The Project Gutenberg EBook of The Modern Malady, by Cyril Bennett This eBook is for the use of anyone anywhere at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this eBook or online at www.gutenberg.org/license Title: The Modern Malady Or, Sufferers from "Nerves" Author: Cyril Bennett Release Date: January 25, 2015 [EBook #48072] Language: English Character set encoding: UTF-8 *** START OF THIS PROJECT GUTENBERG EBOOK THE MODERN MALADY *** Produced by Chuck Greif and the Online Distributed Proofreading Team at http://www.pgdp.net (This file was produced from images available at The Internet Archive) THE MODERN MALADY. THE MODERN MALADY; Or, Sufferers from “Nerves.” Or, Sufferers from “Nerves.” BY CYRIL BENNETT, AUTHOR OF “THE MASSAGE CASE,” ETC. WITH A PREFACE BY HERBERT TIBBITS, M.D., F.R.C.P.E., FOUNDER OF THE WEST END HOSPITAL FOR DISEASES OF THE NERVOUS SYSTEM, ETC. “Absence of knowledge has for its inevitable fruit this result; that the right exercise of our faculties leads, at first, not to true, but to false conclusions. The only means whereby our progress in knowledge can be made harmonious is in frankly recognising and accepting this law of our life.”—James Hinton. LONDON: EDWARD ARNOLD. 1890. [All rights reserved.] CONTENTS PREFACE. BY DR. TIBBITS. I HAVE been requested to write a Preface to the “Modern Malady,” and I have pleasure in doing so, as it seems to me that the author, with whose views I am in general agreement, has adequately and successfully carried out a work, not over easy, but certainly wanted—i.e., an introduction to public consideration, from a non-medical point of view, of a condition of ill-health which is increasingly prevalent in all ranks of society; which is as common in the slums of the East End as in the mansions of the West; which incapacitates innumerable people (both men and women) from the efficient discharge of the duties, and from the proper enjoyment of the pleasures, of life; which undoubtedly often owes its origin to injudicious medication; which is quite capable of cure in certain ways which are not those generally adopted; and which is still more capable of prevention. The condition is technically called “Neurasthenia,” or “nerve-weakness.” This is but a generic word, a convenient designation for a condition of the nervous system, the symptoms of which vary widely; but beneath all these symptoms, various as they may be, there is as their foundation a condition of nerve-prostration and fatigue; and a permanent removal of this condition is only brought about by keeping in mind a recollection of its origin and directing treatment to the fons et origo mali; by repairing, if only slightly damaged, by building up, if shattered, this unfortunate nervous system. This state of ill-health used to be called “Hysteria,” a name derived from an erroneous idea that there is a special connection between the disease and a particular organ of the body. It was even once thought that this organ moved about to various parts of the body, and so caused the local symptoms; and various nauseous drugs were given for centuries, on the theory that by their offensive taste they would drive the wanderer back to its proper place. It is also popularly supposed that “hysterical” people simulate their symptoms and can control them if they wish. Both of these views are quite wrong. The disease is a real disease, as truly a disease as is a fever or an attack of bronchitis, and it is found in men as well as women. In this connection I would ask, with Cyril Bennett, “Do the majority of people know that they possess a nervous system at all? We still hear educated persons talk of their nerves as if they were something spiritual, as though nervous disorder were not a physical disease.” We should remember that the nervous system is one continuous structure, and it is only the necessities of nomenclature and the ingenuity of anatomists that have divided it into so many parts. It is as continuous as is an oak tree with its various branches. The spinal cord and the nerves are composed in varying proportions of the same materials as is that part of the system which we call the brain: injury and disease with them give rise to symptoms analogous to similar injury or disease to the brain. Indeed, there are several brains,—some in the cord itself, one in relation with the stomach and called the “abdominal brain,”—but the intellect and perception reside only in that portion of nervous material which is confined within the skull; injury there—in addition to the symptoms common to injury in other parts—influencing intellect, perception, and memory; and this is the only distinction. Neurasthenia is especially prevalent, not only with members of certain families (we all know people peculiarly liable to suffer from the “nerves”), but certain races are more prone to it than others—the French and American more than ourselves; and this fact must not be lost sight of, nor the fact that the relatives of many of these patients—probably afflicted themselves with a latent form of the same condition—are frequently but ill-fitted to help the patient to recovery, so that a temporary removal from their care is sometimes advisable. But prevention is better than cure, and this is best secured by healthy hygienic, physical, mental, and moral surroundings,—by bestowing upon the growing human plant a share of as intelligent a care as the gardener bestows upon his grapes and his peaches; by no undue forcing, by no undue straining, and by no undue school pressure; but by bodily exercises in proportion to the strength of the body, and progressively increased as the strength of the body increases, and by mental exercises equally proportioned to the increasing mental strength, and not forced beyond it; for the exercise of nerve-power is as fatiguing as that of muscle-power, brings on the same feeling of exhaustion, and requires the same recuperation by adequate food and rest. So much for prevention: but when the nervous system has broken down—when the symptoms may vary from extreme mental and physical exhaustion to that condition of what has been called “Death-trance,” where the patient is apparently dead; that