MENTAL OVER-WORK AMONG PUBLIC MEN. 23 



intermittent pulse, and anginal attacks preceded the develoj^ment 

 of phthisis. In the other, a similar condition of heart and pulse 

 was present, with cardiac dyspnaa and vertiginous seizures. 



The fact that sleeplessness is one of the effects and early indica- 

 tions of mental over-work is so well known that it is almost unnec- 

 essary to dwell upon it. It was present in some degree in almost 

 eveiy one of my cases in which the trouble from over-work did not 

 come on suddenly. The progress towards complete insomnia is usu- 

 ally gradual ; at first it. is likely to be fitful slumber broken by 

 dreams. ^Vhat sleep is had is not refreshing. Soon the patient 

 may not be able to sleejD for hours. The brain is harassed by the 

 thoughts of the day, which can neither be downed nor dismissed. 

 They sometimes almost madden by their sameness. Finally, if not 

 remedied, the insomnia becomes as absolute as that present in some 

 forms of insanity, which jDerchance it presages, and which yields 



not to 



"poppy, mandragora, 



ISTor all the drowsy syrups of the world." 



Pain, or a feeling of intolerable distress in the back of the head 

 or neck, was complained of in twelve cases. It is undoubtedly 

 a frequent symptom of acute neurasthenia, and also not rarely a 

 prodrome of coming organic trouble. A judge resigned his posi- 

 tion on the bench because of this distress, couj^led with insomnia ; 

 and because of it also an over-worked young physician seriously 

 considered abandoning his profession. Pain in the back of the 

 head, as well as other forms of headache, may be due to eye-strain ; 

 a cervico-occipital myalgia of rheumatic or lith^emic origin is often 

 met with ; and chronic neurasthenics sufler from nape-aches which 

 their habits of self-inspection and self-analysis magnify to undue 

 proportions ; but over and above all these are cases in which this 

 symptom can only be explained by extreme nervous exhaustion. 

 Each patient complaining of this sensation should be carefully 

 studied in order to determine whether it is a matter of trifling 

 or serious import. 



