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| author | Roger Frank <rfrank@pglaf.org> | 2025-10-15 04:41:34 -0700 |
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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..6833f05 --- /dev/null +++ b/.gitattributes @@ -0,0 +1,3 @@ +* text=auto +*.txt text +*.md text diff --git a/13197-0.txt b/13197-0.txt new file mode 100644 index 0000000..c9dbf2f --- /dev/null +++ b/13197-0.txt @@ -0,0 +1,1402 @@ +*** START OF THE PROJECT GUTENBERG EBOOK 13197 *** + +WEAR AND TEAR, + +OR + +HINTS FOR THE OVERWORKED. + +BY +S. WEIR MITCHELL, M.D., LL.D. HARV., + +MEMBER OF THE NATIONAL ACADEMY OF SCIENCES, PRESIDENT OF THE COLLEGE OF +PHYSICIANS OF PHILADELPHIA, ETC. + +_FIFTH EDITION_, +THOROUGHLY REVISED. + +PHILADELPHIA: +J.B. LIPPINCOTT COMPANY. +LONDON: 10 HENRIETTA STREET, COVENT GARDEN. + +Entered according to Act of Congress, in the year 1871, by +J.B. LIPPINCOTT & CO., +In the Office of the Librarian of Congress at Washington. + + +PRINTED BY J.B. LIPPINCOTT COMPANY, PHILADELPHIA. + + + +PREFACE. + +The rate of change in this country in education, in dress, and in diet +and habits of daily life surprises even the most watchful American +observer. It is now but fifteen years since this little book was written +as a warning to a restless nation possessed of an energy tempted to its +largest uses by unsurpassed opportunities. There is still need to repeat +and reinforce my former remonstrance, but I am glad to add that since I +first wrote on these subjects they have not only grown into importance +as questions of public hygiene, but vast changes for the better have +come about in many of our ways of living, and everywhere common sense is +beginning to rule in matters of dress, diet, and education. + +The American of the Eastern States and of the comfortable classes[1] is +becoming notably more ruddy and more stout. The alteration in women as +to these conditions is most striking, and, if I am not mistaken, in +England there is a lessening tendency towards that excess of adipose +matter which is still a surprise to the American visiting England for +the first time. + +I should scarcely venture to assert so positively that Americans had +obviously taken on flesh within a generation if what I see had not been +observed by many others. It would, I think, be interesting to enter at +length upon a study of these remarkable changes, but that were scarcely +within the scope of this little book. + +[Footnote 1: Happily, a large class with us.] + + + + + + +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. Somewhat 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 accordance 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 doctor's stand-point, +the evils which their own experience had taught them to see in our +present mode of tasking the brains of the younger girls. + +[Footnote 1: In 1871.] + +I hope, therefore, that I am justified in the belief 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 statistics 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. + +The sermon of which these words are the text has been preached many +times in many ways to congregations 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 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 out-door 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 colonist 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 prodigal 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 accumulations of power, but also wastefully +spending the capital? From a few we have grown to millions, and already +in many ways 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 competitions which make it +hard to live nowadays and embitter the daily bread of life. Neither had +they the 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 +competition 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 towards social advancement, and the overeducation 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 re-examine this +question--to see if it be true that the nervous system 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 venturing 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 questions of mental +hygiene of which in general we hear but too little. If the strictures I +have to make applied 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 mechanical +labor, as opposed to that of the clerk, is being "levelled 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 manufacture, 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 +antagonize 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 centres +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 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 centres which originate or +evolve muscular power do sometimes suffer from undue taxation; but it is +certainly true that when this happens, the evil result is rarely as +severe or as lasting as when 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-centres 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 excess of mental labor? The simple +answer is, that mental overwork is harder, because as a rule it is +closet or counting-room or at least in-door 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 quickening 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 material of mental acts as compared with motor +manifestations, and here, therefore, are at fault; because, although 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 motor 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 referable 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 +_wide-awakefulness_ 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 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 writing 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 Feuchtersleben's "Dietetics of the +Soul," both out of print, which deals in a readable fashion with this or +kindred topics.[1] Many men are warned by some sense of want of +clearness 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 attentive 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 system drive +him to take exercise. Especially when working 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. + +[Footnote 1: See, now, "Brain-Work and Overwork," by H.C. Wood, M.D.; +also, "Mental Overwork and Premature Disease among Public and +Professional Men," by Ch. K. Mills, M.D.; also, "Overwork and Sanitation +in Public Schools, with Remarks on the Production of Nervous Disease and +Insanity," by Ch. K. Mills, M.D.,--_Annals of Hygiene_, September, +1886.] + +One of our ablest medical scholars reports himself to me as having never +been aware of any sensation 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 accustomed 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 +clasping his hands over his head; and also there is desire to lie down +and rest. + +"I am not aware," writes a physician of distinction, "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 thinking organs rather too hard. As a +result, I began to have headache after every period of intellectual +exertion. 