1911 Encyclopædia Britannica/Neurasthenia

NEURASTHENIA (Gr. νεῦρον, nerve, and ἀσθένεια, weakness), the general medical term for a condition of weakness of the nervous system. The symptoms may present themselves as follows: (1) general feeling of malaise, combined with a mixed state of excitement and depression; (2) headache, sometimes with the addition of vertigo, deafness and a transitory clouding of consciousness simulating petit mal or migraine; (3) disturbed and restless, unrefreshing sleep, often troubled with dreams; (4) weakness of memory, especially for recent events; (5) blurring of sight, noises or ringing in the ears; (6) variable disturbances of sensibility, especially scattered analgesia (partial and symmetrical) affecting the backs of the hands especially, and in women the breasts; (7) various troubles of sympathetic origin, notably localized coldness, particularly in the extremities, morbid heats, flushings and sweats; (8) various phenomena of nervous depression associated with functional disturbances of organs, e.g. muscular weakness, lack of tone, and sense of fatigue upon effort, dyspepsia and gastric atony with dilatation of the stomach and gastralgia; pseudo-anginal attacks and palpitation of the heart; loss of sexual power with nocturnal pollutions and premature ejaculations leading to apprehension of oncoming impotence. Objective signs met with in organic disease are absent, but the knee-jerks are usually exaggerated.

According to the complexity of symptoms, the neurasthenia is more particularly defined as cerebral, spinal, gastric and sexual. The cerebral form is sometimes termed psychasthenia, and is liable to present morbid fears or phobias, e.g. agoraphobia (fright in crowds), monophobia (fright of being alone), claustrophobia (fright of being in a confined place), anthropophobia (fright of society), batophobia (fright of things falling), siderodromophobia (fright of railway travelling). There may also be mental ruminations, in which there is a continuous flow of connected ideas from which there is no breaking away, often most insistent at night and leading to insomnia. Sometimes there is arithmomania (an imperative idea to count). Such cases often exhibit a marked emotionalism and readily manifest joy or sorrow; they may be cynical, pessimistic, introspective and self-centred, only able to talk about themselves or matters of personal interest, yet they frequently possess great intellectual ability, and although there may be mental depression, there is an absence of the insane ideas characteristic of melancholia.

Traumatic neurasthenia is the neurasthenia following shock from injury; it is sometimes termed " railway spine," " railway brain," from the frequency with which it occurs after railway accidents, especially in people of a nervous temperament. The physical injury at the time may be slight, so that the patient is able to resume work, but symptoms develop later which may simulate serious organic disease. As in all forms of neurasthenia, the subjective symptoms may be numerous and varied, whereas the objective signs are but few and slight. Many difficulties, therefore, present themselves in arriving at a sound opinion as to the future in such cases. It is desirable not only to study the case carefully, but to obtain some knowledge of the previous history of an individual who is claiming damages on account of traumatic neurasthenia.  (F. W. Mo.)