What a world of symptoms this simple word covers! Many and varied are its clinical manifestations. Alas, how common it is among the American people with their overworked nervous systems!

The term also covers a vast deal of medical ignorance. The disease has been the means of enriching the vendors of patent medicines, the keepers of resorts at mineral springs, and has afforded a good income for a large majority of the practising physicians of the world. Its refractory qualities have baffled the skill of many a practitioner. It is the mother of more medical fads than is any other disease. Volumes have been written upon it, sanitariums without number have been constructed for its cure. What is it? Nervous exhaustion, brain fag. Insomnia is its handmaiden, digestive disturbance its constant companion. Headache, backache, constipation, diarrhoea, uterine affections, aye, every part of the body finds a lodging-place for some of its symptoms. It affects the mind as well as the body. It produces irritability of temper, inattention and morbid fancies of all kinds. It impoverishes the blood, it affects the eyes, and perverts all the other senses.

Each individual case does not usually present all of the array of symptoms mentioned, but they are blended together in every puzzling combination conceivable. It both obscures and simulates most, if not all, of the other diseases of the body. It is blamed for the existence of many of them. When long continued it perverts the whole temperament of the individual. It causes one to he preoccupied in one's self. Hence selfishness is a very common symptom. So absorbed are these patients in their own misery that they forget their duties to their friends and to society at large.

I shall now endeavor to report a few cases, and hope by so doing to make some of its clinical types clear.

The first patient was a lady, thirty-six years of age. She was married and the mother of one child. She was above medium height, fairly well nourished, had a rather dark complexion and brown hair and eyes.

She had been abroad a great deal, and had consulted for her various ailments a number of eminent practitioners and specialists. She talked volubly, was fairly well educated and appeared well. I was called to her in the evening and found her so much depressed that I feared melancholia. She complained of tinnitus aurium (ringing in the ears). She had pain in the upper part of the back of the neck and the head (cervico-occipital neuralgia). She complained of pain in the lumbo-sacral region (the lower part of the back). She did not sleep well, for which she had taken at different times the following list of drugs, all of which she said "disagreed" with her, which is not surprising.

First, bromide of soda and chloral, morphine in combination with atropine, phenacetine with and without bromides, antipyrine, chloro-dyne, whisky, brandy, cannabis Indica, sul-phonal, several of the valerianates, a number of the homeopathic potences of caffia. She had tried massage and warm baths, all for insomnia, in a period of four years.

For her other symptoms she had attended most of the mineral springs of Europe. Was treated with the water-cure by a pupil of Dr. Winternitz in Vienna. She had been douched with cold water and with warm water. She had tried the Scotch douche. She had tried shower-baths. She had tried electricity with and without baths. She had had glasses prescribed by no less than six eminent oculists. In justice to these gentlemen let me say, however, that their prescriptions were all practically alike. She had consulted a number of specialists, and was treated by them for uterine and ovarian difficulties. She had tried lavage (washing out of the stomach). She had taken no less than eighteen of the salts of iron, in combination with phosphorus, quinine, cinchonidine, and cinchona. The salts of zinc had also tried their hand upon her. Specialists of the throat and nose had done their best for her. As she had had an occasional attack of hives (urticaria) the dermatologists had also done what they could for her. Her friends prayed for her, and she prayed for herself. All in vain. The Christian Scientists argued with her that her disease did not exist, which was partly true.

Magnetic physicians laid their hands upon her, but, alas! with no success.

In fact, strange as it may seem, this lady had tried all of the methods related, and while benefited for a time by each, was cured by none.

Now, readers, must I relate it?

She was hypnotized once, twice, thrice, and the number steadily increased until the limit of seventy-five was reached. She got better after each one of them, but, shame to all of the healing methods, she did not get well. I suggested everything that my brain could invent. I had her take every sort of mental exercise, of diversion and amusement she had long since had enough. She studied painting and music to no avail. This sweet, complacent, refined, professional, expert invalid set at naught regular medicine, religion, occultism, in fact, all of the methods for the cure of the ills of man, and the last I heard of her she was in California, trying the grape cure, but was receiving no benefit.

This description is not overdrawn, and I have no doubt it is almost the daily experience of every physician who is thrown in contact with so-called nervous invalids. This form of disease is chiefly found among the wealthy. Its causes are, first, the want of a purpose in life, and a lack of mental capacity, inordinate vanity, and, above all, profound narrow selfishness. From studying women of all classes in very large numbers, I am led to believe that a majority, perhaps a large majority, of them, suffer more or less every day. Some of them, I am thankful to say many, by the exercise of their wills, and by devotion to their homes and to society are able in a measure to forget their sufferings. Many times what they do not forget they nobly bear.

The second of these cases will illustrate another form of neurasthenia, and it seems to me ridiculous to call the two widely-different conditions by the same name.