with the male sexual organ have been credited with the most active etiological role, especially localized disorders, pros tatitis, posterior urethritis, seminal ves iculitis, etc., and general disorders and habits, such as gonorrhoea and mastur bation.
In neurasthenia involving the genito urinary organs there is nothing organ ically rong, although the finger in the rectum usually discloses a very sensitive condition of the prostatic region. In many of the cases the commencement of trouble is coincident with a preceding gonorthcea. Guyon (Ann. des Mal. des Organes Genito-urin., Sept., '93).
1. Neurasthenia proper can always be traced to excessive masturbation, unnatural sexual intercourse, etc. 2. Anxiety- neurasthcnia—distinguished by dread, restlessness, agoraphobia, vertigo in walking, sleeplessness, etc.—can also invariably be traced to sexual influences in the nature of unsatisfied impulses, coitus interruptus, abstinence with in flamed desires, etc. The physician is urged to assume an abnormal sexual life as his guiding star in the etiology of neurasthenia, as this alone will help him to treat it rationally, after winning his patient's confidence. Sigmund Freud (Wien. klin. Woch., Nos. 2, 4, 5, and 7, '98).
Many functional derangements of the genito-urinary system, which have been called purely nervous or symptoms of neurasthenia, have as their pathological and anatomical basis a chronic or other form of prostatitis, and the so-called neurasthenia disappears as soon as this pathological condition has been cured. If these cases were only recognized early and treated properly, there would be a great diminution in the number of neu rasthenic patients. A greater decrease, however, would follow the stamping out of gonorrlicea and the education of the public in the physiology of the sexual organs. Hottinger (Corresp. f. Schweizer Aerzte, No. 6, '97).
In most cases the active exercise of the sexual function is affected. The lesion, therefore, is to be looked for in or about the seminal vesicles and their ejaculatory ducts. In 19 of 20 consecu tive cases a seminal vesiculitis, and not neurasthenia, IA ill prove to be responsible for the symptoms. Eugene Fuller (Med. Rec., Feb. 5, '98).
Attention called to prevalence of neu rasthenia among those afflicted with a posterior urethritis either with or with out a stricture of large calibre. Whether
it is due to the worry of the local disease or from the poisons absorbed from the urethra itself is not clear, but probably both agents are at work. In syphilis neurasthenia is by no means uncommon, especially- among those who have been saturated with drugs. Indeed, the super saturation in many eases is the causal factor. Ravogli (Jour. Amer. Med. Assoc., May 21, '98).
A simple laceration of the perineum may result in profound neurasthenia that will disappear when the perineum is restored. Impaired sexual gratifica tion in. both male and female may result from laceration of the perinemn, and therefrom result unhappiness and neu rasthenia. In some cases the neiwous condition is the result of irritation from the vermiform appendix. Coecygodynia is a condition that may give rise to nerv ous symptoms on account of the inti mate relationship that exists between the coccyx and the ganglion impar. The fear of bearing children with the result ing efforts to induce sterility, thought to be a frequent cause of neurasthenia. Joseph Eastman (Med. News, June 25, '98).
Syphilis is often incriminated, but it is probable that the injudicious use of mercury is mainly responsible for the many cases traced to this cause.
Cases in which heredity play the preliminary rOle usually appear during the transition between childhood and puberty-15 to 20 years, while those in which the acquired form obtains occur during the most active period of life: i.e., between 30 to 45 years. Pathology.—Neurasthenia was until recently solely attributed to exhaustion of the nerve-centres presiding over gen eral nutrition, and particularly of the brain. Recent researches have tended to ilioNV, IIONNeVer, that the primary mor l.id changes exist in the organism at larp.'. Indeed, actual loss of substance in the protoplasmic cells, especially of the nucleus. has been noted by Hodge. impaired metabolism, with accumulation of waste-products, which in turn ac cumulate in the blood, gives rise to an autointoxication affecting especially the nervous system; and the functions over which the various systems preside are correspondingly impaired. This is fur ther encouraged by the continued waste of energy from which the patient suffers if he persists in imposing even slight tasks upon his weakened organism. A vicious circle of pathogenic activity is thus formed.