AN ENQUIRY INTO THE NATURE, CAUSES, AND METHOD OF CURE, OF NERVOUS DISORDERS.
In a LETTER to a FRIEND.
By ALEX. THOMSON, M. D.
LONDON, PRINTED FOR J. MURRAY, No 32, FLEET-STREET.
MDCCLXXXI.
AN ENQUIRY, &c.
DEAR SIR,
IN compliance with the request which you urged in so obliging a manner, I am now to present you with a few remarks on the nature, causes, and method of cure, of Nervous Disorders. Under this denomination, in its full extent, are included several diseases of the most dangerous kind; as the apoplexy, epilepsy, and convulsions, beside the hysteric passion and hypochondriacal disease. The enquiry, however, shall be restricted to those complaints more particularly denominated nervous, and which seem to depend upon extreme sensibility of constitution. But the nerves being the basis of our subject, it may be proper to premise a few words on those delicate parts of the human frame, universally admitted to be the medium of intercourse to the body and soul.
The nerves are minute ramifications, resembling chords; proceeding either from the brain or the spinal marrow, and distributed to the various parts of the body, for the purposes of sensation and motion. With regard to their structure anatomists are divided; some holding them exquisitely fine tubes; others, filaments without any cavity. The former hypothesis, countenanced alike by experiment and analogy, is consequently far the more probable. Those who maintain the tubular formation, conclude that the nerves are furnished with a fluid secreted in the brain, and known by the name of animal spirits.
Nervous complaints are so various and eccentric, that a volume would hardly suffice to a complete description of them. The most common symptoms are, weakness, flatulence, palpitations, watchfulness, sleepiness after eating, timidity, flashes of heat and cold, numbness, rigors of different parts, vertigo, pains, especially of the head, back, and loins, hiccup, difficulty of respiration and deglutition, anxiety, dry cough, limpid urine, &c.
An opinion prevails that nervous disorders are more frequent in this country at present, than in any former period. This is commonly imputed to the drinking of tea, now so general among people of all ranks. Whether this celebrated exotic really proves so injurious as has been imagined, may still be matter of dispute. That in many constitutions it excites nervous symptoms, such as tremors, palpitations, and watchfulness, we are certain from experience; but we also know that in others it is regularly taken, not only without any sensible bad effects, but even with advantage. It relieves a headake, dispels drowsiness, and is often observed to promote digestion.
Should we examine the whole economy of persons most addicted to tea-drinking, at least of those who are imagined to be chiefly affected by it, perhaps we might discover other probable causes of weakness. The numerous modes of indulgence practised in times of refinement and luxury, ought all to be allowed their respective share in producing this effect. The farther we depart from simplicity and temperance in diet, and the more we sacrifice the wholesome exercises to the inactivity attending domestic amusements, the greater will be the influence of every physical error in diminishing the vigor of the constitution.
When we consider that those causes have more or less operated, at some period or other, in every country where refinement has any time existed; and when we take into the account the numerous causes of weakness which have arisen from accident or disease, there might seem reason for concluding, that in the space of some thousand years, the constitution of man has undergone an extraordinary change. But such an opinion, however plausible, is much to be questioned. On a subject of this nature we can draw no argument from experience. The vigor of one age has declined, before that of another has arrived at maturity; and no standard is transmitted, by which we may determine the comparative strength of generations. Perhaps it will be said, that this point has long been settled by the poets.
Iliad xii.
A pond'rous stone bold Hector heav'd to throw,
Pointed above, and rough and gross below:
Not two strong men th'enormous weight could raise,
Such men as live in these degen'rate days.
Pope.
Virgil, with a noble boldness, multiplies the number into twelve. Of the stone which Turnus lifted, to throw at Aeneas, he says,
Vix illud, lecti bis sex cervice subirent,
Qualia nunc hominum producit corpora tellus.
Aeneid xii.
So vast, that twelve strong men of modern days
Th'enormous weight from earth could hardly raise.
Dryden.
