THE RELATION OF CHRONIC NASAL INFLAM- MATION TO SO-CALLED NERVOUS PROS- TRATION; OR THE RESULT OF EXCESSES. THOS. F. RUMBOLD, M. D., Smm■Fwmgffiecr. There are many business and professional men who suffer from irritability of temper, from inability to hold the mind continuously on a definite subject, from sleeplessness, from for- getfulness and a state of mind in which their thoughts tend to wander from one trifling matter to another, who have a con- stant desire for change and excitement, who complain of con- tinual mental weariness and physical exhaustion and an almost complete loss of ambition. In the majority of instances these numerous mental and physical ailments are plainly traceable to the ultimate effect of excesses of various kinds. These excesses induce colds that affect the nasal mucous membrane, which ultimately affects the brain and other important organs of the body. But these symptoms are almost universally said, even by physicians, to be occasioned by continuous application of the mind to busi- ness and professional duties, and this condition is given the popular appellation “nervous prostration.” No doubt con- tinuous brain work may, in the case of a very few persons who are not affected with nasal inflammation, be sometimes the cause of peculiar mental conditions; but my observations have led me to believe that the symptoms very seldom appear except in persons who have chronically inflamed nasal passages, and that they are far more frequently the result of excesses and of colds induced by these excesses, which ulti- mately affect the brain, than by close mental application per se. Long continued and progressive nasal inflammation is far more frequently the cause of these symptoms of brain exhaus- tion and nervous prostration than it is credited with being. As this inflammation is rarely painful, the victim is entirely un- Chronic Nasal Inflammation and Nervous Prostration. 4 afflicted as mentioned above, acquired this disease in the manner I have described. Second. It is not likely that a person may be affected with nervous prostration as it is called and still have healthy nasal passages ? Answer. There may be such an instance, but I say I have not seen him, and I have looked for him for over thirty years. Thbd. Does it follow that every man who has a normally clear mind is also perfectly healthy in his nasal passages ? Answer. No, it does not. If he has a normally clear mind and has diseased nasal passages, it proves that the disease of these cavities has not reached the brain. It is not the inflam- mation of the nasal cavities per se that causes brain trouble, but the extension of this inflammation into the brain. Fourth. Does it follow that every man affected with nasal inflammation must suffer from the same mental disability as do those who commit excesses ? Answer. Yes, if the nasal inflammation has been severe enough to extend to the brain. A woman who does not com- mit these excesses and yet is afflicted with nasal inflammation that has extended to the brain will have some or all of these symptoms, especially if she taxes her brain as severely as do business and professional men. Fifth. If a business or professional man commits excesses, but does not attend to business or professional duties, will he show symptoms of brain exhaustion, that is, mental disa- bility ? Answer. No, his symptoms will not exhibit the full extent of his mental weakness, unless he exercises his brain. Sixth. Does it follow that any man may be affected seri- ousfy mentally by an apparent slight, but long standing, nasal inflammation ? Answer. Yes, just as some persons are seriously affected by trifling accidents, as a scratch of a pin, resulting in an attack of erysipelas. Seventh. Is there not a large number of men who have com- mitted these excesses, apparently as healthy as are those who have not committed these excesses ? Chronic Nasal Inflammation and Nervous ProsU ation. 5 Answer. It is well to use the qualifying phrase, “appa- rently as healthy,” in this question, for no such person can be healthy. It takes a longer time for the excesses to injure or kill some than it does others; but every person, without excep- tion, is injured by them when their use is continued for several years. Questions like these come from young men. It is seldom that an “old sinner” asks such questions, for they are fully aware of the evil effects of excesses; although some of these also give a few exceptional instances of old age, good health, etc., in support of their habits. That men are apparently healthy while addicted to excesses, is to them a guarantee that they also may indulge in the same excesses with impunity. Their statements of these apparent facts pointedly indicate that they want a good excuse to continue habits that have a posi- tive hold on their nervous system, and are continued for the mocking pleasure that is in them. Who hears of these men after they are broken down from the result of excesses ? Perhaps not more than one in fifty of them is known to the public, yet this one, in all probability, has done more harm in one month to young men by his per- nicious example and his ability to appear uninjured by his excesses, than he can correct by his daily regrets expressed during the last few years of his wretched, miserable, suffering life. It is the active, the apparently healthy, that are seen and heard; they are pointed to as proofs of the harmlessness of the excesses; the mentally and physically wrecked ones are out of popular sight and hearing. Show me the man who has indulged in the use of tobacco and stimulants, even moderately, from his fifteenth to his fiftieth year of age, and I will show you the man who fre- quently complains of being exhausted while attending to his business. He will complain of the other mental ailments men- tioned, and will require long vacations. If to these troubles he has added other diseases, acquired through immoral prac- tices,—which are partly the effects of the use of tobacco and stimulants on the mind, the tobacco, through its depressing effects begetting a desire for stimulants, and stimulants, vene- real excesses, followed by loss of the virile powers—his cup of unavailing regret