MENTAL OVER-WOKK AMONG PUBLIC MEN. 19 



Da Costa', and Putuaiir, among others. A tendency is seen in 

 some quarters to refer all the symptoms and disorders commonly 

 classed as neurasthenic, and apparently resulting from mental 

 strain and over-work, to a lithsemic state of the blood. Such 

 symptoms are certainly sometimes thus best explained. For sev- 

 eral years, and particularly since the appearance of Dr. Da Costa's 

 paper, I have been on the alert for cases of lithramia, and in a few 

 instances I have had brilliant successes from anti-lithsemic treat- 

 ment. Lithffimia and neurasthenia, however, are not interchange- 

 able terms. Such symptoms as mental distress, insomnia, head and 

 neck pains, neuralgias, etc., are present when neither gout nor half- 

 gout can be demonstrated by examinations of the urine or blood, 

 or by any other known means. When lithsemia is present and can 

 be demonstrated by treatment or otherwise, the disorders of assimi- 

 lation which have led to it are often of primary nervous origin. 

 While it may be entirely the result of inheritance, or errors of 

 diet, in other cases it would seem to be induced by nervous strain, 

 and is, therefore, likely to occur in those with whom we are 

 now concerned. My experience coincides with that of Da Costa, 

 who says : " Lithremia is much more common in men than in 

 women. Its chief sufferers are men in the prime of life. It comes 

 on in some who live luxuriously, eat largely, drink freely, take little 

 exercise in the open air, and are indolent in their habits. But it is 

 quite as often, or oftener, seen in the active brain workers of good 

 habits, in the marked men in the community in which they live, 

 and it is in them, too, that the nervous symptoms of lithoemia are 

 most obvious. My list of lithsemic patients embraces many a 

 name distinguished at the bar, in medicine, in the pulpit, in litera- 

 ture, and in the world of finance. And it is not only brain work 

 and all the habits this implies, but strain and worry which induce it." 

 When vertigo is complained of by over-worked patients, I am 

 particularly inclined to look into the question of lithremia. 



1 American Jom-nal of the Medical Sciences, October, 188L 



2 Boston Medical and Surgical Journal, December 13, 1883. 