Had the human race degenerated, since the Augustan age, in the same progression, to what a degree of weakness must mankind have by this time dwindled!
If the problem were determinable by facts, it would be so by instances of longevity; but even those are far from being decisive. There is reason to doubt whether longevity be a certain criterion of uncommon vigor. Perhaps it may be ascribed rather to soundness of constitution than to superior strength. Admitting the poetic authorities in favor of the primitive ages; admitting the extraordinary muscular force of a Hector, a Turnus, or a Hercules; still the vigor of those heroes can reflect no general lustre on the times in which they lived; nay their fame implies a great inferiority of the contemporary inhabitants of the world.
But to dispute with former ages the palm of constitutional vigor, is not the object of enquiry. The speculation could only be so far useful as it might enable us to ascertain what circumstances in the modern way of living appear the most subversive of corporeal strength. The distinctions characteristic of fashionable life are idleness and intemperance; the never-failing concomitants of high refinement. Celsus observes that those two vices had first spoiled the constitution of the Greeks, and afterwards of his countrymen the Romans, when they had become masters of the luxury, as well as the territories, of that polite people. In similar circumstances, the same causes have similarly operated; and their united influence may, independently of any particular species of modern luxury, continue to produce the same effects.
It is universally admitted, that the predisposing cause of nervous disorders is too great irritability of constitution, which may be either hereditary, or acquired in various ways; for instance, by a sedentary life, too great application to study, intemperance of any kind, tedious diseases, profuse evacuations, or the depressing passions.
Nervous distempers are alike incidental to both sexes; with only this difference, that in the female, from the natural delicacy of constitution, and the manner of life, they are, in general, more frequent and violent than in the other. Being peculiar to neither sex, they are not restricted to any period of life; but usually most prevalent during the middle stages of it.
Though a weakness of the nervous system be often hereditary, it seldom receives any augmentation in the earlier part of life; the playfulness of children, and their exemption from cares, at least from such as are productive of habitual anxiety, counteracting the progress of the disposition. The same causes may continue to operate after the commencement of adult age, unless menstrual irregularities in one sex, or pernicious excesses in the other, call forth the latent seeds of constitutional debility.
At whatever period the disorder first appears, its progress in different persons is liable to great variation. In some it remains a stationary complaint, with intermissions, however, but without exacerbations, for several years; while in others it fluctuates through all the gradations, from the faintest symptom of spasmodic affection, to its consummation in the epilepsy, apoplexy, or hysteric passion.
When but one cause stimulates nervous affection, the health may not be greatly impaired for a time: but when two or more operate in conjunction; for instance, when to a sedentary life is joined the influence of grief or anxiety; and when watchfulness, the natural concomitant of each, is rendered more obstinate by the combination of all; the strength must fast decline, and the disease advance with proportionable rapidity.
An eminent author has observed, that there is scarce a disease which the nervous ailment will not counterfeit: he might have added, that there is hardly any which it may not realize. The debilitated state of the concoctive powers, and the general consequent relaxation, are particularly favorable to the production of chronic disorders; while the irritability of the nervous system no less disposes to those of the acute kind.
When a weakness of the nerves is hereditary, the origin of their diseases is lost in the general debility of the system: but if it has been acquired by errors in what are called the non-naturals, the beginning of those complaints may, for the most part, be traced to a weakness of the stomach and bowels; whence if those diseases do not actually derive their earliest existence, at least the signs of their invasion are there most perceptible. They commonly begin with an oppression, and sense of fullness in the stomach after eating: the sleep is much interrupted with dreams: frequently the person feels a slight pain in the stomach or belly. Those symptoms are at times accompanied with a singing in the ears, and with fits of giddiness, particularly in stooping.
That a disease which depends upon irritability, and is supported by a sympathy in the nervous system, derives its origin from the stomach and bowels, is an opinion strongly confirmed by the texture and offices of those parts. Furnished with numerous branches of nerves, they are extremely susceptible of irritation; to which they are also particularly exposed from the weight or resistance of the food, its occasional acrimony, and the stimulating nature of the gastric fluids, rendered yet more acrimonious by vitiated digestion.
