Clinical lectures on Neurasthenia.

  • Savill, Thomas Dixon, 1856-1910.
Date:
1899
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Licence: Public Domain Mark

Credit: Clinical lectures on Neurasthenia. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    74/168 (page 54)
    Turning now to the question of toxic blood conditions, it is worthy of note in the first place that a very large proportion of the cases I have collected presented some feature in the history of their illness which was, at any rate, capable of producing a toxic condition of the blood. Influenza, scarlatina, and other blood disorders might be mentioned; but certainly by far the most common of these at this hospital was some form of gastric disorder. Out of 157 cases, taken without selection from among my hospital out-patients, 74 revealed definite evidences of some form of dyspepsia, mostly accompanied by constipation, going on for periods varying between a few months and ten years, prio7- to the advent of the neurasthenic symptoms. This fact has a most important bearing on the question before us, as we shall see, for there can be no doubt that gastric disorder results in a defective elaboration of the products of digestion, and the pouring into the blood of a large quantity of imperfectly elaborated and toxic products. Constipation is capable of acting detrimentally in the same way, owing to the reabsorption of many materials which are intended for excretion. That a considerable amoimt of absorption takes place through the large intestine is suffi- ciently evidenced by the maintenance of nutrition and weight, upon the administration of enemata alone in cases, for instance, of gastric ulcer. Bad food or a dietary con- taining a deficiency or excess of certain articles, even without indigestion, are some of other errors which, in persons otherwise predisposed, may, I believe, give rise to neurasthenia; but my cases do not afford statistical proof of this latter point. The frequent association of dyspepsia, or at any rate, dyspeptic symptoms, with neurasthenia, is now universally admitted. A good many observers state that dyspepsia or dyspeptic symptoms frequently precede, accompany or follow the neurasthenia. But their precise relationship is not yet agreed upon, and in my belief is very often seriously misunderstood. Now when two morbid conditions, a and b, are frequently associated, a may be the cause of b or h of a, or they may both be the product of some common cause. These are not precisely the possibilities in the