Download and Read online, DOWNLOAD EBOOK, [PDF EBOOK EPUB ], Ebooks

download, Read Ebook EPUB/KINDE, Download Book Format PDF

Burnout, Fatigue, Exhaustion: An Interdisciplinary

Perspective on a Modern Affliction 1st Edition
Sighard Neckel

OR CLICK LINK
https://textbookfull.com/product/burnout-fatigue-
exhaustion-an-interdisciplinary-perspective-on-a-
modern-affliction-1st-edition-sighard-neckel/

Read with Our Free App Audiobook Free Format PFD EBook, Ebooks dowload PDF
with Andible trial, Real book, online, KINDLE , Download[PDF] and Read and Read
Read book Format PDF Ebook, Dowload online, Read book Format PDF Ebook,
[PDF] and Real ONLINE Dowload [PDF] and Real ONLINE
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Biota Grow 2C gather 2C cook Loucas

https://textbookfull.com/product/biota-grow-2c-gather-2c-cook-
loucas/

Modern and Interdisciplinary Problems in Network

Science: A Translational Research Perspective 1st
Edition Zengqiang Chen

https://textbookfull.com/product/modern-and-interdisciplinary-
problems-in-network-science-a-translational-research-
perspective-1st-edition-zengqiang-chen/

Histories of Dreams and Dreaming: An Interdisciplinary

Perspective Giorgia Morgese

https://textbookfull.com/product/histories-of-dreams-and-
dreaming-an-interdisciplinary-perspective-giorgia-morgese/

Systems, Self-Organisation and Information: An

Interdisciplinary Perspective Pereira Junior Alfredo

https://textbookfull.com/product/systems-self-organisation-and-
information-an-interdisciplinary-perspective-pereira-junior-
alfredo/
Performance Appraisal in Modern Employment Relations:
An Interdisciplinary Approach Tindara Addabbo

https://textbookfull.com/product/performance-appraisal-in-modern-
employment-relations-an-interdisciplinary-approach-tindara-
addabbo/

Nonequilibrium Statistical Physics A Modern Perspective

1st Edition Roberto Livi

https://textbookfull.com/product/nonequilibrium-statistical-
physics-a-modern-perspective-1st-edition-roberto-livi/

Microbial biotechnology: an interdisciplinary approach

1st Edition Shukla

https://textbookfull.com/product/microbial-biotechnology-an-
interdisciplinary-approach-1st-edition-shukla/

Intelligence And State Surveillance In Modern Societies

An International Perspective Frederic Lemieux

https://textbookfull.com/product/intelligence-and-state-
surveillance-in-modern-societies-an-international-perspective-
frederic-lemieux/

An Applied Perspective on Indian Ethics P. K. Mohapatra

https://textbookfull.com/product/an-applied-perspective-on-
indian-ethics-p-k-mohapatra/
Burnout, Fatigue, Exhaustion
Sighard Neckel • Anna Katharina Schaffner • Greta Wagner
Editors

Burnout, Fatigue,
Exhaustion
An Interdisciplinary Perspectives
on a Modern Affliction
Editors
Sighard Neckel Anna Katharina Schaffner
Institute of Sociology School of European Culture and Languages
University of Hamburg University of Kent
Hamburg, Germany Canterbury, United Kingdom

Greta Wagner
Institute of Sociology
Goethe University Frankfurt
Frankfurt, Germany

ISBN 978-3-319-52886-1 ISBN 978-3-319-52887-8 (eBook)

DOI 10.1007/978-3-319-52887-8
Library of Congress Control Number: 2017937049

© The Editor(s) (if applicable) and The Author(s) 2017

This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by
similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica-
tion does not imply, even in the absence of a specific statement, that such names are exempt from the
relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this
book are believed to be true and accurate at the date of publication. Neither the publisher nor the
authors or the editors give a warranty, express or implied, with respect to the material contained herein
or for any errors or omissions that may have been made. The publisher remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.

Cover design by Tom Howey

Printed on acid-free paper

This Palgrave Macmillan imprint is published by Springer Nature

The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
 Contents

1 Introduction 1
Sighard Neckel, Anna Katharina Schaffner
and Greta Wagner

Part I Cultural-Historical Perspectives

2 Pre-Modern Exhaustion: On Melancholia and Acedia 27

Anna Katharina Schaffner

3 Neurasthenia and Managerial Disease in Germany and

America: Transnational Ties and National Characteristics
in the Field of Exhaustion 1880–1960 51
Patrick Kury

Part II Exhaustion Syndromes

4 Exhaustion Syndromes: Concepts and Definitions 77

Johanna M. Doerr and Urs M. Nater

5 Burnout: A Short Socio-Cultural History 105

Wilmar B. Schaufeli
v
vi Contents

6 Burnout: From Work-Related Stress to a Cover-Up

Diagnosis 129
Linda V. Heinemann and Torsten Heinemann

Part III Exhaustion and Self-Realisation

7 What We Talk About When We Talk About Mental

Health: Towards an Anthropology of Adversity in
Individualistic Society 153
Alain Ehrenberg

8 Self-Realisation Through Work and Its Failure 173

Elin Thunman and Marcus Persson

9 Exhaustion and Euphoria: Self-Medication with

Amphetamines 195
Greta Wagner

Part IV Exhaustion Discourses

10 Rechargeable Man in a Hamster Wheel World:

Contours of a Trendsetting Illness 217
Ulrich Bröckling

11 Literary Exhaustion 237

Michael Greaney

Part V Exhaustion and the Social

12 Social Agony and Agonising Social Constructions 259

Iain Wilkinson

13 Exhaustion as a Sign of the Present 283

Sighard Neckel and Greta Wagner
 Contents vii

14 Conclusion 305
Sighard Neckel, Anna Katharina Schaffner
and Greta Wagner

Index 311
 List of Tables

Table 4.1 Fatigue Syndromes 81

ix
 1
Introduction
Sighard Neckel, Anna Katharina Schaffner
and Greta Wagner

Our age, it seems, is the age of exhaustion. The prevalence of exhaustion –

both as an individual experience and as a broader socio-cultural
phenomenon – is manifest in the epidemic rise of burnout, depression,
and chronic fatigue. It is equally present in a growing disenchantment
with capitalism in its current neo-liberal form, in concerns about the
psycho-social repercussions of ever-faster information and communica-
tion technologies, in a general distrust in grand narratives, and in
anxieties about ecological sustainability.

S. Neckel (*)
University of Hamburg, Hamburg, Germany
e-mail: Sighard.Neckel@wiso.uni-hamburg.de
A.K. Schaffner
University of Kent, Canterbury, UK
e-mail: a.k.schaffner@kent.ac.uk
G. Wagner
Goethe University Frankfurt, Frankfurt, Germany
e-mail: Greta.Wagner@soz.uni-frankfurt.de

© The Author(s) 2017 1

S. Neckel et al. (eds.), Burnout, Fatigue, Exhaustion,
DOI 10.1007/978-3-319-52887-8_1
2 S. Neckel et al.

As the precise organic causes of chronic exhaustion are still being

debated, exhaustion theories entail by definition assumptions about the
relationship between mind and body, and between the environment and
society, and are often ideologically charged. Moreover, exhaustion the-
ories frequently function as discursive spaces in which specific cultural
discontents are articulated. They therefore present highly instructive case
studies for an investigation of the ways in which individual suffering and
wider social dynamics are inter-related.
To a certain extent, social problems and wider cultural-historical devel-
opments tend to be mirrored by the rise and fall of specific medical
symptoms and so-called fashionable diseases. It is thus not an entirely
new phenomenon that current exhaustion syndromes provide the occasion
for social self-reflection on the pathologies of modern economic and social
life. It is nevertheless striking that what many consider a predominantly
mental condition has become the symbol of our social condition. While in
the past heart attack, circulatory collapse, or the proliferation of malignant
cells served as symbols of social crises, currently exhaustion syndromes
seem to have few rivals when it comes to the public anamnesis of undesir-
able economic and social developments. A diagnostic commonality has
evolved in public discourse which starts with the ‘exhausted self’ of the
self-responsible subject,1 proceeds to examine symptoms of exhaustion in
the status struggle of the middle classes,2 and finally arrives at the finding
that expansionist conceptions of growth have become exhausted,3 and thus
at a critique of the ideological script that demands the continuous expan-
sion of money, labour, and commodities.
The concept of exhaustion, it seems, can serve equally well to describe
such diverse phenomena as subjective predicaments and social ills.