condition which has furnished the theme for many a sensational story (but the most ghastly incidents of fiction have been paralleled by authenticated facts)—then treatment comes in. The less physic-drinking the better. As the late Sir William Gull said, “Medicine was once given even for fractures. Disease is not cured by drugs. It is the power of Nature that cures disease, and the duty of the medical man is—not to give drugs—but to assist Nature.” So spoke Sir William Gull; and Lord Coleridge, deciding a law case not long since, said, “If you give a man drugs, you make him the arena of a conflict of opposing poisons.” The first thing to do, is to try to remove whatever defect in the general health can be discovered. Then local treatment should be had recourse to. One method of such treatment is that perfected by Weir Mitchell of Philadelphia, and extensively carried out in this country by Playfair, myself, and others. Stated generally, it consists, in severe cases, in keeping the patient absolutely at rest in bed, and obtaining the tonic influence of exercise by daily massage and electricity,—i.e., skilled rubbing and kneading of the muscles, and putting them in action by electricity. At the same time abundant food is given in an easily digestible form. By this method the wearying effects of fatigue are avoided and patients often recover rapidly. Skilled massage and electrisation are essential. Without these, rest in bed will probably convert the patient into a helpless invalid. This method has been carried out extensively, and with marked success, for several years past, at the West End School of Massage and Electricity, 67 Welbeck Street, some of whose students have been sent to the Continent, India, and the Colonies, there training other nurses, and becoming new centres of usefulness. But while upon this subject of massage, I would enter my earnest protest against what is called “isolation,” and especially against any attempt to “manage” a patient. As Cyril Bennett wrote in a former work, when a doctor and a nurse think they are “managing” an invalid, nervous, suffering woman, you may depend upon it that in nine cases out of ten they are mis-managing her. The best physicians of the day are remarkable, not more for their medical knowledge and skill, than for their charm of manner, their human kindness, their warm sympathy with suffering. The wise physician is the family friend, the trusted adviser, the counsellor and comforter in many a trouble and anxiety: and so also with the nurse. She should possess the sensitive rather than the strong hand, and refinement, patience, tact, and sympathy. In certain cases of nervous disease, great benefit is derived from the use alone, and without massage, of the variety of electricity called “Franklinism,” after the illustrious philosopher and statesman who so carefully studied it. We have all heard the story of the thunder-cloud, the kite, the key tied to the kite-string; Franklin’s disappointment that he obtained no electricity; its coming on to rain, and by wetting the string making it a conductor; and his delight at being able to draw sparks—real miniature flashes of lightning—from the key with his knuckles. This form of electricity has been little used until a short time since, owing to certain inconveniences in its application; but recent improvements in the manufacture of instruments have largely removed these inconveniences, and placed at our service a remedy of great promise, and in some cases of unequalled value. The thanks of the medical profession are due to “Cyril Bennett” for a sagacious, though not unkindly, criticism upon the more common methods of treatment of that distressing affection, the “Modern Malady;” and in indicating from a medical standpoint the opinions of a neurologist, I venture to hope that the views of the author, who has so skilfully sketched its salient features, may have received some support. Finally, I would say that the day for the routine treatment of disease has gone by, and progress of the most important character is being made in the study of diet, exercise, sleep, rest, the application of water, cold and hot, and many other agencies; and it has been well said that if in the future, as in the past, nervous diseases are to be the measure of our civilisation; if every increase in the illuminating power of the mind is but an increase of surface to be eclipsed; if all new modes of action of nerve-force are to be so many added pathways to sorrow; if each fresh discovery or invention is to be matched by some new malady of the nerves; we yet have this assurance, that science, with keen eyes and steps that are not slow, is seeking and is finding means of prevention and relief. HERBERT TIBBITS. AUTHOR’S PREFACE. IN the first part of this work I have dwelt on the errors in our mode of treating Neurasthenia, consequent on the wide ignorance of the subject which still prevails; in the second part, I have drawn attention to the principal causes of the malady. The allegory forming the Introduction to Part I. gives a brief history of nervous exhaustion and the modes of treatment which have at various times been thought suitable to this most painful and trying disease. A friend, to whom I read the Introduction, criticised the quotation with which I have concluded it. She objected that I thereby gave too high a place to mere knowledge. I replied that I referred to the highest kind of knowledge. This argument, however, fails to satisfy those who persistently remind one of Eve’s transgression. In my humble opinion, the point of that great and instructive history has always been missed. Adam and Eve were cast out of Eden for eating of the tree of knowledge, but if they had not been cast out of Eden, how could they have been received into heaven? It was necessary to eat of the tree of knowledge in order to desire to eat of the tree of life. Again, before we can even desire to eat of the tree of knowledge, we must be ignorant; and thus we see our ignorance itself to be a needed stage in our upward evolution. We see in a glass darkly; we must become fools that we may be wise. In our imperfect condition we do but catch brief glimpses