CHAPTER XVII 



NEURASTHENIA 



IN the previous chapter we have attempted to catalog 

 some of the factors which tend to subject the nervous sys- 

 tem to gradually deepening injury. We have now to de- 

 vote some space to the ways in which this injury is usually 

 manifested. ''Nervous fatigue," "nerve fag," "nervous 

 prostration," "nervous exhaustion" these are expressions 

 used to denote different degrees of a condition which is 

 covered by the word "neurasthenia." 1 It is an example of 

 what is called a "functional disorder." By this term 

 physicians characterize diseases in which no structural 

 change in the tissues can be demonstrated postmortem. 

 Ordinary neurasthenia is thus brought into contrast with 

 those perversions of nervous reaction which are caused by 

 obvious abnormalities of the brain paralyses, manias, 

 epilepsies, etc., due to hemorrhages, tumors, infections, and 

 the like. The adjective organic is the one chosen to set 

 over against the term "functional." 



The distinction between functional and organic troubles 

 is often a helpful one, but it may be criticized as unscien- 

 tific. There is a medical maxim which says, "There is no 

 psychosis without a neurosis," that is, the nervous system 

 will not act in an abnormal way unless it is physically 

 abnormal. All its disorders are, therefore, organic in the 

 best sense, and a functional disease is a fiction. All that 

 can be claimed for the so-called functional disturbances is 

 that the derangement is chemical rather than structural, 

 molecular rather than molar. It follows, however, that 

 recovery is much more probable in the functional cases. 



1 The word is often restricted to cases of a certain type. It is 

 here used more inclusively, but in a way which does no violence to 

 the root meaning. 



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