At the beginning of the disorder, before the patient has either been cautioned by the physician, or instructed by experience, to abstain from a hearty supper, it is not uncommon for this indulgence to be succeeded, in the night, by a great oppression about the heart and stomach. This state is frequently accompanied with a convulsive motion of the tongue and jaws; during which the former lolls out, and is exposed to the gnashing of the teeth.
When a great weakness of the stomach and bowels has been introduced, many are the occasional causes of irritation from which nervous symptoms may ensue. In general, whatever, by quantity or quality, relaxes the solids, or by acrimony stimulates into spasms; whatever diminishes the energy, or excites to irregular motion, of the animal spirits, tends either immediately or remotely to the production of nervous disorders.
The occasional causes may be divided into the following classes: 1. Wind, phlegm, worms, or acrid matter, in the first passages. 2. Acrid matter in the blood. 3. The diminution or suppression of some accustomed discharge. 4. Inanition, whether occasioned by abstinence or evacuation. 5. Violent passions. 6. Obstructions in the abdominal viscera. 7. The effluvia of some odorous substances.
Though those causes may operate singly towards the production of nervous symptoms, it is not uncommon for two or more of them to act at the same time, and when this happens, the disorder which they excite in the animal economy, as has been already observed, is proportionably violent.
Of all the causes of nervous complaints, none is more pernicious than profuse seminal evacuation. It has been alledged that this discharge always accompanies a chronic weakness: the remark is perhaps not sufficiently confirmed by authorities. When such a case occurs, there is reason to suspect that the seminal weakness had preceded the nervous disorder. On the appearance of the latter, however, the former is liable to be increased.
In attempting the removal of the nervous complaint, the greatest attention is necessary to investigate the precise origin, whether singular or plural, whence it derives its support: for without such knowledge, in vain shall we endeavor to prevent the effects of irritation. With every advantage on our side, we shall often have occasion to regret the obstinacy of the disease. Indeed, that nervous disorders should prove difficult of cure, will not appear surprising, when we consider how much they are distinguished by a variety of opposite indications and circumstances, of a positive and negative, of a physical and moral kind. Amidst the necessity of nourishment, is every impediment to digestion. The impurity of the blood we find aggravated by great irregularity of the discharges. Sleep, however indispensable for recruiting the exhausted strength, in many cases comes not spontaneously; nor can it be procured by medicine, without increasing relaxation. Exercise, absolutely necessary, is often prevented by a listlessness, utterly averse to motion. In morbid irritability, which requires the most soothing treatment, the patient is peculiarly liable to perturbations of body and mind. Notwithstanding incidental or habitual lowness of spirits, which seems to indicate the expedience of some exhilarating liquor, even the moderate use of cordials may be neither effectual nor safe. Anxiety, natural to the complaint, and increased by every consideration, must yet be supported with patience. And lastly, though so complicated a distemper might seem to demand the most active remedies, it is often observed to be aggravated even by those of the gentlest kind.
It may well be imagined, that a disease which for the most part originates from an irritability of the alimentary canal, or is always accompanied with it, requires particular attention to diet. In no other chronic disorder is a dietetic restriction equally indispensable: for the person who would either stop the complaint, or obtain a recovery, must be not only temperate, but circumspect, in all convivial gratifications. The infinite diversity of temperaments renders it impossible to deliver rules accommodated to every individual; but in general, the regimen of those who are subject to nervous complaints may be comprised under the following directions. — The food ought to be easy of digestion, and chiefly of the animal kind: vegetables, on account of the flatulence they occasion, being commonly hurtful. Pastry-work, and butter-sauces, are prejudicial; as are likewise fat meats. Even bread should be eaten sparingly, and never on the day that i
is baked: for, if new, it occasions a great fermentation in the stomach. Wine, for the most part, causes disturbance, if not in the stomach, at least in the bowels of the valetudinary. The same may be observed of malt-liquors: but to some constitutions porter, in the quantity of half a pint, or not exceeding a pint, is often found salutary. For the majority, however, of the nervous, water, either alone, or mixt with a small portion of brandy, which is lighter on the stomach than rum, is the best adapted drink. Whatever kind is used, dilution should always be moderate. Supper ought either to be omitted, or taken in a very sparing quantity, and at an early hour.