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 fulness 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 conditions under which men of note are using their mental +machinery would be everyway worthy of attention. + +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 useless +by the denial of full attention. Or else the imagination 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 overtasked brain belongs more or less to every man who overuses +this organ, and is the well-known initial symptom 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, 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 deserves, even from such thorough believers in unconscious +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 biography 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 before +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 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 thinking organs. But if into +the life of a man whose powers are fully taxed we bring the elements of +great anxiety or worry, or excessive haste, the whole machinery begins +at once to work, as it were, with a dangerous 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, because 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 +employed 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 horseback?" Perhaps, too, +there is concerned a physiological law, which, though somewhat +mysterious, I may again have to summon to my aid in the way of +explanation. 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 nervous system are +increasing rapidly in the more crowded portions of the United States; +but I am not aware that any one 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 frequent 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 together 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 system. But the most unquestionable proof of the increase 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 testing 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 fulfils 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-awake +business centre in America. I owe to the kindness of Dr. J.H. Rauch, +Sanitary Superintendent 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 conclusions 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 therefore ask that I may be supposed to have taken +every possible precaution in order not to exaggerate the reality of a +great evil. Certain diseases, such as apoplexy, palsy, epilepsy, St. +Vitus's dance, and lockjaw or tetanus, we all agree to consider as +nervous maladies; convulsions, 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-centres; 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 extremities 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 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 that 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 +labelled in the reports as dropsy of the brain and convulsions, have +risen to 20.4 times what they were in 1852. Thus in 1852, '53, and '55, +leaving out the cholera year '54, the deaths from nerve disorders were +respectively to the whole population as 1 in 1149, 1 in 953, and 1 in +941; whilst in 1866, '67, and '68, 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 every 9.9 of all deaths. + +I have alluded above to a class of deaths included in my tables, but +containing, no doubt, instances of mortality 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 proportion of this loss of life is really owing to brain +affections, I have thought best to include the whole class in my +statement. + +A glance at the individual diseases which are indubitably nervous is +more instructive and less perplexing. For example, taking the extreme +years, the recent increase in apoplexy is remarkable, even when we +remember that it is a malady of middle and later life, and that Chicago, +a new city, is therefore entitled to a yearly increasing quantity of +this form of death. In 1868 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 '53 there were but two deaths from +this disease; in the next four years there were none. From 1858 to '64, +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, increases in 1868,--8.6 times +as compared with 1852; and 26 times as compared with the four years +following 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 one only, and the +last-mentioned year has but two. 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 +general reader, he need only be told that tetanus is nearly always +caused by mechanical injuries, and that the natural increase of these in +a place like Chicago may account for a large part of the increase. Yet, +taking the record as a whole, and viewing it only with a calm 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 centre 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 +elsewhere throughout the land. + +[Footnote 1: I asked two citizens of this uneasy town--on the same +day--what was their business. Both replied tranquilly that they were +speculators!] + +The facts I have given establish the disproportionate increase in one +great city of those diseases which are largely produced by the strain on +the nervous 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 statistics of this +great business-centre; to see if the answers would weaken or reinforce +the conclusions drawn in 1871. 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 full, and nowhere else are the faces +so expressive of preoccupation, of anxiety, of excitement. It is making +money fast and accumulating a physiological debt of 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 solution of certain awkward questions which force +themselves 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 conditions +under which all work must be done in this country, some are out-growths +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 affect the male sex. If the mothers of a +people are sickly and weak, the sad inheritance falls upon their +offspring, 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 +thoughtfully 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 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 deliberately 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 ball-room. You will see many very +charming faces, the like of which the world cannot match--figures +somewhat too spare of flesh, and, especially south of Rhode Island, a +marvellous 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 eighteen, 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 ungracious 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, neuralgia, weak backs, and the varied +forms of hysteria,--that domestic demon which has produced untold +discomfort 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 do to make a household wretched. Mrs. Gradgrind is, 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 physical failure of our +city-bred women to fulfil 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 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 +numerous artificial infant foods now for sale