting and dietetic restriction resulted in complete recovery and six years after treatment it was reported that there had been no evidence of return of the disease and the patient still had one good leg. The other cases were also urgently importuned to submit to amputation, but a complete physical renovation made surgery unnecessary in any of them. The obvious conclusion is that these diseases must also be considered as toxemias and if treated accordingly they need no longer be classed in medical literature as incurable and of unknown origin.”
It is well to avoid exposure to cold, and, if possible, to spend the winter in the south, until recovery is complete. All nerve-leaks must be stopped and every health-building factor provided.

TRAUMATIC NEUROSIS

Definition: This is a nervous state resulting from injury.

Symptoms: These follow close upon an accident that has done bodily harm. Headache, insomnia, loss of power to concentrate the mind, irritability, despondency and, in severe cases, melancholia, are the prominent symptoms. All symptoms included under neurasthenia are present in some cases.

Etiology: Inasmuch as this condition does not develop in cases cared for Hygienically, it is the opinion of the whole Hygienic field that too much doctor and drugs – narcotics, analgesics, hypnotics, etc. – constitute the chief cause. Injuries shock and enervate, but the tendency is to recover; where rest is provided and toxemia is not great the shock is soon recovered from.

Care of the Patient: “A patient who has been injured should not be fed until the shock is overcome,” says Tilden. “Patients in a state of shock do not digest food. Patients in pain do not digest food. * * * Never feed before the patient is comfortable; until absolute comfort has been established, no food – solid or liquid – should be given beyond a little fruit morning, noon and night.”
Rest and relaxation are essential. Hot applications may be placed over the seat of, pain if this seems necessary, but no drugs are to be given.

CHOREA

Definition: This is a nervous affection, commonly known as St. Vitus dance, which develops largely in those of the neurotic diathesis. Osler tells us that it is often found in “abnormally bright, active-minded children belonging to families with pronounced neurotic taint.”

Symptoms: Chorea manifests in all degrees, ranging from mild to severe and even maniacal forms. Jerky, twitching movements, restlessness, inability to keep still, and ungraceful movements in getting about are seen in mild stages.
The severe form is more distressing. The involuntary contractions of its various groups of muscles partially disable the child, which must have some help in attending to itself and its daily tasks. These symptoms are all greatly exaggerated in the maniacal forms and the child requires constant supervision. Pains in the limbs and joints and disturbances of the heart attest to the general impairment of the child’s health. Fits of crying, loss of temper, irritability, and a general lack of mental and physical poise indicate an unbalanced “psychic” life and a profound impairment of the nervous system.

Etiology: Chorea is caused by anything that will use up the child’s nervous powers and impair its health. Good general health, based on natural hygiene, is the best protection against chorea. Dr. Bendix says: “Anemic, scrofulous and debilitated children, as well as those who have become weakened by acute or chronic disease and nutritive disturbances, are unquestionably affected by chorea more frequently than those who are robust. Therefore, anemic, chlorotic conditions, exhaustive diseases, rapid growth, improper nourishment, the influence of school and other factors, appear to be favorable media for the development of this affection.”
Cases following scarlet fever, diphtheria, measles, etc., must be attributed to the suppressive drugging and the inoculations commonly employed in these conditions.
Chorea develops most frequently from the ages of seven to fifteen although it may develop as early as two years. From seven to fifteen when the “deleterious influence of school-life makes great demand on the youthful organism,” it is most common. Night-lessons or “home work” keep children’s noses buried forever in their books. There is no time for play; no time to get out-doors. A child, unless he is exceptionally bright, either neglects his home work or else he neglects more important things. The mills of education grind slowly, but they grind exceedingly anemic. The nervous, anemic, mentally and physically stunted products of this senseless process are unfitted for the burdens of life.
Sir Wm. Osler says: “The strain of education, particularly in girls during the third hemidecade, is a most important factor in the etiology of this disease. Bright, intelligent, active-minded girls from the ages of ten to fourteen, ambitious to do well at school, often stimulated in their efforts by teachers and parents, form a large contingent of the cases of chorea in the hospital and private practice. Sturgis has called attention to this school-made chorea as one of the serious evils in our modern method of forced education.” * * * “So frequently in children of this class does the attack of chorea date from the worry and strain incident to school examinations that the competition prizes and places should be emphatically forbidden.”
This condition is often attributed to tonsillar troubles and “rheumatic” affections. There is nothing to this, however. They are not causes of the chorea.
Fear, excitement, masturbation, overfeeding, wrong feeding, sugar-excess, lack of rest and sleep, undue fatigue, ghost stories, harsh treatment – “punishment” – all help to bring on nervous derangement.

