The Home Medical Library
The Home Medical Library
By
Kenelm Winslow, B.A.S., M.D.
Formerly Assistant Professor Comparative Therapeutics, Har- vard University ; Late Surgeon to the Newton Hospital ; Fellow of the Massachusetts Medical Society, etc.
With the Cooperation of Many Medical Advising Editors and Special Contributors
IN SIX VOLUMES
First Aid :: Family Medicines :: Nose, Throat, Lungs, Eye, and Ear :: Stomach and Bowels :: Tumors and Skin Diseases :: Rheumatism :: Germ Diseases Nervous Diseases :: Insanity :: Sexual Hygiene Woman and Child :: Heart, Blood, and Diges- tion :: Personal Hygiene :: Indoor Exercise Diet and Conduct for Long Life :: Prac- tical Kitchen Science :: Nervousness and Outdoor Life : : Nurse and Pa- tient :: Camping Comfort :: Sani- tation of the House Jiold :: Pure Water Supply :: Pure Food Stable and Kennel
New York
The Review of Reviews Company
1907
Medical Advising Editors
Managing Editor Albert Warren Ferris, A.M., M.D.
Former Assistant in Neurology, Columbia University ; Former Chairman, Section on
Neurology and Psychiatry, New York Academy of Medicine ; Assistant in
Medicine, University ayid Bellevue Hospital Medical College ;
Medical Editor, New International Encyclopedia.
Nervous Diseases Charles E. Atwood, M.D.
Assistant in Neurology, Columbia University ; Former Physician, Utica State Hospital and Bloom ingdale Hospital for Insane Patients ; Former Clinical Assist- ant to Sir William Gowers, National Hospital, Lo?idon.
Pregnancy Russell Bellamy, M.D.
Assistant in Obstetrics and Gynecology, Cornell University Medical College Dispensary;
Captain and Assistant Surgeon {in charge), Squadron A, New York
Cavalry ; Assistant in Surgery, New York Polyclinic.
Germ Diseases Hermann Michael Biggs, M.D.
General Medical Officer and Director of Bacteriological Laboratories, New York City
Department of Health; Professor of Clinical Medicine in University and
Bellevue Hospital Medical College ; Visiting Physician to Bellevue,
St. Vincent's, Willard Parker, and Riverside Hospitals.
The Eye and Ear J. Herbert Claiborne, M.D.
Clinical Instructor in Ophthalmology, Cornell University Medical College; Former Ad- junct Professor of Ophthalmology, New York Polyclinic; Former Instructor in Ophthal- y in Columbia University; Surgeon, New Amsterdam Eye and Ear Hospital.
Sanitation Thomas Darlington, M.D.
mmi 'oner of New York City; Former President Medical Board, New York
Hospital; Consulting Physician, French Hospital; Attending Physician, 'ilia's Riverside Hospital, Yonkers; Surgeon to New Croton Aqueduct and other Public Works, to Copper Queen Consolidated Mining Com- pany of Arizona, and Ai-izona and Southeastern Railroad Hospital; Author of Medical and Climatological Works.
Menstruation Austin Flint, Jr., M.D.
Obstetric* and Clinical Gynecology, New York University and Bellevue Hos- V Visiting Physician, Bellevue Hospital; Consulting Obstetri- Matcmity Hospital; Attending Physician, Hospital for Rup- ' nankattan Maternity and Emergency Hospitals.
Heart and Blood John Bessner Huber, A.M., M.D.
A ssistant in Medicine, University and Bellevue Hospital Medical College; Visiting Phy- sician to St. Joseph's Home for Consumptives; AutJior of "Consumption: Its Relation to Man and His Civilization; Its Prevention and Cure."
Skin Diseases James C. Johnston, A.B., M.D.
Instructor in Pathology and Chief of Clinic, Department of Dermatology, Cornell Uni- versity Medical College.
Diseases of Children Charles Gilmore Kerley, M.D.
Professor of Pediatrics, New York Polyclinic Medical School and Hospital; A ttending
Physician, New York Infa7it Asylum, Children's Department of Sydenham Hospital,
and Babies' Hospital, N. Y.; Consulting Physician, Home for Crippled Children.
Bites and Stings George Gibier Rambaud, M.D.
President, New York Pasteur Institute.
Headache Alonzo D. Rockwell, A.M., M.D.
Former Professor Electro-Therapeutics and Neurology at Neiv York Post-Graduate
Medical School; Neurologist and Electro-Therapeutist to the Flushing Hospital;
Former Electro-Therapeutist to the Woman's Hospital in the State of
New York; Author of Works on Medical and Surgical Uses
of Electricity, Nervous Exhaustio7i {Neurasthenia), etc.
Poisons E. Ellsworth Smith, M.D.
Pathologist, St. John s Hospital, Yonkers; Somerset Hospital, Somerville, N. J.; Trinity
Hospital, St. Bartholomew's Clinic, and the New York
West Side German Dispensary .
Catarrh Samuel Wood Thurber, M.D.
Chief of Clinic and Instructor in Laryngology, Columbia University; Laryngologist to the Orphan' s Home and Hospital.
Care of Infants Herbert B. Wilcox, M.D.
Assistant in Diseases of Children, Columbia University.
Special Contributors
Food Adulteration S. Josephine Baker, M.D.
Medical Inspector, New York City Department of Health.
Pure Water Supply William Paul Gerhard, C.E.
Consulting Engineer for Sanitary Works; Member of American Public Health Associa- tion ; Member, American Society Mechanical Engineers; Corresponding Member of American Institute of Architects, etc.; Author of '" House Drainage" etc.
Care of Food Janet McKenzie Hill
Editor, Boston Cooking School Magazine*
Nerves and Outdoor Life S. Weir Mitchell, M.D., LL.D.
LL.D. {Harvard, Edinburgh, Princeton); Former President, Philadelphia College of Physicians; Member, National Academy of Sciences, Association of American Physi- cians, etc.; Author of essays : "Injuries to Nerves?' " Doctor and Patient," "Fat and Blood" etc.; of scientific works: "Researches Upon the Venom of the Rattlesnake," etc.; of novels: "Hugh Wynne," "Characteristics" "Constance Trescott," "The Adventures of Francois" etc.
Sanitation George M. Price, M.D.
Former Medical Sanitary Inspector, Department of Health, New York City; Inspector,
New York Sanitary Aid Society of the 10th Ward, 1883; Manager, Model
Tenement-houses of the New York Te7iement- house Building Co., 1888;
Inspector, New York State Tenement-house Commission, 18Q5; Author
of " Tenement-house Inspection," "Handbook on Sanitation" etc.
Indoor Exercise Dudley Allen Sargent, M.D.
Director of Hemenway Gymnasium, Harvard University; Former President, American Physical Culture Society; Director, Normal School of Physical Training, Cam- bridge, Mass.; President, American Association for Promotion of Physical Education; Author of "Universal Test for Strength" "Health, Strength and Power ," etc.
Long Life Sir Henry Thompson, Bart., F.R.C.S., M.B. (Lond.)
•: Ea traordinary to His Majesty the King of the Belgians; Consulting Surgeon to University College Hospital, London; Emeritus Professor of Clin- ical Surgery to University College, London, etc.
Camp Comfort Stewart Edward White
Author of" The Forest," " The Mountains," " The Silent Places " " The Blazed Trail" etc.
&•
S. WEIR MITCHELL, M.D., LL.D.
The essays of Dr. Weir Mitchell in this volume have a special significance that is both medical and literary. In addition to his scientific research as exhibited in many medical essays and mono- graphs, and his long practice as a neurologist, which developed the " Rest Treatment" principle into a prominent and successful branch of the healing art, Dr. Mitchell has found time to employ
tnias for pure literature, particularly in " Hugh Wynne" and similar novels, remarkable among historical romances for their keen penetration into human character. So, through the remarks on 4l Nervousness," " Wear and Tear," and the rest which follow,
:ader discerns not only the certainty of the scientist and the insight of the physician, but also the confident expression of the iter of Letters.
4
The Home Medical Library
Volume VI
NERVOUSNESS NURSING :: :: CAMP CURE
By S. WEIR MITCHELL, M.D., LL.D.
(Harvard, Edinburgh, Princeton)
Former President Philadelphia College of Physicians ; Member Na- tional Academy of Sciences, Association of American Physicians, etc. A uthor of essays : ' ■ Injuries to Nerves, " ' ' Doctor and Patient, ' ' il Fat and Blood," etc.; of scientific works: "Researches Upon the Venom of the Rattlesnake," etc.; of novels : "Hugh Wynne," "Characteristics" "Constance Trescott, " " The Adventures of Frangois, ' ' etc.
CAMP COMFORT
By STEWART EDWARD WHITE, Ph.B.
Author of " The Forest," " The M^S^^HQQNt^t The Blaz^fT Trail," etc.
NEwXoRjqjgp^e^ The Review of Reviews Uompany 1907
Copyright, 1907, by The Review of Reviews Company
THE TROW PRESS, NEW YORK
Contents
PART I
HAPTER PAGE
I. Nervousness and Its Influence on
Character 17
Friendly Advice — Forms of Nervousness — Shocks — Results of Prolonged Strain — Effects of Emotion — Collapse — Rest, Food and Air Needed — Tears the Seat of Trou- ble— The Hour for Absolute Trust — Gid- diness— Mind Cure — Beware of Mesmer- ism— Women More Nervous than Men — The Choice of Careers — Physical Train- ing of Girls — Ideal Mothers — The Higher Education.
II. Convalescence 49
The Return to Health — The Doctor's Sense of Sympathy — Remaking of Tis- sues— The Bankruptcy of Disease — Valu- able Side of Convalescence — Sensatory Acuteness — New Keenness of Perception — Intellectual Clearness — The Atmosphere of Books — Hideous Literary Realism — Physicians as Heroes — Interesting Medi- cal Biographies — The Woman Doctor in Fiction.
Contents
CHAPTER PAGE
III. OUT-DOOR AND CAMP-LlFE FOR WOMEN . JO
Its Joys and Advantages — Notable Cures — Manifold Opportunities — The Pleasures of Tent Life — Out-door Life an Insurance against Colds — Care, Fret and Worry Dis- appear — Worthy Thoughts Inspired — What to Read — Photography and Botany — Word Sketches and How to Make Them — A Mental Cargo of Delicious Memories — The Delightful Tricks of Nature.
PART II
I. Wear and Tear 91
Wasting the Capital of Power — Demand
for Mechanical Labor — Overtaxing the Organs of Thought — Death Statistics of Large Cities — Climatic Conditions — City- Bred Women as Mothers — Evils in the Schools — Young Girls Overtaxed — Re- sponsibilities of Teachers — Ignorance of Health Laws — Cerebral Exhaustion in Men — Nervous Breakdown — Precautions Demanded.
II. Nurse and Patient 146
The Tyranny of the Sick — Relatives not Good Caretakers — Calm, Steady Disci-
8
Contents
CHAPTER PAGE
pline Needed — Keep Fuss out of the Sick Room — Selfishness of Chronic Invalids — How Nurses Contract Diseases — Gener- ous Living and Fresh Air for the Watcher — Sad Effects of Wasting Maladies — In- sanity in the Home — Ordeals Undergone by Members of the Family — The Question of Isolation.
III. Camp Cure ....... 167
Work and Play in America — Spring De- pression— Prehistoric and Modern Man — The Surest Remedy — The Joys of Tent Life — The Mindless Work of the Camp — Throat and Lung Diseases Cured — Out- door Life the Best Alterative for Stomach Troubles — The Worries and Cares of Life Fly Quickly Away — Where to Go — Pic- turesque Delights.
PART III
I. Camping Comfort ix the North
Woods 195
What to Wear — Do Not Carry a Coat — A Sweater Better in Every Way — Other Articles Needed — Take a Small Shelter Tent — Implements and Firearms — Cook-
9
Contents
CHAPTER PAGE
ing Utensils — Fishing Tackle — How to Cope with Insects— An Effective Smudge — The Pack — Endurance a Matter of Ex- perience— The Secret of Woods Walking — Suggestions for Outfits.
II. Camping Comfort in the Western
Mountains 214
Changing Altitudes Require Special Equipment — Riding and Pack Saddles — Padding for the Horses' Backs — The Repair Kit — Horseshoeing and Cobbling Outfit — The Virtues of Hobnailed Boots — Buckskin Gloves a Necessity — The Grub Supply — Special Implements — Personal Belongings.
III. Camp Cookery .... ., . 220
Advantages of Being a Cook — The Provi- sion Bag — The Camp Stove — Take Some "Gold Dust"— How to Build a Fire — Cakes without Eggs, Butter or Milk — A Unique Pudding — Hanging the Kettle — Cooking Venison — The Dutch Oven — Unleavened Bread — Flapjacks — A Log Cabin in the Mountains.
10
Part I
NERVOUSNESS
CONVALESCENCE
OUTDOOR LIFE
BY
S. WEIR MITCHELL
Acknowledgment
We beg to tender grateful acknowledgment to author and publisher for the use, in Part I, of essays from 'k Doctor and Patient/' by S. Weir Mitchell, copyright, 1904, by J. B. Lippincott & Company.
INTRODUCTORY *
If my power to say what is best fitted to help my readers were as large as the experience that guides my speech, I should feel more assured of its value. But sometimes the very excess of the material from which one is to deduce formulas and to draw remem- brances is an embarrassment, for I think I may say without lack of modesty in statement, that perhaps scarce any one can have seen more of women who have been made by disease, disorder, outward circumstance, temperament, or some combination of these, morbid in mind, or been tormented out of just relation to the world about them.
The position of the physician who deals with this class of ailments, with the nervous and feeble, the pain- worn, the hysterical, is one of the utmost gravity. It demands the kindliest charity. It exacts the most temperate judgments. It requires active, good temper. Patience, firmness, and discretion are among its neces-
1 Extracts from Dr. Mitchell's Introductory to "Doctor and Patient." — Editor.
13
Introductory
sities. Above all, the man who is to deal with such cases must carry with him that earnestness which wins confidence. None other can learn all that should be learned by a physician of the lives, habits, and symp- toms of the different people whose cases he has to treat. From the rack of sickness sad confessions come to him, more, indeed, than he may care to hear. To confess is, for mysterious reasons, most profoundly human, and in weak and nervous women this tendency is sometimes exaggerated to the actual distortion of facts. The priest hears the crime or folly of the hour, but to the physician are oftener told the long, sad tales of a whole life, its far-away mistakes, its failures, and its faults. None may be quite foreign to his purpose or needs. The causes of breakdowns and nervous dis- aster, and consequent emotional disturbances and their bitter fruit, are often to be sought in the remote past. He may dislike the quest, but he cannot avoid it. If he be a student of character, it will have for him a personal interest as well as the relative value of its applicative side. The moral world of the sick-bed ex- plains in a measure some of the things that are strange in daily life, and the man who does not know sick women does not know women.
I have been often asked by ill women if my
14
Introductory
contact with the nervous weaknesses, the petty moral deformities of nervous feminine natures, had not less- ened my esteem for woman. I say, surely, no! So much of these is due to educational errors, so much to false relationships with husbands, so much is born out of that which healthfully dealt with, or fortunately surrounded, goes to make all that is sincerely charm- ing in the best of women. The largest knowledge finds the largest excuses, and therefore no group of men so truly interprets, comprehends, and sympathizes with woman as do physicians, who know how near to dis- order and how close to misfortune she is brought by the very peculiarities of her nature, which evolve in health the flower and fruitage of her perfect life.
15
CHAPTER I Nervousness and Its Influence on Character
There are two questions often put to me which I desire to use as texts for the brief essay or advice of which nervousness * is the heading. As concerns this matter, I shall here deal with women alone, and with women as I see and know them. I have elsewhere written at some length as to nervousness in the male, for he, too, in a minor degree, and less frequently, may become the victim of this form of disability.
So much has been written on this subject by myself
1 Neither nerves nor nervousness are words to be found in the Bible or Shakespeare. The latter uses the word nerve at least seven times in the sense of sinewy. Nervy, which is obsolete, he employs as full of nerves, sinewy, strong. It is still heard in America, but I am sure would be classed as slang. Writers, of course, still employ nerve and nervous in the old sense, as a nervous style. Bailey's dictionary, 1734, has nervous, — sinewy, strongly made. Robt. WTiytte, Edin., in the preface to his work on certain maladies, 1765, says, "Of late these have also got the name of nervous," and this is the earliest use of the word in the modern meaning I have found. Richardson has it in both its modern meanings, "vigorous," or "sensitive in nerves, and consequently weak, diseased." Hysteria is not in the Bible, and is found once in Shakespeare; as, "Hys- terica passio, down," Lear ii. 4. It was common in Sydenham's day, — i.e., Charles II. and Cromwell's time, — but he classified under hysteria many disorders no longer considered as of this nature.
17
Nervousness
and others, that I should hesitate to treat it anew from a mere didactic point of view. But, perhaps, if I can bring home to the sufferer some more individualized advice, if I can speak here in a friendly and familiar way, I may be of more service than if I were to re- peat, even in the fullest manner, all that is to be said or has been said of nervousness from a scientific point of view.
The two questions referred to above are these : The woman who consults you says, " I am nervous. I did not use to be. What can I do to overcome it? " Once well again, she asks you, — and the query is common enough from the thoughtful, — " What can I do to keep my girls from being nervous ? "
Observe, now, that this woman has other distresses, in the way of aches and feebleness. The prominent thing in her mind, nervousness, is but one of the symp- tomatic results of her condition. She feels that to be the greatest evil, and that it is which she puts forward. What does she mean by nervousness, and what does it do with her which makes it so unpleasant ? Remark also that this is not one of the feebler sisters who ac- cept this ill as a natural result, and who condone for themselves the moral and social consequences as things over which they have little or no reasonable control. The person who asks this fertile question has once been well, and resents as unnatural the weaknesses and in- capacities which now she feels. She wants to be helped, and will help you to help her. You have an
18
S. Weir Mitchell
active ally, not a passive fool who, too, desires to be made well, but can give you no potent aid. There are many kinds of fool, from the mindless fool to the fiend-fool, but for the most entire capacity to make a household wretched there is no more complete human receipt than a silly woman who is to a high degree nervous and feeble, and who craves pity and likes powder. But to go back to the more helpful case. If you are wise, you ask what she means by nervousness. You soon learn that she suffers in one of two, or probably in both of two, ways. The parentage is always mental in a large sense, the results either men- tal or physical or both. She has become doubtful and fearful, where formerly she was ready-minded and courageous. Once decisive, she is now indecisive. When well, unemotional, she is now too readily dis- turbed by a sad tale or a startling newspaper-para- graph. A telegram alarms her; even an unopened letter makes her hesitate and conjure up dreams of disaster. Very likely she is irritable and recognizes the unreasonableness of her temper. Her daily tasks distress her sorely. She can no longer sit still and sew or read. Conversation no longer interests, or it even troubles her. Noises, especially sudden noises, startle her, and the cries and laughter of children have become distresses of which she is ashamed, and of which she complains or not, as her nature is weak or enduring. Perhaps, too, she is so restless as to want to be in constant motion, but that seems to tire her
19
Nervousness
as it once did not. Her sense of moral proportion be- comes impaired. Trifles grow large to her ; the grass- hopper is a burden. With all this, and in a measure out of all this, come certain bodily disabilities. The telegram or any cause of emotion sets her to shaking. She cries for no cause ; the least alarm makes her hand shake, and even her writing, if she should chance to become the subject of observation when at the desk, betrays her state of tremor. What caused all this trouble ? What made her, as she says, good for noth- ing? I have^ of course, put an extreme case. We may, as a rule, be pretty sure, as to this condition, that the woman has had some sudden shock, some severe domestic trial, some long strain, or that it is the outcome of acute illness or of one of the forms of chronic disturbance of nutrition which result in what we now call general neurasthenia or nervous weakness, — a condition which has a most varied parentage. With the ultimate medical causation of these disorderly states of body I do not mean to concern myself here, except to add also that the great physiological revolutions of a woman's life are often responsible for the physical failures which create nervousness.
