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blic. Neurasthenia is due to exhaustion and poisoning of the nervous system, the chief symptoms of which is persistent _neuro-muscular fatigue with general irritability_. Its minor symptoms are almost as numerous as the various activities possible in mind and body. The Predisposing Cause of neurasthenia is inherited nervous instability, but among nervous diseases, neurasthenia seems the least dependent on heredity, this factor playing a less important part than Exciting Causes which are the sparks that fire explosive trains laid by the living, and often by the dead. Worry in any form (especially when accompanied by excess of brain-work), Accident-shock, Sexual abuse, Abuse of drink, drugs or tobacco, Lack of exercise, Exhausting diseases, Menopause, and diseases of the womb, "Society life", Retirement, are the commonest exciting causes of neurasthenia; hard brain-work, unless accompanied by worry, not being injurious. The disease is more common in men than women (because of the more active part played by them in the struggle for existence), in cities than in the country, in mental than in manual workers, in the "idle rich", and in races which live feverishly, like the Americans. It is rare in old age. Ambition, the race for "success", the struggle to carry out projects beyond the reasonable capacity of one man, and the ceaseless work and worry with little sleep and no real rest which mark life to-day are responsible for this disease. Competition has increased in all conditions of life; free course is given to ambition, individuals impose on their brains a work beyond their strength; and then comes care and perhaps reverse of fortune; and the nervous system, under the wear and tear of incessant excitation, at last becomes exhausted, The basic symptom is an inability to stand a normal amount of mental or physical strain, and shows itself in seven marked ways: 1. Muscular Fatigue, which is often most marked in the morning. The patient rises reluctantly, feeling as if he had not slept, is listless and "lazy", and can neither work nor play much without getting unduly tired. This weariness may pass off as the day wears on. 2. Backache is often constant and annoying. It may be a pain, or a general discomfort, and may be felt anywhere in the back, the nape of the neck and down the spine being common places. The legs often "give way", and, in severe cases, patients believe they cann
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