Alfred T. Schofield - Nerves in Disorder (1903)

7/27/2019 Alfred T. Schofield - Nerves in Disorder (1903)

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NERVES IN DISORDERA PLEA FOR RATIONALTREATMENT

BTALFRED T. SCHOFIELD, M.D., Etc.

HON. PHYSICIAN FRIEDENHEIM HOSPITAL

FUNK & WAGNAI.I.S COMPANYN:BW YORK AND I.ONDON


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TOM I. E.

AND OTHER HELPERSTHIS BOOK

IS DEDICATED

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TPREFACE

HIS little book consists substantially History ofthis book.

of a lecture (with additions) deliveredat the Sanitary Institute twelve years ago.It was printed at the time by special desirefor private circulation. Now it is entirelyrecast, and published for the first time inresponse to very numerous requests.

Given originally to the public in the form Free fromof an address, it was kept free from needless caiities.and unintelligible medical expressions ; andin the additions needed to bring it up todate the same style has been preserved.

It is now published because it is hoped Object, thethat an- earnest attempt to plainly set forth suffering.what Functional Nerve Diseases really arewill dispel the ignorance which regards themmainly as either shams or frauds. A short


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viu PREFACEtreatise like this, however imperfect, couchedin plain phraseology, may also do somethingto relieve those needless sufferings of nervouspeople which are due to a misapprehensionof the nature of the disease, coupled withdoubts as to its absolute reality.

If the causeless misery so frequently in-flicted by the patient's nearest friends canbe lessened, as it is hoped, by the readingof this book, its publication will be more thanjustified. We speak of "justification" becausewe think this is distinctly needed in anymedical or semi-medical work brought beforethe public.

Reason for ^g ^ rule, medical works are for medicalpublica-^'* men, according to the unwritten law of the

profession. But when it appears possible, bythe diffusion of knowledge and the simplepresentation of facts concerning nerve dis-orders, to lessen and often to end muchneedless pain inflicted on these sufferers,and at the same time to inspire hope bypointing out common-sense lines of treat-ment, it is manifest that an exception must


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PREFACE ixbe made. It is hoped that the presentwork may accomplish something towardsthis end.

Moreovei owing to the increased value importanceof subject,of the brain as distinguished from the restof the body in the march of civilisation,functional nerve disease is becoming dailyof more importance, and the recognition ofits nature, as well as the value of its earlycure, a matter of ever greater consequence.A few simple hints on self-cure in slightcases, as well as the elementary diagnosisof these cases, and an outline of rationalmedical treatment, have been given.The treatment of functional nerve dis- Old abuses

still existeases, since this lecture was first delivered,has undoubtedly been largely changed forthe better by some skilled specialists, andsome of my statements may not seemwholly justified now ; but they are left,because, as many a sufferer knows, the oldabuses do still exist, and a true view andenlightened treatment of nerve disease isfar from universal.


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PREFACEA short glossary is appended, not alto-

gether on account of the difficulty of thewords, but to point out the special mean-ing the author wishes to emphasise in thetext

ALFRED T. SCHOFIELD, M.D.

6, Harley Street, W,Easter, 1903.


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CONTENTSCHAPTER I

PAGEFUNCTIONAL NERVOUS DISORDERS . 3Increase of Functional Nerve Disease Brain

Strain increases, Body Strain decreasesValueof understanding the SubjectFunctional NerveDisease little understood Former RoutineTreatment of NervesPainful Results from Mis-taken DiagnosisHysteria is not " Shamming"A Nervous Invalid in a Healthy FamilyCause of CrueltyTreatment of a Nerve SuffererIllustration from an Actual CaseResult ofseeing the DoctorThe Turning-point in herLife for Good or for EvilCase of a NervousMotherSufferings not exaggeratedA Changeneeded Three Causes of this TreatmentPatients are often to blame for being misun-derstoodRelief when understoodImaginaryDiseases and Diseases of the ImaginationUnconscious Mind must be recognisedTheMind is oneConsciousness is Mental SightThe Process known by the ProductConscious-ness a Small Part of MindThe Mind and the


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CONTENTSSpectrumThe Supra-consciousWe live con-sciously and exist unconsciouslyLimits of theConscious MindThree Systems influenced bythe WillRational Action of the UnconsciousMind Reason and Unreason UnconsciousMind plays the Greatest Part in DiseaseSirJames Paget and the Unconscious MindMentalSufferings in Nerve DiseasePhysical SufferingsFears of losing Reason unfoundedNeuras-thenics and Neuromimetics Dr. Allbutt on Neur-astheniaHypochondriaVarieties of Neuras-theniaClasses of Neurasthenics" Hysteria "should not be generally usedIts Proper UseBut used here to mean NeuromimesisOrganicand Functional Various Symptoms.

CHAPTER IINEURASTHENIA AND NEUROMIMESIS

DESCRIBED 33Normal Nerve ActionSix Varieties of Nerve

StructureTransference of VibrationsHow theTeeth are set on edgeWe think as we feel,and feel as we thinkIdeas start Real Feel-ingsWe are not deceived if the Ideas areConsciousUnconscious Vibrations or Sensa-tionsVibrations from Involuntary MemoriesVibrations from Voluntary MemoriesPain isfelt in Brain, but referred to Nerve Origin inSkinVarious Causes of Pain in the LittleFinger"Ideal" Agony in a ButcherSevenCauses for the Same PainUndistinguishable in


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CONTENTSNerve DiseasePain is a Mental ImpressionPain may be with or without a Physical OriginUnconscious Mind produces Nerve MimicryHealth is Unstable EquilibriumPower of theIntellectPower of the EmotionsEtiologyof Nerve Disease The Predisposing Causeis HeredityExciting CausesWorryMentalIdlenessStrain and Overwork Physical andOther CausesNervous People the Salt of theEarthDetails ofNeurastheniaCauses of Neur-asthenia and HysteriaNeurasthenia in CleverPeopleClasses of NeurasthenicsNot due toRush of LifeCauses of NeurastheniaEffectof AlcoholList of Symptoms of NeurastheniaSome Additions Classification of SymptomsTwo Stages in NeurastheniaSymptoms ofNerve IrritationRepose a. Sign of Brain PowerNervous DebilityNeuromimesis and Hys-teriaSeat is in the BrainPain the CommonSymptom in HysteriaThe Cause being in theBrainIt is wrong to describe " Brain Pain "as Nothing at allSymptoms of True EmotionalHysteriaSimulations of Hysteria, or Neuro-mimesisHysterical and InsaneNervousnessis not HysteriaHysteria in Ill-balanced Brains" Suppressed " Gout and HysteriaDr. Buz-zard on the HystericalHysterical Cases notFraudulentHysterical Joint DiseaseChangesin the JointHysterical Spinal Disease andParalysis Cure of a Case Varieties otParalysis Paralysis of the Special SensesHysterical Tumours Fifty Cases of HystericalTumoursCure of a CaseSpasm of the GulletHysterical Aphonia Other DiseasesSym-ptoms often appear FraudulentNeuromimesisis more than MimicrySymptoms of Hysteriaor Neuromimesis.


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m CONTENTSCHAPTER III PAOION MENTAL THERAPEUTICS . , 87

Mental Therapeutics cannot be omittedSeldom studied scientificallyThe Reason whyA Physician wields Two ForcesValue ofPersonality for Good or Evil Manner inMedicineValue of Faith and HopeGreatPower of Unconscious MindDe Fleury'sProphecy The Physician's Vestibule TheInner Chamber of Mental TherapeuticsMentalCurative QualitiesThe Doctor himself as aMedicineValue of the Family PhysicianFour Varieties of Mental TherapeuticsThe VtsMedicatrix NaturaIs it a Force?Views ofDr. Mitchell BruceThe Vis is the Action ofthe Unconscious MindMental Therapeuticsact in All Diseases Examples Anaesthesiawithout AnaestheticsSickness and Death fromMind Action.

CHAPTER IVSELF-TREATMENT, UNCONSCIOUS ANDCONSCIOUS 107The PictureDescription of a Clinique

Treatment lightly dismissedSuccess in Treat-ment largely due to the Vis Medicatrix NatureDr. Wilkinson on the Vis Medicatrix NaturesMedical Treatment of Minor Importance inMany CasesCure is much more difficult inmany Nerve DiseasesBecause the Vis Medica-trix Aaturcz itself is InactiveFirst Step is to


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CONTENTSrestore the Vis to ActivityQuacks thrive onFunctional Nerve DiseasesWhy Quacks stillflourishThe Public care most for CuresMental Therapeutics ignoredGood Treatmentis mostly EmpiricalScientific Teaching is in-creasing Cure of Disease by the PatientPatient can do much in an Early StageRemoveCauses as far as possiblePatient can changethe EnvironmentOne Reason for consulting aDoctorNo Loss of Self-controlPatient canoften treat the DiseaseBy exerting MentalPowersEspecially in Nerve DiseasesPastorChiniquy and Typhoid Fever Chiniquy'sSecond CureCure of Typhoid in a NurseThe Will thrown into the ScaleMany SimilarCasesAuto-suggestionWithout HypnotismDominant Ideas determine ConductIllustra-tion of Auto-suggestionDomestic TreatmentNerve Disorders seldom unhinge the Mind.