1
Alain Ehrenberg, The Weariness of the Self: Diagnosing the History of Depression in the
Contemporary Age, trans. David Homel et al. (Montreal: McGill-Queens’s University Press,
2010a).
2
See Steffen Mau, Inequality, Marketization and the Majority Class: Why Did the European Middle
Classes Accept Neo-Liberalism? (New York: Palgrave Pivot, 2015).
3
Meinhard Miegel, Stefanie Wahl, and Martin Schulte with the collaboration of Elias Butzmann,
Altering Attitudes: From a Culture of Consumerism to a Culture of Prosperity (Bonn: Denkwerk
Zukunft – Stiftung kulturelle Erneuerung, 2011).
 1 Introduction 3

This concept is thus able to connect individual psychological crises with

the fact that broad sectors of society are exposed to tension-laden living
conditions, and with the problematic state of an entire economic and
social system. Here, the condition of being drained seems to be what
connects individuals, social classes, growth-oriented capitalism, and the
ecosystem into a crisis-ridden constellation. What appears at the indivi-
dual level as exhaustion, and at the social level as excessive demands on
certain social classes, manifests itself at the economic level as indebtedness
and in the ecological domain as wasteful expenditure of finite resources.
Medically speaking, the symptoms of exhaustion feature in various
syndromes. They are core features of depression, chronic fatigue syn-
drome (CFS), and the burnout syndrome. These conditions are being
diagnosed with increasing frequency. Above all, depression is on the rise
throughout the world; the WHO estimates that in the year 2020, it
could be the second most common illness in Western industrialised
countries.
The increase in diagnoses of exhaustion is interpreted in very different
ways. Is it primarily changing social demands on subjects that are giving
rise to new suffering? Is it mechanised and urbanised, accelerated or
marketised modernity that impacts well-being and accounts for the
increase in exhaustion-related mental illness? Or is it the diagnoses
that become fashionable at certain times themselves that point to social
changes? If that were the case, the concepts and medical classifications
would tell us more about social change than about changes in the kinds
of suffering afflicting modern subjects.
Among critical social scientists advocates of both these hypotheses can
be found. Medicalisation theorists regard the increase in conditions such
as depression as labelling processes in which non-medical facts are
reinterpreted in medical terms, so that more and more areas of human
life are being assimilated by the medical system. In the course of this
development, it is claimed that social problems become pathologised
and medical markets are created or expanded.4 The other interpretation

4
See, for example, Peter Conrad, The Medicalization of Society: On the Transformation of Human
Conditions into Treatable Disorders (Baltimore: The Johns Hopkins University Press, 2007).
4 S. Neckel et al.

of the increase in diagnoses of mental illnesses offered by social sciences

assumes that social change and certain social dynamics can give rise to
psychological suffering, and hence that the increase in the diagnoses of
illnesses is not only an indication of expanding medical markets but also
of problematic social trends.5 Finally, the increasing attention being paid
to human exhaustion can be interpreted as partaking in discursive
processes of self-reflection and can be historicised to form critiques of
modernity, and even to form critiques of pre-modern developments that
were perceived as problematic.6

Exhaustion as a Sign of the Times?

There is no disputing fact that people have always felt exhausted after
exerting themselves. Moreover, hardly anyone would deny that there
have been epochs in history in which comparably extreme demands were
made on the subjective capacities of certain social classes. Nevertheless,
we must ask why so many people regard exhaustion as emblematic of the
present. A distinctive feature of analyses of the present is that they try to
offer an inclusive interpretation of present-day society. Following Max
Weber’s remarks on ideal types, one could say that they aim through a
‘one-sided accentuation of one or more points of view’ to get at the heart
of what is a characteristic of society as a whole.7 Their goal is to
intervene in public discussions and to reverse problematic developments.
Like medical diagnoses, analyses of the present also generally imply
specific therapeutic suggestions. In this connection, they are often not
only accused of unacceptably reducing complexity by combining overly

5
See Axel Honneth, ‘Organized Self-Realization: Some Paradoxes of Indivdualization’, European
Journal of Social Theory 7: 4 (2004), 463–78; Harmut Rosa, ‘Wettbewerb als Interaktionsmodus:
Kulturelle und sozialstrukturelle Konsequenzen der Konkurrenzgesellschaft’, Leviathan 34:
1 (2006), 82–104; and Leistung und Erschöpfung: Burnout in der Wettbewerbsgesellschaft, ed.
Sighard Neckel and Greta Wagner (Berlin: Suhrkamp, 2013).
6
Anna Katharina Schaffner, Exhaustion: A History (New York: Columbia University Press, 2016).
7
Max Weber, ‘“Objectivity” in Social Science and Social Policy’, in The Methodology of the Social
Sciences, trans. Edward A. Schils and Henry A. Finch (Glencoe, IL: Free Press 1949), pp. 49–112
(p. 90).
 1 Introduction 5

contradictory symptoms into a diagnosis of a disease. They are also often

suspected of being formulated in the terms of the tradition of
Nietzschean cultural criticism, the origins of which lie in late nine-
teenth-century critiques of modernity and in disappointed expectations
regarding the Enlightenment project. Allied with this suspicion is the
criticism that analyses of the present involve culturally pessimistic or
nostalgic descriptions whose implicit normative points of reference are
pre-modern, non-technologised societies.
Even the editors of this volume do not agree over whether contem-
porary society truly faces an unprecedented epidemic of exhaustion, or
whether exhaustion and anxieties about its effects are ubiquitous, trans-
historical phenomena. Rather, the contributions assembled here reflect a
plural range of interpretations of exhaustion. While some contributions
interpret the rise of exhaustion syndromes in sociological terms as an
effect of a society marked by unrestrained competition, other contribu-
tors adopt a perspective based on the history of culture, medicine, and
ideas. In some cases, therefore, exhaustion is the subject of an analysis of
the present, while in others the analyses of present manifestations of
exhaustion are compared to historical phenomena.
A concern in many ages, the cultural preoccupation with exhaustion
usually intensifies in periods in which rapid socio-cultural and techno-
logical change occurs. We understand exhaustion as an individual phy-
sical and mental state, but also as a broader socio-cultural phenomenon.
Physically, exhaustion manifests itself as fatigue, lethargy, and weakness.
It can be a temporary state (e.g. as a result of exertion) or a chronic
condition. The contributions in this essay collection focus predomi-
nantly on pathological forms of exhaustion, and those that are not
obviously the result of an underlying and clearly diagnosable medical
condition. On a mental level, we can describe the symptoms of exhaus-
tion as weariness, disillusionment, apathy, hopelessness, and lack of
motivation. Exhaustion can also be the cause of behaviours such as
restlessness and the avoidance of activity, effort, and challenges.
The symptoms of exhaustion have featured in various diagnoses, some
of which are now obsolete, and which include melancholia, acedia,
hypochondria, nervous weakness, neurasthenia, depression, CFS, and
burnout. Over the past centuries, the symptoms of exhaustion have
6 S. Neckel et al.

variously been explained as a product of biochemical imbalance, as a

psychological or a somatic ailment, as a viral disease or an immune
dysfunction, as a desire to return to a death-like state of repose, or as a
broader cultural response to a faster pace of life and transformations in
economic and social structures. These theories show how the relation
between mind and body, the individual, society, and the cultural and
natural environment have been imagined at different historical moments.
Some theories privilege holistic models, in which body, mind, and the
social environment are accorded equal importance; some focus exclu-
sively on biology, some on the psyche, and some on social structures.
The current era, therefore, is not the first to understand itself as being
marked by excessive exhaustion. An interesting horizon of comparison is
offered by the 1880s, when people also thought they were living in an age
of exhaustion. Neurasthenia was rampant in Europe and North America
and was regarded as the trendsetting illness par excellence, the signature
disease of the time. Its causes were thought to reside in the radical social
change taking place at the time, whose salient features were urbanisation,
industrialisation, and technological progress. Modern living conditions,
advances in communication and transportation, and the associated accel-
eration seemed to be subjecting the human nervous system to excessive
strain. Emil Kraepelin, a German psychiatrist who laid the groundwork
for the classification of mental diseases, called neurasthenia the ‘disease of
our time’ and distinguished it from other psychopathologies as an
acquired syndrome: ‘the growth of large cities and the competitive con-
ditions prevailing in them lead for a large portion of the people to an
increase in the demands they have to meet and at the same time to greater
fragmentation of activity, restlessness, and irregularity in the conduct of
life’.8 The German neurologist Wilhelm Erb wrote about neurasthenia:
‘Everything proceeds in haste and in a flurry; the night is used for travel,
the day for conducting business; even vacation trips become strains on the
nervous system.’9 The living conditions of bourgeois elites had been

8
Emil Kraepelin, Psychiatrie. Ein Lehrbuch für Studierende und Ärzte. Band 1 (Leipzig: Barth
Verlag, 1900), p. 196.
9
Wilhelm Erb, Über die wachsende Nervosität unserer Zeit (Heidelberg: Hörning, 1894), p. 20.
 1 Introduction 7

transformed in a short time by technical innovations and were thought to

be leading to symptoms such as headaches, irritability, hopelessness,
insomnia, craving for drugs, and exhaustion.10 Alain Ehrenberg describes
neurasthenia as the first ‘fashionable complaint’. What was specifically
new at the end of the nineteenth century was the idea of ‘exogenous
suffering’, that is the idea that external conditions were having internal,
psychological effects.
Today, just as at the end of the nineteenth century, the perception of
the present as an age of exhaustion comes in the wake of a phase of rapid
social change. Just as the major changes in the conduct of life triggered
by secularisation and industrialisation may have led to the exhaustion
crisis of neurasthenia, so, too, the digital revolution and the acceleration
of financial market-driven growth capitalism may have contributed to
bringing about the exhausted self of the present.

Exhaustion Discourses
Even though diagnoses of exhaustion are on the increase in most countries
throughout the world, there are nevertheless striking variations in national
discourses about exhaustion. Even today in China, for example, neurasthe-
nia is still frequently diagnosed because it is considered to have a physical
cause and those affected are therefore less stigmatised than, for example,
those diagnosed with depression; hence, neurasthenia represents a kind of
somatic cover diagnosis for the psychological symptoms of exhaustion.
Given that exhaustion can be manifest as both a predominantly
mental experience and a bodily feeling, the relationship between body
and mind often becomes the subject of discursive negotiation in the
case of the symptoms of exhaustion. The tension between somatic and
psychological explanations is a focus of continuing debates. The inter-
pretive conflicts over the relationship between body and mind when
exhaustion is diagnosed are especially apparent in the case of CFS.

