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with Robert the waiter' 'that a gentleman should no more think of consulting his stomach than he would his portmanteau as to what he should put into it.' The sufferer, on the other hand, took the view of the French writer who defines dyspepsia as the 'ingratitude of the stomach,' and he determined to bring that ungrateful organ to its senses by systematic starvation. This physiological feud had not continued long before the scorner himself began to experience disagreeable sensations, which bore a striking resemblance to those of his fellow student. For months he endured in silence the tortures of an invisible enemy 'gnawing at his heart." Food gave him temporary relief; indeed, he was hardly ever comfortable except when eating, so that his appetite seemed to increase as that of his friend diminished, and his ailment consequently remained unsuspected. When at length he could bear it no longer he confessed his sufferings to his companion, and together they went to consult a physician.

In a similar manner I have seen not a few who have been sceptical of nervous suffering brought by severe personal experience to confess their error and apologise for their previous harshness of judgment.

That society at large is sceptical on this subject ought scarcely to surprise us when we remember that, until a very recent date, the medical profession maintained the same attitude. Even at the present day nervous subjects are generally regarded by doctors' as most unsatisfactory patients. No sooner do they find such an one than they order him off to the mountains, or over the seas, anywhere to get rid of the trouble of treating him.


If your liver is deranged you have your choice of a score of remedies, from blue-pill to dandelion. You will be advised to increase your exercise and diminish your diet. Every friend you meet will tell you of something that is good for the liver.' He used to suffer just like you, but since he began to eat a raw carrot before breakfast, or to drink a tumbler of hot water at bed time, he has been a different man.

If, on the other hand, it is your nerves that are at fault, your wisest course is to keep silence; for if you should, yielding to a desire for sympathy, reveal your affliction to a friend, he will probably smile upon you in the manner of a superior and inform you what a foolish thing it is to let your nerves get the better of you.'

There is more exquisite torture inflicted by the ignorant advice given to nerve victims than a healthy man can well conceive. They are told in such an offhand manner to keep down their nerves,' that one would imagine their advisers knew of a 'nerve cropper' in the next street, who could step in and prune the nerves as a barber trims the beard.

When a man, previously healthy, is suddenly seized with a nervous attack, we know that it must have had some definite cause, and we rarely fail to do something definite for its cure. Such an

attack may be the result either of drink or worry. In the latter case the patient usually sees a lion in his path; in the former he is surrounded by an army of demons. We don't reason with a man in delirium tremens and inform him that the 'blue devils' are but creatures of his diseased imagination. We give him a dose of chloral and put him to bed. If a hospital surgeon fears to undertake an operation that he has successfully performed a hundred times, we do not try to overcome his disinclination by telling him that he is acting like a fool. We advise him to take a holiday, knowing that his fears will soon vanish with brain rest and upland air. Why, then, should we insult a victim of chronic nervous irritability by informing him that he could live like other people if only he would'?

Some affect to believe that nervous subjects feign their ailments for the purpose of attracting attention and sympathy. It is quite true they frequently exaggerate their sufferings, but that is no excuse for denying their existence. Besides, it is natural to exaggerate a grievance so long as it remains unrecognised. Others admit the reality of the diseased sensations, but maintain that the only way to abolish them is by means of reason. They hold that nervous persons ought to be taught to control their nerves by their reason, and they insist that 'plain speaking' is the strongest aid to recovery. Their experience seems to corroborate this opinion. The sufferers cease to complain to them, so they fancy that their 'plain speaking' has effected a cure. This fancy is, however, very far from the fact, which is that the patients have transferred their complaints to a more sympathetic ear.

It is not easy even for healthy persons to disregard their sensations and act according to pure reason. It is said that there are few travellers who can descend the Rigi railway without leaning all their weight against the back of their seat in order to ease the locomotive.' Reason tells them plainly that their efforts are futile; but although they assent to her teaching they cannot reduce it to practice. If it be so difficult for a healthy man to act contrary to his sensations, how can we expect it of one whose nerves are in a condition of excessive irritability, a condition which renders him liable to impressions of unusual intensity?