CHAPTER VMEDICAL TREATMENT OF FUNCTIONAL

NERVE DISEASES . . . .129Some Conditions of Success in Functional

Nerve Diseases Sympathy in the PhysicianPain is a Mental FactPatience in the PhysicianPerseverance in the PhysicianFirmness inthe PhysicianTact in the PhysicianShould aSymptom be ignored or not ?The Nature ofNeuromimesisDifficulty of treating these Dis-easesImportance of HonestyAttention toDetails Difiiculty of treating FailuresCon-fidence* 'n Doctor ind NurseStudy the Patient's


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xvi CONTENTSPACK

PersonalityMachine-made "Cures" uselessMethods must be AdequateIll-health moreExpensive than any CureNo "Nerve" NursesNeurasthenic Nurse not yet producedAtPresent the Nurse is born, not madeHence theExpense of CuresOn Nursing HomesQualityof Home determines Success of TreatmentShould Doctors have their ow^n ?The MatronTreatment of Neurasthenia ProperTreatmentof HysteriaValue of MassageIsolationSuggestionBest given indirectlyHypnotismThought-turning Personal Influence ofDoctorAfter-treatmentCycling and GolfSpecial Treatment in NeurastheniaRemoveCause in NeurastheniaCause can generallybe removedNatural SymptomsObserve theFive Laws of HealthTravel generally Bene-ficialValue of Rest in BedGuide to Treat-mentPharmacyAfter-cureWhich Voyagesare BestAlcohol and NeurastheniaTreatmentof NeuromimesisIs it Hysteria only ?OrganicDisease mistaken for HysteriaMistakes madeon Both SidesThe Vicious CircleTravellingoften a MistakeRe-make Body and BrainHypnotism not very Successful in HysteriaRange of Mental TherapeuticsIdeas not tooDifficultCures effected by Unconscious MindRational and Psychic Treatment HealthyBrain exercises Good InfluenceElectricityImportance of Suggestion and of IsolationNew Brain is built upNo Details of TreatmentgivenValue of True Christianity.

A SHORT GLOSSARY , , .173INDEX .179


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Functional Nervous Disorders


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CHAPTER IFUNCTIONAL NERVOUS DISORDERS

THERE can be no doubt that disordered increase of. . functionalnerves are everywhere increasing. 1 nerve

do not speak here of organic nerve diseasesof the brain or spinal cord, producingsuch symptoms as paralyses, spasms, anses-thesias, or atrophies, but of functional nervetroubles of all sorts, whose symptoms, thoughperhaps too vague to classify, yet causegreat pain to those who experience them.These sufferers abound all over the world,but are said at present to be least numerousin Germany, Russia, Italy, and Spain, morenumerous in France, more so still in England,and most of all so in the United States.

It is certain that, with the increasing evolu- Brain1 1 1 1 straintion of the bram, which is being worked increases,

harder and harder every day and kept at a decreases.continually augmenting strain and pressure,

3


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4 NERVES IN DISORDERthese functional nerve troubles must increase.On the body, on the other hand, the strainis certainly less ; not only is labour-savingmachinery everywhere more in use, butlocomotion is becoming more mechanical, andin all varieties of work the need for musculareffort is decreasing. Indeed, were it notfor our athletic sports and games the bodymight soon show signs of deterioration. Asit is, it exhibits none of development ; andits value consists more and more in that itis a necessary agent of the brain and mind,to which, when in health, it acts as a well-trained servant, obeying orders and workingfor its interests.Money now is almost exclusively made

at the expense of the wear-and-tear of nerve,as contrasted with muscle tissue ; and it isa matter of ever-increasing economical im-portance to keep the money-making machine,the brain and mind, at the highest productivepitchin short, in a state of perfect health.

Value of The right understandinsr, therefore, on theunder- standing part of the laity, of the way in which thethe subject. altered conditions of life affect the nervous

organism is of the utmost value ; and a trueeconomy consists in making use of the most


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FUNCTIONAL NERVOUS DISORDERS 5enlightened and modern methods of restoringit to health when overstrained or overtaxed.

It is well known, however, in spite of this, Functionalnervethat while organic nerve diseases have disease. little un-received their full share of scientific atten- derstood.

tion, and been the subjects of extendedresearch for many years, much less time orthought has been expended on functionalnerve disorders. Indeed, it is only of lateyears, since this lecture was first given, thatthey have been fully recognised as distinctdiseases in our country.France and America were the two pioneers

in diagnosis and treatment, and they are stillas far in advance of England in methods andtherapeutics as they are in their literature onthe subject.

Listen for a moment to the usual routine Formertreatment in England of a nervous case, trtaunent" When one of these victims to hypochondria,who are commonly called -malades imaginaires,has recourse to medicine for the relief ofpain, or some other disturbance, he is usuallytold it is of no importance ; that he is fancifuland some anodyne is carelessly prescribed.The patient, who is really suffering the painhe has suggested to himself, feels convinced


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6 NERVES IN DISORDERthat his malady is not known, and thatnothing can be done for him. The ideathat his complaint is incurable becomesintense in proportion to his high opinion ofthe physician's skill ; and thus the patient,who was suffering from the painful affectionsuggested by his mind, often goes away, notonly unc'ired, but incurable." *

It is important to observe that a diseasedue to the imagination is not necessarily animaginary disease, but may produce variousfunctional and even organic disturbances.A wise physician once said to me : '* If aman is so ill as to say he is ill when heis not ill, he must be very ill indeed." Thediseases grouped under the heads of nervous-ness, hysteria, etc., are real in origin andeffects, and formidable in their nature ; andit is high time that the ridicule, the offspringof ignorance, with which they have beenso long surrounded be entirely done away

Painful re- with. These unhappy patients have beenmistaken greatly wrongcd, and often cruelly treated.diagnosis. . .,.,.- ..A nervous mvalid is a iar greater sunererthan a man with a broken leg ; but with

a would-be sapient but truly asinine nod,* " Animal Magnetism " (Parkes).


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FUNCTIONAL NERVOUS DISORDERS 7we are content to dismiss the former as " onlyhysterical."

In a recent medical work we read : " The Hysteria isnot "sham-sister of the ward and the house physician ming."settled between them that the case washysterical, and the girl was malingering"{i.3. shamming) ; that is, that hysteria meansshamming. Such a statement takes us backto the dark ages, when all insanity waspossession by an evil spirit ; for it certainlyimplies that one with serious nerve diseaseis simply controlled by some lying principle.More sympathy and less contempt are indeedfelt for a drunkard than for a hypochondriac.On this head Sir James Paget says,* " To calla patient ' hysterical ' is taken by many peopleas meaning that she is silly, or shamming, orcould get well if she pleased. . . . Hysteria... is a serious affection, making life uselessand unhappy, and not rarely shortening it."

Picture the misery of a nervous invalid in a nervousinvalid ina hearty English family, say of the bucolic a healthy

order. " It is all fancy," is the stock phrasebefore her face ; " it is all humbug," the onebehind her back. This ignorance is partlydue to the fact that the symptoms are gene-

Sir James Paget, " Selected Essays," p. 74,


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8 NERVES IN DISORDERrally subjective rather than objective, andthat observation is not so much needed intheir interpretation as reasoning power.So much is this the case that one great

object in publishing this monograph is toput an end to the unconscious cruelty that

Cause of is SO common in these conditions. This crueltycruelty. spnngs from several reasons, which it willbe well to consider in some detail. Let usfirst of all get the picture clearly before us.

Treatment A mother or a daughter, more rarely aof a nervesufiferer. father or a son, becomes gradually the victim

of some nervous disorder. Let us suppose thecase of a daughter in some robust family.From the first the sufferer feels instinctivelythat the disease is something to be ashamedof, and to be concealed as far as is possible.This is of course only feasible up to a certainpoint, and as soon as the girl begins to bea trouble to others every effort is made byher family to assure her " it is nothing," thatshe is only " putting it on," that she could" stop it if she liked," that she only does it" to gain sympathy," and so on. If com-passion for the sufferer is shown by anymember of the family it is severely repressedby the others, as being " bad for her " and


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FUNCTIONAL NERVOUS DISORDERS 9"encouraging her." One who had been so lUustration

, .... , from antreated came to a physician quite recently, actual case.and on entering his consulting-room burstinto an agony of tears and exclaimed : " Oh,doctor ! do you think I am shamming ? "

This girl was really suffering, I advisedlysay, agonies. The mental tortures, indeed,are often so indescribable that no physicalpain is to be compared to them ; and overand above all else is the fear that the sufferershould be dubbed "hysterical," which meansand can mean to her nothing else thanfraudulent. These sufferings are at times sogreat that they may almost drive the patientto utter desperation, but they have to beconcealed as far as is possible on accountof the general ignorance that still prevails asto their real cause.

