MENTAL OVER-WORK AMONG PUBLIC MEN. 17 



When to this is superadded attendance upon private examining 

 associations and text-book cramming, the only wonder is that so 

 many survive. Young men finish with credit and honor their 

 medical course not unfrequently only to become invalids or to pass 

 to their graves in a few months, victims of the mental over-work 

 and bad hygiene of the colleges where they sought instruction in 

 health and healing. 



The symptom-gi-oups and diseases represented by the series of 

 sixty cases may be summarized as follows : Acute neurasthenia, 18 

 cases ; insanity, 10 ; phthisis, 9 ; diabetes, 4 ; cerebral hemorrhage, 

 4 ; Bright's disease, 3 : posterior spinal sclerosis, 3 ; pneumonia, 3 ; 

 bulbar paralysis, 1 ; angina pectoris, 1 ; erysipelas, 1 ; hepatitis, 1 ; 

 enteritis, 1 ; glossitis, 1. 



Beard^ makes the sweeping assertion that neurasthenia " is at 

 once the most frequent, most interesting, and most neglected ner- 

 vous disease of modern times." He holds that it is a chronic func- 

 tional disease of the nervous system, the basis of which is impover- 

 ishment of nervous force and waste of nerve-tissue in excess of re- 

 pair. Professor Bartholow^ denies that neurasthenia is a primary 

 nervous affection or a substantive disease, holding that it is always 

 symptomatic and secondary, and defining it as " a disease usually 

 functional, situated in one or more organs, during the course of 

 which reflex disturbances of the brain occur, and numerous subjective 

 sensations in all parts of the body are realized by consciousness." 



With reference to this difference of opinion, it may be said that, 

 on the one hand, there is nothing either impossible or improbable 

 in the assumption of a primary exhaustion of nerve-centres from 

 over-work ; but, on the other hand, cause and effect are doubtless 

 often confounded by those who fall back on " neurasthenia" to clear 

 up the mystery of every half-understood nervous case. A chronic 

 condition, known properly as neurasthenia, is often met with among 



1 Op. cit. 



2 The Polyclinic, January 15, 1884. A paper read before the Philadelphia 

 County Medical Society. 



2 



