Neurasthenia.

Synonym.—Nervous Prostration.

Definition.—A chronic functional disease of the nervous system, characterized by mental and physical exhaustion.

Etiology.—Like most functional nervous lesions, certain predisposing factors play an important part, chief of which may be mentioned heredity, occupation, age, and sex.

Heredity.—All parents suffering, not only from nervous derangements, such as irritability, degenerations, etc., but also from syphilis, tuberculosis, rheumatism, and kindred affections, bequeath to their offspring a feeble vitality and feeble resisting power which are favorable to neurasthenia.

Occupation.—Any profession or calling that entails great mental strain, and where large responsibilities are assumed, favors neurasthenia.

Age.—Neurasthenia comes with maturity, when the cares and anxieties of life press heavy; hence is rarely seen before twenty nor after the age of fifty-five or sixty, when the burdens are shifted to younger shoulders.

Sex.—Unlike hysteria, the majority of neurasthenics are found among men.

Exciting Causes.—Overwork exhausts not only physical but mental power as well, and the great competition and tension that prevails in all lines of work and business, necessitates a great tax on the mental power, and often results in overwork. Whenever a man takes his business cares home with him, dines with them and sleeps with them, lie is on the road that leads to neurasthenia. Sexual excesses and masturbation exhaust nerve force, and are a fruitful cause of the disease.

Orificial irritation is one of the most common exciting causes, and one that is perhaps the most frequently overlooked. Rectal lesions are prolific causes of nerve waste, while urinary wrongs sap the vitality and give rise to prostration.

Unhappy marriages are not an infrequent cause of neurasthenia in both sexes, while fear of infectious diseases may so wear upon the nervous system as to give rise to the disease. Various accidents, especially those occurring on railroads and on the water, may cause the disease, and is known as traumatic neurasthenia.

Pathology.—There are no characteristic pathological changes in this disease, and about all that can be said of the lesion is, that it consists of irritation of the nerve centers, followed by more or less weakness.

Symptoms.—The symptoms are so varied and complex that it will simplify their narration to group the cases according to the predominance of certain phenomena; thus we have the cerebral, the spinal, the gastro-intestinal, the cardiac, the urinary, and the sexual varieties.

The general symptoms are great irritability, marked despondency, great prostration, both physical and mental, without sufficient cause, and loss of weight. So many are the symptoms that the patient, fearing that some may be forgotten, presents a long list of symptoms carefully written down.

The Cerebral Variety.—Headache is a prominent symptom, there frequently being tenderness of the scalp. Insomnia is quite characteristic, and the patient arises unrefreshed; there is more or less despondency; the patient is anxious, worried, and fearful of some impending danger. There is impairment of memory, and reading seems to tire the patient; in fact, a continued tired feeling is generally present.

The Spinal Variety.—Great weakness and prostration is a common symptom, the patient complaining of feeling sore and stiff on rising. Backache, with tenderness along the spine, is characteristic, while there is perverted sensibility, manifested by a tingling, crawling, or burning sensation, or certain parts will feel hot or cold; sometimes there will be lightning pains, simulating locomotor ataxia. Ankle clonus is sometimes present, while the reflexes are exaggerated.

Gastro-intestinal Variety.—Gastric disturbances, with their attendant symptoms, are the chief characteristics of this form. Hyperacidity, waterbrash, nausea, retching, and vomiting, with more or less headache, are present. The patient sleeps poorly, has unpleasant dreams, and develops an irritable disposition. There is flatulency, rumbling of the bowels, constipation alternated with diarrhea, and a sense of weight or soreness over the abdomen.

The Cardiac Variety.—While there is an absence of organic lesions, there is palpitation on slight exertion, precordial distress, and sometimes sharp pain as in angina. Throbbing of the abdominal aorta is a distressing symptom and one that causes much anxiety on the patient's part. In some cases a capillary pulse may be detected. This group of symptoms causes the patient to become fearful of a sudden termination of life. Loss of flesh is apt to accompany this form.

Urinary Variety.—The quantity of urine voided is usually small, and albuminuria, oxaluria, and glycosuria may be present. The patient becomes irritable, and there is a dull headache.

Sexual Variety.—A victim of this variety is often an object of pity. The fear of becoming impotent preys upon the mind, the patient is melancholy, sleeps poorly, has nocturnal emissions, complains of pain or crawling sensations in the testicles, has perverted sexual desires, and frequently masturbates. The patient, worried and distracted, leads a miserable existence.

Diagnosis.—This is not often difficult. The physical and mental prostration without undue exertion, the multiplicity of symptoms, with due prominence of some one of the above groups, makes the diagnosis one of but little difficulty.

Prognosis.—Where the patient has not become the victim of morphia, chloral, or alcohol, and where a rational treatment is early observed, the prognosis is favorable. Where the patient's mind can be centered on something" besides self, and where hope can be aroused, the patient will recover.

Treatment.—A careful search for the cause must be made, the removal of which starts the patient, many times, to a speedy recovery, the history of the following case being a good illustration:

Mr. A, aged forty-five, a prominent business man, had suffered many things, chief of which was a constant headache at the base of the brain. Failing to get relief from medication, galvanism, and massage, he was placed on the rest-cure as outlined by Weir Mitchell. He gave up his business for six months and devoted his time to the rest-cure. After six months of this treatment the pain in the head subsided, and he returned to his business, only to find a return of the pain in the occipital region. At this time I saw the patient, and obtained the above history. On examining his rectum (he was not aware of any trouble in this part of his anatomy), I found a rectal fissure, the cauterization of which not only stopped the headache, but effected a permanent cure. After a failure of six months' treatment by diet and rest, a single application of nitric acid to the anal fissure effected a cure.

Where orificial irritation is the cause of the lesion, and it is a very frequent cause, nothing in the way of rest or medication can take the place of a removal of the cause.

The same may be said of overwork of an organ; it must have rest, and if it be the brain, but little result may be looked for unless mental rest is secured. Where sexual excesses are draining the system, the patient can not hope for relief if he continue his dissipations.

Many times a sea voyage gives the best of results, securing not only an enforced bodily rest, but the constant change (where the voyage is along the coast with frequent ports) furnishes an agreeable rest for the mind as well.

The rest-cure, as first introduced by Weir Mitchell, will many times be the only effective treatment. This may be modified to suit the individual case. The treatment consists in absolute rest (the worst cases not being allowed to get up to void urine, the feces, or even turn in bed without assistance), passive exercise, massage, diet, and, electricity. As the patient improves, baths are to be added. The treatment is to be continued from one to three months. A favorite diet in the beginning" is one glass of milk every two hours, gradually increasing the quantity till lie is taking a pint or more at each feeding. After two or three weeks, solids are added, which consist of fruits and vegetables, and finally chops, steak, and roast-beef. The faradic and static currents give the best results.

Where the patient is not very sensitive to shock, cold shower or sponge baths are attended by good results. As the patient grows stronger and takes on flesh, outdoor exercise should be taken, care being exercised not to carry it to exhaustion. Tennis, golf, rowing, and surf-bathing will prove of great benefit in stimulating the appetite, improving digestion, and establishing the excretions.

The patient should have cheerful surroundings, agreeable companions, and his reading should be of a light vein and a humorous style, especially avoiding the tragic and all that tends to excite the mind. In the way of medication, the treatment will be entirely symptomatic, only giving remedies when specially indicated. Avena, passiflora, rhus, and the compound tonic mixture will be frequently called for, while chronic constipation must be corrected by appropriate medication before much relief will be obtained.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.