Neurasthenia
Title
Neurasthenia
Creator
Baruch, Simon, 1840-1921
Identifier
WWP15847
Date
1919 September 23
Source
Cary T. Grayson Papers, Woodrow Wilson Presidential Library, Staunton, Virginia
Language
English
Text
NEURASTENIA.
I have divided these cases into the excitable, depressed, and intermediate types. In the first type very cold water and very strong pressure must be avoided. A tub bath at 100 for 15 or 20 minutes at bed-time, the patient being wrapped in a previously heated sheet and dried in bed, is useful in allaying irritability and furthering sleep. In the morning such patient may be treated by sitting or standing in a tub containing 18 inches of water at 102 - 104 F. Having a vessel containing water at 90 at hand, a sponge is dipped into it. Pressure of the wet sponge upon each shoulder, the nucha and the chest successively produces a mild stimulation of the cutaneous nerves which arouses the patient sufficientily if followed by gentle friction, to enjoy the morning walk before breakfast. The temperature should be daily reduced, or twice daily, but not below 80 F. When this is reached the quantity of water used for these ablutions should be doubled.
Second: In the intermediate type of neurasthenia the object of Hydrotherapy is to improve the general physical condition. For this purpose neurovascular training is of great value. The above procedure, using dashes of water with a basin over back, shoulders and chest, is used instead of the sponge, and 70 F is the limit. It is important that a gradual introduction into the water treatment be practiced. When the prescription is Tonic, the Douche treatment described in Chapter , page , may follow or be begun at once. It is here of great value.
In the Depressed type, stimulation is added to the tonic effect by using the jet douche in connection with the fan douche at the same or lower temperature, prior to concluding the procedure. The pressure of the douche may be increased one pound every day until 30 pounds are reached, since mechanical excitation is thereby added to the thermic. The temperature, duration and pressure must be regulated in accordance with the object in view, whether tonic, stimulating or soothing. This applies especially to the Intermediate type of Neuresthenia. Treatment may be used twice daily.
The author would protest against the unfortunately too common use of the Scotch Douche ( a jet douche alternately at 70° and 110° ), which is too indiscriminately applied to the trunk in hospitals and sanitaria in all types of neurasthenia cases. Except in very vigorous but apathetic or torpid individuals this procedure is irrational.
The failure of Hydrotherapy in Neurasthenia is chiefly attributable to lack of precision in the directions of the physician. In a published clinical lecture delivered by an eminent neurologist, the following statement occurs: “Cold water in the morning is the most useful treatment for Neurasthenia. Let your patient stand in warm water and squeeze a sponge dipped in cold water over the back of his neck.” The temperature, duration, frequency of application and management of the patient after the treatment are disregarded, but when he discourses upon the use of drugs in the same lecture he states distinctly, for instance with regard to strychnine, that he always gives it before meals, states the definite dose, frequency of repetition and other directions, which if applied to the water treatment would offer far more valuable results to his hearers than they could possibly obtain from the indefinite directions with which he opens his lecture.
The author does not wish to be understood that the procedures mentioned in this chapter are the only methods to be recommended. They simply represent an outline of his method, from which he deviates readily and often with satisfactory results when indicated. In dealing with Neurasthenia or with other diseases, the chief demand made upon the medical attendant is familiarity with the technic and rationale of the most useful procedures. If he takes into careful consideration the therapeutic indications of each case, whether he aims for stimulation or calming effects, for alternative, reducing, or perturbing results, he may adapt the procedure to every case. He must individualize more cautiously in Neurasthenia than in any other disease, because these patients are easily discouraged. I have not infrequently observed otherwise intelligent patients refuse to continue after the first treatment, although this is always mild. I have less difficulty in persuading my own patients to continue, than the patients of colleagues, who are sometimes influenced by their graphic description of the shock (?) endured (from water at 95°), or from the tremendous (?) force of the stream (ten pounds pressure), or from the terrible (?) chills experienced, or the cold contracted after this heroic (?) treatment -- a treatment which hundreds of the feeblest nervous women have endured without complaint.
Such cases are favorable subjects for Hydrotherapy, if they can be induced to persevere, and I desire to warn my colleagues against accepting their statements. The value also of the mental discipline arising from overcoming their objections and groundless fears will be evident to the practiced therapeutist.
That injustice will not be done the patient by disregarding his objections is evident from my observations. Among many thousand treatments, of which I have reports and knowledge, the complaints do not number fifty. Among these about a dozen have contracted colds on the day of treatment -- an infinitesimal number even if their accounts be always correct, which is doubtful. Reaction is usually so well provided for that the injunction to go into the open air after hydriatic treatment may be obeyed without hesitation or apprehension of colds.
INSOMNIA being a frequent manifestation in a large majority of Neurasthenics the Wet Pack for an hour or longer at 70F is a most valuable procedure at bedtime. Early resort to this measure may forestall dependence on medicinal hypnotics, which are the bane of these cases. Needless to urge a precise technic, without which failure must result.