Eventually, in most cases, matters reach Result ofseeing thesuch a pitch that the self-conscious sufferer, doctor.who feels by this time more of a culpritthan a patient, has to see the doctor, prob-ably the local medical man. He, possiblyto some extent influenced by the familyrequest to confirm their verdict, and believingin his heart that nerves are mostly " fancy,'*from a total absence in his own medical


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lo NERVES IN DISORDERStudies of any training in their pathology,very likely tells the patient that she is allright, her pain, etc., are purely imaginary, andthe girl leaves his presence being assured in-directly, and partly convinced, that she is animpostor, and that after all she is hysterical.The doctor's official sanction always makesthe home persecutionthough such persecu-

tion is not unkindly meant, but intended toact as a cure more severe ; and the suffereris soon reduced to apathy and despair.Obvious physical symptoms by this timeprobably supervene, and the patient gets somuch worse that she is reluctantly taken to getthe opinion of some eminent specialist. This,practically, is the turning-point in her life.

The turn- If the Selection of the man be a wiseinhei?fe one, and he is truly a serious student ofor goo fyj^^.^jQj^j^j nerve disorders, the patient has

not been five minutes in his room beforeshe feels she is understood for the firsttime since she was taken ill, it may bemany years before. She begins to describeher symptoms, which have hitherto beentreated with ridicule, timidly and apolo-getically, but as she finds she is gravelylistened to, and apparently believed, she


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FUNCTIONAL NERVOUS DISORDERS iigrows bolder and more fluent, and whenshe has finished, she no longer expects tohear the familiar formula, " It is nothing," etc.,but listens with wrapt interest to her pros-pects of cure ; and she departs willing tofollow to the utmost the directions of thefirst man who has treated her sufferingswith respect. Should she, however, unfortu- Or for evil,nately fall, as is still possible, into the handsof a consultant but little more modern inhis 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 " think somuch of herself," her fate is practicallysealed, and she departs not only unrelieved,but possibly invalided for life.Would that I could depict the causeless

cruel sufferings and the chronic invalids thatare entirely the results of such treatmentConsider the feelings of a mother who all Case of anervousher life has given her strength to her family, mother,and who, when at last it begins to fail andnerve symptoms set in, is made to feel a fraudand her sufferings unreal. Or again, con-sider the case of a daughter, the sole invalidin an otherwise healthy household, who is


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12 NERVES IN DISORDER

Sufferingsnot exag-gerated.

A changeneeded.

Threecauses ofthis treat-ment.

compelled to hide her nervous dreads andagonising pains for fear of ridicule, untileither the mind or nervous system entirelygives way.Do not think for one moment these suffer-

ings are imaginary or overdrawn. I shouldnever depict them, nor would this lecturebe published, did I not know they exist inhundreds of cases to-day ; indeed, so commonare they that there are few who read theselines who will not be able to recall fromtheir own knowledge some such scene.

It is truly high time that this, the mostneglected class of disease, received moreattention at the hands of the profession, andthat it occupied a different place in the mindsof the public ; so that the added load ofcruel treatment and misunderstanding shouldbe taken away from the nervous sufferer,and he or she be no longer condemned toendure needless pain from the ignorance ofothers. So much for the picture : now forthe reasons that alone make it possible.

It appears to me that the common con-temptuous treatment of nervous invalids andtheir own deep feeling of shame at theirailments spring from three distinct causes.


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FUNCTIONAL NERVOUS DISORDERS 13In the first place, the medical attitude to-

wards these cases is too often contemptuousor incredulous, and these feelings are reflectedand exaggerated in the conduct of the friendsof the patient.

In the second, popular opinion has for solong associated the very word " hysteriawith fraud and pretence that it is almostvain to combat it.

In the third place, it may not be deniedthat the symptoms of these diseases, spring-ing as they do from disordered nerves, donot exhibit the grave and regular sequenceof organic diseases, but are often to the lastextent vague, contradictory, and capricious,and sometimes apparently foolish.We may even go further than this, if we Patientsare often toare justly to hold the balance of truth in blame for

1 r beingthis matter, and say that patients have often misunder-themselves to blame to no small extent fortheir own capricious conduct, that they couldwell repress, which leads to such painfulsuspicions of their good faith. It may notbe denied that the idea of fraud would bemuch less common if patients vigorouslyexercised whatever self-control they mightpossess to confine the signs of disease to


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14 NERVES IN DISORDERthose symptoms which are unavoidable.Doubtless loss of self-control is itself oftenone of these signs. Still much more mightfrequently be done by patients to avoidthe appearance of " putting it on " thatthey are so often credited with. Perhapsthis little hint may be as useful to sufferersas I hope the strong remarks I have alreadymade may be to their friends and advisers.

All this, however, does not throw anydoubts upon the very real character of thedisease or the pain attached to it.

Reiiefwhen When once nerve patients can go to doctorsunder-stood. with confidence that their sufferings will be

understood and regarded as real and bondfide, I am convinced that, so far from thistending to establish and perpetuate and fosterthese diseases, it will largely mitigate theirterrors, greatly shorten their duration, andmake many a life happy that is at presenttortured and despairing.

Imaginary Up to fifty years ago doctors failed to makediseases ..... , , ,and the distmctions we have drawn betweenthe iraagi- an imaginary disease and one due to the

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


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FUNCTIONAL NERVOUS DISORDERS 15error they were making, and the disastrousconsequences for which they were surelyresponsible. It never occurred to them thatan imaginary disease was a disease a personJiad not got ; but a disease due to the imagina-tion, on the contrary, was a disease the personhad got. Once this is fairly understood, andwe thoroughly and clearly grasp that adisease of the imagination only differs froma disease of the lungs in being more obscureand difficult to treat, that it probably causesmore suffering, and may end in death, weare up to date, at any rate, in this matter.

Archaic survivals (early Victorian), how-ever, everywhere abound amongst doctors, towhom the above is utterly futilea playingwith expressions, and a trifling with theword " disease." I do not, of course, defendthe term "imagination" or "imaginary" asscientific, but it is accurate enough for ourpurpose.The difficulty is that, the disease being Uncr .1-

seen to be partly of mental origin, and no miud mustmind being known or recognised by the nised.doctor but conscious mind, he concludes thatthe patient must be aware of the mind actionwhich is causing the disease, and that she


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l6 NERVES IN DISORDERis therefore to some extent to blame. Thetruth, which we hope will now be recognised,is that all the causative changes take placein the unconscious mind, and that the patientis wholly ignorant of anything but the resultsin the bodythe pain or disease suggested.This is the true solution of the difficulty.

But we must try to explain as simply aspossible what we mean by the terms " con-scious " and " unconscious " minds. Theseexpressions are in themselves misleading,and give the idea that there are two minds,and thus obscure the essential unity. Ionly use the latter term here provisionallyuntil " mind " is generally understood toinclude all mind, and not only, as now, a

The mind small part of it. The mind is one : butIS one. ' '

while one part is in constant illumination,another is never lighted by consciousness ;and between the two stretches a tract ofuncertain extent that is sometimes in lightand sometimes in darknessthe sub-consciousregion.

nessTs'^ Consciousness, after all, only representsTt^ what I see of my mind ; but surely there

are many ways of detecting its presencebesides sight ; and one might as well limit


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FUNCTIONAL NERVOUS DISORDERS \^the body to what one can see of it, ignoringthose parts that are discerned by touch, asto make consciousness the only proof of mind.We can, of course, see the image of ourfaces in a glass, but we can just as clearlysee the unconscious mind reflected in actions,and we have no more right to deny theexistence of the one than of the other. To The pro-

cess knownsay you cannot thmk or feel unless you are by theconscious of the process, is to say one cannottell a man is a watchmaker unless one actuallysees him make the watch ; whereas onereaches this conclusion by seeing the watchitself which he has made. In this case youinfer the process when you see the productthe watch. In like manner, the results ofunconscious thought seen in consciousnessprove the existence of the unconscious mind.We must not only get rid of the idea thatconsciousness is mind, but also that it isthe only proof of mind.

Mind, in fact, may be conscious, sub-conscious, or unconscious. The second statemay be brought into consciousness by effort,the last cannot.Our conscious mind as compared with the ness^asmlii

unconscious mind has been likened to the ^^^'^^'^


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i8 NERVES IN DISORDERvisible spectrum of the sun's rays, as com-pared with the invisible part which stretchesindefinitely on either side. We know nowthat the chief part of heat comes from theultra-red rays that show no light, and the mainpart of the chemical changes in the vegetableworld is the result of the ultra-violet raysat the other end of the spectrum, which areequally invisible to the eye, and are onlyrecognised by their potent effects.