Prognosis: Recovery is the rule although without proper care there may be recurrences and the child may grow to maturity lacking poise and subject to many functional disturbances of the so-called nervous type.

Care of the Patient: The key to the proper care of these cases lies in the fact that the nervous twitchings and other symptoms are seldom present during sleep. Rest in this, as in all nervous cases, is the great desideratum. The child should be put to bed and kept there until all twitchings and convulsive movements are thoroughly controlled.
Everything that excites or disturbs the child should be excluded from his environment. Noise, bright lights, quarrelsome people, and other disturbing factors should not he permitted in the child’s room.
When the child is put to bed, he should also be allowed to fast. No food should be allowed for at least a week. If the child’s condition warrants, the fast may be carried further.
A fruit and vegetable diet should follow the fast for a week to ten days, after which, if the nervous symptoms are overcome, and, the child has normal control over its movements, a normal diet, as given in Volume II of this series, may be fed.
Daily exercise, sunshine, fresh air, plenty of rest and sleep, play and outdoor life, proper food, and absence of fear, overexcitement, stimulants, etc., will rapidly restore the child to full health and prevent a recurrence. If the child is of school age, it certainly should not be re-entered in school until it is fully recovered.

HEADACHE

Definition: This is pain or aching in the head. It may result as a reflex from many conditions in the body and is classified as:

Indurative Headache: This is a comparatively rare form, sometimes called rheumatic, and is said to be excited by chilling. It is increased by movements affecting the muscles of the head, and is associated with tenderness in the scalp and presence of sensitive nodular swellings at points upon the skull corresponding to the insertions of the muscles.

Headache of Cerebral Hyperemia and Cerebral Anemia: Active cerebral congestion is blamed upon prolonged mental work, fever, and exposure to the sun. Passive cerebral congestion results from obstruction to the flow of blood from the brain, as by a tumor of the neck, or heart affection. It is also said to be due to a relaxed condition of the muscles in elderly people.
Cerebral anemia is frequently merely part of general anemia. It is also seen in “neurasthenia” resulting from overwork, prolonged emotional excitement, excesses, etc. Aortic stenosis may also give rise to it. In this form of headache the patient describes his feeling as one of gnawing or of weight. The mind is depressed, there is sometimes fainting, the extremities are cold, the face and eye-grounds are pale, and lowering the head relieves pain.

Headache of Organic Brain Affection: This is headache associated with meningitis, cerebral tumor, abscess, softening of the brain etc. It is distinguished by its persistence and its association with other evidences of organic cerebral pathology such as vertigo, vomiting, optic neuritis, and so-called focal symptoms. How uncertain the diagnosis may be is revealed by a case we cared for in which severe, persistent headache that drugs would not afford even a brief respite from pain, led to a diagnosis of brain tumor and an operation urged. Twenty-four hours without food resulted in the disappearance of all pain.

Hysteric and Neurasthenic Headache: Persistent headache is frequently present in hysteria, which grows worse at the menstrual periods, but which improves under pleasurable excitement. It is frequently localized and described as resembling “driving a nail into the head,” but it may be diffuse.
In “neurasthenia” the headache is, as a rule, a dull pain or merely a sensation of fatigue. It is usually in the occipital region but may also be diffuse. Mental and physical effort almost invariably aggravate the ache and it accompanies other “neurasthenic” symptoms such as ready fatigue, backache and disturbances of sleep.

Reflex Headache: Eye-strain, ovarian and uterine affections, gastric irritation, nasal catarrh or sinusitis, etc., give rise to headache. We doubt that eye-strain produces headache.

