BODY WEIGHT AND MENTAL IMPROVEMENT. BY DR. A. R. MOULTON, Although defective nutrition of the body is well known to be one of the principal predisposing causes of nervous and mental disorders, I am unable to find in the books and monographs at my command a distinct discussion of the relation between bodily weight and mental condition. In giving the clinical histories of their cases, few authors record the weight of their patients when well, and most of them make only a cursory allusion to the avoirdupois as affected by treatment, or to its significance as a desirable condition. Full stress has been laid upon the harmful effects of overwork in general, the debilitating influences of disease, and the dangers attending privation and care; the subject of toxic agencies in the organism, and their action upon the brain, has been well-nigh exhausted, and the question of the effects of "organic sympathies" in causing mental breakdown, or continuing the subject of them in a state of mental disorder, is receiving its share of discussion; but, under the head of treatment, the importance of fattening patients before lasting improvement can be expected has not, to my mind, received the consideration it deserves. There is, however, testimony which bears out the writer's belief that improvement in the recoverable class of the insane depends upon improved nutrition, is usually preceded by gain in weight, and that successful treatment is along those lines. Clouston speaks of one of his cases "getting very stout," after which he improved and returned to his family. To maintain this condition "every effort is made to keep up bodily health and stoutness." Again he says, Again he says, "every pound of body-weight gained means a gain in nervous and mental tone." One of his examples is of a man who "gained a stone in weight, and was well in six months," while another was discharged recovered at the end of five months, "having gained a stone and a half in weight," showing the hopefulness in some forms of melancholia, and giving a key to the line of the treatment pursued. Clouston also records the case of a woman who got well after being five years insane, having become "very stout and healthy." In another case the same author "did not give up hope, for the patient digested eleven glasses of milk a day, and gained weight," and as a prophylactic in one case, besides following certain set forms as to his daily life, he was advised to weigh himself every month and to stop work and take a sea voyage "when he found he had lost three pounds." Macphail, in his chapter upon the "Blood of the Insane," in "Tuke's Dictionary of Psychological Medicine," remarks that "there appears to be a close connection between gain in weight, improvement in the quality of the blood, and mental recovery." Bucknil and Tuke long ago said: "Mental health depends so greatly upon physical health, that the physician will constantly be able to promote the prophylaxis by giving good advice as to the growth of a sound body." They truthfully assert that the brain must have a free circulation of arterial blood, and that "in the stage of acute insanity the treatment is physiological." Stearns, in directing as to the treatment in melancholia, states a very important truth in describing a condition, frequently met with in all forms of insanity, and his conclusions are in accordance with those of other observers. He says "the tendency is to lose flesh and become emaciated; the nerve centres are imperfectly nourished and consequently have an insufficiency of energy; hence, when the patient once begins to increase in adipose tissue, it is a most favorable indication, and one looking toward recovery." Doctor Chapin has frequently, in his hospital reports and elsewhere, shown that recovery from mental disorder is intimately connected with, if it does not depend upon, improved general health, and in his report for 1892 he says: "We continue to recognize that our acute and recoverable cases embrace a large number who have passed into a stage of various forms of mental disorder, preceded by nervous prostration and caused by overwork, illness, some defective nutrition of the nervous mass, some deficiency in the quality of the blood, or quantity of same. They have a chance to make a good recovery with improved sleep, nutrition, and an average increase of weight, usually amounting to twenty pounds." The following cases treated in the department for men, Pennsylvania Hospital for the Insane, are illustrative of the thought herein expressed: 1. Is a lawyer, twenty-seven years of age, who was admitted to the hospital on April 28, 1892. Three uncles had been insane, all of whom recovered. This patient was intemperate, and had been in poor physical health for some years. He had been melancholy and suicidal for four months, and when admitted was confused, had hallucinations of hearing, a sluggish circulation, sub-normal temperature, was thin and anæmic. He had suffered from insomnia; and chloral, the bromides, and caffeine had been given, which had had a stupefying effect upon him. For many weeks his mental reflexes were slow, and he suffered the usual dyspeptic symptoms of melancholia. He gained flesh, and on November 15th (nearly seven months after admission) weighed one hundred and forty-one