SEXUAL NEURASTHENIA IN MEN
Authors: ALBERT J. UNDERHILL
Journal: JAMA (1913)

diabetic opacity of the crystalline lens, was living nine¬ teen years after the appearance of the eye disease.It has been my experience, that with proper «are, dia¬ betics may live for many years after the development of ocular lesions, and that a proper dietary and regimen not only improve the general condition and lengthen life, but also exert a most favorable influence on the ocular disease, even in some instances causing less opaei lient inn of the lens, for diabetic cataract is the one form of cata¬ ract which yields in any degree to non-operative meas¬ ures. HEART-DISEASEThe ophthalmoscope may also give evidence of the existence of heart-disease; (bus in aortic insufficiency there is almost constantly a pulsation of the retinal arteries, synchronous with the radial pulse, and alter¬ nating with enlargement of the veins.In fatty heart there is not infrequently extensive disease of Ihe vessels, which may give rise to ocular hemorrhages.II may be of interest to mention, in this connection, that ophthal¬ mologists have been unable to recognize the connection between fatty heart and arcus senilis, all forms of heart- disease being absent in those very cases in which aicus senilis develops at a prematurely early age.Cardiac disease may also manifest itself within Ihe eye in the form of an embolism or thrombosis of the retinal vessels.In aneurvsiu of Ihe aorta or iiinoininala, vasomotor and ociilopupillary sympathetic symptoms are often found on the corresponding side.Initial irritative symptoms give place later to paralytic symptoms.Individuals on the far side of 66 years, who have had repeated small hemorrhages in the conjunctiva and retina usually die within a few years from cerebral apo¬ plexy.Ilaskel Derby, for example, followed the life Ins- lory oí thirty-one such'put ¡cuts between the ages of 43' and 83 years and found that almost half died within two years of his first observation and most: of them rather suddenly from heart-disease or apoplexy.Kaehlnian found changes in the retinal vessels in nearly half of all patients with general arterial sclerosis.Lead, tobacco and alcohol often reveal their toxicity in the fundus oculi, and syphilis can all'eet almost all of the structures of the eye.Tuberculosis.alsohas its ocular manifestations.It would require a far greater knowledge of neurology and psychiatry limn 1 possess to prognosticate how long a man may live after the pathologic processes which induce paresis are sufficiently well established to induce ocular changes; yet it would seem that the most san¬ guine examiner would hesitate to recommend a man with Ibis disease as a safe risk.In this insidious disease, in which initial symptoms are usually (hose of a purely functional disturbance, the recognition of the earliest physical signs should be of Ihe greatest importance.These are often ocular and if recognized and appreciated should be of the greatest aid in diagnosis.It is at this lime that failing vision is complained of, and while in BOnie installées this may be dependent on atrophie changes already present in the nerve, in most instances it will be found to be in the nature of a slight degree of unibly-"pia, which on careful functional testing will be found to he of psychic origin; as Dereuni-has pointed out, a kind of visual hyperesthesia quite in keeping with the general psychic disturbance which is setting in, in con¬ junction also with the lessening of general cutaneous sensibility which is always noted sooner or later.Kven ¡il this time, pupillary irregularity may be noted.Dif¬ ference in the size of the pupils, one should remember, may occur physiologically, but in such cases this differ¬ ence is usually slight.To quote Dercum :- If, however, a difference in the nine of the pupils be noted and this difference is associated with a sluggishness to light reaction, or if the pupils, being equal, react slightly differently to light, the Unding is suggestive with regard fo paresis in