Alfred T. Schofield - Nerves in Disorder (1903)

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NERVES IN DISORDER
A PLEA FOR RATIONAL TREATMENT
BT
ALFRED
T.
SCHOFIELD,
M.D.,
Etc.
HON. PHYSICIAN FRIEDENHEIM HOSPITAL
FUNK & WAGNAI.I.S COMPANY

N:BW
YORK AND I.ONDON
TO
I.
E.
AND OTHER HELPERS

THIS BOOK
IS
DEDICATED
4.252Q4:
PREFACE
T
at
for
HIS
little
book
consists
substantially
History of
this book.
of a lecture (with additions) delivered

Sanitary Institute twelve years ago.
the
It was printed at the time
by
special desire
it
private circulation.
Now
for
is
entirely
recast,
and published
the
first
time in
response to very numerous
requests.
in the
Given originally to the public

of an address,
it
form
Free from
caiities.
was kept
free
from needless
;
and
in
unintelligible medical
expressions
it
and
the additions needed to bring
up to
date the same style has been preserved.

It
is
now
published because
it
is
hoped
Object, the
suffering.
that an- earnest attempt to plainly set forth
what Functional Nerve Diseases

will dispel the
really are
ignorance which regards them
mainly as either shams or frauds.
short
viu
PREFACE
however imperfect, couched
treatise like this,
in plain phraseology,
may
also
do something
to relieve those needless sufferings of nervous
people which are due to a misapprehension

of the nature of the disease,
coupled with
doubts as to
its
absolute reality.
If the causeless misery so

flicted
frequently infriends
by the
patient's
it
nearest
can
be lessened, as
of this book,
justified.
its
is
hoped, by the reading
publication will be
more than
We
this
speak of "justification" because

is
we
think
distinctly
needed
in
any
medical or semi-medical work brought before

the public.
Reason
publica^'*
for
^g ^
rule,
medical works are for medical
men, according to the unwritten law of the

profession.
But when
it
appears possible, by
the
diffusion of
knowledge and the simple
presentation
orders,
of facts concerning nerve dis-
to
lessen
and
often
to
end
much
needless
pain
the
inflicted
on
to
these
inspire
lines
sufferers,
and
at
same time
hope by
of treat-
pointing
out
is
common-sense
ment,
it
manifest that an exception must
PREFACE
be
ix
made.
It
is
hoped
that
the
present
work
may
accomplish
something towards
this end.
Moreovei
of the brain
owing to the
increased value importance

of subject,
as distinguished from the rest
of the body in
functional
the
march of
is
civilisation,
nerve disease
becoming daily
of
of more importance, and the recognition

its
nature, as well as the value of
its
early
cure, a matter of ever greater consequence.
few simple hints on self-cure in slight

well
as
cases, as
the elementary diagnosis

rational
of these cases, and an outline of
medical treatment, have been given.
The treatment
eases,
of
functional
nerve disdelivered,
Old abuses
still
exist
since this
lecture
was
first
has undoubtedly been largely changed for

the better by
some
skilled specialists,
and
seem
left,
some
wholly
of
my
statements
may
they
not
are
justified
now
exist,
but
because, as
many
still
a sufferer knows, the old
abuses do
enlightened
far
and a true view and

of
treatment
nerve
disease
is
from universal.
PREFACE
short
glossary
is
appended, not
alto-
gether on account of the difficulty of the

words, but to point out ing the author wishes
to
the special
mean-
emphasise in the
text
ALFRED
T.
SCHOFIELD, M.D.
6,
Harley Street, W,
Easter, 1903.
CONTENTS
CHAPTER
I
PAGE
FUNCTIONAL NERVOUS DISORDERS

Increase of Functional Nerve Disease
Strain increases,
Brain
Routine
Body
Strain decreases
Value
of understanding the Subject
Functional Nerve
not "
Disease
little
understood
Former
is
Treatment of Nerves
taken Diagnosis
Hysteria
Painful Results from MisShamming"
Nervous Invalid in a Healthy Family Cause of Cruelty Treatment of a Nerve Sufferer
Illustration
from an Actual Case
Result
of
seeing the Doctor

Life for
The
Turning-point in her
Good
or for Evil
Mother needed
Sufferings not exaggerated A Change
Case
for
of a Nervous
Three
Causes
of
this
Treatment
being misunImagination
Patients are often to
blame
derstood
Relief
when understood Imaginary
Diseases and Diseases of the
The Mind is one Consciousness is Mental Sight The Process known by the Product Consciousness a Small Part of Mind The Mind and the
Unconscious Mind must be recognised
CONTENTS
Spectrum The Supra-conscious We live consciously and exist unconsciously Limits of the Conscious Mind Three Systems influenced by
the Will
Mind Mind
Reason
Rational
Action of the Unconscious
and
Unreason
Unconscious
Sir
plays the Greatest Part in Disease
James Paget and the Unconscious Mind Mental Sufferings in Nerve Disease Physical Sufferings Fears of losing Reason unfounded Neuras-
thenics and Neuromimetics
Dr. Allbutt on NeurIts
asthenia
thenia
HypochondriaVarieties of Neuras " Hysteria " of Neurasthenics should not be generally used Proper Use But used here to mean Neuromimesis Organic
Classes
and Functional Various Symptoms.
CHAPTER
DESCRIBED
Normal Nerve Action
Structure
II
NEURASTHENIA AND NEUROMIMESIS

33
Six Varieties of Nerve

feel,
Teeth
and
ings
feel
Transference of Vibrations How the are on edge We think as we Real Feelas we think Ideas
set start
We
are not deceived if the
Ideas are
Conscious
tions
Unconscious
Vibrations or
Sensa-
from Involuntary Memories Vibrations from Voluntary Memories Pain is
Vibrations
felt
in Brain,
but referred to Nerve Origin in
Skin
Finger
Various Causes of Pain in the Little "Ideal" Agony in a Butcher Seven Causes for the Same Pain Undistinguishable in
CONTENTS
Nerve Disease Pain is a Mental Impression Pain may be with or without a Physical Origin Unconscious Mind produces Nerve Mimicry Health is Unstable Equilibrium Power of the Intellect Power of the Emotions Etiology The Predisposing Cause of Nerve Disease is Heredity Exciting Causes Worry Mental Idleness Strain and Overwork Physical and Other Causes Nervous People the Salt of the
Earth
Details of Neurasthenia Causes of Neur Neurasthenia

in Clever
asthenia and Hysteria
Classes of NeurasthenicsNot due to Rush of Life Causes of Neurasthenia Effect of Alcohol List of Symptoms of Neurasthenia Some Additions Classification of Symptoms Two Stages in NeurastheniaSymptoms of Nerve Irritation Repose Sign of Brain Power Nervous Debility Neuromimesis and Hysin the Brain Pain the Common teriaSeat Symptom in Hysteria The Cause being in the Brain It wrong to describe " Brain Pain " as Nothing at Symptoms of True Emotional
People
a.
is
is
all
Hysteria
Hysterical and Insane Nervousness not Hysteria Hysteria in Ill-balanced Brains " Suppressed Gout and HysteriaDr. Buzzard on the Hysterical Hysterical Cases not Fraudulent Hysterical Joint Disease Changes in the Joint Hysterical Spinal Disease and Paralysis Cure of a Case Varieties
mimesis
is
Simulations
"
of Hysteria, or Neuro-
ot
Paralysis
Paralysis
of the
Special Senses
of Hysterical
Hysterical
Tumours Fifty Cases
Tumours Cure of a Case Spasm of the Gullet Hysterical Aphonia Other Diseases Sym-
ptoms often appear Fraudulent Neuromimesis is more than Mimicry Symptoms of Hysteria
or Neuromimesis.
CONTENTS
CHAPTER
III
PAOI
ON MENTAL THERAPEUTICS
Mental
Therapeutics cannot
scientifically
87
be omitted
Seldom studied
The
Physician wields
for
Two
or
Forces
Personality
Good
of
Evil
Manner
Reason why Value of

in
Medicine
Value
Faith
and Hope
Great
Power
of
Prophecy
The
Unconscious
Mind
De
Fleury's
Physician's
Vestibule
The
Inner Chamber of Mental Therapeutics

Curative Qualities
Mental
The
of
the
Medicine
Value
Doctor himself as a Family Physician
Four Varieties of Mental Therapeutics The Vts Medicatrix Natura Is it a Force? Views of
the Action of Dr. Mitchell Bruce The Vis the Unconscious Mind Mental Therapeutics act in All Diseases Examples Anaesthesia without Anaesthetics Sickness and Death from
is
Mind
Action.
CHAPTER
IV
SELF-TREATMENT, UNCONSCIOUS AND CONSCIOUS

The
ment
Picture
107
Treatment
lightly dismissed
Description of a Clinique Success in Treatin
largely
due to the Vis Medicatrix Nature
Dr. Wilkinson on the Vis Medicatrix Natures Medical Treatment of Minor Importance
Many
Cases
Cure
is
much more
difficult
in
many Nerve
Diseases
is
trix Aaturcz itself
Because the Vis MedicaInactive First Step to

is
CONTENTS
restore the
Vis to Activity
Functional Nerve Diseases

flourish
Quacks thrive Why Quacks

Good
Teaching
is
on
still
The
Public
care most for
Mental Therapeutics ignored

is
Cures Treatment
in-
mostly Empirical
Scientific
creasing
Cure
of Disease by the Patient
Patient can do
much in an Early Stage

possible
Causes as
far as
Patient
Remove
can
can change
the Environment
Doctor
often
No
One Reason
Disease
in
for consulting
Loss of Self-control
the
Patient
By exerting Mental Nerve Diseases Pastor Chiniquy's Chiniquy and Typhoid Fever Second Cure Cure of Typhoid in a Nurse The Will thrown into the Scale Many Similar Cases Auto-suggestion Without Hypnotism Dominant Ideas determine Conduct Illustration of Auto-suggestion Domestic Treatment Nerve Disorders seldom unhinge the Mind.
treat
Powers
Especially
CHAPTER V
MEDICAL TREATMENT OF FUNCTIONAL
NERVE DISEASES
Some
Pain
is
.129
Conditions of Success in Functional
Nerve Diseases
Sympathy
in
in
the Physician
a Mental Fact
Perseverance
the Physician
Patience in the Physician the Physician Firmness in

Physician
?
Tact in the
Should a
Nature of Neuromimesis Difficulty of treating these Diseases Importance of Honesty Attention to

ignored or not
Symptom be
The
Details
Difiiculty
fidence* 'n
Failures ConDoctor ind Nurse Study the Patient's
of
treating
xvi
CONTENTS
Machine-made "Cures" useless Methods must be Adequate Ill-health more Expensive than any Cure No "Nerve" Nurses Neurasthenic Nurse not yet produced At born, not made Hence the Present the Nurse Expense of Cures On Nursing Homes Quality
Personality
is
PACK
of
Home
determines Success of Treatment
Should Doctors have their ow^n ? The Matron Treatment of Neurasthenia Proper Treatment
of Hysteria
Best given indirectlyHypnotism Thought-turning Personal Influence of Doctor After-treatment Cycling and Golf
Suggestion
Special
Value
of
Massage
Isolation
Treatment
in
Neurasthenia Remove
Cause in Neurasthenia
be removed
Cause
can generally
Travel generally BeneficialValue of Rest in Bed Guide to Treatment PharmacyAfter-cure Which Voyages are Best Alcohol and Neurasthenia Treatment Hysteria only Organic of Neuromimesis
Five Laws of Health
Is
it
Natural
Symptoms
Observe
the
Disease mistaken for Hysteria
on Both Sides
and Brain Hypnotism not very Successful in Hysteria Range of Mental Therapeutics Ideas not too Difficult Cures effected by Unconscious Mind Rational and Psychic Treatment Healthy
often a Mistake
The Vicious Re-make Body
Mistakes made Circle Travelling
Brain exercises
Good Influence Electricity
Importance of Suggestion and of Isolation
New
given
Brain built up No Details of Treatment Value of True Christianity.

is
A SHORT GLOSSARY
INDEX
.173
.179
Functional Nervous Disorders
CHAPTER
THERE can be no
of
the
doubt that disordered

.
.
increase of functional
nerves are everywhere increasing.
nerve
do not speak here of organic nerve diseases

brain
or
spinal
cord,
producing
such symptoms as paralyses, spasms, ansesthesias, or atrophies,
but of functional nerve
troubles of
all sorts,
whose symptoms, though

to
classify,
perhaps
too
vague
yet
cause
great pain
to those
who
all
experience them.
over the world,
These
in
sufferers
abound
but are said at present to be least numerous
Germany, Russia,
in
all
Italy,
and Spain, more

still
numerous
France, more so
in
England,
and most of
1
so in the United States.
It is certain that,
with the increasing evolu1
Brain
strain increases,
tion
of the bram, which
is
being worked
harder and harder every day and kept at a

continually augmenting strain and pressure,
3
decreases.
NERVES
IN
DISORDER
must
increase.
these functional nerve troubles
On
is
the body, on the other hand, the strain

certainly less
;
not only
is
labour-saving
more in use, but locomotion is becoming more mechanical, and in all varieties of work the need for muscular
machinery
everywhere
effort
is
decreasing.
Indeed,
were
it
not
for
our athletic sports and games the body
might soon show signs of deterioration.

it
is,
As
and
it
it
exhibits none of development
its
is
value consists more and more in that
a necessary agent of the brain and mind,
to which,
when
in health,
it
acts as a well-
trained servant, obeying orders

for its interests.
and working
Money now
at the
is
almost
exclusively
made
it
expense of the wear-and-tear of nerve,

muscle tissue
;
as contrasted with
and
is
a matter of ever-increasing economical importance to keep the money-making machine,

the brain and mind, at the highest productive
pitch
Value of
understanding the subject.
in short, in a state of perfect health.

life
right understandinsr, therefore, on the part of the laity, of the way in which the
The
altered conditions of
affect the
;
nervous
organism
is
of the utmost value
and a true
economy
consists in
making use of the most
enlightened and modern methods of restoring

it
to health
It is well
when
overstrained or overtaxed.
in spite of this, Functional
nerve
known, however,
organic
full
that
while
nerve
diseases
.
have
disease
little
un-
received their
tion,
share of scientific attenthe

subjects
derstood.
and been
of extended
less
research for
many
years,
much
it
time or
thought has been

nerve disorders.
expended on functional
Indeed,
is
only of late
given, that
years, since this lecture
was
first
they have been fully recognised as distinct

diseases in our country.
France and America were the two pioneers

in diagnosis
and treatment, and they are
still
as far in advance of
England
in
methods and
therapeutics as they are in their literature
on
the subject.
Listen for a
moment
to the usual routine Former
treatment in England
"
of a
nervous
case, trtaunent
When
one of these victims to hypochondria,

of
who are commonly called -malades imaginaires,

has recourse to medicine for the
pain, or
told
it is
relief
is
some other
disturbance, he
;
usually
of no importance
is
that he
is
fanciful
and some anodyne
carelessly prescribed.
The
patient,
who
is
really suffering the pain

feels
he has suggested to himself,
convinced
6
that
his
NERVES
malady
is
IN
DISORDER
known,
incurable
not
and
that
nothing can be done for him.

that
his
The
idea
complaint
is
becomes
patient,
intense in proportion to his high opinion of
the physician's
skill
and thus the
who was
suffering from the painful affection
suggested by his mind, often goes away, not
only unc'ired, but incurable." *

It is
important to observe that a disease

is
due to the imagination

imaginary disease, but
functional
not necessarily an
various
may produce
organic
and
even
disturbances.
A
is
wise physician
is
once said to
to say he
ill
me
ill
'*
:
If a
man
so
ill,
ill
as
is
not
he must be very
when he indeed." The

origin
diseases grouped under the heads of nervousness,
hysteria,
etc.,
are
real
in
and
;
effects,
it is
and formidable
in their
nature
and
been
high time that the ridicule, the offspring
of ignorance, with which they

so long
Painful re-
have
surrounded be entirely done away
with.
These unhappy patients have been

and .,.,.is
mistaken
diagnosis.
greatly wrongcd,
often
cruelly treated.
..
nervous mvalid
iar greater
;
sunerer
than a
man
*
"
with a broken leg
but with
a would-be sapient but truly

Animal Magnetism
"
asinine nod,
(Parkes).

we
are content to dismiss the former as " only
hysterical."
In a recent medical work

sister
we
read
"
The
was
Hysteria is not "sham-
of the ward and the house physician
ming."
settled
between
them
that
the
case
hysterical,
{i.3.
and
;
the girl
was malingering"
shamming.
to
shamming) that is, that hysteria means Such a statement takes us back
ages,
the dark
when
all
;
insanity
for
it
was
possession by an
evil spirit
certainly
implies that one with serious

is
nerve disease
simply controlled by some lying principle.

less
More sympathy and

felt for
contempt are indeed

"
a drunkard than for a hypochondriac.
On this
as
head Sir James Paget says,*

'
To
call
a patient
hysterical
'
is
taken by
silly,
many
.
.
people
meaning that she

if
is
is
or shamming, or
.
could get well

...
she pleased.
Hysteria
useless
it."
a serious affection, making
life
and unhappy, and not rarely shortening
Picture the misery of a nervous invalid in a
nervous
invalid in
a hearty English family, say of the bucolic

order.
" It is all fancy," is
;
a healthy
the stock phrase
before her face
" it is
all
humbug," the one

is
behind her back.
This ignorance
partly
due to the
Sir
fact that the
symptoms
are gene-
James Paget,
" Selected Essays," p. 74,
8 rally
NERVES
subjective
IN
DISORDER
objective,
rather than
is
and
in
that observation
not so
much needed
their interpretation as reasoning power.
So much
object in
is
this
the case that one great
publishing this
monograph
is
to
put an end to the unconscious cruelty that

Cause of
cruelty.
in these conditions. This cruelty spnngs from several reasons, which it will be well to consider in some detail. Let us
is
SO
common
first
of
all
get the picture clearly before
us.
Treatment of a nerve
sufiferer.
mother or a daughter, more rarely a
father or a son,
becomes gradually the victim

Let us suppose the
family.
of some nervous disorder.

case of a daughter in
some robust
From
of,
the
first
the sufferer feels instinctively

is
that the disease
something to be ashamed
far as is possible.
and to be concealed as
is
This
of course only feasible up to a certain
point,
and as soon as the
girl
begins to be
a trouble to others every

her family to assure her she
" to
is
effort is
made by
" it is
nothing," that
only " putting

it
it
on," that she could

it
" stop
if
she liked," that she only does
gain sympathy," and so on.

for
passion
the
sufferer
it is
is
If comshown by any
member
by the
of the family
severely repressed
others, as being
"
bad
for her "
and

"encouraging her."
treated
,
9
lUustration
came
to a physician quite recently,

his
One who ....
had been so
,
from an
actual case.
and on entering
into an
consulting-room burst
agony of
girl
tears
and exclaimed
I
"
Oh,
"
doctor
do you think
am shamming ?
I
This
say,
was
really suffering,
advisedly
agonies.
The mental
compared
to
tortures, indeed,
are often so indescribable that no physical
pain
is
to be
them
and over
and above
all else is
the fear that the sufferer
should be dubbed "hysterical," which
means
than
and can
fraudulent.
mean
to
her nothing
else
These sufferings are at times so
great that they

to
may
almost drive the patient
utter
desperation, but they

is
have to be
account
concealed as far as
possible on
still
of the general ignorance that

to their real cause.
prevails as
Eventually, in
most
cases, matters reach Result

sufferer,
doctor.
of
seeing the
such a pitch that the self-conscious
who
feels
by
this
time more of a culprit
than a patient, has to see the doctor, probably the local medical man.
to
He, possibly
some extent
influenced
by the family
mostly
" fancy,'*
request to confirm their verdict, and believing

in
his heart that nerves are

total
from a
absence in his
own
medical
lo
NERVES
IN
DISORDER
in
Studies of
any training
tells
their pathology,
is
very likely
the patient that she
all
right, her pain, etc., are
purely imaginary, and
the
girl leaves his
presence being assured inis
directly,
and partly convinced, that she

all
an
impostor, and that after
she
is hysterical.
The doctor's official sanction always makes though such persecuthe home persecution
tion
is
not unkindly meant, but intended to
act as a
is
cure more
reduced
physical
to
severe
and the and
sufferer
soon
apathy
despair.
this
Obvious
symptoms by
time
probably supervene, and the patient gets so much worse that she is reluctantly taken to get
the opinion of
practically,
is
some eminent
of the
specialist.
in
This,
life.
the turning-point
her
The
turn-
If the
Selection
is
man
be a wise
student of
inhei?fe
one,
and he
truly
a serious
or goo
fyj^^.^jQj^j^j
nerve disorders, the patient has
not been five minutes in his she

feels
room
for
it
before
first
she
is
understood
taken
the
time
since
she was
ill,
may
be
many
her
years before.
She begins
have
timidly
to describe
symptoms, which
with
ridicule,
hitherto
been
apolo-
treated
getically,
and
is
but as she finds she

to,
gravely
listened
and
apparently
believed,
she

grows
bolder
ii
and more
fluent,
and when
she has finished, she no longer expects to
hear the familiar formula, "
It is nothing," etc.,
but listens with wrapt interest to her prospects of cure

follow to the
first
;
and she departs willing

has
treated
she,
to
utmost the directions of the
man who
fall,
with respect.
nately
as
Should
is
still
her sufferings however, unfortu- Or
for evil,
possible, into the

little
hands
in
of a consultant but
his
more modern
views than the old family practitioner,

-
and should the great man confirm the verdict

that "it is nothing,"
"
-^
and prescribe that she

"
must take a change," and not

of
herself,"
think so
much
sealed,
her
fate
is
practically
and she departs not only unrelieved,

life.
but possibly invalided for
Would
that
could depict the causeless
cruel sufferings
and the chronic invalids that

treatment
are entirely
the results of such
Consider the feelings of a mother

her
life
who
fail
has given her strength to her

last
it
all Case of a nervous family, mother,
and who, when at and her

in
begins to
feel
and
nerve symptoms set

sufferings
in, is
made to unreal. Or
a fraud
again, con-
sider the case
of a daughter, the sole invalid

is
an otherwise healthy household, who
12
NERVES
IN
DISORDER
compelled to hide her nervous dreads and

agonising
either the
pains
for
fear
of
ridicule,
until
mind
or nervous system entirely
gives way.
Sufferings not exaggerated.
Do
not think for one
moment
would
these sufferI
ings are imaginary or overdrawn.
should
lecture
exist in
never depict them,
nor
not
this
be published, did
know they
;
hundreds of cases to-day
indeed, so
common
are they that there are few

lines
their
who read these who will not be able to recall from own knowledge some such scene.
is
A change
needed.
It
truly high time that

class
this,
the most
neglected
of disease,
received
attention at the hands of the profession,
more and
that
it
occupied a different place in the minds

;
of the public
so
that
the added
load of
cruel treatment
and misunderstanding should

the
be taken away from
nervous
sufferer,
and he or she be no longer condemned

others.
to
endure needless pain from the ignorance of
So much
for
the picture
now
for
the reasons that alone

Three
causes of
this treat-
make
it
possible.
It
appears to
me
that the
common
at
con-
temptuous treatment of nervous invalids and

their
ment.
own deep
feeling
of shame
their
ailments spring from three distinct causes.
"
13
In the first place, the medical attitude to-
wards these cases
is
too often contemptuous
or incredulous, and these feelings are reflected
and exaggerated
of the patient.
in the
conduct of the friends
In the second, popular opinion has for so
long associated the
very word
it
"
hysteria
is
with fraud and

vain to combat
pretence that
it.
almost
In the third place,

that the
it
may
not be denied
symptoms of
these diseases, spring-
ing as they do from disordered nerves, do
not exhibit the grave and regular sequence

of organic diseases, but are often to the last
extent vague, contradictory, and capricious,
and sometimes apparently
foolish.
this, if
We may
this matter,
even go further than
we
r
Patients are often to

for
are justly to hold the balance of truth in blame
and say that patients have often
being misunder-
themselves to blame to no small extent for

their
own
capricious conduct, that they could
well
repress,
which leads to such
painful
suspicions of their
good
faith.
It
may
not
be denied that the idea of fraud would be
much
less
common
if
patients
vigorously
exercised whatever self-control

possess to confine the signs
they might
of disease to
14
NERVES
symptoms
loss of
IN
DISORDER
are
is
those
which
unavoidable.
itself often
Doubtless
self-control
Still
one of these
frequently
the
signs.
much more might

to
be
done
of
"
by patients
putting
it
avoid
"
appearance
on
that
they are so often credited with.

this little hint
Perhaps
may
be as useful to sufferers
I
as
hope the strong remarks

to their friends
have already
advisers.
made may be
All
this,
and
however, does not
throw any
doubts upon the very real character of the

disease or the pain attached to
Reiiefwhen understood.
it.
When
once nerve patients can go to doctors
with confidence that their sufferings will be
understood and regarded as real

fide,
I
and bond
from
this
am
convinced that, so
far
tending to establish and perpetuate and foster

these diseases,
terrors,
it
will largely mitigate
their
greatly shorten
their
duration,
is
and
make many
Imaginary
diseases
life
happy
that
at present
tortured and despairing.
and
the iraagi-
the
years ago doctors Up ..... distmctions we have drawn

to fifty
, ,
failed to
,
make
the
as
to
between
to
an imaginary disease and one due

imagination, malingering.
and
airily
dismissed
both
No
suspicion
seems ever
to
have
entered
their
minds as
the
root

error they were making,
15
and the disastrous

they were
surely
consequences for
responsible.
It
which
never occurred to them that
an imaginary disease was a disease a person

Jiad not got
tion,
;
but a disease due to the imagina-
had got. Once we thoroughly
on the contrary, was a disease the person this is fairly understood, and and
clearly
grasp that
differs
disease of the imagination only
from
a disease of the lungs in being more obscure
and
difficult to treat, that it
probably causes
in
more
suffering,
and may end
death,
we
are up to date, at
any
rate, in this matter.
Archaic survivals (early Victorian), however,
everywhere abound amongst doctors, to

the above
is
whom
word
utterly futile
playing
the
with expressions, and

" disease."
I
trifling
with
do
not, of course, defend
the term "imagination" or "imaginary" as

scientific,
but
it
is
accurate enough for our
purpose.
The
mind
difficulty
is
that, the
disease
being Uncr
.1-
seen to be partly of mental origin, and no miud
must
being
known
or
recognised
by
the
nised.
doctor but conscious mind, he concludes that

the patient
must be aware of the mind action
which
is
causing the disease, and that she
l6
NERVES
therefore to
IN
DISORDER
to blame.
is
some extent
will
The
truth,
is
which we hope
now be
recognised,
that all the causative changes take place
in the unconscious mind,

is
and that the patient
wholly ignorant of anything but the results
in the
body
the
pain or disease suggested.
This
is
the true solution of the difficulty.