If she is at the wTorst she becomes a ready victim of hysteria. The emotions so easily called into activity give rise to tears. Too weak for wholesome restraint, she yields. The little convulsive act we call crying brings uncontrollable, or what seems to her to be
20
S. Weir Mitchell
uncontrollable, twitching of the face. The jaw and hands get rigid, and she has a hysterical convulsion, and is on the way to worse perils. The intelligent despotism of self-control is at an end, and every new attack upon its normal prerogatives leaves her less and less able to resist.
Let us return to the causes of this sad condition. It is a common mistake to suppose that the well and strong are not liable to onsets which cause nervousness. As a rule, they rarely suffer; but we are neatly bal- lasted, and some well people are nearer to the chance of being so overturned than it is pleasant to believe. Thus it is that what for lack of a better name we call " shock " is at times and in some people capable of inflicting very lasting evil in the way of nervous- ness.
We see this illustrated in war in the effects of even slight injuries on certain people. I have known a trivial wound to make a brave man suddenly timid and tremulous for months, or to disorder remote or- gans and functions in a fashion hard to understand. In the same way, a moral wound for which we are not prepared may bring about abrupt and prolonged consequences, from which the most robust health does not always protect us, and which is in proportion dis- astrous if the person on whom it falls is by tempera- ment excitable or nervous. I have over and over seen such shocks cause lasting nervousness. I knew a stout young clerk who was made tremulous, cowardly, sleep-
21
Nervousness
less, and, in the end, feeble, from having at a funeral fallen by mishap into an open grave. I have seen a strong woman made exquisitely nervous owing to the fall of a wall which did her no material damage. Earthquakes cause many such cases, and bad ones, as we have had of late sad occasion to know. The sudden news of calamity, as ol a death or financial disaster, has in my experience made vigorous people nervous for months. A friend of mine once received a telegram which rather brutally announced the dis- grace of one dear to him. He had a sense of ex- plosion in his head, and for weeks was in a state of nervousness from which he but slowly recovered. There is something in cases like his to think about. The least preparation would have saved him, and we may be sure that there is wisdom in the popular idea that ill news should be gently and guardedly broken to such as must hear it. To be forewarned is to be forearmed we say with true wisdom.
Prolonged strain of mind and body, or of both, is another cause apt to result in health failures and in nervousness as one attendant evil. The worst one I know is to nurse some person through a long disease. Women are apt to think that no one can so well care for their sick as they. Intrusion on this duty is resented as a wrong done to their sense of right. The friend who would help is thrust aside. The trained nurse excites jealous indignation. The volunteer gives herself soul and body to the hardest of tasks, and is
22
S. Weir Mitchell
rather proud of the folly of self-sacrifice. How often do we hear a woman say with pride, " I have not slept nor had my clothes off for a week." She does not see that her very affection unfits her for the calm con- trol of the sick-room, and that her inevitable anxiety is incompatible with tranquil judgment. If you tell her that nursing is a profession, and that the amateur can never truly fill the place of the regular, she smiles proudly, and thinks that affection is capable of all things, and that what may be lost in skill will be made up in thoroughness and compensated by watchfulness, such as she believes fondly only love can command. It is hard to convince such a woman.
It rarely chances that women are called upon to suffer in their common lives emotional strains through very long periods, and at the same time to sustain an excess of mental and physical labor. In days of finan- cial trouble this combination is sometimes fatal to the health of the strongest men. When a loving relative undertakes to nurse one dear to her through a pro- tracted illness, she subjects herself to just such con- ditions of peril as fall upon the man staggering under financial adversity.
The analogy to which I have referred is curiously complete. In both there is the combination of anxiety with physical and mental overwork, and in both alike the hurtfulness of the trial is masked by the excite- ment which furnishes for a while the means of waging unequal battle, and prevents the sufferer from know-
23
Nervousness
ing or feeling the extent of the too constant effort he or she is making. This is one of the evils of all work done under excessive moral stimulus, and when the excitation comes from the emotions the ex- penditure of nerve-force becomes doubly dangerous, because in this case not only is the governing power taken away from the group of faculties which make up what we call common sense, but also because in women overtaxing the emotional centres is apt to re- sult in the development of some form of breakdown, and in the secondary production of nervousness or hysteria.
If she cannot afford a nurse, or will not, let her at least share her duties with some one. Above all, let her know that every competent doctor watches even the best of his trained nurses, and insists that they shall be in the open air daily. Your good wife or mother thinks in her heart that wThen she has sickness at home she should not be seen out of doors, and that to eat, sleep, or care for herself is then wicked or something like that.
If you can make a woman change her dress, eat often, bathe as usual, and take the air, even if it must be so at night, she can stand a great deal, especially if you insist that she shall sleep her usual length of time. If she will not listen or obey, she runs a large risk, and is very apt to collapse as the patient re- covers, and to furnish her family with a new case of illness, and the doctor and herself with some variety
24
S. Weir Mitchell
of disorder of mind or body arising out of this terrible strain on both.
If physical tire, without chance for rest, with anxiety and incessant vigilance, is thus apt to cause wrecks in the nurse of ordinary illness, far more apt is it to involve breakdowns when a loving mother or sister endeavors to care for a protracted case of in- sanity. Unless the man of the house interferes, this effort is sure to bring disaster. And the more sensi- tive, imaginative, and loving is the self-appointed nurse, the more certain is she to suffer. There are no cases in which it is so hard to advise, none in which it is so difficult to get people to follow your advice. The morbid view of insanity, the vague sense of its being a stain, the horror of the hospital, all combine to perplex and trouble us. Yet here, if at any time, it is wise to cast the whole weight on the physician and to abide by his decision.
Families see this peril, and can be often made to understand the unwisdom of this sacrifice; but, in cases of prolonged disease, such as hysteria in a bedridden sister or mother, it is hard to make them hear reason, and still more hard to make the nursing relation un- derstand that she is of necessity the worst of nurses, and may share the wreck she helps to make.
These old and happily rare cases of chronic nervous invalids are simply fatal to loving nurses. I have said, perhaps too often, that invalidism is for most of us a moral poison. Given a nervous, hysterical,
25
Nervousness
feeble woman, shut out from the world, and if she does not in time become irritable, exacting, hungry for sympathy and petty power, she is one of nature's noblest. A mother or sister gives herself up to caring for her. She is in the grip of an octopus. Every fine quality of her nature helps to hurt her, and at last she breaks down utterly and can do no more. She, too, is become nervous, unhappy, and feeble. Then every one wonders that nobody had the sense to see what was going on. I can count many examples of nervousness which have arisen in this fashion. Per- haps my warning may not be without good results. Over and over I have made like statements in one or another form, and the increasing experience of added years only contributes force to my belief that, in still urging the matter, I am doing a serious duty. I ought to say also that the care of these invalids is, even to the well-trained and thoughtful nurse, one of the most severe of moral and physical trials, and that, in the effort to satisfy the cravings of these sick people, I have seen the best nurses crumble as it were in health, and at last give up, worn out and disheartened. A part of the responsibility of such disasters falls on the physician who forgets that it should be a portion of his duty to look sharply after the health of too devoted nurses as well as that of selfish patients.
I have now said all that I need to say of the causes which, directly or indirectly, evoke the condition we call nervousness. Many of these are insidious in their
26
S. JVeir Mitchell
growth. Too often the husband, if she be married, is immersed in his own cares, and fails to see what is going on. u I am not ill enough to see a doctor/' she says, and waits until she has needlessly increased the difficulties of his task. Let us suppose, however, that, soon or late, she is doing, in a merely medical way, all that he insists upon, what more can she do for herself? She has before her very likely a long trial, severe in its exactions in proportion to her previous activity of mind and body. She most prob- ably needs rest, and now that physicians have learned its value, and that not all ills are curable by exertion, she is told to lie down some hours each day. If she cannot eet rid of her home duties, let her try at least to secure to herself despotically her times of real and true rest. To lie down is not enough. What she needs is undisturbed repose, and not to have to ex- pect every few minutes to hear at her door the knocks and voices of servants or children. It is difficult to secure these most needful times of silent security even in health, as most women too well know. Very often the after-meal hours are the most available and the more desirable as times of repose, because in the weak digestion goes on better when they are at rest. She will find, too, that some light food between meals and at bedtime is useful, but this is within the doctor's province, and I am either desirous to avoid that or to merely help him. Air, too, she wants rather than any such great exertion as wearies ; and, as regards
27
Nervousness
this latter, let her understand that letter-writing, of which many women are fond, must be altogether set aside.
It is, however, the moral aspects of life which will trouble her most. The cares which once were easily shaken off stick to her like burrs, and she carries them to bed with her. I have heard women say that men little know the moral value to women of sewing. It becomes difficult when people are nervous, but this or some other light handiwork is then invaluable.
By this time she has learned that her minor, every- day duties trouble her, and when about to meet them, if wise, she wrill put herself, as we all can do, in an attitude of calmness. This applies still more forcibly to the larger decisions she must so often have to make as to children, house, and servants. Worry, as I have elsewhere said,, is as sand in the mental and moral machinery, and easily becomes a mischievous habit. We can stand an immense deal of work, and can, even if weak, bear much, if only we learn to dismiss small questions without worry or unreasonable re- considerations. As concerns temper, we constantly prepare ourselves to meet even just causes of anger, and thus by degrees learn more and more easily, and with less and less preparation, to encounter tranquilly even the most serious vexations. In health, when not nervous, a woman well knows that there are seasons when she must predetermine not to be nervous; and when ill-health has made her emotional, she must learn
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to be still, more constantly on guard. Above all, it is the small beginnings of nervousness which she has to fear.
Tears are, for the nervous woman, the seed of trouble. Let her resolutely shun this commencement of disaster. The presence of others is apt to insure failure of self-control. A word of pity, the touch of affection, the face of sympathy, double her danger. When at her worst, let her seek to be alone and in silence and solitude to fight her battle. Fresh air, a bath (if she can bear that), even the act of un- dressing, will often help her. I once quoted a valued friend as saying that " we never take out of a cold bath the thoughts we take into it," and the phrase is useful and true.
Above all, let such a woman avoid all forms of emotion. Her former standards of resistance apply no longer, and what once did not disturb will now shake her to the centre. A time comes, however, when she will do well to meet and relearn to bear calmly all the little emotional trials of life. I knowT a nervous woman — and no coward, either — who for months, and wisely, read no newspapers, and who asked another to open and read all her letters and telegrams. The day came when she was able to resume the habits of health, but for a long time the telegram at least was a sore distress, and she could only meet it by a resolute put- ting of herself in the attitude of tranquillity of which I have spoken. To say more should be needless. For
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the nervous strong emotions are bad or risky, and from violent mirth to anger all are to be sedulously set aside. Calm of mind and quiet of body are what she most needs to aid the more potent measures of the physician.
The woman in the situation I have described has probably a variety of symptoms on which her condi- tion causes her to dwell. A great many of them are of little practical moment. If she is irresolute and weak, she yields where she should not, and finds for inactivity or for fears ample excuses in the state of her own feelings. An unwholesome crop of dis- abilities grows out of these conditions. It then be- comes the business of her physician to tell her what is real, what is unreal, what must be respected, what must be overcome or fought. She has acquired within herself a host of enemies. Some are strong, some are feeble. The hour for absolute trust has arrived, and she must now believe in her adviser, or, if she can- not, she must acquire one in whom her belief will be entire and unquestioning.
Let us take an illustration. Such a woman is apt enough to suffer from vertigo or giddiness. " If I walk out," she says, " I become giddy. I am rarely free from this unless I am in bed, and it terrifies me." You know in this case that she is still strong enough to exercise in moderation. You say, " Walk so much daily. When you fall we will think about stopping. Talk to some one when you go out; have
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a friend with you, but walk.'' She must believe you to succeed. This is a form of faith-cure which has other illustrations. You tell her that she must dis- regard her own feelings. She credits you with know- ing, and so wins her fight.
There is a sense of fatigue which at some time she should learn to treat with disrespect, especially when disuse of her powers has made their exercise difficult, and yet when returning health makes it wise to employ them. To think, and at last to feel sure that she cannot walk is fatal. And above all, and at all times, close attention to her own motions is a great evil. We cannot swallow a pill because we think of what, as regards the larger morsels of food, we do automatically. Moreover, attention intensifies fatigue. Walk a mile, carefully willing each leg-motion, and you will be tired. The same evil results of attention are observed in disease as regards other functions over which we seem in health to be without direct power of control.
" Mind-cure," so called, has, in some shape, its legitimate sphere in the hands of men who know their profession. It is not rare to find among nervous women a few in whom you can cause a variety of odd symptoms by pressing on a tender spine and sug- gesting to the woman that now she is going to feel certain pains in breast, head, or limbs. Nervous women have, more or less, a like capacity to create or intensify pains and aches, but when a woman is
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assured that she only seems to have such ailments she is apt, if she be one kind of woman, to be vexed. These dreamed pains — I hardly know what else to call them — are, to her, real enough. If she be another kind of woman, if she believes you, she sets herself to disregard these aches and to escape their results by ceasing to attend to them. You may call this mind- cure or what you will, but it succeeds. Now and then you meet with cases in which, from sudden shock or accident, a woman is led to manufacture a whole train of disabling symptoms, and if in these instances you can convince her that she is well and can walk, eat, etc., like others, you make one of those singular cures which at times fall to the luck of mind- or faith-cures when the patient has not had the happy fortune to meet with a physician who is intelligent, sagacious as to character, and has the courage of his opinions. I could relate many such cases if this were the place to do so, but all I desire here is to win the well woman and the nervously-sick woman to the side of the physi- cian. If she flies from him to seek aid from the ignorant fanatic, she may, in rare cases, get what her trained adviser ought to give her and she be willing to use, while in unskilful hands she runs sad risks of having her too morbid attention riveted to her many symptoms ; for to think too much about their disorders is, on the whole, one of the worst things which can happen to man or woman, and wholesome self-atten- tion is difficult, nay, impossible, to command without
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help from a personally-uninterested mind outside of oneself.
I cannot leave this subject without a further word of solemn warning. In my youth we had mesmerism with its cures, then we had and have spiritualism with its like pretensions. From time to time we have had faith-cures. They come and they go, and have no stable life. The evil they do lives after them in the many mental wrecks they leave. When the charlatan Newton was ordering every class of the sick to get well, I was called upon to see case after case of the most calamitous results on mind and body. Now and then he had the luck to meet some one who was merely idea-sick, — a class of cases we know well. Then he made a cure which would have been as easy to me as to him. I made much inquiry, but could never find a case of organic disease with distinct tissue-changes which he had cured. A man with hopeless rheumatic alterations of joints was made to walk a few steps without crutches. This he did at sore cost of pain, and then came to me to tell me his tale with a new set of crutches, the healer having kept the old set as evidence of the cure. And now we have the mind- cure, Christian science and the like, — a muddle of mystical statements, backed by a medley of the many half-examined facts, which show the influence of mental and moral states over certain forms of dis- order. The rarity of these makes them to be suspected. Hardly any have the solid base of a thorough medical
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study, and we lose sight of them at the moment of cure and learn nothing as to their future.
The books on mind-cure are calculated to make much and serious evil. I have read them with care, and have always risen from them with the sense of confusion which one would have if desired to study a pattern from the back of a piece of embroidery. There is, however, a class of minds which delight in the fogs of mystery, and, when a book puzzles them, ac- cept this as evidence of depth of thought. I have been bewildered at times by the positiveness and reasoning folly of the insane, and I think most trained intelli- gences will feel that books like these mystical volumes require an amount of care and thinking to avoid be- wilderment of which the mass of men and women are not possessed. In a few years they will be the rarely read and dusty volumes, hid away in libraries, and consulted only by those who undertake the sad task of writing the history of credulity. Their creed will die with them, and what is best of it and true will continue to be used by the thoughtful physician, as it has been in all ages. But, meanwhile, it is doing much harm and little good. Every neurologist sees already some of its consequences, and I, myself, have over and over had to undo some of the evil it had done.
Our nervous woman is well. Slowly, very slowly, she has won flesh and color, which means gain in quality and quantity of blood. By degrees, too, she
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has been able to return to the habits and endurances of health. And now she asks that other question, " I have daughters who are yet young, but how shall I guard them against nervousness? " and again puts forward this single complex symptom in disregard of the states of body which usually accompany it, and are to us matters quite as grave. She knows well that the mass of women are by physiological nature more liable to be nervous than are men. It is a sad draw- back in the face of the duties of life, that a very little emotional disturbance will suffice to overcome the woman as it does not do the man, and that the same disease which makes him irritable makes her nervous. Says Romanes, in an admirable and impartial article on the mental differences of men and women, " She is pre-eminent for affection, sympathy, devotion, self- denial, modesty, long-suffering or patience under pain, disappointment, and adversity, for reverence, venera- tion, religious feeling, and general morality." I accept his statement to add that these very virtues do many of them lead to the automatic development of emotion, which, in its excesses and its uncontrolled states, is the parent of much of the nervousness not due to the en- feeblement of disease.1
With the intellectual differences between man and woman I have here little to do. That there is differ- ence, both quantitative and in a measure qualitative, I believe, nor do I think any educational change in
1 Journal of Popular Science, July, 1887.
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generations of women will ever set her, as to certain mental and moral qualifications, as an equal beside the man. It would be as impossible as to make him morally and physically, by any educational or other training, what the woman now is, his true superior in much that is as high, and as valuable as any mental capacities he may possess; nor does my creed involve for woman any refusal of the loftiest educational at- tainments. I would only insist on selection and cer- tain limitations as to age of training and methods of work, concerning which I shall by and by have some- thing more to say. Neither would I forbid to her any profession or mode of livelihood. This is a human right. I do not mean to discuss it here either as citizen or physician; but, as man, I like to state for my fellow-man that there are careers now sought and won and followed by her which for him inevitably lessen her true attractiveness, and to my mind make her less fit to be the " friendly lover and the loving friend." * ^Esthetic and other sacrifices in this direc- tion are, however, her business, not mine, and do not influence my practical judgments as to what freedom to act is or should be hers in common with men. For
1 One would like to know how many women truly want the suffrage, and how, when it was won, the earnest anti-tariff wife would construe the marriage service in the face of the husband's belief in high tariff. The indirect influence of women in politics is worth a thought. We felt it sorely in 1861, and thence on to the war's end, and to-day it is the woman who is making the general prohibition laws probable. For ill or good she is still a power in the state.
