Affections of the Brain and Nervous System

the hygienic system orthopathy chapter 16

AFFECTIONS OF THE CEREBRAL MEMBRANES

CHRONIC CEREBRAL LEPTOMENINGITIS
Definition: Chronic inflammation of the pia mater.

Symptoms: These are persistent, dull headache, mental deterioration, vertigo, muscular weakness, low grade optic neuritis, occasionally nausea, vomiting, and ringing in the ears.

Etiology: Injury, alcoholism, sunstroke and "syphilis" are given as causes. It sometimes accompanies brain abscess and brain tumor and follows acute leptomeningitis.

Prognosis: Early care may result in recovery, although the outlook is always uncertain.

Care of the Patient: These cases need rest and fasting more than anything else. All stimulation and excitement should be avoided. A diet of fruits and vegetables should follow the fast for a prolonged period.

Symptoms To Expect
CHRONIC CEREBRAL PACHYMENINGITIS
Definition: Inflammation of the dura mater.
Symptoms: Same as for chronic cerebral leptomeningitis.
Etiology: Seen in severe anemia, chronic affections of the blood vessels, sunstroke, alcoholism, Injury to the bead and insanity.
Prognosis: This is unfavorable.
Care of the Patient: Same as for chronic cerebral leptomeningitis.

HEMORRHAGIC PACHYMENINGITIS
Definition: A blood-tumor of the dura mater.

Symptoms: In some cases no symptoms are present during life. If the pathology is marked, headache, failure of memory, impairment of intellect, stupor, contracted pupils, local convulsions, or palsies are seen. These symptoms may alternately improve and grow worse over a long period. In severe cases with extensive effusion of blood, the symptoms resemble those of apoplexy.

Prognosis: This is very unfavorable.

Care of the Patient: Same as for leptomeningitis.

TUBERCULOUS MENINGITIS
Definition: This is inflammation of the membranous coverings of the brain of a tubercular nature.

Symptoms: These are the same as those for chronic leptomeningitis plus tubercular symptoms.

Etiology: It is secondary to tuberculosis elsewhere.

Prognosis: Unfavorable.

Care of the Patient: Same as for tuberculosis.

AFFECTIONS OF THE CEREBRUM

APHASIA
Definition: This is inability to express or to comprehend ideas in speech or equivalents of speech. Two varieties - motor and sensory - each of which are subdivided into cortical and subcortical, are recognized. Sensory aphasia is again divided into visual and auditory forms.

Symptoms: Motor aphasia is inability to express thought in words. When the brain lesion is in the third frontal convolution (cortical motor aphasia) the power of silent talking and reading are lost as well as power of articulate speech. In the most common forms of aphasia, the lesion is in the adjacent tracts which carry the speech impulses to the articulatory muscles (subcortical motor aphasia) and only the power of speech is lost.
Sensory aphasia is inability to understand written or printed words (word-blindness, or visual aphasia), or to understand spoken words (word-deafness or 'auditory aphasia). The lesion is in that portion of the brain known as the angular gyrus, where visual word memories are stored, or in the first temporal convolution, where auditory word memories are stored, or in one of the incoming (subcortical) tracts of special sense.
In cortical visual aphasia the patient is unable to read aloud or to himself, nor can he write (agraphia) spontaneously or from dictation. In subcortical visual aphasia he can write spontaneously and from dictation, but is unable to read what he or others write.
In cortical auditory deafness he cannot understand spoken words or write from dictation, and, being unable to understand his own speech, he misplaces words (paraphasia) or talks jargon. Though word-deaf, the patient can speak spontaneously, read aloud and write in subcortical auditory aphasia.

Etiology: may be a transient condition due to sudden fright, brain congestion, migraine, hysteria, epileptic convulsions, and may appear in convalescence from fevers; or, it may be due to organic changes in the brain such as tumor, gumma, abscess, pressure by a depressed fracture, softening of the brain, embolism, thrombus, apoplexy, etc.

Prognosis: In softening of the brain the case is hopeless; after apoplexy, recovery frequently follows; recovery may follow removal of depressed fracture; it follows aphasia due to fright, hysteria, migraine and epileptic convulsions. The outlook is more hopeful in young, individuals.

Care of the Patient: Attention should be given to the causes of the primary pathology. Care for as directed under epilepsy, migraine, apoplexy, etc.

ACUTE ENCEPHALITIS
Definition: This is inflammation of the brain substance - usually of the gray matter.

Symptoms: The symptoms are not well defined and the condition is sometimes mistaken for typhoid fever. The common symptoms are headache, inability to sleep, coma, delirium and vomiting. Paralysis may follow recovery. It is often followed by brain abscess.

Etiology: See Suppurative Encephalitis. .

Care of the Patient: See Suppurative Encephalitis.

APOPLEXY - Cerebral
Definition: This is hemorrhage into the brain followed by the formation of a blood-clot. It is popularly known as a "stroke."

Symptoms: Such prodromal symptoms as headache, vertigo, disturbed sleep, ringing in the ears, and, perhaps, a sense of numbness or weakness on the affected side, often precede the hemorrhage. In many cases, however, the patient falls suddenly without previous warning.
The face is flushed, the eyes injected, the, lips blue, breathing stertorous, the pulse full and slow, the temperature, at first subnormal from shock, later rises from irritation and the urine and, feces may be passed involuntarily. Convulsions are frequent and paralysis of some parts of the body accompanies. Even while the patient is comatose, the paralysis may be detected.
The head and eyes may be strongly rotated toward the side on which the hemorrhage occurs (conjugate deviation); one cheek often flaps more than the other, the pupils may be unequal, movements are made only on the unaffected side, when the affected arm is raised and allowed to fall, it drops lifeless; and occasionally the temperature is higher in the axilla of the paralyzed side.
In grave cases the subject does not awake from coma, the pulse grows feeble, respiration assumes the Cheyne-Stokes type, the reflexes cease, mucus collects in the throat producing a rattling sound, the temperature rises to 103° or 104°F. and death follows in a few hours to one or two days.
In some cases either consciousness is not lost or else its loss is very transient; in others paralysis develops immediately but unconsciousness does not become complete for twenty-four hours.
If death does not result, consciousness is usually regained in from twelve to forty-eight hours, and hemiplegia (paralysis of one side) remains on the opposite side of the body. Usually the muscles of the face and upper chest escape the paralysis. The tongue tends to deviate toward the paralyzed side when protruded. There is no tendency to rapid wasting of the affected muscles, and sensation is usually unimpaired. In walking the patient supports the paralyzed arm and swings the leg forward in a rotary movement from the trunk.
In very light cases not all of the above symptoms develop.

Etiology: Degenerative changes in the blood vessels and plethora, due to overeating, or high blood pressure from any cause, result in rupture of a vessel in the brain. Affection of the blood vessels is the immediate cause of apoplexy. Toxemia covers the ground of cause quite thoroughly. Any sudden increase in blood pressure from anger, excitement, a cold bath, stimulation, effort; or any great enervating influence such as alcohol, loss of sleep, fatigue, etc., may precipitate a hemorrhage.

Prognosis: A "stroke" is not always fatal. Many people have two or more "strokes" before they result fatally. Even in the very aged, if the hemorrhage is small, the outlook for improvement is often good. Many cases recover their powers of locomotion and speech and other faculties that have been impaired, and even outlive the average expectancy. If the clot is, small, the paralysis may completely disappear. More frequently recovery is only partial. Six months to two years are required for all the improvement possible.
Prevention: People who know they are in line for apoplexy should adopt a very moderate regimen of living and lead a very quiet life. The diet should be largely of fruits and vegetables; excitement, great effort and all stimulation, should be avoided.