10
See Patrick Kury, ‘Von der Neurasthenie zum Burnout – eine kurze Geschichte von Belastung
und Anpassung’, in Leistung und Erschöpfung, ed. Sighard Neckel and Greta Wagner (Berlin:
Suhrkamp Verlag, 2013), pp. 107–28 (p. 109).
8 S. Neckel et al.

First named and defined in the 1980s, CFS, which is also known as
myalgic encephalomyelitis (ME) and post-viral fatigue syndrome, holds
a special place among the exhaustion syndromes discussed in this essay
collection.11 Post-exertion malaise, severe mental and physical fatigue, a
sense of effort that renders many everyday activities impossible, and
difficulties with concentrating, cognitive tasks, and short-term memory
are among its cardinal symptoms.12 The search for empirical diagnostic
markers and the biomedical origins of the illness is still ongoing, and
future findings may well demonstrate that the illness is predominantly
caused by physical rather than social or psychological forces. Yet, at
present, ME/CFS remains a controversial diagnosis subjected to widely
divergent interpretations, and has in recent decades prompted fierce
debate among medical practitioners and patients.13
At the centre of the ME/CFS controversy is the question of whether
or not psychiatric and psycho-social factors contribute to, or even cause,
the development of the condition. Some researchers and the majority of
patients suffering from ME/CFS argue strongly for the purely somatic
origins of the condition. Most commonly, viral infections, immune
dysfunctions, and central nervous system or metabolic disorders are
thought to trigger the illness.14 Other researchers believe that ME/CFS
has a microbiological trigger (such as Epstein-Barr virus), but that social,

11
Gary Holmes at the Centres for Disease Control and Prevention (CDC) coined the term CFS
in 1988.
12
See the CDC’s web information on CFS, online at: http://www.cdc.gov/cfs/causes/risk-groups.
html (accessed January 2015).
13
For an analysis of the debates concerning the symptoms, epidemiology, and therapeutics of the
condition, see Simon Wessely, Matthew Hotopf, and Michael Sharpe, Chronic Fatigue and Its
Symptoms, rev. ed. (Oxford: Oxford University Press, 1999); and Michael Sharpe, ‘Chronic
Fatigue Syndrome’, The Psychiatric Clinics of North America, 19: 3 (1996), 549–73.
14
See, for example, M. M. Zeineh, J. Kang, S. W. Atlas, M. M. Raman, A. L. Reiss, J. L. Norris,
I. Valencia, and J. G. Montoya, ‘Right Arcuate Fasciculus Abnormality in Chronic Fatigue
Syndrome’, Radiology 274: 2 (2015), 517–26; A. L. Landay, C. Jessop, E. T. Lennettee, and
J. A. Levy, ‘Chronic Fatigue Syndrome: Clinical Conditions Associated with Immune Activation’,
Lancet 338 (1991), 707–12; A. M. Lerner, C. Lawrie, and H. S. Dworkin, ‘Repetitively Negative
Changing T Waves at 24-H Electrocardiographic Monitors in Patients with Chronic Fatigue
Syndrome’, Chest 104 (1993), 1417–21; and R. Freeman and A. L. Komaroff, ‘Does the Chronic
Fatigue Syndrome Involve the Autonomic Nervous System?’, American Journal of Medicine
102 (1997), 357–64.
 1 Introduction 9

behavioural, and psychological factors may subsequently contribute to

perpetuating the illness and also to a patient’s inability fully to recover
from the viral infection.15 Yet other researchers completely dismiss the
validity of biological explanations, and argue that ME/CFS is primarily a
psychosomatic or a behavioural problem, closely related to depression
and anxiety, and should therefore be classified as a psychiatric disorder.16
And a final group of scholars emphasises the social origins of the ill-
ness.17 Generally, ME/CFS is either considered a syndrome with poten-
tially many causes or else with a single cause that has not yet been
conclusively established.
The politics of the disease remain complex. Judith A. Richman and
Leonard A. Jason, for example, point out gender biases in the construc-
tion of and discourse surrounding this illness, which affects more women
than men. They argue that ‘the failure of Western medicine to demon-
strate a viral etiology for CFS led to a paradigmatic shift in research
perspectives that subsequently enforced psychiatric and socio-cultural
explanations for CFS. As a result, CFS was de-legitimised as a biomedi-
cal phenomenon within medical, academic, governmental, and public
arenas’.18 Following sustained criticism of the psycho-social and beha-
vioural ME/CFS illness models, the search for the biological causes of
ME/CFS has recently been intensified.19 Many sufferers feel frustrated
about the lack of progress in identifying the underlying organic factors of

15
Stephen T. Holgate, Anthony L. Komaroff, Dennis Mangan, and Simon Wessely, ‘Chronic
Fatigue Syndrome: Understanding a Complex Illness,’ Nature 12 (2011), 539–44.
16
See, for example, Edward Shorter, From Paralysis to Fatigue: A History of Psychosomatic Illness in
the Modern Era (New York: The Free Press, 1992); Elaine Showalter, Hystories: Hysterical
Epidemics and Modern Media (New York: Columbia University Press, 1998); and Richard L.
Kradin, Pathologies of the Mind/Body Interface: Exploring the Curious Domain of the Psychosomatic
Disorders (New York: Routledge, 2013).
17
See, for example, S. E. Abbey and P. E. Garfinkel, ‘Neurasthenia and Chronic Fatigue
Syndrome: The Role of Culture in the Making of a Diagnosis’, American Journal of
Psychotherapy 148 (1991), 1638–46; and N.C. Ware and A. Kleinman, ‘Culture and Somatic
Experience: The Social Cause of Illness in Neurasthenia and Chronic Fatigue Syndrome’,
Psychosomatic Medicine 54 (1992), 546–60.
18
J. A. Richman and L. A. Jason, ‘Gender Biases Underlying the Social Construction of Illness
States: The Case of Chronic Fatigue Syndrome’, Current Sociology 49 (2001), 15–29.
19
For a summary of recent criticism of the PACE trial, see, for example, David Tuller,
‘Re-Examining Chronic Fatigue Syndrome: Research and Treatment Policy’, online at:
10 S. Neckel et al.

their condition, and blame the government and the medical establish-
ment for failing to direct more funds to ME/CFS research. Scientists and
scholars who propose that psychogenic factors may play a role in the
illness are often targeted by radical activists, who sometimes even resort
to threats to dissuade them from their research. The sufferers accuse
these researchers of creating the impression that CFS is merely a figment
of the imagination of those who have been diagnosed with it.20 These
activists see the claim that psychological factors may play a role in CFS as
a failure to recognise and show respect for their suffering. They regard
‘psychological’ causes as synonymous with ‘self-incurred’ or ‘not real’.
Yet suffering as a result of exhaustion is not only situated at the
interface between body and mind – it also connects individual suffering
with the social sphere. This is particularly clear in the case of the burnout
syndrome. Burnout is an affliction that has acquired astounding popu-
larity in therapeutic and public discourses in some Western countries
over the past decade. In Germany, for example, so many people began to
suffer from burnout by the end of the last century that it triggered a
veritable flood of stories on the topic in the media. There was scarcely a
single magazine that did not have burnout as a lead story, or a TV
programme that did not report on it. Clearly, in Germany, a mood of
discontent with the pressure to perform in contemporary working life,

http://healthaffairs.org/blog/2016/02/04/reexamining-chronic-fatigue-syndrome-research-and-
treatment-policy/ (accessed September 2016).
In October 2015, Francis Collins, the director of the National Institutes of Health (NIH),
announced a major new funding initiative. See https://www.nih.gov/news-events/news-releases/
nih-takes-action-bolster-research-myalgic-encephalomyelitis/chronic-fatigue-syndrome (accessed
September 2016).
In February 2015, the Institute of Medicine published a comprehensive report on ME/CFS, in
which a refinement of the diagnostic criteria of the condition as well as a new name is proposed.
Systemic exertion intolerance disease, the committee argues, emphasises more clearly the central
characteristic of the disease, namely, ‘the fact that exertion of any sort – physical, cognitive, or
emotional – can adversely affect patients in many organ systems and in many aspects of their lives’.
The report entitled ‘Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining
an Illness’, released in February 2015, is available online at: http://www.nationalacademies.org/
hmd/Reports/2015/ME-CFS.aspx (accessed 16 September 2016).
20
Robin McKie, ‘Chronic Fatigue Syndrome Researchers Face Death Threats from Militants’,
The Observer (August 2011), online at: http://www.theguardian.com/society/2011/aug/21/
chronic-fatigue-syndrome-myalgic-encephalomyelitis (accessed March 2016).
 1 Introduction 11

with the increasing pace of work and communication, with excessive

everyday demands and newly perceived forms of alienation, is being
articulated with the help of the burnout syndrome. This has concrete
consequences: in Germany, the average number of sick days due to
burnout has risen 18-fold since 2004, to 43.21 Diagnoses of burnout
are also on the rise in the Scandinavian countries and in the Netherlands.
What is most striking here is the symbolism associated with the
concept of burnout. An important factor in its popularity seems to be
that the diagnosis of burnout can be worn like a ‘badge of honor of the
performance-oriented society’.22 Someone who has burned out must
previously have been inflamed by something, which exempts the condi-
tion from the stigma of individual failure. Thus, the term burnout
contains a reference to prior commitment. Moreover, it is associated
with visual imagery which implies a mechanistic, and hence an anti-
psychological, picture of the human being. Even though people who are
afflicted with burnout experience overwhelming fatigue, they are still
exhausted even after waking up from a long sleep. In their case, the
switch between exertion and regeneration has been thrown into crisis. In
the popular visual imagery of burnout discourse, this depletion is sym-
bolised by the condition of being burned out, which finds its allegorical
expression in the burned-out match. No one expects a spent match to
catch fire again.
However, among the metaphors associated with burnout is also an
image that implies the possibility of starting a new cycle – namely, the
drained battery, an image that is strikingly often used in public discourse
to describe the cause of collapse due to exhaustion. The empty battery
signals the state of exhaustion and its flashing warning light in the
symbolic language of technology; it is the final warning before the device
switches off. In the image of the human being articulated here, the
personal reserves of energy have been depleted by persistent exertion