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most men, when she seizes the apple, she drops the rose. I am a little afraid that Mrs. Lynn Linton is right as to this, but it took some courage to say what she said,1 and she looks at the matter from a more practical point of view, and deserves to be read at length rather than quoted in fragments.
I return to the subject. We want our young girl to be all that Romanes says she is. We desire, too, that she shall be as thoroughly educated in relation to her needs as her brothers, and that in so training her we shall not forget that my ideal young person is to marry or not, and, at all events, is to have a good deal of her life in her home with others, and should have some resources for minor or self-culture and oc- cupation besides the larger ones which come of more distinctively intellectual acquirements.
I turn now to the mother who asks this question, and say, " What of your boys? Why are you not concerned as to them ? " " Oh, boys are never nervous. One couldn't stand that ; but they never are. Girls are so different." My answer is a long one. I wish I could think that it might be so fresh and so attractive as to secure a hearing; but the preacher goes on, Sun- day after Sunday, saying over and over the same old truths, and, like him, with some urgency within me to speak, I can only hope that I may be able so to restate certain ancient verities as to win for them a novel respect and a generous acceptation.
1 Fortnightly \ 1886.
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The strong animal is, as a rule, the least liable to damaging emotion and its consequences. Train your girls physically, and, up to the age of adolescence, as you train your boys. Too many mothers make haste to recognize the sexual difference. To run, to climb, to swim, to ride, to play violent games, ought to be as natural to the girl as to the boy. All this is fast changing for us, and for the better. When I see young girls sweating from a good row or the tennis-field, I know that it is preventive medicine. I wish I saw how to widen these useful habits so as to give like chances to the poor, and I trust the time will come when the mechanic and the laborer shall insist on public play- grounds as the right of his little ones.1
The tender mother, who hates dirt and loves neat- ness, and does not like to hear her girls called tom- boys, may and does find it hard to cultivate this free out-door life for her girls even when easy means make the matter less difficult than it is for the caged dweller in cities during a large portion or the whole of a year.
I may leave her to see that delicacy and modesty find place enough in her educational trainings, but let her also make sure that her girls have whatever chance she can afford to live out of doors, and to use the
1 The demagogue urges his rights to much that he cannot have in any conceivable form of society. Let him ask for free libraries, free baths, free music, and, above all, free and ample play-grounds within easy reach. I wonder that the rich who endow colleges do not ever think of creating play-grounds. I wish I could open some large pockets by an appeal to hearts at large.
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sports which develop the muscles and give tone and vigor. Even in our winters and in-doors? she can try- to encourage active games such as shuttlecock and graces. I know of homes where the girls put on the gloves, and stand up with their brothers, and take gallantly the harmless blows which are so valuable a training in endurance and self-control.
I am reminded as I write that what I say applies and must apply chiefly to the leisure class ; but in others there is a good deal of manual work done of necessity, and, after all, the leisure class is one which ia rapidly increasing in America, and which needs, especially among its new recruits, the very kind of advice I am now giving. Severer games, such as cricket, which I see girls playing with their brothers, tennis, fencing, and even boxing, have for both sexes moral values. They teach, or some of them teach, endurance, contempt of little hurts, obedience to laws, control of temper, in a word, much that under ordinary circumstances growing girls do not get out of their gentler games. These are worth some risks, and such as they are need not trouble seriously the most careful mother. Xeither need she fear for girls up to the age of puberty that they are any more liable to serious damage than are her boys.
When for her young daughters this time of change comes near, she may rest assured that their thorough physical training will have good results. Beyond this point it is hard to generalize, and, of course, the more
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violent games, in which girl and boy are or may be as one, must cease. But each case must stand alone, and so be judged. There are plenty of healthy girls who may continue to row, to ride, to swim, to walk as before, but there are individual cases as to which advice is needed, although, as to all girls, it should be the rule that at certain times temperate exercise, lessened walks, and no dancing, riding, rowing, skat- ing, or swimming should be allowed. Girls feel these restrictions less if they are so stringently taught from the outset as to become habits, and this is all I care to say.
Once past the critical years, and there is no reason why the mass of women should not live their own lives as men live theirs, except that always, in my opinion, the prudent woman will at certain times save herself. It is still true that even healthy women exercise too little. Our climate makes walking unpleasant, and to get in a good sweat in summer, or to wade through slush in winter, is hateful to the female soul. The English reproach us with this defect, and rightly, but do not estimate the difficulties of climate. Australian women walk little, and the English dame who comes to this country to live soon succumbs to the despotism of climate and abandons her habits of ample exercise afoot.
The in-door resources of women for chest and arm exertion are sadly few, and I think it fortunate when they are so situated as to have to do things in the
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household which exact vigorous use of the upper ex- tremities. Nothing is a better ally against nervousness or irritability in any one than either out-door exer- cise or pretty violent use of the muscles. I knew a nervously-inclined woman who told me that when she was losing self-control she was accustomed to seek her own room, and see how long she could keep up a shuttlecock without a failure. As to weather, again, I should say the worse the weather the better the ex- ercise of a brisk walk; and my wise mother shall see that her girls do not dawdle about in-doors, but get a good tramp under all skies as a part of the habits of life. A sturdy struggle with a rough day blows the irritability and nervousness of the hour out of any but the truly sick, and I know as to some folks that the more they are out of doors the better they are morally as well as physically.
My ideal mother has looked on and seen her daugh- ters grow up to be strong and vigorous. When the time came, she has not forgotten that she has had and has to deal with one of her own sex. During the years of their childhood she should understand, as concerns her girls, that to differentiate too largely their moral lessons from those of their brothers is unwise. Some- thing as to this I have said in a former chapter as con- cerns the training of invalid children. It applies also to the well. The boy is taught self-control, repres- sion of emotion, not to cry when hurt. Teach your girls these things, and you will in the end assure to
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them that habitual capacity to suffer moral and physi- cal ill without exterior show of emotion, which is so true an aid to the deeper interior control which sub- dues emotion at its sources, or robs it of its power to harm. Physical strength and an out-door life will make this lesson easy and natural. Be certain that weakness of body fosters and excuses emotional non- restraint, and that under long illness the most hardy man may become as nervously foolish as a spoiled child. Crave, then, for your girls strength and bodily power of endurance, and with this insist that the boy's code of emotional control shall be also theirs. But to do all this you must begin with them young, and not have to make each year undo the failure of the last. A dog-trainer once told me that it was a good thing to wThip the smallest pups with a straw, and to teach them good habits, or try to do so, from birth. He put it strongly ; but be sure that if we wish to build habits thoroughly into the mental and physical struc- ture of childhood, we shall do well to begin early. As regards the out-door life, I shall have something more to say in another place, for much is within the reach of the thoughtful, which, with reasonable means, they can get for girls and women, and which yet they do not get ; and there are many wrays in which also we can so train our girls as to create for them constant and lasting bribes to be in the air.
The question of education is a more difficult one to handle. In childhood I do not see that our wise
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mother need be anxious ; but there comes a day when her girl is entering womanhood, when she will have to think of it. I have dealt with this question so fully of late that I have little here to add.1 Our pub- lic schools are so organized that there is small place or excuse for indulgence, although, under wise man- agement, this has been shown to be possible.2 But there is a vast and growing class which is so situated that the mother can more largely control the studies and hours of her girls than can the parents of those who frequent our municipal schools.
A great change is on her child. Let her watch its evolution, and not with such apparent watchful- ness as shall suggest the perils she is to look out for. We are all organized with a certain capital of nerve- force, and we cannot spend it with equal recklessness in all directions. If the girl bears well her gathering work, — that is, as one could wish, — we may let her alone, except that the wise mother will insist on lighter tasks and some rest of body at the time when nature is making her largest claim upon the vital powers. The least sign of physical failure should ring a graver alarm, and make the mother insist, at every cost, upon absence of lessons and reasonable repose. The mat- ter is simple, and I have no more to say.
I am dealing now so entirely with the moral and physical aspects of a woman's life, and so distinctly from the medical point of view, that I do not feel
1 "Wear and Tear," 6th ed., 1887. 2 Ibid., p. 54,
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called upon to discuss, in all its aspects, the mooted question of the values and the perils of the higher education. At one time it was not open to women at all. Now it is within her reach. Our girl is well, and has passed, happily, over her time of development. Will the larger education which she so often craves subject her to risks such as are not present to the man, — risks of broken health and of its consequences ? I wTish to speak with care to the mother called upon to decide this grave question. I most honestly be- lieve that the woman is the better in mind and morals for the larger training, better if she marries, and far better and happier if it chances that she does not. If we take the mass of girls, even of mature age, and give them the training commonly given to men, they run, I think, grave risks of being injured by it, and in larger proportion than do their brothers. Where it seems for other reasons desirable, it should be, I think, a question of individual selection. The majority of healthy young women ought to be able to bear the strain. Once in a female college, the woman goes on, and it is my own experience that, on the whole, she exhibits a far larger list of disastrous results from such work than do young men. If she be in the least degree nervous or not well, I, for one, should resolutely say no to all such claims; for let us bear in mind that the higher education is rarely to be used as men use it, to some definite end, and is therefore not, on the whole, so essential to her as to him. Few
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women mean it as a way towards medicine, or even the upper ranks of teaching; and if they do, the least doubt as to health ought to make us especially unwill- ing to start an unseawTorthy or uninsurable vessel upon an ocean of perilous possibilities. I wish that every woman could attain to the best that men have. I wish for her whatever in the loftiest training helps to make her as mother more capable, as wTife more helpful; but I would on no account let the healthiest woman thus task her brain until she is at least nineteen. If she is to marry, and this puts it off until twenty-three, I consider that a gain not counted by the advocates of the higher education. I leave to others to survey the broad question of whether or not it wTill be well for the community that the mass of women should have a collegiate training. It is a wide and wrathful question, and has of late been very well discussed in Romanes's paper, and by Mrs. Lynn Linton. I think the conclusions of the former, on the whole, are just; but now, whatever be my views as to the larger in- terests of the commonwealth and the future mothers of our race, I must not forget that I am giving, or trying to give, what I may call individualized advice, from the physician's view, as to what is wisest.
Let us suppose that circumstances make it seem proper to consider an ambitious young woman's wish, and to let her go to a college for women. We pre- sume that she has average health. But let no prudent mother suppose that in these collections of persons
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of one sex her child will be watched as she has been at home. At no time will she more need the vigilant insight of a mother, and yet this can only be had through letters and in the holiday seasons. Nor can the mother always rely upon the girl to put forward what may cause doubt as to her power to go on with her work. I utterly distrust the statistics of these schools and their graduates as to health, and my want of reliance arises out of the fact that this whole ques- tion is in a condition which makes the teachers, scholars, and graduates of such colleges antagonistic to masculine disbelievers in a way and to a degree fatal to truth. I trust far more what I hear from the women who have broken down under the effort to do more than they were fit to do, for always, say what you may, it is the man's standard of endurance wThich is set before them, and up to which they try to live with all the energy which a woman's higher sense of duty imposes upon the ambitious ones of her sex. I have often asked myself what should be done to make sure that these schools shall produce the mini- mum amount of evil; what can be done to avoid the penalties inflicted by overstudy and class competitions, and by the emotional stimulus which women carry into all forms of work. Even if the doctor says this girl is sound and strong, her early months of college labor should be carefully watched. Above all, her eyes should be seen to, because in my experience some un- suspected disorder of vision has been fruitful of head-
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aches and overstrain of brain, nor is it enough to know that at the beginning her eyes are good. Ex- treme use often evolves practical evils from visual difficulties at first so slight as to need or seem to need no correction.
The period of examinations is, too, of all others, the time of danger, and I know of many sad break- downs due to the exaction and emotional anxieties of these days of competition and excitement.
Let me once for all admit that many girls improve in health at these colleges, and that in some of them the machinery of organization for care of the mental and physical health of their students seems to be all that is desirable. That it does not work satisfactorily I am sure, from the many cases I have seen of women who have told me their histories of defeat and broken health. The reason is clear. The general feeling (shall I say prejudices?) of such groups of women is bit- terly opposed to conceding the belief held by physi- cians, that there are in the woman's physiological life disqualifications for such continuous labor of mind as is easy and natural to man. The public sentiment of these great schools is against any such creed, and every girl feels called upon to sustain the general view, so that this acts as a constant goad for such as are at times unfit to use their fullest possibility of energy. Modest girls, caught in the stern mechanism of a system, hesitate to admit reasons for lessened work or to exhibit signals of failure, and this I know to be
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the case. The practical outcome of it all is that the eyes of home can never be too thoughtfully busy with those of their girls who have won consent to pursue, away from maternal care, the higher education of female colleges. I must have wearied that wise mother by this time, but, perhaps, I have given her more than enough to make her dread these trials.
I should say something as to the home-life of girls who go through the ordinary curriculum of city day schools were it not that I have of late so very fully reconsidered and rewritten my views as to this in- teresting question. I beg to refer my unsatisfied reader to a little book which, I am glad to know, has been helpful to many people in the last few years.1
xSee " Wear and Tear," page 91.— Editor.
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CHAPTER II Convalescence
To my mind, there is nothing more pleasant than the gradual return to health after some revolutionary disease which has removed a goodly portion of the material out of which is formed our bodily frame. Nature does this happy work deftly in most cases, where, at least, no grave organic mischief has been left by the malady; and in the process we get such pleasantness as comes always from the easy exercise of healthy function. The change from good to better day by day is in itself delightful, and if you have been so happy, when wrell, as to have loved and served many, now is the good time when bun and biscuit come back to you, — shapely loaves of tenderness and gracious service. Flowers and books, and folks good and cheery to talk to, arrive day after day, and have for you a new zest which they had not in fuller health. Old tastes return and mild delights become luxuries, as if the new tissues in nerve and brain were not sated, like those of the older body in which they are taking their places.
When you are acutely ill, the doctor is business-
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like and gravely kind; you want him in a way, are even anxious to see him for the relief he may bring, or the reassurance. But when you begin to feel as if you were a creature reborn, when you are safe and keenly enjoying the return of health, then it is that the morning visit is so delightful. You look for his coming and count on the daily chat. Should he chance to be what many of my medical brothers are, — educated, accomplished, with wide artistic and mental sympathies, — he brings a strong, breezy freshness of the outer world with him into the monastic life of the sick-room. One does not escape from being a patient because of being also a physician, and for my part I am glad to confess my sense of enjoyment in such visits, and how I have longed to keep my doctor at my side and to decoy him into a protracted stay. The convalescence he observes is for him, too, a pleasant thing. He has and should have pride in some distinct rescue, or in the fact that he has been able to stand by, with little interference, and see the disease run its normal course. I once watched a famous sur- geon just after he had done a life-saving operation by dim candle-light. He stood smiling as the child's breath came back, and kept nodding his head with pleasant sense of his own competence. He was most like a Newfoundland dog I once had the luck to see pull out a small child from the water and on to a raft. When we came up, the dog was wagging his tail and standing beside the child with sense of self-approval
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in every hair. The man wagged his head ; the dog wagged his tail. Each liked well what he had done.
Thus it is that these half-hours by the convales- cent's couch are full of subtle flatten' for the doctor, and are apt to evolve the social best of him, as he notes the daily gain in strength and color, and listens, a tranquil despot, to one's pleas for this freedom or that indulgence. He turns over your books, suggests others, and, trained by a thousand such interviews, is likely enough a man interesting on many sides.
You selfishly enjoy his visit, not suspecting that you, too, are ignorantly helpful. He has been in sadder homes to-day, has been sorely tried, has had to tell grim truths, is tired, mind and body. The visit he makes you is for him a pleasant oasis : not all con- valescents are agreeable. He goes away refreshed.
Most doctors have their share, and more, of ill- ness, and are not, as I have seen stated, exempt from falling a prey to contagious maladies. Indeed, our records sadly show that this is not the case. Perhaps there is value for them and their future patients in the fact that they have been in turn patient and doctor and have served in both camps. Like other sick folks, the physician, as I know, looks forward, when ill, to the " morning visits " quite as anxiously as do any of those who have at times awaited his own coming.
That medical poet who has the joyous art of send- ing a ripple of mirth across the faces of the Anglo- Saxon world recognizes this fact in a cheerful poem,
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called " The Morning Visit/' and to which I gladly refer any of my readers who would like to know from the lips of Oliver Wendell Holmes what manner of delightful patient he must have been. I can fancy that he lost for his doctor many a pleasant hour.
It has seemed to me as if this wonderful remaking and regrowing of the tissues might be likened to a swift change from the weak childhood of disease to a sudden manhood of mind and body, in which is something of mysterious development elsewhere un- matched in life. Death has been minutely busy with your tissues, and millions of dead molecules are being restored in such better condition that not only are you become new in the best sense, — renewed, as we say, — but have gotten power to grow again, and, after your terrible typhoid or yellow fever, may win a half- inch or so in the next six months, — a doubtful ad- vantage for some of us, but a curious and sure sign of great integral change.
The Greeks had a notion that once in seven years we are totally changed, the man of seven years back having in this time undergone an entire reconstruc- tion. We know now that life is a constant death and a renewing, — that our every-day nutrition in- volves millions of molecular deaths and as many mil- lions of births, — although to liken that which is so exquisitely managed, so undisturbingly done, to the coarser phenomena of death and birth is in a measure misleading.
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Diseases such as typhoid fever, or a sharp local lung-trouble like pneumonia, really do make these minute changes approximate in abruptness to death. You weigh, let us say, one hundred and eighty pounds, and you drop in three weeks of a fever to one hundred and thirty pounds. The rest of you is dead. You have lost, as men say, fifty pounds, but your debt to disease, or to the blunders of civilization, for it is a case of creditor behind creditor, is paid. Your capital is much diminished, but you have come out of the trial with an amazing renovation of energy. This is the happy convalescence of the wholesome man. The other, the unlucky, fellow, does not get as safely through the cleansing bankruptcy of disease. The vicious, unlucky, or gouty grandfather appears on the books of that court in mysterious ways; his sins are pathologically visited on his child's child in this time of testing strain.
In the happy rush towards useful health, of a con- valescence undisturbed by drawbacks, it is pleasant to think, as one lies mending, of the good day to come when my friend, recovering from typhoid or small- pox, shall send for his legal adviser and desire him as usual to bring suit against the city for damages and loss of time.
A little girl coughed in my face a hideous breath of membraneous decay. I felt at once a conviction of having been hit. Two days later I was down with her malady. She herself and two more of her family
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owed their disease to the overflow of a neighbor's cesspool, and to them — poor, careless folk — Death dealt out a yet sterner retribution. There was a semi- civilized community beyond both. Should one go to law about it and test the matter of ultimate re- sponsibility ?
The amiability of convalescence is against it. One feels at peace with all the world, and so lies still, and reflects, " like souls that balance joy and pain," as to whether, on the whole, the matter has not had its valuable side. Certainly it has brought experiences not otherwise attainable.