Care of the Patient: Even in the mildest cases the patient should not get out of bed for two or three weeks and no food but water should be given during most or all of this period. Weger says:
"If a fast is instituted at once and a hands-off policy tactfully pursued, the chances of stopping the hemorrhage and causing absorption of the blood-clot are greatly enhanced. In fact the life of the patient may depend on early treatment of the right kind."
After the fast, the food should be principally fruits and green vegetables. The patient should be fed very little and he must be content to live with a reduced arterial pressure and reduced weight.
What Tilden says about treatment will be of advantage to prevent recurrence. He says: "The treatment should begin months and years before the disease manifests. Those who are heavy eaters, continually carrying a large quantity of blood in the brain, evidenced by flushed face and enlarged veins over the forehead, and other signs of too much blood, such as ringing in the ears, head swimming, etc., should take a hint and reform their manner of living. The time to cure this disease is several years before it manifests. No one can be fooled into knowing he is headed in that direction; for all he needs to do is to look at himself in the glass, and he will find he is altogether too stout and too plethoric-looking, and the face is usually quite flushed. He should know what his habits are. A man who uses stimulants to excess must know, or should know, that he is bringing upon himself degeneration of the blood-vessels and that the time must come when apoplexy will result. It does not necessarily need to be found in the brain. Apoplexy may take place in the kidneys or any other vital organ."

CEREBRAL ANEMIA
Definition: A lack of blood in the brain. It may be acute or chronic.

Symptoms: Acute. Pallor of the face, vertigo, confusion of ideas, ringing in the ears, dimness of vision, dilatation of the pupils, nausea, a tendency to yawn, sometimes fainting, and, occasionally, in extreme cases, convulsions and coma are seen.

Chronic. Vertigo, headache, irritableness, disturbed sleep, failure of memory, lack of ability to concentrate, intolerance to light, a tendency to faint, and extreme lassitude characterize chronic anemia of the brain. These symptoms improve when the patient lies down.

Etiology: Acute cerebral hemorrhage is seen in fainting or syncope following shock, great loss of blood, after sudden withdrawal of fluid from the abdominal cavity, and, in surgical cases, after ligation of the carotid artery. Chronic anemia of the brain is seen in heart affections, especially in aortic stenosis, hardening of the arteries that prevents the blood from reaching the brain, and in general anemia.

Prognosis: This depends on the cause. Most cases of acute anemia are quickly recovered from. Recovery from the chronic form depends on recovery from the heart and arterial pathology and from general anemia.

Care of the Patient: In acute cerebral anemia rest and fresh air are the great needs. Stimulants should not be employed. Care for the chronic case according to whether he has hardening of the arteries, heart affection or general anemia.

CEREBRAL PARALYSIS IN CHILDREN
Definition: Hemiplegla, diplegia, or paraplegia appearing at birth or in the first few years of life, and usually associated with wasting and hardening of certain portions of the brain. The condition is also known as spastic paralysis of infants.

Symptoms: Hemiplegia (paralysis of a lateral half of the body) comes on suddenly and is, frequently accompanied by fever, convulsions or coma. These severe symptoms subside after a few hours or days and the child is left paralyzed on one side.
Diplegia (paralysis Involving similar parts on both sides of the body) and paraplegia (paralysis from the waist down) usually date from birth and are characterized by rigidity and loss of power in the arms and legs, or in the legs alone. Children thus affected are generally idiots or imbeciles and are often afflicted with epilepsy.

Etiology: The cause in prenatal cases is not known; in congenital cases meningeal hemorrhage induced by difficult labor is thought to cause the paralysis. Infantile cases result from acute encephalitis, hemorrhage, thrombosis, or embolism.

Prognosis: This is not favorable. In rare cases hemiplegia ultimately disappears and the child regains health, but in most cases it is followed by secondary rigidity and commonly by imbecility, epilepsy, and movements resembling those of chorea, or continuous movements of the fingers and toes follow. The other forms are hopeless.

Care of the Patient: During the convulsive stage no food but water should be given. After convalescence is advanced educational exercises may be helpful. The whole life of the child should be well regulated.

INSANITIES

Time was when the lunatic was considered a separate being, wholly apart from all the regular members of society. Slowly the world is catching up with Sylvester Graham, who declared over a hundred years ago that "even in the worst kinds of madness, the mind is still strictly true to the same general laws that always govern the human mind in all conditions." Insanity is not a definite and fixed state as different and distinct from sanity as black is different from white. It is no more possible to fix upon a precise boundary line between sanity and insanity than it is to place one's finger on the line of demarkation between health and "disease."
The imbecile and the neurotic who becomes insane still possess mind. The behavior of the "abnormal" man is but a lessening or an exaggeration of the behavior of the "normal" man. No man loses his mind. Insanity introduces no new principle of action into the processes of mind. The principle of unity does not forsake us here. And, just, as the evolution of pathology from simple to complex, may be watched in the liver, so may it be watched in mental affections.
Having partially recognized the fundamental unity of nervous and mental "disease," it is now incumbent upon neurologists, psychologists, etc., to recognize the unity of so-called physical "diseases." Once this fact is clearly recognized it will become apparent that these neuropathological conditions depend upon the same cause for their genesis, development and continuity as does pathology of the heart, or lungs, or liver or kidneys. The evolution of pathology in one organ or part of the body is identical with the evolution of pathology in another organ or part.
Various classifications of insanity have been made, but like all other efforts to classify "diseases" these are not satisfactory. Whichever system of classification is employed we never find any definite lines of cleavage dividing these classes into distinct groups. Maudsley writes: "Insanities are not really so different from sanities that they need a new, special language to describe them, nor are they so separated from other nervous disorders by lines of demarkation as to render it wise to distinguish every feature of them by a special technical nomenclature. The effect of such a procedure can hardly fail to make artificial distinctions where divisions exist not in nature and thus to set up barriers to true observation and inference."

Etiology: Retrograde changes in the mental life of the adult are due to injury to the brain, pathology of the brain, and to reflex irritations in other parts of the body. Shock, mental suffering, emotional stress, etc., may enervate the brain and lower its resistance to the causes of brain pathology. Insanity is seen in certain glandular dysfunctions as shown in the chapter dealing with affections of the ductless glands.
Inflammation and degeneration of the brain tissue is due to the causes of inflammation and deterioration in the liver, lungs, kidneys, heart, or other organ. Hardening of the arteries of the brain, by cutting off the blood supply to the brain, results in a gradual softening and deterioration of its tissues.
A potent source of reflex irritations of the brain is pathology in the sex organs. Inflammation of the uterus or prostate gland or of the ovaries and testicles, or tumors of these same organs, often results in insanity.
Another great cause of insanity is drugs - tobacco, tea, coffee, morphine, heroin, bromids, serums, etc. The habitual or' "medicinal" use of drugs, especially hypnotics, anodynes, narcotics, etc., plays havoc with the brain and nervous system.
Changes found in the brain at death represent the endpoint of the pathological process and are not the cause of insanity. Enervation and toxemia and their many emotional, sexual, physical, dietetic, etc., causes constitute the true cause of insanity.
If dementia, for instance, represents the end-point in a long drawn-out pathological evolution, what are its connections with the other pathological conditions of the body which precede it, develop concomitantly with it, and which succeed it? They are all parts of the same pan-systemic pathological evolution and all arise out of the same basic causes. The pathology of the brain and nerves does not differ in its essential character from the pathology found in the other tissues of the body. Nervous and mental affections are all of a piece with all other affections of the body. They are not set apart from the rest of the pathology of the body.

