Weakness

People come to the doctor saying, "I'm weak." Or they may say "I get tired easily." People who are healthy have vim and vigor. Ben Hecht once said: "They have bounce." Elasticity in both mind and body is a sign of health. Those who lack energy and who are listless usually have something wrong. Such symptoms may be quite different from the loss of power in the muscles, which may be due to other causes. Just being unduly fatigued is also different from being faint or slightly dizzy.

Any physical or emotional disorder can be accompanied by lack of energy or listlessness. After an acute infection, following hemorrhage whether sudden or prolonged, or following long-continued subjection to cancer, this lack of energy may be a prominent symptom.

A severe emotional outbreak or upset leaves people weak, exhausted. Such outbreaks can also lead to depression or neurosis accompanied by anxiety.

Lassitude or languor may also be noted frequently as the result of insufficient action of the thyroid gland or from deficiency of secretion in the adrenal glands. However, excessive action of the glands can also lead to overstimulation and ultimate exhaustion.

Lassitude is often observed by the doctor in cases of chronic disease of the liver; in the old days people called this "debility." Shakespeare says in As You Like It, " I did not woo the means of weakness and debility."

Various drugs, by their effects or actions on the body can bring about lassitude, among these particularly bromides, alcohol, and the barbituric acid derivatives.

Asthenia And Feebleness

A number of conditions can produce asthenia. A long-continued infection, an excessive action of the thyroid with too-rapid beating of the heart, severe anemia, nutritional deficiencies, or habitual taking of drugs or poisons may be a prime factor. The doctor has to make a thorough study using many laboratory tests to determine the cause with certainty.

Dr. Tinsley Harrison has said that nearly all patients with true asthenia have lassitude but the majority of patients with lassitude do not have asthenia.

When people are troubled by faintness, lightheadedness or dizziness a great variety of conditions must be investigated. Usually this symptom results from disturbance of the supply of blood to the brain. The difficulty may be in the blood vessels of the brain, in the power of action of the heart or in the quality of the blood. The symptom can occur also in epilepsy and in hysterical conditions. Sudden drop in the sugar in the blood also causes this symptom. This symptom makes people anxious, although the conditions causing it are seldom fatal.

Coma Or Unconsciousness

Persistent unconsciousness or coma is quite different from recurrent or repeated attacks of sudden fainting. The coma may be preceded by stupor or may alternate with delirium. Among the common causes of coma are serious deficiencies of oxygen, sugar or vitamins; excessive amounts of sedative or hypnotic or narcotic drugs. Coma occurs from intoxications associated with diabetes, uremia or liver disturbances. Heat stroke or freezing may result in long periods of unconsciousness. Damage to the circulation of the blood and excessive pressure on the brain, such as that which follows fractured skull or concussion, may be the cause of loss of consciousness that persists.

When the doctor examines a patient who has been long in coma he must find out first and as soon as possible the cause of the condition. Frequently unconscious people have been thrown into jail with a charge of drunkenness, when the cause of their stupor was not alcohol but a skull fracture. The same thing has happened to people who had had too much insulin. A person intoxicated by alcohol has the odor of alcohol on the breath; diabetic coma carries with it an odor like that of spoiled fruit and uremia gives an odor to the breath like that of urine. An exceedingly high temperature may mean heat stroke.

The doctor may measure the patient's blood pressure as a clue to the cause of unconsciousness. An exceedingly high blood pressure may mean a stroke, or apoplexy, or uremia. An exceedingly low pressure may mean diabetes, drugs, drunkenness, or a hemorrhage.

Convulsions

No single mechanism is known that is responsible for all kinds of convulsions. Changes in the supply of oxygen reaching the brain, in the relationship between acid and alkali-called the acid-base-balance; changes in the amount of calcium, sugar or chlorides in the blood; disturbance of the fluid balance or equilibrium between salt and water in the body and associated changes in the pressure on the brain have all been related to convulsions. A great variety of conditions may develop in which these chemical changes in the tissues of the body occur.

By a series of careful examinations the doctor can often classify convulsions in relationship to a definite cause, but there still remain great numbers of cases for which no specific cause can be determined. Where some positive factor is established-for instance, pressure on the brain from a growth, a gunshot wound or a fracture-some positive measures may be taken to control the epilepsy. Convulsions in children are most often idiopathic epilepsy. In older people a definite cause may be found as a tumor, or a change in pressure on the brain from some other cause.

When a person has convulsions, help should be given to keep him from injuring himself by falling against hard or sharp objects. A soft gag in the mouth will prevent biting or injuring the mouth and tongue. Doctors can prescribe or give by injection drugs that serve to induce quiet. However, any attack of convulsions should always be an indication or a warning that immediate steps must be taken to determine what is wrong.

Paralysis

Startling and frightening to any person is sudden loss of ability to move any portion of the body that one moves voluntarily. The anxiety associated with sudden loss of ability to see, or hear, or taste, or feel heat or pain, strikes terrible dismay. Yet these conditions are frequent enough to warrant the assurance that good medical care can do much to alleviate the difficulties and benefit people who have been stricken with paralysis.

Of course, such diseases as infantile paralysis or meningitis or encephalitis may damage only certain groups of muscles.

From the area involved and the symptoms associated the doctor may be able to tell the portion of the spinal cord or brain that is damaged. Much depends on whether there is just failure of movement, or whether this is accompanied by wasting of the tissues, difficulty in circulation of the blood or other significant factors.

Harm may come to the nervous system from hemorrhages, infections, blows or injuries, tearing or breaking of the nerves. A nerve can be injured in an arm or a leg, which then affects only the muscles reached by that nerve. A knowledge of just where each nerve originates and goes is needed for a diagnosis. Specialists with such knowledge are called neurologists.