Of the deeper and more serious insights a man gathers in the close approach of death and the swift, delicious return to safety and enlarging powers I hardly care to speak. To a physician, it is simply invaluable to have known in his own person pain, and to have been at close quarters with his constant enemy, and come off only wounded from the contest. In the anxiety about you is read anew what you look upon in other households every day, and perhaps with a too accustomed eye. And as to pain, I am almost ready to say that the physician who has not felt it is imperfectly educated. It were easy to dwell on this aspect of convalescence, but the mental state of one on the way to health is not favorable to connected thought. It is more grateful to lie in the sun, at the window, and watch the snow-birds on the ice-clad maoles across the way, and now and then, day after
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day, to jot down the thoughts that hop about one's brain like the friendly birds on the mail-clad twigs.
I make no apology for the disconnectedness of my reflections, but turn gladly to my records of the joyous and less grave observations which the pass- ing hours brought me. Much as I have seen of disease and recoveries in all manner of men and women, the chance to observe them in my own person presented me with many little novel facts of interest. I find in my brief notes of this well-remembered time many records of the extraordinary acuteness won for a while bv the senses.
Xot dubious, but, alas ! brief, is the gain which the sensorium acquires in this delightfully instructive passage out of death's shadow into certain sunshine. In my own case there was a rapid exfoliation, as we call it, of the skin, a loss and renewal of the outer layer of the cuticle. As a result of this, the sense of touch became for a while more acute, and was at times unpleasantly delicate. This seemed to me, as I first thought of its cause, a mere mechanical result, but I incline to suspect now that it was in a measure due to a true increase in capacity to feel, because I found also that the sister sense of pain was height- ened. Slight things hurt me, and a rather gentle pinch gave undue discomfort. No doubt a part of this was owing to my having taken a good deal of opium, and then abruptly laid it aside. As I have elsewhere stated, this is apt to leave the nerves over-
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sensitive for a season. The sense of hearing seemed to me to be less wide awake. I did not hear better, but high notes were for a while most unpleasant. The sense of taste grew singularly appreciative for a time, and made every meal a joyful occasion. The simplest food had distinct flavors. As for a glass of old Madeira, — a demijohned veteran of many ripen- ing summers, — I recall to this day with astonishment the wonderful thing it was, and how it went over the tongue in a sort of procession of tastes, and what changeful bouquets it left in my mouth, — a strange variety of varying impressions, like the play of colors. In these days of more unspiritual health and coarser sense I am almost ashamed to say what pleasure I found in a dish of terrapin.
The function of smell became for me a source both of annoyance and, later on, of pleasure, I smelt things no one else could, and more things than I now can. The spring came early, and once out of doors the swiftly-flitting hours of sensory acuteness brought to me on every breeze nameless odors which have no being to the common sense, — a sweet, faint confusion of scents, some slight, some too intense, — a gamut of odors. Usually I have an imperfect capacity to apprehend smells, unless they are very positive, and it was a curious lesson to learn how intense for the time a not perfect function may become. Recent re- searches have shown that a drug like mercaptan may be used to test the limit of olfactory appreciation. We
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have thus come to know that the capacity to perceive an odor is more delicate than our ability to recognize light. Probably it is an inconceivable delicacy of the sense of smell more than anything else which enables animals to find their way in the manner which seems to us so utterly mysterious. Yet, even in human beings, and not alone in a fortunate convalescence, do we see startling illustrations of the possibilities of this form of sensorial acuteness. I know of a woman who can by the smell at once tell the worn gloves of the several people with whom she is most familiar, and I also recall a clever choreic lad of fourteen who could distinguish when blindfold the handkerchiefs of his mother, his father, or himself, just after they have been washed and ironed. This test has been made over and over, to my satisfaction and surprise.
If a man could possess in the highest degree and in combination all of the possible extremes of sensory appreciativeness seen in disease, in hysteria, and in the hypnotic state, we should have a being of extraor- dinary capacities for observation. Taylor, in his " Physical Theory of Another World," a singular and half-forgotten book, has set this forth as conceivable of the beings of a world to come, and dwelt upon it in an ingenious and interesting way. For a long time even the inhalation of tobacco-smoke from a friend's cigar disturbed my heart, but one day, and it was, I fear, long before my physician, and he was wise, thought it prudent, I suddenly fell a prey to our lady
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Nicotia. I had been reading listlessly a cruel essay in the Atlantic on the wickedness of smoking, and was presently seized with a desire to look at King James's famous " counterblast " against the weed. One is like a spoiled child at these times, and I sent off at once for the royal fulmination, which I found dull enough. It led to results the monarch could not have dreamed of. I got a full-flavored cigar, and had a half- hour of worshipful incense-product at the shrine of the brown-cheeked lady, — a thing to remember, — and which I had leisure enough to repent of in the sleep- less night it cost me.
This new keenness of perception, of taste and touch, of smell and sound, belongs also, in the splendid rally which the body makes toward health, to the intellectual and imaginative sphere of activities. Something of the lost gifts of the fairy-land of childhood returns to us in fresh aptitude for strange, sweet castle-build- ing, as we lie open-eyed, or in power to see, as the child sees, what we will when the eyes are closed, —
Pictures of love and hate,
Grim battles where no death is. Tournaments,
Tall castles fair and garden terraces,
Where the stiff peacock mocks the sunset light.
And man and maiden whisper tenderly
A shadowy love where no heart ever breaks, —
Love whose to-morrow shall be as to-day.
With the increase of intellectual clearness, within a certain range, come, as with the brightened senses,
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certain drawbacks, arising out of the fastidiousness which belongs to the changing man just at this time. Let him, therefore, be careful what novels he chooses, for of all times this is the one for fiction, when we are away from the contradictions of the fierce outer world, and are in an atmosphere all sun and flowers, and pleasant with generous service and thankful joy. Be careful what Scheherezade you invite to your couch. By an awful rule of this world's life, in all its phases, the sharper the zest of enjoyment, the keener the pos- sible disgusts may be. I recommend Dumas's books at this crisis, but they should be read with acceptance ; as stories, their value lying largely in this, that no matter who is murdered or what horror occurs, you somehow feel no more particular call upon your com- passion than is made when you read afresh the ter- rible catastrophes of Jack the Giant-Killer.
A delightful master of style, Robert Louis Steven- son, in a recent enumeration of the books which have influenced him in life, mentions, as among the most charming of characterizations, the older Artagnan of the Vicomte de Bragelonne. I feel sure that on the sick-bed, of which he does not hesitate to speak, he must have learned, as I did, to appreciate this charm- ing book. I made acquaintance then, also, with what seems to me, however, the most artistic of Dumas's works, and one so little known that to name it is a benefit, or may be, the Chevalier d'Harmen- thal.
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In the long road towards working health, I must have found, as my note-books show, immense leisure, and equal capacity to absorb a quantity of fiction, good and bad, and to find in some of it things about my own art which excited amused comment, and but for that would long ago have been forgotten. Among the stuff which I more or less listlessly read was an astonishing book called " Norwood." It set me to thinking, because in this book are recounted many things concerning sick or wounded folk, and those astonishing surgeons and nurses who are supposed to have helped them on to their feet again. The ghastly amusement which came to me out of the young lady in this volume, who amputates a man's leg, made me reflect a little about the mode in which writers of fic- tion have dealt with sick people and doctors. I lay half awake, and thought over this in no unkindly critical mood,
" With now and then a merry thought, And now and then a sad one,"
until I built myself a great literary hospital, such as would delight Miss Nightingale. For in it I had a Scott ward, and a Dickens ward, and a Bulwer ward, and a Thackeray ward, with a very jolly lot of doc- tors, such as Drs. Goodenough and Firmin, with the Little Sister (out of Philip) and Miss Evangeline to take care of the patients, besides cells for Charles Readers heroes and heroines, and the apothecary (out
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of Romeo and Juliet) to mix more honest doses than he gave to luckless Romeo.
Should you wander with a critical doctor through those ghostly wards, you would see some queerer results of battle and fray than ever the doctors observe nowadays, — cases I should like to report, it might be : poisonings that would have bewildered Orfila, heart- diseases that would have astounded Corvisart, and those wonderful instances of consumption which ren- der that most painful of diseases so delightful to die of — in novels. I have no present intention to weary my readers with a clinic in those crowded wards, but it will ease my soul a little if I may say my say in a general fashion about the utter absurdities of most of these pictures of disease and death-beds. In older times the sickness of a novel was merely a feint to gain time in the story or account for a non-appearance, and the doctor made very brief show upon the stage. Since, however, the growth of realism in literary art, the temptation to delineate exactly the absolute facts of disease has led authors to dwell too freely on the details of sickness. So long as they dealt in generali- ties their way was clear enough. Of old a man was poisoned and done for. To-day we deal in symptoms, and follow science closely in our use of poisons. Mr. Trollope's " Gemma " is an instance in point, where every one will feel that the spectacle of the heroine going seasick to death, owing to the administration of tartar emetic, is as disgusting and inartistic a
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method as fiction presents. Why not have made it croton oil? More and worse of this hideous realism is to be found in About's books, such, for instance, as " Germaine " ; but from which censure I like to ex- clude the rollicking fun of " Le nez d'un Notaire." As to the recent realistic atrocities of Zola, and even of Tolstoi, a more rare singer, if we exclude his disgusting drama of peasant life, I prefer to say little.
As to blunders in the science of poisons I say little. The novelist is a free lance, and chooses his own weapons; but I cannot help remarking that, if recent investigators are to be trusted, one unlucky female, at least, must be still alive, for a novelist relates that she was done to death by the internal taking of a dose of rattlesnake venom. I hope when I am to be poi- soned this mode may be employed. She might as well have drunk a glass of milk. That book was a queer one to me after this catastrophe : the woman ought to be dead and could not be.
The difficulty of the modern novelist in giving symptoms and preserving the entire decorum of his pages has amused me a little. Depend upon it, he had best fight shy of these chronic illnesses : they make queer reading to a doctor who knows what sick people are ; and above all does this advice apply to death-beds. As a rule, folks get very horrible at such times, and are a long while in dying, with few of their wits about them at the last. But in novels people die marvellously
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possessed of their faculties ; or, if they are shot, always jump into the air exactly as men never do in fact.
Just here, concerning wounds, a question occurs to me : The heroes who have to lose a limb — a common thing in novels since the wrar — always come back with one arm, and never writh a lost leg. Is it more ro- mantic to get rid of one than of the other? — con- sidering also that a one-armed embrace of the weep- ing waiting lady-love must be so utterly unsatisfactory.
But enough of the patients. Among them I think I like Pendennis the best, and consider little Dombey and Nell the most delightfully absurd. And as to the doctors. Some of them have absolutely had the high promotion to be the heroes of a whole book. Had not one, nay, two, a novel to themselves? There is delightful Dr. Antonio, not enough of a doctor to call down on him my professional wrath. As to Dr. Good- enough, he has been in our family a long while, — on the shelf (God bless him!), — and attended, we re- member, our friend Colonel Newcome in that death- bed matchless in art since Falstaff babbled life away. Yet, after all, he is not a doctor so much as a man charmingly drawn.
There are in novels many good portraits of law- yers, from Pleydell to Tulkinghorn. Whether fair or unjust as pictures, I am scarce able to judge, although I believe that some of them have been rec- ognized by our legal brethren as sufficiently exact. While, however we have plenty of characters which
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for his purpose the novelist labels M.D., there seems to have been some insuperable difficulty in evolving for artistic use a doctor who shall seem at home, as such, among the other characters of the novel,— one, at least, who shall appear to any reasonable degree like a doctor to those who really know the genus doctor thoroughly. Save Lydgate, no doctor in fiction an- swers this critical demand, or seems anything to me but a very stiff lay figure from the moment he is called upon to bring his art into the story, or to figure, except as an unprofessional personage.
Nor does this arise from poverty of types in the tribe of physicians. The training of a doctor's life pro- duces the most varied effects for good or evil, as may chance, upon the human natures submitted to its dis- cipline, so that I think any thoughtful medical man will tell you that there is a more notable individuality among his brethren in middle life than among most of the people he encounters. As for the novelist's effort — an inartistic one, it seems to me — to bring on his stage representations of some especial kind of doctor, I have only a grim smile to give, remembering Mr. Reade's grewsome medico in " Hard Cash," — a personation meant, I suppose, to present to the public a certain irregular London doctor, but which, to the minds of most physicians, reads like an elaborate ad- vertisement of the man in question.
Sir Bulwer Lytton's renderings of a homoeopath and a water-cure specialist are open to the same charge,
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and could only have been successful in the hands of a master.
There are at least two doctors in Balzac's novels. Rastignac, man of fashion and science, is drawn with the master's usual skill, but he is not a doctor. His art has no prominence. It is not shown how his pe- culiarities influenced his work, nor how his art, and its use, altered or modified the man. " The Country Doctor/' by the same strong hand, is far more near my ideal of what this portraiture should be than any other known to me in French literature. The humor- ous aspects of a medical life in the provinces of France are nicely handled in Jules Sandeau's " Doctor Her- beau," but the study, however neat and pleasing, is slight.
Wander where you may, in the drama or the novel, you will still find, I think, that the character of the physician awaits in its interesting varieties competent portrayal.
Shakespeare has left us no finished portrait of a doctor. Moliere caricatured him. Thackeray failed to draw him, and generally in novels he is merely a man who is labelled " Doctor." The sole exception known to me is the marvellous delineation of Lydgate in " Middlemarch." He is all over the physician, his manner, his sentiments, his modes of thought, but he stands alone in fiction. How did that great mistress of her art learn all of physicians which enabled her to leave us this amazingly truthful picture? Her life
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gives us no clue, and when I asked her husband, George Lewes, to explain the matter, he said that he did not know, and that she knew no more of this than of how she had acquired her strangely complete knowl- edge of the low turf people she had drawn in the same book, and with an almost equal skill and truth to nature.
It were easy, I fancy, to point out how the doctor's life and training differ from those of all the other professions, and how this must act on peculiar in- dividualities for the deepening of some lines and the erasure of others; but this were too elaborate a study for my present gossiping essay, and may await an- other day and a less lazy mood.
If any one should be curious to see what are the modifying circumstances in a physician's life which strongly tend to weaken or to reinforce character, I recommend a delightful little address, quite too brief, by Dr. Emerson, the son of the great essayist. It is unluckily out of print and difficult to obtain. If you would see in real lives what sturdy forms of per- sonal distinctness the doctor may assume, there is no better way than to glance over some half-dozen medical biographies. Read, for instance, delightful John Brown's sketch of Sydenham and of his own father, or George Wilson's life of John Reid, the physiologist, whom community of suffering must have made dear to that gentle intelligence, and whose days ended in tragic horror such as sensational fiction may
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scarcely match ; or, for an individuality as well defined and more pleasing, read Pichot's life of Sir Charles Bell, or one of the most remarkable of biographies, Mr. Morley's life of Jerome Cardan.
I am reminded as I write how rare are the really good medical biographies. The autobiographies are better. Ambrose Pare's sketches of his own life, which was both eventful and varied, are scattered through his treatise on surgery, and he does not gain added interest in the hands of Malgaigne. Our own Sims's book about himself is worth reading, but is too realistic for the library table, yet what a strangely valuable story it is of the struggle of genius up to eminent success. But these are the heroes of a not unheroic profession, and I had almost forgotten to set among them, as a study of character, the life of the tranquil, high-minded Jenner, the country doctor who swept the scars of smallpox from the faces of the world of men, and beside him John Hunter, his friend, impulsive, quick of temper, enthusiastic, an intensely practical man of science. These are illustrations of men of the most varied types, whose works show their charac- teristics, and who would, in the end, I fancy, have been very different had fate set them other tasks in life, for if the sculptor makes the statue, we may rest quite sure that the statue he makes influences the man who made it.
These, I have said, are our heroes, but I still think there remains to be written the simple, honest, dutiful
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story of an intelligent, thoughtful, every-day doctor, such as will pleasantly and fitly open to laymen some true conception of the life he leads, its cares, its trials, its influences on himself and others and its varied rewards. John Brown got closest to it in that sketch of his father, and in her delicately-drawn " Country Doctor " Miss Jewett has done us gentle service. But my doctor would differ somewhat in all lands, because nationality and social conventions have their influence on us as on other men, as any one may observe who compares the clergymen of the Episcopal Church in America with those of England.
The man who deals with the physician in fiction would have to consider this class of facts, for social conventions have assigned to the physician in England, at least, a very different position from that which he holds with us, where he has no social superior, and' is usually in all small communities, and in some larger ones, the most eminent personage and the man of largest influence.
In the rage for novel characters the lady doctor has of late assumed her place in fiction. Lots of wives have been picked up among hospital nurses, especially since the Crimean war, and since other women than Sisters of Charity got into the business, and so made to seem probable this pleasing termination of an ill- ness. There was a case well known to me where a young officer simulated delirium tremens in order to get near to a Sister of Charity. If ever you had seen
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the lady, you would not have wondered at his mad- ness; and should any author desire to utilize this in- cident, let him comprehend that the order of Sisters of Charity admits of its members leaving the ranks by marriage, theirs being a secular order ; so that here are the chances for a story of the freshest kind. As for the lady doctor in fiction, her advantages would be awful to contemplate in sickness, when we are weak and fevered, and absurdly grateful for a newly-beaten pillow or a morsel of ice. But imagine the awful temptation of having your heart auscultated. Let us dismiss the subject while the vision of Beranger's Ange Gardienne flits before us as De Grandville drew her.
I have not now beside me Howells's " Doctor Breen's Practice." It is a remarkable attempt to do justice to a very difficult subject, for there are two physicians to handle, male and female, not, I think, after their kind. " Doctor Zay," by Miss Phelps, makes absurd a book which is otherwise very attrac- tive. This young woman doctor, a homoeopath, sets a young man's leg, and falls in love with him after a therapeutic courtship, in which he wooes and she pre- scribes.
The woman doctor is, I suspect, still available as material for the ambitious novelist, but let him beware how he deals with her.
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CHAPTER III Out-Door and Camp-Life for Women
A good many years ago I wrote a short paper.1 meant to capture popular attention, under the title of u Camp Cure." I have reason to think that it was of use, but I have been led to regret that I did not see when it was written that what I therein urged as de- sirable for men was not also in a measure attainable by many women. I wish now to correct my error of omission, and to show not only that in our climate camp-life in some shape can be readily had, but also what are its joys and what its peculiar advantages.2 My inclination to write anew on this subject is made stronger by two illustrations which recur to my mind, and which show how valuable may be an entire out- door life, and how free from risks even for the invalid. The lessons of the great war were not lost upon some of us, who remember the ease with which recoveries were made in tents, but single cases convince more than any statement of these large and generalized re- membrances.
1 See "Camp Cure," page 167.— Editor.
2 "Nurse and Patient," and "Camp Cure," by S. Weir Mitchell. J. B. Lippincott Company, Philadelphia.
