_INEFFECTUAL TREATMENT._
We are most of us so far enlightened concerning our nervous systems as
to regard our nerves as a very useful means of communication between the
various parts of our machinery. The network of telegraph wires in this
country, with their chief offices, have frequently been compared to our
network of nerves with their chief offices, the brain and the spinal
centres. Yet this comparison gives a totally inadequate conception of
the functions of the nervous system. Many of us fail to realise that not
only do the nerves bear messages from one part of the machinery to
another, but that, without their co-operation, we can receive no
impressions from the outside world at all, and can perform no function
whatever. Without their aid, the eyes and ears are valueless, the
muscles refuse to do their work, the digestive and respiratory
processes cannot be carried on. If the nerve-centres are seriously
injured, we become paralysed or die. If they be impaired, the whole body
is enfeebled, and disease or incapacity of some particular organ may be
occasioned.
But, we may ask, how does it come about that, without external injury of
any kind, the nervous systems of good people, leading good lives and
given to good works, become impaired wholesale, and often remain
impaired in spite of all efforts to restore them?
Medical men tell us that, in such cases, the waste in the body exceeds
the nutritive supply; but this assertion may be made with equal truth in
regard to diseases of a different order, and, unfortunately, increase of
the nutritive supply does not necessarily cure nervous exhaustion; it is
the actual _nerve-waste_ that we have to put a stop to. Even where a
patient has purposely starved herself, mere feeding up does but bring
her back to the point at which she began to starve. And if we could know
the truth (if we would even try to know it), we should probably find
that loathing of the food, and incapability to assimilate it, were the
beginning of the seeming craze which, singularly enough, seems to afford
so much amusement to the average nurse. We therefore still have the
original disease to tackle. A long series of observations have convinced
me, that though this original disease is not often satisfactorily cured,
it can be cured, and ought to be cured. The reasons of so much failure
seem to me to be evident enough, and later on I hope to state them
fully.
Let me give some interesting and instructive instances of failure.
A few months ago I was told that a remarkable cure had been effected by
means of a well-known treatment, in which isolation, massage, and
electricity were the chief agents. I accepted an invitation to meet the
patient--a lady--at a friend’s house, and on asking for details of the
case, I was told that she had been for years prostrate on her couch, but
had been entirely restored to health and activity by the above
treatment.
At the time appointed, I went to my friend’s house and was introduced to
this “show-case.” What I saw was a lady manifestly suffering from severe
nervous exhaustion. The strained expression of her face was sufficient
evidence of mental fatigue; her attitude indicated bodily fatigue. Her
voice and manner betrayed a total lack of the energy and elasticity that
distinguish persons of her sanguine temperament when in good health, and
it was evident that continuous conversation was trying to her in the
extreme.
I talked with her for a few minutes, refraining from asking direct
questions. She readily informed me that she was undoubtedly cured by the
treatment she had recently undergone; that, though the massage was very
painful, she had greatly benefited by it; that she had been unable to
stir off her couch before undergoing it, but that she had now returned
to ordinary life, and was doing in all things as ordinary people did.
All I can say is, I am very sorry for ordinary people. She seemed
anxious to impress upon me the fact of her having had a real illness,
and not a fanciful illness; little knowing that at that moment I was
wondering at the strange fancies of those who could imagine such a
miserable invalid to be well. She ended by informing me triumphantly
that she was able to walk--how far do you think? Ten miles? Five miles?
No, not even one mile. This supposed convalescent--this “show-case”--was
able to drag herself _exactly half-a-mile_; that is to say, if she
rested on a seat half-way--and she was unmistakably done up at the end
of it.
And this was the result of paying from ten to twenty guineas a week for
a couple of months!
I ascertained afterwards, on closer inquiry, that the poor lady was
still weak and poorly in the opinion of unbiassed friends, but that her
doctor and nurse had treated her as if she were very fussy, and as if
the thing to be done was to cure her of her fancies. But there was
little need to tell me so: she was so evidently ashamed of ever having
been ill at all.
Why can it not be honestly recognised that a young woman who is too weak
to walk five miles, and chat with her friends afterwards without
over-fatigue, is in an unsatisfactory state of health; and that a young
lady who cannot walk half-a-mile without betraying, in spite of herself,
symptoms of nervous exhaustion, is in a most dangerous and alarming
state of health, and should at once be prevented from fatiguing herself
further, lest she should either die of nervous prostration (failure of
the heart’s action is, I believe, the polite name for this mode of
making our exit), or lest she should fall a prey to one or other of the
many forms of disease which are apt to attack weak women?
