NEUBASTHENIA. 412 NEtTKASTHENIA. and Slavs sliow a speeial .susofplibility, and those of neuiopatliic lieredily and the otl'spring of the physically defective are prone to devel- op it. High altitudes, extremes of eliinatic conditions, wasting diseases, vicious habits, physical illness, injury, shock, and fright, or protracted anxiety, grief, worry, and excitement are comiKtcut causes. Excesses of all varieties, and finally and most important of all, overwork, must he added to the list. The only essential element in the causation of neurasthenia is overstrain, anil this is a quantity relative to the inherent capacities of the individual and often correlated with hered- itary tendencies or defects. Tile major .-iymptoms of the disorder are head- ache, backache, gastro-intestinal disturbances, neuromuscular weakness, mental depression, ir- ritability, and insonuiia. To these in varying number and of inconstant appearance are added tremor, twitchings, startings, sensations of gen- eral fatigue, pressure headaches, drawing feelings in the back of the neck and s)iine, tenderness at various points along the spine, particularly at its two extremities and at the waist, neuralgic pains, and various i)ariesthesi;e described as prickling, tightness, burning, numbness, stitTness, heat, cold, heaviness, soreness, and vague discom- forts referred to the body visgera. Use of the eyes commonly intcnsiiics the headache, and causes prompt fatigue with increase in all the subjective complaints. Sometimes patients sliun the light ccmtinuously. Nervous indigestion, gaseous fermentation, alternating diarrha-a and constipation, cardiac palpitation, feebleness of the circulation, and vascular storms are connnonly presented. The activity of the functions of the genitourinary tract is reduced. On the mental side there is loss of concentration and conse- quently memon* is enfeebled. Continuous appli- cation is impossible. Courage fails, introspec- tion becomes habitual, and many ap])rchensions and distinct phobias of a hypochondiiacnl cast add to the patient's misery. The natural af- fections are diminished and depressed emotiims are continuous. The sleep, disturbed by troiibled dreams, is broken and unrefreshing. The early morning hours are particularly gloomy. The pa- tient's general boilily condition is unsatisfac- tory. .
- emia and loss of llesh are commonly en-
countered.! bough ex<ei>tionally the general nutri- tion is excellent. The great majority of these sym])toms it will be noticed are subjective, not demonstrable physically and ca])able of nnsrep- rcscntation. For this reason such patients are misunderstood by their friends, who either foster the condition by mi.sguided solicitude or give it scant sympathy. A careful examination proves that the nerve force is actually diminished and strength exhausted with undue ease. This is demonstrated by the Cfmtraction of the visual fields under ajijircqiriate tests, the inilial exag- geration and progressive reiluclion of the teiuhm reflexes, the inability to maintain dynamographic records, the tendency to rapid heart, the diges- tive inailequacy, etc. . y one or even very many of the enumerated symptoms may be found in other ailments, hut it is their systematic group- ing and the exclusion of other competent morbid states that enables a diagnosis of neurasthenia to be made. When the brain functions are principally dis- ordered the term cerebral neurasthenia is some- times employed. In the same way spinal and sexual neurasthenia are mentioned, luit in neiuas- thenia no function escapes, though there may be a vaiying preponderance of certain classes of symptoms. All functions are marked by an irri- table weakness. Often this nervims disorder is as- sociated with hysteria, particularly in the trau- matic cases. Not seldom it is secondary to an initial bodily disease, which nuxy or may n(it be present at the same time. Neurasthenia is essentially chronic. Its causa- tion is connnonly of long standing, its onset in- sidious, its course protracted, its recession halt- ing and uuirked by relapses, its tendency to re- currence |u-onounced. It is often associated m ith organic and inorganic diseases, and is encnun- tered as an initial stage in the development of hypochondriasis, melancholia, mania, and gen- eral |)aresis. When iuvc(mi])lieated by organic diseases its ))rognosis is usually fairly gooii. pro- vided the causal conditions can be removed and sullieient adequate rest and upbuilding secured. -Vs it often arises out of the necessities of human existence and social conditions, its proper treat- ment is frequently impossible. The keynote is rest, and in proportion as this can be made com- plete both mentally and physically success re- .sults. The full rest cure plan of Mitchell, espe- cially with women, often secures brilliant re- sults. In a modified form in mild eases it is also ellicient. It implies the expenditure of nuicli time and money. When this is not possible, change of scene, of occupation, of preexisting in- lluences nuist otherwise be obtaineil. The burden of work, the fretting, and earking cares nmsl be minimized, and llu' physical health and stamina raised to the highest ])ossible level. If such pa- tients can be fattened success is almost assured. Drugs play an entirely secondary part in the treatment of neurasthenia, merely meeting inci- dental physical requirements. . y umlerlying physical disease of whirii ni'uraslhcnia may he the superficial manifestation nuist of course re- ceive major care. To the mental perturbation, however, constant attention nuist be ilirecled. The patient's fears nust be allayed, his hopeful- ness encouraged, his introspection diverted, and refreshing sleep .secured. In proportion as the physician grasps the mental siile of the disease, secures the patient's confidence, and meets the requirements of his biased views, in that ratio is he successful and heli)ful in managing the neiuosis. A number of more or less .speculative theorie.s regarding the essence of neurasthenia are cur- rent. Ilodge and others have ])roven by interest- ing lab(u-atory experiments that under conditions of ordinary use the protoplasm of the motor cells is nuirphologieally mmlified and probably more or less exhausted funet i<inally : that during rest and repose it regains its fdrmer appearance and po- tential force. Some enneeive that in neuraslbe- nia the rest periods have been so inadequate that the recuperative powers are belittled, and there is reason to suppose that in some instances this may reach an irrejiarable degenerative degree. Certain allegeil peculiarities of the blood and the freneral disturbance of assimilation are looked upnn by others as arguing a general toxic stale which gives rise to the neurasthenie manifesta- tions. These findings are as likely to be efTeet as cause, but doubtless might operate in a vicious circle to protract the nervous disorder.