The mind Indeed, as these invisible rays extend in-spectrum. definitely on both sides of the visible spectrum,

so we may say that the mind includes notonly the visible or conscious part, and what wehave termed the sub-conscious, that lies belowor at the red end, but the supra-consciousmind, that lies beyond at the violet endallthe regions of higher soul and spirit life,of which we are only at times vaguelyconscious, but which always exist and containour most abstract and spiritual faculties assurely as the sub-conscious links us to thebody on the other ; both the supra- and sub-conscious being parts of the unconsciousmind. Of course, speaking of regions andlevels is merely figurative, the non-extensionof mind being a fundamental doctrine. I


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FUNCTIONAL NERVOUS DISORDERS 19would include in the supra-conscious such The supr-^ , . , . , . , conscious.a faculty as conscience, which is surelya half-unconscious faculty. Moreover, thesupra-conscious, like the sub-conscious, is bestapprehended when the conscious mind is notactive. Visions, meditations, prayers, andeven dreams have been undoubtedly occasionsof the working of the mind apart from thereason or consciousness.The power to use our lives through the

voluntary muscular and nervous systemsappears to have been committed to our reasonand conscious will-power ; while the powerto carry on the processes of life and existencegenerally is under the control of instinct orunconscious mental power. We may be said We live

conscioxislyto live consciously and to exist unconsciously, and existThe two powers are variously exercised ; for sdousiy.while in health the conscious mind often actsto the detriment of the body, the uncon-scious never does, save when it is diseased.The direct limits of the conscious mind andwill are fairly defined, and are generally Limits ofpretty constant, though in some few indi- sciousviduals they extend much further than in the '" *majority ; but under no circumstances canthe will produce any direct organic change in


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NERVES IN DISORDER

Threesystems in-fluenced bythe will.

Rationalaction ofthe uncon-sciousmind.

Reasonandunreason.

the body. With heart and circulation thedirect influence is very small. By consciouseffort in some people the heart can beslowed ; and I believe there have beeninstances where it could be arrested. Wecannot hold our breath indefinitely, but shortof this can vary respiration to any extent byour will.The respiratory (amongst the vegetative

systems) and the nervous and muscularsystems are the three over which the willhas a large range of power, while over therest its control is very limited.Wherever the boundaries of the conscious

are reached, there the powers of the un-conscious mind begin, and its actions, thoughonly styled instinctive, may be truly saidto be on the whole far more rational andbeneficial than those inspired by what isalways assumed to be reason, but whichjust as often is unreason, and, indeed, be-comes at times a positive power for evilover the bodya disaster which rarelyhappens in the case of the unconscious mind.We think we live entirely as reasonablebeings, but it is very seldom that we do,and none of us could exist for a day were


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FUNCTIONAL NERVOUS DISORDERS 21we not guarded and guided incessantly bya never-erring instinctA great part of our mental actions being Uncon-scious mindbeneath the level of consciousness, the result plays theis that the mind may play a large part in pan indisease without our being in the least awareof it, or having the power to prevent it.No physician who limits mind to conscious-ness can in my opinion rightly understandthe true cause of many functional nervediseases ; and it is to this disastrous limitingof our mental processes to our knowledgeof them that so much of the needless painwe have spoken of is really due.A notable illustration of this may be seen Sir JamesPaget andin Sir James Paget's essay on " Nervous the uncon-Mimicry," * where he evidently feels that mind.nervous mimicry is mental in its origin,and yet, limiting, as was common, mind toconsciousness, he is unable wholly to acceptthis hypothesis in all cases. Some {i.e. thosethat can somehow be connected with con-sciousness) he of course recognises as ofmental causation, while others (in children,or at any rate having nothing to do withconsciousness) he does not. He also points

* Sir James Paget, " Selected Essays," pp. 82, 83.


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NERVES IN DISORDER

Mentalsufferingsin nervedisease.

out that he has always failed himself toproduce any mimicry of disease by anydirection of his mind (showing again that itis the conscious mind that he alone recog-nises). He gives this as a proof that allcannot do so ; whereas the truth is thatnone can produce nervous viiniicry by con-scious effort, and if they did it would befraud, and not neuromimesis.

Apart, however, from any suffering fromerrors in diagnosis, which is preventable, thereis in functional nerve disease itself alwaysgreat and unavoidable misery. The diseasemay begin insidiously, and it is only perhapsafter some interval of time that the patientrealises that she is different from othersphysically, or, as it often appears to her,mentally ; for all sufferings can be groupedas belonging to the body or the mind.Mental suffering may "be acute without anydisorder of the mind existing. Indeed, wherethe mind is partly or wholly unhinged, suffer-ing is often wholly absent.

In nerve disease the mental sufferings arereally mostly due to the fact that the con-scious mind is, as a whole, sound, and hencecan feel intensely the disordered state of thf'


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FUNCTIONAL NERVOUS DISORDERS 23nervous system. This may show itself indreads, fancies, fixed ideas, morbid thoughts,suspicions ; or perhaps losses of memory, ofassociation, of vigour, of keenness of intellect,of quickness of feeling, of moral sense, or thefaculties may be exaggerated in many ways ;but through it all the mind, as a whole, issound, and generally recognises the morbidstate of the nerves when explained, and longsto have it removed ; though in some casesthe true condition is not perceived.The bodily sufferings may range from Physical

sufferings.mere weakness to the agonies of almostevery known disease, which can all bereproduced by the unconscious mind withperfect fidelity, even against the consciouswill or wish of the person.

It will be readily understood, withoutentering into details (which may be left tothe next chapter), what a range of sufferingis comprised here in mind and in body ; infact, it may be said once for all that in noother disease, not even in cancer itself, is suchan extended range of acute and often intoler-able pain possible as in functional nervedisease ; and this class undoubtedly containssome of the greatest sufferers on earth. Not


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24 NERVES IN DISORDERFears of Q^iy ^^qq^ j|- consist in the causes we havelosing

-'

'eason enumerated, but superadded is often another,anfoundea which inflicts intolerable agonies, and that isthe apprehension of the loss of the mindthough fortunately this but very seldomcomes to pass.

It is obvious that such fear must frequentlyexist where so much mental suffering isfound, and it is of great comfort that it canbe here emphatically stated that the dreadis far greater than the danger, and thatcomparatively very few nerve sufferers everlose their reason.

Neuras- Looking at the classes of nerve diseasesthemes and neuro- of functional character, we find they fall intomimetics. two great groupsthe Neurasthe7iics, or

sufferers from nerve weakness of various kinds,and the Neuroniimetics, or sufferers fromnerve disorders, or unconscious mind disordersof an " hysterical " nature.The first class of neurasthenics have, as we

have pointed out, only recently been treatedwith respect as real sufferers, and yet

Dr. Aiibutt " neurasthenia," says Allbutt boldly, " ison neuras-thenia, neither a sham nor a figment. It is no

mere hotchpotch into which odds and endsof nerve troubles are thrust"


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FUNCTIONAL NERVOUS DISORDERS 25The word " neurasthenia " simply means

nerve weakness. The term itself was un-known in England before 1886, though usedearlier in Amerioa and Germany.

Neurasthenia used to be called hypochon- Hypochon-driasis, being of course put down at firstto that long-suffering organ, the liver. Theterm " hypochondria " is now reserved fora fixed delusive idea of some particulardisease or local suffering. Herman definesit as "the belief without cause of seriousbodily disease." This brings it very nearhysteria, which is largely the nervous mimicryof disease.

Neurasthenia and neuromimesis, or hysteria,may of course coexist ; but the former is de-cidedly more common in men than the latter.

There are many varieties of neurasthenia. Varieties ofWhen the chief trouble is in the head, we thenia."speak of cerebral neurasthenia ; when it isin the spine, of spinal neurasthenia. Insome the abdominal viscera are affected,and this is visceral neurasthenia. In othersa very common form is sexual neurasthenia,and these are often considered the most in-curable, and are certainly the most trouble-some to deal with.


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26 NERVES IN DISORDERClasses of yj^g classcs of ncurasthenics vary as muchneuras- 'thenics. as the varieties of neurasthenia. There are

three classes clinically constantly observedthe patients who look perfectly well andare cheerful, the nervously ill and wretched,and the mentally ill and gloomy. Thefirst class are well nourished, plump, rest-less, and talk without ceasing ; but theother two are downcast, and the latterespecially will hardly speak. Idlers arefrequently neuropaths, and need equaltreatment for body and mind. This isgenerally successful if these idlers aremen of capacity.

But the subjects of functional nerve diseaseare by no means always drawn from thesame class, either mental, moral, or physical.We find sufferers amongst the greatest andthe least, the noblest and the basest, thestrongest and the weakest, amongst menand women. The same elements, after all,exist in great men and neuropaths ; onlyin the former there is power to subordinatethe means to the end, and to keep the ideanoble and the habits excellent. Nervous-ness, after all, is an excess of self-conscious-ness of a normal quality.


