in the body, in the heart region, in the head, in the abdomen, in the thorax (chest, etc.).  In some cases the anxiety becomes intense.  They are so restless they do not know what to do with themselves.  They throw themselves on the bed, complain, and cry, etc.  Sometimes the patients become so desperate they commit suicide.  Some patients do not wish to see anyone.  Some patients cannot read, reading wearies them so much, or they get confused and dizzy and must stop.  Some are very irritable.  They complain of everything.  Remember they cannot help it, usually.  Some are easily insulted and claim they are misunderstood.  The circulation may be disturbed in some cases.  Then there is palpitation of the heart, irregular and very rapid pulse, pains, and feeling of oppression around the heart, cold hands, and feet.  The heart’s action may be increased by the least excitement and with the fast pulse and palpitation there are feelings of dizziness and anxiety and such patients are sure they have organic disease of the heart.  No wonder.  Flashes of heat, especially in the head, and transient congestion of the skin are distressing symptoms.  Profuse sweating may occur.  In women, especially, and sometimes in men, the hands and feet are cold, the nose is red or blue, and the face feels “pinched.”  Nervous dyspepsia is present in many cases.  The digestion is poor and slow and constipation accompanies it.  Sometimes there is neuralgia of the stomach.  The sexual organs are seemingly affected, many men are “almost scared to death” and they use all sorts of quack remedies to restore their sexual vigor.  Spermatorrhea is their bugbear.  They usually get well if they stop worrying.  In women there is the tender ovary and the menstruation may be painful or irregular.  The condition of the urine in these patients is important.  Many cases are complicated with lithaemia (sand-stone in the urine).  It is sometimes also increased in quantity.

[Nervous system 281]

Physicians’ treatment for Nervous Prostration.—­The patient must be assured and made to believe that the disease is curable, but that it will take time and earnest help on the part of the patient.  Much medicine is not needed, only enough to keep the system working well.  Encouragement is what is needed from attendants.  Remove the patient from the causes that produce the trouble, whether it be business, worry, over-study, too much social duties, or excesses of any kind.  The patient must have confidence in the physician, and he must be attentive to the complaints of the patient.  It is the height of foolishness and absurdity for a physician to tell such a patient before he has thoroughly examined him or her that the troubles are imaginary.  I believe that is not prudent in the majority of cases.  I have heard physicians talk that way to such patients.  I thought, what fools!  The patient needs proper sympathy and sensible encouragement.  You must