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I knew a sick and very nervous woman who had failed in many hands to regain health of mind. I had been able to restore to her all she needed in the way of blood and tissue, but she remained, as before, al- most helplessly nervous. Wealth made all resources easy, and yet I had been unable to help her. At last I said to her, " If you were a man I think I could cure you." I then told her how in that case I wrould ask a man to live. " I will do anything you desire," she said, and this was what she did. With an intel- ligent companion, she secured two well-known, trusty guides, and pitched her camp by the lonely waters of a Western lake in May, as soon as the weather al- lowed of the venture. With two good wall-tents for sleeping- and sitting-rooms, with a log hut for her men a hundred yards away and connected by a wire telephone, she began to make her experiment. A little stove wrarmed her sitting-room at need, and once a fortnight a man went to the nearest town and brought her books. Letters she avoided, and her family agreed to notify her at once of any real occasion for her presence. Even newspapers were shut out, and thus she began her new life. Her men shot birds and deer, and the lake gave her black bass, and with these and well-chosen canned vegetables and other stores she did well enough as to food. The changing seasons brought her strange varieties of flowers, and she and her friend took industriously to botany, and puzzled out their problems unaided save by books. Very soon rowing,
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Out- do or Life
fishing, and, at last, shooting were added to her re- sources. Before August came she could walk for miles with a light gun, and could stand for hours in wait for a deer. Then she learned to swim, and found also refined pleasure in what I call word- sketching, as to which I shall by and by speak. Pho- tography was a further gain, taken up at my sug- gestion. In a word, she led a man's life until the snow fell in the fall and she came back to report, a thoroughly well woman.
A more notable case was that of a New England lady, who was sentenced to die of consumption by at least two competent physicians. Her husband, himself a doctor, made for her exactly the same effort at relief which was made in the case I have detailed, except that when snow fell he had built a warm log cabin, and actually spent the winter in the woods, teaching her to live out in the air and to wralk on snow-shoes. She has survived at least one of her doctors, and is, I believe, to this day a wholesome and vigorous wife and mother.
What large wealth did to help in these two cases may be managed with much smaller means. All through the White Mountains, in summer, you may see people, a whole family often, with a wagon, going from place to place, pitching their tents, eating at farm-houses or hotels, or managing to cook at less cost the food they buy. Our sea-coast presents like chances. With a good tent or two, which costs little,
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you may go to unoccupied beaches, or by inlet or creek, and live for little. I very often counsel young people to hire a safe open or decked boat, and, with a good tent, to live in the sounds along the Jersey coast, going hither and thither, and camping where it is pleasant, for, with our easy freedom as to land, none object When once a woman — and I speak now of the healthy — has faced and overcome her dread of sun and mosquitoes, the life becomes delightful. The Adirondacks, the Alleghanies, and the Virginia moun- tains afford like chances, for which, as these are in a measure remote, there must be a somewhat more costly organization. I knew well a physician who every summer deserted his house and pitched tents on an island not over three miles from home, and there spent the summer with his family, so that there are many ways of doing the same thing.
As to the question of expense, there is no need to say much. All over our sparsely-inhabited land places wild enough are within easy reach, and the journey to reach them need not be long. Beyond this, tent- life is, of course, less costly than the hotel or boarding- house, in which such numbers of people swelter through their summers. As to food, it is often need- ful to be within reach of farm-houses or hotels, and all kind of modifications of the life I advise are pos- sible.
As to inconveniences, they are, of course, many, but, with a little ingenuity, it is easy to make tent-life
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comfortable, and none need dread them. Any book on camp-life will tell how to meet or avoid them, and to such treatises I beg to refer the reader who wishes to experiment on this delightful mode of gypsying.
The class of persons who find it easy to reach the most charming sites and to secure the help of compe- tent guides is, as I have said in another place, in- creasing rapidly. The desire also for such a life is also healthfully growing, so that this peculiarly Ameri- can mode of getting an outing is becoming more and more familiar. It leads to our young folks indulging in all sorts of strengthening pursuits. It takes them away from less profitable places, and the good it does need not be confined to the boys. Young women may swim, fish, and row like their brothers, but the life has gains and possibilities, as to which I would like to say something more. In a well-ordered camp you may be sure of good food and fair cooking. To sleep and live in the air is an insurance against what we call taking cold. Where nature makes the atmospheric changes, they are always more gradual and kindly than those we make at any season when we go from street to house or house to street.
My brothers during the war always got colds when at home on leave^ and those who sleep in a chinky cabin or tent soon find that they do not suffer and that they have an increasing desire for air and openness.
To live out of doors seems to be a little matter in the way of change, and that it should have remark-
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able moral and intellectual values does not appear credible to such as have not had this experience.
Yet, in fact, nothing so dismisses the host of little nervousnesses with which house-caged women suffer as this free life. Cares, frets, worries, and social annoy- ances disappear, and in the woods and by the waters we lose, as if they were charmed away, our dislikes or jealousies, all the base, little results of the struggle for bread or place. At home, in cities, they seem so large; here, in the gentle company of constant sky and lake and stream, they seem trivial, and we cast them away as easily as we throw aside some piece of worn- out and useless raiment.
The man who lives out of doors awhile acquires better sense of moral proportions, and thinks patiently and not under stress, making tranquil companions of his worthy thoughts. This is a great thing, not to be hurried. There seems to me always more time out of doors than in houses, and if you have intellectual problems to settle, the cool quiet of the woods or the lounging comfort of the canoe, or to be out under " the huge and thoughtful night," has many times seemed to me helpful. One gets near realities out of doors. Thought is more sober; one becomes a better friend to one's self.
As to the effect of out-door life on the imaginative side of us, much may be said. Certainly some books get fresh flavors out of doors, and you see men or women greedily turn to reading and talking over verse
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who never dream of it when at home. I am tempted to mention the poets, and even the other authors who gain a kindly rubric for their work from the gentle company of lake and wood and stream. I should frankly name Walt Whitman and Thoreau, and pause pretty soon in wonder at the small number of poets who suggest out-door life as their source of inspira- tion. A good many of them — read as you lie in a birch canoe or seated on a stump in the woods — shrink to well-bred, comfortable parlor bards, who seem to you to have gotten their nature-lessons through plate-glass windows. The test is a sharp one, and will leave out some great names and let in some hardly known, or almost forgotten. Books to be read out of doors would make a curious catalogue, and would vary, as such lists must, with every thoughtful reader, while some would smile, perhaps with reason; at the idea of any such classification. Certainly all would name Wordsworth, and a few would add Clough, whilst the out-door plays of Shakespeare would come in, and we should soon be called on to feel that for this sort of congenial open- air poetic company wTe have still to fall back on the vast resources of English verse. Somehow, as yet, our own poets have not gotten fully into imaginative re- lation with what is peculiar in our own flowers, trees, and skies. This does not lessen our joy in the masters of English verse, because, of course, much of what they have sung has liberal application in all lands : yet is there something which we lose in them for lack of
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familiar knowledge of English lanes and woods, of English flowers and trees. A book of the essentially- American nature — poems found here and there in many volumes — would be pleasant, for surely we have had no one poet as to whom it is felt that he is absolutely desirable as the interpretive poetic observer who has positive claims to go with us as a friendly bookmate in our wood or water wanderings. I have shrunk, as will have been seen, from the dangerous venture of en- larging my brief catalogue. What I have just now spoken of as one's bookmates will appear in very dif- ferent lights according to the surroundings in which we seek to enjoy their society. If, as to this matter, any one doubts me, and has the good luck to camp out long, and to have a variety of books of verse and prose, very soon, if dainty of taste, he will find that the artificial flavoring of some books is unpleasantly felt; but, after all, one does not read very much when living thus outside of houses. Books are then, of course, well to have, but rather as giving one texts for thoughts and talk than as preachers, counsellors, jesters, or friends.
In my own wood-life or canoe journeys I used to wonder how little I read or cared to read. One has nowadays many resources. If you sketch, no matter how badly, it teaches and even exacts that close ob- servation of nature which brings in its train much that is to be desired. Photography is a means of record, now so cheaply available as to be at the disposal of
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all, and there is a great charm of a winter evening in turning over sketch or photograph to recall anew the pleasant summer days. Beyond all this, there is botany. I knew a lady who combined it happily and ingeniously with photography, and so preserved pic- tures of plants in their flowTering state. When you are out under starry skies with breadth of heaven in view, astronomy with an opera-glass — and Galileo's telescope was no better — is an agreeable temptation which the cheap and neat charts of the skies now to be readily obtained make very interesting.
I should advise any young woman, indeed, any one who has the good chance to live a camp-life, or to be much in the country, to keep a diary, not of events but of things. I find myself that I go back to my old note-books with increasing pleasure.
To make this resource available something more than the will to do it is necessary. Take any nice young girl, who is reasonably educated, afloat in your canoe with you, and ask her what she sees. As a rule she has a general sense that yonder yellow bank, tree-crowned above the rippled water, is pleasant. The sky is blue, the sun falling behind you. She says it is beautiful and has a vague sense of enjoyment, and will carry away with her little more than this. Point out to her that the trees above are some of them deciduous pop- lars, or maples, and others sombre groups of pines and silky tamarack with a wonder of delicate tracery. Show her that the sun against the sloped yellow bank
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has covered the water with a shining changeful orange light, through which gleam the mottled stones below, and that the concave curve of every wave which faces us concentrates for the eye an unearthly sapphire the reflex of the darkening blue above us. Or a storm is on us at the same place. She is fearless as to the ducking from which even her waterproof will hardly protect. The clouds gather, the mists trail on the hills, ragged mosses on the trees hang in wet festoons of gray, and look in the misty distance like number- less cascades. It rains at last, a solid down-pour; certain tree-trunks grow black, and the shining beech and birch and poplar get a more vivid silver on their wet boles. The water is black like ink. It is no longer even translucent, and overhead the red scourges of the lightning fly, and the great thunder-roar of smitten clouds rolls over us from hill to hill.
All these details you teach her and more, and paddle home with a mental cargo of fresh joys and delicious memories. My young friend is intelligent and clever, but she has never learned to observe. If she wants to know how, there is a book will help her. Let her take with her Ruskin's " Modern Painters/' It will teach her much, not all. Nor do I know of any other volume which will tell her more.1 Despite its faults, it has so many lessons in the modes of minute
1 "Frondes Agrestes," Ruskin, is a more handy book than "Modern Painters," but is only selections from the greater volumes recommended. "Deucalion" is yet harder reading, but will repay the careful reader.
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study of outside nature that it becomes a valuable friend. Although ostensibly written to aid artistic criti- cism, it does far more than this and yet not all. Other books which might seem desirable are less so because they are still more distinctly meant to teach or assist artists or amateurs. What is yet wanted is a little treatise on the methods of observing exterior nature. Above all it should be adapted to our own woods, skies, and waters. What to look for as a matter of pleasure, and how to see and record it, is a thing apart from such observation as leads to classification, and is scientific in its aims. It is somewhat remote also from the artist's study, which is a more complex business, and tends to learn what can be rendered by pencil or brush and what cannot. Its object at first is merely to give intelligent joy to the senses, to cultivate them into acuteness, and to impress on the mind such records as they ought to give us at their best.
Presuming the pupil to be like myself, powerless to use the pencil, she is to learn how to put on paper in words what she sees. The result will be what I may call word-sketches. Observe these are not to be for other eyes. They make her diary of things seen and worthy of note. Neither are they to be efforts to give elaborate descriptions. In the hands of a mas- ter, such use of words makes a picture in which often he sacrifices something, as the artist does, to get something else, and strives chiefly to leave on the mind one dominant emotion just as did the scene thus por-
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trayed. A few words may do this or it may be an elaborate work. The gift is a rare and great one. The word-paintings of Ruskin hang forever in one's mental gallery, strong, true, poetical, and capable of stirring you as the scenes described would have done, nay, even more, for a great word-master has stood interpretative between you and nature.
Miss Bronte was mistress of this art. Blackmore has it also. In some writers it is so lightly managed as to approach the sketch, and is more suggestive than fully descriptive. To see what I mean read the first few chapters of " Miss Angel," by Anna Thackeray. But a sketch by a trained and poetical observer is one thing; a sketch by a less gifted person is quite an- other. My pupil must be content with the simplest, most honest, unadorned record of things seen. Her training must look to this only.
What she should first seek to do is to be methodi- cal and accurate and by and by fuller. If wise she will first limit herself to small scenes, and try to get notes of them somewhat in this fashion. She is, we suppose, on the bank of a stream. Her notes run as follows :
Date, time of day, place. Hills to either side and their character; a guess at their height; a river be- low, swift, broken, or placid; the place of the sun, behind, in front, or overhead. Then the nature of the trees and how the light falls on them or in them, ac- cording to their kind. Next come color of wave and
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bank and sky, with questions as to water-tints and their causes. Last of all, and here she must be simple and natural, what mood of mind does it all bring to her, for every landscape has its capacity to leave you with some general sense of its awe, its beauty, its sad- ness, or its joy fulness.
Try this place again at some other hour, or in a storm, or under early morning light, and make like notes. If she should go on at this pleasant work, and one day return to the same spot, she will wonder how much more she has now learned to see.
Trees she will find an enchanting study. Let her take a group of them and endeavor to say on paper what makes each species so peculiar. The form, color, and expression of the boles are to be noted. A reader may smile at the phrase " expression/' but look at a tattered old birch, or a silvery young beech-bole, " modest and maidenly, clean of limb/' or a lightning- scarred pine. Tree-study has advantages because it is always within reach. The axe has been so ruth- lessly wielded that you must go far into the woods to get the best specimens of the pine, and the forests about our Maine lakes and in the Adirondacks have been sadly despoiled of their aristocrats. To see trees at their savage best one must go South, and seek the white- oaks of Carolina, the cypress of Florida, but the parks of Philadelphia and Baltimore afford splendid studies, and so also do the mountains of Virginia. Private taste and enterprise is saving already much that will
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be a joy to our children. A noble instance is the great wild park with which Colonel Parsons has protected the Natural Bridge in Virginia. I saw there an arbor- vitae said by botanists to be not less than nine hundred years old, a chestnut twenty-six feet in girth at the height of my shoulders, and oaks past praise. But trees are everywhere, and if my observant pupil likes them, let her next note the mode in which the branches spread and their proportion to the trunk. State it all in the fewest words. It is to be only a help to mem- ory. Then she comes to the leaf forms and the mode in which they are massed, their dulness or translucency, how sunshine affects their brilliancy, as it is above or falls laterally at morn or eve. Perhaps she will note, too, on which the gray moss grows, and just in what forms, and how the mosses or lichens gather on the north side of trees and on what trees.
I may help my pupil if, like an artist teacher, I give one or two illustrations, copied verbatim from my note-books. The first was written next morn- ing, as it is a brief record of a night scene.
Time, July 21, 1887, 9 p.m. Ristigouche River, New Brunswick, Canada. Black darkness. Hill out- lines nearly lost in sky. River black, with flashing bits of white rapid; banks have grayish rocks, and so seem to be nearer than the dark stream limits. Sky looks level with hill-tops. Water seems to come up close. Effect of being in a concave valley of water, and all things draw in on me. Sense of awe. Camp-
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fire's red glare on water. Sudden opening lift of sky. Hills recede. Water-level falls. This is a barren, un- adorned sketch, but it seems to tell the thing.
Or this, for a change. Newport. A beach. Time, August i, 1887; 4 p.m. About me cleft rocks, cleav- age straight through the embedded pebbles. Tones ruddy browns and grays. Gray beach. Sea-weed in heaps, deep pinks and purples. Boisterous waves, loaded with reddish sea-weed, blue, with white crests, torn off in long ribbons by wind. Curious reds and blues as waves break, carrying sea-weed. Fierce gale off land. Dense fog, sun above it and to right. Every- where yellow light. Sea strange dingy yellow. Leaves an unnatural green. Effect weird. Sense of unusual- ness. 1.
Of course, such study of nature leads the intelligent to desire to know why the cleaved rock shows its sharp divisions as if cut by a knife, why yellow light gives such strangeness of tints, and thus draws on my pupil to larger explanatory studies. So much the better.
If when she bends over a foot-square area of moul- dered tree-trunk, deep in the silence of a Maine wood, she has a craving to know the names and ways of the dozen mosses she notes, of the minute palm-like growths, of the odd toadstools, it will not lessen the joy this liliputian representation of a tropical jungle gives to her. Nor will she like less the splendor of sunset tints on water to know the secrets of the pleasant tricks of refraction and reflection.
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I do not want to make too much of a small matter. No doubt many people do this kind of thing, but in most volumes of travel it is easy to see that the de- scriptions lack method, and show such want of train- ing in observation as would not be noticeable had their authors gone through the modest studies I am now in- viting my pupil to make.
Her temptation will be to note most the large, the grotesque, or the startling aspects of nature. In time these will be desirable as studies, but at first she must try smaller and limited sketches. They are as difficult, but do not change as do the grander scenes and ob- jects. I knew a sick girl, who, bedfast for years, used to amuse herself with what her windows and an opera- glass commanded in the way of sky and foliage. The buds in spring-time, especially the horse-chestnuts, were the subject of quite curious notes, and cloud- forms an endless source of joy and puzzle to describe. One summer a great effort was made, and she was taken to the country, and a day or two later carried down near a brook, where they swung her hammock. I found her quite busy a week later, and happy in having discovered that the wave-curves over a rock were like the curves of some shells. My pupil will soon learn, as she did, that a good opera-glass is in- dispensable. Let any one who has not tried it look with such a glass at sunset-decked water in motion. I am sure they will be startled by its beauty, and this especially if the surface be seen from a boat, because
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merely to look down on water is to make no ac- quaintance with its loveliness. A scroll of paper to limit the view and cut out side-lights also intensifies color.
The materials my pupil is to use are words, and words only. Constant dissatisfaction with the little they can tell us is the fate of all who use them. The sketcher, the great word-painter, and even the poet feels this when, like Browning, he seems so to suffer from their weakness as to be troubled into audacious employment of the words that will not obey his will, torment them as he may. Yet, as my pupil goes on, she will find her vocabulary growing, and will become more and more accurate in her use and more ingenious in her combination of words to give her meaning. As she learns to feel strongly — for she will in time — her love will give her increasing power both to see and to state what she sees, because this gentle passion for nature in all her moods is like a true-love affair, and grows by what it feeds upon.
When we come to sketch in words the rare and weird effects, the storm, the sunsets that seem not of earth, the cascade, or the ravage of the " windfall/' it is wise not to be lured into fanciful word-painting, and the temptation is large. Yet the simplest ex- pression of facts is then and for such rare occasions the best, and often by far the most forceful.
I venture, yet again, to give from a note-book of last year a few lines as to a sunset. I was on a steam-
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yacht awaiting the yachts which were racing for the Newport cup.
August 6, time, sunset ; level sea ; light breeze ; fire- red sun on horizon; vast masses of intensely-lighted scarlet clouds; a broad track of fiery red on water; three yachts, with all sail set, coming over this sea of red towards us. Their sails are a vivid green. The vast mass of reds and scarlets give one a strange sense of terror as if something would happen. I could go on to expand upon " this color such as shall be in heaven, ,? and on the sails which seemed to be green, but for the purpose of a sketch and to refresh the traitor memory in the future, the lines I wrote are enough and are yet baldly simple.