to explain as
But we must try

possible what
scious
"
simply as
we mean by
"
the terms " con"
and
unconscious
in
minds.
These
expressions
are
themselves
misleading,
and give the idea that there are two minds, and thus obscure the essential unity. I
only use the latter term here provisionally
until
"
mind
all
"
is
generally
understood
to
include
The mind
IS
mind, and not only, as now, a

of
it.
small
part
'
one.
The mind
in
is
one
'
but
while one part
is
constant illumination,
;
another
is
never lighted by consciousness

stretches
is
and between the two

uncertain
a tract of
in light
extent that
in
sometimes
and sometimes
region.
nessTs'^
darkness
the sub-conscious
only
represents
;
Consciousness, after
all,
Tt^
what
are
see
of
my
mind
but surely there

its
many ways
;
of detecting
presence
limit
besides sight
and one might as well

the
\^
body
to
what one can see of
it,
ignoring
those parts that are discerned

to
by
touch, as
make
consciousness the only proof of mind.
We
can,
of course, see the image of our
faces in a glass, but
we can
just as clearly
see the unconscious
mind and we have no more
reflected in actions,
right
to
deny the
existence of the one than of the other.
To
The
cess
pro-
say you cannot thmk or

conscious of the process,
tell
known
feel unless
you are
by the
is
to say
one cannot
is a watchmaker unless one actually him make the watch whereas one reaches this conclusion by seeing the watch In this case you itself which he has made. infer the process when you see the product
man
sees
the watch.
In like manner, the results of
unconscious
thought seen in consciousness

rid of the idea that
it
prove the existence of the unconscious mind.
We
must not only get

is
consciousness
mind, but also that
is
the only proof of mind.
Mind,
in
fact,
may
be
conscious, sub-
conscious, or unconscious.
The second
state
may
be brought into consciousness by

conscious
effort,
the last cannot.
Our
mind
as
compared with the
nessâsmlii
^^^'^^'^
unconscious mind has been likened to the
i8
NERVES
IN
DISORDER
visible
spectrum of the sun's rays, as com-
pared with the invisible part which stretches

indefinitely
on either
side.
We
know now
that the chief part of heat

ultra-red rays that
comes from the

and the main
rays
show no
light,
part of the chemical changes in the vegetable
world
is
the
result of the ultra-violet
at the other
end of the spectrum, which are

eye,
equally invisible to the
and are only
recognised by their potent

The mind
spectrum.
effects.
Indeed, as these invisible rays extend indefinitely
on both sides of the

that the
visible spectrum,
so
we may say
only the visible or
mind includes not conscious part, and what we

lies
have termed the sub-conscious, that

mind, that
the
below
or at the red end, but the supra-conscious

lies
beyond
are
at the violet
end
all
regions of
higher soul and spirit
life,
of
which
we
only
at
times
vaguely
conscious, but which always exist
and contain
our most abstract and spiritual faculties as

surely
as
the
sub-conscious links us to the

;
body on the other

conscious being
both the supra- and subof

the
parts
unconscious
mind.
levels
is
Of
course,
speaking of regions and

non-extension
doctrine.
I
merely
figurative, the
of
mind being a fundamental

would include
a a
faculty
^
,
19
in
the
.
supra-conscious such The supr-
as
conscience,
faculty.
which
conscious.
is
surely
half-unconscious
Moreover,
is is
the
best
supra-conscious, like the sub-conscious,
apprehended when the conscious mind

active.
not
Visions,
meditations,
prayers,
and
even dreams have been undoubtedly occasions

of the working of the
mind apart from the

our lives through the
reason or consciousness.
The power
voluntary
to
use
muscular
and
nervous
systems
appears to have been committed to our reason
and conscious will-power

to carry
while the power
on the processes of life and existence

is
generally
under the control of instinct or
unconscious mental power.

to live consciously
We may
be said We
and
to exist unconsciously, and

;
live conscioxisly exist
The two powers

to
are variously exercised
for sdousiy.
while in health the conscious
mind
it
often acts
the detriment of the body, the uncon-
scious never does, save
when
is
diseased.
The
will
direct limits of the conscious
mind and
generally
indiLimits of
scious
are
fairly
defined,
and are
in
pretty
constant, though
some few
viduals they extend
much
further than in the
'"
majority
but under no circumstances can
the will produce
any
direct organic
change
in
NERVES IN DISORDER
the body.
With heart and

is
circulation
the
direct influence
effort
in
;
very small.
the
By
heart
conscious
some
and
I
people
believe
it
can
be
slowed
there
have
been
instances
where
could be arrested.
We
cannot hold our breath indefinitely, but short

of this can vary respiration to any extent by
our
Three
systems
in-
will.
The
respiratory (amongst
the
vegetative
fluenced by the will.
systems)
and
the
nervous
and
muscular
systems are the three over which the will

has a large range of power, while over the
rest its control
Rational action of
the unconscious is
very limited.
Wherever the boundaries of the conscious

are
reached,
there
the
powers
its
of the
un-
mind.
conscious
mind
begin,
and
actions,
though
only styled
to
instinctive,
far
may
be
truly said
be on the whole
than those
to
more
reason,
rational
and
is
beneficial
Reason and
unreason.
inspired
by what
but
always
just
assumed
often
is
be
which
as
unreason, and, indeed, be-
over
comes at times a positive power for evil the body a disaster which rarely happens in the case of the unconscious mind.
We
think
we
it
live
is
entirely
as
reasonable
beings,
but
very seldom that

exist for a
we
do,
and none of us could
day were

we not guarded and guided
a never-erring instinct
incessantly
21
by
A
is
great part of our mental actions being Unconscious mind level of consciousness, the result plays the
beneath the
that the
mind may play a
large part in pan
in
disease without our being in the least aware
of
it,
or having the power to
prevent
it.
No
the
physician
who
limits
mind
to conscious-
ness can in
true
;
my
it
opinion rightly understand
cause of
many
functional
nerve
diseases
and
is
to this disastrous limiting
of our mental processes to our knowledge of them that so
much
is
of the needless pain

really due.
we have spoken of
A
in
notable illustration of this
may
be seen
Sir
James
Paget and
the uncon-
James Paget's essay on " Nervous Mimicry," * where he evidently feels that nervous mimicry is mental in its origin, and yet, limiting, as was common, mind to
Sir
mind.
consciousness, he
this
is
unable wholly to accept
hypothesis in
all cases.
Some
{i.e.
those
that can
somehow be connected with conhe of course

recognises
(in
sciousness)
as
of
mental causation, while others

or at
children,
any
rate having nothing to
do with
consciousness) he does not.
He
also points
Sir
James Paget,
" Selected Essays," pp. 82, 83.
NERVES
out that
IN
DISORDER
failed
he has
always
himself
to
produce
any
mimicry of disease
by any
it
direction of his
is
mind (showing again that

mind
this
the conscious
that he
as
alone recogall
nises).
He
gives
;
proof that
truth
is
cannot do so
whereas
the
that
none can produce

scious
effort,
nervous
if
viiniicry
it
by con-
and
they did
would be
fraud,
Mental
sufferings
in
and not neuromimesis. which

preventable, there
itself
Apart, however, from any suffering from

errors in diagnosis,
is
is
nerve
disease.
in
functional
nerve disease
always
disease
great and unavoidable misery.
The
may
after
begin insidiously, and
it
is
only perhaps
patient
some
interval of time that the
realises
that
or,
she
as
all
is
it
different
from
others
her,
physically,
often
appears to
mentally
as
for
sufferings can be
grouped
mind.
belonging
to
the
body or the
Mental suffering
disorder of the
may "be
acute without any Indeed, where
mind
existing.
the
mind
is
is
partly or wholly unhinged, suffer-
ing
often wholly absent.
In nerve disease the mental sufferings are

really mostly
due
to the fact that
the
con-
scious
mind
is,
as a whole, sound,
and hence
thf'
can
feel
intensely the disordered state of

nervous system.
23
This
may show
itself in
dreads, fancies, fixed ideas, morbid thoughts,
suspicions
or perhaps losses of memory, of
association, of vigour, of keenness of intellect,
of quickness of feeling, of moral sense, or the

faculties
may
be exaggerated
it
in
many ways
but through
all
the mind, as a whole,
is
sound, and generally recognises the morbid

state of the nerves
to
have
it
removed
when explained, and longs though in some cases

;
the true condition
is
not perceived.
The
every
bodily
sufferings
to
may
agonies
range
from
Physical
sufferings.
mere weakness
the
of almost
known
fidelity,
disease,
which
can
all
be
reproduced by the unconscious mind with

perfect
will or
It
even against the conscious
wish of the person.
will
be
readily
understood,
without
left
entering into details (which
may
in
be
to
the next chapter), what a range of suffering

is
comprised here
in
mind and
body
in
fact, it
may
be said once
for all that in

itself, is
no
other disease, not even in cancer
such
an extended range of acute and often intolerable
pain
;
possible
as
in
functional
nerve
and this class undoubtedly contains some of the greatest sufferers on earth. Not
disease

NERVES
j|-'
24
Fears of
losing
IN
DISORDER
we have
is
Qîy ^^qq^
consist in the causes

is
'eason
anfoundea
enumerated, but superadded
often another,
which
inflicts intolerable
agonies,
and that
the apprehension of the loss of the
mind
seldom
though
It is
fortunately
pass.
this
but
very
comes to
exist
obvious that such fear must frequently
where so much
it
mental
suffering
it
is
found, and
is
of great comfort that
can
be here emphatically stated that the dread

is
far
greater
than
the
danger, and
that
comparatively very few nerve sufferers ever

lose their reason.
Neurasthemes and
neuromimetics.
Looking at the classes of nerve diseases of functional character, we find they fall into
two
great
groups
the
Neurasthe7iics,
or
sufferers
from nerve weakness of various kinds,

Neuroniimetics,
and
the
or
sufferers
from
nerve disorders, or unconscious mind disorders

of an " hysterical
"
nature.
The first
with
Dr. Aiibutt " on neurasthenia,
class of neurasthenics have, as
we
yet
" is
have pointed out, only recently been treated

respect
as
real
sufferers,
and
It
neurasthenia,"
says
Allbutt
figment.
boldly,
is
neither
sham nor a
into
no
mere hotchpotch
which odds and ends
of nerve troubles are thrust"

The word known
in
"
25
neurasthenia
"
simply means
nerve weakness.
earlier in
The term itself was unEngland before 1886, though used Amerioa and Germany.
down
at
first
Neurasthenia used to be called hypochon- Hypochondriasis,
being of course put
to that long-suffering organ, the liver.
The
term
a
"
hypochondria "
delusive
is
now
reserved for
fixed
idea
of some particular
disease or local suffering.

it
Herman
it
defines
as
"the belief without cause of serious
bodily disease."
hysteria,
This brings
very near
which
is
largely the nervous
mimicry
of disease.
Neurasthenia and neuromimesis, or hysteria,
may
of course coexist
but the former
is
de-
cidedly more
There are
common in men than the latter. many varieties of neurasthenia.

is
Varieties of
thenia."
When
in
the chief trouble
in the head,
;
we
is
speak of cerebral neurasthenia

the
spine,
when
it
of
spinal
neurasthenia.
In
some the abdominal viscera are affected, and this is visceral neurasthenia. In others
a very
common form
is
sexual neurasthenia,
and these are often considered the most incurable, and are certainly the most trouble-
some
to deal with.

26
Classes of neurasthenics.
NERVES
IN
DISORDER
much
yj^g classcs of ncurasthenics vary ' as

as the varieties of neurasthenia.
There are
well
three classes clinically constantly observed
the
patients
who
look
perfectly
ill
and
are cheerful, the nervously
and wretched,
gloomy.
and
first
the
mentally
well
ill
and
The
rest-
class are
nourished,
plump,
;
less,
and two
talk
without
ceasing
but
the
the
other
are
will
downcast,
hardly
and
latter
especially
speak.
Idlers
are
frequently
neuropaths,
for
and
these
need
equal
treatment
generally
body
and
if
mind.
This
idlers
is
successful
are
men
of capacity.
But the subjects of functional nerve disease

are by
no means always drawn from the

mental, moral, or physical.
same
class, either
We
find sufferers
amongst the greatest and and the

basest,
the least, the

strongest
noblest
the
and
great
the
weakest, amongst
men
and women.
exist
in the
in
The same elements, after all, men and neuropaths only

;
former there
is
power
and
to
to subordinate
the
means
to the end,
keep the idea

Nervous-
noble
and the habits excellent.

all, is
ness, after
an excess of self-conscious-
ness of a normal quality.
27
Turning to neuromimesis, which simply means nerve-mimicry, it will be observed we do not use the word " hysteria " at all.
We
word
have
already
pointed
out that from

this
"Hysteria should not. be gene-
maltreatment
has
and
so
misunderstanding
become
;
most
that
undeservedly
to
call
an
actual
"
reproach
is
person
hysterical "
For
this
" hysteria "
him a bad name. reasons the word and has become so unpleasant and
to give
other
misleading that
as
possible,
it
should be used as seldom

to
this
and
end
think
the
I's
word might be severely
restricted
to those
proper
cases described under this head
by the most
modern
acterised
authorities,
which are mainly char-
by alterations in the field of vision, by sensations in various parts of the body, by convulsive
at
and
attacks.
Neurasthenia
and hypochondria,
be confounded with
it.
any rate, should never There may be and

;
always are borderland cases
but
not,
we
should
be clear that neurasthenia

not be called, hysteria.
is
and should
But used
neuromimesis.
But preaching
quite another,
is
one thing and practising

for the present
and
,
m
r
these mean
pages one must be content with the former

without the latter
;
for
it
is
clinically
con-
28
NERVES
till
IN
DISORDER
is
venient,
the difference
generally
re-
cognised,
to
speak
mind,
of
neuromimesis
content
and
hysteria together, both being diseases of the
unconscious
here
and
a
ourselves
with
raising
protest
and
making
suggestions for the future.

fact,
the remarks
shall
As a matter of make on hysteria

neuromimesis, or
organic
disease,
will
apply
nervous
far
more
to
the
mimicry
seizures.
of
than to the true form of narrowed sensations
and convulsive
We may
said,
repeat that in
say,
all
that
to
we have
and
shall
we
It
refer
functional
nerve diseases only. of
may
be that some
full
my
It is
readers
may
not understand the
significance of this term.

Organic
functionaL
used in contradistinction to organic
nerve diseases, which form, as

out, a large
we have pointed
and well-explored group, resting
one and
organic
all
upon some gross and ascertained change in some of the nervous

If
is
it
structures of the body.
is
in the
;
nerves
if it is
ending in the body

in the brain, cerebral.
it
peripheral
it
in the structures of the cord
is
spinal; if
These organic diseases
by pain (of mind or changes than is more other and by body)

are less
characterised

the case in functional
29
Various
nerve diseases.
The
.
symptoms.
symptoms
are
commonly
and
those of paralysis
in various forms
parts, or of imperfec-
tion of muscular actions
and of sensations
but
though
as
a rule the
symptoms
are
more
severe, they cause less distress to the
sufferer,
and are generally treated with much and respect
more
interest
by the
doctor
than those of functional nerve disease.
These few remarks

will
will serve to introduce
the subject to our readers, and
we
trust also
show
are
its
importance both to the patient
and the doctor.
We
firmly convinced
that,
when
the
true causes of functional nerve diseases are
understood,
the sufferings
connected
with
them
will
be lessened, and the cures greatly
multiplied.
Neurasthenia and Neuromimesis

Described
CHAPTER
DESCRIBED
II
BEFORE
if
entering on
.
.
details
of nerves Normal
nerve
action.
" in disorder," it
will
greatly help us
we
briefly consider
in
a simple
of
way
the
normal
order."
manner of
action
nerves
"in
Nervous structures
in
the brain
divided into six varieties:
Six variemay be ties of nerve

^T/stmcttire.
(i)
The organs
;
special sense, including the nerves of hearing,

sight,
touch,
taste,
let
and
smell
and,
that
with
regard to these,
us observe
mere
in the
light,
it
mechanical
their
irritation
of them will produce
phenomena.
will
blow on the eye

irritated
dark
produce the appearance of

is
;
because the optic nerve

is
not,
by waves of light by concussion. Sounds of

true,
in the retina,
all sorts
but
are heard
when
there are none,
if
33
the nerve of hearing

3
34
NERVES
IN
DISORDER
be
irritated by disease, instead of, as usually, by the waves of sound. Smells and tastes are also clearly perceived and described when
none actually
of
this
exist.
The important bearing

disease
will
on
nervous
(2) A'Cfves
soon be
apparent.
of
sensation, that bring
intelligence to the brain
from every part of

Jiei'oe
the body.
(3)
Terminal
centres, in the
cortex or surface of the brain, that receive
and transmit
control
that
all
nerve messages, being under

will.
of the
(4)
Nerves of
the
^notion,
carry
nerve force
from
brain
to
every muscle.
that
(5) Autoviatic nerve centres,

vital
will,
carry out
processes
apart
from
any exercise of
tion,
etc.
such as the beating of
the heart, the processes "of respiration, diges(6) Ideal tiente

centres,
the
seat
of thoughts
Transfercnce of \'ibrauons
only,
the
most actively used

said to contain
all
and, perhaps, least understood of any.

'W\^ nervc molecule
is
one
rhousand or more atoms, and

is
nerve action
believed to be
by vibration of these atoms,
all
force being ultimately caused

If
I
by
ideal
similar
means.
believed
cells
;
tJiink,
certain
vibrations
are
to
I
take place in
my
action,
nerve
if
feel or act, in
my
sensory or motor
nerve
cells.
Thought and
which to us

appear so widely
different,
35
would probably,
had we strong enough powers to see them, be perceived to be changes similar to each other, but occurring in different centres. Both are
cell
actions,
and are nearly
allied,
the cells
often
being probably side by side or very

;
closely connected
and thus an action com-
mencing
suffice.
in
one nerve centre
may
readily
be transferred to another.
An
instance will
of the teeth being set on edge How the teeth are by the scraping of a slate pencil on a slate set on edge
The
fact
is
too well
is
known
?
to need description.
But
air-
what
the cause
We
hear the scrape, and

is
it
as the unpleasant sound
composed of
waves of irregular lengths,

nerve,
to
its
its
jars the auditory
and communicates special vibrations

particles.
It
happens that
lies
in
part of
course this nerve
alongside another,
that joins farther on

teeth and tongue.
one coming from the

jarring
is
The
communi-
cated from the auditory nerve to the dental
nerve by contiguity, and the brain receives

the sensation of the teeth being set on edge
shortly after the disagreeable sound
is
heard.
This
is
an illustration of the transference of
feeling from
one nerve of sensation to another.
36
NERVES
IN
DISORDER
Let us consider transference of vibration * to

sensory and motor centres from ideal centres.
We think
as
we
It
has been well said,
"We
we
feel
think as
we
and
feel,
and feel as feel or think we think. If we feel a

if
we we
feel,
and we
think
feel as
we
ill
think.
;
pain,
we
are
ill."
we
think
centre
are
ill,
we
If
my
and
felt,
ideal
vibrates
with
the
thought of
crossing the Channel in rough weather,

pictures the nausea that would then be
the vibrations are transmitted to the terminal

centres of the sensory nerves running from
the stomach, and
actually feel sick
from
communication of the idea with a sensory

centre
;
and possibly,
if
of a highly nervous
be
organisation,
may
actually
sick
from
transference to a motor centre.

Ideas start
feelings.
Real feelings and real

in entirely ideal Centres
.
acts can be started

If
we
If
//z/;'?;^
intensely
of any part of the body long enough,

sensations
in
we
feel
that part.
we
think of a
good dinner the mouth waters.
We
shiver
to
* The word " vibration," applied all through here nerves and nerve centres, is popular rather than scientific, for such vibr itions cannot be demonstrated.
We
believe, however,
that
every mental action has
some
physical counterpart in the nerve structures, to

it
which we give the name of "vibration," as

consists in
probably
some movement of the nerve atoms.
37
whether we only think of cold or actually

feel cold.
The
really
sensation of pain can be pro-
and vividly by thoughts or ideas alone as light in the eye by striking it

duced as
In short, every sensation of the body ordinarily
produced from without can also be produced

from within.
It is
thus that the ideo-sensory
and ideo-motor actions are produced.

These
_
ideal vibrations, acting
on motor and We are not

.
Other centres, are quite different from the action
of a motor centre by the direct impulse of

the will
;
/-
deceived if the ideas are conscious.
the action being in the latter 'case
voluntary and in the former involuntary.

far,
So
observe,
we have only spoken

that,
of ideas of
which we are conscious, so

centres are abnormal,
although the
modes of exciting these motor and sensory
we know them
to be so,
and hence are not deceived, and do not deceive

others, into believing
them
to be natural.
Thus, when our teeth are set on edge from
sounds we do not go to a dentist

are sick from ideas
if
we
we do not think we are we hear noises in the ear we do not look for them externally if we shiver from thinking of cold we do not put on more clothing. But now let us go one step further
dyspeptic
;
if
into
the region of unconscious
cerebration
38
NERVES
IN
DISORDER
and the theory
and of memories and

I
habits,
wish to present as to the internal causation

" will
of these nerve troubles so often grouped under

the word " hysteria
be made
plain.
cT"^brauons or \yy "^ sensations.
The
brain not only acts by the will and
jdeas
of which
we
are conscious, but
is
continuously vibrating with ideas, memories,
and
trains of thought of
It
is
which we are unwith

regard
to
conscious.
so
even
If
common
attention
sensation.
you concentrate your

in it that
on any part of your body, you

escaped
become aware of sensations

then.
If with a feather
I
your attention before, but were equally there

lightly tickle the
back of your neck, and at the time you are
engaged
in
very earnest
conversation, the
vibration aroused in the brain sensory centre

is
unnoticed by you
and yet
it
if I
call
your
attention to
the fact
is
noticed at once.
I
By
increasing the stimulus
can
make
the
:
waves of vibration
or shuddering of
set in action
motor centres
or
involuntary ones, such as cause a shaking

the
neck
voluntary,
such as turning the head round or moving

away.
If
you are asleep
foot so that
wake
up.
I may tickle your you draw the leg away and you In this case you are probably

conscious
39
of
moving your
leg;
but
the
stimulus that
made you do
it
was too
slight
to reach your consciousness.
We may
thus
be conscious of a transferred vibration leading

to
action or sensation, that set
of the cause
and yet be ignorant Memories it going. and

it
Vibrations
again
will
involuntarily,
may be
and
from
un-
involuntary
consciously, arouse both feelings

I
actions.
may have
smelt the strong scent of some

critical
flower
when some
event took place
a proposal of marriage, or
some sudden news

is
henceforth, whenever the topic
touched on,
the very scent or vibrations of the nerve of

smell that represent
it
are exactly reproduced.
A
to
set
certain field always recalls a certain song

to sing as
we used
we
crossed
it
on our way
school.
Thoughts of old Anglo-Indians the vibrations of Eastern sights and sounds

Observe,
all
in action again in the old centres.

in
these
cases
we
are not considering
vibrations deliberately set
up by the
will in Vibrations
from
voluntary
an unusual way.
duce these
1 1
you think of a green field when in a drawing-room, until you set in vibration the centre of sight and see the green grass;
if
<
1.1/-
You
can, of course, pro-
,-1,1
memories.
or the centre of hearing, and hear the lowing
of the cattle or the
hum
of the insects.
This
40
is
NERVES
much
easier
if
if
IN
DISORDER
no distracting
;
there are
close
sounds, and
you
your eyes
and
still
more so
if
there are
some
insects actually
humming we speak
Pain
IS felt
in the
room.
But the memories

Q^j- fesults,
of are wholly involuntary ones.
m brain,
origin in
skin.
Lg|- yg jjq^ g^j^
but referred definite case, say, to nerve
This pain
....
is is
yp *
the
'
taking a
of a pain in the
little
little finger.
felt in
finger,
we
say,
though we really know that the only seat of
any sensation
(that
in the brain.
It is there, at
the central termination of the
ulnar nerve
we
call
little
the funny-bone), which leads

finger, that all the vibrations
from the
scious
take place of which the mind becomes con-
and
calls pain.
Whenever
little
these vibra-
tions take place in the nerve centre in the brain
connected with the
finger,
the
mind
always refers the sensation to the commence-
ment of the nerve
in the little finger,
whatever
may
be the real origin of this pain.

if
In the same way,

hall-door bell
rings
in
your house the

is
you say there

;
some
one at the
bell,
hall
is
door
if
the drawing-room
:
there
some one
I
there
and yet such

pulled the
I
may
not be the case.
may have
;
door-bell wire inside the hall, or as
passed
down
the kitchen stairs
or a rat
may have

moved
itself
it,
41
bell
or
may have
it
struck
the
and made
ring, or
it,
a shock of earthor a strong gust
quake may have shaken

of wind
;
and
yet,
although these causes are
so various, you, in the kitchen, always say,

"
There
is
some one
,
.
at the front door."
It is so in the
IS
pricked
.,, there
The
in
is
body,
is
pain in the
itself
is
..
(i)
The
little
finger Various
in
causes of ii-i/little finger, pain the
(2)
ulnar nerve
its
pressed
at
on
the
"
"^^'^'
somewhere
elbow
course,
perhaps
the
little
still
there
pain in
cut
finger.
if
The hand may be

the
off,
and
the
nerve be irritated in the stump by pressure
man
feels the
pain in his imaginary

if it
little
still
finger as truly
and vividly as
(3)
were
actually
there.
Or
in
again,
there
may
most
All
be a tumour pressing
centre of
the brain on the
the ulnar nerve,

is
and
the
finger.
acute pain
felt
in
the
little
these instances are from direct irritation of
the nerve in
as
some part of its course. But we have seen, we may go much further.
hall-door wire
The
may have
it is
got caught
with the drawing-room one, so that when

the latter
that rings
;
is
pulled
the
is
hall-door bell
the vibration
(4)
I
thus transferred.
for
So
in the brain.
may,
example.
42
set to
NERVES
work
still
IN
DISORDER
to think of
it
my
little if
finger,
and
so start sensations in
which
But
it
not actual
I
pain are
idea
it
sensations.
if
have the
not be,
I
is
injured,
though
may
may
"Ideal" alone. agony in a
butcher,
feel
the pain
butcher,
acutely from
pale,
*
an
idea
A
was
pulseless,
said,
and
his
suffering
acute
agony, as he
in
arm,
brought the
other day
into
a
for
chemist's shop.
His
cries
were dreadful,
his
he had slipped in hooking a heavy piece of

beef,
and was suspended by

;
sharp hook
and
arm on the yet when the arm was
exposed
it
was uninjured, the hook having

in the sleeve.
only caught
(5)
But again, the pain may have been
originally caused
finger,
by a gathering
in the little
and afterwards kept up, long

centre.
after
it
the gathering was gone, by the thought of

in
the ideal
(6)
Association
may
produce pain, as seeing others with crushed

little fingers.
Or
(7)
memories, conscious or
little
unconscious, of previously crushed

gers,
Seven
causes for the same
pain.
fin-
may
also start
and keep up
finger
this pain.
Observe, then, the varied causes with the
same
(i)
effect.
The
little
is
in
pain
from an injury,
(2)
from pressure on the
nerve, (3) from pressure
on a nerve centre

in the
(5)
43
brain, (4)
from transference by idea,

(6)
from habit of thought,
from association,
(7)
from memory.
Only, in conclusion,
in health
it
we
the
may
little
add that while

finger
is
generally
in
easy to discriminate
between pain
caused by injury to the

set
not.
little
finger
and that
it is
up
in
other ways,
it is
in
Undistingfuishable in nerve
nerve disease
Nay,
sometimes
impossible not only to the sufferer, but to
the
doctor
who
attends
him,
and
hence
mistakes in treatment are easily made.
From
Fi'rsL '
all this
we now
see clearly
all
that
pain in
-^
cases
is
a mental
Pain is a mental mi
pression.
impression arising from certain changes or

vibrations in the cerebral ner\'e centres, and
so entering consciousness.
Second, that in perfect health of the whole
mind we
are generally able correctly to find
the true cause of the pain and the origin of

the vibrations that produce
instance,
it.
We
the
find, for
some part of the body diseased

in
or injured
which we
indeed,
" feel
pain."
Very
liealth
seldom,
in
perfect
mental
does a mere impression produce acute
physical pain.
is
When
\
the unconscious
it
mind
^^'".'?^y
diseased, as in hysteria,
is
far otherwise, without a

_
physical
origin.
Here the suggestions unconsciously made
44
NERVES
IN
DISORDER
vibrate in the ideal centres so strongly that
pain
is
produced and
to that
felt
equal in intensity in
local lesions
every
in the
way
all
produced by
body.
functional nerve diseases the brain
In
centres
vibrate
are
greatly
weakened,
readily
and
hence
to
much more
in in health.
and intensely
changes
they do
It
is
neighbouring ideal centres than

Pain
is felt
more
intensely.
felt
from slight physical causes, and

ideal causes,
is felt
more readily from purely

save
;
but
scious
it is
not referred directly to any supposed

in
Uncondisease mind
neuromimesis
or
nervefear of
produces
mimicry,
mimicry
and here the thought or
the discase has, through the marvellous force
of the unconscious mind, not only power to
produce characteristic pain, but to start the
whole chain of symptoms generally associated

with the disease, and which
Health
equiiiis
in
it
cause the
itself
pain.
is
unstable
We
little
must remember that health
but a Condition of unstable equilibrium, and
a very
push upsets the balance, and pro-
duces dis-ease
Power
lect.
health being, of course, ease.
oi
the intel-
and
In neuromimesis the intellect can influence t produce indirectly through the un,
conscious
mind
hyperaesthesia,
anaesthesia,
varieties of
paraesthesia, dysaesthesia,
and
all

special sensation.
45
The
intellect
can contract
or relax muscles, and cause regular, irregular,
and excessive movements, spasms, and convulsions.

