Editorial. It is manifest to every one that a publication that has its composing room and press room a mile apart, must labor under very great disadvantages. From one cause or another, delays will occur from circumstances that it was impossible to foresee or To obviate this, we have added to our establishment a steam engine and a large Hoe cylinder press. After the issueof the May number, we expect that the JOURNAL will be punctually on time. overcome. It will be noticed that the JOURNAL does not contain the usual 128 pages. The lateness of this issue compels us to leave out a large amount of interesting reading matter, among which is a correspondence of Dr. Frank H. Hamilton; contributions from Dr. Andrews of Chicago, and from Dr. Geo. M. Beard, of New York etc.; we are also compelled to delay until the next issuequite a number of book reviews, book notices, etc. The American Medical Association meets in Atlanta, Ga., on the 6th of May. It is expected that there will be a large attend ance. MISSOURI STATE MEDICAL ASSOCIATION. The Medical Association of the State of Missouri will hold its next annual meeting at Columbia, Mo., May 20th, 1879, at 10 A. M. The change of place has been rendered necessary as the Association could not be entertained at Sweet Springs at the time appointed by the By-laws. Indications already point to a large and interesting session. P. S.-Members on arriving at Columbia will at once report at Garth Hall, Broadway. A. J. STEELE, Cor. Sec'y. METEOROLOGICAL OBSERVATIONS. By A. WISLIZENUS, M. D. The following observations of daily temperature in St. Louis are made with a MAXIMUM and MINIMUM thermometer (of Green, N. Y.). The daily minimum occurs generally in the night, the maximum at p. m. The monthly mean of the daily minima and maxima added and divided by 2, gives quite a reliable mean of the monthly temperature. THERMOMETER, FAHRENHEIT-FEBRUARY, 1879. ERRATA: The maximum in December, 1878, was -1.0 deg. on the 24th DEATHS AND RATE OF MORTALITY Per 1000 Inhabitants, Annually, in the Largest American and Foreign Cities, According to the Latest Returns. THE SAINT LOUIS MEDICAL AND SURGICAL Journal. VOL. XXXVI-MAY, 1879—No. 5. Original Contributions. ARTICLE XXII. CASES OF NEURASTHENIA (NERVOUS EXHAUSTION), WITH REMARKS ON TREATMENT. By GEORGE M. BEARD, M. D., of New York City. The generic term, Neurasthenia, (nervous exhaustion) I have sub-divided into cerebrasthenia, (exhaustion of the brain) and myelasthenia, (exhaustion of the spinal cord).1 The details both of treatment and hygiene of cerebrasthenia, are in some respects quite different from the treatment of myelasthenia. Both forms, however, are to be treated under the guidance of the same general principles, the minute management being different, not only for the two sub-divisions, but different for individuals. 1. For a more detailed description of the disease, I may refer to my original paper on the subject, Boston Med. and Surg. Journal, April 28th, 1869, and also to Erb's chapter on Neurasthenia in vol. xiii, of Ziemssen's Cyclopedia. The nature and defferential diagnosis of neurasthenia were analyzed in the N. Y. Medical Journal, March, 1879. The defferentation be. The general principles by which we are to be guided in the treatment of neurasthenia and allied disorders, may be condensed in the following aphorisms: 1. The treatment should, in the main, be constitutional, with special attention to local manifestations, whenever they become severe. To devote the whole attention to special and local phases, as spinal irritation, cerebral fullness, asthenopia, oxaluria, spermatorrhoea, insomnia or nervous dyspepsia is unphilosophi cal and can never be successful. 2. Dependence should be placed not on any one exclusive mode of treatment, but rather on a combination of various methods. Sedatives and tonics are the chief agents, among which the following deserve chief mention: Electricity in the methods of general faradization and central galvanization, arsenic in its different forms, as Fowler's solution, and chloro-phosphide, arsenite of strychnia, ergot, cannabis indica, all the bromides, quinine, iodide of potassium, digitalis, calabar bean, conium, gelsemin, belladonna, malt, oil, phosphorus, strychnine, iodoform, cimicifugin, kumyss and the salts of zinc; counter-irritation, mental therapeutics, massage, ice bags and hot water bags and hydrotherapy in the form of hot, warm and cold baths, Russian baths and douches. Out of this large repertoire, it is possible to find some combination that will suit the needs of every case. If I were restricted to just one dozen remedies I should chose electricity, arsenic, ergot, quinine, bromides, strychine, iron, oil, phosphorus and mental therapeutics, hydro-therapeutics and counter-irritation. If I were restricted to just one remedy, I should use electricity. Erb suggests quinine and iron as the chief remedies. I have seen cases by the dozen, that had taken quinine and iron, judiciously and faithfully given, and who were still uncured and unrelieved. There is, in fact, no routine plan of treatment for these Each case must be studied closely and carefully by itself. 3. The treatment should be frequently changed, according to the needs of the patient. cases. It is not possible to set the rudder, so that a ship may steer straight across the Atlantic; it must be watched each moment tween cerebrasthenia and myelasthenia, I first presented in an article in the Journal of Nervous Diseases, 1874. The symptoms of both forms of the disease, were described in detail in the Virginia Med. Monthly, June, 1878, and the Journal of Nervous Diseases, April, 1879. |