singularly prove the truth +of this latter statement. Many physicians, 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 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 blame; while really, with rare +exceptions, the newer fashions have been more healthy than those they +superseded, people are better clad and better warmed than ever, and, +save in rare cases, late hours and overexertion in the dance are utterly +incapable of alone explaining 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 produce an effect which +would not in some other countries be so severe. I am quite persuaded, +indeed, that the development of a nervous temperament is one of the many +race-changes which are also giving us facial, vocal, and other +peculiarities 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 conditions which are +utterly mysterious, the obstacles to physical exercise, arising from +extremes of temperature, constitute at least one obvious cause of ill +health among women in our country. The great heat of summer, and the +slush and ice of winter, interfere with women who wish to take exercise, +but whose arrangements 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 as well able +to study, _with proper precautions_, 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 usefulness. + +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 reason, nearly always +exceeds the time stated by teachers to be necessary; and most girls of +our common schools and normal schools between the ages of thirteen and +seventeen thus expend two or three hours. Does any physician believe +that it is good for a growing 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, produce effects +on the growing brain which, in a vast number 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 +pushing,--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 be reinforced by what is to be said +farther on by a competent 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 non-promotion before the pupils; and when, added to +those extra inducements to work, there are given by committees and +superintendents examinations 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 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 they 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 overwork and overworry. The parents and +pupils themselves 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 examinations +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. + +"It will be observed that in this charge against parents I do not speak +of those causes of ill health which really have nothing to do with +overwork, but which are oftentimes forgotten when a school-boy 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 +indulgence 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 +circumstances of the pupil's life which can be conveniently ascertained, +even though those 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 understanding 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 particular pupil to lessen his work. Not +unfrequently there are found other causes of ill health than those which +I have mentioned; such, for instance, as poor ventilation, overheating +of the school-room, 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 overwork, 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."[1] + +[Footnote 1: Forty-ninth Annual Report of the Massachusetts Board of +Education, p. 204 (John T. Prince).] + +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 necessities 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 problem by taking two sets of beings of different gifts, and +of unlike physiological needs and construction, and forcing them into +the same educational mould. + +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 +conscientiousness, 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 surpasses 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 nowadays 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 feminine 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 little 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 proportion 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 professional guardianship at Johns Hopkins is +an admirable exception, and at some other institutions the physical +examination on matriculation becomes of the utmost value, when followed +up as it is in certain of these schools by compulsory physical training +and occasional re-examinations of the state of health. + +I do not see why the whole matter could not in all colleges be +systematically made part of the examinations on entry upon studies. It +would at least point out to the thoughtful student his weak points, and +enable 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 valvular troubles who had suffered from having been allowed +to play foot-ball. Cases of cerebral trouble in students, due to the use +of defective eyes, are common, and I have known many valuable lives +among male and female students crippled hopelessly owing to the fact +that no college pre-examination 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 +compete 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 remonstrate 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 with multiplied studies and unwholesome home life, +plods on, doing poor work, until somebody 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 perfectly 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. +Practically, 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 +admission at Harvard or Yale. Now, let any one compare the scale of +studies for both sexes employed half a century ago with that of to-day. +He will find that its 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 or earlier.[1] + +[Footnote 1: Witness Richardson's heroine, who was "perfect mistress of +the four rules of arithmetic"!] + +I firmly believe--and I am not alone in this opinion--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. Anything, 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 school-girls are suffering in health from +confinement, want of exercise at the time of day when they most incline +to it, bad ventilation,[1] and too steady occupation of mind. At no +other time of life is the nervous system so sensitive,--so irritable, I +might say,--and at no other are abundant fresh air and exercise so +important. To show more precisely how the growing girl is injured by the +causes just mentioned would lead me to speak of subjects unfit for full +discussion in these pages, but no thoughtful reader can be much at a +loss as to my meaning. + +[Footnote 1: 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 +school-house. As a consequence, we hear endless complaints from young +ladies of overheated or chilly rooms. If the teacher be old, the room is +kept too warm; if she be young, and much afoot about her school, the +apartment is apt to be cold.] + +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 every one concerned in our public +schools. + +[Footnote 1: Miss Pendleton.] + +"There can be no question