It
can
also
produce
loss
of
muscular power and paralysis.

in
Intellect can
the
same way influence the involuntary

heart,
in
muscles of the
bowels,
also
lungs,
all
blood-vessels,
It
those
organs.
also
can affect the salivary and

digestion,
nutrition.
mammary
glands,
excretion,
secretion,
and general
of
The mental
the
1
emotions, which largely govern Power
sympathetic
of
all
system,
parts
cause
functional
^^^ emotions.
diseases
diseases
and
many
organic
inflammations,
goitre,
oedema, goitre, ex-
ophthalmic
headache, angina pectoris,
diabetes, Addison's disease,
and neuroses of
the extremities.
So much,
then, for an outline of nerve action.
We
now
turn to the causes of functional Etiology
nerve diseases.
exciting.
These are predisposing and

to nerve
disease.
The predisposing cause

is
trouble The prediscause!"
principally a
nervous diathesis or dispo;
sition.
People are born nervous

with the
that
is,
they
are born
nervous system unduly
46
NERVES
less
IN
DISORDER
less
predominant,
in its action
under control,
nervous
orderly
than in other people.
No doubt
with
highly
developed
is
system
adequate control
or
the best type for a
man
woman
but
without this control he or
she joins sooner or later the ranks of nerve

sufferers.
Is heredity,
The
great predisposing
;
cause
is
therefore
heredity
but
if
(and this
may
be
noted
as important),
the family history
only reveals nervous troubles in other members

as
distinguished from loss
of
form, the invalid, however severe his
mind in any symptoms
and great
his sufferings, is not likely to cross
the border-line of sanity to the other side.
The
Exciting causes.
exciting
causes
may
be mental or
physical.
^\\Q,
is
Worry.
worry,
leading mental cause of nervous disease first and foremost, rather than work.
regulated
Properly
leads
to
brain-work
than
no
nerve
disease
hard
more manual
In-
labour leads to disease of the muscles.

deed,
that
it
it is
is
so
far
from injuring the nerves

their
one of the greatest sources of
strength,
and one of the strongest safeguards

neurasthenia.
evil
;
against
Worry,
however,
is
an unmitigated
it is
a most vicious habit,
doing good to none, but invariably damaging

more or
less the
47
nervous system of the one

to
it.
who
to
gives
way
This must be
of
due
the
constant
cross-currents
thought
eddy backwards and forwards in the difficulty real fatigue and brain, and to
that
in
finding the resultant that shall issue in
action from
among
a large number of con-
flicting forces.
Next
inclined
to
worry as a cause of nerve disease,

it,
Mental
idleness,
or perhaps bracketed with

to
we should be
idleness,
all
place
sudden
mental
such
as school-girls' experience
when
at
once transformed at the close of the
last
term into
"
young
ladies."
The sudden change

more
from working every day through a long timetable containing a perfect olla podrida of
or less useful subjects to the peaceful occupation of arranging the flowers in the drawing-
room for half an hour marked effect on some readily become a prey
from the
If
daily,
has
very
natures,
to
and they
nerve disorders
of brain-work.
the
abrupt
for
cessation
one might
moment play
part
of adviser
here,
one would suggest, when
school-days are over, six or twelve months
of modified work at those essentials that are

invariably
left
out of the school time-table
48
NERVES
allude to
lore,
IN
DISORDER
of
all
we
domestic duties
hygiene, and
sorts,
nature
matters.
other
the
household
Six
months
at
House
of
Education, Ambleside, under Miss Charlotte
Mason
Strain
is
a most admirable prophylactic in
these circumstances.
and
Long-continued strain from any reason

another cause, and so
especially
if
is
is
overwork of
all sorts,
combined with
under-feeding,
as
is
so
common
in the poorer classes.
Bad
mental surroundings, such as association with

other nerve sufferers or anxious or fractious
parents, are other agents
;
and there are many
more.
Physical
and other
causes.
TurninsT to the physical causes, which, however, generally duly act in conjunction
with mental,
we would
place
first
general
ill-health, especially if
dyspepsia be present
little
too
much
;
food or too
food
is
may come
seldom a
is.
next
too
much
physical
work
cause, but too
little
exercise
frequently
frequently develops nervous disease, as
Sudden change of surroundings of any sort when
man
retires
from business, a
girl
gets married,
or sudden
place.
loss of or increase of fortune takes
Shock
etc.,
is
arising
from accidents, bad

;
news,
a cause
so
is
extreme grief

or extreme joy.
49
Such, then, are the principal
sources of nerve trouble.
Now, nervous people are the very salt of Nervous people the the earth, and the leading men in every pro- salt of the They fession are drawn from their ranks.
are
men
with
brains
that
thrill,
that
feel,
that are quick in action, firm, clear, and of
high organisation.
It
is
the nervous
men
:
that rule the world, not lymphatic vegetables.
Listen to an impartial sketch of the type

"
The
is
skin
is
dark, earthy, pale, or

is
may
be
of any shade, and

skull
often hot
and dry.
to
The
quick,
large
spare,
;
in
proportion
small,
the face
muscles
large,
large.
features
eyes
lustrous
circulation
capricious,
veins
by energy and intensity of thought and feeling movements hasty, often abrupt and violent, or else languid. Hands and feet small, frame slight and delicate. Require little sleep, drink
Face
characterised
;
much
tea.
Prone to
to
all
nervous
diseases.
Always seem
are doing.
be able to do more than they

character
its
The
may
be,
on
the
one
side,
admirable for
powers of mind
;
and
on
insight, for its lofty imagination
while,
the
other,
it
may
be
disfigured
by
impetuous and unruly passions.
To
this class

50
NERVES
IN
DISORDER
belong the most intellectual of the race

the wittiest, the cleverest of mankind.
are the poets, the
These
Their
men
or
of
letters,
the students,
the
great
professors,
the
statesmen.
in
dangers
consist
uncontrollable
passions.
less,
They feel pain

can
better
acutely.
Neverthe-
they
endure
long
fatigue
and
privation
than the
of
sanguine.
form
the
leaders
is
mankind.
of
They Amongst
of
women
emotion
;
there
delicacy
organisation,
quickness
of
imagination,
and
fervour
but they are beset
viîth
danger,
from want of control of their great powers."
Now,
it is
the children of these people who,
inheriting the nervous organisation of their
parents without having

of hard work, so often
diseases.
fall
their
safety
valve
victims to nervous
Details of neurasthenia,
Passing
consider a
now from
little
generalities,
in
we
will
more
detail the subjects
of neurasthenia and of neuromimesis, taking

the former
to
first.
In neurasthenia
we have
physically
actions, or
"
do with every variety of brain and nerve
exhaustion that
in
may show
itself
many
various
movements and
mentally in every form of " nervousness
from

slight irritation to
51
extreme nervous debility

of nerve
Causes of neurasthe-
and
different varieties of nerve aberration.

is,
,
Cases of true neurasthenia, that

irritation
or
exhaustion,
dependent
upon
illness,
niaand
external causes or on
some bodily
;
are mainly physical in their origin
the mind,
conscious or unconscious, being only affected

in
a secondary
degree as a result of the
nerve condition.
On
the other hand,
all
cases of hysteria
or neuromimesis contain a distinct primary
mental element, which
is
an affection of the
while
unconscious mind over and above any mere

question of nerve condition
;
all
other
cases of delusions, fixed ideas, true melancholia,
and other
slight
aberrations,
reveal
a primary disturbance, want of balance or
unsoundness of the conscious mind or reason, and these are generally recognised as true
mental
are
cases.
Hysterical patients, however,
not
generally
regarded
as
still,
distinctly
mental, owing to the fact that

in
as a rule,
England mind
it is
is
limited to consciousness.
In France
otherwise, for Charcot, quoted
by F6r6, says, " Hysteria is a psychical malady par excellence^ In this country, from
the fact of
its
seat being the
unconscious
52
NERVES IN DISORDER
in the
mind, which produces
body the syman

the
ptoms complained
lesions
of,
hysteria occupies
intermediate place between
pure nerve
distinct
on the one hand and the
mental troubles on the other.

Neurasthenia
is
by no means a
a species of
disease of
degenerates, or of weak-minded people, any
more than
Neurasthenia in clever people.
it
is
malingering.
In
my
experience the larger number of the

it
,
victims to
are people of good
and even
over-use
great mental powers,
who from an
of these very powers, or at times from a want of use of them, have fallen a prey to
it.
We have
are
already said that the nervous
men
most
rule the world,
and those of this temperament

are
ever the ones whose nerves
likely to break
strain
from their control from overto suffer
and other causes, and hence

sorts.
from neurasthenia of various

In a family
it
is
often the bread-winner
who
is
so
afflicted,
or
perhaps
the
most
intelligent daughter.
low
level of
nervous organisation or imis
perfect education
not often a cause of this

it
disease
for
though
occurs in the unedu-
cated classes, other factors are generally the
predisposing and exciting causes.
One
of
53
Classes of neurasthemes.
the best summaries as to the classes affected
has been
made by Karl
Petren, of Upsala, in
the Deutsche Zeitschrift
fur Nervenheilkunde,
of the frequency of
Bd.
xvii.,
who
reports the results obtained in
a recent investigation
neurasthenia in the various grades of society.
Contrary to usual statements, he does not

find a larger
number of
classes.
cases in the upper
than the lower
Out of some
2,478
patients observed between 1895 and 1899, he
met with 285

neurasthenia.
(ii'5 per cent.) cases of definite
These he resolves into three

artisans
groups
(i)
and
peasants
;
(2)
tradesfolk
lectuals.
and
In
under-officials
(3)
intel-
further
first
division
as
to
sex,
males are easily

(2)
with (i) I4"8 per cent,

(3)
13-2
per
cent,
I3'3
per
cent
(3) 6'6
As
11
-4
regards
women, the numbers

cent.,
are (i)
per cent, (2) ^'6 per
and
per
cent
In
Sweden
it
therefore
now appears
that neurasthenia
the
is
more prevalent amongst
working
are
classes.
On
the other hand,
many
to
cases of neur;
asthenia
put
down
education
but
we must remember that development of the nervous system makes for increased control. It is found by Dr. Allbutt that neurasthenics
54
NERVES
IN
DISORDER
common
in
are, after all,
not more
New York
than London, or among the busy than the idle. The disease abounds in such places as Finland,
and
in the
Yorkshire
collieries.
Petr^n
thinks that, as previous writers have drawn

their
statistics
on the one hand from the

clinics,
higher classes and on the other from

the results disagree, because
thenics
many
status
neuras-
do not come under hospital treatment,

the former
readily
whilst those of
Not due
rush of
to
life.
consult their doctors.
That the disease is ^^^ dependent upon the rush of modern Hfe
seems apparent from the
fact that the greater
number of
and
Causes of
thenia."
cases
came from the

life
is
provincial
parts of Sweden, where

tranquil.
very simple
As regards
ties,
causation, 62 cases have followed

difficul-
family disappointments, 24 financial
and 47 overwork.
after
Twenty-nine cases
21
occurred
influenza,
acknowledged
;
venery and other various exhausting excesses

in
16 females
it
complicated pregnancy and

8
the puerperium,
were directly traced to
alcoholic excesses,
and 2 were produced by
high temperatures experienced during their

avocations.
prominent factor
is
that of hereditary

alcoholism.
'
55
Effect of
In the early years of the century ' ^

etc.,
alcohol
large quantities of spirits,
were almost
influ-
universally consumed,
and where the alcoholic

its
tendency
ence is
is
not directly apparent
felt in
the unstable nervous equilibrium
of the present generation.

reported
in
Several cases are

arteriosclerosis
which
cerebral
was
present.
to
Hygienic conditions also con-
the increase amongst the lower Lack of proper nourishment, insanitary dwellings, and monotony of existence are amongst some of the causes that need
tribute
classes.
attention
in
order
to
prevent
its
further
extension.
We
need not repeat here the

;
list
of pre-
disposing and exciting causes
for
what we
well
to
have given as those

nerve
disease
of general
equally
functional
apply
neurasthenia.
The symptoms
of this
disease vary
as
it.
widely as the classes which suffer from
When
is
a structure such as the nervous system
affected, that is
activity,
an agent
it
in nearly every
bodily
is
obvious
that
the
symptoms must vary with

the weakness predominates.
the part where
The
following long
list,
made of
the more

NERVES
:
DISORDER
56
IN
prominent of these symptoms, clearly shows

this
List of
Scalp tenderness
perience a
symptoms
ofneurasthenia.
headaches (not
or a prominent
in
my exthe
common
symptom)
lilated pupils
feeling
of pressure on
heavy expression of eye congested of the nerves of conjunctivae alteration

vertex
special sense (increased or diminished capri-
ciously)
ears
irritability
atonic voice of mental hopelessness morbid

loss
muscae
volitantes
noises
in
the
control
fears
of
open
places,
of crowds, of confined spaces,
of being alone, of people, of responsibilities, of diseases, of infection, of trains or cabs, of
everything
other
(called by various Greek and compound words, agoraphobia, clausetc.,
trophobia,
etc.)
marked symptom)
neurasthenia)
blushing insomnia drowsiness

(in
(a
visceral
tender teeth dyspepsia love

irritable
of drugs
tender
heart
spine tender coccyx tremors dysphagia
abnormal secretions sweating hands

irritable
"
cough
irregular respiration (sometimes Cheyne cramps morbid sensibility Stokes numbness hypersesthesia exhaustion pruritus flushes cold and hands
")
feet
sudden changes of condition and symptoms.

To
this 57
I may add from Some long ' catalogue addiUons. constant restlessness personal experience
:
defective
memory
dread of noise
dizziness and giddiness of voice or

light
loss
trifling
loss
of sense of proportion, small things looking

big,
and important things
want
heart
of
co-ordination
weariness of brain
palpitation
hand
of
the
"pins and needles" in

pain
limbs
left
sub-mammary
pain
nervous
the
left
inguinal
(flexed wrist, extended
fingers, fine tremors,
and dropped thumb)
flatulence,
and constipation.
above 48 symptoms we
1
Out of
class
may
Classification of
26 as functional,
as mental,
and 7
symptoms.
as physical or to a certain extent organic.
Neurasthenia, after
cribes
all, is
two very
difl"erent
"
a word that destypes of nerve disease, Two

Irritability "
stages
in neuras-
and these are

"
Nervous
and
thenia.
Nervous Debility."
The
seat of the trouble

it
in either case
may be
;
in the spine or
may
be in the brain
and two barbarous words

variety respectively,
of six and seven syllables have been coined

to
express
each
with
which
here.
we need
first
not
trouble
our readers
The
nerve
stage of " nervousness^^ that of

the general result of over-
irritability, is
58
NERVES
IN
DISORDER
is
strain of the
nervous temperament, and
greatly on the increase, as the tension of
life
is
becomes more
diminishing.
acute, while hysteria proper
Constant brain
irritants in the
ideal centres, in the
shape of small but per-
petual worries, render the other nerve centres

as morbidly sensitive as a constant succession
of slight pin-pricks
all
over the body would
the terminal sensory nerves.

tions of nervous irritation are
characteristic.
The
manifesta-
numerous and
Symptoms
of nerve
irritation,
Physically they
intermittent
may
include constant or
movement
of
body and
face,
sharp ringing cough, sudden hoarseness, quick
and irregular breathing,

of the
scalp
starting,
twitching,
flushing, palpitation of the heart, tenderness
or
spine,
headaches
at
the
top and back of the head, congested look

of the eyes, noises in the ears, sleeplessness,
dyspepsia and flatulence, perspiration, flying

pains and cramps, and neuralgia in various
parts.
Mentally,
we
"
;
get
timidity,
irritability,
melancholy, and a dread of being alone, or

"
monophobia
"
;
or in a
close,
crowd, or " agoraconfined

is
phobia
or
in
spaces,
or
" claustrophobia."
There
little
mental

control
59
or power;
wrong words
may be
spoken or written.
Referring to the divisions of the brain, the
cause
may
be said to be largely the result
of want of control by the upper or cortex

over the middle
to
district,
which
may
be due
inherent weakness or constant irritation
from overwork or worry, or daily railway

travelling.
teristic
The constant movement

is
charac-
of this condition
in itself
a sign
of weakness
is
in the higher centres.
baby
Repose a
brain
always in motion.
the
get quieter, and
As we grow older we man with the strong

Rea sign of
brain only
pose, not
moves
for a definite purpose.

is
power.
movement,
These cases
said,
are, in spite
bram power. what we have of

"
generally called " hysterical

"
;
or " hypo-
chondriacal
is
and the
is
real
still
affection,
which
"
nerve irritation,"
rarely found in
medical works as a distinct disease, although

all
the
symptoms
is
clearly point to
;
it,
which
in
hysteria they do not
for
although the latter

generally appears
disease
a nervous one, This

first
it
to be organic.
if
stage of nervousness,
it is still
the cause that produced

is
there,
and
no treatment
adopted, progresses, either
naturally to the second stage, or abnormally
6o
NERVES
IN
DISORDER
etc.,
to general neuralgia, inebriety,

insanity.
Nervous
or even
Before considering the treatment

briefly describe the
we
will
symptoms of the second

viz. "
stage of neurasthenia,
nervous debility."
It
is
This
is
still
worse disorder.
the
manifestation of nerve exhaustion rather than

irritation,
and
is
generally a further stage of

is
nervousness.
It
all
the frequent
It
is
result
of
excesses of
kinds.
characterised
by physical weakness,
pupils,
dilated
and sluggish
occasionally
dimness of
lassitude
sight, general exhaustion,
mental
varied
and
apathy,
by a
It
false
is
and capricious but evanescent

often
energy.
degrees,
combined
be
in
varying
as would
naturally
supposed,
with nervous
hysteria.
irritability,
and frequently with
So
quite
far
still,
from moving about, the patient
is
and becomes increasingly

in
difficult
to arouse to an interest in his surroundings
The symptoms
able at
first,
both stages are very vari-
but tend to become increasingly
fixed as time goes on.
Nenromimesis
Turning
define
its
now
to neuromimesis, '
we must
"hysteria,"
f^^
relationship with the
word

a word which, from
its
6i
misuse, as
we have
is
pointed out, would be

if
it
much
form
better dropped,
were
to
possible.
Hysteria by some
of
made
cover
every
functional
nerve trouble, including hypochondria

melancholia,
as
and
well
as
neurasthenia and
neuromimesis.
Others again
restrict
it
to
the last two.
Those who use the word rightly, restrict it to a disease of narrowed consciousness, characterised
by
defects of vision
and sensation,
and
at
times convulsive attacks of various

;
characters
the
mimicry of disease being

under the head of neuro-
better described
mimesis.
Here, however,
the word
in
"
we
shall often
have to use
practice
hysteria " to include neuromimesis,
accordance
with the
usual
at
present.
Speaking then generally of hysteria

broad sense, we
this
in this Seat
is
in
may
say
that the seat of

is
disease in
every case
it
really in the
brain,,
where
either
actually
originates
or
is
caused by irritation
from some part

however,
or
of the body that
may
by
be slightly diseased.
is,
This real seat of the disease
seldom
suspected
the
patient
the
62
NERVES
who
as,
IN
DISORDER
constantly
friends,
are, as
we have shown,
misled
indeed, the physician
may
himself
be led into error by the remarkable appear-
ances of disease which

parts
it
produces
in various
of the body.
There may, of course,
be real organic disease as well, and the two
may
be combined in any proportions.

is
Hysteria
tions,
so
common
in
that in
some
it
affecis
such as pain
cause,
the back,
disease
the the
in
general
organic
find
being
sufferers
exception.
all
We
hysterical
our hospitals, amongst our friends
in all
circles of society,
and
all
over the Continent.
They used
however,
to
fill
our watering-places with

bath-chairs,
interesting invalids in
who
are,
now comparatively
rarely seen, the
cause of the disease being more generally
known.
Pain the
One symptom
of
of hysteria
is
generally /^/
symptom
some
the
sort
having the character of distinct

^.jjg
hysteria,
^jgg^gg
in
jjj
chest resembling pleurisy,
heart
resembling a
form
of heart
disease, in the spine resembling spinal disease,

in
the knee resembling rheumatic gout, or
elsewhere.
tender,
In such cases even
the skin
is
and a
slight touch hurts as

is
much
as
a heavy one, which
not the case in local

disease.
63
Or, on
the other hand,
any part
of the body, whole limbs or isolated patches,
may
be insensible to pain, and be pricked

its
without
differs
being
its
felt.
This pain, we repeat,
in
origin
from
all
other,
being
neither neuralgia (or pain arising in the nerve

itself),
nor caused by any body disease

in
but,
arising
the
it
ideal
is
centres
of
which
we
have spoken,
vibration
to
probably transferred by
the
nerve centre belonging to
that part of the

is
body with which the idea

is
occupied, and the pain
referred to the
nerves connected with this centre that com-
mence
pain
is
in
that part ot
the
body where the
said to be felt
exist.
and the disease sup-
posed to
As
to this internal causation
we may
use The
cause
again a familiar illustration.
It is true that, brail.'"
however much the hall-door

one
there, this
bell
may
ring,
though we always say there must be some
by no means
follows.
Now
re-
a slight disease in fact, as a sprained knee

or in memojy, as
collection of
the continual
;
painful
one
or in
association, as con-
tinually hearing about one, or reading about
one, or seeing one,

in the brain
may
so cause the centres
connected with the pain, swelling,
64
NERVES
stiffness
IN
DISORDER
to vibrate,
and
of the joint
is
that
the vibration
disease
kept up without any actual

it
being present, or long after
has
ceased to exist.
We
there
must remember that while we may

rings, in
be wrong, when the door-bell

is
saying
some one there, we are certainly wrong, if we go there and find no one, in
It is
wrong saying
it
to describe
"brain
nothing at
nothing at .... ,.,.,. this v/hich bcmg

it is
all.
And
.
yet
we know
day by
,
IS
IS
Said every
some
doctors, through
want of any training what they can
in these
matters,
combined with too great

If
training in believing only in

see or feel or hear.
is
such
men
find there
nothing wrong with the knee-joint, how-
ever loudly the patient

declare and stick to
it
may
complain, they
that he has nothing

that the patient
all
;
wrong with him, and suggest

does not really
feel
the pain at
or, in
other words, that the bell never rang.
Now
affection
the
;
bell
did
ring,
and the disease
does exist
only, instead of being a
common
it
or
disease
of
the
knee,
is
an
obscure
injury
is
one of the
brain.
See what an
unconsciously inflicted on a nervous
sufferer,
who, feeling agonising pain in the

is first
knee or back,
well pulled about,
and
65
then, because nothing can be felt at the spot,

is
is
calmly told that nothing

sent
is
the matter, and
away with
the diseased ideal or other
centre in the brain uncured.
Let us now
briefly
run over the symptoms
of emotional hysteria proper, and then those of simulating hysteria or neuromimesis.
Amongst
hysteria
the
symptoms jr
-'
of
emotional Symptoms
of true
may
be
included
sharp
cough,
emotional
spasms, convulsions,
and
;
choking
from
ball rising in the throat
laughing immode;
rately
and crying, or both together

less
sudden
movements more or
spasms
purposeless.
The
may
be local or general, or of any
groups of muscles,
difficulty
as of the chest, producing

leg,
of breathing with signs of suffoor
cation
of the arm, or
or finger,
or toe, producing temporary or
permanent
are
contraction of the part
these
symptoms
made worse by sympathy, which simply feeds the vitiated ideal centres. The convulsions
or
hysterical
in
fits
are violent,
suffocation
are usually ushered
by
"
and and
very
pain on the rising of the

in
globus
are
"
or ball
the throat.
The
attacks
not
sudden, there being generally some struggling

first.
The
patient then
often shrieks,
5
and
66
NERVES
partly,
IN
not
DISORDER
wholly,
becomes
the
fit
unconscious,
being aggravated by any notice or

for
sympathy,
desire.
herself,
which there
patient the
fit
is
often a great
The
and
or
falls
without
occurs
hurting
in
rarely
the
night
when
there
are
no
bystanders.
is
Nevertheless, the hysterical
convulsion
is
in
no sense a sham.
arched, which
is
The back
rare
in
generally
epilepsy,
and the
less
movements and language

purposive.
are
more or
The tongue
fits
is
not bitten.
There
may
Simulations of hysteria,
be several
or only one.
Mimetic or imitative hysteria, neuromimesis,

is
not characterised by these attacks or general
or neuromimcsis.
sensations, but simulates every
known
etc.,
disease,
including tumours, deafness, blindness,

ness, paralysis, St.
dumband
is
Vitus' dance,
capable of producing, curiously enough, the

highest
case,
tions,
temperatures
of
fever.
In
every
though so various
it is
in
their manifestais
probable that the cause

is
the
same
and that the disease

pictured
in
first
unconsciously
either
the
ideal
centres,
from
these being abnormally excited or disordered,
or from
some slight pain or symptom in the body suggesting the disease or from fear of
;
the disease, or seeing
it
in others, or
having
'

it
67
suggested to the mind
and that
is
in these
ideal
centres the impression

is
so profound
that the disease

sufferer to exist
not only believed by the

the
in
body, but that
its
symptoms
are
absolutely but unconsciously
reproduced, by transference
from ideal
to
motor and sensory nerve
centres, with such
amazing
There
accuracy
as
often
to
deceive
physicians themselves.
is
in
neuromimesis a distinct
order of the "unconscious mind."
A
is
dis- Hysterical and insane.
man
called
"
whose
insane
is
'
"
;
conscious
mind
" is
diseased
but one whose

is
"
unconscious mind
affected
not regarded as insane, but as
hysterical,"
which
to
some
is
a worse
name
than
the
other.
The
delusions
may be
it
equally strong in both cases and the results
on
life
almost as disastrous, and yet
is
quite true that a
man
is
not insane
if
he has
only "hysteria."
This nomenclature should

"
not be disturbed, and the word
insanity
h ould not be allowed to cover any disorders below consciousness. In the present instance we have nothing to do with diseases of the
conscious mind, and
I
do not write of the

get
insane at
that
in
all.
Let
it
be understood, therefore,
unconscious
neuromimesis we
68
ideal
NERVES
centres,
IN
or
DISORDER
without "
fits,"
with
but
the
with
the
unconscious
reproduction of
symptoms of some
ne^fs^not
hysteria,
definite disease,
Hysteria
^
disease
is
therefore, in the
broad sense,
either
fits,
that
manifests
itself
in
exaggerated emotional displays with

in the accurate
or
but unconscious mimicry of

It will thus
"
known
diseases.
be seen that
it is
widely different from

rasthenia, with
its
nervousness," or neu-
long train of well-marked
nerve symptoms that suggest no disease but

the one that
is
is
there.
In neuromimesis there
;
no intention to deceive
and
it
must
care-
fully
be distinguished from malingering or

is
shamming, which and

at
for
a direct attempt at fraud,
which no contempt or ridicule can
be too severe, though of course the two

times
coexist.
may
that
The
essential
difference
is
that determines the question of fraud

in hysteria the
power that perfectly produces

is
the symptoms of the disease

scious
is
the uncon-
mind, a force of which the sufferer

In the latter,
necessarily wholly ignorant.
the agent that clumsily feigns

is
is
some
is
disease
the conscious mind, of which the patient
cognisant and for which he
responsible,
and
this alone constitutes fraud.