When Dives, returning from the banquet, asserts that there are two moons in sight, we do not hope there and then to convince him of his error. Not until the wine is out' shall we be able to persuade him to the contrary. By that time, however, he will not require persuasion his own observation will satisfy him. So it is with a nervous patient. The nervous system must be restored to health before argument can have due effect, and when the nerves are thus restored argument is needless. All foolish fancies and diseased sensations will then gradually disappear.

It is absurd to assert that there can be nothing amiss with that nervous system which does not present any manifest structural

alteration. A man may be utterly insane without any appreciable change taking place in the tissues of his brain; yet no one now denies the necessity for the medical treatment of lunatics. Nervous irritability might aptly be described as insanity of the nerves, and it is certainly quite as deserving of recognition and treatment as insanity of the brain. He whose brain is insane is generally oblivious of the opinion of his fellows, whereas he of insane nerves is usually acutely conscious of want of sympathy on the part of his friends. A harsh word or an unfriendly glance will worry him as much as a heavy loss. Indeed, many such sufferers are driven to drunkenness through dread of the petty annoyances of daily life.

But all nervous subjects cannot be called severe sufferers. There are cases in which certain local nerves have, from various causes, become so perverted in function as to produce troublesome effects, and in which strong mental control on the part of the patient has cured the disease. Take the following instance. A young lady, in other respects healthy, had gastric nerves so wayward that they would only permit a very small amount of food to remain on the stomach. This condition produced both debility and inconvenience. Her physician told her that she might by a strong mental effort free herself from the ailment. She tried her best, but failed. It became apparent that she did not possess sufficient will-power for the task. The physician therefore decided to assist the will by inducing a strong emotion with respect to the ailment; and this he effected in the following manner: Going to the future husband of the lady, he urged him to inform her that their union could not take place until she was cured. The time fixed for the marriage was near at hand, and the shock of such news had an immediately beneficial effect. Her gastric nerves began to resume their normal functions from the moment of that interview.

But the cases in which such treatment is beneficial are very rare. Even when successful in abolishing the ailment, it may prove highly injurious to the patient, who thus strains one set of nerves to control another; for if the higher nerves are not much stronger than the lower, general nervous prostration will ultimately supervene. Many local nerve affections carry off irritation from the nerve centres, just as an attack of gout in the great toe frequently relieves an irritable brain. It is therefore dangerous to suppress a local symptom without previously removing any existing central disease. In the case just related the central nervous system was healthy; consequently no harm resulted from suppressing the local symptom.

Sea-sickness is a familiar example of central nervous disturbance being relieved by the excitement of a distant local effect. Those whom the sea affects, and who cannot be actually sick, generally suffer intense nervous headache. In order to prove that sea-sickness is within the control of the voyager, a ship's surgeon intimated, on leaving port, that his cure for sea-sickness was the application of a

hot iron to the spine. Not a single complaint' was made during the voyage. This scientific inquirer thought that he had proved his point, but we may rest assured that his intimation acted not entirely in the manner intended. There were probably many cases of sickness which never reached his knowledge, and many cases of intense nervous headache produced by restraining the natural mode of relief. The best way to avoid sea-sickness is to lessen the irritability of the entire nervous system by means of a sedative drug. For a similar reason the safest way to cure the majority of nervous affections is by means of nerve rest, to reduce the general nervous excitability of the patient. What is meant by nerve rest will appear later. At present let us inquire how the prevalent mistaken notions of nervous complaints have arisen. The following case will serve as an illustration.