and fleeting shadows of the one mighty Truth. Just as our nervous system must waste that it may be nourished, as the pendulum must fall on the one side that it may rise on the other,[1] so must our ignorance precede our half-knowledge, and our half-knowledge precede the fuller revelation. It is almost needless to add that I am oppressed with a sense of my own incapacity for the task which I have here undertaken. But the most ignorant may teach something to the most learned, if he go through life by a different path. My only hope is that, in dealing with a subject about which so little is known, even my observations—conscientious as they are, however faulty—may be of some slight use to the community to which I owe so much. In preparing this work for the press, I have had the advantage of Mr. Horace Hutchinson’s kind and generous assistance. C. B. CONTENTS. ——— PART I. Our Nerves and their Ill-Treatment. Our Nerves and their Ill-Treatment. CHAP. PAGE I.INTRODUCTION 23 II.A THIEF IN THE NIGHT 37 III.INEFFECTUAL TREATMENT 47 IV.ERRONEOUS NOTIONS 70 V.OBSERVATION 85 ——— PART II. The Causes of Neurasthenia. The Causes of Neurasthenia. VI.INTRODUCTION 101 VII.HEREDITY 104 VIII.IMPERFECTIONS OF OUR SOCIAL SYSTEM 121 IX.AN IMPERFECT SYSTEM OF EDUCATION 142 X.SECONDARY CAUSES OF NERVE-DETERIORATION 161 PART I. Our Nerves and their Ill-Treatment. Our Nerves and their Ill-Treatment. “None shall rule but the humble.”—Emerson. Dedicated Dedicated TO THE MEDICAL MEN, NURSES, AND OTHERS, WHO, BY THEIR GENEROUS ASSISTANCE, HAVE SO LARGELY CONDUCED TO THE SUCCESS OF THE AUTHOR’S LABOURS AMONGST OUR EPILEPTIC AND NEURASTHENIC POOR. CHAPTER I. INTRODUCTORY. ONCE there lived a race of men blest with very strong eyesight—so strong that they were unconscious of possessing sight at all, but accepted their marvellous endowment as a matter of course. These men were hunters, who lived on the birds and beasts they shot with their bows and arrows. After a time our hunters learnt other arts besides that of the chase; various implements were invented; industries such as spinning and weaving were established; the primitive huts and sheds were discarded, and commodious dwellings rose in their place. But their progress was not unattended by serious disadvantages. For instance, the weavers, who passed a great deal of their time indoors, began to lose the strength and keenness of eyesight enjoyed by those who followed the chase. At first little attention was paid to this calamity, but when some of the weavers went blind and became a burden on the rest of the community, a meeting was convened in the council-chamber called Public Opinion, the most influential members of the tribe were consulted, and certain conclusions were arrived at. To be brief, it was decided that the malady in question was nothing more nor less than a special manifestation of the Evil One, and that the prompt execution of the sufferers was the only sure means of preventing the spread of his power. It was therefore decreed that these uncanny and mischievous weavers should at once be put to death. To ensure the conviction of all suspected parties, a mode of trial was ordered which had the advantage of being as efficacious as it was painful. So everything seemed to be made quite safe and comfortable, and the spirits of the tribe improved. In spite of these excellent arrangements, however, some of the invalids contrived to escape the doom thus thoughtfully prepared for them. It so happened that certain of the community, who had not been invited to vote at the meeting, held firmly to the belief that, so far from being possessed by the Evil One, these dreaded weavers were divinely inspired. Just because those whose sight was impaired could not see to do the work which was close to their eyes, their advocates credited them with the ability to discern things which were beyond the range of the most powerful vision. They therefore protected the sufferers from trial and honoured them with superstitious awe. The disabled weavers had themselves done much to promote the conflicting beliefs concerning them. When forced by growing blindness to abandon their trade, they had been glad enough to make a livelihood by seemingly exercising their supposed supernatural vision, and thus to escape from reproach on the score of idleness; not anticipating that they would but lay themselves open to suspicion of demon-fostering. In fact, they were often self-deceived, for the disease exercised a peculiar effect on the optic nerve, causing them, when they closed their eyes, to see before them a variety of colours and forms which had no objective existence, but which they frequently mistook for Divine revelation. Time passed on. Notwithstanding the extreme measures taken to extirpate the malady, it spread widely and increased in severity. Again the matter was investigated, and again a meeting was convened. This august assembly took a different view of the state of affairs from that which had decreed the death of the sufferers. The former enactments were repealed. Indeed, they were declared to be barbarous and unworthy of the community which had so long tolerated them. With singular unanimity it was agreed that the sufferers were really afflicted with some incapacitating disease, the nature of which it was impossible to discover, and for which it was vain to seek a cure. It was supposed to originate in obscure injuries to the arms and legs, but on this point there was difference of opinion. It never occurred to anybody that the malady could have anything to do with impairment of the sight. The ultimate decision of the court was to the effect that the suffering weavers were to be relieved from the necessity of working for their bread; that they should be permitted to remain a burden on the community; that they should be kept within doors and tended as cripples, and that surgeons should visit them and bandage their legs and arms. These changes met with universal approval. The more humane members of the tribe, who had shuddered at the former barbarities, were convinced that the millennium had arrived, while the sufferers themselves accepted their fate willingly enough. For though it was dull