I HAVE been requested to write a Preface to the “Modern Malady,” and I have pleasure in doing so, as it seems to me that the author, with whose views I am in general agreement, has adequately and successfully carried out a work, not over easy, but certainly wanted—i.e., an introduction to public consideration, from a non-medical point of view, of a condition of ill-health which is increasingly prevalent in all ranks of society; which is as common in the slums of the East End as in the mansions of the West; which incapacitates innumerable people (both men and women) from the efficient discharge of the duties, and from the proper enjoyment of the pleasures, of life; which undoubtedly often owes its origin to injudicious medication; which is quite capable of cure in certain ways which are not those generally adopted; and which is still more capable of prevention.

The condition is technically called “Neurasthenia,” or “nerve-weakness.” This is but a generic word, a convenient designation for a condition of the nervous system, the symptoms of which vary widely; but beneath all these symptoms, various as they may be, there is as their foundation a condition of nerve-prostration and fatigue; and a permanent removal of this condition is only brought about by keeping in mind a recollection of its origin and directing treatment to the fons et origo mali; by repairing, if only slightly damaged, by building up, if shattered, this unfortunate nervous system. This state of ill-health used to be called “Hysteria,” a name derived from an erroneous idea that there is a special connection between the disease and a particular organ of the body. It was even once thought that this organ moved about to various parts of the body, and so caused the local symptoms; and various nauseous drugs were given for centuries, on the theory that by their offensive taste they would drive the wanderer back to its proper place. It is also popularly supposed that “hysterical” people simulate their symptoms and can control them if they wish. Both of these views are quite wrong. The disease is a real disease, as truly a disease as is a fever or an attack of bronchitis, and it is found in men as well as women. In this connection I would ask, with Cyril Bennett, “Do the majority of people know that they possess a nervous system at all? We still hear educated persons talk of their nerves as if they were something spiritual, as though nervous disorder were not a physical disease.”

We should remember that the nervous system is one continuous structure, and it is only the necessities of nomenclature and the ingenuity of anatomists that have divided it into so many parts. It is as continuous as is an oak tree with its various branches. The spinal cord and the nerves are composed in varying proportions of the same materials as is that part of the system which we call the brain: injury and disease with them give rise to symptoms analogous to similar injury or disease to the brain. Indeed, there are several brains,—some in the cord itself, one in relation with the stomach and called the “abdominal brain,”—but the intellect and perception reside only in that portion of nervous material which is confined within the skull; injury there—in addition to the symptoms common to injury in other parts—influencing intellect, perception, and memory; and this is the only distinction.

Neurasthenia is especially prevalent, not only with members of certain families (we all know people peculiarly liable to suffer from the “nerves”), but certain races are more prone to it than others—the French and American more than ourselves; and this fact must not be lost sight of, nor the fact that the relatives of many of these patients—probably afflicted themselves with a latent form of the same condition—are frequently but ill-fitted to help the patient to recovery, so that a temporary removal from their care is sometimes advisable.

But prevention is better than cure, and this is best secured by healthy hygienic, physical, mental, and moral surroundings,—by bestowing upon the growing human plant a share of as intelligent a care as the gardener bestows upon his grapes and his peaches; by no undue forcing, by no undue straining, and by no undue school pressure; but by bodily exercises in proportion to the strength of the body, and progressively increased as the strength of the body increases, and by mental exercises equally proportioned to the increasing mental strength, and not forced beyond it; for the exercise of nerve-power is as fatiguing as that of muscle-power, brings on the same feeling of exhaustion, and requires the same recuperation by adequate food and rest.

So much for prevention: but when the nervous system has broken down—when the symptoms may vary from extreme mental and physical exhaustion to that condition of what has been called “Death-trance,” where the patient is apparently dead; that condition which has furnished the theme for many a sensational story (but the most ghastly incidents of fiction have been paralleled by authenticated facts)—then treatment comes in. The less physic-drinking the better. As the late Sir William Gull said, “Medicine was once given even for fractures. Disease is not cured by drugs. It is the power of Nature that cures disease, and the duty of the medical man is—not to give drugs—but to assist Nature.” So spoke Sir William Gull; and Lord Coleridge, deciding a law case not long since, said, “If you give a man drugs, you make him the arena of a conflict of opposing poisons.”

The first thing to do, is to try to remove whatever defect in the general health can be discovered. Then local treatment should be had recourse to. One method of such treatment is that perfected by Weir Mitchell of Philadelphia, and extensively carried out in this country by Playfair, myself, and others. Stated generally, it consists, in severe cases, in keeping the patient absolutely at rest in bed, and obtaining the tonic influence of exercise by daily massage and electricity,—i.e., skilled rubbing and kneading of the muscles, and putting them in action by electricity. At the same time abundant food is given in an easily digestible form. By this method the wearying effects of fatigue are avoided and patients often recover rapidly. Skilled massage and electrisation are essential. Without these, rest in bed will probably convert the patient into a helpless invalid. This method has been carried out extensively, and with marked success, for several years past, at the West End School of Massage and Electricity, 67 Welbeck Street, some of whose students have been sent to the Continent, India, and the Colonies, there training other nurses, and becoming new centres of usefulness.

But while upon this subject of massage, I would enter my earnest protest against what is called “isolation,” and especially against any attempt to “manage” a patient. As Cyril Bennett wrote in a former work, when a doctor and a nurse think they are “managing” an invalid, nervous, suffering woman, you may depend upon it that in nine cases out of ten they are mis-managing her. The best physicians of the day are remarkable, not more for their medical knowledge and skill, than for their charm of manner, their human kindness, their warm sympathy with suffering. The wise physician is the family friend, the trusted adviser, the counsellor and comforter in many a trouble and anxiety: and so also with the nurse. She should possess the sensitive rather than the strong hand, and refinement, patience, tact, and sympathy.

In certain cases of nervous disease, great benefit is derived from the use alone, and without massage, of the variety of electricity called “Franklinism,” after the illustrious philosopher and statesman who so carefully studied it. We have all heard the story of the thunder-cloud, the kite, the key tied to the kite-string; Franklin’s disappointment that he obtained no electricity; its coming on to rain, and by wetting the string making it a conductor; and his delight at being able to draw sparks—real miniature flashes of lightning—from the key with his knuckles. This form of electricity has been little used until a short time since, owing to certain inconveniences in its application; but recent improvements in the manufacture of instruments have largely removed these inconveniences, and placed at our service a remedy of great promise, and in some cases of unequalled value.

The thanks of the medical profession are due to “Cyril Bennett” for a sagacious, though not unkindly, criticism upon the more common methods of treatment of that distressing affection, the “Modern Malady;” and in indicating from a medical standpoint the opinions of a neurologist, I venture to hope that the views of the author, who has so skilfully sketched its salient features, may have received some support.

Finally, I would say that the day for the routine treatment of disease has gone by, and progress of the most important character is being made in the study of diet, exercise, sleep, rest, the application of water, cold and hot, and many other agencies; and it has been well said that if in the future, as in the past, nervous diseases are to be the measure of our civilisation; if every increase in the illuminating power of the mind is but an increase of surface to be eclipsed; if all new modes of action of nerve-force are to be so many added pathways to sorrow; if each fresh discovery or invention is to be matched by some new malady of the nerves; we yet have this assurance, that science, with keen eyes and steps that are not slow, is seeking and is finding means of prevention and relief.

HERBERT TIBBITS.