Out of this practice grow, as I have said, love of accuracy, larger insights, careful valuation of words, and also an increasing and more intelligent love of art in all its forms; nor will all these gains in the power to observe be without practical value in life.
I trust that I have said enough to tempt others to try each in their way to do what has been for me since boyhood a constant summer amusement.
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Part II
WEAR AND TEAR
NURSE AND PATIENT
CAMP CURE
BY S. WEIR MITCHELL, M.D.
Acknowledgment
We beg to tender grateful acknowledgment to author and publisher for the use, in Part II, of essays from " Nurse and Patient " and " Wear and Tear," by S. Weir Mitchell, copyright, 1877 and 1887, by J. B. Lippincott & Company.
CHAPTER I
WEAR AND TEAR,
or Hints for the Overworked
Many years ago 1 I found occasion to set before the readers of Lippincott's Magazine certain thoughts concerning work in America, and its results. Some- what to my surprise, the article attracted more notice than usually falls to the share of such papers, and since then, from numerous sources, I have had the pleasure to learn that my words of warning have been of good service to many thoughtless sinners against the laws of labor and of rest. I have found, also, that the views then set forth as to the peculiar difficulties of mental and physical work in this country are in strict accord- ance with the personal experience of foreign scholars who have cast their lots among us ; while some of our best teachers have thanked me for stating, from a doc- tor's standpoint, the evils which their own experience had taught them to see in our present mode of tasking the brains of the younger girls.
I hope, therefore, that I am justified in the belief
1 In 1871.
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that in its new and larger form my little tract may again claim attention from such as need its lessons. Since it was meant only for these, I need not excuse myself to physicians for its simplicity; while I trust that certain of my brethren may find in it enough of original thought to justify its reappearance, as its sta- tistics were taken from manuscript notes and have been printed in no scientific journal.
I have called these Hints Wear and Tear, because this title clearly and briefly points out my meaning. Wear is a natural and legitimate result of lawful use, and is what we all have to put up with as the result of years of activity of brain and body. Tear is another matter: it comes of hard or evil usage of body or engine, of putting things to wrong purposes, using a chisel for a screw-driver, a penknife for a gimlet. Long strain, or the sudden demand of strength from weakness, causes tear. Wear comes of use; tear of abuse.
i The sermon of which these words are the text has been preached many times in many ways to congrega- tions for whom the Dollar Devil had always a more winning eloquence. Like many another man who has talked wearily to his fellows with an honest sense of what they truly need, I feel how vain it is to hope for many earnest listeners. Yet here and there may be men and women, ignorantly sinning against the laws by which they should live or should guide the lives of others, who will perhaps be willing to heed what one
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unbiased thinker has to say in regard to the dangers of the way they are treading with so little knowledge as to where it is leading.
The man who lives an outdoor life, who sleeps with the stars visible above him, who wins his bodily subsistence at first-hand from the earth and waters, is a being who defies rain and sun, has a strange sense of elastic strength, may drink if he likes, and may smoke all day long, and feel none the worse for it. Some such return to the earth for the means of life is what gives vigor and developing power to the colon- ist of an older race cast on a land like ours. A few generations of men living in such fashion store up a capital of vitality which accounts largely for the prodi- gal activity displayed by their descendants, and made possible only by the sturdy contest with Nature which their ancestors have waged. That such a life is still led by multitudes of our countrymen is what alone serves to keep up our pristine force and energy. Are we not merely using the interest on these accumula- tions of power, but also wastefully spending the capi- tal ? From a few we have grown to millions, and al- ready in many wrays the people of the Atlantic coast present the peculiarities of an old nation. Have we lived too fast? The settlers here, as elsewhere, had ample room, and lived sturdily by their own hands, little troubled for the most part with those intense com- petitions which make it hard to live nowadays and em- bitter the daily bread of life. Neither had they the
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thousand intricate problems to solve which perplex those who struggle to-day in our teeming city hives. Above all, educational wants were limited in kind and in degree, and the physical man and woman were what the growing state most needed.
How much and what kind of good came of the gradual change in all these matters we well enough know. That in one and another way the cruel compe- tition for the dollar, the new and exacting habits of business, the racing speed which the telegraph and railway have introduced into commercial life, the new value which great fortunes have come to possess as means toward social advancement, and the overeduca- tion and overstraining of our young people, have brought about some great and growing evils, is what is now beginning to be distinctly felt. I should like, therefore, at the risk of being tedious, to reexamine this question — to see if it be true that the nervous sys- tem of certain classes of Americans is being sorely overtaxed — and to ascertain how much our habits, our modes of work, and, haply, climatic peculiarities, may have to do with this state of things. But before ven- turing anew upon a subject which may possibly excite controversy and indignant comment, let me premise that I am talking chiefly of the crowded portions of our country, of our great towns, and especially of their upper classes, and am dealing with those higher ques- tions of mental hygiene of which in general we hear but too little. If the strictures I have to make applied
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as fully throughout the land — to Oregon as to New England, to the farmer as to the business man, to the women of the artisan class as to those socially above them — then indeed I should cry, God help us and those that are to come after us ! Owing to causes which are obvious enough, the physical worker is being better and better paid and less and less hardly tasked, while just the reverse obtains in increasing ratios for those who live by the lower form of brain work ; so that the bribe to use the hand is growing daily, and pure me- chanical labor, as opposed to that of the clerk, is being " leveled upward " with fortunate celerity.
Before attempting to indicate certain ways in which we as a people are overtaxing and misusing the organs of thought, I should be glad to have the privilege of explaining the terms which it is necessary to use, and of pointing out some of the conditions under which mental labor is performed.
The human body carries on several kinds of manu- facture, two of which — the evolution of muscular force or motion, and intellection with all moral activities — alone concern us here. We are somewhat apt to an- tagonize these two sets of functions, and to look upon the latter, or brain labor, as alone involving the use or abuse of the nervous system. But every blow on the anvil is as distinctly an act of the nerve centers as are the highest mental processes. If this be so, how or why is it that excessive muscular exertion — I mean such as is violent and continued — does not cause the
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same appalling effects as may be occasioned by a like abuse of the nerve-organs in mental actions of various kinds? This is not an invariable rule, for, as I may point out in the way of illustration hereafter, the centers which originate or evolve muscular power do sometimes suffer from undue taxation; but it is cer- tainly true that when this happens, the evil result is rarely as severe or as lasting as wThen it is the organs of mental power that have suffered.
In either form of work, physical or mental, the will acts to start the needed processes, and afterwards is chiefly regulative. In the case of bodily labor, the spinal nerve centers are most largely called into action. Where mental or moral processes are involved, the active organs lie within the cranium. As I said just now, when we talk of an overtaxed nervous system it is usually the brain we refer to, and not the spine; and the question therefore arises, Why is it that an excess of physical labor is better borne than a like ex- cess of mental labor ? The simple answer is, that men- tal overwork is harder because as a rule it is closet or counting room or at least indoor work — sedentary, in a word. The man who is intensely using his brain is not collaterally employing any other organs, and the more intense his application the less locomotive does he become. On the other hand, however a man abuses his powers of motion in the way of work, he is at all events encouraging that collateral functional activity which mental labor discourages: he is quick-
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ening the heart, driving the blood through unused channels, hastening the breathing and increasing the secretions of the skin- — all excellent results, and, even if excessive, better than a too incomplete use of these functions.
But there is more than this in the question. We do not know as yet what is the cost in expended ma- terial of mental acts as compared with motor manifes- tations, and here, therefore, are at fault; because, al- though it seems so much slighter a thing to think a little than to hit out with the power of an athlete, it may prove that the expenditure of nerve material is in the former case greater than in the latter.
When a man uses his muscles, after a time comes the feeling called fatigue — a sensation always referred to the muscles, and due most probably to the deposit in the tissues of certain substances formed during mo- tor activity. Warned by this weariness, the man takes rest — may indeed be forced to do so; but, unless I am mistaken, he who is intensely using the brain does not feel in the common use of it any sensation refer- able to the organ itself which warns him that he has taxed it enough. It is apt, like a well-bred creature, to get into a sort of exalted state under the stimulus of need, so that its owner feels amazed at the ease of its processes and at the sense of zvidc-azvakefiilncss and power that accompanies them. It is only after very long misuse that the brain begins to have means of saying, " I have done enough; " and at this
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stage the warning comes too often in the shape of some one of the many symptoms which indicate that the organ is already talking with the tongue of disease.
I do not know how these views will be generally received, but I am sure that the personal experience of many scholars will decide them to be correct; and they serve to make clear why it is that men may not know they are abusing the organ of thought until it is already suffering deeply, and also wherefore the mind may not be as ruthlessly overworked as the legs or arms.
Whenever I have closely questioned patients or men of studious habits as to this matter, I have found that most of them, when in health, recognized no such thing as fatigue in mental action, or else I learned that what they took for this was merely that physical sense of being tired which arises from prolonged writ- ing or constrained positions. The more, I fancy, any healthy student reflects on this matter the more clearly will he recognize this fact, that very often when his brain is at its clearest, he pauses only because his back is weary, his eyes aching, or his fingers tired.
This most important question, as to how a man shall know when he has sufficiently tasked his brain, demands a longer answer than I can give it here ; and, unfortunately, there is no popular book since Ray's clever and useful " Mental Hygiene," and Feuchtersle- ben's " Dietetics of the Soul," both out of print, which
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deals in a readable fashion with this or kindred topics.1 Many men are warned by some sense of want of clear- ness or ease in their intellectual processes. Others are checked by a feeling of surfeit or disgust, which they obey or not as they are wise or unwise. Here, for example, is in substance the evidence of a very atten- tive student of his own mental mechanism, whom we have to thank for many charming products of his brain. Like most scholars, he can scarcely say that he ever has a sense of " brain tire," because cold hands and feet and a certain restlessness of the muscular sys- tem drive him to take exercise. Especially when work- ing at night, he gets after a time a sense of disgust at the work he is doing. " But sometimes/' he adds, " my brain gets going, and is to be stopped by none of the common plans of counting, repeating French verbs,, or the like/' A well-known poet describes to me the curious condition of excitement into which his brain is cast by the act of composing verse, and thinks that the happy accomplishment of his task is followed by a feeling of relief, which shows that there has been high tension.
One of our ablest medical scholars reports him- self to me as having never been aware of any sensation
1 See, now, "Brain-Work and Overwork," by H. C. Wood, M.D.; also, 4t Mental Overwork and Premature Disease among Public and Professional Men," by Ch. K. Mills, M.D. ; also, "Overwork and Sani- tation in Public Schools, with Remarks on the Production of Nervous Disease and Insanity," by Ch. K. Mills, M.D., Annals of Hygiene, September, 1886.
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in the head, by which he could tell that he had worked enough, up to a late period of his college career, when, having overtaxed his brain, he was restricted by his advisers to two or three hours of daily study. He thus learned to study hard, and ever since has been ac- customed to execute all mental tasks at high pressure under intense strain and among the cares of a great practice. All his mind work is, however, forced labor, and it always results in a distinct sense of cerebral fatigue — a feeling of pressure, which is eased by clasp- ing his hands over his head ; and also there is desire to lie down and rest.
" I am not aware/' writes a physician of distinc- tion, " that, until a few years ago, I ever felt any sense of fatigue from brain work which I could refer to the organ employed. The longer I worked the clearer and easier my mental processes seemed to be, until, during a time of great sorrow and anxiety, I pushed my think- ing organs rather too hard. As a result, I began to have headache after every period of intellectual exer- tion. Then I lost power to sleep. Although I have partially recovered, I am now always warned when I have done enough, by lessening ease in my work, and by a sense of fullness and tension in the head." The indications of brain tire, therefore, differ in different people, and are more and more apt to be referred to the thinking organ as it departs more and more from a condition of health. Surely a fuller record of the con- ditions under which men of note are using their
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mental machinery would be everyway worthy of atten- tion.
Another reason why too prolonged use of the brain is so mischievous is seen in a peculiarity, which is of itself a proof of the auto-activity of the vital acts of the various organs concerned in intellection. We sternly concentrate attention on our task, whatever it be ; we do this too long, or under circumstances which make labor difficult, such as during digestion or when weighted by anxiety. At last we stop and propose to find rest in bed. Not so, says the ill-used brain, now morbidly wide awake; and whether we will or not, the mind keeps turning over and over the work of the day, the business or legal problem, or mumbling, so to speak, some wearisome question in a fashion made use- less by the denial of full attention. Or else the imag- ination soars away with the unrestful energy of a demon, conjuring up an endless procession of broken images and disconnected thoughts, so that sleep is utterly banished.
I have chosen here as examples men whose brains are engaged constantly in the higher forms of mental labor; but the difficulty of arresting at will the over- tasked brain belongs more or less to every man who overuses this organ, and is the well-known initial symp- tom of numerous morbid states. I have instanced scholars and men of science chiefly, because they, more than others, are apt to study the conditions under which their thinking organs prosper or falter in their work,
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and because from them have we had the clearest accounts of this embarrassing condition of automatic activity of the cerebral organs. Few thinkers have failed, I fancy, to suffer in this way at some time, and with many the annoyance is only too common. I do not think the subject has received the attention it de- serves, even from such thorough believers in uncon- scious cerebration as Maudsley. As this state of brain is fatal to sleep, and therefore to needful repose of brain, every sufferer has a remedy which he finds more or less available. This usually consists in some form of effort to throw the thoughts off the track upon which they are moving. Almost every literary biog- raphy has some instance of this difficulty, and some hint as to the sufferer's method of freeing his brain from the despotism of a ruling idea or a chain of thought.
Many years ago I heard Mr. Thackeray say that he was sometimes haunted, when his work was over, by the creatures he himself had summoned into being, and that it was a good corrective to turn over the pages of a dictionary. Sir Walter Scott is said to have been troubled in a similar way. A great lawyer, whom I questioned lately as to this matter, told me that his cure was a chapter or two of a novel, with a cold bath be- fore going to bed ; for, said he quaintly, " You never take out of a cold bath the thoughts you take into it." It would be easy to multiply such examples.
Looking broadly at the question of the influence of
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excessive and prolonged use of the brain upon the health of the nervous system, we learn, first, that cases of cerebral exhaustion in people who live wisely are rare. Eat regularly and exercise freely, and there is scarce a limit to the work you may get out of the think- ing organs. But if into the life of a man whose pow- ers are fully taxed we bring the elements of great anxiety or worry, or excessive haste, the whole ma- chinery begins at once to work, as it were, with a dan- gerous amount of friction. Add to this such constant fatigue of body, as some forms of business bring about, and you have all the means needed to ruin the man's power of useful labor.
I have been careful here to state that combined overwork of mind and body is doubly mischievous, be- cause nothing is now more sure in hygienic science than that a proper alternation of physical and mental labor is best fitted to insure a lifetime of wholesome and vigorous intellectual exertion. This is probably due to several causes, but principally to the fact that during active exertion of the body the brain cannot be em- ployed intensely, and therefore has secured to it a state of repose which even sleep is not always competent to supply. There is a Turkish proverb which occurs to me here, like most proverbs more or less true : " Dreaming goes afoot, but who can think on horse- back? " Perhaps, too, there is concerned a physiolog- ical law, which, though somewhat mysterious, I may again have to summon to my aid in the way of ex-
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planation. It is known as the law of Treviranus, its discoverer, and may thus be briefly stated : Each organ is to every other as an excreting organ. In other words, to insure perfect health, every tissue, bone, nerve, tendon, or muscle should take from the blood certain materials and return to it certain others. To do this every organ must or ought to have its period of activity and of rest, so as to keep the vital fluid in a proper state to nourish every other part. This process in perfect health is a system of mutual assurance, and is probably essential to a condition of entire vigor of both mind and body.
It has long been believed that maladies of the nerv- ous system are increasing rapidly in the more crowded portions of the United States ; but I am not aware that anyone has studied the death records to make sure of the accuracy of this opinion. There can be no doubt, I think, that the palsy of children becomes more fre- quent in cities just in proportion to their growth in population. I mention it here because, as it is a disease which does not kill but only cripples, it has no place in the mortuary tables. Neuralgia is another malady which has no record there, but is, I suspect, increasing at a rapid rate wherever our people are crowded to- gether in towns. Perhaps no other form of sickness is so sure an indication of the development of the nervous temperament, or that condition in which there are both feebleness and irritability of the nervous sys- tem. But the most unquestionable proof of the in-
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crease of nervous disease is to be looked for in the death statistics of cities.
There, if anywhere, we shall find evidence of the fact, because there we find in exaggerated shapes all the evils I have been defining. The best mode of test- ing the matter is to take the statistics of some large city which has grown from a country town to a vast business hive within a very few years. Chicago ful- fills these conditions precisely. In 1852 it numbered 49,407 souls. At the close of 1868 it had reached to 252,054. Within these years it has become the keenest and most wide-awxake business center in America. I owe to the kindness of Dr. J. H. Rauch, Sanitary Su- perintendent of Chicago, manuscript records, hitherto unpublished, of its deaths from nervous disease, as well as the statement of each year's total mortality; so that I have it in my power to show the increase of deaths from nerve disorders relatively to the annual loss of life from all causes. I possess similar details as to Philadelphia, which seem to admit of the same con- clusions as those drawn from the figures I have used. But here the evil has increased more slowly. Let us see what story these figures will tell us for the Western city. Unluckily, they are rather dry tale-tellers.
The honest use of the mortuary statistics of a large town is no easy matter, and I must th :refore ask that I may be supposed to have taken eve y possible precaution in order not to exaggerate the reality of a great evil. Certain diseases, such as apoplexy, palsy,
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epilepsy, St. Vitus's dance, and lockjaw or tetanus, we all agree to consider as nervous maladies; convul- sions, and the vast number of cases known in the death lists as dropsy of the brain, effusion on the brain, etc., are to be looked upon with more doubt. The former, as every doctor knows, are, in a vast proportion of instances, due to direct disease of the nerve centers; or, if not to this, then to such a condition of irritability of these parts as makes them too ready to originate spasms in response to causes which disturb the extrem- ities of the nerves, such as teething and the like. This tendency seems to be fostered by the air and habits of great towns, and by all of the agencies which in these places depress the health of a community. The other class of diseases, as dropsy of the brain or effusion, probably includes a number of maladies, due some of them to scrofula, and to the predisposing causes of that disease; others, to the kind of influences which seem to favor convulsive disorders. Less surely than the former class can these be looked upon as true nervous diseases; so that in speaking of them I am careful to make separate mention of their increase, while thinking it right on the whole to include in the general summary of this growth of nerve disorders this partially doubtful class.
Taking the years 1852 to 1868, inclusive, it will be found tha. the population of Chicago has increased 5.1 times and the deaths from all causes 3.7 times; while the nerve deaths, including the doubtful class
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labeled in the reports as dropsy of the brain and con- vulsions, have risen to 20.4 times what they were in 1852. Thus in 1852, 1853, and 1855, leaving out the cholera year, 1854, the deaths from nerve disorders were respectively to the whole population as 1 in 1,149, 1 in 953, and 1 in 941 ; while in 1866, 1867, and 1868, they were 1 in 505, 1 in 415.7, and 1 in 287.8. Still omitting 1854, the average proportion of neural deaths to the total mortality was, in the five years beginning with 1852, 1 in 26.1. In the five latter years studied — that is, from 1864 to 1868, inclusive — the proportion was 1 nerve death to every7 9.9 of all deaths.