work to be kept indoors with bandaged limbs, it was infinitely preferable to the hatred and scorn of those around them, to say nothing of a violent and painful death; and though many of them at first wished to use their limbs and to take exercise in the open air on the days when there was no glare to hurt their weak eyes, inactivity was less irksome than constant and futile efforts to fulfil their tasks. So, at first, every one was contented with the new decisions. True, all the sufferers died sooner or later in a crippled condition, after a more or less miserable and monotonous existence; but this unhappy result was regarded as inevitable, and no further cure was sought for. Even the invalids themselves came to attribute their bodily helplessness to their original complaint, and not to the total disuse and tight bandaging prescribed by the court. Years went by, and brought no relief either to the disabled weavers or to those who maintained them. On the contrary, the disease continued to increase with frightful rapidity. All classes of the community—which had, for the most part, abandoned its outdoor pursuits—were attacked in turn. Further investigations were made as to the cause of the calamity; a third meeting was convened, and definite conclusions were arrived at. These, in some respects, showed more knowledge than the conclusions of the second meeting. At the same time they showed less humanity. It seemed as though the pendulum of human feeling had swung violently in the direction of intolerance, then in the direction of tolerance, returning once more, not quite to its former position, but to one far beyond the mean of wisdom and moderation. Possibly the pendulum, in its oscillations, would repeatedly pass and repass this mean point, till its range should grow more and more limited, and it should at length find repose. The third meeting fully recognised many of the follies and absurdities of its predecessors. Powerful speakers and keen investigators argued with great force and clearness that the incapacity of the sufferers arose entirely from disuse of the limbs, and not from disease. By some of the speakers, this disuse was attributed—with a singular momentary forgetfulness of past decrees—to the wicked deceit of the idle, and of the friends who had solicited public charity in their behalf. The whole community—so these excellent, well-meaning members insisted—had been systematically gulled by the devices of impostors. There was nothing in the world the matter with the disabled weavers and those whom they had infected by their example. They must be forced to behave as if they were well, and well they would become. No doubt their eyes were weak. Whose eyes would not be weak after years of confinement within doors? Blazing sunlight and constant use of eyes and limbs would soon cure their fancies, and these infallible remedies must be prescribed for them at once. Such cogent common-sense arguments could not but meet with the approval they deserved to meet with in the minds of the common- sense people who heard them. The recommendations of the speakers were promptly adopted. And now ensued a very singular state of affairs. By command of the court, all invalids disabled by no visible and well-known disorder, were forced to rise from their couches, to drag themselves about in the blazing sunlight, and even to resume their former occupations. Some of them, however, succeeded in simulating well-known disorders of the limbs so cleverly, that they were considered, even by skilled investigators, to be victims of chronic disease, and were mercifully left alone. Others had already been partially cured by the complete rest from their labours they had long enjoyed, and though the rough treatment they received, and the trying effects of sudden exposure to light, caused them great discomfort, they now learnt for the first time that they had recovered the use of their eyes—long incarceration in dark rooms having prevented their discovering the fact sooner. This result, however satisfactory to themselves, was a source of infinite misery to their companions in affliction, for it was hastily assumed that a mode of procedure which had proved in the main efficacious with a few, must prove equally efficacious with all. True, some of the patients went altogether blind the moment they were interfered with, and had to be conveyed to the blind asylum—in accordance with the custom of the country—to be kept there for the rest of their lives at the public expense. Some even developed real diseases of the limbs, in consequence of their unaccustomed efforts to take violent exercise. But these occasional failures by no means daunted the resolution of philanthropic legislators. How could there be such a thing as disease of the eyes while their own eyes were strong? With blindness they were unhappily too well acquainted, even though they had never been blind themselves; for when a man could not see at all, the fact could readily be ascertained. But it was evident that so long as a man could see, he was not blind, and therefore to treat him for loss of sight would be absurd. The larger number of those for whom work and sunlight were prescribed neither lost their sight completely nor recovered it sufficiently to perform their allotted tasks in even the most perfunctory manner. The existence led by these unhappy people was miserable in the extreme. Every effort to use the eyes was painful. The glare of the sunlight was a torture baffling description. And their sufferings were not physical only. Their fellow-men, including their nearest and dearest friends, did their utmost to convince them of the illusory nature of their disease, and continually implored them to exert their wills to overcome temptations to imposture. By the more unfeeling, sneers and reproaches were not spared. In sheer despair the less courageous of these unfortunates died by their own hand. Oddly enough, those who were the most uncompromising in their discouragement of supposed impostors had themselves recently become painfully conscious of impairment of vision. Fear of discovery made them loud in denouncing others; ignorance of the nature of the malady