Clinical lectures on Neurasthenia.

  • Savill, Thomas Dixon, 1856-1910.
Date:
1899
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Licence: Public Domain Mark

Credit: Clinical lectures on Neurasthenia. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    67/168 (page 47)
    DIAGNOSIS Hypochondriasis formerly, and neurasthenia latterly, have been regarded as a kind of hysteria in the male, but I trust that a study of this table will help to dispel these delusions. In their essential qualities, as drawn from a complete cHnical picture of each, they are dissimilar. The respective mental attributes typically reveal this. Briefly it may be said that neurasthenia consists of an exhaustion of the nervous system, and the mind nearly always mani- fests this ; in hysteria there is deficient will control and increased reflex irritability ; whereas hypochondriasis is a pecuhar mental attitude of exaggerated introspection. Besides the two complaints just named there are others which are apt to be confused with neurasthenia. LithcBmia is one of the most important, but here, the habitual deposits of lithates in the urine, the mental hebitude, the absence usually of vaso-motor phenomena and other symp- toms referable to the nervous system; the greater severity of the headache and its shorter duration, and the somno- lence (instead of insomnia) which characterise lithaemia, may aid us in what is really sometimes a most difficult task, the differentiation of these two maladies. Exophthalmic goUre in its early stage is a malady which, before the proptosis and thyroid swelling appear, cannot be distinguished with certainty, though it may be suspected if the case resists all treatment, and the palpita- tion and other cardiac phenomena are very prominent. In chronic alcoholism the tremulousness, fleeting pains in the limbs and debility, may resemble the disease we are considering, but the characteristic facies, the hepatic dis- order, and the history should obviate mistakes. Senile and other tremors should not be difficult of detection. In malarial poisoning and other ancemic conditions, there ought not to be much [difficulty, in presence of the other characteristic symptoms, physical signs, and history of these conditions. The same reasoning applies to other cachectic and debilitated states, such as those due to syphilis, latent carcinoma, latent tubercle, Addison's disease, Hodgkin's disease, &c. In certain cases of neurasthenia, to which I shall shortly