Cases of
69
in .^y^^?"^
brains.
'
neuromimesis occur usually

brain
is
;
lU-baJanced
an ill-balanced or starved
although the conscious
or absolutely diseased,
erratic
so
that,
mind
it is
not unhinged
often
weak and
condition that also lends itself to
the appearance of fraud.
Suppressed
thesis
, ,
gout
.
i.e.
the
,
uric
acid
dia- "Suppressed
"
that has
not exploded in
.
an acute
1
gout and
hysteria.
attack
producing
and
in
as
it
does tinglings, burn-
ings, pains,
pressures,
and other morbid

of
the
sensations
various
parts
body,
Sir
has been very
justly pointed
fertile
out by
James Paget as a
neuromimesis.
exciting cause of
Hysteria
is
thus
real
often
the
in
result
ot
some
with
slight
but
disease
a person
brain;
an
of
ill-balanced
or
worn-out
produce
is,
and
train
this slight
but real disease sets up a

that
true
associations
neuromimetic
the
seat
disease
that
disease
in
of which
is
appears to
the brain. the spring,
well
be
the
body, but
is
really in
in
Hysteria
most common
is
when the
It
nervous system
is
least
balanced.
common
;
in the under-
in the badly
trained
and over-worked, and imperfectly edugirls
cated
in
boys from ten to fourteen, in
70
NERVES IN DISORDER
in spinsters
from sixteen to twenty-five, and

at
any
age.
Over-education
and
subsequent
causes.
It
idleness
is
combined
found
clever.
in
are
fertile
often
people otherwise strong-minded and
The
:
mental
characteristics
found
in these sufferers are thus described
by Dr.
quick,
i-i-
Buzzard
Dr.
Intelligence
,
good,
.
apprehension
i
Buzzard
on the
^^^'^
'
memory good, judgment weak, no ability of concentration of thought for any length
of
time.
deficient.
Accuracy and perseverance are Emotions too easily excited, and

of
control.
incapable
The
expression
of
emotion
subjects
is
incongruous
tears
at
is
at ridiculous
and laughter
tragic.
There
is
great desire for the
sympathy and
is
attention
of others.
Sometimes there
exaggeration
in varying degree, which, however,
probably
a part of the disease." This

there
last
point must be noted.
For while
of the
can be no doubt that
many
feelings,
such as pain, are exaggerated,
we
must remember on the one hand that they are certainly felt, and on the other that
Hysterical
fraudulent,
the
very exaggeration
is
proof,
not of
fraud, but, as
we have
said,
of the ill-balanced

working
will
71
of
the judgment
and
perceptive
powers of the brain.

I
now
give a few typical examples of

selected
neuromimesis,
published
from hospitals
and
cases
rather than
from personal
Hysterical
joint
private practice, for obvious reasons.
Joint Disease.
''
Skey
'
records a case of a
young lady of nineteen whose knee so deceived him that he actually recommended amputation when, suddenly making up her mind one day to attend the wedding of her sister, she got up and walked, and the disease
;
disease.
was cured.
Sir
Benjamin Brodie said that

are
hysterical,
four-fifths of the cases of knee-joint disease
amongst the
rich
and Sir
James
Paget
so.
is
that
one-fifth
amongst the
in
poor are
What
cases
so remarkable about these joint Changes
IS that,
not only are
pam and
the joint.
stiffness
complained
directed
of,
but the continual attention

sufferer to the joints
by the
may
pro-
duce actual enlargement and heat.
short
time ago a young lady came up with a large

swelling on her knee to see one of our most
celebrated surgeons
;
and
he, failing
to re-
cognise the functional character of the disease

in the brain, so
complete was the resemblance
7a
NERVES
IN
DISORDER
to joint disease, told her, like Skey, that the

leg
must be amputated, or
knee-joint resected.
great,
and as
go
to
told to to
any rate the was very she was out of health she was Brighton for a few weeks first,
at
Her
distress
get her
health restored.
She,
however,
drove off to another surgeon,
who
;
fortunately
had made a study of hysteria
and he
dis-
covered the true seat of disease, and in a
few weeks the "knee," or rather brain, was

cured,
and no amputation needed.
Joints
are hysterically affected in the following order
of frequency
wrist, ankle,
Hysterical spinal
disease,
-^
the knee most, then the hip,
and shoulder.
Spinal Disease and Paralysis. "^
Sir
Ben-
jamin Brodie was called to a young lady
who had had

six years,
hysterical
spinal
disease
for
and
for four years
had been lying
on her face on a curious wooden machine
made
slept.
for
the purpose, where she ate and
He
cured her in a few weeks.

tells
Dr. Reynolds
an affecting story of
a young lady whose father was paralysed, and who so feared the same would happen
to herself that she gradually lost the use of
both legs and became a helpless
cripple.
On
the cause being proved to her to be purely
73
mental, in five days she sat up, and after a

fortnight
walked a quarter of a
hospital
mile.
_
A
a
she
on woman was brought
a couch into And
London
had
by two
ladies,
who
paralysis.
said
been
of
suffering
from
incurable
paralysis
the spine for two years, and

all
having exhausted
her they
their
means
a
in nursing
now sought
After
to get
her admitted,
pending
curables.
her removal to
Home
for
InI
two
hours'
treatment
walked with the
woman
half a mile
up and
returned
down home
the
in
waiting-room, and
she
an omnibus, being completely cured.

is
An
amusing case
that of a paralysed
girl,
who, on learning that she had secured the

affections
of the curate that used to visit
her, got out of
bed and walked, cured
and
afterwards
made an
excellent pastor's wile.

this sort of cure
A
is
remarkable instance of
that of a child afflicted with paralysis,

to
who
was brought up from the country

to the
Paris
Hotel Dieu.
The
child,
who had
meomni-
heard a
great deal of the wonderful

hospitals, its
tropolis, its magnificent
potent doctors, and
their
wonderful cures,
vividly
was awe-struck, and
so
impressed
with the idea that such surroundings must
74
NERVES
IN
DISORDER
after
have a curative influence, that the day

her arrival she sat up in bed,
much
better.
The good
doctor just passed round, but had

treat her
till
no time to
the third day,
by
which time, when he came round, she was out of bed walking about the room, quite
restored
by
the glimpses she had got of his
majestic presence.
Cure of a
case.
Dr. Dale
tells
us of the wife of a medical

legs.
man
with hysterical paralysis of her

it
it
She was told to overcome

suggestion)
in a
:
was due to her mind, and
by
force
of will (a futile
she could not, and went about
bath-chair.
One summer
;
a drunken she
Highlander tried to kiss her
up and ran
off,
cured, to her husband.
jumped Here
of
is
we
see
most instructively the impotence of

will-power,
the conscious
and the
force
the unconscious
mind the moment
there
it.
a suggestion strong enough to reach
This
is
the class of disease, as distinguished
from neurasthenia, where sudden and sensational cures are possible
often in appearance
Cases of this
and common, and seem almost miraculous. sort, that come under the
head of hysteria, including especially paralyses

of various kinds, are so exceedingly
common

that
75
Varieties of
paralysis.
there
amples.
give further exno need to Suffice it to say that there is no

is
form of paralysis that

hysteria, from the
loss
is
not simulated by
of power in a single
finger or joint to the total paralysis of

side, or
one
but
of both legs, or of the entire body.

in
The pain may be

is
any part of the
spine,
generally about
the " small "
of the back.
In
rule,
hysterical paralysis
the muscles, as a
do not waste much, and no bed-sores

If the
;
ever form.
helpless
limb
is
bent
it
often remains so
which would not be the
case in true paralysis.
This paralysis of the special

total loss
may
senses.
also affect
It
any or
all Paralysis
special senses
may
be
cause such
of taste
for years
that the
most
nauseous substance can

disgust.
It
eaten
loss
without
of smell,
may
cause
garlic,
total
so that neither
coal
gas,
asafoetida,
It
nor otto of roses can be smelt.
may
It
cause squint of one or both eyes, or colour

blindness, or
any
sort of imperfect sight.

It
may
cause deafness in every degree.
may
cause loss of feeling or touch anywhere, and

the part
may
be
pricked or
cut without
being
felt.
Tumours.
Tumours
of
all
sorts
are
76
NERVES
IN
DISORDER
is
Hysteriaxi
Simulated with a fidelity that

startling,
absolutely-
and
skilled doctors are constantly
being deceived.
They may occur
in
any
in
part of the body, but are
most common
the breast and abdomen.
In the breast severe
pain
is
complained
of,
and a hard mass may

if
be
felt,
which, however, disappears
the hand
be
laid flat
upon the
in
part.
with
those
the
Not abdomen.
so,
however,
Hysterical
patients with perverted nerve centres have an
unconscious power of either contracting part

of a single abdominal muscle so rigidly that
it
forms a hard, round, solid swelling, plainly

;
perceptible
or they can spasmodically con-
tract the digestive canal at
two points so as
to imprison between
portion, which,
being
them a largely distended filled with flatus and

easily
felt
partly
movable and
cavity,
is
in
the
ab-
dominal
tumour.
exactly like an abdominal
If
the
person
be thin
or
and
the
tumour
the
be
pressed
aorta,
down
the
resting
on
abdominal
pulsations
from
the blood-vessel are so perfectly communicated to the false tumour that

to be an aneurism.
Fifty cases of
hvstcricsLl
it
is
believed
was
his
told
by one of
fifty
our bcst-known physicians
that
cases
tumours,
had been sent
in
to
hospital
of this

form
of
^^
pulsating
;
tumour
as
abdominal
to be
aneurisms
all
of them, previous to admission,

certified
having been examined and

such by medical
men
and
yet,
on further
examination, every one of them turned out

to
be of hysterical, and not

in
local,
origin.
The only way

cases,
which they can,

is
in
many
be found out
by
ansesthetising the
patient,
when
regains
the tumour generally disap-
pears, but, of course, returns
immediately the
I
patient
consciousness.
remember
this
in hospital practice
one special case of

of
sort
under
my
care
woman whose
size.
whole abdomen was greatly distended by a

supposed tumour of enormous
chloroform
it
Under
at
once disappeared, but on

it
regaining consciousness there

as
ever.
was as large
therefore,
The woman was

and
it
not,
" cured,"
was no comfort to her to

all
know
to
that
when she was unconscious the

not there
it.
;
swelling was
she wished was

of
i
be relieved ot
therefore put her Cure
under chloroform again, and while unconscious tightly
bound her round with

I
plaster-
of-Paris bandages, that
allowed to set as
hard as stone before she regained consciousness.
This time, of course, she could not
78
NERVES
"
IN
DISORDER
"
expand, and the
tumour
"
was gone.
"
it
;
She
and
well,
was delighted we had

after
removed
keeping the bandage on
for three
weeks
to
accustom her to the idea she was
and so stop the morbid process in her unconscious mind that had produced it, it was
taken
to
off,
and the woman
left,
most thankful
tottered
.
be relieved of her distressing complaint.

special affections.
Spasm
of the gullet.
A
,
young lady
oi
mto
the out-patient department
one of
our large London hospitals not long since,

followed by her mother in an agony of mind,
having an open
tin of "
Brand's
"
in
one hand
and a spoon
this
in the other.
She had brought

and she wished
because her daughter was dying from

gullet,
a contraction of the
to
show us that not even a little jelly could be swallowed. The girl was reduced to a skeleton, and would certainly have died from
neuromimesis
be
if
not relieved
for
there can
no doubt that people
die
solely
from
ques-
hysterical affections,
tion
it.
though some
may
After using appropriate means to
affect the
mind
indirectly, in
about half an
hour the patient was

potatoes,
sitting in
one of the
wards eating a large plateful of boiled mutton,
and
turnips, with " hospital
pudding
"

to
follow.
It
is
79
cases
like
these,
seen by
men wholly
ignorant of
the
powers,
and
perhaps of the existence, of the unconscious

mind, that are necessarily considered fraudulent
and the patients
"
malingerers."
Hysterical aphonia.
A
total
matron of an important
loss
to resign her post
institution had and a large salary through
of
voice.
Examination
showed
that this
was
hysterical, for
when she coughed
she phonated, and the vocal cords were perfect

in action.
Appropriate means in a fortnight

very common, and
patient, however,
completely restored the lost voice.

Hysterical vomiting
often persists for
is
;
months the
appetite
does not lose as

expected.
much weight
as
would be
greatly
The
;
may
be
perverted
it
may
be enormous, or entirely
absent, or depraved
all sorts
of things being
other
diseases.
swallowed.
Symptoms
of obscure diseases,
such as hardenings or softenings of the spinal

cord,
to
that could not be
known
consciously
tremors,
the patient, and
consisting of
rigidity,
spasms,
etc., in
special parts of the
body, are produced by hysteria, and

persist
for
may
months
and only
slight incon-
sistencies reveal that

all.
they are hysterical after

further
But
must not dwell
on these
8o
NERVES
IN
DISORDER
on thinking over
will
cases, only repeating that,
even these few instances,

mind.
it
be
felt
how
the
readily the idea of deception

It
is
comes
to
only when the real aetiology

is
of the disease
is
grasped that such an idea
seen to be inadmissible.
Indeed, without a knowledge of the cause
Symptoms
appLr
fraudulent,
of the
disease,
the
appearances are often
g^ consistent with fraud that one cannot so
much blame
as
the
the doctor
who
suspects
this
medical training which has allowed
him to fall into the error. We must also remember that malingerers abound, drawn
frequently from the ranks of nerve patients,
who
and
produce
feign
artificial
wounds and
sores,
is is
illnesses.
Of
course,
this
common amongst soldiers and sailors, but not uncommon in educated people and,
;
to
make matters
fraudulent
distinction
is
worse,
some
cases are partly
and
partly
hysterical,
and
I
the
not
always
easy.
have,
however, throughout been speaking of real

cases only,
and that
is
why
have written
so strongly of their treatment as unreal from
an ignorance of the
It will
aetiology.
will
be observed here, and
be noticed
again further on, that the unfortunate word

" hysteria," '
8l
Neuromimesis is more than mimicry.
elude "
deal
which we confessedly use to inneuromimesis," actually covers a good

. .
r more than the mimicry of
disease.
In
find
many
the
of the instances given here
we
mind producing not so much mimicries of disease and death as actual lesions and That is to say, the power of death itself. the mind over the body goes far beyond the mere production of mimicries, however
perfect these
may
be
in their
way.
In these
lesion,
it.
we admit
when we
there
is
no
real local
but
only the unconscious simulation of

find
But
with evacuation of pus
examples of inflamed fingers of bruises and ecchy-
moses, actual death, haematemesis, and gan-
grene
we
it
feel
the word " neuromimesis

as elastic as "hysteria"
"
has
become well-nigh
itself.
would hardly do to put these into a separate class. They are but extreme and somewhat rare examples of the power of the
yet
And
mind over the body and the generic term " hysteria " must at present cover them all.
;
Perhaps
the
I
,
it
might be well now to summarise Symptoms

.
.
.
symptoms of
in
hysteria
m
.
one
of hysteria
list,*
as
have done
the case of
neurasthenia.
hysteria,
* Some of these, that are symptoms of emotional have been given on p. 6$.
82
NERVES
IN
DISORDER
is
Hysteria (using the term broadly)

terised
characof the
by
anaesthesias
in
all
parts
body, in regions, patches, sides, and limbs
by
visual anaesthesias resulting in
narrowed
fields
of vision
by
fits
or
paroxysms with
and occasionally
movements,
or without incomplete loss of consciousness
and accompanied by
clonic
tonic spasms, tremors, convulsive
and
large contortions, sometimes of extreme
violence, with
or without cries, foaming at
the mouth,
clenching
of
hands and other

or pains
emotional signs
in
by
dysaesthesias
any
joint in the
body, often in several
in painful
zones or patches in the head, the
back, the heart, the abdomen, the coccyx, the

breast,
the
mucous membrane, the organs

paralysis of every
of special sense, the limbs, and the organs of

generation
by paresis and
or any part of the body capable

or neuro-
normally
!
i
of voluntary motion
by
and
contractions and
mimesis.
wastmg of
tremors,
/.
,.
limbs
or
parts
continual
states,
by intermittent by
/
of
limbs
mental
talkative,
urticaria,
ecstatic,
etc.
vague,
demoniac,
taciturn,
by
of
dermatoses
skin
by
hyperaemias
and
other
eruptions
by haemorrhages
in
all
from organs and
under the skin
parts of the
body

NEURASTHENIA AND KEUROMIMESIS
by stigmata
83
by muscular atrophies (detected

by absence of Babinski's
all
in lower limbs
sign,
extension of big toe on tickling sole of foot)
by pyrexias of
hemiplegia
sorts
by
tetany
by
by
paraplegia
by
and
incoordination
swellings
all
of muscular
movements
by
tumours
(perfectly
simulated) of
sorts,
largely abdominal, fluctuating, solid or pulsat-
ing according to the variety, and of all sizes by abnormal gaits of all kinds by mutism by stammering by aphonia, aphasia, am-
by coughs by dyspnoeaby dysby gastric spasms and gastralgia by flatulence by haematemesis by anorexia by borby vomiting, ordinary and
nesia
pepsias
faecal
borygmi
by
swollen
joints
by
dysuria,
polyuria,
anuria,
incontinence,
retention
less
by
floating
kidneys, also
by more or
elaborate simulation of various diseases, such

as hip disease, asthma, Pott's disease, etc.
I
have now given
a general picture
hysteria,
of
neurasthenia
cially of that
and of
more
call
espe-
phase which we
I
neuro-
mimesis
and
may
pass on
now
to consider
the general principles of mental therapeutics,
and particularly
their application to the cure
of functional nerve diseases.
On
Mental Therapeutics
85
CHAPTER
III
speaking in this chapter specially of IN mental therapeutics, must not for a
it
moment be imagined
sole
that at
these
are
the
in
means of
cure
our
disposal
will
functional
later
nerve disease.
We
discuss
other means
by which
these sufferers
can be restored to health.
Mental
be
omitted
disease,
therapeutics
in
cannot,
however,
of
Mental
pemics
any
treatment
of
nerve
and
is
knowledge
to
in
their
great ^tted.
value
essential
every
cure
physician
who would
disorders.
excel
the
of
these
Mental
used,
therapeutics,
less,
though
universally Seldom
scientific-
more or
are seldom spoken of or
ally,
studied scientifically
are not in
by the
87
profession
and
much
favour even amongst the
88
NERVES IN DISORDER
men who
is,
very
(often unconsciously)
largely
use them.
It
no doubt, the connection of mental
therapeutics directly with faith-healing, mental
science-healing
in
all
its
many
varieties,
and hypnotism, and indirectly with

electricities,
liquid
billionth
all sorts,
dilutions,
and
quack
remedies of
that has so far deterred

its
the profession from examining
wonderful
powers very
The
why.
reason
closely.
For there can be no doubt that the

of mind in
force
medicine, not being a regular
subject of scientific study in medical schools

in this country, has often
been used by clever
and unscrupulous men

rather
for their
own advantage
;
than that of their patients

felt
and the
at such
disgust rightly
practices
is,
by honest men
no doubt, a strong reason why

is
the subject
I
neglected.
sure,
feel
quite
fall
however, that
all
such
fact
reasons will
to the
ground when the

is
of the unconscious mind
admitted, clearly
;
and
its
by scientific men and once powers become generally recognised they

definitely,
will at last, after
long neglect, be
made
the
subject of serious study.

Still
the prejudice exists, to the great loss
of the profession, though
it is
89
have no doubt
gradually disappearing.*
-^
^ physician There are two mighty powers for good ^ ^ ^ wields two in every physician worthy of his name what forces,
he knows and what he

rule
all
as a he only values the former, and places

is
;
but, alas
his reliance
on the hieroglyphics But there

is
in
his
prescriptions.
a consciousness,
in every actual or potential patient
who may
scan these
lines,
that there
is
a something
about his doctor that does him more good

than the medicines, which indeed he does
not always take.
is
And
for,
the doctor he likes

in spite of the fact
the one he sends
that the
other doctor in the

scientific
town has
greater
reputation
and
a longer
string of letters after his name.
One
button,
of the last words of
Henry Gawen
at
Value
ot
my
personality
teacher
01
:
pathology
"
the
London
to
Hospital,
was
to
Don't
underrate
the influence of your

give
own
personality.
Learn
confidence
is
your
felt
patients."
presence
its
of course
"
in
proportion to
power.
lole,
how
did
you
know
* On this head see "The Force of Mind, or the Mental Factor in Medicine" (2nd Edit.), by the author.
J.
&
A. Churchill.
90
NERVES IN DISORDER
? "
Hercules was a god

tent the
"
Because
was con-
moment my eyes
fell
on him
he consat."
quered whether he stood, or walked, or
To
constrain a feeble brain to be governed
by a good and strong one is not a superhuman

labour for one
who
eye
goes about
it
adroitly.
The fno7nent the

eye
of
the patient
meets the
action^
of
the
physician,
psychological
influencing the course of the disease, at once

takes place through the mediu7n
for
of the patient
good
unconscious mind.
The
depression caused
by
a doctor's bad manners or gloomy looks
may
be combated actively by the patient's reason,

but
his
will yet have a bad effect, malgre lui, on body through the unconscious mind, or
" instinct."
Just as with our material science

skill
and physical
we
I
seek by drugs
and
other agents to influence the

so invariably (and, as
body
said,
for good,
have
most often
unconsciously)
does
the
physician's
mind
of
possess
influence that of the patient.
The
to
" gift
healing "
to
that
some men seem
a marvellous extent, so that few sick can
leave their presence without feeling better,

is
a purely unconscious psychic quality, at

rate
in
its
any
origin
though, like other
gifts, it
can of course be perfected by use.
Manner
is
91
much
is
in
medicine,
and
the Manner in
medicine.
personal presence
a power in practice, and
both are worthy of a serious consideration

they seldom
get.
Continually
the consulting
physician
is
brought face to face with cures, aye

diseases
too,
for.
and
the cause of which he cannot
account
And
is
he not often surprised to
find that a continuation of the
same
treatis,
ment originated by when continued by his august
the local practitioner

self,
efficacious ?
And
is
not the local practitioner not only

is
surprised but disgusted as well to find such
the case?
And
this
is
often
what happens
is
in func-
tional diseases,
where the patient

the
unusually
responsive to mental influences.
Indeed,
that
in
is,
it
is
mind and not the drug
as a rule, the potent factor for cure
nerve diseases.
malady induced by mental causes can
Value of
faith
only be cured by mental remedies.

the mental
will
and
full hope.
recognition of the value rightly attaching to
treatment of physical ailments
improve the usefulness of the physician

assist in the
and materially
patients.
recovery of his
In disease, functional or organic.
92
NERVES
IN
DISORDER
of
faith
is
the
therapeutic value
and
hope,
though not in our text-books^
often
enough
to turn the scale in favour of recovery.
For, although drugs are
still
administered,
but few medical

are the entire
men now
believe that they

;
cause of the cure
for
very
gradually
it
is
beginning to dawn upon us
that most nervous diseases at

easily
and
to
naturally
treated
any by
rate are
mental
therapeutics,
efforts
and
that
the
still
persistent
cure them
by the stomach
are
neither reliable nor rational.

Great
It
ill
becomes, therefore, the medical

it
man
is
power of
unconscious
who
recognises in these cases that

to decry
the
mind.
mind which cures

treatment,
if
any form of mental

process
carried out with honesty for the
patient's good,
however
little its
may
have
be understood by him
in detail.
We
seen that the powers of the unconscious mind
over the body are well-nigh immeasurable
and
is
believing, as
we now
do, that our old
division into functional
and organic diseases
merely the expression of our ignorance,

all
and that
diseases, even hysterical, prob-
ably involve organic disturbance somewhere,
we
are
prepared to believe that faith and

cures, putting into opera-
other unorthodox
you
"
93
tion such a powerful agent as the unconscious
mind,
or,
if
prefer
the formula,
the
forces of nature," are not necessarily limited to

so-called functional diseases at
all.
There
ising
is
no doubt
all
this
will
soon be
util-
fully recognised,
and the importance of
the
power of psychotherapy
will
be
everywhere admitted.
attention will
The
result will
be that
no longer be exclusively con-
centrated upon physical
phenomena
and
or bodily
will
;
symptoms, but the man as a whole
be
in
more studied
will
"
body,
in aid.
soul,
spirit
and
curing any one part the powers of
all
three
be used
day will come," says De Fleury,* "when an upright and intelligent physician, strong enough to defy ridicule,
there shall arise
DeFieur/s
and authorised by a noble

dignity
life
and the merit
of his labours to lay claim to the superior

of a
moralist.
If
he
knows the
moralist
human
might
heart well he can draw the sick of

"
soul to him,"
The sound medical

double the
soul
be
able to
amount of
strength
voluntary energy and moral

in us all."
* De
Fleury,
'
Medicine and Mind," Prize Essay of

p. 224.
the French
Academy,

NERVES
.
94
IN
DISORDER
^scudo
less
The
physician's
vestibule,
Dr. A. Morrison, President of the

lapian
u Society, says *
r-.
We
not
often
than half our
duty
in
exploring the
mental
has
life
of the patient. ...

written
good deal
vascular
Is there
been
on
prolonged
tension due to physical causes.
no
such state as prolonged mental tension due
... In such cases, if the physician is to be of any service to his patient, it must be by the agency of mind on mind
to moral causes
?
;
and
inner chamber of
this takes us
out of the vestibule littered
with microscopes, crucibles, and retorts into

The
that inner
chamber
.
the
a
holy of holies
i .
.
in
mental
peutics.
the
life
of a physician and his patients

laid
where heart and mind are

sympathetic
discretion
bare to the
gaze
of
fellow-man, whose
may
be relied on, and who
may
from his training in the knowledge of the
human
able
to
soul as well as the
human body be
dis-
cure
his
brother of a most
his life
turbing factor in
beyond the reach

of a purely
of
the
advanced
therapeutics
physical kind."
Before leaving this subject

at
we may look
some mental
qualities that are recognised
as curative agents.
Dr. A. Morrison,
The
PractitioTter,
1892, p. 27.

Sir
95
of cure
ness
John Forbes gives as psychic powers augmented hope faith cheerful:
Menta
curative
qualities,
mental
mental work
new
activity decreased anxiety new motives for mental action soothing motives for physical
life
moral and religious principles.