gave them hope that work and sunlight might conduce to their own cure. In time, there were in that eccentric community an abundance of deceivers of two different orders: the first pretending an illness other than that which afflicted them; the second pretending to be well when they were ill. It is said that the second class was larger than the first, and that recruits were continually swelling its ranks. Altogether, in spite of the well-intentioned efforts of the investigators, the state of that tribe with regard to eye-disease was very much worse than it had been while the regulations of the second meeting were in force. But, as the night is darkest immediately before the dawn, so, just as things looked blackest, there came a change for the better. It chanced that certain patients suffering from injuries to the limbs found their eyesight much affected by the illness, and were rashly credited with imposture. The injuries were declared to be wholly imaginary, and the usual moral discipline was resorted to in order to cure the patients of their delusion. Consequently, some of them were hopelessly crippled, while others, who ultimately recovered the use of their limbs, were blind for the rest of their days. And now there was a panic in that hitherto contented community. Fears were entertained that real disease (eye-weakness was not yet regarded as actual illness) should frequently be overlooked in the midst of the general craze for extirpating imposture. The continued increase in the number of mysterious invalids occasioned anxious questioning on all sides. The crippled patients seized the opportunity to complain loudly of the usage they had received. Notwithstanding the remonstrances of the more fortunate, they insisted on repeating, to all who would hear them, the whole category of their woes. They never tired of declaring that they had been cruelly and unjustly crippled, and that the eye-weakness with which they had been temporarily afflicted was a terrible and unmistakable malady, more painful even than injuries to the limbs, and more urgently needing rational treatment. So overwhelming was this evidence, so vehement were the witnesses, that public attention was perforce called to their grievances. Further investigations were made; further inquiries were diligently prosecuted; and a fourth meeting was convened. That meeting is still going on. Day after day the discussions are resumed; day after day final judgment is deferred. The causes, nature, and cure of the alarmingly prevalent eye-disease are all earnestly debated. The ultimate decision of the court cannot be doubted. Sooner or later it will be recognised that the great epidemic is a disease like any other, to be treated with kindly consideration—to be cured, to be prevented. Learned investigators, while admitting that their examinations can discover no trace of disease in the eyes of the sufferers, admit likewise that their failure is no argument whatever against its existence. Pending the final judgment of the court, all former cruel enactments have been repealed, and over the door of the council-chamber have been inscribed these words, “Ignorance is the curse of God. Knowledge is the wing on which we fly to heaven.” CHAPTER II. A THIEF IN THE NIGHT. OUR life and progress may be aptly compared to the passage of collections of particles through a fine sieve. The particles that will not crumble are inevitably cast out, while those that succeed in passing through it are rendered finer in the process. It would perhaps be apter still to say, that we are passing continually through a series of sieves, some coarse, some fine, and that the particles which survive the ordeal, though refined in their passage, are perpetually losing something they possessed before. Whether this be an advantage or a disadvantage to them depends on the nature of that which is lost. Those who survive the longest, in spite of constant paring and shaping, fitting them for still finer passages, must have had their sieves carefully graduated for them, each preceding sieve fitting them for the next in order of progression. Just as it is not the loudest things that have the most substance, so it is not the largest things that contain the most power. We are told that there is sufficient force holding together the particles composing a single drop of water to make a whole flash of lightning. In the same way, there may be more force concentrated in a small portion of the nervous system than is diffused throughout all the rest of the body. And our progress through the sieves may be a condensation of great forces into our small compass. Leaving the matter of mere size of body out of the question, one man of coarse organisation (A) may possess more physical strength than a man of fine organisation (B). But B may rule the world while A is a nonentity. B may, by means of his superior mental capacity, subdue the powers of Nature to his will, and thus be master of a force compared to which A’s physical strength is as a drop in the ocean. B’s complex nervous system is the storehouse of a tremendous energy. Now, though we have been shaped in the past by sieves over which we have had no control, we are nevertheless conscious of having acquired some power of selecting and shaping the sieves of the future. Whether or no our action in the matter is predetermined by the shape already given us, the fact that we possess this power is indubitable. In our age it would seem that we have arrived at a sieve that is either exceptionally small or of an exceptional shape. Numbers of particles are just now being rejected, not necessarily suddenly, but often subsequent to unusually protracted, painful, and futile efforts at forcing a passage through. The question arises, Is this state of affairs inevitable? Have we not power to graduate our sieves more effectually? And granting this power of selection and modification, is it not possible that the sieve through which we are endeavouring to force ourselves may be ill-shapen, and calculated therefore to occasion needless destruction and deformity? In some mode or other, we are all of us constantly considering this problem. Pass through the sieves we