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Debility is a general term denoting imperfect health. For descriptive purposes debility is classified as general, nervous, or cardiac, according to the system which appears to suffer most yet it must always be borne in mind that any lowering of the vitality of any one part of the body is bound to react harmfully upon the health of the whole.
General Debility
This shows itself in an impaired power of performing the accustomed activities of life without fatigue and distress it is often the earliest warning of some serious disease that is at first obscure in its nature and insidious in its attack. With the weakening of physical power is associated also a weakening of those powers by which the body is enabled to resist the onset of disease and to overcome the results of infection.
The bodily weakness acts and is reacted upon by the mind. Worry about the health, as about business or anything else, lowers vitality, depresses then vital functions and slows down the nervous activities.
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The causes of general debility are numerous usually more than one can be found responsible. Unhealthy surroundings, unsuitable and insufficient food, lack of exercise, and absorption of poisons from the digestive tract are responsible individually or collectively for much debility among those who, while suffering as yet from no definite disease, are in a state of impaired health which unfits them for the activities of their daily life. Proper nourishment, abundant sunlight and unlimited fresh air are the prime necessities for health, and of these a well balanced dietary are by far the most important; deprived of any of these the vital powers are lessened, the resistance to disease is lowered, and the growth and maintenance of the tissues in health and vigour seriously impaired.
The body demands a certain irreducible number of elements in its food, and of each of these a certain irreducible quantity must be forthcoming ; substitution of one form of food by another is possible only within certain well defined limits; if these are over-stepped ill health follows, it is of equal importance that the processes of digestion should not be impaired by careless habits with regard to feeding, temperance in food and proper mastication.
By muscular exercise the body ensures three very important things: efficient circulation, efficient respiratory exchange of gases in the lungs, and adequate removal of waste matters from the body, A sedentary life restricts all these beneficial functions, and, coupled, as it so often is, with shelter from sunlight and confinement in a vitiated atmosphere, is a potent source of debility.
Absorption of poisons is a very common cause of general debility. The process is so insidious and its cumulative effects are produced so gradually that it is often overlooked until some acute illness or serious failure of health calls attention to a long established state of chronic poisoning (auto-intoxication). Constipation is a very common example of such causes of debility; stagnation in the large bowel, with putrefaction of its contents, and the excessive growth of harmful germs explains many a case of impaired vitality. Chronic infections of the teeth and tonsils are other examples of common causes of debility. The poisonous fumes of arsenic, lead or hydrocarbons are an occasional cause and are usually unsuspected.
Toxins of the tubercle bacillus may produce a state of general debility that precedes by weeks or months the more obvious and striking symptoms and signs of tuberculosis, in the young patient especially the possible existence of a tuberculous origin for debility must always be remembered and excluded.
Acute illnesses in which there is severe poisoning of the heart or nervous system, or both, by the infective organisms and their products as in typhoid fever, influenza and pneumonia may be followed by a debilitated condition that may last for months.
The natural degenerative changes in the blood vessels, the heart, the ductless glands and the digestive organs incident to advancing years may explain the gradually increasing debility of the aged. In some cases, however, some more active cause may quicken the rate of progress of the disability, and may be amenable to appropriate treatment.
Profound Influences of Ductless Glands
Anomalies of the ductless glands (q.v.) explain a certain proportion of many cases of obscure debility which are met with. These glands, of which the thyroid, supra-renal, pituitary and sex glands may be sited as examples, secrete certain substances which are absorbed direct into the blood and exert profound influences upon the working of the various orgaus of the body and upon its health and development as a whole.
Failure of these glands to function actively is, however, generally secondary to some of the causes above mentioned, and is therefore best dealt with by treating the cause. Under skilled supervision the giving of appropriate ductless gland materials derived from animals may be helpful, but the blind use of such remedies is far more likely to do more harm than good in the long run.
Nervous Debility
Debility has its nervous and physical manifestations, but in what is often called nervous debility the nervous symptoms are the most prominent and may completely overshadow the physical state, its manifestations are largely mental; brain fag (q.v.), fatigue after moderate mental effort, loss of the power of concentration, unreliability of memory, irritability and loss of control of the emotions are common complaints. To the onlooker the condition may reveal itself by a fixity of the lines of facial expression (facial wrinkles), a fine tremor of the hands, an indistinctness of speech or an excessive response to an external stimulus. Almost invariably the sufferer is the subject of recurring headaches of considerable severity.
Nervous debility has many causes; it may he the sequel to exhausting illness of any kind, or to prolonged chronic poisoning. Or it may follow prolonged mental and physical strain, such as that of nursing a sick relative, profound mental shocks, worry, severe emotional disturbance or some hidden source of mental conflict.
Treatment of nervous debility will depend on the cause of the trouble, but mental influences are likely to be the most useful. At the same time general measures designed to improve the physical condition and vascular tone are necessary.