that the health of growing 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 +examinations; 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 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 in-door +social amusements 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 school-room 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 apprehension. + +"This, with other statistics, would seem to bear 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 injurious 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 hundreds of girls hurried annually forward +beyond their physical or mental capacity, in advance of their physical +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." + +[Footnote 1: Philadelphia.] + +"Overpressure in school appears to me to be a disease of the body +politic from which this member suffers; but it also seems to me that +this vast school system is the most powerful agency for the correction +of the evil. In the case of girls, the first principle to be 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 education 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. + +"Edward Everett Hale, with his far spiritual sight, has discerned the +necessity for restoring home training, 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 prepared 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 +afterward,' cannot be too often quoted. Let branches in household +economy 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 insufficient food, and of acquiring skill in +household duties in addition to the school curriculum, we not only +simplify and harmonize her work, but we send out in every case a woman +prepared to carry this new influence 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 pre-empted 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 +advantage 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 capacity 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 over-pressure 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 a teacher. This unwholesome feature is the one distinctive +strain which must be removed from the 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. + +"Every teacher knows that the average girl of seventeen has not reached +the physical, mental, or moral development necessary to enter upon this +severe and high professional course of studies, and that one year is +insufficient for such a course. + +"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 instruction to a good high school covering a term of four +years. In this as in all other progressive formative periods the way out +is ahead. + +"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, +when they have sent out a large body of American women prepared, not for +a single profession, even the high feminine vocation of pedagogy, but +equipped for her highest, most general and congenial functions as the +source and centre of the home." + +I am unwilling to leave this subject without a few words as to our +remedy, especially as concerns our public schools and normal schools for +girls. What seems to me to be needed most is what the woman 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 hygienic +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 perhaps of all +civilized females the least qualified to undertake 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 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 dangers 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 national career alone will be +willing to admit my proposition, but among the higher intellectual +workers, such as astronomers, physicists, and naturalists, I have +frequently 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 answered 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 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 honored 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 +savans 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 be. Why this is I cannot say, but it is not more +mysterious than the fact that agents which, as sedatives or excitants, +affect the great nerve-centres, do this very differently in different +climates. There is some evidence 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 external temperatures, as well +as by the fact which Dr. Brown-Séquard discovered, and which I have +frequently 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 quantities 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 influences. + +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 +corporal 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 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] + +[Footnote 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.] + +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 anxiety or of +grave responsibility, are subject to the same form of disease; and this +I presume is why we meet with numerous instances of nervous exhaustion +among merchants and manufacturers. The lawyer and clergyman offer +examples, but I do not remember to have seen many bad cases among +physicians. Dismissing the easy jest which the latter statement will +surely suggest, the reason for this we may presently encounter. + +My note-books 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 involving 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 business, 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 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 counting-house 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 sea-shore. This +incessant monotony tells in the end. Men have confessed to me that for +twenty years they had worked every day, often travelling 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 representative 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, and +just as they are thinking, "Now we will stop and enjoy ourselves," the +brain, which, slave-like, 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 maturing; 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 responsibilities 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-increasing strain, and responsibilities +of gradual growth tend, with his out-door life, to save him from the +form of disease I have been alluding to. This element of open-air life, +I suspect, has a share in protecting men who in many respects lead a +most unhealthy existence. 