must, if we would survive. The process seems never-ending. We may be able to select or modify our sieves, hurry our progress or retard it, but we can neither stand still nor turn back. If we cannot or will not fit ourselves to the sieve, or if mankind, by their combined action, cannot or will not fit the sieve to us, then we must be cast out. This casting out, if sudden, we term death; if slow, disease and death. We have habituated ourselves to regard life and health as natural— death and disease as unnatural if premature; but for our mode of thought in the latter case there seems little justification. The process of disintegration that we call disease is wholly natural. The result of two opposing forces is the path of our planet in space; the result of two opposing forces is our life. Let either force gain the ascendancy, and our life goes, or begins to go. Sooner or later, then, we must be rejected from a sieve. But our early rejection and our late rejection are two very different matters. Our sudden rejection or our slow rejection are two very different matters also. Disintegration is always going on, but if we absorb sufficient nutriment to repair the waste adequately, we are in health. If, owing to disease of any part, the waste is more than we can repair, one of the opposing forces has gained the ascendancy, and death has begun. We justly regard this slow death in life as a most terrible fate: we will do anything to avert it. To death itself we may be resigned; to some it is an escape from suffering; by some it is regarded as the entrance to a higher life. But all alike shrink from the prospect of dragging out long years of pain and hopeless misery in the sick-room. And just as we are becoming better acquainted with the causes and prevention of disease in various forms, one form of it has recently spread in our midst to an alarming extent, our ignorance of its nature and origin rendering us powerless against its incursions. Nervous prostration encounters us on all sides. It finds victims in all classes of life. It has come amongst us like a thief in the night. Disease, like any other adversary, finds out the most vulnerable part. The most vulnerable part of our machinery is that about which we are most ignorant. We are lamentably ignorant about our nervous systems; our adversary, repulsed in other quarters, effects an entrance there. It is far more difficult to expel him when once he has made his abode with us, than to fortify the stronghold against him. Prevalent as this particular form of disease is at the present moment, that is not the worst of the evil. It is alarming and disheartening to be told that it is still on the increase; but such is nevertheless the fact. Professor Huxley very wisely says, that Nature gives us a blow and leaves us to find out its meaning. More than that, she never stops giving us blows until we have succeeded in doing so. It must be candidly admitted that we are inexpressibly dull and require many very hard knocks, and that when some one else is knocked and not ourselves, we are apt to be extremely heartless. It is only lately that the majority of non-medical people have become conscious of possessing a nervous system at all. We still hear even educated persons talk of their nerves as though they were something spiritual—as though nervous disorder were not a physical disease. Such inexcusable ignorance leads to shadowy, pernicious ideas about the impossibility of curing the malady, or, supposing it to be regarded as curable, to the adoption of cruel and fantastic methods of treatment. If only we were forced to have all our remedies tried on ourselves before trying them on others, patients would henceforth have a better time of it. Unfortunately, many supposed remedies which are not unpleasant to the healthy are torture to the diseased. I regret to say, that I still come across people who regard nervous prostration as sheer wickedness and obstinacy on the part of the sufferer. Indeed, I have even heard the grace of God and a change of heart talked about by excellent women as the only cure for cases that had come under their notice. Far be it from me to underrate the power of any good influence; but you have only to suggest that asthma shall be treated by spiritual influence, and you will find that the good folks regard you as a lunatic or as a profane person. Asthma being undoubtedly a nervous disease, these distinctions are a little puzzling. I have even heard of church-going being suggested as a remedy for nervous excitability, regardless of the ventilation of the building, the length of the sermon, and the tunefulness of the singing. Now, with all due respect for church- going, I sometimes cannot help regretting that the friends and advisers of the nervous do not believe in charms, like the Neapolitans. If charms do no good, at all events they do no harm; and if ignorant superstition must find vent, it is well if we can, at least, render it innocuous. The spiritual treatment of the diseased is nothing new; on the contrary, it is hallowed by ancient custom. Anna of Saxony, the insane wife of William the Silent, was shut up by her father in a miserable room, and by his orders preached to daily, through a hole in the door, by a minister of religion. But perhaps the poor lady suffered from insomnia! Unfortunately the preaching proved ineffectual, for she died raving mad. An intelligent Italian gentleman, interested in the case of an English friend suffering from nervous prostration, once endeavoured to console him by saying that, in his opinion, it was only clever people who suffered from nerves. Stupid people had the same things the matter with them, he said, but they were too stupid to find it out. An original notion, certainly. Unhappily, however true it may be that we lack the wits to diagnose our ills, I know of many persons belonging to the labouring classes who could scarcely be considered clever even by their best friends, yet who are not only afflicted with the universal malady, but are painfully conscious of the fact. Indeed, no rank or occupation secures immunity from the visitations of our modern foe. In these days of ready communication and