Care of the Patient: The present care of the insane is not much advanced over that of two thousand years ago. Although much cruelty is still practiced it is not as common nor as open as formerly. Nerve and mind destroying drugs are used and dope has largely supplanted chains, night sticks and strait jackets. Psycho-analysis promised much but failed to make good; indeed many neurologists assert that many patients are made worse by being psychoanalyzed.
It is most important to remove and correct all causes of enervation and give these patients a good physiological house cleaning, after which a diet of fruits and vegetables should be employed. All hygienic factors are important and all drugs should be avoided.
Dementia: This is insanity characterized by more or less complete loss of intellect. Several forms are described, as primary, secondary, terminal, senile and praecox, but these distinctions are of minor importance.

Imbecility: An imbecile (idiot) is one born without normal mental equipment. Perhaps injury at birth or arrest of development after birth account for some causes. There are various forms and degrees of imbecility, ranging from mild cases in which the individual is regarded as backward, to pronounced cases in which the unfortunate is unfitted for anything, is a mere burden on society which, in a more enlightened age, will not be borne by its healthy members.

Insanity: Or a lack of mental soundness, integrity, is divided into acquired, affective, circular, cyclic, climacteric, communicated, confusional, doubting, emotional, epidemic, hereditary, homicidal, ideational, ideophrenic, impulsive, menstrual, moral, perceptional, and periodic forms. These distinctions are of no practical value.

Mania: This is violent insanity with wild excitement. It is divided into alcoholic, a Potu, Bell's, dancing, epileptic, puerperal, religious and transitory manias. Again these distinctions are unimportant.

Psychosis: This is any mental "disease." Anxiety psychosis, exhaustion psychosis, toxic, maniac depressive psychosis, etc., are described. For all practical purposes these distinctions may be ignored.
DEMENTIA PRAECOX
Definition: This is an adolescent insanity developing usually between the ages of fifteen and thirty.

Symptoms: it is characterized by mental deterioration, emotional apathy, hallucination, delusions, and finally dementia.

Etiology: Hereditary neurotic diathesis, or neurosis resulting from larval deficiencies form the foundation for this condition. Emotionalism, improper food, sexual excesses or repressions, etc., lead to enervation, toxemia and, finally, dementia.

Prognosis: Our experience leads us to believe that proper care from the first will assure recovery in practically all cases.

Care of the Patient: "Patience and time must be stretched to the limit by those who hope to effect a cure." Each case must be thoroughly studied and cared for intelligently. All causes of enervation must be eliminated, even while the fast is in progress. These cases must be gently but firmly disciplined and should be kept busy doing those things they like to do. Rest and a general health-building program are essential. Recovery may be expected in from six months to two years.
MELANCHOLIA
Depression: This is a depression of spirits. Eight or nine distinct types are classified, each with special outstanding characteristics.

Symptoms: This presents a variety of symptoms not unlike those included under the term neurasthenia. In melancholia all impressions seem exaggerated and there is most profound mental depression. An abnormal self-consciousness exists and there are delusions and hallucinations. There is, mentally, a state of abject misery and anguish without apparent cause. There is always insomnia, although these cases all sleep more than they think. Duties are neglected and the sufferer is unable to explain his worries or his lack of interest in everyday affairs. Gloomy foreboding and a sense of impending calamity, to himself and family, are present. The sufferer is filled with suspicion, distrust and insane jealousy, though he may retain his usual reasoning faculties. His emotions are easily disturbed and he generally tends to retire within a carapace of reticence and uncommunicativeness, with either extreme restlessness or apathetic and quiet indifference.

Etiology: Many of these cases are due to organic changes in the brain or nervous system or in other organs of the body. Others are purely functional and are due to the usual causes of functional impairment.

Prognosis: Cases due to organic changes rarely recover. Other cases usually run a protracted course that ends in recovery. The outlook in delusional melancholia is not so favorable, these cases commonly terminating in a pronounced type of insanity.

Care of the Patient: The profound enervation evident in these cases calls for prolonged rest. The evident failure of the gastro-intestinal tract makes attention to feeding most important. A fast not only rests the greatly debilitated digestive system, but permits elimination of toxins. Toxins must be kept low. The environment must be changed and the mind diverted. The whole mode of living must be ordered in conformity with the laws of life. All enervating influences require correction and much patience and time are required.
PARETIC DEMENTIA
Definition: This is a chronic inflammation of the cerebral cortex characterized by a change of disposition, failure of memory, mental exaltation, delusions of grandeur, tremors, epileptiform convulsions and paresis. It is also known as general paralysis of the insane,' general paresis, and chronic meningoencephalitis.

Symptoms: Usually beginning "insidiously" with a change in disposition - the industrious becoming slothful; the ambitious, apathetic; the chaste, dissolute; the liberal, parsimonious; the complaisant, churlish; and the truthful, false - there follow loss of energy, failing memory and weakened judgment. A peculiar egotism and mental exaltation accompanies the impairment of the faculties; the sufferer becoming boastful, talkative and easily provoked to furious outbreaks. The use of wrong letters and suppression of syllables in writing reveals failure of memory.
At this stage motor symptoms begin to manifest. The pupils are often unequal, the tongue trembles when it is protruded, the speech is slow, hesitating and indistinct, and the gait is somewhat shuffling.
The most characteristic mental symptom of fully developed paretic dementia is the delusion of grandeur manifested in the subject's magnified estimate of his social or political status, wealth, strength or power of intellect. Although the mind is usually serene and cheerful, periods of profound depression are frequent. The sensibilities are blunted, and the "animal nature" is ascendant. The mind becomes progressively involved; there develops extreme indifference to all that goes on; there is voracious appetite, with bolting of food, and soiling of the clothes with food.
The tremor of the tongue grows, the lips and other parts of the face begin to tremor, speech grows indistinct and "scanning," the pupils fail to respond to light, though still accommodating to distance (argyll-Robertson pupil) ; and there is usually an increase in the reflexes, though these may be lost. Epilepsy-like and apoplexy-like convulsions are common.
In the final stage the mental power is almost obliterated, health fails, the bladder and, rectum empty themselves involuntarily, the gait is unsteady, and finally, the subject becomes unable to leave his bed. Death closes the scene.
Paresis shows occasional, sometimes continual symptoms throughout all stages of its advancement. In its early stages there are usually "unmistakable signs of queerness." This goes on to "gradual mental break down." The victim's manners, customs, and habits are likely to strike off at odd tangents. He may become egotistical and develop a troublesome attitude toward others. Delusions of grandeur, with extravagance as a likely outstanding characteristic, may develop. Criminal tendencies may result in forgery, embezzlement, murder, revolting sex crimes, etc. Accompanying the odd mental quirks, and varying in, intensity and variety in some cases, are severe, recurring headaches, dizziness, insomnia, memory lapses, nervousness and numerous types of convulsive seizures and paralysis.

Etiology: It is said to be due to "syphilis" and that "the disease centers its attack upon the centers of the brain" while the brain, involvement is supposed to begin "at the very time of the first general invasion of the spirochetes."
Tilden says: "the mental derangements are brought on from venery and fear." He should have added, plus drug poisoning. There can be no doubt that paresis, like all other troubles, is time summation of multiple causes.
The symptoms described are not "specific." They are common in people in all walks of life who eat to excess of deficient and stimulating foods, imbibe alcoholics, tea, coffee, soda fountain slops, indulge in tobacco, practice excessive venery, who overwork, worry a lot, secure insufficient rest and exercise and who palliate their symptoms with drugs. I cannot see the need for a disease called "syphilis" to produce these symptoms and to finally produce degeneration of the brain. Hardening of the arteries of the brain from any cause may easily produce these symptoms.