To a person of common-sense, the bodily fatigue of painful massage, and
the mental fatigue of being regarded as an imbecile, would hardly seem
conducive to cure in cases where repose of mind and body are urgently
needed; but in terror of that foe to our progress, the fixed idea, one
is careful to leave a corner for even the remotest of possibilities.
How this poor lady originally became a victim to the modern malady I do
not know. What happened after it had developed itself is easy enough to
comprehend. She had dragged herself about in misery till she could drag
herself about no more, and then she had taken to her couch. Want of
fresh air and exercise soon started a whole host of minor ills, which,
though painful and annoying, were less dangerous than continued
over-fatigue. These ailments were ineffectually doctored, one after
another, in a variety of ways. Then came a physician who carried her
bodily off to town, cured all the small ailments at once, and by means
of the strong moral influence brought to bear upon the patient,
persuaded her that lying in bed and having ailments was exceedingly
selfish and sinful, besides being inhuman to those about her. It was
then impressed upon her that she was cured, and she was warned against
falling into sin any more. The patient actually found some of her ills
cured, and persuaded herself that the remainder would yield in time.
It is a matter of fact that the intellectually weak are readily wrought
upon by those about them. In like manner, those who are suffering from
nervous prostration are often mere reflectors of their companions, and
their strength of character on recovery is a surprise to persons who
have only known them during illness. Our powers of will and judgment
depend not only on the number and correctness of the impressions
collected and combined in the storehouse of the nervous system, but on
the physical strength we have at command with which to put our machinery
in motion. Nervous weakness cannot but impair the needful connection
between its highly specialised parts.
So the patient is entered in the doctor’s book as cured, and goes home
to lead an ordinary life. The supposed success causes other ladies to be
treated in a similar manner. If the doctor refrains from telling them
how fanciful Miss So-and-so was, the nurse repairs the omission. In the
meantime Miss So-and-so, little suspecting that she is being held up as
a warning and an example,--perhaps even by name,--finds that her small
stock of strength has not been sufficiently increased to enable her to
bear the strain of an active existence. Perhaps she will break down
under some well-known disease, in which case her friends will say, “How
very unfortunate, just as Dr. ---- had cured her of her nervousness!”
Perhaps she will give in and take to her bed again, and then the nurses
will say to their patients, “She was all right as long as _we_ had her,
but after she went home she took to her messy ways again, and now you
see what she’s come to.”
If I have heard this sort of thing said once, I have heard it a hundred
times. In the days when I was even more ignorant than I am now, I used
to argue with these worthy, misguided folks; but I have since realised
the futility of trying to reason with people whose sieves have not pared
and shaped them into a capability for reasoning correctly.
Now you and I, and all cultured men and women in our community, have a
voice in the meetings at the council-chamber of Public Opinion, and have
power to modify the sieves through which these nurses pass. In fact, we
are always modifying them in one way or another, whether we recognise
the fact or not. And if we so far shirk our responsibilities as to allow
the sieves to be formed badly, then we are very selfish, and that is
infinitely worse than being ignorant and stupid. We shall not advance
matters a single stage by throwing mud at individuals who have
conscientiously done their best in very difficult circumstances.
Here is another case of failure which ought to commend itself to our
sense of humour.
I recently met a young lady who showed the ordinary symptoms of nervous
exhaustion. She had not collapsed entirely, but was forcing herself by
sheer strength of will to undergo the painful dragging-about process.
She informed me that she had just been consulting a physician who had
labelled her “hysteria.”[2] How delighted we all are when we get hold of
a label! I am, for one. Now this particular label is the concise and
technical mode of saying, “Disease unknown;” and in these days of hurry,
it is a great advantage to be concise.
But excellent as the label is in this respect, edifying as it is as an
example of candour, it is, unfortunately, peculiarly discouraging to the
patient, and therefore encouraging to the disease. So we are glad to
learn that it has at length been respectfully put to its long, last
sleep by our kind friend Dr. Tibbits; and, though we are willing to
admit that refuges for our half-knowledge are necessary landing-places
in our upward evolutionary climb, we must also regard this service
rendered by Dr. Tibbits as by no means the least with which he has
benefited humanity.
In “Massage and its Applications,” pp. 20-21, we read as follows:--
“I would ask you to allow me to enter my protest against that refuge of
destitute physicians and surgeons--the word ‘Hysteria!’ _What does it
mean? What do you understand by it?_ I have looked up many definitions
of it from all writers of repute, and I will not give you any one of
them. _The thing is non-existent._ The word is, as I have said, a refuge
for destitute medical practitioners, who, having to do with dreadfully
harassing cases of functional nervous disorder, take _‘Hysteria’_ as
their motto and their shield, and retire--or do not retire--from the
case under its shelter.”[3]
To go on with the story. The young lady was shut up and treated for
fussiness, though the wrong party would seem to have been under
treatment. And when the fuss was over, and the lady--with lightened
purse--was mercifully let loose again, she stoutly maintained that she
was no better than before. Her doctor, however, declared her to be
cured, and attributed her want of recognition of the fact to “hysteria.”
