ent, has increased the proportion of people involved.

Particularly the increase in the size and number of the cities, as
compared with the country, is a great factor in the spread of
neurasthenia. Then, too, the introduction of so-called time-saving,
_i.e._ distance-annihilating instruments, such as the telephone,
telegraph, railroad, etc., have acted not so much to save time as to
increase the number of things done, seen, and heard. The busy man with
his telephone close at hand may be saving time on each transaction, but
by enormously increasing the number of his transactions he is not saving
_himself_.

The keynote of neurasthenia is _increased liability to fatigue_. The
tired feeling that comes on with a minimum of exertion, worse on arising
than on going to bed, is its distinguishing mark. Sleep, which should
remove the fatigue of the day, does not; the victim takes half of his
day to get going; and at night, when he should have the delicious
drowsiness of bedtime, he is wide-awake and disinclined to go to bed or
sleep. This fatigue enters into all functions of the mind and body.
Fatigue of mind brings about lack of concentration, an inattention; and
this brings about an inefficiency that worries the patient beyond words
as portending a mental breakdown. Fatigue of purpose brings a
listlessness of effort, a shirking of the strenuous, the more
distressing because the victim is often enough an idealist with
over-lofty purposes. Fatigue of mood is marked by depression of a mild
kind, a liability to worry, an unenthusiasm for those one loves or for
the things formerly held dearest. And finally the fatigue is often
marked by a lack of control over the emotional expression, so that anger
blazes forth more easily over trifles, and the tears come upon even a
slight vexation. _To be neurasthenic is to magnify the pins and pricks
of life into calamities, and to be the victim of an abnormal state that
is neither health nor disease._

The more purely physical symptoms constitute almost everything
imaginable.

1. Pains and aches of all kinds stand out prominently; headache,
backache, pains in the shoulders and arms, pains in the feet and legs,
pains that flit here and there, dull weary pains, disagreeable feelings
rather than true pains. These pains are frequently related to
disagreeable experiences and thoughts, but it is probable that fatigue
plays the principal part in evoking them.

2. Changes in the appetite, in the