Toxemic Headache: Uremia resulting from nephritis, often results in headache. Headache may also be due to alcoholism, nicotinism, caffeinism, diabetes, gout, etc. Ultimately all headaches are toxic headaches.

Etiology: In the final analysis all of the above “headaches” are the results of enervation and toxemia based on an unphysiological or unbiological mode of living. Toxemia and indigestion build all the pathologies upon which the headaches rest.

Care of the Patient: There is no cure short of removal of cause. Palliating headaches and leaving cause untouched is folly. All enervating causes must be eliminated from the life of the patient. Rest must be used to restore nerve energy. Fasting will rid the body of its toxic overload. A correct diet and generally correct mode of living will build and maintain good health. Drugs to relieve headache only confirm the headache habit and hinder recovery. Aspirin, for instance, causes worse headache than it relieves.
The cause to be removed in congestive headache is the overstimulating habits, which enervate and favor hyperemia in those who have a tendency to cerebral stasis. This same is true of the varicosities in other parts of the body. All foods and drugs make a congestive headache worse. Hypodermic reliefs in these cases are often followed by a funeral a few days after the “relief” is given.

HYSTERIA (Hypochondriasis)

Definition: A neurosis, mainly of women, characterized by lack of control over emotions and acts. Like neurasthenia, rheumatism and “syphilis,” it is a “catch-all” or “waste-basket” of medicine into which is thrown anything the doctor does not understand. Hypochondriasis is its analogy in the male.

Symptoms: Its nature and complexities are so variable that accurate definition or description is precluded. Weaknesses and lack of control of the will, reason, imagination, and emotions, with both sensory and motor disturbances exist in the same individuals. Real and imaginary body ailments are exaggerated or distorted and magnified to the point of obsessive introspection in both hysteria and hypochondriasis.
Hysteria may occur as a paroxysm, or as a prolonged hysterical state. Its many and complex symptoms may simulate almost any affection. For their most effective demonstrations these patients require an audience, leading to the conclusion that there is a certain amount of wilfulness in their outbreaks. Some of them possess no regard whatever for the fears and anxieties of relatives and friends. Many of them are “astoundingly versatile, acrobatic, vociferous, emotional, eratic, erotic and pestiferous.” They exhaust all the resources of nurses, doctors and family while their affection thrives on sympathetic ministrations and their motor and sensory abnormalities and perversions “run the whole gamut of what appears to be pre-meditated and ingenious affection.”

Etiology: In women, hysterical outbreaks are frequently associated with the menstrual period, functional crises, or definite pelvic pathologies, and with the menopause. Paroxysms may be precipitated by sexual, digestive, circulatory, or nervous disturbances.

Care of the Patient: One should first make sure that he is dealing with hysteria and not with real pathology masked by hysterical symptoms. Then he should adopt a policy of firmness and frankness with scant sympathy. Call the patient’s bluff at once and without apology and refuse to be influenced, subjugated or dominated by the patient.
The doctor should have complete control of the patient, unhampered and uninfluenced by family and friends whose minds are full of visions of pathologies, dire emergencies, and terrible consequences, and who are easily dominated by the perversities of the patient.
Fasting, rest, dietetic regulations, correction of uterine displacements and correcting environmental influences will produce rapid and dependable recovery.

INSOMNIA

Definition: Inability to sleep: wakefulness.

Symptoms: The inability to sleep is the characteristic symptom. Otherwise the patient may present any nervous symptom seen in any state from a mild neurasthenia to insanity.

Etiology: Wakefulness results from irritation of the nervous system. Pain, worry, anxiety, even the belief that one cannot sleep will prevent sleep. Poisons circulating in the blood such as occurs in cholemia, nephritis, auto-toxemia, intestinal toxins, mercurial mania, different drug. habits, etc., will prevent sleep. Insomnia is seen in most nervous affections. Nervousness from eating beyond digestive capacity, gastric irritation from indigestion, acid stomach, etc., result in wakefulness. Indeed any enervating habit may bring on a nervous state that prevents sleep.