" Imagination," says Sir
J.
C. Browne,* "
is
one of the most
effectual of psychical agencies
by which we may modify the conditions of health and disease." A disciplined imagination is one of the most valued tools of a
physician.
strong will
is
a good therapeutic agent
Mental
feelings
therapeutics
may
be
directed
to
calming the
mind
in
excitement, arousing
hope, and love,
of joy,
faith,
by
suggesting motives for exertion, by inducing

regular mental work, especially composition,
by giving the most favourable prognosis possible, by diverting the thoughts from the
malady.
Sympathy,
ambition,
medicines.
religion,
common
altruism,
sense, patience,
indifference, neglect,
philanthropy,
are
all
at
times
good
mental
The
* See
doctor himself, his illegible prescripSir J. C.
Browne, Leeds Address, 1889.
96
NERVES
IN
DISORDER
his fee (if impressive),
The doctor tion, his room,

himself as a medicine,
and even
are
all
Valuable
therapeutic
agents,
and
mind unconsciously, besides their conscious effects on the stomach and pocket.
affect
the
Sympathy
the hands
after
all,
is
indeed a powerful drug in

a skilful
administrator
;
of
for,
patients think
his
much more
;
of the
doctor
than
prescriptions
while he
poor
man
as we have already
pharmacy
all
said, generally
thinks his
and himself nothing.
Success largely depends upon our striking

the keynote of the characters
deal with.
" he
is
we have
to
" In
nerve disease," says Coleridge,
the best physician
who knows
visits
best
how
the family physician.
to inspire hope."
wise doctor pays
many
learns
that are
^^^ confined to strictly professional topics

for in
them the doctor

it is
much, as the
before him.
unconscious mind displays

Indeed,
itself
not too
much
to say that until
the doctor has seen his patients at their ease

in
their
fully
knows them.
in the
own surroundings he never really The stiff ten minutes consulting-room does not reveal much
of the complex causes of a difficult case of

functional nerve disease.
It is
thus that a family physician in the

first
97
instance has the greatest opportunities
of mental treatment.
useful,
His blue
pill
may be
but his opportunities of social inter-
course, his tact in encountering false notions
and
instilling
healthy ideas, are
the
most
Four
varieties of
powerful remedial agents he possesses.
There are at
least
four
ways by which
power of the
in
itself,
mental therapeutics can be applied to disease,

1.
mental
therapeutics.
By
the
direct
active
/-I
unconscious
mind inherent
unconscious
and
generally called the vis medicatrix naturcB.

2.
By
the
mind
influenced
directly
by surrounding
the
personalities or other
unconscious agencies acting as suggestions.

3.
By
unconscious
conscious,
mind influenced
which has
faith
indirectly
by the
the
in persons, systems, places, etc.

4.
By
unconscious
mind
indirectly
acted on by the conscious
by
distinct effort
n determination to get well

Iness, ignore pain, etc.
I
to
shake off
must not enter on these

I
varieties in detail
;
now, as
but
I
shall
have to recur to them again
may
point out that, broadly speaking,
mental therapeutics are divided into natural
and
artificial
the former consisting of the
ealing power residing in the
body
itself
and
98
NERVES
IN
DISORDER
The
vis
knowfi as the vis medicatrix naturcBy and the

latter
medicatrix
ttatura.
of the
various
means used
n:iind
by the
of the
physician consciously or unconsciously, that
reach the disease through the

patient.
With
regard
to
natural
mental
thera-
peutics, the first
point perhaps
interest,
is
to consider,
is
and one of great
what
really
meant
Is
it
by
has
the
well-known expression vis

been
.
7nedicatrix natures.
a
It
of
course
hotly
all.
disputed
force?
whether such a force exists at

this
Then,
if
be admitted,
it
it
has been strongly argued

;
that
is
not a true force
while,
on the
it
other hand, by a very large majority
has
been decided that

of
it
is,
and one moreover

value
in
almost
inestimable
cure.
It
appears to
natural
me
that this vis consists of the

in
power resident
sorts
the unconscious
its
mind
of
to preserve the
;
body against
if
enemies
all
and,
these
should
have
gained an entrance in the shape of disease

or
accident,
to
combat them
call
"
vigorously
of
largely
disease,"
by what we
symptoms
and also by other processes.
These
all,
"natural powers," however, form, after
only a part of the mental factor in therapeutic
medicine.
99
Further powers can be aroused
and brought into action by mental therapy,

in
stimulating the patient's

efforts
greater
shall
in
various
own mind to ways which we
consider.
So
that the vis medicatrix
natures
and the energy aroused by mental

represent together the powers
its
therapeutics
of the unconscious mind in
beneficial rule
over
the
body.
We
will
adduce
proceed.
further
reasons for this view as
we
Views Dr. Mitchell Bruce writes respecting ^ ^ this of Dr. * " agent are compelled to acknowledge Mitchell
:
We
-1 r a power of natural recovery mherent

1
m
.
Bruce.
the
body a similar statement has been made by writers on the principles of medicine in all ages. The body does possess a means and mechanism for modifying or neutralising
. . .
influences
" I
which
it
cannot directly overcome."

"
believe,"
he continues,!
that a natural
power of prevention and repair of disorder and disease has as real and as active an
existence within us
as
have the
ordinary
functions of the organs themselves."
The
the
most, then, a doctor can do

in
is
to assist The vu
is
body
making use of
this great
power,
of the unconscious
^''*^-
* Dr. Mitchell Bruce, Practitioner^

t
Ibid.f p. 248.
xxxiv., p. 241.
lOO
NERVES
IN
DISORDER
repeat,
is
which,
we may once more

mind.
really
nothing more than the action of the unconscious
The
vis
is
a fine illustration
of the power of the mental factor in pathology

if
not literally in medicine.
So great indeed
is this
natural power that not the most skilled

is
combination of drugs
its aid,
of any avail without
while the
purest
if
most haphazard remedies

can
accomplish
this ever-present force.
of the
empiricism
marvels
backed by
this
But
for
marvellous
set
power, a morbid
inevitably
;
disturbance
once
up would
continue to the point of annihilation
for
is
treatment addressed to the living body

absolutely
meaningless except as an
appeal
to
such powers of resistance as a patient
possesses.
When
these powers
of the un-
conscious mind
fail,
as in the closing scenes

it
of any fatal
illness,
is
idle
to
expect
anything from treatment, as of course we

all
know death
really
is
the result of the
failure of the vis medicatrix naturcB.

Mental
therapeutics act
diseases,
Mental therapeutics are not

nervous diseases only.
efficacious in
else;
We
"
have shown
is
where * how widely spread

* See " The Force of Mind
Churchill.
their value
J.
so
(2nd Edition).
& A.
that there
is,
loi
as a matter of fact, hardly

it is
disease where
not
felt.
We may
in other
give just one or two instances
here of the power of the mind on the body
than nervous diseases.

Examples,
Sir Humphry Davy, wishing to experiment with some new preparation on a
paralysed
patient,
put
first
a thermometer
believing this
under
his tongue.
The man,
was the new remedy, soon felt so much better that Sir Humphry told him to come the next
day
and
in a
few days, with the thermometer
applied for
well.
some minutes each day, he was

Gerbe,
Dr.
Ranieri
of
Pisa,
cured
401
out of 629 cases of toothache by making the

sufferers crush
fingers,
specific.
a small insect between their
which he represented was an unfailing

took into a hospital ward some
A surgeon
time ago a
for five years,
little
boy who had kept
his
bed
fall.
having hurt his spine in a
He
his
had been all the time totally paralysed in legs, and could not feel when they were
;
touched or pinched
in the least degree.
nor could he move them

After careful examina-
tion the surgeon explained
minutely to the
I02
NERVES
IN
DISORDER
boy the awful nature of the electric battery, and told him to prepare for its application next day. At the same time he showed him
a sixpence, and, sympathising with his
told
state,
him that the sixpence should be

have
to
his
if,
notwithstanding, he should
improved
enough the next day

pushing a
chair,
walk leaning on and

also save the
which would
in the park,
need of the battery.
In two weeks the boy
was running races
and
his cure
was reported
in the Lancet.
There are several recorded cases of dropsy

entirely disappearing through fear.
Anaesthesia without
anaesthetics.
who had taken ether three young J o lady

before,
and a half years
on the inhaler being

the
face,
held three inches
away from
unconscious
and
retaining a faint odour of ether, went right

off,
and became
without
any
ether being used or the inhaler touching her
body.
Dr.
small
W.
B., in 1862,
having to remove some

the
tumours from
head
of
a lady,
prepared to put her under chloroform, and

sent for the bottle, meanwhile
piece of flannel before her face.
his
surprise,
holding the
He
saw, to
she was
going off;
and she
was soon unconscious, before the chloroform
arrived.
103
The
doctor removed a tumour, and
the dry flannel being taken
away
the patient
;
showed signs of returning consciousness on its being replaced she again went off, and the
operation was completed.
After some time
she awoke, having been completely unconscious

all
the time.
and
Sickness death
Dr. Dureaud reports a certain unjustifiable
experiment on a hundred hospital patients,

to
it
from mind
action.
whom
sugar-and-water was given

it
and
less
was afterwards pretended that

administered
in
was an
emetic
mistake.
No
lie)
than eighty out of the hundred became
sick.
gentleman, led to believe (by a

in
that
he had slept
a bed where a
man had
died
of cholera, developed through fear of the disease, and died.
symptoms
Perhaps these cases
will
be sufficient to
power mind can exercise over the body, and to help him to understand the great part it must
indicate to the reader something of the
the
play in the cure of diseases of functional
nervous
origin,
which are so closely con-
nected with it
Self-Treatment, Unconscious and
Conscious
los
CHAPTER
IV
SELF-TREATMENT, UNCONSCIOUS AND CONSCIOUS
W
A
have already described something The

picture.
of the routine medical treatment of

as
nervous patients that until recently was
common as it was mistaken and and we do not think the picture has been
overdrawn.
injurious,
There can be no doubt

intelligent
that
functional
nerve diseases have not been handled in an
and
scientific
way.
itself JDescnpciinique.
reason for this at once suggests
when one
cussed.
attends the medical schools and
cliniques at hospitals,
and hears diseases

which
the
dis-
The way
in
is
medical
history of the case
taken, the subjective
and objective symptoms noted, the predisposing and

exciting causes
;
discussed,
and
the aetiology settled
the wonderful care in

107
io8
NERVES
all
IN
DISORDER
symptom
is
putting
its
together,
giving each
due weight, and the diagnosis which

fill
at length arrived at,
one with admiration
and awe at the science and exactitude of

medical research.
Treatment
lightly dis-
missed.
of the casc
gut when we procecd to the treatment ^ we experience a shock for the

;
treatment
is
the
subject of no such grave

is
consideration, but
probably dismissed in a
sentence, and occasionally

this,
we do not
get even
the matter being
left
altogether to the
discretion of the house-physician.
The
interest in
surgery no doubt centres

in
round the operation,

Success in treatment
largely due to the vis
medicine round the
diagnosis of the disease.

It
may
be asked.
How
;
is
it
possible that
succcssful treatment in ordinary diseases can

.
medicatrix
be
a Secondary matter
lines,
on contradictory
merely expectant
the shape
on often and sometimes being

carried
in this case, in
placebos,
of inoperative medicines, stilling
the cravings of the hospital patient's
mind
(as
and stomach?
It
is,
The answer
is
remarkable.
that
it is
more and more recognised

at
notably in a recent remarkable address by

Sir
Frederick Treves
Liverpool)
by the
physicians standing around the bed, that they
SELF-TREATMENT
are in the presence of another
109
and greater
gifted
doctor
Dr.
in
V.
M. N.
a doctor trained in
divinely
to
no human
heal
all
schools,
but
varieties
of disease, and
to repair
every species of injury

natures
the
vz's
medicatrix
other words, the " Unconscious
Mind."
"
Wilkinson,*
his
far
Every thoughtful practitioner," says Dr. " will acknowledge that, when
therapeutic reserves are exhausted,
by
Dr. wîikinson on the vis medicatrix natura.
the most reliable consultant
is
the vis
medicatrix natures.
To
first
ignore the fact that
she has already been in charge of the case

for days,
when we
approach with our

at least
mixtures and tabloids,

in
is
a mistake
Medical
treatment
of
medical ethics."
negligence, therefore, in This comparative o ^ > the treatment of ordinary diseases works well,
mmor
importance
in many cases.
because of the force always in operation for
good behind the doctor; who now knows

that the fever, the cough, the sweat, the loss
of appetite, are one and

devised
for
all
curative
symptoms
by the
good.
patient's
unconscious mind
his
Much good
(and sometimes
drugs,
;
harm)
*
is undoubtedly done by by other forms of treatment
and
but
ii.
every
Dr. Wilkinson,
The
Lancet^ 1897,
1518.

no
NERVES
IN
DISORDER
really wise physician
ultimately due to the
knows that no cure is means he uses, though

credit.
he doubtless generally gets the

is
This
not always the case, however, in the more

districts,
benighted country
where sometimes
grate-
the greatest compliment paid by the patient

to the doctor
ful
is
when he says with a

"
!
air
that his medicine has not " done
him
(the patient)
any harm
is
Cureb much more

difficult in
g^t thg difference

to treat functional
many nerve
<Uaeasea.
great when nerve diseases.

after
we come Not untreatment
frequently the
is
practice,
is
the diagnosis
established,
to dismiss the
still
more
curtly,
and often with hardly-conBut look

in
cealed contempt.
results.
at the disastrous
In most ordinary diseases the vis

is
medicatrix natures
the doctor
;
full
vigour behind
and even
if his
treatment be of
a very passive order, the cure actively goes
on under the guidance of the unconscious

mind.
ijecause the VIS
In
nervous diseases
rcason
that,
it
is
not
so,
for the
medicatrix
itself is
simple
the
nervous
system
itself
being exhausted or diseased, the vts

the
unconscious
mind
is
weakened
in
its
or
;
hindered, or even
for the patient is
arrested
action
weakened and diseased
in
SELF-TREATMENT
in
the centres of his being, in the innermost
machinery of
his
life,
and thus so frequently
remains uncured.
The
far
truth
is
that nervous diseases require
more
careful, well-devised,
carried-out treatment than
and elaboratelyany other ailment,

himself
is
ill,
because here Dr.
V.
M. N.
and cannot co-operate, as

with the physician.
It
in other diseases,
would appear that
in
neuromimesis the
very unconscious power of cure that
we
call
the vis works in a morbid manner, and causes

disease instead of curing
origin of the ailment
;
it,
and
is
itself
the
instead of being a vis
medicatrix naturcB
it is
a vis morbus natures.

to be successful,
Hence the treatment,
has
often to be lengthy, elaborate, and expensive,
and people wonder that nerve diseases are so hard to cure, having no idea that it is for want of the efficient help of Nature's
doctor.
What
is
a wise physician does in these cases
to get the vis inedicatrix natures as soon
First step to restore the vis to

IS
as possible
Ml-mto workmg
activity.
order, so that
it
may
co-operate in the further treatment of the

disease.
But
this
requires
a knowledge of mental
112
NERVES
for
IN
to
DISORDER
minister
to
therapeutics,
diseased,
mind
conscious or
unconscious, mental
remedies must be used, and these are by
no means
Quacks thrive on
functional
in
favour in the profession,
nor
are they very skilled in their use.
nerve
diseases,
Hve and thrive on the misuse of Ouacks =* patients who might them, and hundreds of * " well be curcd by physicians are driven to
them, because the former have never seriously
studied the special therapeutics of functional
nerve diseases,
^cks
stiu
Lately
^
writer
in
the
British
Medical Journal
quacks,
flourish.
has
been
denouncing
and pointing out many of their questionable practices. But the writer does not say why
they
still
flourish
nor why, in this educated
period, they are as numerous, or

in the
more
so,
as
dark ages, and can

large
still
undoubtedly
cures.
produce
If the
numbers
of
genuine
common
sense of the public has not

suffi-
yet enabled this enlightened body to

ciently distinguish
between the value of the

practitioner
regular
orthodox
and
the
opposing army of quacks, special
" pathists "
and faddists of all sorts, whether counts or commoners, it is to be feared that there is
rather a poor prospect of their ever doing
" ;
SELF-TREATMENT
SO as long as matters are as they are.
public,
113
The
higher
prosaid,
curiously enough, set
far
value on
fessional
a "cure" than the trained
man.
With him,
as
we have
most
"
interest centres in the diagnosis of the disease,
and
it
is
to this point that the
careful
teaching and training are directed.
We
"
;
do
but
not say that to most

it
it
is
the
end
"
is
certainly
it,
a very prominent
so.
means
indeed to
and necessarily
the
The
care
public,
and with them the quacks. The public

diagnosis,
for
little
about
which
for cures.
they
have
neither
learning
for
is
nor
interest
what they do look

alas
!
the cure, which,
is
often effected without
any diagnosis
risk to the
at
all,
though not without grave
patient for
as
want of
it.
As
and
long,
therefore,
quacks
cure diseases, so long will the

;
public
employ them
no
Carlylean quotations as to the

fools
amount of number of
classi-
in the world, or
contemptuous
fication of the cured diseases as imaginative,

will alter their attitude.
The
subject of mental therapeutics
is
still ^^"^^^
peutics Ignored,
ignored in medical works generally. o ^

physiologies no reference
is
In our
to
now made
the central controlling power that rules the
114
NERVES
IN
DISORDER
body for its good, and the power of the mind over the body is seldom spoken of. Systems of medicine, however large and modern, display the same character as the
physiologies.
"
rather old
book,
Pereira's
Materia Medica," devotes three pages

2,360
to
out
Dr.
of
"psychic
therapeutics."
in his "
Shoemaker, of Philadelphia,
1,200
System
of Medicine," spares one page out of about

;
but most of the others, including far
larger works, devote none.
Every
to
possible,
and even impossible, aid

is
therapeutics
;
gravely
the
discussed
at
length
including
;
values
of
obscure
organic extracts
of special
artificial
forms
;
of exercise under
names of every variety of light, heat, and Rontgen ray of German synthetic compounds with
innumerable
;
barbarous
foods,
polysyllabic
titles
of
;
patent
while
and of systems innumerable

is
not one line
devoted to the value of the

physicians treat nervous
mental factor
Good
treat-
in general therapeutics.
No doubt many
^^^ what
mostly empincai.
diseases of functional origin wisely
and
well,
we contend
for
is
that
the know-
ledge they display was taught at no school,
was learned from no book, but
is
intuitive
SELF-TREATMENT
and empirical
selves.
;
115
they owe nothing in this to
their costly training, but everything to
them-
This
is
not as
it
should be.
The
power of mental therapeutics and the general

treatment of functional nerve diseases should
be
the
subject
of
careful,
special,
and
;
scientific
teaching in every medical school
Scientific
tc3.chiri'^ IS
and
will
if I
may
judge by the
many encouraging increasing,
letters
that reach
in
become so
me from various sources, many hospitals before long.

further in detail,
We
might pursue the subject of maltreatresults of neglected
ment or want of treatment

and describe thedisastrous
cases
it is
;
but the task
is
an invidious one, for
far better to consider one's
own
faults
than to dwell on the mistakes of others.
We will
selves
in
therefore turn
now
to the question Cure
of the cure of these diseases, confining ourthis
of disease by the patient,
chapter to considering what

for themselves, either entirely
patients can
do
apart from the doctor, or with his aid

supervision.
and
There can be no doubt that few patients a patient

are aware
selves
how much they

Before
it
when
suffering from incipient functional
can do for them- much in an ^^^^ ^^^'

ever gets to a
nervous disease.
Ii6
NERVES
IN
DISORDER
medical stage, when professional help must be

called
in,
they can arrest

their
it
and regain
their
cases.
health
by
When
own man or
treatment in
a
many
woman
first
finds out
that his nerves are not in
good condition,
instead of indulging in fancies and imagining
he
Remove
fer^^^p^sibie.
may
be losing his reason, or that he
is
" Only pretending,"
he should seek out the two
It
is
causes that brought him to his present state

^Yie
is
predisposing and the exciting causes.

generally
the
case
that
the
former
difficult or impossible to
alter,
the latter
easy.
Predisposing causes are mainly questions
of heredity, which obviously cannot be cured,
but must be endured. Or perhaps they may be the general surroundings or mode of life, or some sort of past shock or trouble.
The
exciting
cause,
on
the
contrary,
is
generally
some present
incident or pressure
or trouble or condition that can more easily
be
altered, avoided, or
removed.
There
diet
may
may
be contributing causes of a physical nature

there very
frequently are.
sleep
The
be
be
wrong, the
may
In
insufficient,
the climate
may
be at
fault,
all
the work or
these cases
occupation too severe.
SELF-TREATMENT
the
first
117
step,
obviously,
that
is
to
remove any
or
possible cause
may have produced

illness.
contributed to the
change of
diet,
of
life,
of surroundings,
of climate, of work, of
habits
rate,
companions, or
;
Patient can change the ofenviron-
and these, at any are within the patient's power to make,

be necessary
it
may
though
frequently happens that the trouble
and
responsibility
if
involved
make him
far
happier
he
first
saddles a doctor with the
responsibility
of his deeds,
by acting on
to a doctor, One reason
for consult-
"medical advice."
Many and many

his illness
man 'comes
remove
it,
not because he does not
know what
causes
ing a
doctor.
and how
to
but because
he lacks the courage to take the necessary

steps,
and only when strengthened by the

need
actions,
doctor's fiat has the resolution to act.
We
such
not enter into
particulars
of
which necessarily
:
vary with
to
each individual case

the patient can do
in
suffice
it
say that
himself
much
"
to cure
the early stages of
common- sense measures

of his disease,
whatever.
" by taking remove the causes without taking any drugs
nerves
to
One
of the
first
is
points to note,
when the nervous system
on the verge of
Ii8
NERVES
IN
DISORDER
is
No loss
control.
of
becoming unbalanced,
possible
to retain
by every
For
this
means
one's self-control.
reason tears are often dangerous then, and
should be restrained, except in some extreme

cases where they afford necessary
relief.
If
a state of nerves or nervousness comes on,
anything and everything should be done to

avoid a breakdown, which always paves the
way and makes

to run
it
easier for a second
^just
as a horse which has run
away once wants

in the
away
this
again.
To
is
end a brisk walk

;
open
air
beneficial
or,
if
this
be not possible or
is
prudent,
a very good plan
to
undress
bath,
completely on the spot, take a
warm
followed with brisk rubbing, and then dress

again, preferably in fresh things.
Patient can often treat the disease,
But the patient can do more.

,
He
i
can
this
i
definitely attack the nerve

in
symptoms, and
two
ways
it
either
by
counter-irritants,
thus distracting attention from

centrating
face
them by con-
elsewhere
or he can directly
them and overcome them by exerting the force of mind over the body by will, by the formation of habits, and in other
ways.
The power of
the
mind over the body
SELF-TREATMENT
has
limits,
119
but they have
never yet been By exerting

powers.
ascertained.
What
a patient can do to cure
himself, the forces
he can set in action, are

are inclined to believe
as yet
unknown.
We
they are
will
far greater
than most imagine, and
undoubtedly be used more and more.

is
strong will
a good therapeutic agent.
Mental
therapeutics
may
be
directed
by
in
the patient himself to calming the
mind
excitement, arousing feelings of joy, hope,

faith,
and love
exertion,
especially
by suggesting motives for by ordinary regular mental work, composition; by giving oneself EspedaUy
;
the most favourable

disease,
life
suited to cure the
diseases.
by diverting the thoughts from the

give two illustrations of the self-
malady.
We may
mainly,
if
cure of patients effected by their
own minds,
not entirely.
In 1837, Pastor Chiniquy, then a
Roman
pastor
'^^^
Catholic priest, got severe typhoid fever in and" Canada, and four physicians told his bishop %^^^^
there
was no hope of
his recovery.
On
the
thirteenth
day they said he had only a few minutes to live, and his pulse could not be felt. He then in a vision saw his favourite
ittint, St.
Anne, to
whom
Jie cried
for cure
I20
NERVES
IN
DISORDER
with every power of his soul, and he heard

her say
"
You
will
be cured."
He
recovered,
and Quebec rang with the miracle. He was examined by two Catholic and two
Protestant
doctors.
Dr.
Douglas,
Protestant,
showed Chiniquy
being a
his recovery
was
that
due to
will,
his
man
of remarkably strong
resist
and determination to
death
the will
his
had a
real
power over the body, and

conquered.
strong will had
Chiniquy
listened, but preferred his saint,
and had a
votive picture painted of her for ;^5o.

priest
who saw
miracle,
it
was no
then told Chiniquy the cure and that most of the crutches
the
hanging
round
church
impostors, and the rest
were left by by those cured by the

representing
the
power of the mind over the body.

Till
1858 that
picture,
saint telling
Chiniquy's in
Chiniquy he would be cured, was

In that year he again got
the church.
second
typhoid fever in Chicago, and once more was

given up as dying.
But
this
time he did
a determinareturning.
not cry to the saint,

tion to get better,
but made
and soon
felt life
He
then saw the saints had no part in his
previous cure, and took his picture
down and
burnt
it.
SELF-TREATMENT
The
details,
121
above, even
contains
if
not
accurate
in
all
a good
illustration
of the
power a patient has over his disease. I will give one more, from personal experience. I had some time ago l in a favourite nurse, who ^"'^ typhoid always had a superstition she would die of a nurse.
fever. She contracted it at length when nursing a bad case of mine, and lay
typhoid
in
a county hospital
apparently dying, in
the third week of the disease, in a low typhoid

condition,
and
in to
with
every
appearance
clear.
first
of
collapse, but with the

I
mind
went
see
her for the
time,
and found her much depressed. She told me she was about to die.
" Certainly," I said.
She looked up and
replied,
I
"Yes, but
mean it " Then

She
I said,
always said
should."
I retorted. ?
of course you will,"
stared,
and
is
said, "
Don't you mind
"
"What
saying
the use of minding?
You
die,"
are going to die

"
if
you say
so."
My
so doesn't
make me
she answered.
" Perhaps
it
does,"
replied, " for if
you
said
live."
you wouldn't
die,
you would probably
122
NERVES IN DISORDER
saw, as far as
that
I
Thewii
thrown into
the scale,
reached
point
when
could judge, she had o j the throwing of

'
the will into either balance would determine
the issue.
"
*'
Do you mean
Yes,
I
that
? "
she said.
do,"
replied, " and,
what
is
more,
unless
again.
you say
It is
so, I
won't come and see you
now
11.30,
and
if
now, at
this
hour of the morning, you turn your mind

the other way, and determine to live and not
die,
I'll
do
all I
can to help you.

I'll
You
shall
have another nurse, and

to let
get the doctor
you have a little champagne. But this must come from you." She looked me hard in the face, and, seeing I meant it, and believing me in her heart, she said in deepest earnestness, " I will," and
resolve
from that hour she steadily gained strength,
and soon got

I
life,
well.
firmly believe that interview saved her
and that from that moment the curative

vz's
action of the
niedicatrix naturce
conscious mind
was immensely strengthened
the
un-
and quickened by the force of the woman's

conscious *^y
cases.
will.
those
To some this may seem strange, but to who have studied the subject many
SELF-TREATMENT
similar instances will
123
for in
come
to
mind
one way or another such cases occur every day, though they most often pass unnoticed.
The
its
cultivation of the will greatly increases
power.
But the mere' determination, howfreed from
ever strong, to be
the nervous
sufferings does not always drive
them away
we have a
far greater
power
to effect this,
and that is the power of auto-suggestion. I do not say for a moment this is as
efficacious as enlightened medical treatment,
Auto-
but
it
has these advantages

it
that
it
costs
nothing, that
that
it
can be applied at home, and
requires
no
drugs
differs
is
nor
apparatus.
This
auto-suggestion
^
entirely
from
Without
hypnotism.
'
hypnotism, in that there J sr

the patient has
and no hypnotist, J r
is
not to go to sleep, but
in full possession of his faculties.
What he
has to do
is
carefully
saturate his brain
and systematically to by suggestion with what

This
sight,
he wishes himself to be or to become. can be done by speech, by thought, by
and by
all
hearing.
Here are
to
set
four brain-paths,
of which
tend
the
unconscious
mind
cure.
the
vis
to
work
at
the process
of
The
point to see in this
method of cure
"
124
NERVES
all
IN
DISORDER
is
is
that after
the condition of the patient

little
often so nicely balanced that a
may
turn the scale the right way.