Cardiac Debility
So far as it represents organic affection of the heart, this condition is far less common than is supposed. As a result of fever, prolonged illness or definite heart disease, heart weakness may occur, but the vast bulk of so-called weak hearts are not weak at all; they are merely irritable and unstable in their action. Their condition is due to disordered nervous control, or to poisoning from some hidden source such as a septic tonsil, dental decay, or chronic appendicitis.
Enfeeblement of muscular and nervous energy produced by various agents and activities and in which available energy is brought almost or completely to a standstill is spoken of as exhaustion. In all probability the process involves in nearly all instances an excess of toxic substances, themselves the products of muscular or nervous activity. When these accumulate to a certain amount in the muscle or in the blood stream and other tissues the nervous system becomes poisoned to the extent that it can no longer function normally.
Causes of exhaustion may be prolonged physical strain involving, of course, nervous as well as purely muscular strain, severe physical injury as in an aecident, surgical operations, privation or starvation, emotional stress such as worry or anxiety or the stress of war conditions and prolonged or severe illness of any kind. All these lead to the production of so-called "fatigue substances" which bring about symptoms of exhaustion.
The symptoms of general exhaustion are in order: Excessive weariness of mind and body, loss of interest in the outside world, headache, irritability, depression, loss of memory, loss of power of concentration and finally actual confusion of mind which may lcad to abnormal conduct and delusional ideas.
On the physical side there is loss of flesh, loss of muscular power, dyspepsia, constipation and exaggeration of the nervous reflexes. Any system or organ in the body may exhibit functional derangement as a result of exhaustion. Exhaustion may, of course, occur in a particular muscle or group of muscles when induced by over action limited to them.
Brain fag, nervous prostration, exhaustion, is a condition characterised by increased suscentibility to fatigue on slight exertion, whether physical or mental. It is an old term what we would equate today with chronic fatigue (editor). The usual cause is associated with anxiety, worry or excitement, or prolonged emotional disturbance due to failure to adapt to the circumstances of life. In many cases there is a condition of auto-intoxication (q.v.) at the root of the trouble. Excessive work alone, if undertaken in favourable conditions, rarely gives rise to symptoms of brain fag. It is commonest during the middle period of life, and most readily affects those who possess an unstable or highly strung nervous system. It should also he remembered that overwork is a relative term, depending on the forces and endowment of the individual. the excessive use of tea or coffee, or the use of more powerful drugs to whip the flagging energies of an overtired brain, aggravates the condition.
As regards the mental attitude, brain fag shows itself by forgetfulness, moodiness, restlessness, and lack of concentration. Sustained effort is impossible. The subject may be depressed or irritable, quarrelsome and exacting. Sleep is generally fitful and the sufferer wakes in the morning feeling tired. He is usually at his best about tea-time.
All the senses become over-excitable. Noises, such as the rumble of traffic or the crowing of a cock, which were easily tolerated when in health. now seem unbearable. A bright light is intolerable. The skin is unduly sensitive to cold. A frequent symptom is a heavy, numb sensation on the head, which has been termed a lead-cap. The will-power is reduced.
A characteristic physical condition accompanies these mental symptoms. The sufferer generally loses weight and is pale. The hands are tremulous and moist with sweat. The legs feel heavy, the appetite is poor and discomfort follows eating. The muscles, like the mind, are fatigued by slight exertion.
The treatment of early or mild cases of brain fag may be summed up in two words- rest and change. A restful holiday in cheerful surroundings, a few days in bed, or a change of occupation, will sometimes suffice to recoup squandered energies. In prolonged cases a cure is always attainable, but a prolonged period of rest with isolation from all disturbing influences and, usually, a course of psychological or spiritual treatment are necessary. Toxaemic cases require treatment directed to removing the source of poisoning, in addition to that directed to the nervous state. Mild sedatives are also indicated in nearly all cases. Afterwards a carefully regulated life of simple routine without strain should be secured, if possible.
Exhaustion is a definite entity in animals, and those used for sport, especially the horse, are the most liable to be affected. It occurs when animals which are not perfectly fit are subjected to prolonged exertion.
The symptoms are that the animal collapses and has not the energy to move another step; if it has fallen it lies with the head extended and is unable to rise. The breathing is shallow and accelerated and the pulse fast and weak. If the animal is allowed to rest for a while it will usually recover sufficiently to be moved, but on no account should it be hurried. All unnecessary exertion should be avoided, and if the patient is a horse, he should be placed in the nearest stable or loose box, bedded down, bandaged, rugged and made as comfortable as possible.
He must not be given cold water to drink, but some that has had the chill taken off, or, better still, linseed or oatmeal gruel. This is most important, as in animals which have been subjected to physical strain ending in exhaustion the blood has collected to a great extent in the vessels of the abdomen and those of the intestines are intensely congested. Should the animal be given a drink of cold water this comes in direct contact with the congested vessels and causes a sudden chill.
Stimulants such as alcohol (whisky or brandy), spirits of nitrous ether, aromatic spirits of ammonia or camphor should be given either by the mouth or subcutaneously and the animal should be fed with soft, nourishing and easily digested food and be rested for two or three days.