Care of the Patient: Insomnia is a symptom following mental and physical dissipation, and can be eliminated by rest and fasting, but not by drugs. It is not loss of sleep that makes these cases sick; it is sickness that keeps them awake. The causes of their illness must be sought for and removed. All stimulating and enervating practices must be discontinued. Fasting will eliminate toxemia, remove intestinal intoxication and relieve nerve irritation. Rest will restore nerve energy, hence restore efficient function. The more “sleep” inducing drugs these people take, the more confirmed they become in their wakefulness. All such drugs must be avoided. There must be no compromise with this rule.

MIGRAINE

Definition: This is a neurosis characterized by periodic paroxysms of intense headache, usually on one side of the head and frequently accompanied by visual, gastric and vaso-motor disturbances. It is commonly called sick-headache, and bilious headache, and is also known as megrim and hemicrania.

Symptoms: Restlessness, depression and somnolence are common premonitory symptoms. The crisis often begins with flashes of light, colored spectra, dimness of vision and blindness for one half the field of vision in one or both eyes. Severe pain is usually limited to the temporal-frontal region of one side, though it sometimes spreads until it involves the whole head. Nausea and vomiting frequently develop. Pallor of the face, coldness of the extremities, or flushing or sweating are the most common vasomotor disturbances. Less frequently there may be numbness or tingling of one extremity, dizziness, ringing in the ears, transient motor weakness or loss of speech.

Etiology: This is a typical toxic crisis or reaction and no matter what the supposed immediate or exciting cause, the real cause is invariably toxemia. Worry, eye-strain, Intense mental effort or strain, digestive disturbances, uterine or ovarian dysfunction or congestion, anemia,’ and excesses are listed among its “causes.” These headaches are produced by coffee, tea, tobacco, alcohol, continued, eating of excesses of starch, badly combined foods, or not enough fruits and vegetables, and all other enervating influences.

Prognosis: Tilden says, “as soon as they are put on the proper treatment the headache will cease, never to return.” Weger says:
“Among the many cases of migraine coming under our care, less than five per cent have not been permanently cured.”

Care of the Patient: Due to frequent recurrences and the consequent opportunity for observation, the application of the Hygienic theory of etiology – enervation and toxemia – can be more effectively demonstrated in migraine than in those affections of less regular periodicity. Weger says: “every disease-building factor can be checked and demonstrated in any given case so that the whole complex can be laid bare and uncovered to the understanding. The relationship of migraine to menstrual function, to pelvic congestion, to other abnormal states of the reproductive system can be definitely established by careful study. All observations, taken collectively, permit the physician to formulate a regimen of physical and mental activities and a dietary within the needs and capacity of the patient that will result happily in the majority of cases, if not in all. The responsibility of living within definite limitations lies entirely with patients most of whom prefer a life of strict scientific asceticism to the nerve-shattering and pleasure-destroying effect of recurring sick headaches.”
He tells us that careful study of cases of migraine in which he did not achieve permanent recovery revealed an irremediable psychic factor that made complete cure impossible. “Some of the more obstinate cases,” he says, “present the picture of a habit neurosis in which the sensation of pain persists in traveling over established or eroded nerve paths after the primary cause is removed. In some it is impossible to change the mode of living or the special method of making a living, which may put an unbearable tax upon the nervous system through brain fatigue. In some the underlying cause of continuous enervation and toxemia is an unhappy married life. In others it is a life of disappointments or unfulfilled wishes or desires in those who think that single blessedness is a singular misfortune. The effect of emotional states should not be underestimated.”
Everything that causes enervation must be discontinued and failure to remove a single enervating factor may result in failure of recovery. Rest for restoration of normal nerve energy and fasting to remove toxemia should be followed by a health-building regimen. Here is as good a place as any to offer a little criticism of the practices of both Tilden and Weger. They do not sufficiently stress the building of vigorous positive health by the use of the causes of health. They were often inclined to be content with merely removing the causes of pathology.

NEURASTHENIA (Nervous Prostration)

Definition: A. functional affection of the nervous system characterized by a lack of nervous energy and increased sensitiveness to external impressions used largely as a blanket-term to cover the doctor’s ignorance.

