MENTAL OVER-WORK AMONG PUBLIC MEN. 25 



with alarm, may be dependent on some easily remediable ear-aftec- 

 tion. Our discussion would not be complete without a reference 

 to such cases, which have received the fuller attention which they 

 deserve from Mitchell, Thompson, Risley, and others. 



In five cases of cerebral syphilis, not included in the sixty cases, 

 the symj^toms were at first attributed to worry and mental over- 

 work. Two were men engaged in scientific work, one was in offi- 

 cial position, one was a physician, and one a merchant. All were 

 actively engaged intellectually, and were under pressure. The 

 brain symptoms were relieved in four cases by potassium iodide ; 

 the fifth, after three attacks of paralysis, died. Worry and brain 

 work played an added part in this last case. 



Insanity in some fin-m was developed or jDrecipitated, apparently 

 as the result of mental strain and over-work, in ten cases. In those 

 cases in which the patient's condition could be traced for some time 

 prior to the outbreak of recognizable insanity, indications of coming 

 evil were present, but went unheeded. Investigation revealed a 

 family history of insanity in three cases, and some transmitted 

 neurotic vice may have been in existence in other cases, but this was 

 not ascertained. The forms of insanity were melancholia in six 

 cases, paretic dementia in three, and acute mania in one case. 

 From the cases studied in the present connection, as well as from 

 general observation, I should say that melancholia is the type of 

 mental disease most apt to result from pure intellectual over-work ; 

 that is, from tasking the highest cerebral centres beyond their in- 

 herited or acquired powers. 



Paretic dementia is likely to occur among public and profes- 

 sional men when to intellectual labor are added emotional strain 

 or excesses. It is undoubtedly seen more frequently among men 

 in business careers. My note-books contain many cases fairly at- 

 tributable to business worry and excitement. Dr. H. M. Hurd^ 

 believes that the disease has a direct relation to business reverses. 

 He shows that since 1883, and the financial reverses which fol- 



1 Keport of the Pontiac Michigan Hospital for the Insane, 1881-82. 