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FUNCTIONAL NERVOUS DISORDERS 27Turning to neuromimesis, which simplymeans nerve-mimicry, it will be observed

we do not use the word " hysteria " at all. "Hysteriashould not.We have already pointed out that from be gene-maltreatment and misunderstanding thisword has become most undeservedly anactual reproach ; so that to call a person" hysterical " is to give him a bad name.For this and other reasons the word

" hysteria " has become so unpleasant andmisleading that it should be used as seldomas possible, and to this end I think theword might be severely restricted to those I's propercases described under this head by the mostmodern authorities, which are mainly char-acterised by alterations in the field of vision,by sensations in various parts of the body,and by convulsive attacks. Neurastheniaand hypochondria, at any rate, should neverbe confounded with it. There may be andalways are borderland cases ; but we shouldbe clear that neurasthenia is not, and shouldnot be called, hysteria.But preaching is one thing and practising But usedquite another, and for the present m these mean neu-

, 1 1 r romimesis.pages one must be content with the formerwithout the latter ; for it is clinically con-


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FUNCTIONAL NERVOUS DISORDERS 29the case in functional nerve diseases. The Various

. symptoms.symptoms are commonly those of paralysisin various forms and parts, or of imperfec-tion of muscular actions and of sensationsbut though as a rule the symptoms aremore severe, they cause less distress to thesufferer, and are generally treated with muchmore interest and respect by the doctorthan those of functional nerve disease.These few remarks will serve to introduce

the subject to our readers, and we trust alsowill show its importance both to the patientand the doctor.We are firmly convinced that, when thetrue causes of functional nerve diseases areunderstood, the sufferings connected withthem will be lessened, and the cures greatlymultiplied.


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Neurasthenia and NeuromimesisDescribed


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CHAPTER IINEURASTHENIA AND NEUROMIMESIS

DESCRIBEDBEFORE entering on details of nerves Normal

. . nerve" in disorder," it will greatly help us action.if we briefly consider in a simple way thenormal manner of action of nerves "inorder."

Nervous structures in the brain may be Six varie-ties ofnervedivided into six varieties:(i) The organs ^T/stmcttire.special sense, including the nerves of hearing,sight, touch, taste, and smell ; and, withregard to these, let us observe that meremechanical irritation of them will producetheir phenomena. A blow on the eye in thedark will produce the appearance of light,because the optic nerve is irritated ; not, itis true, by waves of light in the retina, butby concussion. Sounds of all sorts are heardwhen there are none, if the nerve of hearing

33 3


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34 NERVES IN DISORDERbe irritated by disease, instead of, as usually,by the waves of sound. Smells and tastesare also clearly perceived and described whennone actually exist. The important bearingof this on nervous disease will soon beapparent. (2) A'Cfves of sensation, that bringintelligence to the brain from every part ofthe body. (3) Terminal Jiei'oe centres, in thecortex or surface of the brain, that receiveand transmit all nerve messages, being undercontrol of the will. (4) Nerves of ^notion,that carry nerve force from the brain toevery muscle. (5) Autoviatic nerve centres,that carry out vital processes apart fromany exercise of will, such as the beating ofthe heart, the processes "of respiration, diges-tion, etc. (6) Ideal tiente centres, the seatof thoughts only, the most actively usedand, perhaps, least understood of any.

Trans- 'W\^ nervc molecule is said to contain onefercnce of\'ibrauons rhousand or more atoms, and all nerve action

is believed to be by vibration of these atoms,all force being ultimately caused by similarmeans. If I tJiink, certain vibrations arebelieved to take place in my ideal nervecells ; if I feel or act, in my sensory or motornerve cells. Thought and action, which to us


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NEURASTHENIA AND NEUROMIMESIS 35appear so widely different, would probably,had we strong enough powers to see them, beperceived to be changes similar to each other,but occurring in different centres. Both arecell actions, and are nearly allied, the cellsoften being probably side by side or veryclosely connected ; and thus an action com-mencing in one nerve centre may readilybe transferred to another. An instance willsuffice.The fact of the teeth being set on edge How the

, teeth areby the scraping of a slate pencil on a slate set on edgeis too well known to need description. Butwhat is the cause ? We hear the scrape, andas the unpleasant sound is composed of air-waves of irregular lengths, it jars the auditorynerve, and communicates special vibrationsto its particles. It happens that in part ofits course this nerve lies alongside another,that joins farther on one coming from theteeth and tongue. The jarring is communi-cated from the auditory nerve to the dentalnerve by contiguity, and the brain receivesthe sensation of the teeth being set on edgeshortly after the disagreeable sound is heard.This is an illustration of the transference offeeling from one nerve of sensation to another.


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36 NERVES IN DISORDERLet us consider transference of vibration * tosensory and motor centres from ideal centres.

We think It has been well said, "We think as weas we feel,and feel as feel or think we feel, and we feel as we think.we think.If we feel a pain, we think we are ill ; andif we think we are ill, we feel ill." If myideal centre vibrates with the thought ofcrossing the Channel in rough weather, andpictures the nausea that would then be felt,the vibrations are transmitted to the terminalcentres of the sensory nerves running fromthe stomach, and I actually feel sick fromcommunication of the idea with a sensorycentre ; and possibly, if of a highly nervousorganisation, may actually be sick fromtransference to a motor centre.

Ideas start Real feelings and real acts can be startedfeelings. in entirely ideal Centres . If we //z/;'?;^ intensely

of any part of the body long enough, we feelsensations in that part. If we think of agood dinner the mouth waters. We shiver* The word " vibration," applied all through here

to nerves and nerve centres, is popular rather thanscientific, for such vibr itions cannot be demonstrated.We believe, however, that every mental action hassome physical counterpart in the nerve structures, towhich we give the name of "vibration," as it probablyconsists in some movement of the nerve atoms.


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NEURASTHENIA AND NEUROMIMESIS 37whether we only think of cold or actuallyfeel cold. The sensation of pain can be pro-duced as really and vividly by thoughts orideas alone as light in the eye by striking itIn short, every sensation of the body ordinarilyproduced from without can also be producedfrom within. It is thus that the ideo-sensoryand ideo-motor actions are produced.These ideal vibrations, acting on motor and We are not

. deceivedOther centres, are quite different from the action if the_ 1 1 1 1 /- ideas areof a motor centre by the direct impulse of conscious.

the will ; the action being in the latter 'casevoluntary and in the former involuntary. Sofar, observe, we have only spoken of ideas ofwhich we are conscious, so that, although themodes of exciting these motor and sensorycentres are abnormal, we know them to be so,and hence are not deceived, and do not deceiveothers, into believing them to be natural.

Thus, when our teeth are set on edge fromsounds we do not go to a dentist ; if weare sick from ideas we do not think we aredyspeptic ; if we hear noises in the ear wedo not look for them externally ; if we shiverfrom thinking of cold we do not put on moreclothing. But now let us go one step furtherinto the region of unconscious cerebration


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38 NERVES IN DISORDERand of memories and habits, and the theoryI wish to present as to the internal causationof these nerve troubles so often grouped underthe word " hysteria " will be made plain.

cT"^- The brain not only acts by the will andbrauons or \yy jdeas of which we are conscious, but issensations. "^continuously vibrating with ideas, memories,and trains of thought of which we are un-conscious. It is so even with regard tocommon sensation. If you concentrate yourattention on any part of your body, youbecome aware of sensations in it that escapedyour attention before, but were equally therethen. If with a feather I lightly tickle theback of your neck, and at the time you areengaged in very earnest conversation, thevibration aroused in the brain sensory centreis unnoticed by you ; and yet if I call yourattention to the fact it is noticed at once.By increasing the stimulus I can make thewaves of vibration set in action motor centres :involuntary ones, such as cause a shakingor shuddering of the neck ; or voluntary,such as turning the head round or movingaway. If you are asleep I may tickle yourfoot so that you draw the leg away and youwake up. In this case you are probably


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NEURASTHENIA AND NEUROMIMESIS 39conscious of moving your leg; but thestimulus that made you do it was too slightto reach your consciousness. We may thusbe conscious of a transferred vibration leadingto action or sensation, and yet be ignorantof the cause that set it going. Memories Vibrations

fromagain will involuntarily, and it may be un- involuntaryconsciously, arouse both feelings and actions.I may have smelt the strong scent of someflower when some critical event took placea proposal of marriage, or some sudden news ;henceforth, whenever the topic is touched on,the very scent or vibrations of the nerve ofsmell that represent it are exactly reproduced.A certain field always recalls a certain songwe used to sing as we crossed it on our wayto school. Thoughts of old Anglo-Indiansset the vibrations of Eastern sights and soundsin action again in the old centres. Observe,in all these cases we are not consideringvibrations deliberately set up by the will in Vibrationsfroman unusual way. You can, of course, pro- voluntary1 1 < 1.1/- ,-1,1 memories.duce these if you think of a green field whenin a drawing-room, until you set in vibrationthe centre of sight and see the green grass;or the centre of hearing, and hear the lowingof the cattle or the hum of the insects. This


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40 NERVES IN DISORDERis much easier if there are no distractingsounds, and if you close your eyes ; and stillmore so if there are some insects actuallyhumming in the room. But the memorieswe speak of are wholly involuntary ones.

Pain IS felt Lg|- yg jjq^ g^j^ yp Q^j- fesults, taking am brain, * ' but referred definite case, say, of a pain in the little finger.to nerve ....rigin in This pain is felt in the little finger, we say,skin. though we really know that the only seat of

any sensation is in the brain. It is there, atthe central termination of the ulnar nerve(that we call the funny-bone), which leadsfrom the little finger, that all the vibrationstake place of which the mind becomes con-scious and calls pain. Whenever these vibra-tions take place in the nerve centre in the brainconnected with the little finger, the mindalways refers the sensation to the commence-ment of the nerve in the little finger, whatevermay be the real origin of this pain.

