1..olation is recommended by many writers. when neurasthenia is accom panied by very marked symptoms of lowered nutrition and muscular weak ness, and when a prolonged rest in bed is insufficient to arrest the emaciation. The other factors of the treatment here are excessive feeding and rest in bed, the latter being necessary during the first six weeks of the complete treatment. The overfeeding consists especially in the progressive administration, each day, of 3, 4, 3, and 6 pints of milk in divided amounts. Occasionally, at the end of a few weeks, one or two eggs a day may be added to the milk diet.
Electricity is extolled by many writers. As to the particular current to be used, no general rule can be laid down. Rock well and other authorities assert that static electricity, together with other forms of electricity, is not only a tonic or a sedative, but an eliminator of poisonous materials. It not only influences nervous action through the vasomotor system, but excites vital function by acting on the cell and its protoplasm, hastening nutritive changes and cellular activity; excretion is thus stimulated and poisons are eliminated— precisely the desiderata in neurasthenia. G. Betton Massey contends that there is a tendency to abuse of and overrate rest in the treatment of this condition, espe cially in cases that had previously led a sedentary existence. The treatment should, he thinks, embrace measures for arousing the defective activities of the sympathetic system of nerves as a prin cipal feature, and he finds that strong galvanic currents to the abdomen and general galvanic stimulation are prefer able to the routine methods of using the faradic current now prevalent.
it is generally conceded that electric ity can be left olf in neurasthenia. As to the massage, it depends, of course, upon how it is done. It is almost sure to produce sound sleep if properly given in the evening to neurasthenics who have been wakeful. 13nt if neurasthenic pa tients who sleep well without massage are massaged in the evening they are sure to be wakeful after it, and yet they do not feel the loss of sleep next (lay; they have gained something after all. Douglas Graham (-Tour. Amer. Med. Assoc., Jan. 26, 1901).
Hydrotherapy has also been highly recommended. In cases attended with severe dyspeptic symptoms Winternitz obtains excellent results from the fol lowing procedure: The patient is placed on his back and covered with a sheet well wrung out of cold water (from the armpits to the knees). Before covering
this with a dry sheet, a coil of rubber tubing is applied to the epigastrium, through which a current of warm water at a temperature of 122° F. is passed. This procedure is employed for half an hour before each meal during a number of weeks.
The application of cold over the spine is credited with marked efficacy by Kin near, the bags being applied from the fourth to the last lumbar vertebra.
Insomnia sometimes requires active measures, but morphine, stimulants, and all agents capable of starting a "habit" should be strictly prohibited. The bro mides are also pernicious in these cases. since they tend to retard metabolism. Trional, sulphonal, a mylene-hydrate, etc., have been recommended for the purpose, but the hot pack is far prefer able.
Among the general remedies, strych nine still holds the first place. Begin ning with ' /Go grain, three times a day.
the dose should gradually be increased until the physiological effects of the remedy appear. The dose should then be slightly reduced, and the weaker dose continued persistently until recovery be comes assured. The concentrated extract of avena sativa, a teaspoonful after meals in a glassful of water, the dose being gradually increased, is often effective.
Treatment begins with removal of the cause. Then in neurasthenia there is a state of autofection, so that either be fore or after any surgical interference that may be required, these poisons should be neutralized and eliminated from the system. A salt of lithia known as thialion is excellent in these cases, a teaspoonful being given in hot water be fore meals. In the course of thirty-six to forty-eight hours its gentle laxative effect is realized. From this time on it should be given less frequently. C. A. L. Reed (Gaillard's Med. Jour., Jan., '99).
Codeine is a sort of specific, since its good effects cannot be due to its narcotic properties, considering the small dosage. In 1/0-grain doses, given thrice daily for four to five days, and later the same amount five to six times daily, it pro duces most satisfactory effects. The dose can be decreased as soon as the patient feels relieved and tbe improve ment persists under the (lose reached. Otto Dornbliith (Centralb. f. (1. ges. Therap., xviii, No. 10, 1901).