Symptoms: These are extremely varied although all cases have certain characteristics in common. It is customary to group symptoms as follows:

Cerebral Symptoms (psychasthenia): These include depression of spirits, inability to concentrate the mind on any subject (except self) for any length of time, insomnia, dizziness, headache, irritability of temper, introspection and various forms of morbid fears – fear of crowds, of closed places, darkness, etc. There is moodiness, critical examination of symptoms, exaggerated pessimism and restlessness.

Spinal Symptoms: Chief among these are pain in the back, tender spots along the spine, weakness of the extremities, marked prostration after moderate exertion, ocular disturbances, unpleasant dreams, and numbness, tingling, formication, neuralgic pains and other subjective phenomena.

Gastro-intestinal Symptoms: Lack of appetite, coated tongue, indigestion with abdominal distress, and constipation are chief among these. There is usually much emaciation.

Circulatory Symptoms: Palpitation of the heart, pseudoangina, cold hands and feet, hot flashes, and sometimes violent pulsations of the abdominal aorta are chief among these.

Sexual Symptoms: In males there is often a genito-urinary obsession and fear of impotence and spermatorrhea; in females painful menstruation or absence of menstruation, with ovarian irritation, fear of mental imbalance and a sense of social inferiority are quite common.
There is almost no end to the symptoms that may be described under this term and patients so suffering make their own lives miserable and are often a sore trial to family, friends and those who care for them.

Etiology: These symptoms are caused by extravagant dissipation of energy in many useless ways and to such a degree that the body’s functional activities do not receive their due measure of nervous support. Digestive secretions and all functional activities become impaired, metabolism is deranged, and a vicious cycle of physical and mental reactions “becomes established in chaotic perversity.”
Individuals of neurotic tendencies are pushed most readily into this condition by excesses in eating, working, sex, emotional stress, alcohol, tea, coffee, tobacco, gastro-intestinal irritation, pelvic irritations and toxic saturation. Many obscure conditions are often diagnosed neurasthenia because the factor of toxic saturation is not sufficiently considered.

Prognosis: These conditions are usually not quickly overcome, though happy results are usually obtained when toxemia and intestinal autointoxication are eliminated.

Care of the Patient: In the care of these cases it is necessary to frankly and reasonably interpret the condition to the patient in order to secure his or her full cooperation. It is necessary to explain that physical impairments precede the mental depression. These cases are often ridiculed and censured for their troubles, which are assumed to be under direct control of the mind, and this arouses a feeling of resentment and injustice. The neurasthenic refuses to admit the influence, even though it may often be true, and develops a marked state of sullen displeasure. The antagonistic forces thus aroused often render progressive recovery impossible and usually lead to a change of doctors.
Diverting the patient’s mind and holding him to interests outside of himself helps him toward recovery and requires a practical understanding and tactful application of the principles of psychology. This calls for the prior establishment of complete confidence. This must be relied upon merely as a helpful adjunct of the real care.
Recovery depends upon the correction of all causes, elimination of toxemia and restoration of full nerve force. Rest and fasting are more important than psychology. All sources of irritation and stimulation must be removed. These procedures, plus time and the proper use of exercise, sunbaths, diet, etc., and health slowly returns.

OCCUPATION NEUROSES

Definition: A form of muscular spasm induced by the frequent and prolonged execution of certain coordinated movements, and occurring only in the performance of work requiring those particular movements.

Symptoms: Several forms of occupation neurosis are seen, these developing among writers, telegraph operators, pianists, typists, and seamstresses. Writer’s cramp, or writer’s palsy, may be taken as typical. The subject experiences a sense of fatigue or a dull ache in the wrist and hand with a tonic or clonic spasm of the muscles whenever he attempts to write. In some cases there are muscular weakness and. tremors. These cases are unlike neuritis in that the subject can execute all other movements involving the same muscles and in that there is an absence of tenderness along the course of the nerve and a lack of muscular atrophy.

Etiology: Occupation neuroses develop chiefly in neurotic individuals as a result of overwork. Doubtless there is exhaustion of the cerebral centers concerned in the execution of the movements, which are affected by the spasm. Such exhaustion is possible only in greatly enervated and, therefore, toxemic subjects.