I have divided these cases into the excitable, depressed, and intermediate types. In the first type very cold water and very strong pressure must be avoided. A tub bath at 100 for 15 or 20 minutes at bed-time, the patient being wrapped in a previously heated sheet and dried in bed, is useful in allaying irritability and furthering sleep. In the morning such patient may be treated by sitting or standing in a tub containing 18 inches of water at 102 - 104 F. Having a vessel containing water at 90 at hand, a sponge is dipped into it. Pressure of the wet sponge upon each shoulder, the nucha and the chest successively produces a mild stimulation of the cutaneous nerves which arouses the patient sufficientily if followed by gentle friction, to enjoy the morning walk before breakfast. The temperature should be daily reduced, or twice daily, but not below 80 F. When this is reached the quantity of water used for these ablutions should be doubled.
Second: In the intermediate type of neurasthenia the object of Hydrotherapy is to improve the general physical condition. For this purpose neurovascular training is of great value. The above procedure, using dashes of water with a basin over back, shoulders and chest, is used instead of the sponge, and 70 F is the limit. It is important that a gradual introduction into the water treatment be practiced. When the prescription is Tonic, the Douche treatment described in Chapter , page , may follow or be begun at once. It is here of great value.
In the Depressed type, stimulation is added to the tonic effect by using the jet douche in connection with the fan douche at the same or lower temperature, prior to concluding the procedure. The pressure of the douche may be increased one pound every day until 30 pounds are reached, since mechanical excitation is thereby added to the thermic. The temperature, duration and pressure must be regulated in accordance with the object in view, whether tonic, stimulating or soothing. This applies especially to the Intermediate type of Neuresthenia. Treatment may be used twice daily.
The author would protest against the unfortunately too common use of the Scotch Douche ( a jet douche alternately at 70° and 110° ), which is too indiscriminately applied to the trunk in hospitals and sanitaria in all types of neurasthenia cases. Except in very vigorous but apathetic or torpid individuals this procedure is irrational.
The failure of Hydrotherapy in Neurasthenia is chiefly attributable to lack of precision in the directions of the physician. In a published clinical lecture delivered by an eminent neurologist, the following statement occurs: “Cold water in the morning is the most useful treatment for Neurasthenia. Let your patient stand in warm water and squeeze a sponge dipped in cold water over the back of his neck.” The temperature, duration, frequency of application and management of the patient after the treatment are disregarded, but when he discourses upon the use of drugs in the same lecture he states distinctly, for instance with regard to strychnine, that he always gives it before meals, states the definite dose, frequency of repetition and other directions, which if applied to the water treatment would offer far more valuable results to his hearers than they could possibly obtain from the indefinite directions with which he opens his lecture.
The author does not wish to be understood that the procedures mentioned in this chapter are the only methods to be recommended. They simply represent an outline of his method, from which he deviates readily and often with satisfactory results when indicated. In dealing with Neurasthenia or with other diseases, the chief demand made upon the medical attendant is familiarity with the technic and rationale of the most useful procedures. If he takes into careful consideration the therapeutic indications of each case, whether he aims for stimulation or calming effects, for alternative, reducing, or perturbing results, he may adapt the procedure to every case. He must individualize more cautiously in Neurasthenia than in any other disease, because these patients are easily discouraged. I have not infrequently observed otherwise intelligent patients refuse to continue after the first treatment, although this is always mild. I have less difficulty in persuading my own patients to continue, than the patients of colleagues, who are sometimes influenced by their graphic description of the shock (?) endured (from water at 95°), or from the tremendous (?) force of the stream (ten pounds pressure), or from the terrible (?) chills experienced, or the cold contracted after this heroic (?) treatment -- a treatment which hundreds of the feeblest nervous women have endured without complaint.
Such cases are favorable subjects for Hydrotherapy, if they can be induced to persevere, and I desire to warn my colleagues against accepting their statements. The value also of the mental discipline arising from overcoming their objections and groundless fears will be evident to the practiced therapeutist.
That injustice will not be done the patient by disregarding his objections is evident from my observations. Among many thousand treatments, of which I have reports and knowledge, the complaints do not number fifty. Among these about a dozen have contracted colds on the day of treatment -- an infinitesimal number even if their accounts be always correct, which is doubtful. Reaction is usually so well provided for that the injunction to go into the open air after hydriatic treatment may be obeyed without hesitation or apprehension of colds.
INSOMNIA being a frequent manifestation in a large majority of Neurasthenics the Wet Pack for an hour or longer at 70F is a most valuable procedure at bedtime. Early resort to this measure may forestall dependence on medicinal hypnotics, which are the bane of these cases. Needless to urge a precise technic, without which failure must result.
Files
Collection
Citation
Baruch, Simon, 1840-1921, “Neurasthenia,” 1919 September 23, WWP15847, Cary T. Grayson Papers, Woodrow Wilson Presidential Library & Museum, Staunton, Virginia.