NEURASTHENIA (Nee Lat.. from Gk.
veupov, neuron, nerve aRthenria, weakness), nerve weakness. Perhaps the most fre quent of the acquired neuroses. The symptom group making up this clinical entity was first familiarized by Beard of New York in 1g69. and it is sometimes called the American disease, though now recognized as a world-wide malady. As a rule all forms of nervous energy are reduced and fatigue quickly appears upon the exercise of any motor, mental. or organic'. activity. It is es sentially a disorder of the productive period of life, hut does over in neurotic children and in nervous adults of advaneed years. The sexes are about equally affected. Hebrews, Scandinavians, and Slays show .t special susceptibility, and those of neuropathic heredity and the offspring of the physically defective are prone to devel op it.
High altitudes, extremes of climatic conditions, wasting diseases, vicious habits, physical illness, injury, shuck, and fright, or protracted anxiety, grief. worry. and excitement are competent causes. Excesses of all varieties, and finally and most important of all, overwork. must be added to the list. The only essential element in the causation of neurasthenia is overstrain, and this is a quantity relative to the inherent capacities of the individual and often correlated with hered itary tendencies or defects.
The major symptoms of the disorder are head ache, backache, gastro-intestinal disturbances, nenro muscular weakness, mental depression, ir ritability, and insomnia. To these in varying number and of inconstant appearance are added tremor, twitchings, starlings, sensations of gen eral fatigue, pressure headaches. drawing feelings in the back of the neck and spine, tenderness at various points along the spine, particularly at its two extremities and at the waist. neuralgic pains, and various para•sthesia- described as prickling, tightness, burning. numbness, stiffness, heat, cold, heaviness. soreness, and vague discom forts referred to (lie body viscera. Use of the
eves commonly intensities the headaelle, and causes prompt fatigue with increase in all the subjective complaints. Somet imes patients shun the light continuously. Nervous indigestion, gaseous fermentation, alternating diarrhma and constipation, cardiac palpitation, feebleness of the circulation, and vascular storms are commonly presented. The activity of the functions of the genito-urinary tract is reduced. On the mental side there is loss of concentration and conse quently memory is enfeebled. Continuous appli cation is impossible. Courage fails, introspee Om becomes habitual, and many apprehensions and distinct phobias of a hypochondriacal cast add to the patient's misery. The natural :if feetions are diminished and depressed emotions are continuous. The sleep, disturbed by troubled dreams, is broken and unrefreshing. The early morning hours are particularly gloomy. The pa tient's general bodily condition is unsatisfac tory. Arumnia and loss of flesh are commonly en countered.1 hough exceptionally the general nutri tion is excellent. The great majority of these symptoms it will be noticed are subjective, not demonstrable physically and capable of misrep• resentation. For this reason such patients are misunderstood by their friends, who either foster the condition by misguided solicitude or give it scant sympathy. careful examination proves that the nerve force is actnally diminished and strength exhausted with undue ease. This is demonstrated by the contraction of the visual fields under appropriate tests. the initial exag• gerat ion and progressive reduction of the 'tendon reth•xcs, the inability to maintain dynamographic records, the tendency to rapid heart, the diges tive inadequacy. etc. Any ?Ine or even very many of the enumerated symptoms may be found in other ailments. hut it is their systematic- group• and the exclusion of other eompetent morbid states that enables a diagnosis of neurasthenia to he made.