rapid rise and fall of families, influences affecting one part of the community quickly affect the whole. True, certain conditions may be more fatal to fine organisations—to the noblest and the best, to the most useful and the most intelligent—than to the ill-developed; but of this more hereafter. When I see people dropping out of the ranks one after another, each probably having been confident that to him, at any rate, the disease would never come, I am reminded of De Quincey’s “Klosterheim,” where citizen after citizen was stolen away by the unseen foe. We understand so little of the causes of these break-downs, that we will not be warned in time; our partial but growing weakness is so gradual, that we become accustomed to it, and think that nothing worse will befall us; and yet the final collapse is often so sudden, that it at last comes upon us unawares, and our total prostration is a surprise to ourselves. Perhaps some shock or accident is blamed for the disaster, the long period of weakness preceding it being ignored; or we fall a victim to some well-known illness, and regard it as the judgment of Heaven, which we were powerless to avoid, instead of telling ourselves that we might have avoided it, and ought to have avoided it, by acting wisely in the first instance, and fortifying ourselves against its inroads. CHAPTER III. INEFFECTUAL TREATMENT. WE are most of us so far enlightened concerning our nervous systems as to regard our nerves as a very useful means of communication between the various parts of our machinery. The network of telegraph wires in this country, with their chief offices, have frequently been compared to our network of nerves with their chief offices, the brain and the spinal centres. Yet this comparison gives a totally inadequate conception of the functions of the nervous system. Many of us fail to realise that not only do the nerves bear messages from one part of the machinery to another, but that, without their co-operation, we can receive no impressions from the outside world at all, and can perform no function whatever. Without their aid, the eyes and ears are valueless, the muscles refuse to do their work, the digestive and respiratory processes cannot be carried on. If the nerve-centres are seriously injured, we become paralysed or die. If they be impaired, the whole body is enfeebled, and disease or incapacity of some particular organ may be occasioned. But, we may ask, how does it come about that, without external injury of any kind, the nervous systems of good people, leading good lives and given to good works, become impaired wholesale, and often remain impaired in spite of all efforts to restore them? Medical men tell us that, in such cases, the waste in the body exceeds the nutritive supply; but this assertion may be made with equal truth in regard to diseases of a different order, and, unfortunately, increase of the nutritive supply does not necessarily cure nervous exhaustion; it is the actual nerve-waste that we have to put a stop to. Even where a patient has purposely starved herself, mere feeding up does but bring her back to the point at which she began to starve. And if we could know the truth (if we would even try to know it), we should probably find that loathing of the food, and incapability to assimilate it, were the beginning of the seeming craze which, singularly enough, seems to afford so much amusement to the average nurse. We therefore still have the original disease to tackle. A long series of observations have convinced me, that though this original disease is not often satisfactorily cured, it can be cured, and ought to be cured. The reasons of so much failure seem to me to be evident enough, and later on I hope to state them fully. Let me give some interesting and instructive instances of failure. A few months ago I was told that a remarkable cure had been effected by means of a well-known treatment, in which isolation, massage, and electricity were the chief agents. I accepted an invitation to meet the patient—a lady—at a friend’s house, and on asking for details of the case, I was told that she had been for years prostrate on her couch, but had been entirely restored to health and activity by the above treatment. At the time appointed, I went to my friend’s house and was introduced to this “show-case.” What I saw was a lady manifestly suffering from severe nervous exhaustion. The strained expression of her face was sufficient evidence of mental fatigue; her attitude indicated bodily fatigue. Her voice and manner betrayed a total lack of the energy and elasticity that distinguish persons of her sanguine temperament when in good health, and it was evident that continuous conversation was trying to her in the extreme. I talked with her for a few minutes, refraining from asking direct questions. She readily informed me that she was undoubtedly cured by the treatment she had recently undergone; that, though the massage was very painful, she had greatly benefited by it; that she had been unable to stir off her couch before undergoing it, but that she had now returned to ordinary life, and was doing in all things as ordinary people did. All I can say is, I am very sorry for ordinary people. She seemed anxious to impress upon me the fact of her having had a real illness, and not a fanciful illness; little knowing that at that moment I was wondering at the strange fancies of those who could imagine such a miserable invalid to be well. She ended by informing me triumphantly that she was able to walk—how far do you think? Ten miles? Five miles? No, not even one mile. This supposed convalescent—this “show-case”—was able to drag herself exactly half-a-mile; that is to say, if she rested on a seat half- way—and she was unmistakably done up at the end of it. And this was the result of paying from ten to twenty guineas a week for a couple of months! I ascertained afterwards, on closer inquiry, that the poor lady was still weak and poorly in the opinion of unbiassed friends, but that her doctor and nurse had treated her as if she were very fussy, and as if the thing to be done was to cure her of her fancies. But there was little need to tell me