Prognosis: Recovery is reasonably certain in all cases. Relapses are common due to recurrence of cause.

Care of the Patient: Rest is the most important need in these cases. Not merely rest of the affected parts, but of the whole organism. All causes of enervation must be removed. Writing, sewing, typing, telegraph operating, or whatever the patient has been doing, must be discontinued until complete recovery has occurred.

NERVOUS CHILDREN

Nervousness is quite common in children today. Parents, teachers, nurses, doctors and everyone who has to deal with children know only too well how prevalent is this condition.

The nervous child is irritable and ill-tempered, fretful and capricious. His sleep is likely to be disturbed and unrefreshing. He seldom sleeps soundly. His appetite is capricious, his tongue often coated, and his breath bad. He is usually underweight and does not put on weight no matter what food is given him. On occasions he will be a little feverish and may present extreme lassitude. In the worst cases, enuresis (bed wetting), diarrhea, vomiting and other evidences of physical disorders are present.

These “trivial” ailments may seem to the average person to bear no relation to the nervousness, but they are truly indicative of an underlying systemic derangement that must be attended to at once if more serious developments are to be avoided.

Nervous children are not likely to be well developed and alert. They are more prone to be limp, underdeveloped and listless. Some of them are said to be “on the go” all the time, but this overstimulation does not last. Soon these lack the zest and eagerness that should be the mark of all young life. They bear every evidence of nervous fatigue and physical exhaustion.

The round shoulders, flattened chest, protruding abdomen, exaggerated spinal curves, loose knees, and sallow, pasty complexion all bear evidence that the child is not well nourished.

Dr. Harry Clements says: “In all cases the condition of the alimentary tract will be found abnormal and far from wholesome. In the worst form we may see the condition known as cyclical vomiting. The child is prostrated under the attack. The face has no colour, the lips may be red but dry, and the muscular structure of the body seems utterly relaxed. The breath is foul, and the bowels are either violently diarrheic or badly constipated. The whole picture is that of systemic poisoning, plus a violent reaction of the digestive processes against normal functioning.”

Incontinence of the urine, day and night, and incontinence of the feces are seen in extreme cases also.

It should be evident that we are dealing with a condition that requires study and patience, for in a large number of these there enters a hereditary neurotic diathesis, which makes the child’s nervous system unstable. Dr. Harry Clements astutely remarks: “It will be obvious that the old-fashioned method of looking at his tongue and prescribing a laxative will neither help the child nor satisfy the parent that the physician has grasped the significance of this problem.”

It is necessary to thoroughly study such a child. Its whole life and its heredity must be gone into. Its diet, sleep, social contacts and its studies and mental efforts are all important. Much of the remedy is educational and few parents and physicians are prepared to handle such cases correctly. Indeed parental mismanagement is largely responsible for the condition of the nervous child. The mental overstimulation of children, by our present hot-house method of mis-education, is a large factor in producing nervousness in children. Whipping, scolding, nagging, fault-finding and other such elements in the child’s environment, are injurious to the nervous system of a child. Frightening children with scarey stories, bogie men, dogs, etc., and leaving them in dark rooms for something to catch, and locking them in closets, are criminal procedures. Parents guilty of such cruelty deserve severe punishment.

Says Dr. Harry Clements: “The nervous child suffers from his contact with grown-up persons who are forever communicating to him their criticisms, their failures, and their fears. When he reacts with fits of temper, irritability, fretfulness, he meets with reproofs and punishments which he neither respects nor heeds.”

The nervous child needs sympathetic understanding, kindness, firmness, and the best of care. Nothing helps such children like a proper diet and outdoor life. Such a child, if his condition is bad, should be removed from school. All criticism, nagging, scolding, whipping, etc. should be abandoned. The genitals should be carefully cleansed and cared for to remove all irritation that may exist in these. Plenty of rest and sleep are required. By all means avoid drugs, serums, tonics, coffee, cocoa, chocolate, operations on the tonsils and adenoids, etc.

BITING THE NAILS

Biting the nails may be only a habit without reason, but it is most likely to be a symptom of nervousness. Look to the correction of nervousness.