I have alluded above to a class of deaths included in my tables, but containing, no doubt, instances of mor- tality due to other causes than disease of the nerve organs. Thus, many which are stated to have been owing to convulsions ought to be placed to the credit of tubercular disease of the brain or to heart maladies ; but even in the practice of medicine the distinction as to cause cannot always be made ; and as a large propor- tion of this loss of life is really owing to brain affec- tions, I have thought best to include the whole class in my statement.
A glance at the individual diseases which are in- dubitably nervous is more instructive and less perplex- ing. For example, taking the extreme years, the recent increase in apoplexy is remarkable, even when we re- member that it is a malady of middle and later life, and that Chicago, a new city, is therefore entitled to a
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yearly increasing quantity of this form of death. In 1 868 the number was 8.6 times greater than in 1852. Convulsions as a death cause had in 1868 risen to 22 times as many as in the year 1852. Epilepsy, one of the most marked of all nervous maladies, is more free from the difficulties which belong to the last- mentioned class. In 1852 and 1853 there were but 2 deaths from this disease; in the next four years there were none. From 1858 to 1864, inclusive, there were in all 6 epileptic deaths ; then we have in the following years, 5, 3, 11 ; and in 1868 the number had increased to 17. Passing over palsy, which, like apoplexy, in- creases in 1868 — 8.6 times as compared with 1852, and 26 times as compared with the four years follow- ing 1852 — we come to lockjaw, an unmistakable nerve malady. Six years out of the first eleven give us no death from this painful disease; the others, up to 1864, offer, each, 1 only, and the last-mentioned year has but 2. Then the number rises to 3 each year, to 5 in 1867, and to 12 in 1868. At first sight this record of mortality from lockjaw would seem to be conclusive, yet it is perhaps, of all the maladies mentioned, the most deceptive as a means of determining the growth of neural diseases. To make this clear to the gen- eral reader he need only be told that tetanus is nearly always caused by mechanical injuries, and that the nat- ural increase of these in a place like Chicago may ac- count for a large part of the increase. Yet, taking the record as a whole, and viewing it only with a calm
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desire to get at the truth, it is not possible to avoid seeing that the growth of nerve maladies has been inordinate.
The industry and energy which have built this great city on a morass, and made it a vast center of insatiate commerce, are now at work to undermine the nervous systems of its restless and eager people,1 with what result I have here tried to point out, chiefly because it is an illustration, in the most concentrated form, of causes which are at work throughout the land.
The facts I have given establish the dispropor- tionate increase in one great city of those diseases which are largely produced by the strain on the nerv- ous system resulting from the toils and competitions of a community growing rapidly and stimulated to its utmost capacity. Probably the same rule would be found to apply to other large towns, but I have not had time to study the statistics of any of them fully; and for reasons already given, Chicago may be taken as a typical illustration.
It were interesting to-day to question the later sta- tistics of this great business-center ; to see if the answers would weaken or reenforce the conclusions drawn in 1 87 1. I have seen it anew of late with its population of 700,000 souls. It is a place to-day to excite wonder, and pity, and fear. All the tides of its life move with bustling swiftness. Nowhere else are the streets more
1 I asked two citizens of this uneasy town — on the same day — what was their business. Both replied tranquilly that they were speculators.
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full, and nowhere else are the faces so expressive of preoccupation, of anxiety, of excitement. It is mak- ing money fast and accumulating a physiological debt cf which that bitter creditor, the future, will one day demand payment.
If I have made myself understood, we are now prepared to apply some of our knowledge to the solu- tion of certain awkward questions which force them- selves daily upon the attention of every thoughtful and observant physician, and have thus opened a way to the discussion of the causes, which, as I believe, are deeply affecting the mental and physical health of working Americans. Some of these are due to the climatic con- ditions under which all work must be done in this country, some are outgrowths of our modes of labor, and some go- back to social habitudes and defective methods of early educational training.
In studying this subject, it will not answer to look only at the causes of sickness and weakness which af- fect the male sex. If the mothers of a people are sickly and weak, the sad inheritance falls upon their off- spring, and this is why I must deal first, however briefly, with the health of our girls, because it is here, as the doctor well knows, that the trouble begins. Ask any physician of your acquaintance to sum up thought- fully the young girls he knows, and to tell you how many in each score are fit to be healthy wives and mothers, or in fact to be wives and mothers at all. I have been asked this question myself very often, and
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I have heard it asked of others. The answers I am not going to give, chiefly because I should not be believed — a disagreeable position, in which I shall not delib- erately place myself. Perhaps I ought to add that the replies I have heard given by others were appalling.
Next. I ask you to note carefully the expression and figures of the young girls whom you may chance to meet in your walks, or whom you may observe at a concert or in the ballroom. You will see many very- charming faces, the like of which the world cannot match — figures somewhat too spare of flesh, and, es- pecially south of Rhode Island, a marvelous littleness of hand and foot. But look further, and especially among New England young girls : you will be struck with a certain hardness of line in form and feature which should not be seen between thirteen and eight- een, at least; and if you have an eye which rejoices in the tints of health, you will too often miss them on the cheeks we are now so daringly criticising. I do not want to do more than is needed of this ungra- cious talk : suffice it to say that multitudes of our young girls are merely pretty to look at, or not that; that their destiny is the shawl and the sofa, neu- ralgia, weak backs, and the varied forms of hysteria — that domestic demon which has produced untold dis- comfort in many a household, and, I am almost ready to say, as much unhappiness as the husband's dram. My phrase may seem outrageously strong, but only the doctor knows what one of these self-made invalids can
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do to make a household wretched. Mrs. Gradgrind isr in fiction, the only successful portrait of this type of misery, of the woman who wears out and destroys generations of nursing relatives, and who, as Wendell Holmes has said, is like a vampire, sucking slowly the blood of every healthy, helpful creature within reach of her demands.
If any reader doubts my statement as to the phys- ical failure of our city-bred women to fulfill all the natural functions of mothers, let him contrast the power of the recently imported Irish or Germans to nurse their babies a full term or longer, with that of the native women even of our mechanic classes. It is difficult to get at full statistics as to those of a higher social degree, but I suspect that not over one-half are competent to nurse their children a full year without themselves suffering gravely. I ought to add that our women, unlike ladies abroad, are usually anxious to nurse their own children, and merely cannot. The nu- merous artificial infant foods now for sale singularly prove the truth of this latter statement. Many physi- cians, with whom I have talked of this matter, believe that I do not overstate the evil ; others think that two- thirds may be found reliable as nurses ; while the rural doctors who have replied to my queries state that only from one-tenth to three-tenths of farmers' wives are unequal to this natural demand. There is indeed little doubt that the mass of our women possess that peculiar nervous organization which is associated with great
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excitability, and, unfortunately, with less physical vigor than is to be found, for example, in the sturdy English dames at whom Hawthorne sneered so bitterly. And what are the causes to which these peculiarities are to be laid ? There are many who will say that late hours, styles of dress, prolonged dancing, etc., are to be blamed; while really, with rare exception, the newer fashions have been more healthy than those they super- seded, people are better clad and better warmed than ever, and, save in rare cases, late hours and overexer- tion in the dance are utterly incapable of alone explain- ing the mischief. I am far more inclined to believe that climatic peculiarities have formed the groundwork of the evil, and enabled every injurious agency to pro- duce an effect wThich would not in some other countries be so severe. I am quite persuaded, indeed, that the development of a nervous temperament, with lessened, power of endurance, is one of the many race-changes which are also giving us facial, vocal, and other pe- culiarities derived from none of our ancestral stocks. If, as I believe, this change of temperament in a people coming largely from the phlegmatic races is to be seen most remarkably in the more nervous sex, it will not surprise us that it should be fostered by many causes which are fully within our own control. Given such a tendency, disease will find in it a ready prey, want of exercise will fatally increase it, and all the follies of fashion will aid in the work of ruin.
While a part of the mischief lies with climatic con-
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ditions which are utterly mysterious, the obstacles to physical exercise, arising from extremes of temper- ature, constitute at least one obvious cause of ill health among women in our country. The great heat of sum- mer, and the slush and ice of winter, interfere with women who wish to take exercise, but whose arrange- ments to go out of doors involve wonderful changes of dress and an amount of preparation appalling to the masculine creature.
The time taken for the more serious instruction of girls extends to the age of nineteen, and rarely over this. During some of these years they are undergoing such organic development as renders them remarkably sensitive. At seventeen I presume that healthy girls are nearly as well able to study, with proper precau- tions, as men; but before this time overuse, or even a very steady use, of the brain is in many dangerous to health and to every probability of future womanly use- fulness.
In most of our schools the hours are too many for both girls and boys. From nine until two is, with us, the common school time in private seminaries. The usual recess is twenty minutes or half an hour, and it is not as a rule filled by enforced exercise. In certain schools — would it were common ! — ten minutes recess is given after every hour; and in the Blind Asylum of Philadelphia this time is taken up by light gymnastics, which are obligatory. To these hours we must add the time spent in study out of school. This, for some
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reason, nearly always exceeds the time stated by teach- ers to be necessary; and most girls of our common schools and normal schools between the ages of thir- teen and seventeen thus expend two or three hours. Does any physician believe that it is good for a grow- ing girl to be so occupied seven or eight hours a day? or that it is right for her to use her brains as long a time as the mechanic employs his muscles? But this is only a part of the evil. The multiplicity of studies, the number of teachers — each eager to get the most he can out of his pupil — the severer drill of our day, and the greater intensity of application demanded, pro- duce effects on the growing brain which, in a vast num- ber of cases, can be only disastrous.
My remarks apply of course chiefly to public-school life. I am glad to say that of late, in all of our best school States, more thought is now being given to this subject; but we have much to do before an evil which is partly a school difficulty and partly a home difficulty shall have been fully provided against.
Careful reading of our Pennsylvania reports and of those of Massachusetts convinces me that while in the country schools overwork is rare, in those of the cities it is more common, and that the system of push- ing, of competitive examinations, of ranking, etc., is in a measure responsible for that worry which adds a dangerous element to work.
The following remarks as to the influence of home life in Massachusetts are not out of place here, and will
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be reinforced by what is to be said farther on by a com- petent authority as to Philadelphia :
" The danger of overwork, I believe, exists mainly, if not wholly, in graded schools, where large numbers are taught together, where there is greater competition than in ungraded schools, and where the work of each pupil cannot be so easily adjusted to his capacity and needs. And what are the facts in these schools? I am prepared to agree with a recent London School Board Report so far as to say that in some of our graded schools there are pupils who are overworked. The number in any school is, I believe, small who are stimulated beyond their strength, and the schools are few in which such extreme stimulation is encouraged. When, with a large class of children whose minds are naturally quick and active, the teacher resorts to the daily marking of recitations, to the giving of extra credits for extra work done, to ranking, and to holding up the danger of nonpromotion before the pupils ; and when, added to those extra inducements to work, there are given by committees and superintendents examina- tions for promotion at regular intervals, it would be very strange if there were not some pupils so weak and so susceptible as to be encouraged to work beyond their strength. There is another occasion of overwork which I have found in a few schools, and that is the spending of nearly all of the school time in recitation and putting off study to extra time at home. When, in a school of forty or more, pupils belong to the same
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class, and are not separated into divisions for recitation and study, there is a temptation to spend the greater part of the time in recitation which few teachers can resist; and if tasks are given, they have to be learned out of school or not at all. Pupils of grammar schools are known to feel obliged to study two or three hours daily, from this cause, at a time when the}' should be sleeping, or exercising in the open air. Frequently, however, it is not so much overwork as overworry that most affects the health of the child — that worry which may not always be traced to any fault of system or teacher, but which, it must be admitted, is too often induced by encouraging wrong motives to study.
" In making up the verdict we must not forget that others besides the teacher may be responsible for over- work and overworry. The parents and pupils them- selves are quite as often to blame as are the teachers. An unwillingness on the part of pupils to review work imperfectly done, and a desire on the part of parents to have their children get into a higher class, or to graduate, frequently cause pupils to cram for exam- inations, and to work unduly at a time when the body is least able to bear the extra strain. Again, children are frequently required to take extra lessons in music or some other study at home, thus depriving them of needed exercise and recreation, or exhausting nervous energy which is needed for their regular school work.
11 It will be observed that in this charge against parents, I do not speak of those causes of ill health
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which really have nothing to do with overwork, but which are oftentimes forgotten when a schoolboy or girl breaks down. I allude to the eating of improper and unwholesome food, to irregularity of eating and sleeping, to attendance upon parties and other places of amusement late at night, to smoking, and to the in- dulgence of other habits which tend to unduly excite the nervous system. For very obvious reasons these causes of disease are not brought prominently forward by the attending physician, who doubtless thinks it safer and more flattering to his patrons to say that the child has broken down from hard study, rather than from excesses which are somewhat discreditable. While parents are clearly to blame for endangering health in the ways indicated, it may be a question whether the work required to be done in school should not be regulated accordingly; whether, in designating the studies to be taken, and in assigning lessons, there should not be taken into consideration all the circum- stances of the pupil's life which can be conveniently ascertained, even though these circumstances are most unfavorable to school work, and are brought about mainly through the ignorance or folly of parents. Of course there is a limit to such an adjustment of work in school, but with proper caution, and a good under- standing with the parents there need be little danger of advantage being taken by an indolent child; nor need the school be affected when it is understood to be a sign of weakness rather than of favor to any par-
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ticular pupil to lessen his work. Not infrequently there are found other causes of ill health than those which I have mentioned; such, for instance, as poor ventilation, overheating of the schoolroom, draughts of cold air, and the like; not to speak of the annual public exhibition, with the possible nervous excitement attending it. All of these things are mentioned, not because they belong directly to the question of over- work, but because it is well, in considering the question, to keep in mind all possible causes of ill health, that no one cause may be unduly emphasized. " x
In private schools the same kind of thing goes on, with the addition of foreign languages, and under the dull spur of discipline, without the aid of any such ne- cessities as stimulate the pupils of what we are pleased to call a normal ( !) school.
In private schools for girls of what I may call the leisure class of society, overwork is of course much more rare than in our normal schools for girls; but the precocious claims of social life, and the indifference of parents as to hours and systematic living, needlessly add to the ever-present difficulties of the school teacher, whose control ceases when the pupil passes out of her house.
As to the school in which both sexes are educated together a word may be said. Surely no system can be worse than that which complicates a difficult prob-
1 Forty-ninth Annual Report of the Massachusetts Board of Educa- tion, p. 204 (John T. Prince).
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lem by taking two sets of beings of different gifts, and of unlike physiological needs and construction, and forcing them into the same educational mold.
It is a wrong for both sexes. Not much unlike the boy in childhood, there comes a time when in the rapid evolution of puberty the girl becomes for a while more than the equal of the lad, and, owing to her conscien- tiousness, his moral superior, but at this era of her life she is weighted by periodical disabilities which become needlessly hard to consider in a school meant to be both home and school for both sexes. Finally, there comes a time when the matured man certainly sur- passes the woman in persistent energy and capacity for unbroken brain work. If then she matches herself against him, it will be, with some exceptions, at bitter cost.
It is sad to think that the demands of civilized life are making this contest almost unavoidable. Even if we admit equality of intellect, the struggle with man is cruelly unequal and is to be avoided whenever it is possible.
The colleges for women, such as Vassar, are now- adays more careful than they were. Indeed, their machinery for guarding health while education of a high class goes on is admirable. What they still lack is a correct public feeling. The standard for health and endurance is too much that which would be normal for young men, and the sentiment of these groups of women is silently opposed to admitting that the femi-
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nine life has necessities which do not cumber that of man. Thus the unwritten code remains in a measure hostile to the accepted laws which are supposed to rule.
As concerns our colleges for young men, I have lit- tle to say. The cases I see of breakdown among women between sixteen and nineteen who belong to normal schools or female colleges are out of all pro- portion larger than the number of like failures among young men of the same ages, and yet, as I have hinted, the arrangements for watching the health of these groups of women are usually better than such as the colleges for young men provide. The system of pro- fessional guardianship at Johns Hopkins is an admir- able exception, and at some other institutions the phys- ical examination on matriculation becomes of the utmost value, when followed up as it is in certain of these schools by compulsory physical training and occa- sional reexaminations of the state of health.
I do not see why the whole matter could not in all colleges be systematically made part of the examina- tions on entry upon studies. It would at least point out to the thoughtful student his weak points, and en- able him to do his work and take his exercise with some regard to consequences. I have over and over seen young men with weak hearts or unsuspected val- vular troubles, who had suffered from having been al- lowed to play football. Cases of cerebral trouble in students, due to the use of defective eyes, are common, and I have known many valuable lives among male
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and female students crippled hopelessly owing to the fact that no college preexamination of their state had taught them their true condition, and that no one had pointed out to them the necessity of such correction by glasses as would have enabled them as workers to com- pete on even terms with their fellows.
In a somewhat discursive fashion I have dwelt upon the mischief which is pressing to-day upon our girls of every class in life. The doctor knows how often and how earnestly he is called upon to remon- strate against this growing evil. He is, of course, well enough aware that many sturdy girls stand the strain, but he knows also that very many do not — and that the brain, sick w7ith multiplied studies and unwhole- some home life, plods on, doing poor work, until some- body wonders what is the matter with that girl ; or she is left to scramble through, or break down with weak eyes, headaches, neuralgias, or what not. I am per- fectly confident that I shall be told here that girls ought to be able to study hard between fourteen and eighteen years without injury, if boys can do it. Prac- tically, however, the boys of to-day are getting their toughest education later and later in life, while girls leave school at the same age as they did thirty years ago. It used to be common for boys to enter college at fourteen; at present, eighteen is a usual age of ad- mission at Harvard or Yale. Now, let anyone com- pare the scale of studies for both sexes employed half a century ago with that of to-day. He will find that its
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demands are vastly more exacting than they were — a difference fraught with no evil for men, who attack the graver studies later in life, but most perilous for girls, who are still expected to leave school at eighteen on earlier.1
I firmly believe — and I am not alone in this opin- ion— that as concerns the physical future of women they would do far better if the brain were very lightly tasked and the school hours but three or four a day until they reach the age of seventeen at least. Any- thing, indeed, were better than loss of health ; and if it be in any case a question of doubt, the school should be unhesitatingly abandoned or its hours lessened, as at least in part the source of very many of the nervous maladies with which our women are troubled. I am almost ashamed to defend a position which is held by many competent physicians, but an intelligent friend, who has read this page, still asks me why it is that overwork of brain should be so serious an evil to women at the age of womanly development. My best reply would be the experience and opinions of those of us who are called upon to see how many schoolgirls are suffering in health from confinement, want of exercise at the time of day when they most incline to it, bad ventilation,2 and too steady occupation of mind. At
1 Witness Richardson's heroine, who was "perfect mistress of the four rules of arithmetic ! n
2 In the city where this is written there is, so far as I know, not one private girls' school in a building planned for a schoolhouse. As a con-
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no other time of life is the nervous system so sensi- tive— so irritable, I might say — and at no other are abundant fresh air and exercise so all-important. To show more precisely how the growing girl is injured by the causes just mentioned would lead me to subjects unfit for full discussion in these pages, but no thought- ful reader can be much at a loss as to my meaning.
