There are three chief types of neurasthenics: in one class is the person that appears robust, and is really so except in his nervous system, which lacks a governor. Such patients have little more than a troubled appearance to draw the attention of a chance observer to their condition. A second class is made up of eloquent narrators of their troubles. They try all the physicians in turn, then the homoeopaths and osteopaths and similar quacks, and they add patent medicines prescribed by themselves. They are petulant, capricious, and despite their apparent energy they accomplish nothing. The third class are silent, limp, clammy-handed; they are brought against their will to see the physician; they are sulky; bitter and unreasoning haters; inclined to melancholy. They may have a tendency even to suicide, but this is somewhat rare. Neurasthenics are not so liable to insanity as is popularly supposed, but such an outcome is possible in certain {232} cases. If their vague fears go on into a more or less fixed delusion there is cause for anxiety lest insanity result, but care should be taken here to be sure the delusion is really irremovable. Some neurasthenics are afraid to cross an open square or a wide street, others dread any closed apartment. Vertigo is common; so is insomnia. Insomnia is almost a constant symptom. The patient may have naps or he may have uninterrupted vigils. Sometimes there is a heavy but unrefreshing sleep. Sleepless patients are thrown into distracting rage by the barking of a neighbour's dog, the howling of cats, or the cackling of a successful hen, and they haunt the magistrates' courts in efforts to suppress such noises. They put cotton in their ears, wear heavy nightcaps, stop clocks, board up windows in search of sleep, which is not found. These patients commonly have an enduring feeling of weight or constriction in the head, especially at the occiput,--a headache that is not actual pain. They also have vertigo, which is independent of any aural disease, and this is transient, showing itself on abrupt changes of position. Another phase of neurasthenia is spinal. These cases have pain in the back and their legs give out. The back-pain is a diffuse ache, or it manifests itself on pressure at certain spots along the spine. There may be severe pain at the coccyx, especially in women. The walking may simulate paralytic forms if hysteria is mixed with the neurasthenia. Cardiac symptoms are often prominent, especially palpitation, but there is a nervous excitation of the heart rather than any definite lesion. The gastro-intestinal symptoms are often important. Pain referred to the stomach and acidity are common, the tongue is coated, the faeces scybalous. Digestion is torpid. Sometimes there is nervous diarrhoea. A list of the belly symptoms described by some neurasthenics is interminable.