Definition.—A condition of weakness or exhaustion of the nervous system.

The term, invented by Beard, covers an ill-defined, motley group of symptoms, which may be either general and the expression of derangement of the entire system, or local, limited to certain organs; hence the terms cerebral, spinal, cardiac, and gastric neurasthenia. In certain respects it is the physical counterpart of insanity. As the essential feature in the latter condition is the abnormal response to stimuli, from within or without, upon the higher centres presiding over the mind, so neurasthenia appears to be the expression of a morbid, unhealthy reaction to stimuli acting on the nervous centres which preside over the functions of organic life. No hard and fast line can be drawn between neurasthenia and certain mental states, particularly hysteria and hypochondria.

[…] Acquired.—The functions, though perverted most readily in persons who have inherited a feeble organization, may also be damaged by exercise which is excessive in proportion to the strength — i.e., by strain. The cares and anxieties attendant upon the gaining of a livelihood may be borne without distress, but in many persons the strain becomes excessive and is first manifested as worry. The individual loses the distinction between essentials and non-essentials, trifles cause annoyance, and the entire organism reacts with unnecessary readiness to slight stimuli, and is in a state which the older writers called irritable weakness. If such a condition be taken early and the patient given rest, the balance is quickly restored. In this group may be placed a large proportion of the neurasthenics which we see in this country, particularly among business men. Other causes more subtle, yet potent, and less easily dealt with, are the worries attendant upon love affairs, religious doubts, and the sexual passion.

[…]When the spinal symptoms predominate—spinal irritation or spinal neurasthenia—in addition to many of the features just mentioned, the patients complain of weariness on the least exertion, of weakness, pain in the back, and of aching pains in the legs. There may be spots of local tenderness on the spine. Occasionally there may be disturbances of sensation, particularly a feeling of numbness and tingling, and the reflexes may be increased. The aching pain in the back or in the back of the neck is the most constant complaint in these cases. In the women it is often impossible to say whether this condition is one of neurasthenia or hysteria.

[…]The diagnosis is readily made. It is sometimes difficult to distinguish the cases from hysteria, and this is not surprising, as we cannot always differentiate the two conditions. Neurasthenia occurs chiefly in men; in fact, it is in many ways in them the equivalent of hysteria.

[…] Treatment of Neurasthenia.— Many patients come under our care a generation too late for satisfactory treatment, and it may be impossible to restore the exhausted capital. In other instances, the recovery takes place rapidly, the patient remains well for a few months or a year, and then overwork, or even the ordinary wear and tear of life, again prostrates him. Other persons drift into a condition of chronic invalidism or become slaves to morphia or chloral. In the case of business or professional men, in whom the condition develops as a result of overwork or overstudy, it may be sufficient to enjoin absolute rest with change of scene and diet. A trip abroad, with a residence for a month or two in Switzerland, or, if there are symptoms of nervous dyspepsia, a residence at one of the Spas, will usually prove sufficient. The excitement of the large cities abroad should be avoided. Better still for these cases, if they carry it out, is a life in the woods or on the plains. Three months of tent-life in the Adirondacks or the same length of time in the Rocky Mountains will sometimes cure the most marked cases of this kind. Such a plan is not, however, within the circumstances of all. In a much larger class, including a large proportion of neurasthenic women, a systematic Wier Mitchell treatment rigidly carried out should be tried (see hysteria). For obstinate and protracted cases, particularly if combined with the chloral or morphia habit, no other plan is so satisfactory. The treatment of the gastric and intestinal symptoms so important in this condition has already been considered. In milder grades of the condition massage alone will be found very useful. For the irregular pains, particularly in the back and neck, the thermo-cautery is invaluable. Medicines are of little avail. Strychnia in full doses is often beneficial. For the relief of sleeplessness all possible measures should be resorted to before the employment of drugs.

Source: William Osler, "The Principles and Practice of Medicine" (New York: Appelton, 1892), 978-980

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