This attention is the more necessary, as errors committed in diet never fail to affect the nightly rest; a consideration of the greatest importance. For, though digestion may have hitherto proceeded without much uneasiness, yet when its progress is retarded by a recumbent posture, which also greatly impedes the discharge of flatulence from the stomach; when the aliments, by retention in the bowels, have acquired a more considerable degree of acrimony; and when the body, by the relaxing warmth of the bed, is rendered more susceptible of irritation, sleep, if not entirely prevented, which is sometimes the case, is at least so much interrupted as hardly to afford any refreshment.
Previous to an account of the cure of nervous disorders, it cannot be improper to make a few remarks on the method by which it has hitherto been usually conducted. We know too little of the physiology of the nerves, to be intimately acquainted with the nature and modifications of their diseases. Our theory is conjectural; and our practice, if not founded on principles too vague, is frequently indiscriminate. Among the occasional causes mentioned above, only a few may be safely opposed by an immediate recourse to astringent and strengthening remedies: yet too often has this method been pursued under different circumstances of the complaint. Of this preposterous practice not the only ill consequence is the fruitless administraction of corroborants: for the process of cure being commenced where it ought to have ended, the requisite preparation is neglected, and a foundation laid for the establishment of the disease.
When nervous disorders arise from inanition, or from the suppression of some accustomed discharge, their origin may be ascertained from either of those causes. If they proceed from the latter, the evacuation ought to be recalled; if from the former, hasty repletion must be avoided. Without this caution the digestive powers will be oppressed, and a load of impure humours will be generated; which, by farther weakening the body, contaminating the blood, and hazarding obstructions in the bowels, will not only increase the original, but may give rise to two other principal causes of the complaint.
If the weakness productive of nervous distress be owing to any sudden and great evacuation, recourse should immediately be had to strengthening remedies: but in all cases, except the above, preparation is necessary; and the stomach being either primarily or secondarily affected, the treatment might do well to begin with a gentle vomit of ipecacuanha or camomile flowers. The next indication is a laxative, to be repeated occasionally through the course of the complaint, when the patient is subject to costiveness; a state that generally accompanies nervous disorders, and always tends to increase them. In different cases different laxatives are proper. When bilious humours cause irritation, rhubarb may prove most suitable; but if acid humours, as often, predominate, a tea-spoonful or two of magnesia may be given, either alone, or mixed with a few grains of the former. All rough and violent purges are to be avoided, as they increase at once irritation and weakness.
After discharging from the stomach and bowels any acrid humours which may have occasioned irritation, prescription should be adapted to the particular cause, or causes, supposed to produce or promote the disease. Thus, if there should be reason to suspect worms, anthelmintic medicines must be given. But when obstructions in the abdominal viscera appear the cause of the disorder, recourse is to be had (after blooding, if the patient be plethoric) to deobstruent medicines; as the saponaceous, gum ammoniac, &c. with the use of warm fomentations. It is difficult, indeed, to ascertain such obstructions, unless, what seldom happens, the tumors be perceptible to the touch. But if the signs of weak digestion be attended with fixt pains in the belly, and a quick pulse, without much heat or thirst, the existence of this cause may be presumed.
