A statistical study of the relations of neurasthenic, dyspeptic, and allergic symptoms




Kling, Carlos Prado

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Individual or case examinations of the neurasthenic individual almost invariably yield a certain number of physiological symptoms of disorder in addition to the recognized mental and emotional troubles. It is quite likely, for instance, that the neurasthenic's digestion will be upset in various so-called "functional" ways, which, even though no respectable ulcer or other organic lesion be found, are quite as real and objective and distressful to the patient as any other class of symptoms. It is also likely, according to the writer's observations, that he will manifest any number of another class of symptoms which, no matter whether they be produced by reflex nervous mechanisms, or directly by a mild and modified anaphylactic reaction to some foreign protein, may be placed under the general category of "allergic" or hypersensitive disease symptoms. A simple definition of "allergy" at this stage is not very enlightening, for a full picture of all its varied manifestations is requisite to do it justice. Its generality and variability of symptoms make a formal definition empty. It is defined by the American Medical Dictionary as "a condition of unusual or exaggerated, specific susceptibility to a substance which is harmless in similar amounts for the majority of members of the same species." Von Pirquet, who introduced the term in 1913, defines it as "the change in reaction capacity which follows in animals or man after recovery from disease or after treatment with foreign substances." It is manifested in the symptoms of that group of diseases which includes hay fever, asthma, catarrh, migraine, urticaria, eczema, etc., and is thought of as the underlying physiological reaction causing these diseases. It is the writer's observation that neurasthenic individuals are likely to manifest a number of the physiological symptoms of this disease. One subject, for instance, who is failing in four-fifths of his courses in college because of easy fatigability, inability to concentrate, day-dreaming, emotional depression, etc., is found to have a variety of intestinal disorders with urticarial rash and is found by skin tests to be specifically sensitive to milk and eggs, which when eaten cause a delayed reaction of intestinal allergy. Both physiological and neurasthenic symptoms disappear with avoidance of these proteins and with the administration of small doses of ephedrine. The subject subsequently passes all his courses with a grade of B. Another subject with marked emotional instability and depression and most of the other neurasthenic symptoms displays also the physiological symptoms of intestinal allergy and upon careful questioning reveals a history of violent migraine attacks and intestinal crises after eating meals at unaccustomed restaurants. Another subject with all the personality difficulties of neurasthenia upon questioning and testing is found to have an allergic constitution with hay fever, rheumatism, and migraine. Still another subject of restless, instable disposition, with overworked, irritable emotions and strong inferiority complex is found to have migraine, hay fever, intestinal allergy, and rhinitis. Examinations show also an allergic strain or constitution in the family history, with close relations suffering from similar allergic forms. Such cases lead one to suspect that perhaps there may be some causal relations obtaining among these sets of symptoms and at least justify an effort to find out how general or to what extent are the relations, if any, among them. The next step will then be to discover, by the statistical treatment of questionnaires given to a large group, what degrees of relationship obtain among these three groups of symptoms: the mental and emotional traits of neurasthenia, the physiological symptoms of indigestion, and the physiological symptoms of the allergic diseases