Lecturer on Nervous Diseases in the University of New York. I ah to speak tonight of a condition of I the system that is, perhaps, more frequently ] than any other, in our time at least, the cause and effect of disease. I refer to neurasthenia, or exhaustion of the nervous system. The morbid condition or state expressed by this term has long been recognized, and, to a certain degree, understood, but the special name neurasthenia is now, I believe, for the first time presented to the profession. It is quite recently, indeed, that the phrase nervous exhaustion has been popularized, at least as a term expressive of any special condiiion of the system. Prof.

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more common than in all the world besides, and that the symptoms, behavior, and clinical history are the same in both countries. At the time when my first article on this subject was prepared (1868), I used the general term neurasthenia to cover all forms and types of nervous exhaustion, the symptoms coming from the brain and from the spinal cord being described together and indiscriminately. This imperfection Professor Erb has repeated, and, to that extent, the value of his essay is impaired, since, in strictness, the disease neurasthenia should appear both in the volume on the brain and on the spinal cord, in the former as cerehrasthenia, or exhaustion of the brain, in the latter as fnyelasthenia, or exhaustion of the spinal cord. PREFACE. 9 Many important symptoms he does not mention, and no attempt is made to explain in detail the diagnosis, pathology, or rationale of the disease. CONTENTS. CHAPTER I. Introduction. PAOB Why the Study of Neurasthenia has been neglected.-The Symptoms of a Subjective Character.-Reasoning vs. Observation on.-Less Frequent in Europe.-More Medicine used in America 25-35 CHAPTER n. Symptoms of Nervous Exhaustion. How to Study Cases.-Tenderness of the Scalp.-Cerebral Irritation.-Dilated Pupils.-Sick Headache and Various Forms of Head Pain.-Pain, Pressure, and Heaviness in the Head.-Changes in the Expression of the Eye.-Congestion of the Conjunctiva.-Disturbances of the Nerves of Special Sense.-Neurasthenic Asthenopia.-Muscce. Volitantes.-Noises in the Ears.-Atonic Voice.-Deficient Mentiil Control.-Mental Irritability.-Hopelessness.-Morbid Fears.-Astraphobia or Fear of Lightning.-Topophobia or Fear of Places.-Agoraphobia or Fear of Open Places.-Claustrophobia or Fear of Closed Places.-Anthropophobia or Fear of Society.-Monophobia or Fear of being Alone.-Phobophobia or Fear of Fears.-Mysophobia or Fear of Contamination.-Pantaphobia or Fear of Everj'thing.-Symptomatic Merely.-Morbid Fears Rarely E.xist Alone. Flushing and Fidgetiness.-Frequent Blusbing. »^Sleeplessness.-Bud Dreams.-Insomnia.-Drowsin^s.-Tenderness of the Teeth and Gum.s.-Nervous Dyspepsia (/>y.s;v7)«iV Asth^nujtte).-Deficient Thirst and Citpacity for Assiniiliiling Fluids.-Desire for Stimulants and Narcotics.-Dryness of the Skin.

THE causes of American nervousness are compli. cated, but are not beyond analysis: First of all modern civilization. The phrase modern civilization is used with emphasis, for civilization alone does not cause nervousness. The Greeks were certainly civilized, but they were not nervous, and in the Greek language there is no word for that term. The ancient Romans were civilized, as judged by any standard. Civilization is therefore a relative term, and as such is employed throughout this treatise. The modern differ from the ancient civilizations mainly in these five elements -steam power, the periodical press, tlie telegraph, the sciences, and the mental activity of women. When civilization, plns these five factors, invades any nation, it must carry nervousness and nervous diseases along with it. C'iuiZization very Zz'mited in extent.All that is said here of American nervousness refers only to a fraction of American society; for '' It is not giveu to ordinary humauity to reach a summit of ambition in more than one direction at once." * See my work on Sea-sickness, last edition.

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