Dominant
ideas
determine
conduct.
various
point out in and Bernheim ' ways that great results are frequently determined by emotion-ideas or " dominants
Liebcault, Vofft,
themselves insignificant.
baker's shop
stealing or
A man
outside a
may be
not
just balanced
between
Hunger prompts the one way, principle the other. Now, if an emotionidea is presented to his mind of his starving
family at home, he takes a loaf and becomes
a thief
If,
on the other hand, a vision of
prison Or the verse "

rises
Thou
brain,
shalt not steal
forcibly in
his
in
he walks away.
nerve affections
In the same
way
many
a comparatively slight self-suggestion will enable us to do what we otherwise could

not,
iiiuste-ation
and so overcome some nervous dread. For instance, a person with some unfear
ofautosuggestion
reasonable
that
is
poisonmg
his
life
maybesides
cause, besides
removing
combating
any
it
contributing
his
will-
with
power
its
actively
bringing his reason to bear on

folly to
employ auto-suggestion by and show it

;
himself by saying aloud at the

just
most impressionable time, when
waking
SELF-TREATMENT
or falling asleep,
is,
125
how unreasonable
by
the fear
seeing in
by thinking
similar thoughts,
print the folly of his fears described,
and by
hearing others
say the
same.
all
This
may
but
not cure the trouble in

it
instances,
effectual,
will in slight cases
be found
and
Domestic
treatment.
is
at
any
rate innocuous.
.
this, some definite domestic treatment may be added. As a prophylaxis agamst
Besides
11.
incipient
neurasthenia
we may mention
;
for
women a day's complete rest in bed and for men a week-end away from home, at a
good inn
in the
country or at the seaside.

ideas,
For incipient nervous dreads or
some*
times hard enforced work, that engrosses the
mind
as well as tires the body,
is
an admirable
curative.
Of
course in these and
many
result,
other
methods
time
disappointment
may
in
all
and
may
be
lost,
and
of them the
counsel of a wise physician to direct in the

details of auto-suggestion, etc.,
is
a great help
but in the absence of
this
we
are sure that
a great deal can thus be done by the patient
himself without medical advice.
One great point

to disabuse his
is
for the patient
thoroughly
Nerve
unbinge the mind.
nervous
... disorders
mind
of the idea that these seldom
are a sign that the
-11
mind
-1
126
is
NERVES
This
;
IN
DISORDER
going.
all
is
often the worst torture
of
to bear
indeed, so
it
sometimes when
is
bad is it, that removed all the other

if
symptoms disappear
Let the
to
as
by magic.
sufferer, then, in the earlier stages
of nerve trouble, seek to remove the cause,
suggestion,
combat the symptoms by his will, by and by habits and occupations

next chapter
will
calculated to cure them.

If all fails, perhaps the
show what the physician

for him.
may
further
do
Medical Treatment of Functional
Nerve Diseases
127
CHAPTER V
MEDICAL TREATMENT OF FUNCTIONAL
NERVE DISEASES
T may
be
best, in
1
outlining the treatment Some

!
of functional nerve diseases by the medical
11
and
con-
ditions of
success
man, to first point out some conditions on which success depends in the general
management of
loUow with
mimesis.
the treatment
these
cases,
then
as
to
a few special
remarks
to
of neurasthenia
and neuromostly to
Experience
in
medicine
has
;
be bought, and often dearly

following points have
in
and if the any value to others

diseases,
it
handling
they
these
are
difficult
is
because
painful
the
outcome
in
of
many
lessons
and
failures
working
J functional nerve diseases.
amongst these cases
for
many
at
years.
One may
though
in
say here
129
the outset that,
our modern textbooks neurasthenia
I30
NERVES
IN
DISORDER
distinct
and hysteria are rightly treated under

heads, as
generally,
we are now speaking of treatment we will use the former term in

sense
to
broad
embrace
all
functional
nerve cases.
To make
lise
the hints given as clear and as

it
useful as possible,
may
the
;
be well to crystalFirst,
;
them around
;
four
centres.
the
physician
secondly,
patient
thirdly,
methods
details.
of
treatment
fourthly,
various
diag-
In other words
personality,
nosis, treatment,
and
details.
The
of
first
point one would

the
make
(in
in
conteeth
nection with
physician
the
much
that has been written,
the practice of
and against some noted neuropaths) is
that one of the chief conditions of success

is
sympathy, and one of the chief causes of
failure is the
want of
"^
it.
Sympathy
in the
^Jq
not Say
it
;
need be always, or even

but,
physician,
frequently,
in
shown
believing as
do
the subconscious
mind, and
the
quick
unconscious relation of one mind to another
when
ever
in
harmony,
real
it
have no doubt whatis
that
sympathy
in
it
always
felt
wherever
exists
the
physician
;
for
the sufferer, though
be not shown
the
MEDICAL TREATMENT
proof being that
his
skill,
it
131
gives a
confidence in
of
and
restful
is
feeling
being
understood
that
no mean
write.
factor in the
cure of every disease, but especially so in

those of which
these,
indeed,
we now we are
Concerning
that
certain
any
doctor
who does
not inspire
his
patients
with this confidence will have more failures
than cures.
To
feel
this
sympathy one must

the
believe
in the reality of the sufferings of the patient,
and dismiss
pected
truth
absolutely
blight of sus-
malingering.
One must grasp
the
of the brilliant dictum of Sir James
Paget,
who
"
declared that while the
patient
says she
" will
will."
cannot
"
and the nurse that she

is
not,"
the truth
that
she
"
cannot
Let us
already,
is
remember,
what has been

the
said Pain
fact.
is
mental
that a disease of
imagination
pain,
not an imaginary disease,

its
and that
in
last
analysis,
fact,
is
a mental rather than

reality does not in
its
a physical
the
least
for
its
depend upon
neurasthenics
resting on
any
that
definite physical basis.
To
there
tell
is
or
hysterics
nothing
the
matter
with
them,
132
NERVES
IN
DISORDER
dis-
because no clear physical basis can be

covered
for
the
symptoms complained
in
of
unless
cases,
for
done
deliberately,
exceptional
is
a definite purpose
to
confess
oneself unfit to deal

diseases.
with functional nerve
As
slowly,
very
slowly,
the
enormous
powers of the subconscious mind over the
body are beginning to be dimly perceived, such crude and false statements are becoming rarer but they are still common enough amongst those whose opinions are
;
founded solely upon physical diagnosis.

Patience
physician,
is
The next
patience,
qualification
in
the
is
physician
different
and
this,
think,
from mere endurance,
and
really
depends
It is
upon the
those
first
quality
sympathy.
the
only
who know
the tortures undergone by
functional
nerve sufferers
pariahs
and
can
outcasts
amongst patients and doctors

for
and
who
feel
their
sufferings,
that
possibly put
the sufferer
up with the trying nature of and his multifarious and often
apparently incurable troubles.
As long
as
a doctor has any doubt as to the definite
and
real
character of the disease,

is
as long
as the bona fides of the patient
a matter
MEDICAL TREATMENT
of question, so long
is
it
133
very
difficult for
him not to be
defective in patience.
The
our
lack
of this virtue in
doctors
fills
holiday
and
health
resorts
abroad
with patients sent there because the doctor

could not stand the
strain
at
home, and,
recognising his resulting impotence, ordered

travel as the best
way
out.
is
Allied
to patience
perseverance.
The
Perseverphysician,
despondency of the
to them, over
control,
patient, the
scepticism
of relations, the continued and heavy expense
which the physician has
little
and the want of any signs of imit
provement,
virtue also
may
be for weeks, render

to
practise.
this
most
difficult
it
And
yet for want of
how many patients go unrelieved, how many incipient cures are nipped in the bud, and how many successful
failures
methods are prematurely abandoned as If we have sound grounds for

!
believing
our treatment
successful
is
rational,
if
it
we
in
have
seen
results
all, if
from
there
let
previous cases, and, above

least
is
the
glimmer of improvement,
There
is
us per-
severe on and on.

to
no space here
but
I
adduce cases
in proof of this,
have
one in mind
that, after
defying every doctor
134
NERVES
every
variety
IN
of
DISORDER
Weir- Mitchell
and
and
similar " cures,"
was
five
at last successfully re-
stored to health mainly
kept in bed for

doctor
Firmness
in the
.
by being persistently months on end, by a

beaten.
is
who would not be

.
Closely connected, again, with this

_
/-.
.
the
rAysician.
question o\ firmness.
it is
Curious as
it
may
seem,
easy to be too firm, and

firm
still
easier not
to be
enough.
lies
The path
in
of success
here undoubtedly
the
golden mean
between the two.

in
Be
inflexible as cast iron
things
essential,
flexible
;
as
steel
in
is
all
matters
non-essential
inflexible
and never, as
This
gives
so
common,
fidence,
from mere doggedness,

con-
but always intelligently.

brings
success,
and avoids
friction
with patients and friends.

" believes in " a doctor
it
;
No
patient really
who
absolutely lacks
all
it
is
the
quality above
others that
inspires respect.
Tact in the
physician.
Perhaps *
really this question *

.
depends upon
.
the next great virtue, without which neurasthenics cannot be successfully treated, and
that
is
tact.
Tact
is
the unconscious mental
touch, the tactus eruditus,

feels
by which one mind

as
another;
and
just
is
physician's
physical tactile sense
educated to discern
MEDICAL TREATMENT
much by mere
difficult path.
135
touch,
so
can mental
tact
help the nerve doctor immensely along his
Take,
for
instance,
the one question of Should
whether to
make
in a
light
it
of
any
particular be ignored
symptom
or to treat
quite seriously.
The
think,
answer does not
neurasthenic in the least
depend, as the doctor
may
naturally
upon the amount of obvious physical basis upon which that symptom may rest, but on the effect on the patient's mind of your and to ascertain this effect levity or gravity
;
beforehand
is
the highest outcome of
tact.
nature
For
it
must ever be recognised, and may The
here be categorically asserted, that amongst

functional nerve diseases hysteria or neuro-
mimesis,
mimesis at any rate

of
the subconscious
;
is
distinctly a disease
mind, of
is
unconscious
suggestion
its all
and
it
in
this
it
very fact of
differs
unconscious nature that
from
forms of malingering, which always imply
conscious fraud.
conditions
Whatever diseased physical

therefore
may
coexist
require
is
is
treatment, but the mental
condition
unthe
doubtedly the more important, and
one which
in
every case requires the greatest

tact.
judgment and
Most medical men,
136
Difficulty
NERVES IN DISORDER
are
inclined
to
believe,
glorify
their
;
of treating these
diseases.
own
particular branch of the profession
but one
recesses
cannot but see
that, in
pursuing to
its
and
in
curing diseases produced by such a
mysterious agent as the unconscious mind,
one has to employ power and means of a

very different nature from the comparatively
simple and straightforward processes of purely
physical medicine and surgery.
Importance of
honesty.
I
may
perhaps just say a word on the

;
value of honesty with these patients

is
for
it
a word by no means limited to

interpretation.
in
I
its
ordinary
absolute
solely
sordid
mean
as
honesty
in
considering
and
acting
the patient's
interests,
distinguished,
not from the doctor's, but from the parents,

friends,
and
relatives,
and
others
whose
aside
counsels and pleadings so often turn
the
otherwise
sound
judgment upon
is
of
the
physician.
Attention
to details.
Lastly,
success
to
depends
that
power
of attention
details
not always
found
in
minds broad enough to grasp the

Minds, as has been pointed
case as a whole.
out, are generally characterised
by observation
quality
gives
or imagination. accuracy
in
The former
details,
the latter
broad and
MEDICAL TREATMENT
wide views.
those
137
rare,
The combination
it
is
and
who
is
possess
are
generally masters
of their profession, and in nerve diseases this
union
of especial value.
The
doctor
is
who
not
knows
and
at
sees
that
his
patient
disturbed
night after the last massage
who
she
gives
exact orders as to her detailed
routine throughout the

is
day
who
ascertains
not roused and agitated by the noisy

grate
cleaning of
and
room
early
in
the
morning, will do
much
for
to ensure the general
success of his elaborate treatment.
capacity
taking
of
pains
and
for
arranging
details
treatment
may
turn
the scale from failure to success in a doubtful

case.
for
So much, then, with extreme brevity, the doctor and his personal powers.
in the
Let us now consider,

the patient.
second place,
the conditions of success in connection with
Here
the
we
find
if
that
success
is
greatly
Difficulty
failures,
handicapped
victim
the patient has been already
of
previous
failures.
As Dr.
Allbutt has pointed out, these always act

prejudicially in sapping the
confidence and
I
courage of the
sufferer.
Personally
have
138
NERVES
this
IN
DISORDER
complication to
found
a most
difficult
deal with.
The mechanical
routine
is
of a
so-called
" Weir-Mitchell cure "
now
so well known,
and so absurdly regarded

panacea,
often
that
this
as such a universal
else
or
something
has
been tried unsuccessfully before you
see the patient, with the result that anything
approaching the same methods

regarded
with
suspicion
;
is
already
it
though
may
essentially differ,
and
result in success instead
of
Confidence
failure.
Another element of success

is
in the patient
and
nurse,
confidence
" nurse,"
in
the doctor and
nurse.
add
because
this
many
physicians are
not aware
how
person can weaken or

at a cure.
wholly frustrate
occurs to
all efforts
case
me
that, treated
by Weir-Mitchell
each time
in
method
failure
twice,
only resulted
loss
and actual
of
weight.
Secret
sapping of the doctor's influence, with neglect

of orders, was the cause in one
rupture of the two, neutralising
in
;
and open
all
efforts,
was difficult, but with agreement between the two was eventuthe other.
case
ally successfully treated.
I
The
must not omit
here,
as
distinct
from
MEDICAL TREATMENT
all
139
study the diagnosis of the disease, and as a great patient's element of success, a close study of the person
ality.
patient's
personality
and
mental
a
calibre.
This so often necessitates, even in two suffering from

the
same
symptoms,
course
of treatment in one case entirely different
from that required by another.
The
as
personal factor
is
so
comparatively
valueless in ordinary physical diseases, such
pneumonia or
it,
gout, that one
is
apt never
to consider
until
one
finds,
from disastrous
experience in functional nerve disease, that

its
proper consideration
is
in
its
way
quite
as important as accurate diagnosis.
We
now come
it
to
the methods
of cure
and here
depends
is
obvious that, though success
largely
upon
the
it
physician
much upon
still
the diagnosis,
and must depend

and adequate
more upon the use of

first
right
means.
In the
in
place, then, with neurasthenics, Machine-
the
greater
,,
number of
.
made
cases
systems
of treatment turning out
" cast-iron "cures" useless. 1
machine-
made
and
from
"
cures
stand
If
condemned
one
in
theory
in
practice.
may
it
say a word
is
practical
experience,
that
the
140
NERVES
cause
of
IN
DISORDER
I
chief
the
failures
have
come
fixed
across
has been the ordering of such and
such cure by
name
(involving
some
routine and surroundings), that failed because
not
adapted or adaptable to the patient's
special needs.
Of
course, wherever a doctor
has any fixed
system,
or
wishes to
save
himself trouble, these ready-made expedients

are
very tempting
but
we must
here
lay
down
the the
as an important condition of success
making a system
patient,
or
treatment to suit
a patient
to suit
rather
It
than
is
the treatment.
far
otherwise
when
dealing with
lesion,
any
definite
fever.
such as enteric
and well-known Here the more

the
of routine
better.
Methods must be
adequate.
and
fixed
treatment often
spoken of the adequacy of the methods used. This adequacy must not be
I
have
judged by the amount of potent drugs prescribed,
or the violence or expense of the
agencies employed.
They may range from

conducted
in
the most elaborate combinations of psychophysical

treatment,
well-
appointed
home
with every possible adjunct,
down
to a few simple prescriptions, or even
short medical talks, or a change of environ-
MEDICAL TREATMENT
ment or occupation, or mere
simple.
rest,
141
pure and
No method
contrary, that
this
can be decried as
;
trivial that
succeeds in curing the patient
but,
on the
at
plan
is
best that
arrives
result with the least time, trouble,
and
expense.
No
many
expense, however,
is
so expensive as
iii-heaith
ill-health,
and one of the strangest of the
expensive
strange
phenomena
that
is
are seen in
^
cvu^^^
otherwise rational people
the ungrudging
way money
luxuries,
is
spent on dress, jewels, and

the
short-sighted
in
and
economy
it
that
is
everywhere
evidence when
is
a question of health, by which alone these

luxuries can be enjoyed.
Most methods involve the use of nurses Nn

or
trained
sort;
is
attendants,
or as
companions
" nerve
of
nurses.
some
and
here,
we have
already
hinted,
a frequent cause of non-success.
Doctor, diagnosis, method
all
may
be
right,
and yet there

This
reason
it
is
no cure because the sub-
ordinate agents are inefficient.

is
not the place to enlarge upon the

this
is
why
upon
so
frequent,
based
of
as
is
the
is
non-recognition
for a class
the
great need there
between the
142
NERVES
IN
DISORDER
and
starched-
three-years
hospital-trained
and-ironed aseptic nurse of the period, and

the depressing mental attendants
Neurasthenic nurse not yet pro-
known
is
to
alienists.
The
be
is
neurasthenic nurse
definite
a being
product,
yet to
evolved as a
duced.
but she
sometimes met with as a chance
growth
hospital
likes
in out-of-the-way places
frequently
simplest
painfully
ignorant,
routine.
alas
of
the
The ordinary
nurse dis-
the neurasthenic cases, largely because
she does not understand the reality of the

disease in
the
absence of physical lesions,

hysterical cases
and partly
there
is
also because in
not only the appearance of fraud, a

perverted
in
but
often
mental
bias
that
takes pleasure
the
fault-finding,
and setting
and
vice
nurse
against
the
doctor,
versa.
It is well for the
doctor to remember
this,
and, even
to
when
a nurse has to be changed,
uphold the nurse to the patient whenNascitur non fit
ever possible, even on therapeutic grounds.

At present
the nurse is born,
is
undoubtedly the
dis-
tinguishing motto of the mental nurse, though

the " fitting
also
;
not made.
"
is
most necessary and useful

this
is
but until
recognised,
is
and the
nurses are to be had, what
the doctor to
MEDICAL TREATMENT
do ?
Well, of course, he
.
143
has to cure his Hence

cures.
the
want of adequate help, the cure has often to be effected by his own personal influence and visits to an
patient.
At
expense of
present,
for
extent
that
\ôuld
not
be
in
the
least
necessary were
our training
system more
adequate and really

This
is
efficient helps to
be had.
all
is
very well for patients that can

naturally very expensive.
is,
pay, but
The outcome
-cases
is
therefore,
all difficult
clearly
this,
that the treatment of

necessarily,
neurasthenic
and from causes quite

control,
far
beyond the
(excluding,
doctor's
more ex-
pensive than that of any other class of disease

of course, any involving major
surgical operations),
and
far
more expensive
be
of On
than
had.
it
need
be,
were
of
efficient nurses to
This
question
nurses raises
that
nursing
nursing homes generally.
In the
first
place,
neurasthenics cannot, as a rule, be cured in

their
own homes,
is
need
rest in
for what they one and all some form. Now, to women
home
their
is
the sphere of the greater part of
work, to the
the
man
of
the
only
rest.
is
it
(with ex-
ceptions)
is
place
Hence home
needed
obviously not
environment
144
for
NERVES
women
;
IN
DISORDER
are cured
and for other reasons men also more certainly and expeditiously
their
away from
necessitates
own
for
family
circles.
This
the nursing
at
home
as an indis-
pensable
the cure.
Quality of home determines success of
adjunct
any rate part of

to say that the
Now,
it
is
not too
much
quality of this
home
largely determines the
treatment
question of succcss in the treatment.
Nurs-
ing homes are so frequently unsatisfactory

that
many
physicians have been
driven to
its
run their own.

vantages, but
backs.
it
This has, of course,
ad-
has great and serious drawI
Of
course
am
here not speaking
of surgical homes, or of any treatment but

that of neurasthenics.
Personally,
I
have never been able to get
over the professional feeling that a physician
ought to look to
alone,
for
his
fees,
and
to his
fees
payment
for
his
services,
and
should not directly or indirectly run a boarding-house under any name, or share in the
profits if derived
Should
doctors
from
his patients.
It
,
may, of course, be urged that a doctor

,
.
have their
can have
his
own
nursing home, and yet

its
.1
have nothing to do with

profits.
management
it
or
In
this
case,
however,
is
hardly
MEDICAL TREATMENT
his,
145
though
his patients
fails
may go
there
and of
free
course he
to
have the perfectly

all-important
hand
has
in dietaries
so
that
is
he
in
when
its
pecuniary management
his hands.
It
may
it is
not,
indeed, be difficult
to
show
own interest that the doctor, and run by home should be the many medical men will see no weight whatever
that
to the patient's
in
what
urge against making a profit from
board and lodging.

for oneself,
One
can in this only speak
and
rate,
for all others like-minded.
At any
doctor's
whether
matron's,
is
the
it
home be
must be
the
or the
one
where the dietary

the
best
practically
relied
unlimited,
where the food can be
on to be of
least,
and well cooked, and, not

quiet and airy,
punctually served with cleanliness and nicety.
The room should be

any
rate
and at
major surgical operations should

If possible,
not be conducted in the home.

it
should
have
some
it.
private
grounds
or
garden attached to
The matron
actively
or sister
in
may
the
or
may
not The
matron,
co-operate
treatment,
but
should at any rate avoid the slightest adverse
comment on any methods she may not
146
NERVES
IN
DISORDER
understand or agree with.

prepared to
request
till
She should be change the nurse at the doctor's

the
patient
all his
is
suited,
and to
promptly carry out

Treatment
of neurasthenia
orders.
Finally,
details
in
we must touch on one

to
cases.
or two
which have much
do with success
the
different
proper,
these
Comparing
varieties of functional nerve disease,
we may
say that the treatment of neurasthenia proper
and hysteria
In the
is
fairly distinct.
former, where
the
is
whole mental
the
brain
is
system
is
is
sound, and
physically,
it
that
worn out
is
while rest
good,
isolation
not often needed, and over-feeding

frequently
and massage can

with.
fight
be
dispensed
In neurasthenia, moreover,
against the symptoms, as
we never we have to
nearly
" cure "
do
Treatment
in hysterical cases.
These
latter, too,
require
isolation,
always some form of Weir-Mitchell
with massage, and probably a large amount

of suggestion, direct or indirect, which neurasthenics do not.
In
mental cases, however, rest in bed

matter, for
it
is
by no means a routine
nearly
always aggravates the disease.
It is also
not
MEDICAL TREATMENT
often of value, as
is
147
we have
seen, if the physique
otherwise good and sound, and the nervous

is
system alone
overworked and weakened,
as in neurasthenia.
It
is,
however, generally needed in cases
of malnutrition, in diseases of neuromimetic

origin,
and and
in doubtful nerve cases, to give
time
opportunity
;
fully
to
determine
the diagnosis
tration,
also,
in severe
nervous pros-
even without other physical lesions

all
and
in
cases
coupled with cardiac infor Value
sufficiency.
Massage
exercise,
is,
of course, always needed
of
massage.
digestive purposes, to take the place of active
where there
this,
it
is
entire rest
in
bed.
all
Besides
disorders
is
of special benefit in
all
of the circulation, in
of muscles, in
joints,
all
wasting
or
or weakness
stiffness
weakness of
in
most cases of
organs, in
pain,
in congestions
of internal
many
to
forms of cardiac disease.
To some massage
others
necessity to
all
;
is
a severe
It
is,
trial,
a great pleasure.
however, a
but
its
value to some extent
depends on the personality of the masseuse.
She can do much

and not
a
little
to
help
the treatment,
it.
to
hinder
The
skill
148
NERVES
IN
DISORDER
to those
also varies greatly,

it
Isolation.
and
who
dislike
this is of special
importance.
relatives
is
The
a
question of friends and
difficult one,
and
is
not answered by the
simple rule of complete isolation.

invaluable
in
This
is
it
hysterical
cases,
wherever
can be carried
pression or
there are
sistence
out without too
much
;
de-
irritation
of the
patient
but
in-
many
it
cases
where too
either
rigid
on
means
failure,
from the
Here,
patient leaving in consequence, or from the
bad
as
results
on the nervous system.

follows
elsewhere, success
an
intelligent
combination of
Suggestion.
flexibility
with firmness.
to
in
" suggestions."
Lastly,
word
pointed
as
These,
as
out
the
previous
if
chapter, can seldom be assimilated

directly.
made
We
must remember one great point with
regard to suggestion
that
yet,
it is
like nitrogen.
in
all
Nitrogen
is
the
it
essential
element
animal
life
forms four-fifths
curious
it
of the air
to say,
we
breathe
and
we
have no power to use
in
a pure state.
We
can only take
it
indirectly,
when com-
bined with other substances in the form of

proteid food.
It
is
the
same with sugges-
MEDICAL TREATMENT
tions.
149 in
Not one
hysterical
sufferer
hundred can receive and
made directly
generally
indirectly
that
is,
by them if consciously they must

profit
;
be presented, as
to
we have
said,
the unconscious
mind by the
treatment and environment of the patient.
An
if
electric
shock often cures slight hysterical
diseases
it
instantaneously,
more
;
particularly
as
it
is
expected to do so
acting,
does,
on the unconscious mind through the

doubt
conscious.
No
it
would be
easier if
we could
is
Best given
The by suggestions from ideal cure it, all you have to do

say to these
sufferers, "
disease
caused
to
centres, and,
is
to believe
you
are well
"
;
and, indeed, with a very few this
can be done with success, even in cases of
some
is
gravity, while in very slight
symptoms
would be
be
is
of " nervousness " this direct auto-suggestion

quite
successful.
fcftr
Still,
as
it
impossible
us to take our nitrogen pure the
from the
unhealthy
in
air,
mind cannot
as a rule
thus acted
:
on directly when
treatment.
.
the brain
suggestion must be wrapped up
objective '
doubtful
benefit
Some
patients, as
Hypnotism is ofHypno^ lism. in most neurotic cases. we have seen, and many
-^
ISO
NERVES IN DISORDER
of low mental calibre, are benefited by the

direct
suggestion
well
;
that
they
are
rapidly
getting
more,
however,
to
the
use of means
directed
by benefit combat the

as
elecetc.
symptoms
tricity,
complained
of
such
the
massage, drugs, exercises,
which,
and
in-
besides doing a very great

directly,
amount of good
suggestions
do
still
more by
the
they
convey to
patient's
mind,
to
thus afford
a rational
prelude
an
telligible cure.
They appeal
to the patient's
reason,
and
afford
satisfactory
food to the
mind, which finds a very natural gratification

in the use of extensive
Thoi'0*t.
urning.
and elaborate means.

that
Another form of
can only be
indirect suggestion,
administered by a
the
fullest
physician
who
is
in
is
confidence
of
his
evil
patient,
that
which points out the
and the weakness

character of
and
that
the
feeds
folly
of that
itself;
mind
upon
and that draws out the mind to
altruistic
and worthy
which
through
has
;
objects,
and thereby
the
alters the
flow of the unconscious current of thought,
been
feeding
disease
all
and thus makes the subconscious

details
mind
itself
Other
undo the mischief it has done. important enough to effect
MEDICAL TREATMENT
success are
circulation,
lessness,
151
the
management of dyspepsia,
constipation,
rest-
sleeplessness,
depression,
and other troublesome

quite
as
symptoms.
In
neurasthenia,
much
as
in
hysteria,
the
in
beneficial
influence
is
of real
;
confidence
the
doctor
very marked
and when
upon
in
this is assured, the patient

its
makes
rapid progress, owing to
stimulating effect
his unconscious mind.
The
all
its
personal
cures
factor
must
bulk
nerve
largely
Personal
influence of doctor,
'
of functional
disease,
and
used,
value
always
must be recognised and with wisdom and care, lest

a valuable aid
to health
ill-health.
that
which
is
be
It
used as a crutch to support

is
here indeed
that the
practical
in
;
wisdom
mental
of the medical
factor
man comes
for the
and influence
may,
like
any drug,
be abused as well as used, and overdoses
may drug
as
or even poison the patient as

chloral.
much
opium or
A
"
moment's
reflection,
indeed, will
as the
show
of
that no
power so strong
" force
mind
can be used without

Aftertreatmeot.
due
care.
Fmally, in most nerve cases,
to
ensure
a permanency in the cure, the patient should
152
NERVES
IN
DISORDER
connected
should
not return to the
surroundings
state.
with his diseased
An
and
as
effort
be made to find out his tastes as regards

place,
occupation,
the
definite
sports,
amusement,
(which
to
and
for far
directions
given
should never be
at as
omitted)
after-life,
any
rate
some
coincide
months, should
with
the
as
possible
natural
bent of the patient's

CycUne
'"
interests.
It
may
be borne in mind that
in cycling
and golf we have now two favourite

powerful therapeutic agencies.
and
of
For
that
is
the
successful
all
treatment,
sorts,
then,
nerve diseases of
we need much
schools,
might be taught
in
the
but
not,
and much
I
that cannot be taught in
any
school.
consider that the successful
nerve doctor owes less to his teachers and
more
to
his
idiosyncrasy,
experience, and
applied
common
sense than any other variety
of medical man.
Special
So
far
we have spoken of
.
the
cure of
ttt
treatment inneurasthenia.
functional nerve disease generally.
now
note a point or two in

as
... connection with

from neuro-
We
will
mi
neurasthenia
distinguished
mimesis (or hysteria).
MEDICAL TREATMENT
In the treatment of these cases,
if
153
other-
wise healthy,
we have
this great
advantage
over hysteria, that in nervousness the main

cause
is
nearly always external to the patient,

it is
whereas in hysteria
the brain
itself.
nearly always within
On
the other hand,

it
we must
remember
that,
while
is
the tendency of
cases of hysteria suddenly to get well under
treatment, cases of nervousness never do, but
always require a considerable length of time.
means of cure in neurasthenia is obviously to remove the principal cause and whenever the disease is clearly recognised, this must be done at all costs. That is to say, whether it is school, college,
first
The
great
Remove
cause in
neuras-
business,
professional
it
or
public
work,
it
matters not,
at
must
it
be
stopped for a time
once
for
must be remembered that

delay
every
month's
that
may mean
in
at If
least
double
extra
time
cure.
the
trouble has
been brought on through pro-
longed overwork or worry, total rest
may
be
best.
If
it
is
through cessation of hard
work, and want of employment of the brain

in its
accustomed way, some steady healthful

a slight case of over-pressure in one
occupation must be prescribed and carried out.