But then hysteria was the supposed disease for which the lady had been
treated!
So in this case the doctor had cured a disease which had no existence,
while the lady, in consequence of the disease which had no existence
and which had been cured, continued to consider herself as ill as
before.
Unfortunately, some cases of failure are less amusing than this one, and
have a more tragic ending. I have on record several instances in which
patients were treated as if a morbid craving for sympathy were the cause
of their illness, whereas it was in one case merely a symptom of the
disorder; in another, it was induced by the withholding on the part of
others the helpful sympathy with suffering which we all of us need, and
which we should all of us be ready to give; and in other cases there was
no proof at all of its existence. The results were extremely sad. One
lady, who had been treated to isolation and the interference of
incompetent nurses, became insane. A young man who had been forced to
exert himself became epileptic; another became partially paralysed.
These are solemn warnings. Those who have lain for a length of time in
bed are often more easy to cure than those who have long dragged
themselves about in pain and weakness. This is the interpretation, I
suspect, of the saying that it is the half-ill who are most difficult to
relieve. By the half-ill is meant those who are still dragging
themselves about, though they are often more ill than those who are
lying in bed.
Nervous exhaustion, as has been abundantly proved, is not usually
difficult to cure. Even epilepsy, if taken in time, yields
satisfactorily to rational treatment.[4] And if only nervous exhaustion
were better understood, the numbers of our insane and epileptic patients
would at once be marvellously reduced. Unhappily, the fantastic means
too often resorted to in order to cure supposed hysteria destroys the
patients’ faith in medical men, and renders them unwilling to submit to
further experiments. If only one could get hold of them in the early
stages of the disease, much suffering might be saved in the future. When
this is done, it sometimes happens that the patient does not realise how
much misery he has been spared, and is not proportionately grateful.
The other day a lady in a sadly overworked condition consulted a very
well-known medical man. He informed her that she was suffering from
“hysteria,” and recommended her to seek active employment. The lady, not
being a homœopath, objected to the proposed treatment. Since she was
suffering from fatigue, of what use could it be to prescribe fatigue as
a cure? The inexorable doctor took refuge in the imperative mood,--a
very favourite refuge when the patient has been labelled “disease
unknown,”--and she was overruled. With misplaced confidence and
reprehensible docility, she forced herself back to her work. Shortly
afterwards she had to be placed under care.
A worthy great-uncle of mine was one morning engaged in doctoring the
out-patients at the hospital he attended, when a poor woman addressed
him in pathetic tones, begging him to cure the malady in consequence of
which she endured unutterable things.
“Certainly, my good woman,” he said cheeringly. “What’s the matter?”
“I have a newt, sir,” was the unexpected response.
“A what?”
“A newt, sir, inside me.”
My uncle then recognised the case as being what he called “hysterical.”
People in those days were more sympathetic and less contemptuous in
their treatment of such unfortunates than most of us are now, so he said
in a kindly, soothing manner--
“Poor thing! Well, well, we’ll soon set that right. Now don’t you
distress yourself, my good woman. _I’ll_ soon settle the newt for you!”
Thereupon he gave her a bottle of coloured water and some bread-pills,
directing her to take them steadily for a few days and then return to
show herself to him. He fully expected, he added, that she would then be
quite restored to health.
Away went the sufferer.
At the time appointed she again visited the hospital.
“Well,” said my uncle cheerfully, “how are you? Newt’s quite done for, I
suppose?”
“Oh no, sir,” she replied piteously. “A terrible thing’s happened.”
“Indeed! Sorry for that. What is it?”
“_The newt’s had young ones!_”
My uncle gave that case up. I have no doubt he thenceforth regarded
“hysteria” as incurable in confirmed cases.
It is really surprising that so successful a practitioner should have
been short-sighted enough to treat a mere symptom instead of the disease
in which it originated. He appeared to think that his patient was
suffering from hallucination, from a morbid idea, and that if he could
remove the idea, she would be well. Had he realised that morbid ideas
argue a morbid condition of the nerves, and that the mere removal of one
hallucination after another would not suffice to repair actual
nerve-waste, he would certainly have refrained from expending his own
nerve-force in a vain endeavour. But I am glad to know that he at any
rate refrained from dissipating still further the poor woman’s small
capital of strength by frightening her and discouraging her. In this
respect his method compares favourably with that now in vogue at many
hospitals.
Here are three instances of more modern usage.
