Nothing is so successful as a prolonged holiday amongst unfamiliar scenes, and the effects of a tour in a strange country should be sought when the patient's means afford him the facility of travelling. In the great majority of cases this is much more desirable than the usual recom mendation to loaf about some secluded seaside spot or health resort where sick folk will be his only companions. Often a sea-voyage with an agree able associate is most beneficial.
Games and sports, when the season permits, may be freely indulged in, but severe muscular exercises are to be avoided. Fishing to those who formerly enjoyed the sport and even to those who are strangers to it is often helpful; yachting is an ideal only within the reach of a few. Golf is upon the whole the most easily procurable open-air pastime, and for those beyond middle life it supplies everything desirable in the treatment of neurasthenia.
When the physician has possessed himself of the entire confidence of the patient by a thorough investigation of his ailment and by giving a sym pathetic ear to the recital of his abnormal sensations he should utilise to the fullest extent the clement of suggestion, pronouncing calmly and forcibly his assurance of a certain and complete recovery. Till this confidence has been gained and the assurance of a recovery insisted upon little progress will be made under any system of treatment.
Secondary or traumatic neurasthenia is so frequently complicated with the worrying experiences of law procedures that little improvement need be expected till the patient gets free from his legal anxieties. An intelli gent individual may be assured that his ailments are mainly due to the severe shock received by his nervous system in the brief moment between the perception of his formidable danger and the reception of bodily injury; and that as the latter plays but a minor role in the production of his illness, complete recovery may be confidently expected. This appears to be also the determining cause in most cases of shell-shock, and hence the obvious value of physical exercises.
Sexual neurasthenia occurs as a rule in younger subjects, and in addition to moral treatment active exercises, as cricket, football and mountain climbing may be permitted.
The worst form of neurasthenia is that allied to and frequently combined with hysteria which follows the long and tedious nursing of some relative; in such cases prolonged physical strain is often associated with anxiety or grief; the resulting breakdown is complete and profound, and can only he met by Weir Mitchell treatment.
It is difficult to lay down a rule for the duration of the treatment in all cases; it is a common mistake to make it too short. A period of six months at least is required if the patient is to hope for a complete recovery, and often a year may be necessary. Amongst those whose spare means prohibit a long holiday the wisest procedure is to insist upon a total change of occupation. This may be recommended as a temporary expedient, and if the patient takes to his new avocation he may he en couraged to permanently adopt it with advantage.
Drugs should play a secondary role in the treatment of neurasthenia; they cannot, however, be discarded in any case. Though quackery is to be contemned, the moral effect of a course of medicinal treatment is always of value, and the physician as a matter of fact will never meet with a case in which he cannot conscientiously find indications for the admin istration of remedial substances. The beneficial results of suggestion have been already referred to; these may often he obtained without any sacrifice to principle through skilfully prescribed drugs; many patients become depressed and anxious when informed that medicines will do them no good.
Phosphorus as a routine drug gives the best results, but ordinary phosphates possess no power or influence over the nutrition of the fagged brain and nervous system. Free phosphorus is always of use when given in minute doses gr.); organic phosphates, as in Phytin and the Syrup of the Glycero-phosphates, or the Sanatogen compound of sodium glvcero phosphate with casein may be administered. The preparations of phosphates and hypo-phosphites containing strychnine should be avoided. As in hysteria, strychnine often aggravates the patient's misery, making him feel more acutely his abnormal sensations and increasing his insomnia and nervous excitability; phosphorus will produce the same effects if given in full doses. During convalescence, the syrup of triple phosphates with strychnine may be advantageously prescribed, as Iron is always beneficial.