cussed either his case or my treatment with him when he was in the normal condition, and the foregoing history of the case was obtained from his mother.

He is now a useful member of society, a successful plantation manager and a contented man. He still has, so his friends say, a very quick temper, and is sometimes irritable. But many plantation managers as well as others have the same complaint. However, I regret that I did not suggest amiability while I was treating him.

In closing, I wish to call attention to the inexcusable neglect that the medical profession is giving suggestion as a means of relieving conditions which are not amenable to medicinal

treatment.

The physician falls into disrepute by using drugs in the treatment of diseases in which drugs can do no good. The feeling that we must give something to every case, if only a placebo, is very prevalent. If the confidence of the patient in his or her physician is great enough to amount to suggestion the patient may recover through the administration of the placebo, but if failure results the patient is discouraged and makes the round of physicians, goes into the hands of the so-called Christian Scientist or the osteopath, and is often relieved by these absurdities. The relief obtained through such irregulars is entirely due to suggestion. Every manipulation they make is for effect. A patient doubting at first becomes in their hands so suggestible that the hope of cure becomes a belief, and a cure results. Of course, such a patient gets no more out of such a treatment than he can be made to put into it. But the osteopath and the Christian Scientist and the patient are all more or less sincere; being sincere, they will continue to protest for their rights as they see them. To fight them is to martyrize and advertise them. We can only show them up by becoming familiar with suggestion and relieving these cases before they get to their hands. Their patients are almost invariably those whom physicians have failed to relieve.

NEURASTHENIA.*

BY B. FRANK TURNER, M.D.

MEMPHIS.

Neurologist to the City Hospital.

Prior to the researches of Beard, in 1869, those disturbances of the nervous system which were not obviously due to lesions thereof, and purely functional in character, were usually ascribed to lesions and disorders of other portions of the anatomy, toxemias, etc. At about this time Beard promulgated the doctrine that it is possible to have a variety of neuroses manifesting themselves in all sorts of functional disorders of the nervous system, and due to nerve exhaustion, without the existence of any lesion of the nervous system, and independent of other general disorders. This doctrine has now come to be recognized by the best neurologists here and abroad.

ETIOLOGY. Under this head the disorder may be said to occur most frequently between the ages of 20 and 50. Occasional cases may be demonstrated in childhood or adolescence, and occasionally cases may be seen beyond the age of 50, but both of these are rare. Sex: It appears to occur in both sexes alike. Climatic Influences: It cannot be said to be absent in any part of the world, but it appears to be commonest in the higher latitudes and also in the higher altitudes. Races: It may be found in every race, but is most common in those which have emotional tendencies, notably, the Hebrew and the Slavonic. Heredity: While it cannot be spoken of as a disorder which may be transmitted, it is nevertheless true that such hereditary tendencies as may be considered neuropathic certainly exercise a powerful inducing influence.

CAUSES. These may be considered under two general headspredisposing and inciting. Amongst the predisposing causes defective education may be especially noted. It is easily demonstrated in those individuals who, in the processes of development from babyhood to adult life, which we, in a general sense, denominate education, suffer least restraint, are most poorly disciplined, are permitted to develop mercurial

* Read before the Memphis Medical Society, September 5, 1899.

tendencies. These people we find to be the victims of these unhappy manifestations of nervous disorders. Occupation likewise may exercise a powerfully predisposing influence. Sedentary life, the too intense application to one's vocation, confinement beyond physiologic limits, all sooner or later tend to develop in the individual an exhaustion of the nervous system. Inciting causes are such as the excessive indulgence in alcohol, tobacco and other stimulants, excessive venery, trauma, exhausting diseases, toxic states and emotional shocks. Of these, however, it is my belief that entirely too much emphasis is usually placed upon excessive venery. Within the realm of neurology it would seem as if this bugaboo is used too frequently to intimidate the unwary. Pernicious as may be the results of excessive venery, in my opinion its victims are far less numerous than is generally accredited to it.

PATHOLOGY. There cannot be said to be a characteristic lesion of neurasthenia. A few years ago, however, Hodge demonstrated that nerve cells may undergo chemical changes during their activities very analogous to such chemical changes as glandular and other cells have long been known to undergo, thereby demonstrating at once that nervous energy originated in the chemical metabolisms of nerve cells, and suggesting also the possibilities of such cells becoming exhausted histologically, just as glandular and other tissue cells have long been known to do. Histologically, then, we conceive neurasthenia to be a functional derangement of some part of or the whole of the nervous system, due to cellular exhaustion.