21
See BKK Gesundheitsreport, Gesundheit fördern – Krankheit versorgen – mit Krankheit leben,
2012 (www.bkk.de/fileadmin/user_upload/PDF/Arbeitgeber/gesundheitsreport/
Gesundheitsreport_2012/Gesundheitsreport_2012.pdf) (accessed January 2013), p. 43.
22
Wolfgang Schmidbauer, ‘Mehr Hofnarr als Hofrat. Über die Krisen der Psychotherapie’, in
Kursbuch 170 ‘Krisen lieben’ (Hamburg: Murmann, 2012), pp. 150–73 (p. 159).
12 S. Neckel et al.

and excessive commitment, and the battery must be recharged through

therapy or coaching. Here, ideally, techniques should be learned which
preclude a recurrence of exhaustion and optimise the cycle of exertion
and regeneration so that a sustainable energy balance results. The image
of the drained battery seems to owe its intuitive public appeal to the fact
that burnout is described as a condition in which the human energy
balance has become skewed.

Exhaustion and Self-Fulfilment

A less mechanistic, but in recent years widely discussed, socio-psycho-
logical interpretation of the increase in suffering due to exhaustion
concerns the task of self-fulfilment – so often perceived by modern
individuals as a personal obligation. Alain Ehrenberg has interpreted
the exhaustion experienced by modern subjects as exhaustion of being
oneself, as a pathological condition of inadequacy. Present-day society is
characterised to a lesser extent than earlier societies by rigid norms and
prohibitions and, unlike the disciplinary society, no longer rewards
conformity. In today’s society, the operative ideals of action are auton-
omy and individual responsibility. Therefore, the dominant form of
psychological suffering is no longer neurosis based on feelings of guilt,
but instead depression, an illness of accountability. ‘Depression’, writes
Ehrenberg ‘whose main feature is a loss of self-esteem, is a pathology of
magnitude: the depressed person is not up to the task of becoming a self;
instead it wears her down. Old-fashioned bourgeois guilt and the strug-
gle to free oneself from the law of the father have now been replaced by
the fear that one might not live up to one’s own high ideals, which gives
rise to a feeling of inability and inadequacy.’23
In his description of the etiology of burnout the founder of burnout
research, the New York-based psychoanalyst Herbert J. Freudenberger,

23
Alain Ehrenberg, ‘Depression: Unbehagen in der Kultur oder neue Formen der Sozialität’, in
Kreation und Depression: Freiheit im gegenwärtigen Kapitalismus, ed. Christoph Menke and Juliane
Rebentisch (Berlin: Kadmos, 2010b) pp. 52–62 (p. 54).
 1 Introduction 13

also accorded a central role, in addition to sheer overload, to the feeling

that one is disappointing high expectations. To burn out means ‘to
deplete oneself; to exhaust one’s physical and mental resources; to
wear oneself out by excessively striving to reach some unrealistic expec-
tation imposed by oneself or by the values of society’.24 Whereas the
point of reference for Freudenberger’s burnout research in the 1970s
was the social professions in which individuals were excessively
dedicated to helping clients, pupils, or patients, in the current
world of work performance expectations have in many cases become
immoderate and unrealistic far beyond the social professions.
Employees in all sectors are required to identify completely with
their company, as though its success served a higher purpose which
can be achieved only through the full commitment of its employees.
Modern working life in many sectors is no longer marked by
small-scale controls, but instead by a high degree of flexibility and
personal responsibility.
A glance at the origins of burnout research thus reveals interesting
connections between the genealogy of burnout and that of the modern
professional world of the present. The sharp increase in the number
of diagnoses of burnout raises the question of whether the idealistic
helpers of the 1980s have anything in common with the members
of the present-day workforce. It seems as though today, employees
across all sectors identify with corporate objectives in exactly the
same way as dedicated social workers did with their clients back in
the 1980s.
Burnout can thus be regarded as a kind of reactive depression that
follows the disappointment of not being rewarded for complete personal
dedication. Yet what makes the present-day world of work so disap-
pointing? Has the introduction of new forms of organisation in many
companies failed to live up to employees’ expectations regarding oppor-
tunities for self-fulfilment? Flexible working hours, the abolishment of
hierarchies, self-organisation, and opportunities for bringing one’s own

24
Herbert J. Freudenberger and Geraldine Richelson, Burnout: The High Cost of High Achievement
(New York: Anchor, 1983), p. 16.
14 S. Neckel et al.

interests into play have become part of the everyday reality of more and
more companies. However, this transformation did not only encourage
the quest for self-fulfilment but it also increased the scope for corporate
action. As Luc Boltanski and Ève Chiapello have shown, ‘new capital-
ism’ has endogenised the criticism that was aimed at it already in the
1970s.25 Thus, the objections against hierarchy, bureaucracy, and alie-
nation, whose spokespeople used to be left-wing activists and the new
social movements, presided over the introduction of flexible working
conditions in companies.
Today employees are required to be entrepreneurs selling their
own labour power, and to optimise it continually. Like the idealis-
tic social worker of the 1970s and 1980s, the present-day entre-
preneurial self is compelled to contribute its subjectivity and is
concerned to efface once again the boundaries between work and
private life. The aim of the self-realisation that was supposed to
have been fulfilled in the past by breaking up encrusted structures
has now been transformed into a requirement, into ‘institutiona-
lized expectations inherent in social reproduction’ whose intrinsic
purpose has been lost.26 It is now a long-established practice to
understand one’s work as an expression of intrinsic interests and
to show that one does not work because one has to, but because
one wants to. In this way, the concept of alienation acquires a new
meaning: to perform alienated work, to be alienated from one’s
work, is no longer a social condition that is vulnerable to the
critique of capitalism, because the expectation to become one
with one’s own work is one of the impositions of the present.
Today individual resistance seems to reside precisely in the act of
not identifying too strongly with one’s work. In therapy, burnout
patients learn to restore precisely that strangeness that should
loosen the identification with work and to look for other sources
of recognition outside of work.

25
Luc Boltanski and Ève Chiapello. The New Spirit of Capitalism, trans. Gregory Elliott (New
York: Verso, 2005).
26
See Honneth, ‘Organized Self-Realisation’, p. 467.
 1 Introduction 15

Interdisciplinary Perspectives
This interdisciplinary essay collection explores the complex connections
between psychological, sociological, and biologic theories of exhaustion.
Examining the status of exhaustion symptoms in medical, psychological,
sociological, historical, and literary accounts, it analyses the interplay
between the processes involved in the production of mental health diag-
noses, socio-cultural transformations, and subjective illness experiences.
The volume is divided into five themed sections. It opens with a
section on historical models of exhaustion. Adopting a cultural-historical
perspective, Anna Katharina Schaffner argues that exhaustion is not at all
a modern preoccupation, nor the specific bane of our age of techno-
capitalism, as many critics argue, but that anxieties about exhaustion and
its psychological, physical, and social effects have always been with us.
She shows that theories of exhaustion and its corrosive effects can be
found in many historical periods, including Greek antiquity and the
Middle Ages. The symptoms of mental and physical exhaustion were
considered to be among the core symptoms of melancholia, theorised in
the broader framework of humoural theory by the physician Galen. An
alternative model of exhaustion emerged in Late Antiquity and blos-
somed in the Middle Ages: the notion of sloth, or acedia. Just like
melancholia, acedia included various symptoms of mental and physical
exhaustion among its core indicators, such as weariness, torpor, apathy,
lethargy, sleepiness, irritability, cognitive impairment, and hopelessness.
Yet, unlike melancholia, which was treated and defined by physicians,
sloth fell under the remit of theologians such as St Thomas Aquinas. It
was understood not as an organic disease, but rather as a spiritual and
moral failing.
The Swiss historian Patrick Kury analyses the emergence of nine-
teenth-century neurasthenia and ‘managerial disease’, a pre-cursor of
burnout associated with stressful jobs, as well as cardiovascular and
psychosomatic lifestyle diseases, and which was frequently diagnosed
in the 1950s and 1960s in Germany. Investigating the cultural-historical
factors that led to the rapid spread of these ‘diseases of civilisation’, Kury
pays close attention to the knowledge transfers between the United
States and Germany that characterise these fatigue and stress discourses.
16 S. Neckel et al.