Of all the occasional causes of nervous complaints, wind in the stomach or bowels is the most frequent, and that which universally excites the most troublesome symptoms. For dispelling it the usual recourse is carminatives: but, unless the wind be in the stomach, those seldom afford immediate relief; sometimes they even aggravate the complaint. A more certain remedy is a tea-spoonful of the spiritus aethereus, diluted with two table-spoonfuls of water. For the same end, nothing is more efficacious than opium, prescribed with assa foetida; which proves equally successful, whether the flatulence be in the stomach or intestines. In nervous disorders, however, opiates are never to be given without great reserve, as they impair the strength, and increase the depression of spirits, so common in those cases. A glass of cold water, by contracting the muscular coat of the stomach, will sometimes immediately operate the discharge of flatulence. But should this simple expedient prove ineffectual, it must not again be attempted.
In oppression from the above cause, external applications may also be successful. Much benefit has been received from rubbing, at bed-time, upon the stomach and belly, some of Bate's anodyne balsam, mixt with half its quantity of the expressed oil of mace, and a fourth part of the oil of mint. An antihysteric plaster may likewise be employed with advantage.
It is advisable for persons troubled with flatulence to rub the belly a little, in a circular direction, in the morning, before getting up. For this purpose the hand were preferable to the flesh-brush, did it not expose the joints of the fingers to swelling: a consequence to which nervous patients are peculiarly liable, and when it does take place, the pain is often instantaneously exasperated, on taking the smallest quantity of wine, or any strong liquor.
In flatulent complaints of the stomach and bowels, to rub the legs frequently with a flesh-brush has been found of good effect; which seems to be produced by exciting agreeable oscillations. This exercise, however, ought not to be continued above a few minutes at a time; otherwise it is apt to occasion languor, and increase irritability.
A symptom not uncommon with nervous persons is a coldness of the extremities, particularly the feet. To this they are chiefly exposed in the winter, when they sit by a bad fire, and fix their attention on any object. In such circumstances should they venture to bed, the consequence is almost certain that they will continue awake, until by some means or other the uneasy sensation be removed. The best expedient is to chafe the feet with warm bricks, or any application calculated to answer the same purpose.
For the nervous pain in the small of the back, sometimes so acute that the patient can hardly stand upright, it is advisable to fold round the body a napkin, which has either been warmed at the fire, or, what is better, likewise impregnated with the steams of myrrh, benzoin, and frankincense, burnt on a shovel. In many cases, this application gives almost instant relief.
The immediate cause of nervous disorders appearing to be either a deficiency, or irregular motion, of the animal spirits, the most efficacious might seem to be such medicines as exert the speediest influence on the nervous system. For whatever warms the stomach, and excites in it an agreeable sensation, affords a temporary relief. This remark may be thought to suggest the discrete use of cordials; which, doubtless, in some cases, may have their propriety. Several reasons concur, however, to prescribe with great moderation, where not entirely to prohibit the recourse to those remedies, whether of the vinous or of the spirituous kind. The former, by the fermentation they undergo in the stomach and bowels, are apt, as before observed, to create disturbance in nervous habits; and the latter, it is well known, have an injurious effect on the viscera. But when wine does not disagree with the patient, and when spirituous liquors are sufficiently diluted, it would be hard, in cases so entitled to sympathy, to prohibit any prudent gratification.
In this disease, the best cordials are those that have no immediate tendency to exhilarate, in the manner of intoxicating liquors; but such as rather allay than excite an irregular motion of the spirits, and enliven only by removing the obstacles to their placid and equable exertion. For medicines to accomplish this important purpose, have the various departments of nature been ransacked. Long and whimsical was the prescription of animal substances, and many the fruitless researches among the mineral tribes; until modern practice learned to place its dependence on the simples of the vegetable kingdom, and principally on those of the fetid class. Happy recourse, were its efficacy equally established, and itself directed by more determinate rules. With the common method of administering those remedies, however, small is the reason to be satisfied. Frequent is the practice to give them at stated times, without considering whether they be duly indicated. The consequence of such repetition is, that they gradually lose their sedative and antispasmodic power; an inconvenience against which we cannot be too guarded, in the treatment of so tedious a disease; where palliative remedies, though used only when requisite, by habit become necessary to the constitution. Cautiously are we, therefore, to reserve them for the more urgent symptoms; for languors, faintings, oppression from flatulence, &c.
