Another typical neurasthenic complaint is nervous asthenopia, which has been exhaustively studied by Wi'brand and Siinger and which most commonly develops between the ages of In and I I.
"The patients complain of flickering before the eyes; they say that the letters and lines on a page disappear as they look at them, that everything is confused, and that reading makes the eyes water and gives them violent pain in the brow and eyes. When a child complain ing of these symptoms is asked to read aloud it is noticed that it soon begins to halt; the individual words are not properly recognized, and sometimes whole syllables are improperly pronounced. The child grad ually holds the book nearer and nearer; for a time it is able to read a few words correctly, and then the old trouble begins again. Finally, when the little patient is holding the book so close that it almost touches its nose, the reading stops altogether and a series of peculiar rnanceuvres, rotation of the head, turning of the book toward the source of light, and so on, are begun without producing any improvement in the vision. These visible efforts to read are accompanied by wrinkling of the fore head, contraction of the eyebrows and of the orbicularis palpebraruni, twitching of the lips, and in short, by a series of active as.sociated move ments in the entire muscular region supplied by the facial nerve.
"According to Wi!brand and Sanger, this affection is quite frequent ; but although we paid especial attention to the matter we hardly ever found a ease of it in our own material. Nevertheless, it is of some im portance as a typical neurasthenic affection.
" With regard to the psychic behavior of the child, the irritable weak ness first manifests itself in a striking uncertainty of disposition, while the intelligence, on the other hand, seems to be but little affected. Owing to the diminished resistance to fatigue, the child's attention soon flags and it loses interest in studies which it hacl previously pursued with pleasure and a desire to excel; so that children who are suffering from neurasthenia, although of norrnal intelligence, go on from bad to worse in their school work and exhibit a constantly increasing dulness (neurasthenia cerebralis, limminghaus). This dulness is often the expres sion of a melancholic or hypochondriacal depression, whieh also is the direct result of the subjective sense of weakness.
" In young neurasthenic children fear is the most prominent psychic symptom. The children are afraid of everything strange that they are brought in contact with; they are afraid of any friendly little (log or eat, of a new toy, of a strange face or unfamiliar room. At the same time this fear, which manifests itself in wild outcries and struggles and a terrified expression of countenance, has no normal motive and is not due to any past experience of harm: for even a child with .sound nerves
will ery out on seeing a dog, if it has ever been bitten, and bawls and struggles against the doctor, if the latter has ever hurt him. Older children usually control themselves to the extent of suppressing their tears and manage to keep frotn crying out, but it is ea.sy to see that fear is gripping them by the throat and that they are hardly able to speak. At the same time they remain at a respectful distance from the doctor and tremble whenever he makes the slightest movement.
" Sometimes the children hide their fears under an assumption of courage or obstinacy. Thus, I know a four-year-old neurasthenic who, whenever Ile is spoken to by a stranger, shakes his Est at him, although with a frightened expression of countenance, and threatens to "soak him one," but at once bursts into tears and tries to run away if one attempts to molest him.
" Fear as well as joy, especially in older children, finds expression in severe paroxysms of sustained convulsive laughing or crying. Children who as soon as they enter the consulting room, or at the latest when they are undressed, make a wild scene, and throw themselves on the floor in a fit of rage, are always neurasthenic children that have also been badly brought up. In many of these neurasthenic children the emotion of fear or anger, sometimes also of sudden fright after some inadvertent injury, produces brief attacks of a dazed condition ('Ireg blcibeil') which the laity quite aptly describe as 'convulsive rage.' " These attacks have recently been described in detail by Neumann. When the child attempts to cry it is unable to progress beyond tbe stage of inspiration; the expiratory muscles remain in spasmodic contraction and breathing is arrested. In desperation the child strikes out with its fists once or twice, the face becomes pale and the entire body rigid, the eyes are turned up, and consciousness is last. As a rule, involuntary evacuation of the bowels does not take place. Usually the attack lasts only a few seconds, although to the anxious relatives it often seems as many minutes. As the spasm relaxes the child, who in the meantime has usually fallen backward, rarely forward, at last manages to catch its breath and gives a loud cry, which may or may not be preceded by a short inspiration, as if the child had at last succeeded in making the intended expiratory movement which it was prevented from effecting by the spasm of the inspiratory muscles." As appears from this description, attacks of this kind may show a very great similarity to the expiratory apncea which is related to laryngo spasm (see page 30F.).