In the same way, if in your house thehall-door bell rings you say there is someone at the hall door ; if the drawing-roombell, there is some one there : and yet suchmay not be the case. I may have pulled thedoor-bell wire inside the hall, or as I passeddown the kitchen stairs ; or a rat may have


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NEURASTHENIA AND NEUROMIMESIS 41moved it, or I may have struck the bellitself and made it ring, or a shock of earth-quake may have shaken it, or a strong gustof wind ; and yet, although these causes areso various, you, in the kitchen, always say," There is some one at the front door."

It is so in the body, (i) The little finger Various.,, , . .. ii-i/- causes ofIS prickedthere is pain in the little finger, pain in the(2) The ulnar nerve itself is pressed on " ^ "^^'^'somewhere in its course, perhaps at theelbowthere is pain in the little finger.The hand may be cut off, and still if thenerve be irritated in the stump by pressurethe man feels the pain in his imaginary littlefinger as truly and vividly as if it were stillactually there. (3) Or again, there maybe a tumour pressing in the brain on thecentre of the ulnar nerve, and the mostacute pain is felt in the little finger. Allthese instances are from direct irritation ofthe nerve in some part of its course. Butas we have seen, we may go much further.The hall-door wire may have got caughtwith the drawing-room one, so that whenthe latter is pulled it is the hall-door bellthat rings ; the vibration is thus transferred.So in the brain. (4) I may, for example.


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42 NERVES IN DISORDERset to work to think of my little finger, andso start sensations in it which if not actualpain are still sensations. But if I have theidea it is injured, though it may not be, Imay feel the pain acutely from an idea

"Ideal" alone. A butcher, pale, pulseless, andagony in a *butcher, suffering acute agony, as he said, in his

arm, was brought the other day into achemist's shop. His cries were dreadful, forhe had slipped in hooking a heavy piece ofbeef, and was suspended by his arm on thesharp hook ; and yet when the arm wasexposed it was uninjured, the hook havingonly caught in the sleeve.

(5) But again, the pain may have beenoriginally caused by a gathering in the littlefinger, and afterwards kept up, long afterthe gathering was gone, by the thought of itin the ideal centre. (6) Association mayproduce pain, as seeing others with crushedlittle fingers. Or (7) memories, conscious orunconscious, of previously crushed little fin-gers, may also start and keep up this pain.

Seven Observe, then, the varied causes with thecauses forthe same same effect. The little finger is in painpain. (i) from an injury, (2) from pressure on the

nerve, (3) from pressure on a nerve centre


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NEURASTHENIA AND NEUROMIMESIS 43in the brain, (4) from transference by idea,(5) from habit of thought, (6) from association,(7) from memory. Only, in conclusion, wemay add that while in health it is generallyeasy to discriminate between pain in thelittle finger caused by injury to the littlefinger and that set up in other ways, innerve disease it is not. Nay, it is sometimes Undistin-

gfuishableimpossible not only to the sufferer, but to in nervethe doctor who attends him, and hencemistakes in treatment are easily made.From all this we now see clearly :Fi'rsL that pain in all cases is a mental Pain is a' -^ mental miimpression arising from certain changes or pression.

vibrations in the cerebral ner\'e centres, andso entering consciousness.

Second, that in perfect health of the wholemind we are generally able correctly to findthe true cause of the pain and the origin ofthe vibrations that produce it. We find, forinstance, some part of the body diseasedor injured in which we " feel the pain."Very seldom, indeed, in perfect mentalliealth does a mere impression produce acutephysical pain. When the unconscious mind ^^'".'?^yis diseased, as in hysteria, it is far otherwise, without a

\ _ physicalHere the suggestions unconsciously made origin.


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44 NERVES IN DISORDERvibrate in the ideal centres so strongly thatpain is produced and felt equal in intensity inevery way to that produced by local lesionsin the body.

In all functional nerve diseases the braincentres are greatly weakened, and hencevibrate much more readily and intensely tochanges in neighbouring ideal centres thanthey do in health. Pain is felt more intensely.It is felt from slight physical causes, andis felt more readily from purely ideal causes,but it is not referred directly to any supposed

Uncon- disease save in neuromimesis or nerve-scious mindproduces mimicry ; and here the thought or fear ofmimicry, the discase has, through the marvellous force

of the unconscious mind, not only power toproduce characteristic pain, but to start thewhole chain of symptoms generally associatedwith the disease, and which in it cause the

Health is pain. We must remember that health itselfunstableequiii- is but a Condition of unstable equilibrium, and

a very little push upsets the balance, and pro-duces dis-easehealth being, of course, ease.

Power oi In neuromimesis the intellect can influencethe intel- t , , , ,lect. and produce indirectly through the un-conscious mind hyperaesthesia, anaesthesia,paraesthesia, dysaesthesia, and all varieties of


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NEURASTHENIA AND NEUROMIMESIS 45special sensation. The intellect can contractor relax muscles, and cause regular, irregular,and excessive movements, spasms, and con-vulsions. It can also produce loss ofmuscular power and paralysis. Intellect canin the same way influence the involuntarymuscles of the heart, lungs, blood-vessels,bowels, also those in all organs. It alsocan affect the salivary and mammary glands,digestion, excretion, secretion, and generalnutrition.The mental emotions, which largely govern Power of

1 r 1 ^^^ emo-the sympathetic system, cause functional tions.diseases of all parts and many organicdiseasesinflammations, oedema, goitre, ex-ophthalmic goitre, headache, angina pectoris,diabetes, Addison's disease, and neuroses ofthe extremities.So much, then, for an outline of nerve action.

We now turn to the causes of functional Etiologynerve diseases. These are predisposing and disease.exciting.The predisposing cause to nerve trouble The predis-

is principally a nervous diathesis or dispo- cause!"sition. People are born nervous ; that is, theyare born with the nervous system unduly


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46 NERVES IN DISORDERpredominant, less under control, less orderlyin its action than in other people. No doubta highly developed nervous system withadequate control is the best type for a manor woman ; but without this control he orshe joins sooner or later the ranks of nervesufferers. The great predisposing cause is

Is heredity, therefore heredity ; but (and this may benoted as important), if the family historyonly reveals nervous troubles in other membersas distinguished from loss of mind in anyform, the invalid, however severe his symptomsand great his sufferings, is not likely to crossthe border-line of sanity to the other side.The exciting causes may be mental or

physical.Exciting ^\\Q, leading mental cause of nervous diseasecauses. Worry. is worry, first and foremost, rather than work.Properly regulated brain-work no more

leads to nerve disease than hard manuallabour leads to disease of the muscles. In-deed, it is so far from injuring the nervesthat it is one of the greatest sources of theirstrength, and one of the strongest safeguardsagainst neurasthenia. Worry, however, isan unmitigated evil ; it is a most vicious habit,doing good to none, but invariably damaging


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NEURASTHENIA AND NEUROMIMESIS 47more or less the nervous system of the onewho gives way to it. This must be dueto the constant cross-currents of thoughtthat eddy backwards and forwards in thebrain, and to real fatigue and difficultyin finding the resultant that shall issue inaction from among a large number of con-flicting forces.Next to worry as a cause of nerve disease, Mentalidleness,or perhaps bracketed with it, we should be

inclined to place sudden mental idleness,such as school-girls' experience when all atonce transformed at the close of the lastterm into " young ladies." The sudden changefrom working every day through a long time-table containing a perfect olla podrida of moreor less useful subjects to the peaceful occupa-tion of arranging the flowers in the drawing-room for half an hour daily, has a verymarked effect on some natures, and theyreadily become a prey to nerve disordersfrom the abrupt cessation of brain-work.If one might for a moment play the partof adviser here, one would suggest, whenschool-days are over, six or twelve monthsof modified work at those essentials that areinvariably left out of the school time-table


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48 NERVES IN DISORDERwe allude to domestic duties of all sorts,nature lore, hygiene, and other householdmatters. Six months at the House ofEducation, Ambleside, under Miss CharlotteMason is a most admirable prophylactic inthese circumstances.

Strain and Long-continued strain from any reason isanother cause, and so is overwork of all sorts,especially if combined with under-feeding,as is so common in the poorer classes. Badmental surroundings, such as association withother nerve sufferers or anxious or fractiousparents, are other agents ; and there are manymore.

