Richardson, Neurasthenic Factor in Mental Disease. 183 



of the patient. The nutritive error in the cell elements of the 

 brain often continues long after the general condition has im- 

 proved. I know of no other form of disease in which such 

 patient perseverance in well doing is necessary. 



The treatment of such nutritional errors is a complex sub- 

 ject. It will require every resource of the physician and tax 

 his ingenuity to the utmost. It is by no means restricted to the use 

 of medicinal agents. The first requisite is a sufficient supply of as 

 similative material of good quality as represented in healthy blood. 

 The second is to secure the opportunity of the brain cells to receive 

 this by a correction of the hyperaemia, obstruction or degener- 

 ation which has prevented it reaching them. The third is to 

 diminish the demands upon the cells so that their work shall 

 not be in excess of their recuperative power. The 

 fourth is to secure the prompt removal of their waste 

 products by clearing the channel of the lymph spaces of the 

 debris which has come from the obstruction of the blood cur- 

 rent. The fifth is to divert the functional activity of the cells 

 from the directions in which it is defective, and to develop new 

 functional tendencies, new habits of action, if such they may be 

 called, to the end that the healthy balance may be re-estab- 

 lished. We are required to repair their diminished inhibitory 

 control and to .stimulate them to activity where disuse has led 

 to disorder 



We have not space to go further into details, but it may be 

 said, in general terms, that medicinal agents are not so potent as 

 the regulation of functional activity in the cell elements. 



