In reference to all those varieties of neurasthenia - and it must be remembered that either sex may suffer - rest, change of environment, abundant feeding, and such drugs and food as will improve the condition of the blood, comprise the methods of treatment. Yet it is only by working out the details of such treatment with judgment and care, and adapting them to the individual case, that success will be obtained. In many cases it will be sufficient to send the patients away to a bracing place with some suitable companion who will see that the directions as to fresh air, exercise and abundant food, are carried out. Those are the milder cases in which no prolonged building up may be necessary - men and women who still retain their recuperative capacity, who have not developed the achings, the tiredness, the actual inability to walk and the restlessness and sleeplessness which characterize the worst cases; they are simple cases to deal with, although even in such it is often a good plan to put the patient to bed for a week, to feed her up, and if she fails to assimilate her food to let her walk for an hour each day or have massage for two hours.
In severe cases of neurasthenia, however, such a simple plan is inadmissible. The various aches of the patient, her weak and anaemic condition, her inability to walk even, without experiencing disagreeable and trying palpitation, all make such an active treatment impossible. For such patients what has to be done is to adopt some means of getting them into good condition. This can only be done by rest and by abundant feeding. Yet rest with abundant feeding and without exercise in such cases will soon bring discomfort and dyspepsia, and so make the condition worse. So that a substitute has to be found for the exercise which the patient is too weak to take but which is necessary if the food is to be assimilated. This substitute for active exercise is found in passive exercise - massage of the muscles - rubbing and kneading and pinching them, forcing blood through them and leading to such changes in their metabolism, and in that of the organs generally, as would be effected by vigorous active exercise. Another adjuvant in this matter is electricity. The use of a strong but not painful faradic current in such cases is helpful. It causes muscular action without fatigue, and although it is certainly not so useful as massage, it is by no means to be despised for its active physical effects.
It will now be desirable to go into some detail with reference to the care and treatment of one of these severe cases. The patient must, of course, be separated from her friends and her habitual environment, and she must have as a nurse a capable, kind, and sympathetic but unemotional person. All letters must be forbidden, even the daily paper stopped, and the treatment should be carried out in a large, well-lighted, airy room. Absolute rest in bed is essential. The patient is not, at first at least, allowed out of bed for any purpose, and for the first three days nothing is to be given except milk and rusks. The milk should be given in quantities of 4 oz. every two hours at first, but the total quantity in twenty-four hours should be increased in three days to 2 quarts. It is undesirable to wake the patient in the night, but her milk should be placed by her bed and she must drink it if she wakes. After three days of this simple diet of milk and rusks a small morning meal is given - a little fish and bread and butter, and bread and butter with milk in the evening. Then two days later, i.e. on the fifth day of treatment, a cutlet may be given in the middle of the day, and in two or three days more three light meals should be taken in addition to the 2 quarts of milk. The character of the meals can be left to the patient and nurse, but fat bacon and an egg in the morning, a chop or cutlet and stewed fruit and cream in the middle of the day, and fish with butter-sauce in the evening, will indicate the kind of meals desirable.
All this time, of course, the massage and electrical treatment go on, the first day twenty minutes' massage morning and afternoon or evening should be given, next day half an hour twice daily, and on the fifth day an hour twice daily. The faradic current should be used twice daily for a quarter of an hour at a time. At the end of ten days raw meat-juice should be given, 1 oz. daily. If it is very unpalatable to the patient, it can often be easily given in milk, or the meat may be quickly cooked on the outside and the juice squeezed out. Such juice from partly-cooked meat is much less unpalatable than the real raw meat-juice.
There is, of course, often trouble with the bowels. A dose of calomel is usually desirable about the third day, but after that it is usually easy to regulate the bowels with the fruit and butter and cream, or if that is insufficient, a small nightly dose of cascara and mix vomica will usually suffice.
Difficulties are, of course, encountered in most cases, but with the rationale of the treatment - the combination of rest with the assimilation of much nourishing food - before one's eyes, these difficulties will usually vanish. The patient's objections to going on have sometimes to be overcome, but as a rule they are not serious - the chief difficulty being usually, in the first place, to obtain consent to the treatment. When a patient has once definitely made up her mind to go through with it, the occasional objections that she afterwards raises are, as a rule, easily overcome.
Such are the methods to be followed in cases subjected to this treatment, and in many of them the results are most satisfactory and striking. Yet there are others in which disappointment is met with. These are cases usually in which the habit of absence of effort and initiative is deeply ingrained, and although temporary success is sometimes met with in those, a relapse into the old condition is apt to occur.
With reference to the cases of anorexia nervosa to which reference has been made, these must be treated on exactly the same lines as those just described. The desideratum in these cases, as in the others, is to fatten the patient and to improve the condition of the blood. The fattening process is usually rapid, and I have known a case of this character weighing 4 1/2 stone on admission to the Home go out in eight weeks' time weighing just twice as much.
This treatment by rest, isolation, massage and abundant feeding is also of the greatest use in most cases of traumatic neurasthenia whether with predominating cerebral or spinal symptoms. In the severer cases, as a rule, such treatment is inefficacious, although occasionally modified success is met with. And it may be stated, as a general rule, that in all cases of depraved and lowered nerve function treatment of this character, the object of which is by improving nutrition to restore a normal condition of the nervous system, is to be strongly urged. It may not be invariably successful, but it will succeed in the majority of cases of neurasthenia in effecting a complete cure, and in the others it nearly always leads to very definite improvement.