Fetid medicines, taken at bed-time, by assuaging nervous agitations, favor a disposition to sleep. But they will be taken to no purpose, and may even increase perturbation, if the patient retire prematurely to bed, while the gastric, or abdominal region is distended with flatulence. On those occasions, it is of great advantage to promote the discharge of wind from the stomach, by gentle pressure with the hand; which method should also be practised sitting up in bed, if uneasiness, from the same cause, be felt in a recumbent posture.
In prosecuting the radical cure of nervous complaints, the most efficacious remedies are steel, the Peruvian bark, and the cold-bath. In some cases, the two first may with propriety be combined; in others, one of them only can be administered with advantage. When the pulse is slow, either may be given; if frequent, unless this symptom be occasioned by weakness, steel especially is unadvisable. It ought, however, to be remarked, that in those disorders, the pulse is subject to great irregularity; and therefore, that no positive indication should be drawn from it, without the concurrence of other circumstances. Both steel and bark are improper while the patient is plethoric, or afflicted with fixt pains in the belly. Chalybeate waters are indicated in the same circumstances with steel medicines, and may be found alike beneficial.
By nothing is the body more effectually strengthened than by the cold-bath, which should, therefore, never be neglected, when no particular circumstance forbids. To bathe three or four times aweek, is sufficient; and at the end of every three months the practice ought to be intermitted, for a week or ten days; a caution also to be adopted with regard to the strengthening medicines.
The method of using the cold-bath in summer and autumn, and the internal corroborants in the winter and spring, is liable to exception. For the former, by far the more efficacious, is by this means too long interrupted, and in the seasons when, if the bath be of fresh water, its influence is sensibly greater. A more advisable method is to use the bath, with the bark and chalybeates, in shorter alternations; bathing two or three weeks, and then taking the medicines half that time. Nay, there lies no objection against the use of the Peruvian bark every day the person does not bathe; observing to intermit the medicine occasionally for a few days. A light tincture of the bark, joined to bitters, may be used in this manner with success.
When acids do not disagree with the stomach, twenty or thirty drops of the elixir of vitriol may be taken once or twice aday, in a small dish of camomile or rosemary tea.
Beside those remedies, and a strict attention to diet, it is necessary that the patient use daily exercise; than which nothing is more conducive to promote digestion, facilitate sleep, and restore to the constitution the possible degree of strength. Both the kind and duration of exercise must be suited to the state of the patient. The most beneficial is riding on horseback. Whatever be the exercise, the person should carefully avoid fatigue, which not only retards the cure, but excites palpitations and spasms of different parts, with variety of uneasiness. In those circumstances, fetid medicines have peculiar power. Of use they may be also to allay the craving of the stomach, to which nervous persons are frequently subject. But this symptom finds, perhaps, no better remedy than a crust of bread, or any thing solid.
A dry air, temperately cool rather than warm, is most favorable to the cure of nervous disorders. If ever the Peruvian bark be preferable to cold-bathing, it is during a moist state of the atmosphere. At least in such seasons it might be alternated with the other. In moist weather, the flesh-brush is also of particular service; but it should always be administered by an attendant. For a nervous person is soon fatigued with the exercise: and as the most proper time for it is that of going to bed, the consequence of such fatigue might be continued watchfulness.
In the treatment of nervous disorders, no care is more important than that of preserving tranquillity. Vexation, grief, and despondence are peculiarly injurious; while on the other hand, chearfulness, and whatever promotes it, as agreeable company and amusement, essentially conduce to the cure; which may be also considerably forwarded by the practice of early rising.
When the disorder may have resisted all the above remedies, from the use of a milk-diet has relief sometimes been effected. But this final resource must either be continued during life, or quitted with great caution, and by slow degrees.
If these remarks should afford you any satisfaction, I shall be doubly gratified in having performed your commands.
I am, Dear Sir, Your most obliged And humble Servant, A. THOMSON.
No. 59, Margaret street, Cavendish-square,
August 16, 1781.