Manager disease was driven by the anxiety that there was a worryingly
high mortality rate among Germany’s overtaxed (and mainly male)
elites, who were physically and mentally exhausted by the enormous
task of rebuilding the country’s economy after the Second World War,
and often paid the price for driving forward the German ‘economic
miracle’ with their own lives. It was only in the 1970s that the concept of
psycho-social stress took hold in German public and medical debates.
Kury argues that the neurasthenia and managerial disease diagnoses, just
like stress and burnout, ‘are often regarded positively, and appear in
phases of rapid social and economic change’.
The second section of this collection is dedicated to the role of
exhaustion symptoms in specific contemporary syndromes, in particular
burnout, CFS, and depression. Contributions in this section are written
by clinical experts, including psychiatrists and psychologists. Johanna
Doerr und Urs Nater investigate the different ways in which medically
unexplained fatigue-like symptoms have been treated, focussing on
difficulties in differentiating between different conditions. They begin
by relating the development and variations of the neurasthenia diagno-
sis, investigating the overlap of this diagnosis with depression diagnoses.
Following this, a comparison is made with East Asian diagnostic prac-
tices regarding medically unexplained fatigue, and the changes that have
occurred in this context. The focus of the essay then switches to the
second half of the twentieth century, to the developments of diagnoses
of CFS and of ME. Diagnostic criteria for the various conditions are
examined and found seriously to overlap, with arguments made as to
why one diagnosis may be given rather than another. At this point the
previously discussed conditions, and depression, are all considered in the
light of criteria commonly given for burnout. The conclusion is reached
that differential diagnoses for similarly presenting fatigue conditions is at
best an inexact science, and may lack medically stable grounds.
The Dutch work and organisational psychologist Wilmar Schaufeli
explores the historical roots of burnout as well as the specific socio-
cultural factors that led to its emergence. Addressing the question of
whether the major symptoms of burnout are ubiquitous or context-
specific, he analyses how they relate to similar syndromes, such as
neurasthenia and depression. Have burnout-like phenomena been
 1 Introduction 17

observed in the past as well, and is it a typically Western phenomenon?

Schaufeli’s chapter concludes with a discussion of differences in the ways
the diagnosis is used and understood in North America and Europe.
The following essay explores this idea further. Torsten and Linda
Heinemann investigate German and American academic and popular
media sources in order to analyse different conceptions of burnout in
these cultures. Tracing a development that begins with Freudenberger’s
introduction of the term and that ends with the present day, they show
that a surge in media interest, especially in the last decade, is noticeable
in Germany. In the United States, by contrast, the term remains con-
fined to specific professions, and is not generally considered a culturally
all-embracing condition. Torsten and Linda Heinemann also explore the
specific nature of public discussions of burnout, and draw attention to
the comparatively individualistic conception of the disease in the United
States, which contrasts with what the German media present as pre-
dominantly a social crisis.
Section three of this essay collection explores the link between exhaus-
tion and self-realisation, primarily with recourse to sociological and
cultural-theoretical models and theories. The French sociologist Alain
Ehrenberg, author of The Weariness of the Self: Diagnosing the History of
Depression in the Contemporary Age (1998), reflects on the anthropology
of adversity in individualist societies in his contribution. He argues that
in societies in which autonomy is the supreme value, mental health
‘functions as a discursive space in which many of the core tensions and
conflicts of neo-liberal subjectivity are negotiated’. Mental health, he
writes, ‘is the name individualistic society has given to our style of
dealing with passions, the social and moral equivalent of magical rites
for the modern autonomous individual’. Conditions such as depression
and burnout may thus be seen as a reaction against adversity and
contingency, and constitute forms of psycho-social suffering that are
caused by the idea of inadequacy. Ehrenberg concludes that ‘we have
seen a change in the social status of psychic suffering, and an extension
of its uses, particularly in the political sphere’.
The Swedish sociologists Elin Thunmann and Marcus Persson con-
tribute a narrative analysis, interpreting interviews with exhausted
Swedish workers. These public service workers were found to share
Another random document with
no related content on Scribd:
 OSTEO-MALACIA (MALAXOS SOFT): CACHEXIA
OSSIFRAGA; FRAGILITAS OSSIUM: “THE CRIPPLE:” “THE
STIFFNESS.”

Definition. Disease of the mature. Decalcifying in cancelli and Canals of Havers.

Dairy cows. Heavy milkers. Perverted appetite. Limed soils, sandy or limestone.
Low, damp, soils rich in organic matter. Cultivation. Watery food. Plethoric.
Debilitated. Cold. Change of locality improves. Microbes. Toxins. Lesions: vary
with stage, congestion of marrow, excess of cells and fat, osteoclasts, exudates,
friability of bone, distortions and fractures in pelvis and elsewhere. Symptoms: low
condition, projecting bones, rough coat, perverted appetite, stiffness, decubitus,
swaying limbs, inappetence, drying of milk, fever, bed sores, sloughs, sepsis, pus
infection, fractures. Duration, 2 to 3 months and upward. Enzootic. Prognosis,
varies with enzootic, and stage; best in recent cases, occurring, sporadically.
Treatment: according to cause, rich, generous diet, grain, salt bitters, cod liver oil,
apomorphia, wholesome pasturage, intensive culture change water, dry up milk,
dry stables, pure air, sunshine. Slaughter. Local derivatives.