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Several years ago the wife of a scientific man was seized with what is called 'hysterical' paralysis of the lower limbs. She was informed that her inability to walk was not the result of any organic change, but merely of nervous debility, and she received the usual routine advice, viz. that she must fight against her feelings and make constant efforts to overcome the paralysis by force of will.' She followed this advice for a long time, but getting gradually worse, she gave up all attempts at walking and resigned herself to the ignominy of a Bath-chair. After many months of rest the use of her limbs was suddenly restored. One summer's day she was left on the seashore by her husband, who went a short distance for a newspaper. During his absence a half-intoxicated Highlander approached the lady and threatened to kiss her. In terror she jumped from the Bath-chair and made off in search of her husband. From the date of that incident she gradually recovered her power of locomotion.

At first sight this case seems to support the treatment by forced walking. On consideration, however, it becomes apparent that rest, not exercise, was the means of cure. As long as the patient forced herself to walk she grew worse. Her cure was effected by the prolonged rest to which she subjected herself in the belief that she was incurable. She came to accept the paralysis as inevitable, and this gave her mental rest; for she entirely ceased to worry about recovery. Had she continued to make walking efforts, or even mental efforts, towards recovery, she would not have recovered so soon. The fright to which she was subjected merely revealed to her the fact of her cure. The sudden emotion communicated nerve power to those limbs from which for years it had been excluded; but no such emotion could have enabled her to continue walking if a cure had not been previously effected.

Under great excitement a half-cured patient will sometimes dance at a ball or climb a mountain, only to lapse into deeper exhaustion when the mental stimulus is removed. It is, therefore, highly injudicious to urge a nervously exhausted person to exertion before he has had rest sufficient to enable him to lay up a fresh

store of nervous energy. Under the 'forcing' system one patient walked herself almost into a lunatic asylum to ward off a threatened attack of hysterical paralysis. This is an instance of the lower nerves being controlled by the higher, to the detriment of the latter. It was ultimately decided to prohibit walking in this case, the power of reason being considered of more importance than that of locomotion.

Against the rest cure it is frequently urged that if you once put a nervous woman to bed she will remain an invalid for life. This mistake has arisen from want of experience, for, until Dr. Weir Mitchell inaugurated this treatment, no systematic rest had been employed in this class of cases. Patients were prevented taking to bed until they could hold out no longer, and were obliged to lie still by sheer nervous exhaustion. Then the doctors gave them up as incorrigible, and they were allowed to follow their own inclination.

Their further history is interesting and instructive. They now become chronic invalids, with whom, according to 'everybody,' there is nothing the matter. They are tortured by the consciousness that their ailments are doubted, and this goads them to exertion whenever they are able to move. Thus they squander every small gain of energy, and still further delay the cure. As long as such efforts are continued recovery is impossible; but when hope of cure ceases, and the rôle of invalid is fully accepted, the nerves are allowed to enjoy rest, and begin to gather strength.

If the patient be now removed from sources of agitation, and rest continued for a sufficient period, the exhaustion may ultimately pass away. This favourable result would take place sooner in many cases if the sources of agitation were fully appreciated by friends and attendants. But it is almost impossible for them to understand that trivial circumstances can be of much moment to the patient. They generally regard any apparent ill effects from trifles as the pure result of imagination, and consequently ignore them. They do not know that the diseased imagination is a part of the ailment, which absolute nerve rest is calculated to remove. In the time of rest, however, a new difficulty arises. The muscles, through want of exercise, become weak and flabby, and are utterly unable to respond to the call of the renewed nerves. A period thus arrives when, although the nerves are cured, the patient is still unable to walk through muscular weakness. There being no apparent difference in her symptoms, neither she nor her friends suspect the favourable change in her condition. It is at this stage that 'wonderful' cures are wrought. If a faith healer now gains an influence over the patient, he will soon work a 'miracle.' If a new physician be consulted, he will gain great credit by carrying out the old force method. All that is necessary is, by compelling her to walk, to reveal to the patient the fact of her cure, and to get her muscles strengthened by exercise. One medical man used to drive such patients a short way

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