These patients commonly have an enduring feeling of weight or constriction in the head, especially at the occiput,—a headache that is not actual pain. They also have vertigo, which is independent of any aural disease, and this is transient, showing itself on abrupt changes of position.
Another phase of neurasthenia is spinal. These cases have pain in the back and their legs give out. The back-pain is a diffuse ache, or it manifests itself on pressure at certain spots along the spine. There may be severe pain at the coccyx, especially in women. The walking may simulate paralytic forms if hysteria is mixed with the neurasthenia. Cardiac symptoms are often prominent, especially palpitation, but there is a nervous excitation of the heart rather than any definite lesion.
The gastro-intestinal symptoms are often important. Pain referred to the stomach and acidity are common, the tongue is coated, the faeces scybalous. Digestion is torpid. Sometimes there is nervous diarrhoea. A list of the belly symptoms described by some neurasthenics is interminable.
We often find a sexual form, which is the worst of all and the hardest to cure. It is commonly connected with masturbation. Such neurasthenics are shameless in the description of their nastiness. It is better to keep them from marriage unless they are cured, and they are not to be foisted off on [{233}] any one as husband or wife to effect a cure. Allbutt says of them: "I fear that some of our 'criminal psychologists' are encouraging many sorts of prurient debauchees by dignifying the tales of their vice with the name of science, a course of conduct which is in the worst interests both of these persons themselves and of our own profession. It were a curious inquiry how it comes that sexual perversions are so 'scientific' a study, while the brutalities of the thieves' kitchen or the wiles of other pests of society lie in comparative neglect."
Physical, intellectual, or emotional strain can cause neurasthenia suddenly or gradually. Where it comes on without obvious cause there is commonly a bad family history of nervousness or alcoholism. Anaemia makes it worse; eye-strain, too, is a provoking factor. In some cases a renal congestion is the cause. In many cases a lack of restraint, bad education, uncontrolled passion, are a marked influence in fixing the neurasthenic habit. A sedulous parent nags at a neurasthenic child that is too weak for exertion until the child's susceptibility to correction is blunted. Instead of treatment and help the child receives cuffs and abuse, and hell-fire is held up before him until he deems all religious talk dust and ashes. Encouragement will sometimes do more good than all the threats in the via purgativa. Nagging never cured anything except a tendency toward virtue, and it always deepens neurasthenia. Be careful in the selection of a confessor for a neurasthenic child. Get one that does not believe in kicking a soul into paradise.
The treatment of neurasthenia is difficult. Traveling about in search of health is not advisable. The Weir Mitchell Rest Cure is very effective in many bad cases, but it is costly, and if not correctly applied it is useless. It is the only cure for some patients. Sea air helps a certain class of neurasthenics, but it makes others worse—it is bad for the dyspeptic neurasthenic. A chronic rhinitis, a refractive error of the eyes, a displacement of the uterus, a congested kidney, a floating kidney, a tight prepuce, and similar teasing disorders must be cured before the neurasthenia can be removed; often the neurasthenia disappears with this cure.
Traumatic neurasthenia is like simple neurasthenia in [{234}] most details. It is called also nerve shock, spinal irritation, railway spine. There is always a causative shock or injury, which is followed at once or after an interval by the symptoms of neurasthenia. In acute traumatic neurasthenia there may be, in addition to the symptoms observed in simple neurasthenia, high fever, and such a fever has been observed to go as high as 113 degrees Fahrenheit.
AUSTIN ÓMALLEY.