Prognosis: This is a form of insanity with paralysis that we get little opportunity to care for; first, because our institutions are not designed to care for the insane; and, second, because these cases are usually sent to asylums. I have had opportunity to care for but two cases, and these in the terminal stages, when there was nothing to do except watch them die. It may be possible to restore these sufferers to health if Hygienic methods are employed in the early stages of the trouble. I know of no logical reason why the early stages of paresis will not yield as readily to Hygienic care as does ataxia.

Care of the Patient: Nothing can be done in the late stages. In the early stages, if fear and drugs are eliminated and all enervating practices are discontinued and a general health-building program carried out, recovery may be possible. A fast will aid in eliminating accumulated toxins.
AFFECTIONS OF THE SPINAL CORD
BULBAR PARALYSIS

Definition: An affection rarely occurring before the fortieth year, due to chronic degenerative changes of certain neuclei in the medulla oblongata, and characterized by paralysis of the lips, tongue, pharynx and larynx.

Symptoms: It begins "insidiously" with difficulty in speaking and gradually evolves into paralysis and wasting of the tongue, lips, palate, larynx, and pharynx. Difficulty in swallowing is alone considered. enough to make a diagnosis.

Etiology: An acute form is seen that results from hemorrhage or from acute poliomyelitis of the medulla. The chronic or progressive form is a chronic poliomyelitis of the bulb and is usually a part of amytrophic lateral sclerosis.

Prognosis: Acute forms end fatally in a few days. Chronic forms last four or five years, but the cases seem hopeless.

Care of the Patient: General care to build up the general health, is all that can be done. The condition should be prevented by right living.

CHRONIC ANTERIOR POLIOMYELITIS

Definition: A chronic affection (atrophy) of the nerve cells in the anterior gray horns of the spinal cord, and characterized by progressive wasting of the muscles and a corresponding loss of power, hence its other name, progressive spinal muscular atrophy.

Symptoms: These are said to develop "insidiously." The muscles of the hand commonly suffer first. The muscles atrophy and lose power. The hands assume a claw-like position which is characteristic. Fine tremors or twitchings are almost invariably present in the affected muscles of the shoulder and arm, and then the neck and trunk. The legs are seldom involved until late, and often are not involved at all. Occasionally, however, the first symptoms develop in the lower extremities or back. In the late stages the patient may be reduced to a mere skeleton. Four types are recognized: hand-type, juvenile, infantile facial, and peroneal. ,
Symptoms of bulbar paralysis develop when the degeneration involves the medulla. The paralyzed muscles are flaccid, the deep reflexes are lost in the affected limb, sensation is unimpaired, though there may be complaints of dull pain or coldness. The sphincters are not involved.

Etiology: Inherent weakness of the cells (abiotrophy) is thought to predispose these to early degeneration as it develops frequently between the ages of twenty and fifty, most often in males. Its real cause is the same as that which causes all other nerve degeneration
- enervation and toxemia growing out of wrong life. Sexual excesses and alcoholism doubtless are the real predisposing factors.

Prognosis: The course of the degeneration is very slow and marked by occasional remissions. These indicate that the degeneration is often not as great as the symptoms indicate and that recovery is possible.

Care of the Patient: "Treatment is of no avail," say medical authorities. We agree, but we do not agree that the removal of all the causes of enervation and the elimination of toxemia through physiological rest is of no avail. The Hygienic mode of living offers the best prospect of arresting the degeneration and prolonging life and usefulness.

HEREDITARY ATAXIA

Definition: A "family affection" characterized by symptoms resembling those of locomotor ataxia, and due to hardening of the posterior columns of the spinal cord; known also as Friederich's ataxia.

Symptoms: This affection develops in children and young people up to the twenty-fifth year of life. It sometimes develops in several members of the same family, which indicates a hereditary predisposition to its development. The essential features are ataxia, paraplegia and irregular jerky movements of the head, impaired speech, disorders of vision, and loss of muscular power. Pain is seldom present.

Etiology: "Some cases can be traced to heredity; in others no cause can be ascertained" say medical authorities. It must be due to the usual causes of nerve degeneration, with perhaps inherent weakness of the spinal cells.

Prognosis: "The disease is slowly progressive and treatment is of no avail," say medical authorities.

Care of the Patient: Same as for locomotor ataxia. A Hygienic mode of living offers the best prospect of arresting the degeneration and prolonging life and usefulness.

SPINAL HYPEREMIA

Definition: Congestion of the spine. It may be active (arterial) or passive (venous).

Symptoms: It is characterized by pain in the back with more or less pronounced disorders of sensation or motion. The symptoms vary from a dull pain in the lumbar region, radiating to the hips, to very alarming symptoms such as rigidity, pain in the abdomen, tingling in the hands and feet, jerking of the limbs, exaggerated reflexes and incomplete loss of power. It may last from a few hours to several days. If prolonged it evolves into myelitis.

Etiology: Cold and exposure, arrested menses, habitual hemorrhoidal discharge, tension from protracted erect posture, and injuries are listed as causes. Most of these can act only as exciting causes in the greatly debilitated and toxemic.

Care of the Patient: Rest, lying in any position except on the back and fasting are the prime needs. Gentle rubbing may afford relief.

SPINAL SCLEROSIS
Definition: This is myelitis with an increase of the connective tissue of the spinal cord. Four types are recognized, as follow:

Ataxic Paraplegia: This is a combined lateral and posterior sclerosis of the spinal cord.

Symptoms: It develops slowly as the structural changes in the cord gradually become more and more extensive. The paralysis affects muscles higher up than in locomotor ataxia and there is also a tendency to spasms in the lower extremities. Sensation is unimpaired, neuralgic pains are absent, the knee jerk is exaggerated and the affection may easily be mistaken for tabes dorsalis.

Prognosis: This is not very favorable, but there is every reason to believe that the tissue degeneration is not always as great as the symptoms indicate and function may be re-established in many cases that appear to be hopeless.

Cerebrospinal sclerosis: This is a multiple sclerosis affecting both the brain and cord. It is also known as disseminated sclerosis and insular sclerosis.

Symptoms: It is characterized by pains in the back, disorders of sensation, loss of coordination, tremor on motion, scanning speech, and varying degrees of mental impairment. In well-developed cases. there are increasing weakness in the lower limbs with exaggerated tendon-reflexes, involuntary oscillation of the eye-balls, defective vision and optic atrophy, headache, giddiness, numbness or tingling in the limbs and various other symptoms that are not constant.

Prognosis: This is not favorable. Our experience has demonstrated that the sclerosis may be checked if Hygienic care is instituted early and that improvement may be obtained, even, in advanced cases.

Lateral sclerosis: A rare condition, known also as Charcot's "disease," Erb's palsy, amytrophic lateral sclerosis, and anteriolateral sclerosis.

Symptoms: Bilateral paralysis of the legs with muscle contractions and exaggerated reflexes characterize this affection. Loss of power is the first symptom. There is a gradual increase of weakness and heaviness in the limbs. The knees are drawn together, the legs drag behind and move forward rigidly as a whole with no knee action and the toes catch against the ground often causing falling.

Prognosis: Complete recovery is rare. Much may be accomplished in its early stages.

Posterior spinal sclerosis: This is a degenerative affection of the sensory neurons of the spinal cord, often involving, also, the sensory neurons of the cranial nerves, and characterized by incoordination, loss of deep reflexes, disturbances of sensation and nutrition and various ocular phenomena. It is also known as locomotor ataxia and tabes dorsalis.

Symptoms: These are divided into three stages as follow:

Pre-ataxic (or early) stage: The symptoms of this stage are sharp, shooting pains in the lower half of the back and legs, severe backache, numbness and tingling of the feet, a sense of constriction about the body, disturbances of the urinary and sexual systems (usually of a paretic type), deficiencies of vision, loss of deep reflexes, paroxysms of intense pain in the stomach, and isolated areas of hyperesthesia or anesthesia.