ENURESIS NOCTURNA

Definition: This is bed wetting, or the involuntary emptying of the bladder during sleep.

Symptoms: Wetting the bed and various nervous symptoms are the only symptoms.

Etiology: Neurotic or nervous children are Inclined to the bed-wetting habit when enervated, toxemic and suffering from digestive derangements. Involuntary emptying of the bladder is normal from the day of birth until the child has reached that stage in its development, when it normally assumes voluntary control of this function. Children with nerve impairments will continue to involuntarily void their urine, while asleep, long after they should have complete voluntary control over urination – sometimes for years.

The exciting cause is any enervating influence; overeating, eating between meals, eating stimulating foods, using stimulants of any kind – coffee, tea, cocoa, soda fountain slops, etc. drugs, excessive drinking of milk or water, salt, too much sugar and sweets of all kinds, the excessive use of butter, cream, meat, eggs, cake and pastries, the use of gravies, digestive disturbances, fear, excitement, fatigue, etc.

Fear is one of the greatest dissipators of nerve energy to which children are subject. Parents who rule their children by fear, instead of love and reason, constantly slap and scold their children, pick on them, find fault with them and punish them until they ruin their health. A chronic shrew can keep a home atmosphere so tense and panicky that health for the children and all who live in it takes wings and files away. Children are scarcely over one illness until they are sick again; and, if they are troubled with sensitive neurotic bladders, bed-wetting will be a nightly occurrence. If they are scolded and punished for the enuresis this tends to make the condition worse.

Fear of bed-wetting, the displeasure of parents, and the punishment often administered are enervating and become a cause that perpetuates the habit.

If the neurosis is of the stomach, digestive crises (indigestion) will be frequent. Then, if nursed and cared for badly, an eruptive fever may develop; or, if the throat is the neurotic center, feeding, medicating and foolish nursing may result in diphtheria, even death.

Neurotic children are caused much suffering by school-life. Their fear of not pleasing the teacher is a constant drain on their nervous forces. Faulty lessons are often enough to cause indigestion. Failure at school and criticism at home are sufficient to result in indigestion and fever.

Care of the Patient: These cases should be cared for as advised for the nervous child and every cause of nervousness corrected. An occasional period of two or three days on fruit with rest in bed will be found very helpful. The amount of fluid given in the evening should be reduced. Dr. Harry Clements writes: “The highly sensitive child who becomes a victim to this distressing complaint may find it difficult to escape from his bonds, and the effects of the injury to his emotional condition may be apparent for years. If the parents of the child happen to be stupid and unkind, he may be abused and brow-beaten until all sensibility is lost and he becomes case-hardened and a real problem. If the parents extend to him more consideration and more hope – particularly more hope – he will grow out of the habit and it will not seem to him so dreadful after all. In many cases the hyper-sensitiveness and self-discouragement of the child stand most solidly in the way of successful treatment. It is only when he has freed himself from the obsession of weakness, and the fear of the act, that the problem is solved. It is not the appeal to force or coercion that cures the child; it is the development of self-control through the realization of dawning boyhood and its responsibilities that lifts the burden from his mind and body.”

GRINDING THE TEETH

This is an indication of nervousness or indigestion. Where the trouble is due to indigestion the child is likely to cry out at night.
When a child continually grinds its teeth during the day and never relaxes its jaws during sleep at night, this symptom results from the profound irritation of the nervous system caused by the never-ending fermentation in the stomach, with absorption of poisonous gases and other products of gastric acidity. Eating between meals, overeating, eating wrong foods, eating wrong combinations of food, and all causes of enervation ‘will cause this symptom, which may also be seen in adults.
“Worms,” was the diagnosis of our mothers and grandmothers, when this symptom developed. Worms are not cause.

Care of the Patient: The remedy is apparent – correct the diet – feed to avoid decomposition – and all causes of nervousness (enervation).

INFANTILE ECLAMPSIA (Spasms)

Definition: This is convulsions in children. These are involuntary spasms or contractions of the muscles of the body. We will deal only with convulsions in children, as uremic convulsions, epileptic convulsions, hysteric convulsions, etc., are dealt with elsewhere.