Definition. A softening and fragility of the bones of adult animals,

in connection with solution and removal of the earthy salts.
This is essentially a disease of mature animals and is thus easily
distinguished from rachitis, in which the lesions are due to a faulty
development of young, growing bone. In osteo-malacia, too, the
decalcifying proceeds most actively in the walls of the Haversian
canals and cancelli, while in rachitis it progresses especially under
the periosteum and in and around the epiphyseal cartilage.
The disease is found most commonly in dairy cows, but softening
of the bones of mature animals has also been seen in horses and
other animals. Dieckerhoff, who quotes cases in mature horses,
adduces similar instances in colts under a year old, occurring
enzootically, and without the specific lesions of rachitis. Seven out of
sixteen broke their femurs in October, 1886, all kept on the same
place, in good box stalls, and well cared for. Landois found in bones
an abnormal amount of fat, ossein, water and lime salts. Grawitz
found no material change in the cancellated tissue. In one district in
Jutland, Stockfleth found an extraordinary number of broken legs as
the result of castration of colts, which had not shown the thickening
or distortions of rachitis.
Causes. The disease is particularly common in cows which yield a
calf every year, and especially in heavy milkers, in which respect it
agrees with the osteo-malacia of woman. The heavy demands upon
the system for the nourishment of the fœtus and the supply of milk,
undoubtedly lay the system open to attack, if they do not directly
cause the disease. An early and usually a persistent feature of the
malady is a depraved appetite, the causes of which may be read up in
Vol. II. The statements there made, require some qualification,
inasmuch as osteo-malacia is at times found on limestone soils with
hard, calcareous water, and on rich, alluvial valley soils abounding in
both clay and lime (Sarginson, Leclainche), as well as on barren
sands and granite soils deficient in both lime and phosphorus. It may
even appear on virgin or mucky soils after liming, which had been
free from the trouble up to that time (Thorburn). The decomposition
of the abundance of organic matter, hastened by the quicklime, has
evidently been a contributing cause.
The excess of organic matter in the soil seems to be a considerable
factor. Both Thorburn and Sarginson mention the “mossy” soils and
waters, and in Lanarkshire, Scotland, and Westmoreland, England,
where they practised, black muck and peats abound. This is
corroborated by the prevalence of the disorder in the damp lowlands
of Belgium and Jutland, in the Swiss valleys, on the damp lands of
New Jersey and the Carolina seaboard, and generally on damp
pastures with rank, watery herbage.
When land has been better cultivated and enriched by manure, the
disease has in many cases disappeared. This has been observed in
England (Sarginson), Wurtenberg, Switzerland, etc. (Leclainche).
Succulent, watery food (potatoes, turnips), have been quoted as
causes, as also rank, watery grasses, deficient in nutritious solids, but
such food has invariably come from habitual osteo-malacia soils. On
the rich, cultivated soils of the Lothians, Scotland, cattle are fed in
large numbers on turnips alone, and osteo-malacia and pica are alike
unknown. It is often noticed that the fodder grown on particular
(osteo-malacia) soils will cause the disease when fed elsewhere, so
that the inference is that some agent derived from these soils, and
which is destroyed or rendered harmless by cultivation, is carried in
the food. It cannot be a mere defect of nutritive matter, as this could
be counter-balanced by the simple expedient of consuming a larger
ration. Leclainche has seen the disease in its worst form in herds
which received a rich and varied ration, while it spared adjacent
herds that were kept on rather short rations. Even young plethoric
animals suffered badly, though having all they would eat of natural
fodders (hay) from districts where the disease was unknown, and in
addition grain, linseed cake, cooked legumes and bread. In two
neighboring stables, where the stock were kept in identical
conditions, receiving the same food, in equal quantity, one was
decimated by the malady, while the other was spared (Leclainche).
The affection often prevails on the higher lands, which, beside
having the poorer soils, are specially exposed to cold storms and
frosts, so that chill enters as an accessory condition. In
Westmoreland, England, the river Eden divides the affected from the
sound lands; the victims are found on the west bank which receives
the cold, east winds, and not at all on the east bank where the warm,
soft, west winds prevail. Thorburn noticed that the majority of cases
start in spring, when the animals, debilitated by the winter’s
seclusion, are exposed to severe vicissitudes of temperature and
driving storms, to the strain of parturition, a fresh, heavy milk yield,
and moulting.
The presence of a contagion has been suggested, but if this exists it
must be habitually introduced in the food or water rather than
transmitted from victim to victim. The healthy will often stand
beside the diseased for an indefinite length of time without injury,
and in certain recent cases a change to an uncontaminated farm, or
an abundant ration drawn from such sound soil, will secure
immediate improvement and recovery in a few weeks. In view of
such prompt recoveries it would be quite as reasonable to suspect
some ptomaine or toxin taken in with the food. The question of a
microbe or a microbian poison is as yet a mere hypothesis.
Cows become more susceptible with advancing age, and Dengler
alone claims to have seen the disease in calves. This is unfavorable to
the idea of immunity, and rather favors that of debility or cachexia.
Lesions. These are confined to the bones. Decalcification in the
Haversian canals and cancelli, reduces the bony tissue to a thin soft
plate. Yet the condition is not constant. Grawitz found no special
dilatation of the canals or cancelli in colts. Nessler and others found
decrease of the lime salts, Bibra and Grouven detected no marked
change, and Hoffmann and Begemann found an actual excess of
phosphates. Doubtless the specimens selected and the stage of the
disease, whether in active progress or during convalescence, may
somewhat explain discrepancies. The fat cells increase in the cancelli,
with more or less hyperæmia, and even blood staining as the disease
advances, the bone cells become less branching, and there may be
gelatinoid exudates. The resistance of the bone is diminished, it may
be indented with the finger, or scraped off with the nail, or cut with a
knife. It breaks under a slight strain, and is easily crushed under the
weight of the animal so that fractures and distortions of all kinds are
met with. In breeding cows the earliest and most marked lesions are
in the pelvic bones, but fractures of the bones of the limbs are
common.
Symptoms. Poor condition or even emaciation, with very visible
projection of the bones is common. The coat is rough, the skin tense,
inelastic and hide bound, appetite variable, sometimes impaired, and
nearly always perverted so that the patient will lick the manger
continually or pick up and chew all sorts of objects, bones, leather,
articles of clothing, pieces of wood or iron, stones, etc. The amount of
food consumed may, however, be up to the normal. The most
marked feature is the difficulty and stiffness of locomotion. The
patient lies most of the time, rises languidly and with difficulty and
moves the limbs as if each were a rigid post without joints. The hocks
will knock together, and the restricted movements of the joint are
often attended by cracking. Yet appetite, temperature and yield of
milk may remain normal.
Later appetite and milk secretion fail, temperature rises a degree
or two, the animal refuses to rise, remaining down twelve to twenty-
four hours at a time, and rising first on the hind parts, and remaining
on the knees for a length of time, moaning and indisposed to exert
herself further. Many cases at this stage begin to improve and may
get well in five or six weeks. Some will remain down for several
weeks and finally get up and recover. With constant decubitus
however, the animal falls off greatly, becoming emaciated and weak,
the appetite may fail altogether, and the patient is worn out by the
persistent fever, nervous exhaustion and poisoning from the
numerous bad sores. Abscesses, sloughs and fistulæ are common
over the bony prominences.
It is in these last conditions above all that fractures and distortions
of the pelvic bones and less frequently of the bones of the legs occur.
They occur earlier as well in connection with falls, blows, crowding
by their fellows and sudden active movements of various kinds.
The disease may advance for two or three months, and in case of
pelvic fractures and distortions, there may be permanent lameness,
and dangerous obstruction to parturition, even though the bones
should acquire their normal hardness through the deposition of lime
salts.
It has been noted that the disease is usually confined to well
defined areas, and that even in these it has its periods of abatement
and recrudescence so that given years are osteo-malacia years. In the
department of l’Aube, France, Leclainche, particularly noted the
enzootics of 1865–6, 1870, 1875–6, and 1883–4.
Prognosis. The gravity of the affection varies greatly under
different conditions. Some outbreaks are mild while others are very
severe, and the prognosis must vary with this gravity. Again at the
decline of an enzootic the disease is more benign and less ruinous. A
case in its very earliest stage is much more hopeful, than one that is
far advanced, with bones extensively softened or even broken,
digestion and assimilation badly impaired, and infecting sores and
sloughs on different parts of the body. Isolated cases are usually
much milder than when the affection has gathered strength enough
to determine an enzootic.
Treatment. This will vary with the predominance of the causes,
essential or accessory. In some cases the suspension of the injurious
food and a rich alimentation on well grown fodders from sound lands
will meet every need. Green clover, alfalfa, and other leguminous
products, ground oats, beans, peas, linseed cake, rape cake, cotton
seed and vetches may be especially named. Even animal food may be
availed of, and cases are recorded in which cows have themselves
hunted for snails and frogs and devoured them greedily. The free
access to common salt, and a liberal supply of bone meal are helpful.
Iron and bitter tonics, (gentian, quinine, salicine, nux, copperas,
tincture of iron) and cod liver oil, in pint doses daily, have been
found advantageous. Apomorphia has been found especially valuable
in correcting the preverted appetite, and stimulating digestion.
Where it is feasible to move the affected herd from the
unwholesome pasturage or locality to one in which the aliment is
rich and the disease unknown, success usually follows the change.
On poor, uncultivated lands where the disease appears yearly, or at
short intervals, intensive culture with heavy manuring, and the heavy
feeding of the herd on grain products, linseed cake, etc., will often
banish the trouble.
Care should be taken to change the water as well as the food.
Finally every drain upon the system should be lessened or stopped.
The milk may be dried up and the animal should not be bred. Sweet,
dry buildings, pure air, sunshine and grooming are important
auxiliaries.
In severe outbreaks, in high conditioned animals, the owner often
consults his interest, in sending the victims to the butcher as soon as
the affection shows itself and before time has been allowed for the
inevitable emaciation and loss.
Some, on osteo-malacia lands, have profited by changing the
entire herd every two years, as they become rapidly worn out under
successive attacks.
As local derivatives, oil of turpentine, hot vinegar, tincture of
iodine and biniodide of mercury have been employed. Open sores are
treated with antiseptic lotions, creolin, lysol, carbolic acid, iodine
lotions, iodoform, etc.
 RAREFYING OSTEITIS. OSTEOPOROSIS. OSTEO-
MALACIA OF THE HORSE. BIG HEAD.

Definition. Distinction from rachitis. Process of rarefaction, cell proliferation,

congestion, solution of earthy salts and fibrous matrix, osteoclasts, Howship’s
lacunæ. Dried bone light, spongy, friable, though enlarged in repaired cases, dense,
heavy. Face lesions. Dyspnœa. Dropping teeth. Causes: microbian hypothesis,
disturbance of bone nutrition, faulty food, lack of bone salts, cellar stables, floor on
ground, malaria, cold, damp soils, city life, early life, breed, asses and mules,
breeding. Nature. Symptoms: illness, inappetence, lifelessness, early fatigue and
perspiration, stiffness, lameness, distortions, stumbling, knuckling, arthritis,
tender puffed joints, thickened softened bones, facial swellings, narrowing of
intermaxillary space, chisel teeth, difficult mastication, shedding teeth, emaciation,
marasmus. Phosphates in urine when disease is active. Relation to exostosis.
Prevention and treatment. Hygienic, move from cellar stable, or ground floor,
secure air space under floor, ventilation, warmth, sunshine, grain feeding, pasture,
change food, rest, salicylates, salicin, salol, phenacetin, blisters, phosphates, bone
dust, phosphorus, bitters, iron, barium chloride.

