This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol1", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
2. Sometimes the affection, originating as above, may coexist with other diseases originating in different causes. Inflammation of one of the important organs may complicate thehysterical phenomena, and demand a close scrutiny. The danger is that, in the turbulence of the nervous phenomena, the more serious disease may be overlooked. It will be the duty of the practitioner to investigate the case carefully, and, having made the diagnosis, to employ the nervous stimulants altogether in subservience to the measures required by the more dangerous affection. To go on stimulating with assafetida, ether, camphor, etc., in such a case, under the impression that it is merely nervous, might prove very-detrimental, perhaps fatal. Yet, with due attention to the coexisting disease, the nervous stimulants may often be used safely in conjunction with other remedies, and even beneficially to the more serious complaint, by preventing the injurious reaction of the nervous disorder upon it.
3. More frequent than either of the preceding categories, is that in which the nervous disorder merely complicates some other pathological condition, which has called it into existence and sustains it. In such cases, much injury has been done by overlooking the real disease, and addressing remedies to the more obvious and apparently violent nervous phenomena. It has been too common to treat them by the nervous stimulants chiefly or exclusively, and to persevere long with such treatment to the unspeakable injury of the patient. The practitioner should be always on his guard against this easy mistake, and never rest satisfied, in the treatment of nervous diseases which may be at all obstinate, until he has traced them satisfactorily to their cause. Judicious measures now employed will often put an end to an affection, which may have been torturing the patient, and embarrassing the practitioner, for months, perhaps for years. We have not space here to specify the several morbid conditions which may thus give rise to nervous disorder. The consideration of them belongs to treatises on the practice of medicine. My object here, in noticing them, has been to complete a view of the circumstances which should regulate the use of the nervous stimulants. I would merely call attention to the stomach and bowels, the liver, the urinary organs, and in women the uterus, as the frequent seats of disease exhibiting itself in various nervous disorders; and to an anemic state of the blood, as one of the most prominent and efficient causes of the same affections. This impoverished state of the blood may act doubly. It directly weakens the nervous centres through the want of material for their support; while the insufficiently supplied functions of the system generally, by their unceasing calls upon the nervous centres of circulation and respiration to supply them with more and better blood, maintain in these centres a high degree of irritation, leading to diversified nervous disorder. Now the indications, in all such cases, is to address remedies especially to the original disease, and to employ the nervous stimulants simply as adjuvants, in order to suppress any occasional excess of nervous derangement, and to prevent its injurious reaction upon the organs or the system.
In the use of this class of remedies, the practitioner should also beat-in mind the general rule in relation to all stimulants; that the system becomes habituated to them by constant use, and thus, after a time, almost ceases to feel their influence, unless exhibited in constantly increasing quantity. They should, therefore, seldom be employed continuously for any great length of time. Hence, in persistent, and especially incurable organic diseases, the nervous stimulants are of doubtful utility, and should be used rather to correct occasional disorder, than to sustain a permanent impression.
This class of medicines is contraindicated in inflammatory and febrile diseases, when the state of the system is sthenic, and the blood rich and abundant. Simple fever, or even inflammation, does not always forbid their use; on the contrary, when the blood is impaired in those cases, and a tendency to a low condition is observable, or even in the mere absence of the opposite condition, they may often be used advantageously in relieving attendant nervous disorder. They are especially contraindicated, when high congestive irritation, positive inflammation, or organic disease, such as hemorrhage, tumours, etc., occupies the nervous centres them selves.
To the severest nervous diseases, or those which are deeply radicated in the cerebral or spinal centres, the nervous stimulants, as such, are inapplicable. Apoplexy, epilepsy, insanity, palsy, tetanus, profound coma, and even convulsions, other than those of a comparatively light character, are beyond their control. They may occasionally be used as adjuvants in such affections, when not contraindicated; but should not be relied on.
Before closing these general observations, it will be proper to give a brief view of the different nervous affections, or rather forms of nervous disease, in which this class of medicines is employed.
Preliminarily, I would call the attention of the reader to the admitted fact, that depression and over excitement or irritation of the nervous centres are attended, to a considerable extent, with the same phenomena. How this may happen I have endeavoured to explain in my treatise on the Practice of Medicine. The circumstance is practically of little importance as concerns the use of the present class of medicines; for they are applicable, as already explained, to both these opposite conditions, except, in reference to irritation, when it is attended with active congestion or inflammation in the centre itself, or its immediate vicinity; but the view which the practitioner may take of the pathological condition, whether one of exaltation or depression, will very much influence the coincident treatment.