The treatment of neurasthenia or nervous exhaustion is much the same whether the condition is due to an accident, overstrain, or to a faulty inheritance. A great deal of sleep and much food are essential. The indication for treatment is to overcome the sleeplessness and to stimulate the desire for food. Cases vary widely in severity. The treatment of the most severe cases by the Weir Mitchell method is troublesome, tedious, and expensive. The difficult point to determine in certain cases is whether the Weir Mitchell method is necessary, or whether simpler means will suffice.

Diet For Neurasthenics. In Mild Cases

A great deal of improvement can be gained by keeping the patients in bed until midday for a month, with the window wide open and with the addition of four tumblers of milk, and four full slices of thickly buttered bread per diem to an ordinary mixed diet. The extra milk may be taken either with the ordinary meals or preferably in the intervals. In these cases an important adjunct to this dietetic treatment is the use of hot and cold water bathing. Bathing the face, neck, and extremities twice or thrice daily with hot water at a temperature of 105° F. is very beneficial, and when done at night helps to promote sleep. As the case improves, the temperature of the morning douche may be reduced until a sitz bath with the water at 60 F. can be taken, a hot sitz bath being still taken at night.

In severe cases the Weir Mitchell method should be adopted. This system, in addition to the special feeding, requires absolute rest for some six weeks; seclusion from friends, callers and family; massage and electricity, to promote digestion and the nutrition of the muscles. A good nurse is essential; she must be bright, sensible, kindly, and the patient must take to her. The following outline of treatment is adapted to a severe case.

First Week

The patient is to be confined to bed, and the nurse is to feed the patient.

Massage

Two applications a day. Beginning with a quarter of an hour each time, and working up to half an hour or more by the end of the week. After the massage, to rest alone in a darkened room for an hour.

Food

Three ounces of fresh milk every three hours, increasing the amount daily until the patient by the end of the week is taking 10 ounces every three hours; that is, an increase from 18 ounces to 60 ounces per day. On the sixth and seventh days a little porridge, gruel, custard, or egg may be added.

Gain In Weight

During the first week or so the gain may be 5 to 6 lbs. Unless the patient is gaining at least 2 lbs. weekly, it may be assumed that matters are not progressing satisfactorily.

Second Week

The patient should now be able to feed herself.

Massage

This may now be increased to two applications a day, each application lasting from three-quarters to one hour.

Food

Solid food may be cautiously begun - fish, egg, chop, mince. The milk taken ought now to be up to 60 to 80 ounces per day. If dyspeptic troubles arise from over-feeding, all solid food must be stopped for twenty-four hours and resumed. The probability is that the massage is ineffectual, and the operator should be changed.

Gain In Weight

Probably 3 or 4 lbs.

Third And Fourth Weeks

Massage

The same in amount as at the end of the second week. Electricity in the form of Faradism to the principal muscles may be employed as an adjunct in treatment; the applications lasting from twenty minutes to half an hour daily.

Food

By this time the patient may be on a full diet (see below), and in addition taking at least 60 to 80 ounces of milk per diem.

Daily Diet Sheet

7 A. m. - 10 ounces of milk.

Breakfast: 8.30 a.m. - Plate of porridge, or gruel, or Hominy; or bowl of bread and milk with a gill of cream; fish, bacon, eggs, or kidney; cocoa or coffee; bread or rolls; butter or marmalade.

9 a.m. - 10 ounces of milk.

11 a.m. - Cup of beef-tea with 2 teaspoonfuls of beef peptonoids.

Luncheon: I.30 P.M. - Fish, tripe, sweetbread, cutlets, game, or poultry, served with one vegetable, with a sweet such as stewed fruit; 10 ounces of milk to be sipped slowly during this meal.

4 P.M. - 10 ounces of milk with sponge cake; bread and butter, or rusk.

6.30 P.M.: A three-course meal. - Soup or fish; joint or poultry; sweet or savoury, or dessert; taking with meal 10 ounces of milk.

8.30 p.m. - Beef-tea and 2 teaspoonfuls of peptonoids.

10 p.m. - 10 ounces of milk.

Fifth And Sixth Weeks

In the fifth week the patient begins to sit up in bed, and the afternoon massage is gradually reduced, then stopped; then a gradual reduction of the morning massage and electricity takes place. The excess of food is gradually reduced; firstly, the amount of milk is lessened, and the patient by the end of the sixth week should be eating an ordinary amount of food daily. During the last week the patient can get up daily for a short time. Patients are better not to return at once to their ordinary course of living. It is advisable that they should if possible travel quietly with a suitable companion for a month or more before returning home. In the case of hospital patients, a few weeks' stay at a convalescent home is advantageous.

A rarer form of neurasthenia is occasionally met with, in which the patient is stout and flabby. In these cases a course of mild starvation is a necessary preliminary to the Weir Mitchell treatment. The system of treatment recommended by Playfair is specially applicable to these patients, as follows; -

"Confine patient strictly to bed: diet with skimmed milk, at first 2 quarts per diem given in small quantities every two hours, after a day or two lessen this gradually till not more than a pint per diem is taken. If the patient's strength fail unduly under this, some beef-tea or soup may be temporarily substituted for the milk. Under the minimum diet the weight gradually loses about 1/2 lb. per diem (the patient should be weighed every second day), and when some 14 to 20 lbs. have been taken off, pure milk may be substituted for skimmed, and the treatment as detailed above pursued".