Ataxic stage: As the nerve degeneration progresses there is a want of certainty and precision in the movements of the legs especially in the dark, and a gradual loss of control of the muscles. The walk becomes a peculiar heavy shambling, futile attempt to direct the feet. If the patient stands erect with his eyes closed and his feet in juxtaposition he sways and tends to fall; or, if the upper extremities are affected the ataxia becomes evident when he attempts to touch his finger to the tip of his nose. If placed in a recumbent position with his eyes closed he is usually unable to recognize the position in which his limbs are placed.
The steps are awkward and jerky, the foot is raised high, projected forward and outward and brought down forcibly with a thud. The body is bent forward, and the eyes are directed to the floor. Although there is not great loss of muscular power in this stage, the muscles are abnormally flaccid.
Such trophic abnormalities as perforating ulcer in the sole of the foot, abnormal brittleness of the bones, and painless swellings of the large joints, with effusion, atrophy of the bones and cartilages, and ultimately dislocation (Charcot's joint) develop.

Paralytic stage: This develops in from ten to twenty years if the patient lives. This stage is characterized by inability to walk, progressive muscular weakness, inability to retain the urine, cystitis, bed sores, and increasing marasmus.
In a small percentage of cases symptoms of paretic dementia develop and the condition is called tabo-paralysis.

Etiology: We assume that the cause of the hardening in the different parts of the cord that gives rise to these different "forms" of spinal sclerosis is the same. We are usually told that the cause is obscure, which means it is unknown. Locomotor ataxia is said to be caused by "syphilis" and cases are treated accordingly; hence the uniform failure in these cases.
Dr. Alsaker says "the tendency of late years is to blame syphilis for more and more of the nervous disorders from which people suffer.
Some medical men claim that this disease causes all cases of locomotor ataxia. It is true that many of the ataxias have had syphilis, but by no means all of them. Many of them have also had measles and corns.
Locomotor ataxia has as varied a causation as other diseases have, and to blame one previous disorder is either mental laziness or perversion of the truth."
Many cases of ataxia give no history of "syphilis" and do not react positively to the Wassermann test. These are treated for "syphilis" anyway.
A little investigation of the past lives of every one of these sufferers will reveal enough of sensuality and gross living to cause their troubles without dragging in an imaginary "disease" called "syphilis." These people have been living in a manner that weakens and debases their bodies. Years of gluttonous eating, late hours, excessive venery, drinking, tobacco using and other forms of sensuality and dissipation, eroticism in thought, and, added to these, the drugs that are taken by such men and women for their aches and pains, are enough to produce in them any one or more of the mental and nervous and other "diseases" which are referred to as the third stage of a "disease" called "syphilis." Tilden says, "I know from sixty-five years of experience that * * * locomotor ataxia is the result of excessive venery and is curable." Alcoholism, injury to the cord, vascular and nervous sclerosis from toxemia are undoubtedly causes. Perhaps the drugs given for "syphilis" are the most potent causes.
Tilden also says that a cause for locomotor ataxia "need not be looked for beyond the daily lives of subjects. Everyone has abused himself sexually; indeed the history of such cases usually runs about as follows: 'I began at eight years of age to masturbate, and kept it up one to half dozen times a day until I began visiting women, and, have had intercourse once to four times every twenty-four hours for the past twenty years.' Does such an individual require syphilis to paralyze him? Add to this abuse wrong eating, tobacco and often alcoholics, coffee and tea, then can any sane man believe that syphilis is necessary to add to all that crime against health, to make a successful ataxia?"

Prognosis: In the early stages, this is favorable. In advanced stages, the case is hopeless.

Care of the Patient: We care for all of these cases alike and a description of our care for locomotor ataxia will suffice. The care of locomotor ataxia cases should have no reference to a "disease" called "syphilis." All causes of impaired health should be corrected and every health-building measure employed. Tilden says, "when cases of locomotor ataxia apply to me for treatment, I treat the individuals for what their symptoms represent. If they have any stimulating habits, these have to be given up at once. Their wrong eating habits are corrected immediately. When it is possible for them to go to bed, they are sent to bed, and kept there until the coordination has been restored." He tells us that he has treated many cases of locomotor ataxia with plus four Wassermanns, whose symptoms cleared up within sixty to ninety days, and adds, "where they have given up their bad habits and continued living in the right way, they have continued to remain well."
To be able to bring about resolution of hardening in the cord in locomotor ataxia and a consequent restoration of normal movement is something so-called "regular medicine" hardly dares hope for.
Dr. Weger reports that "several tabetic cases advanced to the cane and crutch stage have been able to discard these aids to locomotion within a few months and have improved sufficiently to carry on extensive enterprises, play golf, and live normal lives for six or eight years, only to have the tabes reassert itself and become progressively worse. These cases were those of men past middle life whose habits were exemplary and who could be depended upon to do much better than the average person in carrying out instruction."
I have had no such experiences and Dr. Weger is the only Hygienic practitioner who reports such recurrences. I incline to the opinion that the habits of these men were not as exemplary as they had led Dr. Weger to believe, and that they had not carried out instructions well. Unless we abandon all rational views of the trouble and accept the delusions that cluster around the spirochete, we must know that something in the lives of these patients caused the recurrences.
We often see an almost complete clearing up of all symptoms in multiple-sclerosis during a long fast only to have some of them return in milder form as soon as eating is resumed.

SYRINGOMYELIA
Definition: A rare affection of the spinal cord, occurring chiefly in males between the ages of ten and forty, characterized by the formation of cavities within the cord, and by atrophy of certain muscles, peculiar disturbances of sensation and various trophic changes.

Symptoms: The affection usually involves the upper extremities, the chief symptoms being wasting of the muscles (atrophy of both hands and arms) fibrillary tremors, loss of sensations of pain and temperature, but with well preserved or but slightly affected tactile sensation, lateral curvature of the spine, and such trophic disturbances as fissures, ulcers, gangrene and affections of the joints. Such eye symptoms as continuous rolling of the eye-ball, inequality of the pupils, and narrowing of visual field are frequently seen. The affection is nearly always bilateral.

Complications: In many instances symptoms of lateral sclerosis, posterior sclerosis or bulbar pathology are superadded.

Morvan's "Disease" is thought to be a form of syringomyelia but differs from the above description in that there are loss of tactile sense and the development of painless felons.

Etiology: Injury and "acute infectious diseases" are mentioned as causes. Acute "infectious diseases" cause nothing. They are caused by toxemia and sepsis and these are the causes of syringomyelia.

Prognosis: Syringomyelia is considered incurable but not fatal and patients may live in comparative comfort for many years and eventually die of other affections.

Care of the Patient: We believe that proper care at the beginning would arrest the progress of the pathology in this condition and prevent the development of the helplessness described above. The care would not differ from that given for neurasthenia or myelitis.
AFFECTIONS OF THE NERVES
DIVER'S PARALYSIS
Definition: A condition of motor and sensory paralysis with other nervous symptoms observed in divers and others subjected to increased atmospheric pressure; known also as Caisson "disease," and "bends."

Symptoms: These may appear immediately on reaching the surface or after the passage of several hours. Pains in the joints followed by motor and sensory paralysis in the lower extremities are, the chief symptoms. Sometimes the bladder and rectum are involved. The paralysis may sometimes take the form of hemiplegia or monoplegia instead of paraplegia. Gastralgia and vomiting are common symptoms.

Etiology: It usually requires a pressure of more than two hundred atmospheres to produce the paralysis and the time required decreases as the pressure increases. Congestion hemorrhage and softening in the cord result from the pressure.

