The cases classed under the heading of neurasthenia may be roughly divided into four groups which are superficially very similar to each other but which, on closer study, may be found to be based on wholly different psychio mechanisms: (1) hystero-neurasthenia, (2) splanchnic neurasthenia, (3) sexual neurasthenia, (4) neurasthenic state allied to manic-depressive psychoses.

Hystero-neurasthenia is characterized by vague general hypochondriasis with purely subjective symptoms, without organic basis, and may often be shown to be motivated exactly in the manner of the above discussed hysterical manifestations. It is, to my mind, but a special type of hysteria or simulated disease. It is apt to be seen in individuals presenting the same sort of character defect as that which underlies common hysteria, but better endowed in intelligence and education, more polished and diplomatic, more subtle and plausible. Thus, during the World War, all observers have noted that this condition is relatively more frequent in commissioned officers than enlisted men. My experience has amply shown that the possession of intelligence far above the average and good educational and social opportunities is not incompatible with gross lack in moral sentiment.

Splanchnic neurasthenia is characterized physically by general undernutrition, muscular atony, lack of endurance, tendency to become giddy and faint, rather light and restless sleep at night, perhaps troubled with muscular twitchings and jerkings, somnolence during the day, frequent headaches, and various abdominal symptoms referable to visceroptosis which is usually present in more or less pronounced degree: dull pain and tenderness in hypochondriac or iliac regions, poor and capricious appetite, frequent nausea and vomiting, constipation, "gas pains," and occasionally signs of floating kidney or uterine displacements. Mentally this condition is characterized mainly by habitual hypochondriasis, i.e., preoccupation with bodily symptoms, disinclination to effort or exertion, and a resulting general futility, superficiality, and inefficiency.

Sexual neurasthenia occurs more often in men than in women. The patients commonly complain of seminal emissions, premature orgasm upon attempts of intercourse, impotence; they are filled with anxious thoughts of "lost manhood " which they would attribute to masturbation in youth. They allow their minds to dwell almost constantly on their sex function, are self-absorbed and brooding, often bashful and seclusive. They are given to reading quack literature and going to advertising doctors. Many cases would seem to be mild or incipient dementia praecox.

Neurasthenic states allied to manic-depressive psychoses are popularly known as "nervous prostration" or "nervous breakdown" and are characterized by depression, discouragement, difficulty of concentration, feeling of inadequacy, and psychomotor retardation. Often they are accompanied by suicidal tendency.