When the brain functions are principally dis ordered the term cerebral neurasthenia is some tines employed. In the same way spinal and sexual neurasthenia are mentioned, but in neuras thenia no function escapes, though there may be a varying preponderance of certain classes of symptoms. _111 functions are marked by an irri table weakness. Often this nervous disorder is as sociated with hysteria, particularly in the trau matic cases. Not seldom it is secondary to an initial bodily disease, which may or may not be present at the saline time.
Neurasthenia is essentially chronic. Its causa tion is commonly of long standing, its onset in sidious, its course protracted, its recession halt ing and 'narked by relapses, its tendency to re currence pronounced. It is often associated -with organic and inorganic diseases. and is encoun tered as ail initial stage in the development of hypocliondriasis, melancholia. mania, and gen eral paresis. When uncomplicated by organic diseases its prognosis is usually fairly good, pro vided the causal conditions can be removed and sufficient adequate rest and uplmilding secured. \s it often arises out of the necessities of human existence and social conditions, its proper treat ment is frequently impossible. The keynote is rest, and in. proportion as this can be made com plete both mentally and physically success re sults. The full rest cure plan of Alitehell, espe cially with women, often secures brilliant re sults. In a modified form in mild cases it is also efficient. It implies the expenditure of much time and money. \Vhen this is not possible, change of scene. of oecopstbou, of preexisting in fluences must otherwise be obtained. The burden of work, the fretting, mud earking cares must be minimized, :111(1 the physical health and stamina raised to the highest possible level. if such pa
tients can he fattened success is almost assured. 1)rug, play an entirely secondary part in the treatment of neurasthenia, merely meeting inei dental physical requirements. Any underlying physical disease of which neurasthenia may be the superficial manifestation must of course re ceive major care. To the mental perturbation, however, constant attention intist be directed. The patient's fears must be allayed. his hopeful ness his introspection diverted. 1111(1 refreshing sleep secured. In proportion as the physician grasps the mental side of the disease.
secures confillenee, and meets the requirements of his biased views, in that ratio is he successful and helpful in managing the neurosis.
A number of more or less speculative theories regarding the essence of neurasthenia are emir rent. !bulge and others have proven by interest ing laboratory experiments that under conditions of ordinary use the protoplasm of the motor cells is morphologically modified and probably more or b•ss exhausted functionally: that during rest and repose it regains its former appearance and po tential force. "4mile conceive that in neurasthe nia the rest periods have been so inadequate that the recuperative powers are belittled. and there is reason to suppose that, in sonic instances this 'nay reach an irreparable degree. Cell a in a Ilegeil peenlin rit ies of the blood and the oeneral dismrbonce of assimilation are looked upon by others as arguing a general toxic state which gives rise to the neurasthenic manifesta tions. These findings are as likely to lie effect as cause, but doubtless might operate in a vicious circle to protract the nervous disorder.