A merican Nervousness . 
604 
[September, 
these factors all at once by themselves, and in their relations 
to each other. 
There is one disease, the type and centre of a large family 
of functional diseases, to which I have applied the term neu- 
rasthenia . If we understand the philosophy of this disease 
and its treatment, there will be little difficulty in understand- 
ing the philosophy and treatment of very many of the family 
of functional nervous diseases to which it belongs. Neuras- 
thenia is pre-eminently an American disease. It might, in- 
deed, be properly called Neurasthenia Americana . Although 
it is found in England and on the Continent, it was here first 
systematically described, and here it exists in greater variety 
and frequency than in all other countries combined. The 
generic term neurasthenia — nervous exhaustion — I sub- 
divide into two : cerebrasthenia — exhaustion of the brain ; 
myelasthenia — exhaustion of the spinal cord. 
Among the symptoms that I have referred to cerebrasthenia 
(brain exhaustion) are tenderness of the scalp, cerebral 
irritation, tenderness and whiteness of the teeth and gums, 
flushing of the face, special idiosyncrasies in regard to food 
and external irritants, morbid desire for stimulants and 
narcotics, insomnia in its varied manifestations, dilated 
pupils, melancholia or mental depression, deficient memory, 
or power of intellectual control, different forms of morbid 
fear, as astrophobia (fear of lightning), agoraphobia (fear of 
places), anthropophobia (fear of man and society), and its 
opposite, monophobia (fear of solitude), sick headache, and 
various forms of headache, and pains in the head, dis- 
turbances of the nerves of special sense, as tinnitus aurium , 
and specks before the eyes, subjective tastes and odours, 
dryness of the skin, eyes, throat, and mucous membranes 
generally. 
Neurasthenia is differentiated from organic disease, by 
taking into consideration these four elements : (1) The 
fluctuations and inconstancy of the symptoms; (2) heightened 
reflex aCtion ; (3) the existence of some certain special 
symptoms, which will really be found in organic spinal 
disease ; such, for example, as different forms of morbid 
fears, palmar hyperidrosis, excessive tenderness of the spinal 
cord, deficient thirst, abnormally aCtive pupils, mental de- 
pression, extreme insomnia, morbid desire for stimulants 
and narcotics. In certain organic diseases, it is true, there 
may be heightened reflex aCtion; but, as a rule, reflex aCtion 
is diminished in organic or structural disease of the spinal 
cord. Closely analysed, a large proportion of the symptoms 
of neurasthenia, as I have before described them, are of a 