A woman of the labouring class presented herself at a country hospital
for treatment. She declared herself to be afflicted with severe pain in
one leg, rendering it almost helpless, and preventing her from
accomplishing her daily work. The medical gentlemen to whom she
addressed herself could find nothing wrong with the limb, and harshly
told her that her complaint was “hysteria.” One would have thought that
having discovered the disease and given it a name, they would have done
something to cure it. Not at all. The woman was sent away unrelieved, to
be a burden on her unhappy family or on the community, as the case might
be. Yet these gentlemen had probably heard of such things as nerves, and
knew them to be an even more essential part of the body than the legs.
Their refusal to treat the patient in question would have been excusable
had they systematically excluded all nervous cases, but this does not
appear to have been their practice. The poor woman went home and
struggled to do her work, but failed from weakness. In despair she
consulted a quack, who put her on an efficacious course of treatment and
cured her triumphantly. A member of the Hospital Committee, having these
facts brought under his notice, attended the next meeting, and moved
that that quack should at once be taken on to the staff to assist the
medical gentlemen with his valuable advice. The motion was lost.
Another woman, suffering from severe nervous exhaustion, applied for
relief at a large hospital in London, and received the same
answer--“Only hysteria.” One would really have thought that a disease so
widely recognised, and causing so much perplexity, would be a bad enough
thing to have without more being expected of one. However, the woman was
told that her complaint was all sham and nonsense, and she was sent
about her business. She went in despondency, for she was in a fearfully
exhausted condition. Soon afterwards a painful malady made its
appearance of the description usually considered “interesting,” and the
same hospital, which had closed its doors on the invalid, now opened
them wide, received her with kindness, and studied the disease
diligently. They failed to cure it, but that is a detail. Indeed, I
think they would have cured it if they could, but perhaps it was
incurable. This hospital admits itself to have been mistaken. It says it
was wrong in crediting the patient with “hysteria;” she was really
suffering, the doctors say, from the exhaustion preceding this
particular form of disease. In short, if they could have cured the
neurasthenia, which was the woman’s sole disease when she went to the
hospital in the first instance, she need never have contracted the
disease which was found so interesting. Lower the vitality of the whole
organism, and the part originally weakest breaks down; or the patient
may be exposed to some malign influence,--such as blood-poisoning, for
example,--which, in health, she would have been able to withstand, but
to which, in an enfeebled condition, she falls an easy prey. I had
watched this patient become ill. I had even tried to arrest her downward
progress; but my hands being tied, I could accomplish very little. She
was of neurasthenic inheritance, and was put in unfavourable conditions.
A hospital, taking entire possession of her at the right moment, might
have done a good deal.
At another hospital a young probationer began to break down from
overwork. She fell a victim to neurasthenia, and a very painful and
distressing malady she found it. She consulted one of the medical staff,
who rebuked her, told her she was suffering from “hysteria,” and ordered
her to go and work. Her health would have been destroyed, and she would
have been forced to abandon her career, had not a kindly, sensible
physician--such as, happily, abound in the much-tried medical
profession--come to the rescue, set her feet upon a rock, and ordered
her goings. She is still leading an active, useful life.
There have probably been many cases in which the patient has become
neurasthenic from monotony and want of occupation, and in which her cure
has seemingly been effected by her being forced to exertion. As a matter
of fact, the good results have been obtained chiefly by the patient
being placed in better conditions, and I have seen many such cases, who
have been entered in the doctor’s book as cured, relapse again on the
smallest provocation. Yet, as I have said before, neurasthenia can be
cured, and ought to be cured; and if we fail in our efforts, there must
be a screw loose in our mode of treatment.
One more instance of failure may be given here, out of a very large
number that might be recorded.
A young lady, rendered justly anxious by increasing nerve-weakness,
consulted a well-known physician. He asked what ailed her. She described
her symptoms, the most usual symptoms of neurasthenia. His comment on
her report was singular. He wondered that she should have come to him at
all, having no more than that the matter with her. One is again tempted
to ask what more one can be expected to have the matter? Surely,
continued languor, depression, neuralgia, and weakness are a
sufficiently heavy burden for anybody to bear, to say nothing of want of
comprehension on the part of others. Did the good gentleman wish the
lady to wait until she had developed something more “interesting”? Not
at all. We should wrong him by entertaining any such idea. He merely
believed neurasthenia to be three parts fuss and nonsense, and he
thought he was proving himself a kind friend to the young lady by
rousing her to a sense of her duty--the duty of dragging herself about
and saying nothing of her ailments. It is odd how very ready we all are
to preach duty--to somebody else. Nevertheless, let us honour the
conscientious physician for his honesty. Unfortunately, he failed to
cure the young lady, and for anything I know to the contrary, she may by
this time have developed something extremely interesting.