Symptoms: There are few conditions that strike more terror into the heart of parents than to see their child in convulsions. Yet convulsions, are not, of themselves, dangerous and it is a very uncommon thing for a child to die in convulsions. The child may be unhappy and indisposed and appear sick for a day or two; the face may be flushed and white around the mouth, there may be nausea and vomiting, or gagging and efforts at vomiting, there may be high temperature, before the spasm comes on. Some children are threatened with convulsions for several hours before the real spasm develops: in others it comes on suddenly. The child will scream, cling, to its mother in a frightened manner, after which it may quiet down for a minute, then have the same symptoms repeated. Often there is pain in the bowels which are usually bloated with gas, and there may be vomiting. The effort at vomiting causes an excess of blood to rush to the brain and the convulsion ensues immediately.

The child appears excited or frightened, its arms and hands begin to jerk in rapid succession, the jerking usually confined to one hand and arm, the head jerking and twisting to the opposite side of the body, the face is drawn and distorted, the eyes roll or stare, the pupils are dilated and in a few seconds there is a struggle for breath, due to shutting off the air by the spasmodic contractions of the muscles of the throat and chest. As the convulsions continue the child becomes purple (bluish to black) in the face, the tissues about the face become puffed and engorged. After a variable period the intervals between the jerks increase in length, relaxation begins, inhalation is accompanied with a distressing rattling in the throat, which scares the parents, but which is due simply to mucus that accumulated in the throat during the spasm. Sometimes the mucus is bloody due to biting the tongue. The jerking slowly subsides as slow relaxation occurs.

In severe cases a child may be little more than fully relaxed after passing through one of these convulsions, before another sets in, which may be as severe as the first one. The length of time these spasms last varies from a minute to two or three minutes. Infants at the breast have been known to develop a convulsion every twenty minutes for twelve to twenty-four hours. The convulsions in these cases are lighter than that described above.

Etiology: Convulsions occur chiefly in infants and children with unstable and poorly adjusted nervous systems. Slight causes may bring on convulsions in some children. Undoubtedly these are the children that give us most of our cases of epilepsy. Most children never have convulsions, while others may have them at frequent intervals if their nervous systems are irritated from any cause.
Convulsions in infants at the breast come from toxic poisoning from the mother’s milk, or from drug poisoning from the same source. Most of these cases occur in the first six months of life, most of them in the first three months, many of them less than three weeks after birth. In older children they are brought on by indigestion, from overeating or improper eating. Vomiting usually frees the stomach of food.
Severe indigestion causing pain in the stomach and bowels, a catarrhal condition of the throat, extending to the ears and mastoid cells, meningitis, severe injury, fear, or sudden fright, shock, unfit milk from a sick, or tired, or excited mother may result in convulsions in infants and children, for the nervous system of a child is very susceptible to irritations.

Care of the Patient: The cause reveals the prevention and the remedy. Breast feeders must be weaned at once. Stop all food and give no drugs. No food should be given until all symptoms have passed for at least twenty-four hours. Put the child to bed, in front of an open window or door and let it alone. Don’t disturb it. Keep the child warm.
Convulsions are “self-limited” and, while most parents and friends will insist on some kind of treatment to satisfy their superstition that something be done, treatments are valueless and harmful.

A few years ago I visited a child that I was told was dying. When I reached it, from across the street, I found the child in convulsions. The mother was sitting in a chair, with the child in her arms, tossing it up and down and sobbing: “Oh! my poor child! Oh! my poor child!
I took the child from her, laid it on a table, over which a folded quilt had been hastily spread, and placed it in the open door. Almost immediately the twitching movements began to cease, the eyes, thrown upward, soon returned to their normal position, the head which was thrown back relaxed and the child began to look around. In fifteen minutes the child was asleep.
This child had been given a cup of coffee only an hour previously, the milkman having delayed in delivering the milk. The poor ignorant mother who made her own breakfast on coffee, as so many ignorant people do, gave this poisonous drug to her baby, also. I attributed the convulsion to the caffeine poisoning.

PICKING AT THE NOSE

Picking at the nose is the result of irritation of the nostrils. It is evidence of a catarrhal condition. Correct the catarrh.