Prognosis: As a rule recovery ensues in a few days or weeks. In a few cases the paralysis is permanent. In severe cases coma develops and death occurs in a few hours.

Care of the Patient: A gradual transition from a high to a low pressure will usually prevent the paralysis. If symptoms develop the patient should be returned to the high pressure and then subjected to gradual decompression. Severe cases should be cared for as described under acute myelitis.

HERPES ZOSTER (Shingles)
Definition: This is an acute inflammation of the ganglia of the posterior nerve roots, characterized by more or less intense pain and a vesicular eruption upon a red and inflamed base along the peripheral or cutaneous nerve. It is also called posterior ganglionitis.

Symptoms: Shingles may develop in various parts of the body from the face down to the legs. - The most common site is along the intercostal nerves of the chest, where it is almost always unilateral. Severe complications and organic changes are rare. Clusters of vesicles (blisters) mounted on inflammatory bases, accompanied and preceded by sharp, neuralgic pains, mark the affection. The eruption will not cross the median line either in front or behind. The fluid soon becomes turbid, dries up and forms yellow-brown crusts, which fail off in a few days.

Etiology: It is a reflex irritation; its real cause is poisoning from intestinal putrefaction. It is a common development in fevers - pneumonia, malaria, cerebrospinal meningitis - and in neuritis and neuralgia.

Prognosis: It commonly gets well quickly, though neuralgic pains may persist for some time and its development near the eye may result in permanent damage to this organ.

Care of the Patient: Rest in bed and a fast of sufficient length to result in full elimination should be employed in all cases. Drugs to "relieve" pain should be avoided. After the fast the diet should be fruits and vegetables.

FACIAL PARALYSIS
Definition: This is paralysis of one side of the face; called also Bell's palsy.

Symptoms: The affected side is expressionless, the natural lines are obliterated, the angle of the mouth droops, the eye cannot be closed, tears flow over the cheek, and speech is affected from impaired motion of the lips. If laughing or whistling are attempted the absence of movement on the affected side is still more conspicuous.

Etiology: Many cases are due to neuritis resulting from its usual causes; other cases are due to pressure, an inflammatory exudate, upon the nerve-trunk between the brain and skull, or from a tumor, or blood clot or abscess involving the facial center; a few cases result from paralysis of the nerve within the temporal bone as a result of a fracture or an extension of Inflammation of the middle ear.

Prognosis: This is guardedly favorable in most cases. The prognosis must depend on the pathology back of it.

Care of the Patient: Remove the cause - that is, correct all causes of enervation and toxemia. Fasting for toxemia will help.

NEUROMATA
Definition: This is a tumor of the nerve made up of nerve substance proper. Sometimes the tumor is a growth from a ganglionic cell. What is called a false nerve tumor is a fibroid development in which the fibrous tissue mixes with the nerve tissue.

Multiple Neuromata are tumors of the terminal nerves or the cutaneous branches of the sensory nerves. They may be associated with tumors of the nerve trunks. They are often seen on the face, breast, or about the joints.

Amputated Neuromata are nerve tumors that develop on the ends of amputated nerves. They cause great suffering.

Etiology: These tumors result from the usual cause of tumors. See Tumors.

Prognosis: Guardedly favorable.

Care of the Patient: Care must be on general principles. Digestion must be improved and energy conserved. All stimulants must be given up.

RAYNAUD'S "DISEASE"
Definition: A comparatively rare vasomotor neurosis characterized by local anemia, congestion and symmetrical gangrene.

Symptoms: This affection "begins" in the fingers or toes and tends to become progressive, although recurrent periods of remission of symptoms are common. The affection develops most frequently between the ages of ten and thirty in those of a neurotic tendency. In its first stage the affected part - symmetric parts, as a finger on each hand, a toe on each foot, the lobes of the ears, are usually affected - becomes extremely pale, cold and anesthetic (local syncope). After a variable time the part becomes purple, livid and intensely painful (local asphyxia). Occasionally the third stage develops, in which congestion gives way to dry gangrene. Hemoglobin may appear in the urine. The condition may easily be confused with endarteritis obliterans.

Etiology: "The cause is unknown" is the statement that comes from all sides. "The disease is believed to be dependent upon spasm of the peripheral arterioles of central origin." Spasm is supposed to occlude the blood vessel, thus cutting off nutrition to the part which consequently dies. There is every reason to believe that this affection, is an outgrowth of toxemia. Tilden says: "The disease would have no existence if those afflicted were living properly. It is simply a surface manifestation of toxin poisoning, and, the same as most diseases to which flesh is heir. It originates in the gastro-intestinal canal."

Care of the Patient: Tilden adds: "Hence the intestinal derangement must be righted, first, last, and all the time, by correcting the eating habits and otherwise properly caring for the body." Weger says: "I have been privileged to treat five or six cases in all of which the diagnosis had been made by well-qualified specialists, whose treatment was unavailing though it conformed to the best in medical practice. Under our supervision all made satisfactory recoveries and remained well. In one case amputation of one leg above the knee had already been resorted to and the condition of the other leg seemed to warrant the same procedure. A period of fasting and dietetic restriction resulted in complete recovery and six years after treatment it was reported that there had been no evidence of return of the disease and the patient still had one good leg. The other cases were also urgently importuned to submit to amputation, but a complete physical renovation made surgery unnecessary in any of them. The obvious conclusion is that these diseases must also be considered as toxemias and if treated accordingly they need no longer be classed in medical literature as incurable and of unknown origin."
It is well to avoid exposure to cold, and, if possible, to spend the winter in the south, until recovery is complete. All nerve-leaks must be stopped and every health-building factor provided.

TRAUMATIC NEUROSIS
Definition: This is a nervous state resulting from injury.

Symptoms: These follow close upon an accident that has done bodily harm. Headache, insomnia, loss of power to concentrate the mind, irritability, despondency and, in severe cases, melancholia, are the prominent symptoms. All symptoms included under neurasthenia are present in some cases.

Etiology: Inasmuch as this condition does not develop in cases cared for Hygienically, it is the opinion of the whole Hygienic field that too much doctor and drugs - narcotics, analgesics, hypnotics, etc. - constitute the chief cause. Injuries shock and enervate, but the tendency is to recover; where rest is provided and toxemia is not great the shock is soon recovered from.

Care of the Patient: "A patient who has been injured should not be fed until the shock is overcome," says Tilden. "Patients in a state of shock do not digest food. Patients in pain do not digest food. * * * Never feed before the patient is comfortable; until absolute comfort has been established, no food - solid or liquid - should be given beyond a little fruit morning, noon and night."
Rest and relaxation are essential. Hot applications may be placed over the seat of, pain if this seems necessary, but no drugs are to be given.

HYSTERIA (Hypochondriasis)
Definition: A neurosis, mainly of women, characterized by lack of control over emotions and acts. Like neurasthenia, rheumatism and "syphilis," it is a "catch-all" or "waste-basket" of medicine into which is thrown anything the doctor does not understand. Hypochondriasis is its analogy in the male.

Symptoms: Its nature and complexities are so variable that accurate definition or description is precluded. Weaknesses and lack of control of the will, reason, imagination, and emotions, with both sensory and motor disturbances exist in the same individuals. Real and imaginary body ailments are exaggerated or distorted and magnified to the point of obsessive introspection in both hysteria and hypochondriasis.
Hysteria may occur as a paroxysm, or as a prolonged hysterical state. Its many and complex symptoms may simulate almost any affection. For their most effective demonstrations these patients require an audience, leading to the conclusion that there is a certain amount of wilfulness in their outbreaks. Some of them possess no regard whatever for the fears and anxieties of relatives and friends. Many of them are "astoundingly versatile, acrobatic, vociferous, emotional, eratic, erotic and pestiferous." They exhaust all the resources of nurses, doctors and family while their affection thrives on sympathetic ministrations and their motor and sensory abnormalities and perversions "run the whole gamut of what appears to be pre-meditated and ingenious affection."