Physical TurninsT to the physical causes, which,and other causes. however, generally duly act in conjunction

with mental, we would place first generalill-health, especially if dyspepsia be presenttoo much food or too little food may comenext ; too much physical work is seldom acause, but too little exercise frequently is.Sudden change of surroundings of any sortfrequently develops nervous disease, as whena man retires from business, a girl gets married,or sudden loss of or increase of fortune takesplace. Shock arising from accidents, badnews, etc., is a cause ; so is extreme grief


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NEURASTHENIA AND NEUROMIMESIS 49or extreme joy. Such, then, are the principalsources of nerve trouble.Now, nervous people are the very salt of Nervouspeople thethe earth, and the leading men in every pro- salt of the

fession are drawn from their ranks. Theyare men with brains that thrill, that feel,that are quick in action, firm, clear, and ofhigh organisation. It is the nervous menthat rule the world, not lymphatic vegetables.Listen to an impartial sketch of the type :

" The skin is dark, earthy, pale, or may beof any shade, and is often hot and dry. Theskull is large in proportion to the facemuscles spare, features small, eyes quick,large, lustrous ; circulation capricious, veinslarge. Face characterised by energy andintensity of thought and feeling ; movementshasty, often abrupt and violent, or elselanguid. Hands and feet small, frame slightand delicate. Require little sleep, drinkmuch tea. Prone to all nervous diseases.Always seem to be able to do more than theyare doing. The character may be, on theone side, admirable for its powers of mindand insight, for its lofty imagination ; while,on the other, it may be disfigured byimpetuous and unruly passions. To this class

4


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50 NERVES IN DISORDERbelong the most intellectual of the racethe wittiest, the cleverest of mankind. Theseare the poets, the men of letters, the students,the professors, or the statesmen. Theirgreat dangers consist in uncontrollablepassions. They feel pain acutely. Neverthe-less, they can endure long fatigue andprivation better than the sanguine. Theyform the leaders of mankind. Amongstwomen there is delicacy of organisation,quickness of imagination, and fervour ofemotion ; but they are beset vi^ith danger,from want of control of their great powers."Now, it is the children of these people who,inheriting the nervous organisation of theirparents without having their safety valveof hard work, so often fall victims to nervousdiseases.

Details of Passing now from generalities, we willneuras-thenia, consider a little more in detail the subjects

of neurasthenia and of neuromimesis, takingthe former first. In neurasthenia we haveto do with every variety of brain and nerveexhaustion that may show itself physicallyin many various movements and actions, ormentally in every form of " nervousness " from


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NEURASTHENIA AND NEUROMIMESIS 51slight irritation to extreme nervous debilityand different varieties of nerve aberration.

Cases of true neurasthenia, that is, of nerve Causes of, . , , neurasthe-irritation or exhaustion, dependent upon niaand

external causes or on some bodily illness,are mainly physical in their origin ; the mind,conscious or unconscious, being only affectedin a secondary degree as a result of thenerve condition.On the other hand, all cases of hysteria

or neuromimesis contain a distinct primarymental element, which is an affection of theunconscious mind over and above any merequestion of nerve condition ; while all othercases of delusions, fixed ideas, true melan-cholia, and other slight aberrations, reveala primary disturbance, want of balance orunsoundness of the conscious mind or reason,and these are generally recognised as truemental cases. Hysterical patients, however,are not generally regarded as distinctlymental, owing to the fact that still, as a rule,in England mind is limited to consciousness.In France it is otherwise, for Charcot, quotedby F6r6, says, " Hysteria is a psychicalmalady par excellence^ In this country, fromthe fact of its seat being the unconscious


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52 NERVES IN DISORDERmind, which produces in the body the sym-ptoms complained of, hysteria occupies anintermediate place between the pure nervelesions on the one hand and the distinctmental troubles on the other.

Neurasthenia is by no means a disease ofdegenerates, or of weak-minded people, anymore than it is a species of malingering.

Neuras- In my experience the larger number of thethenia inclever victims to it are people of good and evenpeople. ,great mental powers, who from an over-use

of these very powers, or at times from a wantof use of them, have fallen a prey to it.We have already said that the nervous menrule the world, and those of this temperamentare ever the ones whose nerves are mostlikely to break from their control from over-strain and other causes, and hence to sufferfrom neurasthenia of various sorts.

In a family it is often the bread-winnerwho is so afflicted, or perhaps the mostintelligent daughter.A low level of nervous organisation or im-perfect education is not often a cause of thisdisease ; for though it occurs in the unedu-cated classes, other factors are generally thepredisposing and exciting causes. One of


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NEURASTHENIA AND NEUROMIMESIS 53the best summaries as to the classes affected Classes ofneuras-has been made by Karl Petren, of Upsala, in themes.the Deutsche Zeitschrift fur Nervenheilkunde,Bd. xvii., who reports the results obtained ina recent investigation of the frequency ofneurasthenia in the various grades of society.Contrary to usual statements, he does notfind a larger number of cases in the upperthan the lower classes. Out of some 2,478patients observed between 1895 and 1899, hemet with 285 (ii'5 per cent.) cases of definiteneurasthenia. These he resolves into threegroups : (i) artisans and peasants ; (2)tradesfolk and under-officials ; (3) intel-lectuals. In further division as to sex,males are easily first with (i) I4"8 per cent,(2) 13-2 per cent, (3) I3'3 per cent Asregards women, the numbers are (i) 11 -4per cent, (2) ^'6 per cent., and (3) 6'6 percent In Sweden it therefore now appearsthat neurasthenia is more prevalent amongstthe working classes.On the other hand, many cases of neur-

asthenia are put down to education ; butwe must remember that development of thenervous system makes for increased control.It is found by Dr. Allbutt that neurasthenics


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54 NERVES IN DISORDERare, after all, not more common in New Yorkthan London, or among the busy than the idle.The disease abounds in such places as Fin-land, and in the Yorkshire collieries. Petr^nthinks that, as previous writers have drawntheir statistics on the one hand from thehigher classes and on the other from clinics,the results disagree, because many neuras-thenics do not come under hospital treatment,whilst those of the former status readily

Not due to consult their doctors. That the disease isrush of life. ^^^ dependent upon the rush of modern Hfe

seems apparent from the fact that the greaternumber of cases came from the provincialparts of Sweden, where life is very simpleand tranquil.

Causes of As regards causation, 62 cases have followedthenia." family disappointments, 24 financial difficul-

ties, and 47 overwork. Twenty-nine casesoccurred after influenza, 21 acknowledgedvenery and other various exhausting excesses ;in 16 females it complicated pregnancy andthe puerperium, 8 were directly traced toalcoholic excesses, and 2 were produced byhigh temperatures experienced during theiravocations.A prominent factor is that of hereditary


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NEURASTHENIA AND NEUROMIMESIS 55alcoholism. In the early years of the century Effect of' ' ^ alcohollarge quantities of spirits, etc., were almostuniversally consumed, and where the alcoholictendency is not directly apparent its influ-ence is felt in the unstable nervous equilibriumof the present generation. Several cases arereported in which cerebral arteriosclerosiswas present. Hygienic conditions also con-tribute to the increase amongst the lowerclasses. Lack of proper nourishment, in-sanitary dwellings, and monotony of existenceare amongst some of the causes that needattention in order to prevent its furtherextension.We need not repeat here the list of pre-disposing and exciting causes ; for what wehave given as those of general functionalnerve disease apply equally well toneurasthenia.The symptoms of this disease vary as

widely as the classes which suffer from it.When a structure such as the nervous systemis affected, that is an agent in nearly everybodily activity, it is obvious that thesymptoms must vary with the part wherethe weakness predominates.The following long list, made of the more


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56 NERVES IN DISORDERprominent of these symptoms, clearly showsthis :

List of Scalp tendernessheadaches (not in my ex-symptomsofneuras- perience a common or a prominent symptom)thenia. lilated pupilsfeeling of pressure on the

vertexheavy expression of eyecongestedconjunctivaealteration of the nerves ofspecial sense (increased or diminished capri-ciously)muscae volitantesnoises in theearsatonic voiceloss of mental controlirritabilityhopelessnessmorbid fears ofopen places, of crowds, of confined spaces,of being alone, of people, of responsibilities,of diseases, of infection, of trains or cabs, ofeverything (called by various Greek andother compound words, agoraphobia, claus-trophobia, etc., etc.)blushinginsomnia (amarked symptom)drowsiness (in visceralneurasthenia)tender teethdyspepsialoveof drugsabnormal secretionssweatinghandstender spine tender coccyx irritablehearttremorsdysphagiairritable coughirregular respiration (sometimes " CheyneStokes ") cramps morbid sensibility numbness hypersesthesia exhaustion pruritusflushescold feet and handssudden changes of condition and symptoms.


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NEURASTHENIA AND NEUROMIMESIS 57To this long catalogue I may add from Some ' addiUons.personal experience : constant restlessness

defective memorydizziness and giddinessdread of noise or lightloss of voicelossof sense of proportion, small things lookingbig, and important things triflingwant ofco-ordinationpalpitation of the heartweariness of brain"pins and needles" inlimbsleft sub-mammary painleft inguinalpainnervous hand (flexed wrist, extendedfingers, fine tremors, and dropped thumb)flatulence, and constipation.Out of the above 48 symptoms we may Classifica-tion ofclass 26 as functional, 1 5 as mental, and 7 symptoms.

as physical or to a certain extent organic.Neurasthenia, after all, is a word that des-

cribes two very difl"erent types of nerve disease, Two stagesin neuras-and these are " Nervous Irritability " and thenia." Nervous Debility." The seat of the troublein either case may be in the spine or it maybe in the brain ; and two barbarous wordsof six and seven syllables have been coinedto express each variety respectively, withwhich we need not trouble our readershere.The first stage of " nervousness^^ that of

nerve irritability, is the general result of over-


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58 NERVES IN DISORDERstrain of the nervous temperament, and isgreatly on the increase, as the tension of lifebecomes more acute, while hysteria proper isdiminishing. Constant brain irritants in theideal centres, in the shape of small but per-petual worries, render the other nerve centresas morbidly sensitive as a constant successionof slight pin-pricks all over the body wouldthe terminal sensory nerves. The manifesta-tions of nervous irritation are numerous andcharacteristic.