Definition. A form of osteo-malacia occurring in the mature as well

as in the growing horse, characterized by the absorption of earthy
salts from the walls of the cancelli and Haversian canals with
excessive production of the organic basis and cell elements and
enlargement, softening, lightness and fragility of the bones.
It differs from rachitis essentially in this that while the latter
attacks the young growing bone at the chief seats of growth, under
the periosteum and in the epiphyseal ligament, and therefore
especially on the surface of the true bony tissue, osteoporosis attacks
the formed and often the mature bone in its interior, producing
attenuation of the walls of its vascular canals and cancellar cavities
and increase of their fibro-cellular contents. Both result in
enlargement of the bone, but in rachitis this is determined largely by
deposition on the surface while in osteoporosis it takes place by
expansion from within. The further distinction that rachitis appears
enzootically and osteoporosis sporadically applies only to localities in
which the latter is not common. At different points on Long Island,
in New Jersey and on the rich soils in the Mississippi valley and on
the Atlantic and Gulf coasts, osteoporosis often prevails enzootically
and has its recrudescences like rachitis.
The process of rarefaction and softening may be thus stated. In the
Haversian canals and narrow spaces there is an active proliferation
of cells and increase of vascularity, with a gradual solution and
removal, not only of the earthy salts, but also of the fibrous matrix in
the walls of these spaces. As in the normal changes in bone, the
absorption appears to be effected through the large cells or
osteoclasts grouped around the blood vessels. In the osseous tissue,
which abuts on the vascular tissue, are to be found excavations,
simple or irregular, (Howship’s lacunæ), containing granular cells
and the larger osteoclasts. In a similar manner bone is softened and
absorbed in connection with tubercle, or the pressure of tumors,
aneurisms, actinomycosis. In case of recovery, repair takes place by
the disposition of new bone, so that the enlarged and rarefied bone
may in the end become harder than before. This applies especially to
the cancellated bone. On the articular ends of the affected bones, the
granulation tissue makes its way into and through the cartilage of
incrustation with resulting active disease of the joint.
The condition of the bone is well illustrated in the dried or
macerated specimen. Taken from a bad case in the active stage of the
disease, it crumbles under pressure and weighs as light as a sponge,
whilst from an advanced or recovered case, it is hard and resistant,
and weighs as much more than the normal bone as it exceeds it in
bulk. The morbid rarefaction usually affects the whole skeleton more
or less, yet in perhaps the majority of cases; the change is greatest in
the bones of the face, and the resulting distortions are usually
symmetrical on the two sides. It may show mainly in the maxilla,
which is thickened to twice or even five times its normal thickness, it
may show in rounded, general swelling of the nasal and superior
maxillary bones and those around the orbit, or it may involve the
turbinated bones, the vomer and even the cartilaginous nasal
septum. Loosening and evulsion of the molar teeth is common and
snuffling breathing may occur as in rachitis affecting the nasal bones
of dogs and swine.
Causes. We are still in the dark as to the essential cause of
rarefaction of bone. There is a growing tendency to suspect a
microbian origin, and many facts are held to point in that direction.
It seems to have been unknown in England in the early part of the
19th century, and is not noticed by Blaine, Youatt, Percivall nor other
of the early writers. In Varnell’s cases the same man had two farms
not far apart and equal in soil, drainage and stabling, stocked with
horses bred from the same parents with the same kind and amount
of feed and work, yet on one farm six cases of osteoporosis occurred,
and on the other not a single case. McNeil, in charge of street car
stables, found the disease destructively prevalent in the best
appointed stables and absent from others in the worst hygienic
condition. In a superior stable with 220 horses he had 47 cases in
two years, and in a fine stable with 100 horses he had 26 cases in the
same length of time. In the poorer stables, the horses bred in the
same way on all kinds of soils and with no difference in feeding nor
management escaped. It is the common experience in Europe and
America that a farm or district, which has been previously free from
the disease suddenly has an outbreak in enzootic form, and this will
last for a year or two, then remit only to appear with its old force
after an interval of some years. Even during the active prevalence of
the disease on one or on several adjacent farms, others in the
immediate vicinity, and differing in no appreciable way, geologically,
hydrostatically, in buildings, food, water, general management nor
work, completely escape. Berus, Hoskins and other city veterinarians
have noticed, that it was almost the rule, that a fresh horse put in the
stall of one that had suffered from osteoporosis soon contracted the
disease.
W. L. Williams noticed on two different farms in Central Illinois,
on which the disease suddenly appeared, that for years after the
comparative subsidence of the affection there was an unusual
prevalence of spavins, splints, ringbones and other diseases of the
bones. Meyer has noticed that cases sent from Cincinnati into the
country, and that have got well, will succumb to the affection if
brought back into the city stables in which they originally contracted
it.
 All of this points very strongly to one of two things; either a
pathogenic germ in the system of the affected animal; or the
presence of a pathogenic microbe in the stable, water, or other part
of the environment, the toxic products of which are taken into the
animal system.
But as yet no specific pathogenic microbe has been demonstrated
so that this doctrine must still be held as a mere plausible
hypothesis.
Many veterinarians with long experience in such cases absolutely
deny contagion. The hypothetical contagion undoubtedly extends
slowly, and uncertainly from animal to animal, probably, like
actinomycosis, taking place mainly through the soil, or some outside
medium, rather than by direct contact; or a special susceptibility on
the part of the individual animal may be necessary to render it
effectual.
Accessory Causes can be spoken of more confidently but even of
these no one, nor small group, can be advanced as essential. The
process of bone nutrition is readily disturbed by a variety of
conditions, and such disturbances may easily become the occasion of
weakening the resisting power and mayhap of admitting the
hypothetical microbe to get in its pathogenic work.
Faulty food has been a favorite explanation. A lack of lime in the
soil and fodder seems, at times, to have had a baneful effect, if only,
in lowering the general tone and impairing the nutrition. Yet we see
osteoporosis on limestone soils (New York, etc.), and in animals
generously fed on grain. The same remarks apply to phosphorus and
phosphates. Their deficiency apparently contributes to the
production of the disease, and yet under other conditions, their
abundance is no barrier to its development. The excess of free
phosphorus produces osteitis and it is held by some that an over-
abundance of phosphates acts in the same way. It has been sought to
incriminate a too nitrogenous diet in some cases, and in others one
too rich in fat or carbohydrates. The many cases in Philadelphia and
Pennsylvania were mostly in animals that had been well fed and were
in good condition when attacked (Marshall).
Special food may be the direct cause, bran diet has been already
noted. Hinebauch found an acute osteitis with bone softening and
arthritis in horses fed on millet, green, partially matured and ripe.
Horses elsewhere have fed on millet, without such results, but not
perhaps, in the same environment, nor in presence of the
hypothetical microbe. Millet is not the sole nor common cause of
osteoporosis, but there is reason to suspect that it is at times an
important accessory cause.
Of all prejudicial conditions none is to be so dreaded as
unwholesome stables. Of 200 cases reported by Berus, in Brooklyn,
almost all were in cellar stables or those with floors laid on the soil.
Meyer finds that “most all cases can be traced to an unwholesome
atmosphere, or gases arising from vaults, sewers, cellars, filthy
streams, or from a hollow space under the floor.” Harbaugh says
every case was stabled in damp, ill-drained, unventilated and badly
lighted buildings. The worst outbreak was in a basement with a
damp wall, on one side, and none suffered except those that stood
next to this wall. The horses standing on the opposite side, which was
on a level with the ground outside, escaped. Removal from a cellar
stable to the floor above, put a sudden stop to the appearance of new
cases. James, of St. Louis, found 20 successive cases in a stable on a
dirt floor, and Jasme, of Charlestown, finds nearly all his many cases
on earth floors in malarial regions.
Malaria has been blamed, especially by southern observers,
accustomed to see the disease on the warm alluvial seaboard and
river bottoms. That this environment predisposes to the disease, by
undermining the health, is doubtless the case, but in spite of
occasional remissions in the symptoms, malarial germs cannot be set
down as the constant cause. One of the worst cases I ever saw, with
every bone in the body soft, spongy and light, developed at Inglis
Green laundry, Edinburgh, where malaria is absolutely unknown,
but where the brook received large quantities of chlorine.
Cold is an undoubted factor, though the disease is most prevalent
in our warm southern states. Many veterinarians have noticed its
coincidence with rheumatism, in which cold is so often the
dominating accessory cause. Some have even suspected that it is only
a modified type of the rheumatic condition. Hinebauch found his
cases of millet disease in cold basement barns, or with leaking roofs,
so that the floor and bedding were constantly wet. He found that cold
always aggravated the disease, and bad air even more so, while
salicylates seemed to have a marked curative influence.
 Damp soils should be named in this connection. These not only
chill the air by evaporation, and condense the cold dews at night,
contributing to produce the extremes of hot noon day and cold night
temperature, with corresponding disturbances of the bodily health,
but they favor the preservation of the infinitesimal forms of life
(bacteria, protozoa) and therefore of the hypothetical microbe of the
disease.
City life is a most potent cause. Berus tells us that hundreds of
horses die yearly in Brooklyn of osteoporosis, and that if sent early to
the country a large proportion recover. The same is true of New York
City and Philadelphia. Of Cincinnati, Meyer says that he has failed to
find a case more than five miles outside the city limits, and that cases
sent to the country make a partial or complete recovery. If returned
to their former city stables, nearly all contract the disease anew
within a year.
Many cases, however, are found in the country and often within a
circumscribed area. These indicate, as in the city cases, a localized
cause, bacteridian or otherwise.
Early life predisposes, the majority of cases taking place before the
sixth or seventh year, yet the disease occurs at all ages up to twenty
years and over.
Breed does not seem to make a material difference, and though
Shetland ponies have acquired a bad reputation, their propensity to
become fat and soft, their too often idle, pampered life, and the
confined quarters in which they are frequently kept, account for
much of the mortality.
Asses and mules habitually escape, even in the South, where the
latter animal is so numerous and often so poorly kept. In Hinbauch’s
millet disease, the mules suffered more than the horses.
Breeding horses, male and female, have often acute attacks and
die early. The drain on the system and confinement seem to act
injuriously.
Nature. Until we know the essential cause or causes of
osteoporosis, we must be in doubt as to its pathology. We are even
debarred from pronouncing authoritatively upon the essential
identity or difference of the various forms of softening, or rarefaction
of bone. In obedience to the clinical manifestations and structural
changes, rachitis, fragilitas ossium and osteoporosis have been
separately described, but we cannot positively say that they are not
all due to one essential cause, manifesting itself differently according
to the activity of trophic processes in the bones of the victim. In the
growing foal the active developmental processes in the epiphyseal
ligament and periosteum may determine that the symptoms shall be
pre-eminently those of rickets, yet we often see these complicated by
the facial and other lesions of osteoporosis. Both may be the result of
one etiological factor, or there may be a complex disease resulting
from the presence of two. Again in the pregnant cow in which the
relaxation of the ischio-pubic symphysis and pelvic ligaments means
a profound change in the bone nutrition at this point, the presence of
the hypothetic microbe, or other essential factor, may determine a
decalcifying and fragility of the pelvic bones generally. Again in the
mature male and non-breeding female, in the absence of the
disturbing conditions of nutrition just named, the vascular elements
in the Haversian canals and cancelli may determine the simple
rarefaction and expansion of the bone which characterizes
osteoporosis. When present in the bone in any of these conditions,
acids doubtless fulfill an important rôle in the decalcifying and
softening process, but behind these it may be surmised that there is
an unknown cause or causes, which it is for the bacteriologist,
chemist or botanist to discover.
Symptoms. These are largely the same as in brain disease. There
may be first a period of illness, with poor appetite, lack of spirit and
energy, early perspiration and fatigue, or if at large, leaving the herd,
soon followed by some stiffness of gait and lameness, which may be
intermittent, disappearing under exertion, or shifting from one joint
or limb to another after the manner of rheumatism. Sometimes it
shows in stiffness of the neck, so that the patient finds difficulty in
lowering the head to graze; in others the back and loins are stiff and
arched so that the animal has difficulty in rising and turns slowly and
painfully; in still other cases the dorsal and lumbar vertebræ are
depressed so that the back is hollow. Even before the manifestation
of lameness, the affected limb may stand forward at the fetlock or
knee, the gait is clumsy and awkward, and the patient may suddenly
stumble and fall, showing little or no power of prompt recovery of
balance. A horse, and especially a young horse, with this habit of
stumbling is always to be suspected. The long bones of the limbs tend
to enlarge or thicken, and this is likely to be more uniform than in
rachitis, and not to be confined so much to the epiphysis. The
implication of the stifle, hock or other joint, with marked synovial
distention, and mobility or dislocation of the patella, is common and
may be the earliest manifestation of illness. The bones of the face
usually show early changes. The superior maxillary and nasal bones,
beneath the zygomatic spine and infra-orbital foramen and along the
line of the molar alveoli become especially bulging and rounded, the
other facial and cranial bones suffering to a lesser degree. In the
lower jaw, also, the disease predominates along the region of the
molar alveoli, and the loosening of the molars permits them to
deviate inward so that the grinding surfaces come perceptibly nearer
to the median line, and the outer half of the tooth is rapidly worn
while the inner edge projects as a sharp cutting ridge (chisel teeth).
For the same reason, the softening branches of the lower jaw
deviate inward, tending to still further destroy the due
approximation of the upper with the lower molars, and to diminish
the breadth of the intermaxillary space. The great thickening of the
rami of the maxilla tends still further to reduce the intermaxillary
furrow.
Fractures and detachment of tendons and ligaments are common
results of the rarefaction, a portion of the bone often remaining
adherent to the tendon.
Cary gives the following statistics of fifteen cases: lame in the fore
limbs 11 (mostly shoulder), in hind limbs 11 (mostly hip and stifle),
stiff in loins 8, unable to rise without aid 3, had indented ribs 4, had
shifting lameness 8, had chronic indigestion 6; mares 5; geldings 8;
mules 2; ages were—one 3 years, five 6 years, three 7 years, one 8
years, two 9 years and three 10 years.
When the bones are enlarged their softness and friability may be
shown by pricking with a needle, which will often freely penetrate the
rarefied bony tissue. It should be first rendered antiseptic by dipping
in strong carbolic acid.
From the first the general health fails, there is difficulty in
mastication, digestion is more or less impaired, nutrition is imperfect
and muscular flabbiness, weakness and wasting advance more or less
rapidly. In advanced cases emaciation is often a marked feature.
 Examination of the urine gives valuable indications, though the
results obtained have been supposed to be contradictory. While
rarefaction of the bone is advancing rapidly the urine is charged with
an excess of phosphates in ratio with the activity of the morbid
process. When on the other hand the disease has come to a standstill
and the process of repair in the rarefied bones has begun, the
absence of phosphates is no less characteristic. A patient therefore
may show greatly enlarged and softened bones with persistent
lameness, and yet the urine may show little or no phosphate. The
phosphaturia may, therefore, be made the basis of a reasonable
prognosis. Excess of phosphates indicates an active pathological
process, with an uncertain outcome, while the absence of phosphates
indicates an arrest of rarefaction and holds out good hope of
recovery.
I have long observed the same in cases of obstinate and intractable
spavins, splints, ringbones and other bone diseases. Phosphaturia
bespeaks a faulty nutrition of the bone and explains the failure of
remedial measures, while lack of phosphates in the urine, or a
reduction to the normal amount is likely to become a guarantee of
improvement under local treatment. The treatment however, must
be first constitutional to correct the condition of malnutrition and
then local to correct the osteitis.
Prevention and treatment. As in rachitis hygienic measures give
the most uniformly good results. The change of stable is especially
demanded from a cellar or basement stable, one with joists laid on
the ground or one with an earth floor saturated with urinary and
feculent products. In different cases an enzootic has been arrested,
coincidently with the removal of the stock to the floor above, and in
others with the removal of the filth saturated earth beneath a ground
floor, and the laying of a new floor with ample space beneath for the
free circulation of air. In the same line would be thorough drainage
of the site and to carry off liquid manure to a well ventilated
receptacle. Exposure to cold and wet is to be sedulously avoided as
greatly favoring the onset of the disease, and hurrying the milder
cases into a fatal activity. Free air and sunshine are all important and
it is the universal experience that city cases taken early and sent to
dry, sunny pastures, mostly recover, or at least undergo marked
amelioration. The fact that certain cases originate during an open air
life does not invalidate this position but merely shows that other
pathogenic conditions may be too potent to be overcome by this
hygienic one.
A liberal allowance of sound grain is essential to success, even in
the case of patients sent to pasture. Those that have recovered or
improved at pasture, should be retained in the country and on no
account returned to the same city stables in which they contracted
the disease. Even in the country a different stable should be secured
if possible.
Any food that has manifestly contributed to the disease, should be
withheld (bran, millet, musty or fermented food or that drawn from
particular fields).
Overwork must be forbidden, and indeed any work at all during
the active stage of the disease. The victim should also be withdrawn
from breeding, at least until it has fully recovered the normal
consistency of its bone.
In cases aggravated by cold or wet, or which show the rheumatic
propensity to shift from place to place, sodium salicylate in ounce
doses several times a day may appear to benefit, and as a germicide
this may be tried on all cases. Salicin, salol, or phenacetin may be
used as substitutes. Where the disease has been largely localized,
blisters have appeared to be beneficial.
Phosphates and phosphorus have been lauded by German
veterinarians, but in other hands, and when the morbid process was
active they have proved useless, or even hurtful. Bone dust or
phosphate of lime or soda may be freely used at any time and
appears to act as a general tonic, beside supplying lime and
phosphoric acid which may possibly be availed of for bone nutrition.
Phosphorus and phosphorated oil in excess always softens the bone
and much more so when this process is already excessive. In small
doses (gr. ⅙ to ½) and after the process of rarefaction has ceased, it
is valuable in hastening bone consolidation and fitting the patient to
return to work.
Bitters, iron and other tonics are valuable in improving the general
tone and indirectly the bone nutrition.
Cary had prompt improvement in connection with intravenous
injection of barium chloride once a week for four weeks, and ½ oz.
doses of sodium salicylate thrice a day. It remains to be seen whether
or not this is generally applicable.
 OSTEO-MALACIA IN OTHER ANIMALS.