If
it
is
154
NERVES
IN
DISORDER
special pursuit, total
change of work to some
other line
It
is
may
suffice.
may
be that this brain or spine irritation
up by some cause outside the head, but inside the body as by certain objectionset
able habits not
uncommon amongst growing

by
over-eating,
boys
Cause can
generally
and
girls,
by
spirit-
drinking, or
by
tight-lacing.
In any case the cause should be carefully
be re-
sought out, and
in nearly
every case
it
will
be
found to be something which the patient can
and must lay aside as a
first
means of
growth
cure.
The symptoms may be, some organic cause, such

brain, or trouble in
of course, due
as a
to
in the
some
internal organs; but
nerve symptoms arising from these do not

properly constitute the disease of nervousness.
Natural
symp
oras.
remember that many people are nervous " even when in health, from being of a nervous temperament and coming of a nervous parentage. The symptoms here, [-j^Q^g]^ resembling those we have described,
must
also
"
We
need not excite. apprehension, being natural

to the individual.
It is
when a
person, not
naturally prone to
these symptoms, begins
from a certain date suddenly or gradually

to develop them, that
we
recognise the onset
MEDICAL TREATMENT
of a distinct disease known as
or neurasthenia.
155
" nervousness,"
Having^ thus removed the initiatory cause of the disease, whatever it may be and at
'
Observe
the five laws of
health.
whatever
cost,
we proceed
to
further
steps.
These consist of temporary change of scene
and
life,
of the careful observance of the five
laws of health
clothing,
good
is
food, pure air, proper
cleanliness,
and
suitable
exercise
and
rest
and
body
travel
of the use of certain drugs.
If the
sound and the health good,
Travel
generally
the change will generally take the form of beneficial.
by land or sea. This travel must not be hampered by too fixed plans, by insufficient means or insufficient time, or by uncongenial society. In some cases the sufferer had best be alone, in others some wise and cheerful friends should go and in the worst cases a young medical man would
foreign
;
be
best.
If
the
case
has,
however, been
allowed to progress to nervous debility, no
such measures are possible at
first.
Carelessness in this respect, of not recognising and curing nervous irritation

till it
has
proceeded to nervous exhaustion, has led to

deplorable results, not only in wasting hundreds
of pounds and months of time, but in dragging
156
NERVES IN DISORDER
may
truly
a worn-out body about on what be

called "
a wild goose chase," often leading

life
to loss of
or permanent loss of health.

learn
When
unlike
treated
shall
we
that
no nerve
that
cases,
other
diseases,
can
be successfully
each case
by any
routine, but
must be separately and

on
Value of
rest in bed.
intelligently studied
?
its
own
merits, for
no two are alike

1
All cases of debility, therefore, must be
put to bed, preferably under the direct care

of doctor and
nurse,
-.11
i-
and
apart
from
the
too sympathetic surroundings of

friends
sine
:
home and
the
is
it
though
in
this
is
by no means
cases
that
qud non
these
in
hysteria.
The
and
itself,
strength
must
rest.
be
quietly
food,
rest
restored
the
system rebuilt
by
This
massage,
will,
electricity,
and
of
influence of
new
combined with the brain material, do a great and
vivifying
deal towards not only curing the physical

debility,
but the nerve trouble as well

the
afterwards
therapeutic
force
of
new
impressions, and
perhaps a certain amount
of medicinal
aid, will
complete the cure.

points in
One
or two special
treatment
may
be mentioned here.
In combating sleeplessness in these cases
MEDICAL TREATMENT
opium
is
157
not a useful drug, and should not

Coffee (strong) and tea sometimes
disease,
be used.
aggravate the
beneficial.
but
sometimes
are
As
that,
a guide to treatment
though
many
of
the
we may remember Guide to treatment. symptoms of

is
nervousness are similar to those of anaemia,

in
the former disease the blood
of good
quality
and there
heart, while in
no weakness of the the latter it is very poor and

is
there
course,
is
some
be
weakness.
There
of
the
may, of
two,
for
irritation.
combinations
anaemia paves the

Iron
these
is
way
to
nerve
of use in both diseases.

arise
Again,
if
symptoms
from organic disease,

whereas
we
as
find
the reflex action of muscles, such

;
the knee jerk, diminished
in
functional
nervousness
the
seat
they
the
is is
are
increased.
Again,
if
of
nerve
trouble
be in the brain, walking
a very
good
remedy
if
in the spine
it
bad, and often
cannot be undertaken for some time.
The
leading drugs that have been found Pharmacy,

in this special disease,
of some power
more
it
particularly in America,
where alone
ap-
pears to have been thoroughly studied, are

ergot,
arsenic,
Indian hemp,
caffeine, coca,
158
salts
NERVES
IN
DISORDER
with
Fowler's
of zinc, and bromides,
solution.
All require careful administration
under
direct
medical
advice
oil is
for
definite
limited periods.
Cod-liver
also of use
and galvanism
tion
in the first stage,
and
faradisa-
and galvanism
in the second.
So-called
by occasionally mind by faith. Their supposed galvanic power is practically of

galvanic belts are useful only
acting through the
as
little
direct use as the " liquid " electricity
of the late Count Mattel

AftcMure.
The
after-cure of neurasthenics
:
is
always
a matter of anxiety
as a broad rule, one
may
over
say that the seaside and an altitude

2,000
feet
do not
suit
most, but
voyage, woods, and lower mountain slopes

do.
The
pursuit of one's favourite outdoor
sport or occupation,
is
with moderate cycling,
a good general scheme.

In voyages for rest in nerve irritation, the
1 1
Which
voyages
are best
a Cape and Australia
are best
voyages
debility,
after partial restoration
from nervous
the Mediterranean, India, and America are

preferable, because they are
As
rule,
the treatment
tedious,
and
should
be
more lively. is and must be about the same

the patient
is
length as the disease.
When
MEDICAL TREATMENT
restored,
is
159
he need never relapse
if his after-life
by common sense and hygiene. Travelling long distances to town daily

regulated
this
may produce
the
travelling
disease, not,
and
of
after a cure
must
course,
be
re-
newed, but a move made nearer to business.

In neurasthenia there
is
a distinct danger
the
Alcohol
thenia.
of alcoholic stimulants,
use
of
v/hich
should always be controlled by the doctor.
There more
In
is
no disease whose beginnings are

checked,
or
easily
whose
advanced
stages are
more
difficult to cure.
summing
up
the
treatment ol
say
:
this
first
disease in either stage,
we would
or
make
sure of the diagnosis as to the disease
being a functional irritation
exhaustion
;
of the nerve centre in brain or spine

then, having
and
is
made
find
sure that the disease
actually
there,
out the
it.
real
cause or
causes that produced
And now we come to the medical treatment of neuromimesis, the form of hysteria
with which
Treatment
mimesis."
we
are specially concerned here.
With
regard, then, to the cure

it it
of neurothat,
mimetic hysteria,
like neurasthenia,
is
most important
be undertaken as soon
l6o
NERVES
is
IN
DISORDER
;
as the disease
clearly recognised
for
we
must remember there is always a danger of the want of use of any part leading to real
organic disease of that part, often in a very
short time, and
in
emotional hysteria
may
possibly develop
into other
brain disorders.
The mode
certain
of treatment must, of course, vary

:
with the character and gravity of the disease

general
principles,
however, can be
of
all, it
safely laid
down.
But,
first
may be
broadly stated that no one can successfully
undertake such cure unless he fully recognise

the origin of the disease,
nature,
its
gravity,
its
real
and
its
distressing
full
character.
The
doctor should be
of sympathy, but, except
in rare instances,
Is
it
show none.
is
The
is
first
thing, of course,
is
to ascertain
only?
that the disease
hysteria
07ily.
Now
this
a most difficult thing to verify in these
patients,
and nothing
to find a disorder of the
disease of the
it
body
more common than mind treated as a but on the other hand

is
does happen at times that, in trying to avoid
this error, diseases of the
body
are mistaken
for diseases of
mental origin only.

three such cases are brought
As
write
this,
before me.
MEDICAL TREATMENT
One
set,
is
i6i
Organic
disease
that of a broken
leg,
which was
but when examined a fortnight after for
mistaken
hysteria,
excessive pain was diagnosed as a nervous

affection
and treated by massage, with the

;
result of preventing the union

of the case being revealed
the true state
by the Rontgen rays. Another, that of a boy of very nervous temperament, whose parents were repeatedly assured by medical men of standing that the constant pain, sweats, and loss of flesh were due to " nerves " alone, until sudden hemorrhage revealed tuberculosis that had been long there.
third, that of
girl
diagnosed to have
" hysterical " pain in the hip, for
which violent
movements were prescribed, until after a fortnight the Rontgen rays revealed dislocation of the joint. Of course on the other r Side the nistances are mnumerable of nervous disease being diagnosed as organic, and many
II-
Mistakes
made on
both
sides,
a patient has
lost his leg
through "hysterical"
knee-joint disease.
The
sides
serious mistakes thus
made on both
surgeons and
difficulty
by eminent and
indicate
skilled
physicians
at times
the
extreme
of arriving at the truth, and the
great care needed in diagnosis.

If there
is,
however, after careful examina-
i62
NERVES
IN
DISORDER
at the bottom,
tion, clearly
no organic disease
cause
then the case must be one arising from nerve

disorder,
the
of the
nerve
disorder
being either physical or mental, or often a
combination of both
course, wholly
the
brain
being, of
dependent
for
healthy action
on good blood.
The vicious
circle.
^
They
leads
vicious circle
it is
is
often kept
up '
in these
cases which
absolutely essential to break.

be, with loss of appetite
begin,
it
may
from some slight cause.

to
This, in these cases,
disordered
is
thoughts, and
This, again,
;
the idea
of disease
appetite
started.
makes the
therefore get
starves
more capricious the thoughts still worse, and so the body the brain, and the brain the body
still
and the emaciated

enough,
first
patient, having,
probably
of
all,
worn out her
friends, sinks
at last into her grave from sheer starvation.

I
have seen such deaths.
Travelling
often a
^he
patients
'
pernicious practice of sending these

to travel here
mistake,
and there
has
led
in
search
of health cannot be too strongly condemned,
and
in
my
experience
to
is
most
full
disastrous results.
The Continent
relations
of
these miserable parties of pale-faced sufferers,
with
their
anxious
and
friends.
MEDICAL TREATMENT
wandering despondently about
in
163
search of
what they
cases
I
will
never find there.
The worst
this order,
have ever met with are of
and have come for treatment direct from the midst of some futile tour and I cannot
;
but think such cases are often sent abroad

as a last
resource
by physicians who have
never really grappled with the question as

to
how such diseases can alone be cured. The first thing obviously is to re-make
as possible the vitiated
;
as Re-make
body and
far
with fresh flesh

then,
body and brain brain, and blood and nerve and

patient
into
shall
when we have put the

possible bodily
the best
health,
we
have cured the physical cause of the nerve disorder at any

ously,
rate.
Then, or even simultane-
any mental and possibly moral cause mind must be deliberately, scientifically, and systematically attacked by
in the unconscious
the careful substitution of
good habits of
This
is
thought and action for bad.
done
mainly by suggestion, but without any of

the doubtful and unpleasant accompaniments
of hypnotism.
Hypnotism
collected
is
indeed by no means specially Hypnotism
suited for hysterical cases.
Ernest Hart,
who successfioi
"^
much
information at the Salpdtrifere,
y^'**

l64
NERVES
:
IN
DISORDER
Babinski,
writes
"
Charcot,
Richet,
and
others have concluded that for curative pur-
poses hypnotism
is
very rarely useful, gener-
ally entirely useless,
and often
fact,
injurious."
As a matter of
suggestions
naturally
its
useful
therapeutical
can
perfectly
well
be
made
present a
without
hypnotism.
At
use
is
perhaps
greatest in affording
unique means for investigating obscure psychic
phenomena.
It is not,
In this direction
it
is
far
more
successful than in therapeutics.
however, enough in mental therapresent
peutics
to
good suggestions
ones.
we
Such
must
also
remove previous bad

about, the
a patient must therefore be isolated, to avoid

conversations
and
sympathy being
sufferings
;
shown
with,
patient's
all
of
which keep up the action or vibration of the

diseased ideal centres.
Range
mental
theraof
The range
cver,
of mental therapeutics
is,
how.
by
no
means
,,
limited
to
hysterical
diseases.
mind
to
its
are such that

influence.
it
The powers of the unconscious we can place no limits
When
the
mind
is
really
unsound,
is
interesting
and remarkable
mental
obviously because
though quite
intelligible
to notice that
;
therapeutics generally
fails
MEDICAL TREATMENT
165
the conscious psychic element through which

it
should act
is
in itself disorganised.
said, it will
From
what has been

in
be gathered that
ordinary and some nervous diseases, while

therapeutics
acts
it
mental
largely
through
the unconscious mind,
can also be successintelligence
fully presented directly to the
and,
on
all
the other hand, in
true hysteria
nearly
the work has to be done uncon-
sciously, the conscious
mind being
are
fixed, not
on mental therapeutics, but on the outward
means
of
the
used.
Suggestions
often
adparts
vantageously directed to
body,
leaving
the
sound
diseased
the
part
severely alone.
Suggestion in hysteria
physical condition
is
said to cure the
ideas not
cult,
through an intermediate
short,
It
emotional change
rather than
in
;
a thought.
by a feeling must of course
begin with an idea

moralist tries
idea,
it
but when the doctor-
to
inculcate a valuable fixed

far off or difficult
must not be too
of comprehension.
their
effect
all
Such
less
ideas often
fail
of
with indolent neuropaths,

afflicted
who
or
are
more or
is
with mental
myopia.
suggestion
The moment
adopted,
it
the
new
idea
begins to act on
I66
NERVES
IN
DISORDER
unconscious
the
body through the
mind
exactly like a drug.

Cures
effected .aicon
r.ii'
by
The
mind.
health,
circle
best cures of hysteria are naturally, ^

.
therefore,
effected
through the unconscious

is
If the case
in
every
way
the
it
good
be
the
and
has
not
entered
vicious
of dyspepsia and debility,
may
to
cured instantaneously by applying

irritated
ideal
centres
that
keep
up
the
disease good suggestions, consciously or unconsciously, sufficiently powerful to overcome
the bad ones.

effectual if
Suggestions are thoroughly
one uses the boldness and force
of which Sir James Paget speaks, and has gained the respect and trust of one's patient.
If all
this
appears as novel as some of

here
used,
it
the
terminology
is
simply
the
because
mental
therapeutics
is
still
it
Cinderella of medical science, for
is
yet
that
very
dubious
orthodoxy
to
suggest
there can be
any means of cure more potent
than those found within the revered pages
of the British Pharmacopoeia,

^tionai
psychic
This
rational
and
psychic treatment
is,
however, certainly gaining ground.
It has, as
we have said, The negative
a negative and a positive side.

consists in
removing injurious
MEDICAL TREATMENT
influences from the patient's
167
mind, whether
they be objective from the outer world, or

subjective from the patient's
own
disordered the
thoughts
patient's
the positive, in infusing into
mind
curative
mental influences, mental
such as hope and rational ideas, which tend

to
counteract the unsound
action.
It is
needless to say that a successful doctor
requires in this a combination of tact,
know-
ledge of
that
all
human
do not
tact
nature, patience,
possess.
and temper
Such
as
and character are every whit

to
conducive
success
as
scientific
equipment.
It
is
important to remember
is
that,
when
Healthy
brain sxcrcises
the brain
tissue
restored to health
it
by good nerve
gocd
and healthy blood,
can be made by
exercised a
suggestion to exercise as healthy an influence
over the body as previously
it
harmful one.
If ideal centres
can produce
ideal diseases, surely the rational cure is

first
by
a
bringing
these
ideal
centres
into
healthy condition, and then making them the
means of curing the ideal disease. Mental disease requires, and can ultimately only
be cured by, mental medicine.
this
When
will
will
be understood?
And when
nauseous

l68
NERVES
to
IN
DISORDER
raind
drugs cease
diseased
?
be
ministered to a
Of
the usual remedies given, Dr.

:
Russell Reynolds says

"
The whole
list
of anti-hysteric remedies
musk,
castor, valerian,
and the
in
like
appear
:
to have this
one property
common
that
they do no good, and delay the real treat-
ment of the
case,
which
'
is
not one to be
cured by nauseous
gums,' but largely
by
mental, moral, and social management." Tonics, in helping to build

flesh
Electricity.
up the new
also
and blood,
are, of course, valuable.
Electricity,
properly
applied,
is
therapeutic aid
we can seldom wholly

its
is
disis
pense with
obvious
and the reason of

consider
it
value
when we
the most
for
powerful agent that

action on the nerves.
If the
we
possess
direct
case be a severe one

all its
it
must be
withdrawn from
the cure;
it
surroundings during
and afterwards, if these are bad, must never return to them again.
Such are a few bare general outlines of methods that have to be varied to suit
each separate
case.
We may
two
points.
now
the
briefly
recapitulate one or
Bear
in
mind
that
perhaps
most
MEDICAL TREATMENT
powerful
is
169
curative
agent
at
your
disposal importIf
a suggestion properly conveyed.
you
suggestion
have confidence, and have gained the respect
and
and
trust of
your patient, you can suggest
produce
many
press
symptoms.
If,
for
instance,
you
some
? "
particular
part
"
of the spine or
elsewhere,
and
will
say,
Do
you But
at
feel
if
any pain here

you
persist in
he
say
" No.'
your suggestion half

centres
"
a dozen times, and the nervous

all
are
susceptible,
he
will
say
Yes,"
felt.
and
even
the pain suggested by you will be
Now,
if
is
it
not rational
to
believe,
if
we have
not positive proof, that
you
can produce pain
you can take

pain
by
the
?
in a joint by suggestion, away suggested or hysteric same means, and by the same
means alone
Then
for
isolation
under
nearly
the
doctor's
care and
of
while
the
is
always
that
necessary
the
disease
friends
fly
because
is
suggestions
local are generally kept

relatives
up by the
they
is
and
unless,
it is
indeed,
to
the opposite
extreme, which
all
as
bad or
worse, and say

It
is
so difficult
sham and nonsense. not to do harm by sym;
pathising with the patient's sufferings
and.
I70
for
NERVES
many
reasons,
IN
few
DISORDER
difficult
cases
can
be cured unless the environment be wholly

changed, and specially adapted
Newbrain
IS
for the cure.
built up.
new
_
brain
is
then built
up *
a
of
new
healthy tissue by the well-known methods,

modified
as
needed,
it
in
about
month
all
during which
suggestions,
is
kept free from

at
bad
in-
and
the
same
time
sensibly
and
unconsciously brought under
the
healing
power
is
of
good
always
;
ones.
This
if
building
up
is
nearly
required
for
the disease
of any standing
the
we must
one
conis
remember
channel
that,
nerves being the

all
through which
energy
veyed to every part of the body, when they
go wrong the whole body soon gets wrecked.

No
details
of treat-
mentgiven.
do not give any detailed particulars of treatment, simply because it is absolutely

.
.
We
impossible to do so
off with
electricity,
an
or
implicit
and any one who starts faith in massage or

or any
Weir-Mitchell
other
fixed
man, and
routine,
is
treats his patients
by any
the
fail.
almost
bound,
from
very
protean nature of the disease, to

I
must add here one word about

it
religion.
While
is
true that
that
the
morbidness and
over-introspection
accompany various
MEDICAL TREATMENT
sorts of fanaticism form
171
Value
true
of
emotional causes
one of the greatest of hysteria, on the other

its
Chns
tianity.
hand
plicity
true as
Christianity in
Divine
is
sim-
taught by
its
Founder
Dr.
"
most
things
beneficial
to the mind.
here.
Ormerod may
be
are
quoted
He
to
says
Few
more opposed
patient,
;
hysteria
spirit
than
the
trustful,
altruistic
inculcated
by
to
Christ
it
and few things more conducive
than the excitement seen in revivals,
or the mysticism or self-conceit which sometimes poses as religion."
As
in all else,
it
is
the true that helps;
the imitation only harms.

Here, therefore, a conclusion.
we bring our remarks to Enough has, perhaps, been
said to rescue nervous sufferers from the un-
deserved contempt with which their diseases

are so often treated, not only by their friends,
but
even
by
their
doctors
to
;
show the
real character
of the disease
and, further,
to
indicate
the lines
cases
of rational treatment,
by which
be cured.
of any gravity can alone
A SHORT GLOSSARY
Addison's Disease.
A disease where
in colour.
the skin
becomes very dark

/Etiology.
An
account
of
the
causes
of
disease.
Agoraphobia.
Alienist.
A fear of crowds or open places.

for
A doctor disordered minds. Aliment. Nourishment.

Amnesia.
Loss of memory for words.

{without
ancssihetics).
AncBsthesia
Loss
of
consciousness (without chloroform, ether,

etc.).
Aneurism.
Angina
pectoris.
A tumour containing blood. A disease of acute
pain
in the heart.
A medicine that relieves pain. Dislike to food. Anuria. Suppression of urine. Aorta. The large artery leading from
Anodyne.
Anorexia.
heart.
173
the
174
A SHORT GLOSSARY
Aphasia.
Aphonia.
Apnoea.
Loss of speech. Loss of voice.
Stoppage of respiration.
Arteriosclerosis.
hardening of the walls
of the arteries, seen in gout, old age,
etc
Want of tone. Wasting of muscles. Auto-suggestion. Self-suggestion

Atonia.
Atrophy.
when
fully
conscious without hypnotism.
Borborygmi.
Cerebration.
Cheyne
Internal rumblings. Action of the Stokes A form

brain.
respiration.
of inter-
mittent breathing.
Claustrophobia.
fear of confined spaces.
Clinical (literally "
by the bedside " ). What
the physician observes in the patient

Clonic spasm.
Coccyx.
Spasmodic shaking of limbs. The bone of the

last
spine.
Conjunctiva.
The mucous membrane covering
the eye.
Demoniac
state.
A condition of hysteria with

contortions.
skin.
violent
movements and
Dermatoses.
Diabetes.
Diseases of the
wasting disease with sugar in
the urine.
Diathesis.
Temperament
A SHORT GLOSSARY
Dominants,
175
Controlling ideas that determine
the conduct.
DyscBsthesia.
I nsensibility.
Difficulty of swallowing. Dyspnoea. Difficult respiration.

Dysphagia.
Dysuria.
Difficult in urinating.
Ecchymoses.
Effusion of blood under the skin.
Ecstatic state.
smile.
rigid position with a fixed
Exophthalmic
Faradisation.
current.
Flatus.
goitre.
Swollen
the
neck
with
protruding eyes.
Using
faradic
electric
Wind
is
in the intestines.
Floating kidney.
that
loosely attached kidney,
freely movable.
Galvanism.
Electricity
in
with
the
constant
current.
Gangrene.
Gastralgia.
Goitre.
Hcematemesis.
Hemiplegia.
Enlargement of the neck. Vomiting of blood.

Paralysis of half the body.
Excess of blood in a part,
sensibility.
Mortification. Pain the stomach.
Hypercemia.
Hypercesthesia.
Hypnotism.
Excessive The production
of
artificial
sleep without drugs.
176
A SHORT GLOSSARY
Hypochondria.
Hysteria (Êmotional).
An apprehension of A nervous
anaesthesia.
disease.
disorder
with
Hysteria
fits
and
{Imitative).
Another
word
for
neuromimesis.
Movement resulting from ideas. Ideo-sensory. Feelings aroused by ideas.

Ideo-motor.
Incontinence.
Incoordination.
action.
Loss of power over the bladder. Want of harmony in muscle

groin.
sleep.
Inguinal.
Insomnia.
Connected with the Loss of (action Intermittent. Irregular

pulse, etc.).
of
heart,
Lesion.
An injury to a part Malingering. S ham m Monophobia. Fear of being alone. Specks floating MusccB
in g.
volitantes.
before the
eyes.
Mutism.
Myopia.
Dumbness. Short sight Nascent. Just born. Neurasthenia. Nerve weakness. Neuromimesis. N erve mimicry. Neuropath. Nerve Neuroses. Affections of the nerves.
sufferer.
Neurotic.
Nervous.
A SHORT GLOSSARY
(Edema.
177
The nerve of Paraplegia. Paralysis of lower half of body.

Optic nerve.
sight.
A swelling of any kind.
Paresis.
Loss of power.
I
mperfect sensation. Pathology. The study of Peripheral. To do with the external surface. Phonate. To make a vocal sound.
ParcBsthesia.
disease.
Placebos.
Medicines
given
to
satisfy
the
mind.
Polyuria.
Potfs
Excessive urination. disease Disease of the
bones of the
spine.
Foretelling the course of a disease. Prophylaxis. Precautionary measures against

Prognosis.
disease.
Pruritus.
Irritation of the skin.
Psychotherapy.
Mind-healing.
back
Fever. An affection of the bladder. Retina. The nervous structure at the

Pyrexia.
Retention.
sions.
of the eye that receives visual impres-
Stigmata.
Marks
in the skin
produced by
hysteria.
Tactus
Tetany.
eruditus.
An educated touch.
12
Lock-j aw.
178
A SHORT GLOSSARY
Tonic spasm.
limbs.
Ultra-red.
fixed
convulsive state of
Invisible
heat rays
beyond the
red end of the spectrum.

Ultra-violet.
Invisible
chemical rays beyond
the violet end of the spectrum.