so: she was so evidently ashamed of ever having been ill at all. Why can it not be honestly recognised that a young woman who is too weak to walk five miles, and chat with her friends afterwards without over-fatigue, is in an unsatisfactory state of health; and that a young lady who cannot walk half-a-mile without betraying, in spite of herself, symptoms of nervous exhaustion, is in a most dangerous and alarming state of health, and should at once be prevented from fatiguing herself further, lest she should either die of nervous prostration (failure of the heart’s action is, I believe, the polite name for this mode of making our exit), or lest she should fall a prey to one or other of the many forms of disease which are apt to attack weak women? To a person of common-sense, the bodily fatigue of painful massage, and the mental fatigue of being regarded as an imbecile, would hardly seem conducive to cure in cases where repose of mind and body are urgently needed; but in terror of that foe to our progress, the fixed idea, one is careful to leave a corner for even the remotest of possibilities. How this poor lady originally became a victim to the modern malady I do not know. What happened after it had developed itself is easy enough to comprehend. She had dragged herself about in misery till she could drag herself about no more, and then she had taken to her couch. Want of fresh air and exercise soon started a whole host of minor ills, which, though painful and annoying, were less dangerous than continued over-fatigue. These ailments were ineffectually doctored, one after another, in a variety of ways. Then came a physician who carried her bodily off to town, cured all the small ailments at once, and by means of the strong moral influence brought to bear upon the patient, persuaded her that lying in bed and having ailments was exceedingly selfish and sinful, besides being inhuman to those about her. It was then impressed upon her that she was cured, and she was warned against falling into sin any more. The patient actually found some of her ills cured, and persuaded herself that the remainder would yield in time. It is a matter of fact that the intellectually weak are readily wrought upon by those about them. In like manner, those who are suffering from nervous prostration are often mere reflectors of their companions, and their strength of character on recovery is a surprise to persons who have only known them during illness. Our powers of will and judgment depend not only on the number and correctness of the impressions collected and combined in the storehouse of the nervous system, but on the physical strength we have at command with which to put our machinery in motion. Nervous weakness cannot but impair the needful connection between its highly specialised parts. So the patient is entered in the doctor’s book as cured, and goes home to lead an ordinary life. The supposed success causes other ladies to be treated in a similar manner. If the doctor refrains from telling them how fanciful Miss So-and-so was, the nurse repairs the omission. In the meantime Miss So-and-so, little suspecting that she is being held up as a warning and an example,—perhaps even by name,—finds that her small stock of strength has not been sufficiently increased to enable her to bear the strain of an active existence. Perhaps she will break down under some well-known disease, in which case her friends will say, “How very unfortunate, just as Dr. —— had cured her of her nervousness!” Perhaps she will give in and take to her bed again, and then the nurses will say to their patients, “She was all right as long as we had her, but after she went home she took to her messy ways again, and now you see what she’s come to.” If I have heard this sort of thing said once, I have heard it a hundred times. In the days when I was even more ignorant than I am now, I used to argue with these worthy, misguided folks; but I have since realised the futility of trying to reason with people whose sieves have not pared and shaped them into a capability for reasoning correctly. Now you and I, and all cultured men and women in our community, have a voice in the meetings at the council-chamber of Public Opinion, and have power to modify the sieves through which these nurses pass. In fact, we are always modifying them in one way or another, whether we recognise the fact or not. And if we so far shirk our responsibilities as to allow the sieves to be formed badly, then we are very selfish, and that is infinitely worse than being ignorant and stupid. We shall not advance matters a single stage by throwing mud at individuals who have conscientiously done their best in very difficult circumstances. Here is another case of failure which ought to commend itself to our sense of humour. I recently met a young lady who showed the ordinary symptoms of nervous exhaustion. She had not collapsed entirely, but was forcing herself by sheer strength of will to undergo the painful dragging-about process. She informed me that she had just been consulting a physician who had labelled her “hysteria.”[2] How delighted we all are when we get hold of a label! I am, for one. Now this particular label is the concise and technical mode of saying, “Disease unknown;” and in these days of hurry, it is a great advantage to be concise. But excellent as the label is in this respect, edifying as it is as an example of candour, it is, unfortunately, peculiarly discouraging to the patient, and therefore encouraging to the disease. So we are glad to learn that it has at length been respectfully put to its long, last sleep by our kind friend Dr. Tibbits; and, though we are willing to admit that refuges for our half-knowledge are necessary landing-places in our upward evolutionary climb, we must also regard this service rendered by Dr. Tibbits as by no means the least with which he has benefited humanity. In “Massage and its Applications,” pp. 20-21, we read as follows:— “I would ask you to allow me to enter my protest against that refuge of destitute physicians and surgeons—the word ‘Hysteria!’ What does it mean? What do you understand by it? I have looked up many definitions...