SYMPTOMS. The symptoms of neurasthenia may be as varied as the functions of the nervous system. It may require the highest diagnostic skill, indeed may baffle the most skillful, to differentiate between a functional disturbance due to exhausted nerve power or an organic lesion of some one or more organs in the body. Motor: Muscular weakness, tremor and twitchings are usually met with. The reflexes at first are likely to be exaggerated and later diminished. Sensory: There is never anesthesia. Great fatigue is one of the commonest manifestations. Headache, backache, and diffused tenderness are the rule. Visual disturbances are likely to be present.

Visual fatigue and photophobia are extremely common, and usually lead the patient to consult the oculist for lesions of the eye. Disorders of hearing, smell and taste are frequently observed. Especially common is a sense of roaring or ticking or dropping, as the patient will describe, in one or both ears, and here again operate to send the patient to the specialist for the treatment of disorders which do not exist. Gastrointestinal symptoms may be most variable. Capricious appetite, eructations, palpitation, flatulence, constipation, diarrhea, any disorder in fact which may be generated by functional disturbance of the nerves controlling the organs of digestion. Here, indeed, is the field perhaps which offers the widest scope for errors in diagnosis. The careless diagnostician may ascribe to biliousness or torpid liver or want of gastric juice and what not the cause of symptoms which he takes not the trouble to understand. The circulation is likely to be disturbed, and is generally characteristic. Tumultuous beating of the heart, or great rapidity of the heart beat, throbbing arteries, cold extremities, flushing and pallor of the face, all indicate the powerful influence over the circulation due to an exhausted nervous system. The secretions are likely to be erratic. The genital disorders incidental to nerve exhaustion again offer the widest field for discrepancy in diagnosis. Pelvic pains, hyperesthesia, irregular function, and a host of symptoms not general, but believed to be, are pretty certain to land the victim in the hands of the specialist. And I think that it is now pretty generally conceded that these very disorders of the genital system due to exhaustion of nerve power and its accompanying functional derangements, have occasioned many a needless ovariotomy or hysterectomy or dilating of the sphineter or curettement. The unfortunate feature of the genital manifestations of nerve exhaustion is the powerful influence which they exert upon the spirits of the patients. A tendency to melancholia is under these circumstances all too frequent. Mental disorders, too, are not infrequently manifested. An abridged capacity for work, loss of power of concentration, deficient memory, impaired courage, all exhibit the impress of this condition on the intellectual faculties. Emotional irritability, impaired capacity for sleep, a tendency to develop

hysteria, and finally, the possibility of passing into a condition of melancholia, are not infrequently observed. As regards the general state, the victim may be anemic or plethoric.

The course is essentially chronic. The onset is insidious; the development is slow; remissions are frequent.

THE DIAGNOSIS is of supreme importance. The difficulty in determining between a functional disorder of the nervous system affecting some organ, or of determining the presence of the lesion of such organ, is not always easy. And a tendency on the part of the patient to pass from a condition of neurasthenia into the graver disorders-hysteria, hypochondriasis, dementia-is always possible. Then, too, it is always possible that during a condition of nervous exhaustion, and quite possibly without any relation thereto, actual lesions may be developed, thereby entirely changing the pathological condition, without necessarily altering much the clinical picture. PROGNOSIS depends upon the control of the patient, his age and the cause.

TREATMENT, first of all, lies within the realm of correct hygiene; rest, physical and mental, change of environment, exercise, diet, baths, massage, and a hopeful atmosphere, all promote a restorative influence. The unfortunate feature of these cases is our inability to accomplish the restorative means hereby enumerated. Drugs do little good. Of what use will be a capsule or a teaspoonful of something or other, when some influence deleterious to the well-being of the patient is constantly nagging at the nervous system and exhausting its powers? If we can remove the cause, correct hygiene is likely to accomplish restoration. Simple sedative drugs, tonics, etc., are always useful, but alone can never exercise a curative effect. Odd Fellows' Building.

The tints of Autumn-a mighty flower garden blossoming under the spell of the enchanter, Frost.- Whittier.