The study of neurasthenia, or patho logical fatigue, presents two essential conditions: 1. In normal fatigue, with the discharge of energy, the toxic prod ucts of exercise are always formed in nerve-and-muscle tissues. From this and other sources toxic elements ma,y ac cumulate in the blood and tissues; in pathological fatigue these contribute to a local or general inanition and auto intoxication. Visible changes in nerve cells, attending normal fatigue, go to support the inference of a molecular and chemical variation in pathological fatigue, manifested as a condition of ex hausted or changed nutritional power. These changes bear a direct relation to the etiology and pathology of neuras thenia; and habit, diathesis, and idio syncrasy have an important influence in causing "dispositions to repeat organic processes," both normal and abnormal. Physiological chemistry gives us some knowledge of the nature of autogenous toxic substances. 2. The study of the mental elements in normal and patho logical fatigue shows that the mental symptoms furnish a ready index of the "fatigue": (a) the eraotional tone is either one of well-being or ill-being, and the latter, with mental depre.ssion, indi cates changes in the "sense of body," or common sensations due to deficient energy, inanition, and autointoxication; (b) special disorders of intellect and will are shown by a neurasthenic weakening of voluntary attention, or tho mental pomer of inhibitory control, and of mem ory, etc. Cowles's Shattuck Lectures (Boston Med. and Surg. Jour., July 10 to Aug. 27, '01).
From the results of experiments it is believed that neurasthenia is associated with irregularities of oxidation of nitrog enous substances in the organism, and that it must therefore he classed +with the other disorders due to, and asso ciated with, disordered general metab olism. The chief cause is an intestinal autointoxication. Other predisposing causes of neurasthenia,—such as mental strain, ete.,—which may have their in fluence in the causation of the intestinal disorder, are not excluded.
In all cases there is a considerable diminution in urea and increase in the uric acid. The relation of the total nitrogen to the quantity of urea indi cates a marked decrease in the intensity of nitrogenous oxidation. The relation of the uric acid and disodium phosphate indicates an increased secretion of uric acid. In many cases the condition of the patient improves coincidently with the diminution or disappearance of the arthritic phenomena. Tbe changes in the urine are those characteristic of intes tinal putrefaction, thus suggesting that the cause of neurasthenia is in the in testinal tract. AV. von Bechterew (Neu rol. Centralb., Nov. 15, '98).
Analysis of the blood in thirty-three eases of neurasthenia. Many eases showed a decreased ratio of leucocytes to erythrocytes. Nearly all had a more or less marked oligochrominia, often with many microcytes and a few poikilo eytes. T. H. Romeiser and Joseph Collins (Medicine, Nov., 1000).
Prognosis. —If the organic changes outlined have not had time to so under mine the functions of the organs sec ondarily involved—especially the stom ach and kidneys—as to compromise their physiological functions in nutrition and elimination of waste-products. the prog nosis is usually favorable, provided proper prophylactic measures are strictly enforced, in conjunction with judicious treatment.
The occurrence of symptoms recalling locomotor ataxia or general paresis and impairment of articulation, though alarming, do not necessarily indicate a dangerous condition. Indeed, unless of
too prolonged standing, they are some times the first to yield to appropriate measures.
Study of arterial tension in neura,s thenia by means of the sphygmograph, showing that neurasthenic patients ma,y be divided into three classes: (1) those in whoin the vascular tension is nearly or quite normal and who quickly re cover; (2) those who slico,v a decided loss of vascular tone and who, after a course of treatment, regain a normal ten sion, and who usually recover in a longer or shorter time; (3) those in whom the vascular tone is very much below nor mal, and in whom under treatment it varies, but does not make any substan tial gain. These cases do not improve much, and whatever is gained is of very doubtful permanency. Webber (Boston Med. and Surg. ,Tour., May 5, '98).
Treatment. —Best, mental and phys ical, distractions, nutritious — though easily digested—food, and removal of baneful influences as far as possible con stitute the predominant features of treat ment. Physical and mental rest, how ever, do not imply the total cessation of activity, but a diminution of the work imposed upon the organism as a svhole, preserving for it sufficient dynamic stimulation to activate all vital proc esses. The slight increase in the action of the heart derived from short walk, for instance, increases the distribution of the food-products, and, as life is but the transformed energy of the food in gested, the primary factor of repair is thus assisted. Yet, undue exercise would, by lowering the vital powers, through fatigue, bring about a contrary effect. Metabolism being deprived of a sum of energy corresponding to the ex cess of exertion imposed upon the organ ism, its activity would be reduced in proportion and all the symptoms exag gerated.
This obviously suggests that all indi viduals should not be treated in the same manner, and that the just merits of each individual case should be taken as a guide. AD outline of the course adopted by Weir Mitchell in severe cases will serve to illustrate the general principles of treatment. "On awaking in the morning the patient is to take a cup of cocoa, after which she is to rest for twenty minutes. She is then to get out of bed and sponge herself with cool water or be sponged by an attendant, after which she is to be rubbed dry with a coarse towel. She is then to dress leisurely, and lie down for twenty min utes before breakfast; after which meal she is to lie down again for an hour, and rest absolutely. Massage should be given at 10 or 11 in the morning, and this be followed by an hour of rest. She then takes a cup of strong soup or, preferably, milk. The patient may then go about and attend to any duties until luncheon; and after this meal rest is also to be taken. During the afternoon the patient may walk or drive and at tend to business matters; but she should not exercise more than she can possibly help. If electricity be used, it is best given jus.t before the evening meal or at bed-time. The patient should retire early." All the phases of a drugless treatment are herein represented, each of which must be regulated to snit the patient's means and his strength. Traveling is almost always useful, unless too arduous; the eltaT,es of scene. of the varieties of food. etc., greatly tend to alter the mor bid trout of the mind and to stimulate the activities of the digestive apparatus.