will be full to overflowing. When such a 6 Chronic Nasal Inflammation and Nervous Prostration. man does breax down he is far more disabled mentally than physically. Show me the man who has not committed these or other ex- cesses, and has been an observer of the laws of hygiene, and I will show you the man who does not require a vacation, ex- cept from io o’clock each night to 7 o’clock next morning. He will be good for a full day’s work, every working day, until he is seventy-five years old, and when he gives up his daily work, it will be from natural, physical debility, rather than from mental decay; his mind will be clear and active. A marked contrast to the closing days of the man of excesses. The man who does not commit these excesses does not com- plain of being unable to get his business off of his mind at bed time. When he retires for the night he sleeps soundly and is completely rested, after which his brain is ready for another hard day’s work. He has no nasal inflammation to main- tain an unusual quantity of blood in his brain, this unusual quantity being the sole cause of sleeplessness. With him, as with other healthy persons, the usual, normal proportion of blood leaves his brain when he goes to bed, so that sleep is possible. It is the man whose brain is in such an hypersemic condi- tion that he cannot attend to business, that is unable to sleep soundly. He cannot sleep for the reason, he says, that he has not sufficient control of his mind to withdraw it from his business, yet when in his office, he has not sufficient con- trol of his mind to hold it on his business, showing plainly that the sleeplessness is not due to attention to business, as is said by many physicians, but to other causes that prevent sleep, namely, a diseased condition of the brain, preventing the normal decrease in the quantity of blood in the brain- cavity that is a prerequisite to healthful sleep. “Oh,” says some one to a merchant forty-five years old, who both smokes and chews tobacco inordinately and has drunk whiskey daily for ten or twenty years, “you have applied your- self so constantly and so long to your business that you have exhausted your brain, sir; you are neurasthenic, that is, you have nervous prostration, and if you are not careful you will bring on heart disease.” This flattering statement of his case is not the whole truth. Chronic Nasal Inflammation and Nervous Prostration. 7 Being incomplete, tlie information is erroneous, but worse than that, it is dangerous, for be is not warned of the true cause of his condition. That his brain is exhausted is evident from his inability to use it as he formerly had done, but while this inability to attend to business demonstrates exhaustion, it does not prove that it is the cause of exhaustion. If I should see a farmer who lives in a malarial country, and whose whole system is broken down by daily attacks of inter- mittent fever, fail to follow his plow, I could as truthfully or rather as correctly say : ‘ ‘ My dear fellow, you have plowed your farm for these fifteen years, it is too much for you, your muscular system is exhausted, sir.” That this farmer’s mus- cular system is exhausted is evident from his inability to con- tinue his daily work, but does this weakness demonstrate that his work is the cause of his disability ? Far from it. Are this farmer’s muscles exhausted by plowing or by the malarial fever? Is the merchant’s brain exhausted by atten- tion to business or by other congesting agencies? It is ex- ceedingly important to these two invalids that they receive a full as well as a correct answer to these questions. It is just as evident to me that the farmer’s muscular exhaustion is not due to his plowing per se, as it is that the merchant’s mental weakness is not due to his attention to business pe7 se, and in the latter case, it is due to the results of indulging his animal appetites to such an extent that his brain suffers secondarily. With a few exceptions, these invalid business and profes- sional men would have desisted at once from these excesses if they had been informed of the cause of their infirmities. This is the reason why I say that the physician who informs his patient that attention to business is the sole cause of his brain exhaustion, and that he is afflicted with nervous prostration as a consequence, has given dangerous as well as erroneous advice. If a business man observes that his mind is clear and quick when his head is in a normal condition, and that it is dull, cloudy and slow when his head is affected by a cold, or in damp weather, or after he has partaken of a wine supper and smoked inordinately, he may rest assured that these symptoms of men- tal disability demonstrate plainly that they result solely from inflammation in his nasal passages and the cavities connected Chronic Nasal Inflammation and Nervous Prostration. 8 >cith them, and not from continued application of his mind to any subject; nor is it from a fit of indigestion, as is said by some to be the case. Of course if the stomach or any impor- tant organ is out of order, it will greatly assist in bringing about mental disability. It is well known that when the brain performs its functions, that is, carries on a train of thought, this act in itself, induces a greater flow of blood to it than there would be were it in a passive condition. Even the mental exertion involved in com- puting as simple a calculation as 2 times 2 plus 2 minus 2 divided by 2 equals 2, occasions some degree of hyperaemia, but when the calculations are complex and involve numerous conditions, the degree of hyperaemia must be far greater. It is evident that if a brain be made hyperaemic by disease, as is done by chronic nasal inflammation, before commercial calculations and cares are undertaken, relief from mental exer- tion would be as beneficial as desisting from following the plow would be beneficial to the farmer spoken of; but it is also quite evident that relief from malarial influences in the one, and the congesting agencies in the case of the merchant, that is to say, the use of tobacco and stimulants, etc., that induce and maintain an abnormal flow of blood to the brain, is a far more important matter.