20 THE TONER LECTURES. 



It is almost imijossible to jireseut in orderly array all the symp- 

 toms which may be regarded as the indications of nervous ex- 

 haustion, and the probable precursors of premature disease from 

 brain strain and over-work. These symptoms, indeed, will vary some- 

 what with the individual — with his hereditary tendencies, his habits, 

 and his surroundings. THere are, however, .certain common and 

 positive evidences of existing or coming evil which are present in 

 many cases. The most prominent of these early warnings, which 

 are, at the same time, the symptoms of the affection or condition 

 most conveniently termed acute neurasthenia, are as follows: 1. 

 Certain i)sychical symptoms, such as excessive irritability of temper ; 

 depression of spirits ; morbid impulses and fears ; constantly re- 

 curring thoughts, phrases, or suspicions ; sense of effort ; impairment 

 of memory and attention ; and change in habits and methods of 

 mental work. 2. Laxity or immobility of countenance. 3. A dimi- 

 nution or loss of physical resisting power. 4. Heart failure. 5. 

 Sleeplessness. 6. Pain or distress in the back of the head and neck. 

 7. Nervous dyspepsia. 



Excessive irritability of temper, a state of mental hypersesthesia, 

 is certainly one of the earliest indications of brain over-work. This 

 irritability is apt to alternate with feelings of exhaustion and de- 

 pression, and is occasionally the only marked precursor of serious 

 disease. The account given by one of my patients, a professional 

 man thirty-seven years old, is practically that of many. With a 

 large amount of work on hand, with exacting literary and teaching 

 engagements, with financial anxieties, he was the victim of mental 

 over-work and worry to an extreme degree. The veriest trifles be- 

 gan to annoy him. He could scarcely endure the presence of his 

 OAvn children ; their simple play and noise disquieted him and 

 caused unw(mted ebullitions of temper. He was abrupt and im- 

 patient in his business. He believed that his best friends were 

 turning against him. He became unable attentively to follow a 

 convei'sation. He would sit down at his desk to take up some pro- 

 fessional or literary work, only before long to sink listlessly in his 



