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sort to it in every suspected or generic viagra oregon doubtful case. And again I want to plead for more watchfulness for the first appearance of this disease and for more care in investigating. Could every case be recognized in an early stage, this king of diseases would be robbed of most of its terrors. NEURASTHENIA AND ITS TREATMENT. 1 RATIONAL By G. BETTOX MASSEY, M.D., PHILADELPHIA. Neurasthenma, or the generic viagra oregon "American disease." first de- scribed by the late George M. Beard, of New York, some twenty-five years ago, has since been the subject of much study and many treatises in several languages, as physicians the world over recognized that its occur- rence was by no means limited by political bounda- ries, nor even by the existence of the environments of a new country. That it is peculiarly a disease ot modern civilization, even though described to some extent by Burton in his "Anatomy of Melancholy,'* mainly manifested under conditions of mental high pressure, is but another way of saying that it is one of the penalties of that evolutionary development under generic viagra suppliers which society is continuously progressing. A failure to attain a full correspondence with one's environment is shown by that momentous individual disaster, insan- ity, and though there is rarely any connection between true mental disease and neurasthenia, sufferers from the latter condition should note the hint it conveys of a lack of coequal exercise of the mental and animal capacities of the individual. For there can be no question that neurasthenia is a symptomatic manifestation of an imperfect perform- ance of all or nearly all of the organic functions of the animal life, causing generic viagra suppliers perversion of the nutrition and functionation of the nervous system. Though it may be caused by a sudden mental shock, such a causation is unusual and the cases in which it occurs are more nearly related to hysteria. The common cause as- signed to it excessive mental occupation due to the ' Read before the Philadelphia County Medical Society, No- vember 13, 1895. 834 MEDICAL RECORD. [June 13, 1896 claims of business or society is but relatively true, for in a normal condition it is not work but worry that kills. In the abnormal conditions of alimentation generic viagra suppliers and excretion which are probably the primary cause of neurasthenia, a persistence in any occupation re- quiring a high grade of mental work or irregular hours becomes a persistence in relative overwork, though the same exertions may be harmless under more normal conditions. This \ generic viagra oregon iew that assigns the many functional derange- ments of the nervous system comprised in neurasthe- nia to an auto-intoxication due to an imperfect perform- ance of the abdominal functions is gaining ground, and is evidenced by the recognition of lithaemia in many cases in association with the nervous symptoms. Aii enumeration of the symptoms of neurasthenia would occupy more time and space than are at my dis- posal. Considered as a whole, the subjective symp- toms usually display in generic viagra suppliers a most varied way a more or less pronounced inability to perform with personal sat- isfaction the various tasks imposed upon the generic viagra suppliers individual by the necessities of a gregarious existence. Of ob- jective symptoms the most pronounced are due to dis- ordered action of the sympathetic system of nerves, disordered circulation, and general metabolic sluggish- generic viagra oregon ness. In the treatment, the main purpose should be to arouse the defective activities of the sympathetic and generic viagra suppliers of the organs under its control. The effectiveness of peripheral applications, such as the cold bath of mo- mentary duration or applications of static electricity, in restoring circulatory and nutritive control, is no argument against the abdominal origin of the malady, .is these agencies exert powerful afferent effects upon the sympathetic ganglia as well as upon the cerebro- spinal centres of generic viagra suppliers innervation. Of this nature are also massage and electro-motor stimulation of the limbs and body surface, with the added advantage of a stimula- tion of the local circulation, nutrition, and tissue meta- bolism. But, unless the abdominal generic viagra suppliers sympathetic system i-> directly reai hed, the worst of these cases will fail of 1 omplete remedial alleviation, and dissatisfaction will result to both patient and physician. Rest and regulation of the diet added to these peri- pheral stimulations will do much for some of these cases, but will be lamentably ineffective in others. The importance of rest alone has been enormously overrated, so much so, indeed, that generic viagra oregon hundreds of pa- tients who have done nothing but rest all their lives .iir put through a costly treatment by their physicians under an inordinate belief in this shibboleth, only to find their neurasthenic symptoms made worse by the burdensome effect of temporary additions of fat, or