EXONITTIALMIC GOITRE may also be confounded with neurasthenia, but only when there is no exoplithalmos. The enlargement of the thyroid becomes the only reliable distinguishing feature, the rapid pulse, agitation, tremor, etc., being all present in neurasthenia.
Etiology.—To hereditary influence is attributed the majority of cases of neu Heredity is one of the most important cause.s of neurasthenia. Among acquired causes, the worry attending business affairs, the sequel:1i of infectious diseases, , especially influenza, are regarded as pe culiar factors. Influenza is especially I commOn as a forerunner of neurasthenia, occurring among physicia ns. Phillip ' Zenner (-Jour. Amer. Med. Assoc., May 21, '98).
In women, excessive fecundity, dys menorrhcea, and the menopause arc thought to exercise a marked exciting influence.
it is true that puberty, adolescence, the puerperium, menstruation, and the menopause are often closely related to the outbreak or to the exacerbation of many nervous and mental disorders, but the pelvic organs themselves play but a ' small rOle in these physiological commo lions. They have to do with the whole organism of woman. Pelvic diseases in woman attended by exhausting pain may give rise to neurasthenic and hys terical stat,es, but the influence of ex hausting pain in these organs is no greater than similar exhausting pain elsewhere in the body. Disorders of the female organs which affect the nutrition of the nervous system, such as excessive hternorrhage or suppurative processes, may also be in:portant factors in induc ing functional neurosis, though disor dered blood-states brought about by pelvic disease are very infrequent RS comparea with disordered blood-states dependent upon disease elsewhere. Fred erick Peterson (Anrals of Gyn. and Ped., Aug., '93).
Analysis of 333 cases: 55 per cent. were males, 45 per cent. females. The oldest 1 patient was 67 years, the youngest 6. A large proportion of neurasthenics were Jews. The chief causes were apparently overwork (27 cases) and masturbation (20 cases). In about 50 per cent. of the I.
eases neuropathic diathesis existed. Stig mata of degeneracy were present in 14.3 per cent. Joseph Collins and Carlin Phillips (Med. Record, Mar. 25, '99).
Of all these causes, those connected rasthenia. but a more correct interpreta :,oit of the facts would probably only 4,erihe to heredity a predisposing intim. ence. The disease would thus only ap ear on condition that factors capable of -tarting it prevail during the exposed individual's life. Predisposition through parental neuroses, psychoses, excesses of all kinds. particularly in sexual relations, lowers the resistance of the organism as a living entity (not only of the nervous system). and pathogenic factors find a fruitful field which, had not inherited depravity prevailed, would have proved sterile. Gout, rheumatism, syphilis, and tuberculosis may also act as predisposing conditions in the offspring.
Individuals so predisposed represent by far the majority of cases witnessed. There is another class, however, in which the ever-increasing responsibilities at tending modern methods of living, unrestrained extravagance, desire to promptly acquire wealth, and the worri ment attending the responsibilities in curred, undermines the vital powers of the organism, and do for it what pre disposition, heredity, has procnred for the class first considered. If the lat ter are never exposed, neurasthenic symptoms never develop; if the victim of worriment can so change his occupa tion and. his mode of living before the inroad of the malady is marked, a prompt return to health usually results. In both classes the exciting conditions are similar; and sexual indiscretion, continued worry and overwork, shock accompanying injury, exposure, indis cretions in diet, improperly selected or insufficient food, and many diseases, particularly influenza, syphilis, typhoid fever, and such disorders as alcoholism, morphinism, cocainomania, etc., will act as primary causative factors of the typ ical form.