Etiology: In women, hysterical outbreaks are frequently associated with the menstrual period, functional crises, or definite pelvic pathologies, and with the menopause. Paroxysms may be precipitated by sexual, digestive, circulatory, or nervous disturbances.

Care of the Patient: One should first make sure that he is dealing with hysteria and not with real pathology masked by hysterical symptoms. Then he should adopt a policy of firmness and frankness with scant sympathy. Call the patient's bluff at once and without apology and refuse to be influenced, subjugated or dominated by the patient.
The doctor should have complete control of the patient, unhampered and uninfluenced by family and friends whose minds are full of visions of pathologies, dire emergencies, and terrible consequences, and who are easily dominated by the perversities of the patient.
Fasting, rest, dietetic regulations, correction of uterine displacements and correcting environmental influences will produce rapid and dependable recovery.

NEURASTHENIA (Nervous Prostration)
Definition: A. functional affection of the nervous system characterized by a lack of nervous energy and increased sensitiveness to external impressions used largely as a blanket-term to cover the doctor's ignorance.

Symptoms: These are extremely varied although all cases have certain characteristics in common. It is customary to group symptoms as follows:

Cerebral Symptoms (psychasthenia): These include depression of spirits, inability to concentrate the mind on any subject (except self) for any length of time, insomnia, dizziness, headache, irritability of temper, introspection and various forms of morbid fears - fear of crowds, of closed places, darkness, etc. There is moodiness, critical examination of symptoms, exaggerated pessimism and restlessness.

Spinal Symptoms: Chief among these are pain in the back, tender spots along the spine, weakness of the extremities, marked prostration after moderate exertion, ocular disturbances, unpleasant dreams, and numbness, tingling, formication, neuralgic pains and other subjective phenomena.

Gastro-intestinal Symptoms: Lack of appetite, coated tongue, indigestion with abdominal distress, and constipation are chief among these. There is usually much emaciation.

Circulatory Symptoms: Palpitation of the heart, pseudoangina, cold hands and feet, hot flashes, and sometimes violent pulsations of the abdominal aorta are chief among these.

Sexual Symptoms: In males there is often a genito-urinary obsession and fear of impotence and spermatorrhea; in females painful menstruation or absence of menstruation, with ovarian irritation, fear of mental imbalance and a sense of social inferiority are quite common.
There is almost no end to the symptoms that may be described under this term and patients so suffering make their own lives miserable and are often a sore trial to family, friends and those who care for them.

Etiology: These symptoms are caused by extravagant dissipation of energy in many useless ways and to such a degree that the body's functional activities do not receive their due measure of nervous support. Digestive secretions and all functional activities become impaired, metabolism is deranged, and a vicious cycle of physical and mental reactions "becomes established in chaotic perversity."
Individuals of neurotic tendencies are pushed most readily into this condition by excesses in eating, working, sex, emotional stress, alcohol, tea, coffee, tobacco, gastro-intestinal irritation, pelvic irritations and toxic saturation. Many obscure conditions are often diagnosed neurasthenia because the factor of toxic saturation is not sufficiently considered.

Prognosis: These conditions are usually not quickly overcome, though happy results are usually obtained when toxemia and intestinal autointoxication are eliminated.

Care of the Patient: In the care of these cases it is necessary to frankly and reasonably interpret the condition to the patient in order to secure his or her full cooperation. It is necessary to explain that physical impairments precede the mental depression. These cases are often ridiculed and censured for their troubles, which are assumed to be under direct control of the mind, and this arouses a feeling of resentment and injustice. The neurasthenic refuses to admit the influence, even though it may often be true, and develops a marked state of sullen displeasure. The antagonistic forces thus aroused often render progressive recovery impossible and usually lead to a change of doctors.
Diverting the patient's mind and holding him to interests outside of himself helps him toward recovery and requires a practical understanding and tactful application of the principles of psychology. This calls for the prior establishment of complete confidence. This must be relied upon merely as a helpful adjunct of the real care.
Recovery depends upon the correction of all causes, elimination of toxemia and restoration of full nerve force. Rest and fasting are more important than psychology. All sources of irritation and stimulation must be removed. These procedures, plus time and the proper use of exercise, sunbaths, diet, etc., and health slowly returns.

NERVOUS CHILDREN
Nervousness is quite common in children today. Parents, teachers, nurses, doctors and everyone who has to deal with children know only too well how prevalent is this condition.

The nervous child is irritable and ill-tempered, fretful and capricious. His sleep is likely to be disturbed and unrefreshing. He seldom sleeps soundly. His appetite is capricious, his tongue often coated, and his breath bad. He is usually underweight and does not put on weight no matter what food is given him. On occasions he will be a little feverish and may present extreme lassitude. In the worst cases, enuresis (bed wetting), diarrhea, vomiting and other evidences of physical disorders are present.

These "trivial" ailments may seem to the average person to bear no relation to the nervousness, but they are truly indicative of an underlying systemic derangement that must be attended to at once if more serious developments are to be avoided.

Nervous children are not likely to be well developed and alert. They are more prone to be limp, underdeveloped and listless. Some of them are said to be "on the go" all the time, but this overstimulation does not last. Soon these lack the zest and eagerness that should be the mark of all young life. They bear every evidence of nervous fatigue and physical exhaustion.

The round shoulders, flattened chest, protruding abdomen, exaggerated spinal curves, loose knees, and sallow, pasty complexion all bear evidence that the child is not well nourished.

Dr. Harry Clements says: "In all cases the condition of the alimentary tract will be found abnormal and far from wholesome. In the worst form we may see the condition known as cyclical vomiting. The child is prostrated under the attack. The face has no colour, the lips may be red but dry, and the muscular structure of the body seems utterly relaxed. The breath is foul, and the bowels are either violently diarrheic or badly constipated. The whole picture is that of systemic poisoning, plus a violent reaction of the digestive processes against normal functioning."

Incontinence of the urine, day and night, and incontinence of the feces are seen in extreme cases also.

It should be evident that we are dealing with a condition that requires study and patience, for in a large number of these there enters a hereditary neurotic diathesis, which makes the child's nervous system unstable. Dr. Harry Clements astutely remarks: "It will be obvious that the old-fashioned method of looking at his tongue and prescribing a laxative will neither help the child nor satisfy the parent that the physician has grasped the significance of this problem."

It is necessary to thoroughly study such a child. Its whole life and its heredity must be gone into. Its diet, sleep, social contacts and its studies and mental efforts are all important. Much of the remedy is educational and few parents and physicians are prepared to handle such cases correctly. Indeed parental mismanagement is largely responsible for the condition of the nervous child. The mental overstimulation of children, by our present hot-house method of mis-education, is a large factor in producing nervousness in children. Whipping, scolding, nagging, fault-finding and other such elements in the child's environment, are injurious to the nervous system of a child. Frightening children with scarey stories, bogie men, dogs, etc., and leaving them in dark rooms for something to catch, and locking them in closets, are criminal procedures. Parents guilty of such cruelty deserve severe punishment.

Says Dr. Harry Clements: "The nervous child suffers from his contact with grown-up persons who are forever communicating to him their criticisms, their failures, and their fears. When he reacts with fits of temper, irritability, fretfulness, he meets with reproofs and punishments which he neither respects nor heeds."