Symptoms Physically they may include constant orof nerveirritation, intermittent movement of body and face,

sharp ringing cough, sudden hoarseness, quickand irregular breathing, starting, twitching,flushing, palpitation of the heart, tendernessof the scalp or spine, headaches at thetop and back of the head, congested lookof the eyes, noises in the ears, sleeplessness,dyspepsia and flatulence, perspiration, flyingpains and cramps, and neuralgia in variousparts.

Mentally, we get timidity, irritability,melancholy, and a dread of being alone, or" monophobia " ; or in a crowd, or " agora-phobia " ; or in close, confined spaces, or" claustrophobia." There is little mental


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NEURASTHENIA AND NEUROMIMESIS 59control or power; wrong words may bespoken or written.

Referring to the divisions of the brain, thecause may be said to be largely the resultof want of control by the upper or cortexover the middle district, which may be dueto inherent weakness or constant irritationfrom overwork or worry, or daily railwaytravelling. The constant movement charac-teristic of this condition is in itself a signof weakness in the higher centres. A babyis always in motion. As we grow older weget quieter, and the man with the strong Repose abrain only moves for a definite purpose. Re- brainpower.pose, not movement, is a sign of bram power.

These cases are, in spite of what we havesaid, generally called " hysterical " or " hypo-chondriacal " ; and the real affection, whichis " nerve irritation," is still rarely found inmedical works as a distinct disease, althoughall the symptoms clearly point to it, which inhysteria they do not ; for although the latterdisease is a nervous one, it generally appearsto be organic. This first stage of nervousness,if the cause that produced it is still there, andno treatment is adopted, progresses, eithernaturally to the second stage, or abnormally


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6o NERVES IN DISORDERto general neuralgia, inebriety, etc., or eveninsanity.

Nervous Before considering the treatment we willbriefly describe the symptoms of the secondstage of neurasthenia, viz. " nervous debility."

This is a still worse disorder. It is themanifestation of nerve exhaustion rather thanirritation, and is generally a further stage ofnervousness. It is the frequent result ofexcesses of all kinds. It is characterisedby physical weakness, dilated and sluggishpupils, dimness of sight, general exhaustion,mental lassitude and apathy, occasionallyvaried by a false and capricious but evanescentenergy. It is often combined in varyingdegrees, as would naturally be supposed,with nervous irritability, and frequently withhysteria.So far from moving about, the patient is

quite still, and becomes increasingly difficultto arouse to an interest in his surroundingsThe symptoms in both stages are very vari-able at first, but tend to become increasinglyfixed as time goes on.

Nenro- Turning now to neuromimesis, we mustmimesis 'f^^ . define its relationship with the word "hysteria,"


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NEURASTHENIA AND NEUROMIMESIS 6ia word which, from its misuse, as we havepointed out, would be much better dropped,if it were possible. Hysteria by some ismade to cover , every form of functionalnerve trouble, including hypochondria andmelancholia, as well as neurasthenia andneuromimesis.

Others again restrict it to the last two.Those who use the word rightly, restrict itto a disease of narrowed consciousness, char-acterised by defects of vision and sensation,and at times convulsive attacks of variouscharacters ; the mimicry of disease beingbetter described under the head of neuro-mimesis.

Here, however, we shall often have to usethe word " hysteria " to include neuromimesis,in accordance with the usual practice atpresent.

Speaking then generally of hysteria in this Seat is inbroad sense, we may say that the seat ofthis disease in every case is really in thebrain,, where it either actually originatesor is caused by irritation from some partof the body that may be slightly diseased.This real seat of the disease is, however,seldom suspected by the patient or the


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62 NERVES IN DISORDERfriends, who are, as we have shown, constantlymisledas, indeed, the physician may himselfbe led into error by the remarkable appear-ances of disease which it produces in variousparts of the body. There may, of course,be real organic disease as well, and the twomay be combined in any proportions.

Hysteria is so common that in some affec-tions, such as pain in the back, it is thegeneral cause, organic disease being theexception. We find hysterical sufferers inall our hospitals, amongst our friends in allcircles of society, and all over the Continent.They used to fill our watering-places withinteresting invalids in bath-chairs, who are,however, now comparatively rarely seen, thecause of the disease being more generallyknown.

Pain the One symptom of hysteria is generally /^/symptom of some sort having the character of distinctm hysteria, ^jgg^gg ^ jjj ^.jjg chest resembling pleurisy,

in the heart resembling a form of heartdisease, in the spine resembling spinal disease,in the knee resembling rheumatic gout, orelsewhere. In such cases even the skin istender, and a slight touch hurts as much asa heavy one, which is not the case in local


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NEURASTHENIA AND NEUROMIMESIS 63disease. Or, on the other hand, any partof the body, whole limbs or isolated patches,may be insensible to pain, and be prickedwithout its being felt. This pain, we repeat,differs in its origin from all other, beingneither neuralgia (or pain arising in the nerveitself), nor caused by any body disease ; but,arising in the ideal centres of which wehave spoken, it is probably transferred byvibration to the nerve centre belonging tothat part of the body with which the ideais occupied, and the pain is referred to thenerves connected with this centre that com-mence in that part ot the body where thepain is said to be felt and the disease sup-posed to exist.As to this internal causation we may use The cause

again a familiar illustration. It is true that, brail.'"however much the hall-door bell may ring,though we always say there must be someone there, this by no means follows. Nowa slight disease in fact, as a sprained knee

;

or in memojy, as the continual painful re-collection of one ; or in association, as con-tinually hearing about one, or reading aboutone, or seeing one, may so cause the centresin the brain connected with the pain, swelling,


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64 NERVES IN DISORDERand stiffness of the joint to vibrate, thatthe vibration is kept up without any actualdisease being present, or long after it hasceased to exist.We must remember that while we maybe wrong, when the door-bell rings, in sayingthere is some one there, we are certainlywrong, if we go there and find no one, in

It is wrong saying it is nothing at all. And yet we knowto describe .... ,.,.,. . , , ,"brain it IS this v/hich IS bcmg Said every day bynothing at some doctors, through want of any training

in these matters, combined with too greattraining in believing only in what they cansee or feel or hear. If such men find thereis nothing wrong with the knee-joint, how-ever loudly the patient may complain, theydeclare and stick to it that he has nothingwrong with him, and suggest that the patientdoes not really feel the pain at all ; or, inother words, that the bell never rang.Now the bell did ring, and the disease

does exist ; only, instead of being a commonaffection or disease of the knee, it is anobscure one of the brain. See what aninjury is unconsciously inflicted on a nervoussufferer, who, feeling agonising pain in theknee or back, is first well pulled about, and


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NEURASTHENIA AND NEUROMIMESIS 65then, because nothing can be felt at the spot,is calmly told that nothing is the matter, andis sent away with the diseased ideal or othercentre in the brain uncured.

Let us now briefly run over the symptomsof emotional hysteria proper, and then thoseof simulating hysteria or neuromimesis.Amongst the symptoms of emotional Symptoms -' jr of true

hysteria may be included sharp cough, emotionalspasms, convulsions, and choking from aball rising in the throat ; laughing immode-rately and crying, or both together ; suddenmovements more or less purposeless. Thespasms may be local or general, or of anygroups of muscles,as of the chest, producingdifficulty of breathing with signs of suffo-cation ; or of the arm, or leg, or finger,or toe, producing temporary or permanentcontraction of the part : these symptoms aremade worse by sympathy, which simplyfeeds the vitiated ideal centres. The con-vulsions or hysterical fits are violent, andare usually ushered in by suffocation andpain on the rising of the " globus " or ballin the throat. The attacks are not verysudden, there being generally some strugglingfirst. The patient then often shrieks, and

5


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66 NERVES IN DISORDER

Simula-tions ofhysteria,or neuro-mimcsis.

becomes partly, not wholly, unconscious,the fit being aggravated by any notice orsympathy, for which there is often a greatdesire. The patient falls without hurtingherself, and the fit rarely occurs in thenight or when there are no bystanders.Nevertheless, the hysterical convulsion is inno sense a sham. The back is generallyarched, which is rare in epilepsy, and themovements and language are more or lesspurposive. The tongue is not bitten. Theremay be several fits or only one.Mimetic or imitative hysteria, neuromimesis,

is not characterised by these attacks or generalsensations, but simulates every known disease,including tumours, deafness, blindness, dumb-ness, paralysis, St. Vitus' dance, etc., and iscapable of producing, curiously enough, thehighest temperatures of fever. In everycase, though so various in their manifesta-tions, it is probable that the cause is the same ;and that the d

Documents

Alfred T. Schofield - Nerves in Disorder (1903)