pounds, which was increased by three pounds during the next month, when the records state that "he is quite bright, answers questions more readily, and talks freely with his friends." During the next month his weight fell off nearly twenty pounds, and his mental condition suggested approaching dementia. Following this period, from the last of January, 1893, to the middle of the next November, the patient was in an unsatisfactory state, at first being dull, almost stupid, then he became exalted with violent tendencies. His weight varied from one hundred and thirty-two to one hundred and forty pounds, and when it was lowest he was wakeful and noisy at night, in addition to being opinionated and irritable. In November, 1893, it was necessary to place him in the refractory ward, which is so constructed that patients may get an abundance of out-door air. This man spent nearly fourteen hours a day out of doors. Most nourishing food was continued, and from this time on the curves of mental coherence and of bodily weight were steadily upward. His delusions vanished, and there was the usual transformation seen in patients passing from stupor, with impulsive interruptions, to complete convalescence, when the weight was one hundred and fifty pounds. This gentleman has no recollection of making the journey from his home in Cuba to the hospital, and occurrences at the institution previous to November, 1893, are vague and shadowy. His brother and sister brought him to the hospital, remained in the city and visited him twice a week for a year, yet the only remembrance he has of their presence is the impression that somebody used to call upon him, and that he called the gentleman John," not his brother's name. 2. Is a young man who was twenty years of age when admitted to the hospital on July 23, 1892. There was a decided insane diathesis in his family, though no member had become actually insane. He had always been thin and delicate, and within a comparatively brief period he grew to be very tall, measuring six feet two inches. Four months previous to admission he had la grippe. He worked hard as a bookkeeper, and first showed signs of insanity four days before admission. When received he was in a furiously maniacal condition, and he was too sick to be placed on the scales until July 30th, when he weighed 118 pounds. Under nourishing food, tonics, cod-liver oil, the hypophosphites, etc., he did well, and his excitement was subsiding, when, in the middle of August, he was made much worse by the injudiciousness of his family; his mania returned with increased violence, and on September 3d his weight had fallen to 111 pounds. Food in the shape of milk, eggnog, chicken broth, strong beef tea, etc., was given every hour and a half (fully five quarts of milk or its equivalent being taken during the twenty-four hours), and as soon as he would masticate and swallow solid food it was pushed. By the last of October he had reached 132 pounds in weight, but, although his circulation was less sluggish and his blood had gotten richer, it was nearly another month before his excitement and incoherence had decidedly improved. Then he would sit down quietly, began to make up his sleep, of which he was very short, and he passed on to recovery, going home on December 10th. He weighed at the time 135 pounds, a gain of twenty pounds. He has remained well, and, as is not at all unusual after a patient resumes the active duties of life, has lost a little weight. * As a convenience for the printer, the tabulations were substituted for the weight charts, as originally prepared. W He was 3. Is a young man, a student, twenty years of age. admitted to the hospital on February 14, 1893. He had applied himself closely to his studies, and during the previous October he slept badly and became exhilarated; then he was melancholy for two weeks and began to lose flesh, when positive mania supervened, which increased down to the time of his admission. He was much excited for a few days, but under forced feeding and some stimulation, with the necessary remedies to encourage the excretions and aid digestion, he became quiet and soon slept well. On February 27th, thirteen days after admission, he weighed 154 pounds. The psychical storm through which he passed was followed by stupor, with imperfect circulation, cold extremities, constipation, etc. His weight went down to 147 pounds in April, rose a little, and by the last of May had fallen to 145 pounds, when he did not respond to the calls of nature, nor even seem to understand what was said to him. He was at times suddenly violent. During the next two months he received constant personal attention, was kept much in the open air, and, when the weather was suitable, under the direct rays of the sun; his circulation was stimulated by massage, walking, calisthenics, etc.; large quantities of nourishing food were given, and tonics administered. At the end of July he weighed 154 pounds, his circulation had improved, and, though passive, he was no longer violent. From this time on he gained flesh very rapidly, and his mental improvement was equally marked. He proved to be a fastidious young man, whose disposition was happy and mental reflexes responsive. When discharged on August 28th he weighed 171 pounds, a gain of twenty-six pounds. |