The internal softening and rarefaction of bones in mature animals

has been noted in dogs by Pillvax and Röll, in lambs by Haubner, in
pigs by Haubner and Anaker, and in goats by different observers.
The genuineness of these cases has been questioned by Cadiot and
Leclainche, by Virchow and by others, but in the present uncertainty
as to the dividing lines between rarefaction, rachitis and other
diseases, they deserve notice in this connection.
In dogs the lesions are mostly in the young and are largely rachitic,
yet the enormous swelling of the facial bones, and especially of the
superior maxillary in the comparatively mature animal suggests
osteo-malacia. As in rachitis there are usually impaired digestion,
unthriftiness, slow, stiff movements and lack of life and vigor.
In goats Virchow believes the disease to be neither rachitic nor
osteo-malacia, basing his opinion on the lesions in the bones: “On
the maxillary bones of goats there are often found peculiar
formations in which the parts that have already assumed osseous
structure, have failed to fix the earthy salts. The tumor, which forms
a circumscribed swelling on the upper or lower maxillary bone, is
soft and easily cut with the scalpel, with at certain points only, a hard
resistant material. It is a simple osteoid chondroma, though
veterinarians for some reason associate it with rheumatism.” Profuse
salivation is present.
In lambs it is according to Haubner an atrophy with destructive
ulceration of the bones of the face, complicated by purulent
infiltration of the medullary spaces. “The incisors, and later the
molars, fall one by one, because of the changes in the alveoli, the
gums swell, become violet, red, and ulcerate, the ulcers extending
through the hard palate into the nose, and causing a highly offensive
discharge from both nose and mouth.
 In pigs the disease has been mainly seen in connection with
insufficient or unwholesome food, and badly balanced rations, and
especially with fermented swill and an exclusive maize diet. The
symptoms are shown in the limbs and face, especially (“snuffles”), as
noted under rachitis.
Prevention and treatment are to be sought in avoidance of the
obvious causes, and in applying the same line of tonic treatment as in
the larger animals.
 INDEX.

Abnormal conditions of the hair, 456.

Abrasions, 455.
Abscess behind eye, 350.
of brain, 125.
of spine, 175.
Acariasis, 460.
Acetone in urine, 198.
test for, 198.
Acne, 343.
in horse, 504.
Acromegaly, 133.
Acute eczema in dogs, 492, 495.
in solipeds, 475.
keratitis, 378.
myelitis, 154.
Adenoma of the gland of Harder, 357.
Akinesis, 2.
Albinism, 399.
Albumen in urine, 199.
test for, 199.
Alcoholic intoxication, 147.
Alimentary origin, eczema of, in cattle, 482.
Allantoin, 199.