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Lassitude has its morbid underpinnings which is a primary subject of all doctors and ministers to eliminate from our modern life its vicious and physical manifestations. Its consequences could certainly be reduced largely if the rules of righteous living laid down in this Christian Home Doctor were learned and put into practice by the general public.
Although not precisely definable in terms or accurately measurable, fatigue is a bodily condition of prime importance both to the individual and to the community
Ordinary fatigue of body or mind is a natural phenomenon with which we are well acquainted, and it is only when the fatigue becomes excessive or too easily brought about that it becomes of medical interest.
Muscular fatigue though it may be due to lack of nourishment, is ordinarily the produet of the lengthened use of muscles with resulting accumulation of waste products. Of these carbon dioxide and lactic acid are the chief. Fatigue is thus a sign that one is going too fast, and guides us to protect ourselves from further harm by resting.
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The explanation of indifference to fatigue is found in the relation between expenditure of energy and the amount on deposit. Incessant change in bodily processes is characteristic of life. This change may be sluggish or it may be rapid. If too slow, the tissues and organs of the body are not properly renovated; and if too rapid tissues are broken down faster than they can, be rebuilt and deterioration ensues.
The primary seat of fatigue must be sought either in the central nerve cells or in the delicate network connecting them (synapses). Thence, however it spreads, and may involve all the organs of the body. In normal individuals mental fatigue to the extent of actual exhaustion is not common.
Two types of nervous fatigue may be recognized. There is the natural weariness at the end of the day which leads to sleep and recuperation thereby. The other is more insidious, and has the perverse symptoms of seeming stimulation. It is a state of hypersensitiveness and unrest. The sufferer cannot adequately relax himself and thus aggravates his abnormal state. When advanced, such a condition is termed neurasthenia.,
Continuous fatigue present in a general condition of ill-health or a general feeling of unfitness, and as a symptom of oncoming disease is dealt with under Exhaustion.
"Monday Morning" Inertia Fatigue, as is well known, tends to show itself during the latter days of each week. But it is always less obvious on Saturday morning, when the knowledge of the coming rest appears to banish it. Curiously enough on Monday morning output is usually low, not because of fatigue but because of inertia or rustiness. That, however, is a different problem. Obviously the best hours of work in any setting are those during which the highest output is obtained and maintained. Any rest pauses or shortening of hours which increase the general output are good; any which decrease it are bad.
The amount of energy displayed by any given person will differ, perhaps greatly, from the standard or average according to the individual chosen. Thus, lack of energy, lassitude, listlessness, etc. need not necessarily be a manifestation of bodily disorder unless they are contrary to the individual's normal temperament.
There are many conditions which undoubtedly help to produce a languorous condition - lack of fresh air, constipation and other sources of toxaemia, and bad feeding (nutrition) are among the most important.
The diet must contain a large proportion of fresh material if it is to produce the required amount of energy for bodily functions. Insufficient sleep is another prcdisposing cause. A young adult needs at least eight hours of sleep per day; an older person less. Languor is characteristic also of neurasthenic conditions, the result of mental stress or unrest.
Change of surronndings; fresh air good food and right habits of living are the best means of combating a depressed condition.
The pathological causes of weakness and lassitude may be said to be almost manifold. They may roughly be divided into three groups according to their outstanding features:
1. In the first are diseases which give rise to toxaemia. Any septic focus in the body may become a chronic source of absorption of these poisons. Whilst they may give rise to very serious consequences in the form of rheumatism and arthritis, they all cause lassitude. Bad teeth, or pyorrhoea, or constipation are examples which spring to the mind. But among the less well-known affections may be numbered discharges from the ear and infections of the air saes in the bones of the head, i.e. accumulation of pus in the various sinuses. Chronic appendicitis, chronic gastritis and dilatation of the stomach have the same effect.
2. The malignant new growths comprise the second group. Wherever they may be situated, whatever the particular type, they result in anaemia and wasting, a combination of symptoms known as cachexia.
3. The last big division is made up of the anaemias. Pernicious anaemia shows the phenomenon in its most marked degree; but all of them, from the comparatively simple chlorosis to the acute leukaemias, are characterised by lassitude.
Among the acute specific fevers this exhaustion is very prominerit during the onset of typhoid fever, whilst the wealeness and depression consequent on an attack of influcnza are often so marked as to require extreme measures for their amelioration.
This is not a scientific diagnosis, but a loose and nearly meaningless term which may be applied to almost any so-called nervous condition in which a general want of capacity and liability to fatigue are prominent.. It pertains more to the state of neurasthenia (q.v.), which is essentially a fatigue neurosis.
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.
In Animals. General ill health, loss of weight, nervous excitability and depression are usually the visible sions of a this condition. The most frequent causes are digestive disturbances, due to under-feeding, irregular hours, overwork, iusufficient water, bad teeth, etc. There are also a number of chronic diseases which produce a condition of debility in various ways. Tuberculosis, cancer, worms or skin parasites are examples.
The effect of tubereulosis on its victims is too well known for comment, but debility caused by parasites may be more obscure. The action of lice on animals is most exhausting and debilitating, as they not only cause an irritation, but actually suck blood.
Old age, and the diseases of the kidney ancf the heart so often accompanying old age, are also factors which must be recognized. When an animal is seen to be unthrifty, capricious in its appetite and generally upset, that is to say, when a state of debility has been arrived at, very careful diagnosis is required, as so many causes may be operating.