The following remarks I owe to the experience of a friend,1 a woman, who kindly permits me to use them in full. They complete what I have space to add as to the matter of education, and deserve to be read with care by every parent, and by everyone concerned in our public schools.
" There can be no question that the health of grow- ing girls is overtaxed ; but in my opinion, this is a vice of the age, and not primarily of the schools. I have found teachers more alive to it than parents or the general public. Upon interrogating a class of forty girls, of ages varying from twelve to fourteen, I found that more than half the number were conscious of loss of sleep and nervous apprehension before examina- tions; but I discovered, upon further inquiry, that nearly one-half of this class received instruction in one or two branches outside of the school curriculum, with the intention of qualifying to become teachers. I could
sequence, we hear endless complaints from young ladies of overheated or chilly rooms. If the teacher be old, the room is kept too warm; or if she be young, and much afoot about her school, the apartment is apt to be cold.
1 Miss Pendleton.
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get no information as to appetite or diet; all of the class, as the teacher informed me, being ashamed to give information on questions of the table. In the opinion of this teacher, nervousness and sleeplessness are somewhat due to studies and indoor social amuse- ments in addition to regular school work, but chiefly to ignorance in the home as to the simplest rules of healthy living. Nearly all the girls in this class drink a cup of tea before leaving home, eat a sweet biscuit as they walk, hurried and late, to school, and nothing else until they go home to their dinners at two o'clock. All their brain work in the schoolroom is done before eating any nourishing food. The teacher realized the injurious effects of the present forcing system, and suggested withdrawing the girls from school for one year between the grammar and high-school grades. When I asked whether a better result would not be obtained by keeping the girls in school during this additional year, but relieving the pressure of purely mental work by the introduction throughout all the grades of branches in household economy, she said this seemed to her ideal but, she feared, impracticable, not from the nature of schools, but from the nature of boards.
" A Latin graduating class of seven girls, aged seventeen and eighteen years, stated that they do their work without nervousness, restlessness, or apprehen- sion.
" This, with other statistics, would seem to bear
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out your theory that after seventeen girls may study with much less risk to health.
" So far as I have observed, the strain or tear is chiefly in the case of girls studying to become teachers. These girls often press forward too rapidly for the purpose of becoming self-supporting at the age of eighteen. The bait of a salary, and a good salary for one entering upon a profession, lures them on ; and a false sympathy in members of boards and committees lends itself to this injurious cramming.
" Our own normal school,1 which is doing a great, an indispensable, work in preparing a trained body of faithful, intelligent teachers, has succumbed to this in- jurious tendency. We have here the high and normal grades merged into one, the period of adolescence, stricken out of the girl's school life, and many hun- dreds of girls hurried annually forward beyond their physical or mental capacity, in advance of their phys- ical growth for the sake of those who cannot afford to remain in school one or two years longer. I say this notwithstanding the fact that this school is, in my opinion, one of the most potent agencies for good in the community.
" Overpressure in school appears to me to be a dis- ease of the body politic from which this member suf- fers ; but it also seems to me that this vast school sys- tem is the most powerful agency for the correction of the evil. In the case of girls, the first principle to be
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recognized is that the education of women is a problem by itself; that in all its lower grades, at all events, it is not to be laid down exactly upon the lines of educa- tion for boys.
" The school system may be made a forceful agency for building up the family, and the integrity of the home is without doubt the vital question of the age.
u Edward Everett Hale, with his far spiritual sight, has discerned the necessity for restoring home train- ing, and advocates, to this end, short school terms of a few weeks annually. It is probable that in the future many school departments will be relegated to the home, but the homes are not now prepared to assume these duties.
" When it was discovered that citizens must be pre- pared for their political duties the schools were opened ; but the means so far became an end that even women were educated only in the directions which bear upon public and not upon household economy. The words of Stein, that ' what we put into the schools will come out in the manhood of the nation afterwards,' cannot be too often quoted. Let branches in household econ- omy be connected with all the general as distinguished from normal-school grades, and we not only relieve the girl immediately of the strain of working with insuf- ficient food, and of acquiring skill in household duties in addition to the school curriculum, we not only sim- plify and harmonize her work, but we send out in every case a woman prepared to carry this new influ-
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ence into all her future life, even if a large number of these women should eventually pursue special or higher technical branches; for we are women before we are teachers, lawyers, physicians, etc., and if we are to add anything of distinctive value to the world by entering upon the fields of work hitherto preempted by men, it will be by the essential quality of this new feminine element.
" The strain in all work comes chiefly from lack of qualification by training or nature for the work in hand — tear in place of wear. The schools can restore the ideal of quiet work. They have an immense advan- tage in regularity, discipline, time. This vast system gives an opportunity, such as no private schools offer, for ascertaining the average work which is healthful for growing girls. It is quite possible to ascertain, whether by women medical officers appointed to this end, or by the teachers themselves, the physical capac- ity of each girl, and to place her where this will not be exceeded. Girls trained in school under such wise supervision would go out into life qualified to guard the children of the future. The chief cause of overwork of children at present is the ignorance of parents as to the injurious effects of overwork, and of the signs of its influence.
" The first step toward the relief of overpressure and false stimulus is to discard the pernicious idea that it is the function of the normal school to offer to every girl in the community the opportunity for becoming
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a teacher. This unwholesome feature is the one dis- tinctive strain which must be rem system.
It can be done provided public and political sentiment approve. The normal school should be only a device for securing the best possible body of teachers. It should be technical.
"Even" teacher knows that the average sdrl of
has not reached the physi : .1. mental, or moral
development necessary to enter upon this severe and
high professional course of studies, and that one year
r such a course.
M Lengthen the time given to normal instruction — make it two years : give in this school instruction purely in the science of education : relegate all general instruc- tion to a good high school covering a term of four years. In this, as in all other progressive formative y ; ut is ahead.
14 It will be time enough to talk of doing away with a portion of the girls'" school year when the schools have fulfilled their high mission, whet have sent out
a large body of American women prepared, not for a fession, even the high feminine vocation of pedagogy, but equipped for her highest, most general and congenial function e source and center of the
home."
I am unwilling to leave this subject without a few words as to our remedy, especially ncerns our
public schools and normal schools for girls. What seems to me to be needed m - what the woman
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would bring into our school boards. Surely it is also possible for female teachers to talk frankly to that class of girls who learn little of the demands of health from uneducated or busy or careless mothers, and it would be as easy — if school boards were what they should be — to insist on such instruction, and to make sure that the claims of maturing womanhood are considered and attended to. Should I be told that this is impracticable, I reply that as high an authority as Samuel Eliot, of Massachusetts, has shown in large schools that it is both possible and valuable As concerns the home life, it is also easy to get at the parents by annual circulars enforcing good counsel as to some of the simplest hy- gienic needs in the way of sleep, hours of study, light, and meals.
It were better not to educate girls at all between the ages of fourteen and eighteen, unless it can be done with careful reference to their bodily health. To-day, the American woman is, to speak plainly, too often physically unfit for her duties as woman, and is per- haps of all civilized females the least qualified to under- take those weightier tasks which tax so heavily the nervous system of man. She is not fairly up to what nature asks from her as wife and mother. How will she sustain herself under the pressure of those yet more exacting duties which nowadays she is eager to share with the man ?
While making these stringent criticisms, I am anxious not to be misunderstood. The point which
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above all others I wish to make is this, that owing chiefly to peculiarities of climate, our growing girls are endowed with organizations so highly sensitive and impressionable that we expose them to needless dan- gers when we attempt to overtax them mentally. In any country the effects of such a course must be evil, but in America I believe it to be most disastrous.
As I have spoken of climate in the broad sense as accountable for some peculiarities of the health of our women, so also would I admit it as one of the chief reasons why work among men results so frequently in tear as well as wear. I believe that something in our country makes intellectual work of all kinds harder to do than it is in Europe; and since we do it with a terrible energy, the result shows in wear very soon, and almost always in the way of tear also. Perhaps few persons who look for evidence of this fact at our na- tional career alone will be willing to admit my prop- osition, but among the higher intellectual workers, such as astronomers, physicists, and naturalists, I have fre- quently heard this belief expressed, and by none so positively as those who have lived on both continents. Since this paper was first written I have been at some pains to learn directly from Europeans who have come to reside in America how this question has been an- swered by their experience. For obvious reasons, I do not name my witnesses, who are numerous ; but, although they vary somewhat in the proportion of the effects which they ascribe to climate and to such
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domestic peculiarities as the overheating of our houses, they are at one as regards the simple fact that, for some reason, mental work is more exhausting here than in Europe; while, as a rule, such Americans as have worked abroad are well aware that in France and in England intellectual labor is less trying than it is with us. A great physiologist, well known among us, long ago expressed to me the same opinion; and one of the greatest of living naturalists, who is hon- ored alike on both continents, is positive that brain work is harder and more hurtful here than abroad — an opinion which is shared by Oliver Wendell Holmes and other competent observers. Certain it is that our thinkers of the classes named are apt to break down with what the doctor knows as cerebral exhaustion — a condition in which the mental organs become more or less completely incapacitated for labor — and that this state of things is very much less common among the savants of Europe. A share in the production of this evil may perhaps be due to certain general habits of life which fall with equal weight of mischief upon many classes of busy men, as I shall presently point out. Still, these will not altogether account for the fact, nor is it to my mind explained by any of the more obvious faults in our climate, nor yet by our habits of life, such as furnace-warmed houses, hasty meals, bad cooking, or neglect of exercise. Let a man live as he may, I believe he will still discover that mental labor is with us more exhausting than we could wish it to
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be. Why this is I cannot say, but it is not more mys- terious than the fact that agents which, as sedatives or excitants, affect the great nerve centers, do this very differently in different climates. There is some evi- dence to show that this is also the case with narcotics ; and perhaps a partial explanation may be found in the manner in which the excretions are controlled by ex- ternal temperatures, as well as by the fact which Dr. Brown-Sequard discovered, and which I have fre- quently corroborated, that many poisons are retarded in their action by placing the animal affected in a warm atmosphere.
It is possible to drink with safety in England quan- tities of wine which here would be disagreeable in their first effect and perilous in their ultimate results. The Cuban who takes coffee enormously at home, and smokes endlessly, can do here neither the one nor the other to the same degree. And so also the amount of excitation from work which the brain will bear varies exceedingly with variations of climatic in- fluences.
We are all of us familiar with the fact that physical work is more or less exhausting in different climates, and as I am dealing, or about to deal, with the work of business men, which involves a certain share of corporeal exertion, as well as with that of mere scholars, I must ask leave to digress, in order to show that in this part of the country at least the work of the body probably occasions more strain than
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in Europe, and is followed by greater sense of fatigue.
The question is certainly a large one, and should include a consideration of matters connected with food and stimulants, on which I can but touch. I have carefully questioned a number of master mechanics who employ both foreigners and native Americans, and I am assured that the British workman finds labor more trying here than at home; while, perhaps, the eight- hour movement may be looked upon as an instinctive expression of the main fact as regards our working class in general.
A distinguished English scholar informs me that since he has resided among us the same complaints, as to the depressing effects of physical labor in America, have come to him from skilled English mechanics. What share change of diet and the like may have in the matter, I have not space to discuss.1
Although, from what I have seen, I should judge that overtasked men of science are especially liable to the trouble which I have called cerebral exhaustion, all classes of men who use the brain severely, and who have also — and this is important — seasons of excessive
1 The new emigrant suffers in a high degree from the same evils as to cookery which affect only less severely the mass of our people, and this, no doubt, helps to enfeeble him. The frying pan has, I fear, a better right to be called our national emblem than the eagle, and I grieve to say it reigns supreme west of the Alleghanies. I well remember that a party of friends about to camp out were unable to buy a gridiron in two Western towns, each numbering over four thousand eaters of fried meats.
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anxiety or of grave responsibility, are subject to the same form of disease; and this is, I presume, why we meet with numerous instances of nervous exhaustion among merchants and manufacturers. The lawyer and clergyman offer examples, but I do not remember ever to have seen a bad case among physicians. Dismissing the easy jest which the latter statement will surely sug- gest, the reason for this we may presently encounter.
My notebooks seem to show that manufacturers and certain classes of railway officials are the most liable to suffer from neural exhaustion. Next to these come merchants in general, brokers, etc. ; then, less frequently, clergymen; still less often, lawyers; and, more rarely, doctors ; while distressing cases are apt to occur among the overschooled young of both sexes.
The worst instances to be met with are among young men suddenly cast into business positions in- volving weighty responsibility. I can recall several cases of men under or just over twenty-one who have lost health while attempting to carry the responsibilities of great manufactories. Excited and stimulated by the pride of such a charge, they have worked with a certain exaltation of brain, and, achieving success, have been stricken down in the moment of triumph. This too frequent practice of immature men going into busi- ness, especially with borrowed capital, is a serious evil. The same person, gradually trained to naturally and slowly increasing burdens, would have been sure of healthy success. In individual cases I have found
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it so often vain to remonstrate or to point out the various habits which collectively act for mischief on our business class that I may well despair of doing good by a mere general statement. As I have noted them, connected with cases of overwork, they are these : Late hours of work, irregular meals bolted in haste away from home, the want of holidays and of pursuits outside of business, and the consequent practice of carrying home, as the only subject of talk, the cares and successes of the countinghouse and the stock board. Most of these evil habits require no comment. What indeed can be said ? The man who has worked hard all day, and lunched or dined hastily, comes home or goes to the club to converse — save the mark ! — about goods and stocks. Holidays, except in summer, he knows not, and it is then thought time enough taken from work if the man sleeps in the country and comes into a hot city daily, or at the best has a week or two at the seashore. This incessant monotony tells in the end. Men have confessed to me that for twenty years they had worked every day, often traveling at night or on Sundays to save time ; and that in all this period they had not taken one day for play. These are extreme instances, but they are also in a measure repre- sentative of a frightfully general social evil.
Is it any wonder if asylums for the insane gape for such men? There comes to them at last a season of business embarrassment; or, when they get to be fifty or thereabouts, the brain begins to feel the strain,
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and just as they are thinking, " Now we will stop and enjoy ourselves/' the brain, which, slavelike, never murmurs until it breaks out into open insurrection, suddenly refuses to work, and the mischief is done. There are therefore two periods of existence especially prone to those troubles — one when the mind is matur- ing; another at the turning point of life, when the brain has attained its fullest power, and has left behind it, accomplished, the larger part of its best enterprise and most active labor.
I am disposed to think that the variety of work done by lawyers, their long summer holiday, their more general cultivation, their usual tastes for literary or other objects out of their business walks, may, to some extent, save them, as well as the fact that they can rarely be subject to the sudden and fearful responsi- bilities of business men. Moreover, like the doctor, the lawyer gets his weight upon him slowly, and is thirty at least before it can be heavy enough to task him severely. The business man's only limitation is need of money, and few young mercantile men will hesitate to enter trade on their own account if they can command capital. With the doctor, as with the lawyer, a long intellectual education, a slowly increas- ing strain, and responsibilities of gradual growth tend, with his outdoor life, to save him from the form of disease I have been alluding to. This element of open- air life, I suspect, has a large share in protecting men who in many respects lead a most unhealthy existence.
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The doctor, who is supposed to get a large share of exercise, in reality gets very little after he grows too busy to walk, and has then only the incidental exposure to out-of-door air. When this is associated with a fair share of physical exertion, it is an immense safeguard against the ills of anxiety and too much brain work. I presume that very few of our generals could have gone through with their terrible task if it had not been that they lived in the open air and exercised freely. For these reasons I do not doubt that the effects of our great Civil War were far more severely felt by the Sec- retary of War and President Lincoln, than by Grant or Sherman.
The wearing, incessant cares of overwork, of busi- ness anxiety, and the like, produce directly diseases of the nervous system, and are also the fertile parents of dyspepsia, consumption, and maladies of the heart. How often we can trace all the forms of the first- named protean disease to such causes is only too well known to every physician, and their connection with cardiac troubles is also well understood. Happily, functional troubles of heart or stomach are far from unfrequent precursors of the graver mischief which finally falls upon the nerve centers, if the lighter warn- ings have been neglected ; and for this reason no man who has to use his brain energetically and for long periods can afford to disregard the hints which he gets from attacks of palpitation of heart or from a disordered stomach. In many instances these are the
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only expressions of the fact that he is abusing the machinery of mind or body ; and the sufferer may think himself fortunate that this is the case, since even the least serious degrees of direct exhaustion of the centers with which he feels and thinks are more grave and are less open to ready relief.
When affections of the outlying organs are neg- lected, and even in many cases where these have not suffered at all, we are apt to witness, as a result of too prolonged anxiety combined with business cares, or even of mere overwork alone, with want of proper physical habits as to exercise, amusement, and diet, that form of disorder of which I have already spoken as cerebral exhaustion; and before closing this paper I am tempted to describe briefly the symptoms which warn of its approach or tell of its complete possession of the unhappy victim. Why it should be so difficult of relief is hard to comprehend, until we remember that the brain is apt to go on doing its weary work automatically and despite the will of the unlucky owner; so that it gets no thorough rest, and is in the hapless position of a broken limb which is expected to knit while still in use. Where physical overwork has worn out the spinal or motor centers, it is, on the other hand, easy to enforce repose, and so to place them in the best condition for repair. This was often and happily illustrated during the war. Severe marches, bad food, and other causes which make war exhausting were constantly in action, until certain
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men were doing their work with too small a margin of reserve power. Then came such a crisis as the last days of McClellan's retreat to the James River, or the forced march of the Sixth Army Corps to Gettysburg, and at once these men succumbed wTith palsy of the legs. A few months of absolute rest, good diet, ale, fresh beef, and vegetables restored them to perfect health.
In all probability incessant use of a part flushes with blood the nerve centers which furnish it with motor energy, so that excessive work may bring about a state of congestion, owing to which the nerve center becomes badly nourished, and at last strikes work. In civil life we sometimes meet with such cases among certain classes of artisans : paralysis of the legs as a result of using the treadle of the sewing machine ten hours a day is a good example, and, I am sorry to add, not a very rare one, among the overtasked women who slave at such labor.
Now let us see what happens when the intellectual organs are put overlong on the stretch, and when moral causes, such as heavy responsibilities and overanxiety, are at work.
When in active use, the thinking organs become full of blood, and, as has been shown, rise in tem- perature, while the feet and hands become cold. Na- ture meant that, for their work, they should be, in the first place, supplied with food; next, that they should have certain intervals of rest to rid themselves
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of the excess of blood accumulated during their periods of activity, and this is to be done by sleep, and also by bringing into play the physical machinery of the body, such as the muscles — that is to say, by exercise which flushes the parts engaged in it and so depletes the brain. She meant, also, that the various brain organs should aid in the relief by being used in other directions