The nervous child needs sympathetic understanding, kindness, firmness, and the best of care. Nothing helps such children like a proper diet and outdoor life. Such a child, if his condition is bad, should be removed from school. All criticism, nagging, scolding, whipping, etc. should be abandoned. The genitals should be carefully cleansed and cared for to remove all irritation that may exist in these. Plenty of rest and sleep are required. By all means avoid drugs, serums, tonics, coffee, cocoa, chocolate, operations on the tonsils and adenoids, etc

ENURESIS NOCTURNA
Definition: This is bed wetting, or the involuntary emptying of the bladder during sleep.

Symptoms: Wetting the bed and various nervous symptoms are the only symptoms.

Etiology: Neurotic or nervous children are Inclined to the bed-wetting habit when enervated, toxemic and suffering from digestive derangements. Involuntary emptying of the bladder is normal from the day of birth until the child has reached that stage in its development, when it normally assumes voluntary control of this function. Children with nerve impairments will continue to involuntarily void their urine, while asleep, long after they should have complete voluntary control over urination - sometimes for years.

The exciting cause is any enervating influence; overeating, eating between meals, eating stimulating foods, using stimulants of any kind - coffee, tea, cocoa, soda fountain slops, etc. drugs, excessive drinking of milk or water, salt, too much sugar and sweets of all kinds, the excessive use of butter, cream, meat, eggs, cake and pastries, the use of gravies, digestive disturbances, fear, excitement, fatigue, etc.

Fear is one of the greatest dissipators of nerve energy to which children are subject. Parents who rule their children by fear, instead of love and reason, constantly slap and scold their children, pick on them, find fault with them and punish them until they ruin their health. A chronic shrew can keep a home atmosphere so tense and panicky that health for the children and all who live in it takes wings and files away. Children are scarcely over one illness until they are sick again; and, if they are troubled with sensitive neurotic bladders, bed-wetting will be a nightly occurrence. If they are scolded and punished for the enuresis this tends to make the condition worse.

Fear of bed-wetting, the displeasure of parents, and the punishment often administered are enervating and become a cause that perpetuates the habit.

If the neurosis is of the stomach, digestive crises (indigestion) will be frequent. Then, if nursed and cared for badly, an eruptive fever may develop; or, if the throat is the neurotic center, feeding, medicating and foolish nursing may result in diphtheria, even death.

Neurotic children are caused much suffering by school-life. Their fear of not pleasing the teacher is a constant drain on their nervous forces. Faulty lessons are often enough to cause indigestion. Failure at school and criticism at home are sufficient to result in indigestion and fever.

Care of the Patient: These cases should be cared for as advised for the nervous child and every cause of nervousness corrected. An occasional period of two or three days on fruit with rest in bed will be found very helpful. The amount of fluid given in the evening should be reduced. Dr. Harry Clements writes: "The highly sensitive child who becomes a victim to this distressing complaint may find it difficult to escape from his bonds, and the effects of the injury to his emotional condition may be apparent for years. If the parents of the child happen to be stupid and unkind, he may be abused and brow-beaten until all sensibility is lost and he becomes case-hardened and a real problem. If the parents extend to him more consideration and more hope - particularly more hope - he will grow out of the habit and it will not seem to him so dreadful after all. In many cases the hyper-sensitiveness and self-discouragement of the child stand most solidly in the way of successful treatment. It is only when he has freed himself from the obsession of weakness, and the fear of the act, that the problem is solved. It is not the appeal to force or coercion that cures the child; it is the development of self-control through the realization of dawning boyhood and its responsibilities that lifts the burden from his mind and body."

INFANTILE ECLAMPSIA (Spasms)
Definition: This is convulsions in children. These are involuntary spasms or contractions of the muscles of the body. We will deal only with convulsions in children, as uremic convulsions, epileptic convulsions, hysteric convulsions, etc., are dealt with elsewhere.

Symptoms: There are few conditions that strike more terror into the heart of parents than to see their child in convulsions. Yet convulsions, are not, of themselves, dangerous and it is a very uncommon thing for a child to die in convulsions. The child may be unhappy and indisposed and appear sick for a day or two; the face may be flushed and white around the mouth, there may be nausea and vomiting, or gagging and efforts at vomiting, there may be high temperature, before the spasm comes on. Some children are threatened with convulsions for several hours before the real spasm develops: in others it comes on suddenly. The child will scream, cling, to its mother in a frightened manner, after which it may quiet down for a minute, then have the same symptoms repeated. Often there is pain in the bowels which are usually bloated with gas, and there may be vomiting. The effort at vomiting causes an excess of blood to rush to the brain and the convulsion ensues immediately.

The child appears excited or frightened, its arms and hands begin to jerk in rapid succession, the jerking usually confined to one hand and arm, the head jerking and twisting to the opposite side of the body, the face is drawn and distorted, the eyes roll or stare, the pupils are dilated and in a few seconds there is a struggle for breath, due to shutting off the air by the spasmodic contractions of the muscles of the throat and chest. As the convulsions continue the child becomes purple (bluish to black) in the face, the tissues about the face become puffed and engorged. After a variable period the intervals between the jerks increase in length, relaxation begins, inhalation is accompanied with a distressing rattling in the throat, which scares the parents, but which is due simply to mucus that accumulated in the throat during the spasm. Sometimes the mucus is bloody due to biting the tongue. The jerking slowly subsides as slow relaxation occurs.

In severe cases a child may be little more than fully relaxed after passing through one of these convulsions, before another sets in, which may be as severe as the first one. The length of time these spasms last varies from a minute to two or three minutes. Infants at the breast have been known to develop a convulsion every twenty minutes for twelve to twenty-four hours. The convulsions in these cases are lighter than that described above.

Etiology: Convulsions occur chiefly in infants and children with unstable and poorly adjusted nervous systems. Slight causes may bring on convulsions in some children. Undoubtedly these are the children that give us most of our cases of epilepsy. Most children never have convulsions, while others may have them at frequent intervals if their nervous systems are irritated from any cause.
Convulsions in infants at the breast come from toxic poisoning from the mother's milk, or from drug poisoning from the same source. Most of these cases occur in the first six months of life, most of them in the first three months, many of them less than three weeks after birth. In older children they are brought on by indigestion, from overeating or improper eating. Vomiting usually frees the stomach of food.
Severe indigestion causing pain in the stomach and bowels, a catarrhal condition of the throat, extending to the ears and mastoid cells, meningitis, severe injury, fear, or sudden fright, shock, unfit milk from a sick, or tired, or excited mother may result in convulsions in infants and children, for the nervous system of a child is very susceptible to irritations.

Care of the Patient: The cause reveals the prevention and the remedy. Breast feeders must be weaned at once. Stop all food and give no drugs. No food should be given until all symptoms have passed for at least twenty-four hours. Put the child to bed, in front of an open window or door and let it alone. Don't disturb it. Keep the child warm.
Convulsions are "self-limited" and, while most parents and friends will insist on some kind of treatment to satisfy their superstition that something be done, treatments are valueless and harmful.

A few years ago I visited a child that I was told was dying. When I reached it, from across the street, I found the child in convulsions. The mother was sitting in a chair, with the child in her arms, tossing it up and down and sobbing: "Oh! my poor child! Oh! my poor child!
I took the child from her, laid it on a table, over which a folded quilt had been hastily spread, and placed it in the open door. Almost immediately the twitching movements began to cease, the eyes, thrown upward, soon returned to their normal position, the head which was thrown back relaxed and the child began to look around. In fifteen minutes the child was asleep.
This child had been given a cup of coffee only an hour previously, the milkman having delayed in delivering the milk. The poor ignorant mother who made her own breakfast on coffee, as so many ignorant people do, gave this poisonous drug to her baby, also. I attributed the convulsion to the caffeine poisoning.
PICKING AT THE NOSE
Picking at the nose is the result of irritation of the nostrils. It is evidence of a catarrhal condition. Correct the catarrh.