Urticaria.
Nettle rash.
Vague
state.
Vascular tension.
arteries.
A condition of clouded mind. Pressure of blood the

in
Vertex.
Viscera.
"
The top of the head. Internal organs. Weir-Mitchell curer A system

on
flesh while in bed.
of putting
INDEX
Action and thought similar, 34 of mind unconscious in hysteria,
of organs of special sense, 23 of unconscious mind, 20
1
shows mind, 17 Advantages of auto-suggestion, 123

Êtiology of nerve disease, 45 After cure of neurasthenia, 158
treatment of nerve cases, 151
Alcohol and neurasthenia, 54

Allbutt, Professor,
on difficulty on neurasthenia, 24 on neurasthenics, 53

of,
in failures,
137
Anaesthesia, mental, 102-3
Aphonia, hysterical, cure

Artificial
79
and natural therapeutics, 97
Attention to details in functional nerve disease, 136
Atoms
in nerve molecule, 34 Auditory and dental nerves, 35
Automatic nerve centres, 34 Auto-suggestion and nerve affections, Bernheim, 124

illustration of, 124
24
Liebeault, 124
179
i8o
INDEX
power
123
Auto-suggestion not hypnotism, 123

of,
Babinski on hypnotism, 164
Bad
treatment, three causes

in,
for,
12
Bed, value of a day's rest
125
Bernheim on auto-suggestion, 124

Best suggestions, directions about,
1
48
Blame due
B.
to patient's conduct, 13
M.J. and
quacks, 112
Bodily sufferings of functional nerve disease, 23 Body and brain, re-making of, 163
4 no development Book, object of, 8
less used,
of,
4
in,
Brain, cause of hysterical pain
63
44,
centres of functional nerve disease,
economical value
power, repose
of,
4
33
nervous structures
of,
in,
59
seat of hysteria
is in,
61
strain increasing, 3 Brodie, Sir B., on hysterical joint disease, 71
on spine disease, 72 Browne, Sir J. C, on imagination, 95 Bruce, Dr. M., on vis medicatrix natures, 99 Building up of new brain, 170 Butcher suffering from idea, 42 Buzzard, Dr., on hysteria, 70
Case
of a nervous mother, 1 Cases of hysterical tumour, 76
Cause of
hysterical pain in brain, 63
of nerve irritation, 58
INDEX
Cause of neurasthenia not rush of life, 54 removed by patient, 1 16 to be removed in neurasthenia, 153 Causes for bad treatment, 12
of functional nerve diseases, 45 of hysteria, 51, 69 of neurasthenia, 51
of neuromimesis, 51 of pain in
little finger,
l8i
41
Change
in treatment
tact,
needed, 12
Character and
167
Charcot on hypnotism, 164 on hysteria, 51
Check beginning
in neurasthenia, 159 Chiniquy, Pastor, and typhoid fever, 119 second cure of, 120
Cinderella of medical science, 166

Circle, the vicious, 161
Classes of neurasthenics, 26
of neurasthenics by K. Petr6n, 53
Classification of neurasthenia, 57
Clever people, neurasthenia

Clinique, description
of,
in,
52
107
52
ideas,
1
Coleridge on nerve disease, 96 Common sense, success due to,
Conduct determined by dominant
24
of patients often to blame, 13
Confidence in doctor and nurse, 138
Conscious and unconscious minds,

self-treatment, 103
effort
16,
VJ
and
heart,
20
of,
mind, insanity disease

like spectrum, 18
67
used as life, 19 production of nervous mimicry, 22
i8a
INDEX
Consciousness and respiration, 20 controls three systems, 20

is
not mind, 17
is visible
mind, 16
mind
excels beyond, 21
produces no organic change, 19

Consulting physician, cures
of,
91
Cultivation of will increases power, 122
Curative symptoms of vis medicatrix naturcB, 109
Cure and diagnosis, 113 by ideal centres, 167
by
will power, 119
depends on quality of nursing homes, 144

ill-health
more costly than, 141 more difficult in functional nerve must be adequate, 140 natural powers of, 98 of disease by patient, 115
disease,
10
of hysterical aphonia, 79 of hysterical paralysis, Dale on, 73 of hysterical tumour, 77
of
spasm
of gullet, 78
of,
psychic powers
95
Cures affected by unconscious mind, 166 and public, 113

fixed systems of, 140 machine-made, useless, 139
of consulting physician, on, 91
Weir-Mitchell, 138, 148 Cycling and golfing in nerve cases, 152
Dale, Dr., on cure of hysterical paralysis, 73 Davy, Sir H., mental cure by, loi Death from fear, 103 may be caused by hysteria, 78, 81
INDEX
Dearth of nerve nurses, reason
Description of a clinique, 107
of a nerve sufferer, 8
of,
i6j 142
Debility of nerves, treatment, 156
of neurasthenia and neuromimesis, 31-83

Details of neurasthenia, 50
Diagnosis of hysterical joint disease 71 of hysterical tumour, ^^

cure,
1 1
-^ versus
Difficulty in treating failures, 137
Directions about suggestions,
56
Disease, cure
of,
by
patient,
15
of joint in hysteria, 31
of nerves, functional
and
organic,
28
organic, mistaken for hysteria, i6i
symptoms of organic nerve, 29 treated by a patient, 118 Diseases of imagination and imaginary disease 6 14
131
various hysterical, 29 Disorder of mind not mental suffering, 22

Disorders, functional nervous, 1-29
Distinct disease, nerve irritation, 59 Distribution of functional nerve diseases,
Doctor and his medicine, 89 and nervous patient, 9

increases
home
persecution, 10
in therapeutics, 95 in vis medicatrix natures, 109, ill
personality
of, go,
151
Doctors and homes, 144 should they own nursing homes ? 144 Domestic treatment of functional nerve diseases, 12$
Dominant ideas determine conduct, 123 Door-bell as illustration, 40, 63, 64
i84
INDEX
diseases, 92
in sleeplessness, 156
Drugs and functional nerve
vis tnedicatrix ?taturcE greater than, 100
Dyspepsia and nervous disease, 161
Early
stage of nerves in patient, 117
Economical importance of brain, 4 Economy, short-sighted, in illness, 141 Education in neurasthenia, 52, 53
Electricity, value of, 168
Emotional hysteria, symptoms
of,
65
Emotion and neuromimesis, 45 Empirical treatment and common, 1 14 Environment changed by patient, 117 Essay on nervous mimicry. Sir J. Paget's, 21 Examples of mental therapeutics, 10
of neuromimesis, typical, 71
Existing and living, 19
Expense of nerve treatment, 143

Experience in medicine, 129.
Failures,
difficulty in treating,
of,
137
Faith and hope, value
91
Faith-healing and mental therapeutics, 87
Family physician, value
of,
96
treatment of nerve sufferer, 8
Fear of losing reason unfounded, 24 Feeling and memory, 39
and thinking, 36
Finger, pain
in,
40
unconscious mind, 135
functional nerve disease, 134
Firmness
in disease of
of, in
need
Five laws of health to be observed in neurasthenia, 155 Fixed systems of cure bad, 14.6
INDEX
Fleury, De, on
185
mind
1
healing, 93
qualities,
Foolish specialist,
Forbes, Sir
J.,
mental curative
95
France and America pioneers nerve disease, 5
in treatment of functional
Fraudulent appearance of symptoms, 13 Functional and organic nerve disease, 28 nervous disorders, 1-29
nerve disease and brain centres, 44
and and and and and and and and and
difficulty in cure,
10
drugs, 92
House
of Education, 48
ill-health,
49 mental idleness, 47
pain,
44
1
quacks,
12
school-girls,
47
in,
worry, 46
attention to details
136
bodily sufferings
of,
23
causes great suffering, 22

causes
of,
45
of,
distribution of, 3
domestic treatment
guide to treatment
125
$
France and America pioneers on,

157 hereditary predisposing cause
in, of,
45
honesty
increase
in treating, 136
of,
3
of,
medical cause
46
171
in,
treatment
of, 127,
need of patience
of
132
in,
of perseverance
133
sympathy
in,
in,
130
of tact
134
i86
INDEX
of,
Functional nerve disease, neglect of study personal factor

physical causes
in,
139
of,
48
routine treatment
Sir J.
of, 5
Paget on, 131

of,
success in treatment
129
suffering unparalleled, 23
Gerbe, mental cure by, loi Globus in hysteria, 65
Good
influences of healthy brain, 167
nursing home, points
in,
145
1
treatment mostly empirical,
14
Guide
to treatment in functional nerve disease,
157
Gullet, cure of
spasm
in,
78
Healing, mental
qualities,
94
Health, five laws observed in neurasthenia, 155 is unstable equilibrium, 44
Healthy brain exercises good influence, 167 Heart and conscious effort, 20
Hereditary predisposing
diseases, 45
cause
ot
functional
nerve
Hercules and
lole,
89
Herman on hypochondria,
Home
25 persecution increased by doctor, 10

for nursing, 143
in treating functional
Homes
Honesty
nerve diseases, 136

diseases, 48
House of Education and functional nerve Hypnotism and auto-suggestion, 123

Babinski on, 164
Charcot on, 164

in hysteria, 163
Richet on, 164
Hypochondria and neurasthenia, 25
INDEX
Hypochondria, Dr. Herman on, 25 Hysteria and insanity, 67
lb;
and joint disease, 71 and malingering, 7 and neuromimesis, 60 and religion, 170 and suppressed gout, 69
attacks
of,
65
causes
69 causes organic disease, 81 Charcot on, 51

Dr.
of, 51,
Buzzard
on,
70
in,
Dr. Reynolds on drugs
i68
emotional symptoms
fits of,
of,
65
65
globus
in
in, 65 hypnotism, 163
in ill-balanced brain,
68
my
cause death, 78, 81 mimetic, 66
neuromimesis
is not,
68
for,
not shamming, 7 organic disease taken
161
pain
common symptom
of, 27,
of,
63
proper use
seat
of, in
61
brain, 61
Sir J. Paget on, 7
sudden cures possible

suggestions
in,
in,
74
symptoms
treatment
of,
149 65, 8l
travel in, 162

of,
146
used
neuromimesis, 27, 61 very common, 62

for
word wrongly used,
6,
i'^,
27.
&'
i88
INDEX
aphonia, cure
of,
Hysterical anaesthesia, 102
78
diseases, various, 79 joint disease, diagnosis, 71
mistakes
in,
71
Sir B. Brodie on, 71

Sir J. Paget on, 71 pain, cause in brain,
paralysis, 72, loi
63
common, 75
cure
of,
72
Dr. Reynolds on, 72

varieties of, 75 patients are not mental, 51
of,
^ spasm of gullet, cure

tumour, cases
cure
of, of,
78
spine disease, Brodie on, 72
76
77
77
of, ot,
diagnosis
symptoms
tumours, 75
76
vomiting, 79 Hysterics not fraudulent, 71
Ideal centres, cure by, 167

vibration
of,
36
nerve centres, 34
vibrations, 37 Ideas in suggestion not too
start real feelings,
difficult,
165
36 Idlers and neuropaths, 26 Ignorance of mental therapeutics, 113 Ill-balanced brain, hysteria, 68
Ill-health
and functional nerve diseases, 48 more costly than any cure, 141
INDEX
illustration of auto-suggestion,
189
124
of door-bell, 40, 63, 64 of need in perseverance, 134

Illustrations of self-cure, 119
of unconscious sensations, 38 Imaginary disease and diseases of imagination,

sufferings are not, 12
6, 14,
131
Imagination, Sir
J.
C.
Browne
on, 95
Importance of understanding value of nerves, 4

Increase in brain strain, 3 of functional nerve disease, 3 of scientific teaching, 1 1
Indirect suggestion best, 148
Insanity
and
hysteria, 67
disease of conscious mind, 67

Instinct is a safeguard, 20
Intellect
and neuromimesis, 44
Invalids, nervous, cruelly treated, 6, 7
and Hercules, 89 Irritability and nervousness, 57

lole
Irritation of nerves, 58
Isolation, value of, 148
LiEBEAULT on auto-suggestion, 124

Little finger, causes of pain in, 41
Lives used by conscious minds, 19

Living and existing, 19
Machine-made cures
Malingerers, 80
useless, 139
Malingering and hysteria, 7 Malnutrition and neuromimesis, 147
Man
as a whole, 93
in medicine, 91
Manner
I90
INDEX
of,
Massage, value
147
Matron of nursing home, 145 Meaning of neurasthenia, 25

of vibration of nerves, 36
Medical science, Cinderella
of,
166
treatment of functional nerve disease, 127, I/I Medicine, doctor and his, 89
experience
in,
129
Memory and
39 Mental anaesthesia, 102

cases, rest in
feeling,
bed in, 146 causes of functional nerve disease, 46

curative qualities, Sir
J.
Forbes on, 95
cure by Dr. R. Gerbe, loi
by
Sir H. Davy, loi
healing by Dr. Morrison, 94 hysterical cases not, 5

idleness and functional nerve disease, 47 medicine, prejudice against, 88
origin of nervous mimicry, 2
suffering
is
not mental disorder, 22
therapeutics, 85, 103

act in all diseases, 100
and faith-healing, 87 and systems of medicine, 1 14 and unconscious mind, 165

essential, 87
examples
ignored,
1
of,
01
13
artificial,
natural
and
97
not studied scientifically, 87
range
of,
164
suggestion on, 164

varieties of, 97
--^ vomiting, 103
INDEX
Methods of cure must be adequate, 140
191
Mind
action unconscious in hysteria, 15
extends beyond consciousness, 21

healing,
in
is is
De Fleury on, 93 medicine not studied, 88
not consciousness, 17
one, 16
all visible,
not
17
seen in actions, 17 unconscious, functional nerve disease due
to,
135
Minds, conscious and unconscious,
16, 17
Mistakes in hysterical joint diseases, 72 in treatment, 160

Morrison, Dr., on mental healing, 94
Natural and
Need
artificial
mental therapeutics, 97
powers of
cure, 98
of firmness in functional
of confidence in doctor
and
nurse, 138 nerve disease, 134
of sympathy in physician, 131

of tact in functional nerve disease, 134 Neglect of study of functional nerve disease, 5 Nerve affections and auto-suggestions, 124
cases, after-treatment of, 151
cycling
and golf
in,
152
centres, automatic, 34
ideal,
34
terminal, 34
disease, Coleridge on, 96
functional
irritation
and
organic, 28
a distinct disease, 59 cause of, 58
symptoms
of,
58
mimicry and unconscious mind, 44 molecules, atoms in, 34
192
INDEX
Nerve nurses, born, not made, 142 none trained, 141

reason of dearth
sufferers
of,
142
sufferer, description of, 8
seldom lose reason,

of,
24,
125
treatment, expense
143
Nerves, normal action

of motion, 34, of sensation, 34
of,
33
Nervous
debility, 57
symptoms
treatment
of,
60
1
of,
56
in,
value of rest in bed
156
disease and dyspepsia, 161

increase of functional, 3
disorders, functional, 1-29
invalids cruelly treated, 67
irritability,
mimicry
is
57 mental, 21
not consciously produced, 22

Sir J. Paget on, 21
mother, case
patient
of,
and doctor, 9 and specialist, 10

life,
turning-point in her
10
people
salt of the earth,

of,
49
sketch
49
suffering, tortures of,
Nervousness, 57 is not hysteria, 68

Neurasthenia, after-cure
of,
158
and alcohol, 54 and hypochondria, 25 and neuromimisis described, 31-83 and other diseases, 54
INDEX
Neurasthenia, causes
details of, 50
of, 5
193
check beginnings
in, 1
59
foreign travelling, 155

in clever people, 52 in education, 52, 53
meaning of, 25 not due to rush of life, 54

observe five laws of health
157 Professor Allbutt on, 24
in,
155
pharmacy
in,
proper treatment
of, 146,
153
remove cause
in,
153
symptoms
two stages
of, of,
56
57
exist,
varieties of, 25
Neurasthenic nurses do not
142
symptoms, classification of, 57 Neurasthenics and neuromimetics, 24

classes of, 26
Professor Allbutt's classification
of,
54
Neuromimesis and emotions, 45 and hysteria, 60 and intellect, 44 and malnutrition, 147
causes
of, 5
for, 27,
the term " hysteria " used
61
symptoms
treatment
typical
of, 66, 82,

of, 1
83
71
59
of,
examples
idlers,
very common, 62
Neuropaths and
26
New
of, 170 Nitrogen like suggestion, 148
brain, building
up
Normal action of
nerves, 33
194
INDEX
study of mind in medicine, 88
in,
No
Nurse and
doctor, need of confidence cured of typhoid, 121 Nurses, no trained nerve, 141
138
Nursing home, matron
of, 145 points in a good, 145 homes and doctors, 144.
on, 143
Object of work, 8
Observe five laws of health in neurasthenia, 155 Organic and functional nerve disease, 28 change not produced by consciousness, 19 disease caused by hysteria, 81 mistaken for hysteria, 161
Organs of special sense, action
of,
33
Overwork and
strain,
48
Paget, Sir
on functional nerve disease, 131 J., on hysteria, 7 on hysterical joint disease, 71
on nervous mimicry, 21
Pain always
felt in brain, 40 and functional nerve disease, 44 common symptom of hysteria, 62
in little finger,
is
40
a mental impression, 43 produced by suggestion, 169

referred to origin of nerve, 40
origin,
without physical
43
Paralysis, hysterical, 72, 10
Parkes on treatment of functional nerve disease, 6 Patience in physician in functional nerve disease, 13:
Patient and early stage of nerves, 117
INDEX
Patient can change environment, 117
195
can do much, 115 can exert will-power, 119 can often treat disease, 1 18 can remove cause, 116
cure of disease by,
personality, study
relief
1 1
Patient's conduct often to blame, 13
when
of, 139 understood, 14
Perseverance, illustration of need

in physician in functional
for, 134 nerve disease, 133
factor in functional nerve disease, 139
Personality, Dr. Sutton on, 89
of doctor, 90,
of patient, 139
Petr6n, Karl,
summary
of neurasthenic classes, 53
Pharmacy
in neurasthenia, 157
Physical causes of functional nerve disease. 48

Physician, need of patience in the, 132
of perseverance in the, 133

of
sympathy
in the, 130
wields two forces, 89 Points in a good nursing home, 149
Power
of auto-suggestion, 123
of emotions in neuromimesis, 45 of intellect in neuromimesis, 44, 45 of psychotherapy, 93

of self-suggestion, 123
of unconscious mind, 92 of will increased
by
cultivation, 122
Predisposing cause of functional nerve disease, 45 Prejudice against mental medicine, 88
Production of nervous mimicry impossible consciouslyj

22 Proof of mind not consciousness, 17
196
INDEX
27, 61
Proper use of hysteria,
Psychic and rational treatment, 166
powers of cure, 95 Psychotherapy, power of, 93 Public and cures, 1 13
Quacks and
why
British Medical Journal, 112 and functional nerve disease, 112
they flourish, 112
Quality of nursing
home determines
cure, 144
Range
of mental therapeutics, 164
Rational and psychic treatment, 166
Real feelings started by ideas, 36 Reasonable action of unconscious mind, 20
Reason
for dearth of
nerve nurses, 142

sufferers, 24, 125
of non-study of mental medicine, 88
seldom
Relief
lost
by nerve
is
when
patient
understood, 14
Religion and hysteria, 170 Re-making of body and brain, 163
Remove cause
Repose sign of brain power, 59 Respiration and consciousness, 20 Rest in bed in mental cases, 146
value of a day's, 125
value
of,
in
nervous
debility,
56
1 1
Restored action of vis medicatrix naiurcB,
Richet on hypnotism, 164 Ridicule of functional nerve disease out of place, 6
Routine treatment of functional nerve disease,
Russell Reynolds, Dr., on drugs in hysteria, 168
Safeguard
of instinct, 20
Salt of the earth are nervous people, 49
INDEX
School-girls
197
disease, 47
and functional nerve
Scientific study of
teaching increasing, 115
Seat of hysteria is in brain, 61 Second cure of Pastor Chiniquy, 120

Self-control should not
be
of,
lost,
118
suggestion,
power
123
treatment, conscious and unconscious, 105-26
Sensations, unconscious, 38
Shamming, hysteria is not, 7 Short-sighted economy in illness, 141 Should doctors have nursing homes ? 144
Six varieties of nerve structure Sketch of nervous people, 49
Sleeplessness, drugs
in,
in brain,
33
156
Sound mind feels suffering most, 22 Spasm of gullet, hysterical, cure of, 78 Specialist and nerve patient, 10
Special sense, action of organs
of,
33
Spectrum, conscious mind

Stages of neurasthenia, 57
Strain and overwork, 48
like,
18
Spinal disease, hysterical, 72
on body less, 4 Study of functional nerve disease neglected, $

of patient's personality, 139
Subconscious mind and spectrum, 18 Success due to common sense, 152

in treatment of functional nerve disease, 129
Successful treatment due to vis medicatrix naturce, 108
Sudden cures possible

Suffering most
felt
in hysteria,
74
Sufferers from functional nerve disease cruelly treated, 6
by sound mind, 22
not imaginary, 12
of butcher from idea, 42
198
INDEX
of functional nerve disease, 22 of functional nerve disease unparalleled, 23
Sufferings, bodily, of functional nerve disease, 23
Suggestion, directions about, 148

like nitrogen, 148
ideas
in,
not too 149
difficult,
165
in hysteria,
in

of classes of neurasthenics by K. Petr6n, 53
produces pain, 169
Summary
Suppressed gout and
hysteria, 69 Supra-conscious mind and spectrum, 18
Sutton, Dr., on personality, 89
Sympathy
in hysteria, 65
in physician,
need
of,
130
Symptoms,
curative, of vis medicatrix naturce, 109
of emotional hysteria, 65
of functional nerve disease, 29

.
of hysteria, 81
of hysteria. Dr. Buzzard on, 70 of hysterical tumour, 76 of mimetic hysteria, 66
of nerve irritation, 58
of nervous debility, 60 of neurasthenia, 56 of neuromimesis, 66, 82, 83

often appear fraudulent, 13
Systems of
fixed cures bad, 140

1
of medicine and mental therapeutics,

three, controlled
14
by consciousness, 20
nerve disease, 134
Tact needed
in functional
Teeth on edge, 35 Terminal nerve centres, 34

Therapeutics, doctor
in,
95
INDEX
Therapeutics, mental, 85-103
essential, 87
199
example
the will
in,
of,
loi
not studied, 87 95
Thinking and
feeling,
36
Thought and action

turning, 150
similar,
34
Thoughts and vibrations, 39 Three causes for bad treatment, 12 systems controlled by consciousness, 20
Torture of nerve sufferers, 9 Trained nerve nurses not found, 141 Transference of sensation in nerves, 35 Travel in hysteria, 162
Treatment at home of functional nerve disease, 125 change in, needed, 12

lightly dismissed, 108
medical, of functional nerve disease, 127-71
mistakes
in,
160
1
mostly empirical,
14
of,
of failures, difficulty
137
to,
of functional nerve disease, guide
157
of functional nerve disease, success
in,
129
of hysteria, 146
of nerves, expense
of, 143 of nervous invalid by family, 8
of nervous invalid, cruel, 6,
7,
of neurasthenia proper, 146, 153 of neuromimesis, 159 of rational
and psychic, 166
of routine, of functional nerve disease, 5 Treves, Sir F., on vis medicatrix natures^ io8
Turning of thoughts, 150
200
INDEX
forces of physician, 89
Two
Typhoid fever cured by

nurse cured
stages of neurasthenia, 57 will, 12I

of,
121
1 19 Typical examples of neuromimesis, 71
Pastor Chiniquy and,
U^'C0NSCI0us action ot mind in hysteria, 15 and conscious self-treatment, 105, 126 and conscious minds, 16 mind, action always reasonable, 20 and mental therapeutics, 165 and nerve mimicry, 44
cures effected through, 166
functional nerve disease
due
to,
135
must be recognised by power of, 92

Tjis
doctor, 15
niedicatrix naturcB, action
of,
99
sensation, 38
vibrations, 38
Unfounded
fear of losing reason,
24
nerve disease, 23
Unity of mind, 16 Unparalleled suffering
in functional
Unstable equilibrium and health, 44 Useless machine-made cures, 139
Use
of life
by conscious mind, 19
Value
of day's rest in bed, 125
of electricity, 168
of faith
and hope, 91
-^
of family physician, 96
of hypnotism, 149 of isolation, 148
of massage, 147
of nerves, importance of understanding, 4
INDEX
Value of nursing homes, 144
of voyages, 158
Varieties of hysterical paralysis, 75 of mental therapeutics, 97
20I
of nerve structure in brain, 33 of neurasthenia, 25
Various hysterical diseases, 79

Vibration and thoughts, 39
ideal,
37
of ideal centres, 36 of nerve,
meaning
of,
36
unconscious, 38 Vicious circle, the, 161

Visible
mind is consciousness, 116 mind is not all, 17

curative
Vzs medicatrix natu?'CB, 97-9

V.
M. N. and
symptoms, 107
and typhoid, 122

cause of successful treatment, 108
Dr.
M. Bruce
on,
99
Dr. Wilkinson on, 109
greater than drugs, 100

in action of unconscious mind, 99, 109
in action in functional
nerve disease, IIO
morbid in neurasthenia, ill Sir F. Treves on, 108 Vogt on auto-suggestion, 124
Vomiting, hysterical, 29 mental, 103
Voyage, value
of,
158
cure, 138, 146
Weir-Mitchell
Why
quacks
flourish, II
Wilkinson, Dr., on vis medicatrix naturce^ I09
Will cultivation increases power, 122
202
Will
INDEX
in therapeutics, 95 typhoid cured by, 121
Will-power, cured by, iig

exerted by patient, 119
Wise specialist and nerve patient, 10 World ruled by nervous men, 49 Worry and functional nerve disease, 46
Wrong
use of hysteria,
6, 13,
27
RC351
Sch6
Schofield
Me rTraa_ An d Ijsq r de r
NOV
1 3 1908

Alfred T. Schofield - Nerves in Disorder (1903)

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COLUMBIA LIBRARIES OFFSITE

HEALTH SCIENCES STANDARD

HX641 24932 Nerves RC351 .Sch6

Coflege of ^ijpsiidanfif anb ^urgeon(

Digitized by the Internet Archive

2010 with funding from

Open Knowledge Commons

HON. PHYSICIAN FRIEDENHEIM HOSPITAL

FUNK & WAGNAI.I.S COMPANY

YORK AND I.ONDON

AND OTHER HELPERS

of a lecture (with additions) delivered

It was printed at the time

response to very numerous

Given originally to the public

the additions needed to bring

date the same style has been preserved.

that an- earnest attempt to plainly set forth

what Functional Nerve Diseases

ignorance which regards them

mainly as either shams or frauds.

treatise like this,

to relieve those needless sufferings of nervous

people which are due to a misapprehension

If the causeless misery so

hoped, by the reading

speak of "justification" because

medical or semi-medical work brought before

medical works are for medical

men, according to the unwritten law of the

knowledge and the simple

of facts concerning nerve dis-

manifest that an exception must

increased value importance

as distinguished from the rest

of more importance, and the recognition

nature, as well as the value of

cure, a matter of ever greater consequence.

few simple hints on self-cure in slight

the elementary diagnosis

of these cases, and an outline of

medical treatment, have been given.

has undoubtedly been largely changed for

a sufferer knows, the old

and a true view and

gether on account of the difficulty of the

FUNCTIONAL NERVOUS DISORDERS

of understanding the Subject

Painful Results from MisShamming"

Nervous Invalid in a Healthy Family Cause of Cruelty Treatment of a Nerve Sufferer

from an Actual Case

seeing the Doctor

Sufferings not exaggerated A Change

Patients are often to

when understood Imaginary

Diseases and Diseases of the

Action of the Unconscious

plays the Greatest Part in Disease

thenics and Neuromimetics

Dr. Allbutt on NeurIts

NEURASTHENIA AND NEUROMIMESIS

Six Varieties of Nerve

are not deceived if the

from Involuntary Memories Vibrations from Voluntary Memories Pain is