in examining a large nuinber of pa tients suffering from neurasthenia it was noticed that the customary increase in the rapidity of the pulse that follows the movements of the body in these cases does not occur if the patients bend far forward. After continuing its previous rhythm for from 4 to 15 beats, there is a sudden reGardation of the pulse, which continues for about 16 beats. After this, the pulse gradually reaches its former rapidity. Ortner also pointed out that the sante result ensues if the patients bend their heads backward. This phe nomenon is explained through the venous congestion of the vagns centre, giving rise to slight irritation of that centre. S. Erben (Wiener Woch., :lune 16, '98).
Fine muscular tremors are often ol).
served, especially of the orbicularis oris and the lingual muscles. Short spas modie contractions of isolated groups of muscular fibres and aimless movements of the extremities that suggest, when finial muscles are involved, chorea. The tendon-retlexes are increased in the ma jority of cases.
Vision is often impaired. symptoms sur.gesting astig,inatisin following any prolonged use of the eyes. The pupils sometimes appear unusually large and and often unequal, while the accommo dation seems defective. Unilateral ptosis is often observed. The eyes feel weary and heavy. and letters become blurred: flashes and pain are experienced in most cases after reading even a very short time—a few minutes.
The urine is occasionally increased in quantity, but this is by no means as im portant a sign as some writers would have it. "Lithmmic neurasthenia" is a term applied to a form in which, besides the other symptoms enumerated, mani festations of lithmmia are marked. Phosphaturia. oxaluria. and glycosuria are frequently noted.
Series of non-traumatic cases of hys teria, hypoehondria, and neurasthenia. They showed alimentary glycosuria in 14.4 per cent., as against 32.6 per cent. in traumatic neuroses, which seems to indicate that the latter occupies a posi tion somewhat apart from other func tional nervous diseases. Studies of this nature are especially desirable in neu rasthenia. M. Arndt (Berl. klin. Woeh., Dee. 5, TS).
Sexual impotence is more or less marked and in some cases total. Sem inal emissions at night and durin,,-_, defe cation and micturition may be frequent, and depression after coitus is usually complained of. The testicles or ovaries may be extremely sensitive to pressure, a dull, heavy pain, quite persistent at times, being occasionally experienced.
Digestion is enfeebled and delayed and is associated with atonic constipa tion, and gastralgia is sometimes plained of. Diarrlice,a, however, is no ticed in a small proportion of cases.
hi 3:13 cases analyzed, depression oc curred in 22 per cent., mental confusion in 10 per cent.. headache in 56 per cent.,
general pain in 30 per cent_ insomnia in 70 per eent.. inyasthenia in 37 per cent.. palpitation in 22 per cent., and disturb ance of digestion in nearly all. The initial symptom was most frequently headache. b.:nee-jerk was normal, but ,:howed a slight tendency to exaggera tion (22 per cent.). In 30 per cent. of the patients there was loss of flesh. Joseph Collins ancl Corlin Phillips (Med. Record. -.Mar. 25, '99).
Gastric neurasthenia is not an affec tion of the stomach, pure and simple, but a local expression of a general neu rasthenia, and is. in fact, the commonest manifestation of it. The patient has, in all probability, suffered for a long. time with general neurasthenia of a mild form, but has taken little notice of the diminished capacity for mental and physical work, and the other character istic symptoms, and it is not. until to these are added the special gastric troubles that lie decides to obtain ined ieal advice.
reg,ards the reco,r2mition of gastric neurasthenia, one is practically justified in diagnosing it when we have excluded all organic or anatomical affections of the stomach, and in addition find the characteristic stigmata of general neu rasthenia. The signs elicited upon a physical examination of the patient, and which will confirm the diagnosis. are the following: 1. One will probably be able to elicit the splashing sound (elapote inent, Mayen plutschern) during the whole of the digestive period, but the absence of food-residues from the stomach be fore breakfast will show that the severe form of myasthenia gastriett is absent. It is important to bear in mind that gastric plashing is absent in eases char acterized by the presence of sensory neuroses only. 2. There are usually spots painful on pressure in the upper abdominal region. There is not a single one, as in ulcer, but several, and these not so acutely tender. 3. No diagnostic information is to be obtained hy the chemical exam inn tion of the gastric juice. Usually there is slight hypochlor hydria, occasionally hyperchlorhydria, and often it is quite normal. 4. Gas troptosis and nephroptosis are often present, and strongly suggest neuras thenia. The diagnosis is thus mainly to be made by a process of exclusion. Cieorge Herschel] (Edinburgh Med. Jour., Jan., 1902).
Tinnitus aurium, hyperacousis, and loss of taste also occasionally attend the more prominent symptoms. Undue red ness of the ears and conjunctiva are fre quently observed.
Diagnosis.—Various neuroses and psy choses may readily be taken for neuras thenia when the symptoms of the latter are few and indefinite, but this is rare, and the characteristic fatigue mented by the main symptoms that typify the affection usually' render a diagnosis easy.