NEURASTHENIA. — Gr. rapov, nerve; daoirria, weakness.
Definition.—Functional exhaustion or debility of the tissues, especially those of the nervous system, due primarily to impaired metabolism and secondarily to autointoxication.
Symptoms. — The most prominent symptom of neurasthenia is fatigue, often varying in degree with the dura tion of the case, but usually excessive and persistent. The patient complains of feeling "very tired" and of being able to do mental labor, the least con centration being followed by vertigo, headache, etc.
It is characteristic of this sense of fatigue that it is in simple and typical cases always relieved or lessened by- rest, and always brought on, if absent, or made worse, if present, by exertion. This readiness of fatigne is the primary and fundamental symptoms of neuras thenia. When the fatigue sensations be come exaggerated, they becom e painful, and are then described as aches. Der cmu (Alienist and Nenrol., Oct., '97).
Among the many types of neurasthe nia there are at least four with fairly well-marked characters: There are those due to anxiety and mental distress; cases due to overexertion and stress; others due to beginning degeneration of the neuron and destined to go on to organic breakdown; and a fourth due to toxic causes. In this last class there seems a definite cycle of symptoms: there is headache, fullness in the head, irritable temper, lack of ability- to concentrate the attention, irregular flushings; dyspeptic symptoms; regurgitation, eructation, constipation, foul and fectilant stools are common. There is a definite mental cycle. From noon until 9 r.m. the pa tient feels better, from that time the patient gets worse until 4 A.M.; when he awakes he is extremely depressed and remains so the entire morning. At noon greater cheer comes and the cycle repeats itself. 111. Allen Starr (Med. News, Alay 4, 1901).
The headache varies in intensity from a sensation of heaviness on the top of the head, or fullness, to a feeling com pared by some patients to that which an iron hand tightly constricting the head might produce. This is especially
marked after intellectual labor, and often disappears after the latter ceases.
Tlie pearanee of the patient does not aNays (l( note the existence of the neurasthenic state: indeed, his general iniun may suggest perfect health. In the majority of cases, however, there is pallor and an unmistakable appearance of weariness l.oss of weight and antemia are oft(ii present, and occasionally the physical debility is so great as to keep the patient in bed.
One of the first symptoms noticeable it, neurasthenia is the evident ancemia or. if not anretnia, II:curie change. In all eases of neurasthenia coming under per sonal observation there seems to be some hamie disturbance, no matter whether the case has as a basis an autotoxremia, a toxruinia as a sequel of preceding dis ease, or is apparently purely acquired or is of distinctly hereditary t3-Te. Each type may have some particular promi nent symptom, a sexual one or gastric one; but be the type or special symptom what it may, if the disease persists any length of time there presently appears a condition of blood fairly constant and typical of the disease. The reds may or may not be reduced in count,—at times may be even above count,—but the in dividual erythrocyte has undergone a change so that it resembles the cells in normal blood, which, for want of a better name, may be called old cells. In many cells the cytoplasm in stained specimens seems pushed out to the pe riphery to such an extent that the cell becomes dumb-bell shaped instead of the normal lenticular or biscuit shape. As a result, the cells pack together closely and show a marked diminution in volume by the hmnatokrit. The oxygen-carrying capacity is lowered, and in consequence the hmnoglobin is deficient in color-test. The blood in neurasthenia then would seem to be poor in oxygen-carrying ca pacity, arid not only this, but, owing to the poor vasomotor control, the periph eral blood at least varies much in its character. C. II. Lodor (Jour. Amer. Med. Assoc., Apr. 20, 1901).