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. +For these reasons I do not doubt that the effects of our great civil +war were far more severely felt by the Secretary of War and President +Lincoln than by Grant or Sherman. + +The wearing, incessant cares of overwork, of business 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-centres if the lighter warnings 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 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 centres with which he feels and thinks are more grave +and are less open to ready relief. + +When affections of the outlying organs are neglected, 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 +centres, 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 late war. Severe marches, bad food, and other +causes which make war exhausting, were constantly in action, until +certain 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 with 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-centres which furnish it with motor energy, so that excessive work +may bring about a state of congestion, owing to which the nerve-centre +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 +over-long on the stretch, and when moral causes, such as heavy +responsibilities and over-anxiety, are at work. + +When in active use, the thinking organs become full of blood, and, as +has been shown, rise in temperature, while the feet and hands become +cold. Nature 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 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 +than mere thought; and lastly, she desired that, during digestion, all +the surplus blood of the body should go to the stomach, intestines, and +liver, and that neither blood nor nerve-power should be then misdirected +upon the brain: in other words, she did not mean that we should try to +carry on, with equal energy, two kinds of important functional business +at once. + +If, then, the brain-user wishes to be healthy, he must limit his hours +of work according to rules which will come of experience, and which no +man can lay down for him. Above all, let him eat regularly and not at +too long intervals. I well remember the amazement of a distinguished +naturalist when told that his sleeplessness and irregular pulse were due +to his fasting from nine until six. A biscuit and a glass of porter, at +one o'clock, effected a ready and pleasant cure. As to exercise in the +fresh air, I need say little, except that if the exercise can be made to +have a distinct object, not in the way of business, so much the better. +Nor should I need to add that we may relieve the thinking and worrying +mechanisms by light reading and other amusements, or enforce the lesson +that no hard work should be attempted during digestion. The wise doctor +may haply smile at the commonplace of such directions, but woe be to the +man who neglects them! + +When an overworked and worried victim has sufficiently sinned against +these simple laws, if he does not luckily suffer from disturbances of +heart or stomach, he begins to have certain signs of nervous +exhaustion. + +As a rule, one of two symptoms appears first, though sometimes both come +together. Work gets to be a little less facile; this astonishes the +subject, especially if he has been under high pressure and doing his +tasks with that ease which comes of excitement. With this, or a little +later, he discovers that he sleeps badly, and that the thoughts of the +day infest his dreams, or so possess him as to make slumber difficult. +Unrefreshed, he rises and plunges anew into the labor for which he is no +longer competent. Let him stop here; he has had his warning. Day after +day the work grows more trying, but the varied stimulants to exertion +come into play, the mind, aroused, forgets in the cares of the day the +weariness of the night season, and so, with lessening power and growing +burden, he pursues his purpose. At last come certain new symptoms, such +as giddiness, dimness of sight, neuralgia of the face or scalp, with +entire nights of insomnia and growing difficulty in the use of the +mental powers; so that to attempt a calculation, or any form of +intellectual labor, is to insure a sense of distress in the head, or +such absolute pain as proves how deeply the organs concerned have +suffered. Even to read is sometimes almost impossible; and there still +remains the perilous fact that under enough of moral stimulus the man +may be able, for a few hours, to plunge into business cares, without +such pain as completely to incapacitate him for immediate activity. +Night, however, never fails to bring the punishment; and at last the +slightest prolonged exertion of mind becomes impossible. In the worst +cases the scalp itself grows sore, and a sudden jar hurts the brain, or +seems to do so, while the mere act of stepping from a curb-stone +produces positive pain. + +Strange as it may seem, much of all this may happen to a man, and he may +still struggle onward, ignorant of the terrible demands he is making +upon an exhausted brain. Usually, by this time he has sought advice, +and, if his doctor be worthy of the title, has learned that while there +are certain aids for his symptoms in the shape of drugs, there is only +one real remedy. Happy he if not too late in discovering that complete +and prolonged cessation from work is the one thing needful. Not a week +of holiday, or a month, but probably a year or more of utter idleness +may be absolutely essential. Only this will answer in cases so extreme +as that which I have tried to depict, and even this will not always +insure a return to a state of active working health. + +I am very far from conceding that the vehement energy with which we do +our work is due altogether to greed. We probably idle less and play less +than any other race, and the absence of national habits of sport, +especially in the West, leaves the man of business with no inducement to +abandon that unceasing labor in which at last he finds his sole +pleasure. He does not ride, or shoot, or fish, or play any game but +euchre. Business absorbs him utterly, and at last he finds neither time +nor desire for books. The newspaper is his sole literature; he has never +had time to acquire a taste for any reading save his ledger. Honest +friendship for books comes with youth or, as a rule, not at all. At last +his hour of peril arrives. Then you may separate him from business, but +you will find that to divorce his thoughts from it is impossible. The +fiend of work he raised no man can lay. As to foreign travel, it +wearies him. He has not the culture which makes it available or +pleasant. Notwithstanding the plasticity of the American, he is now +without resources. What then to advise I have asked myself countless +times. Let him at least look to it that his boys go not the same evil +road. The best business men are apt to think that their own successful +careers represent the lives their children ought to follow, and that the +four years of college spoil a lad for business. In reality these years, +be they idle or well filled with work, give young men the custom of +play, and surround them with an atmosphere of culture which leaves them +with bountiful resources for hours of leisure, while they insure to them +in these years of growth wholesome, unworried freedom from such business +pressure as the successful parent is so apt to put on too youthful +shoulders. + +Somewhat distracted by the desire to be brief, and yet to tell the whole +story, I have sought, in what I fear is a very loose and disconnected +way, to put in a new light some of the evils which are hurting the +mothers of our race, and those which every day's experience teaches the +doctor are gravely affecting the working capacity of numberless men. I +trust I have succeeded in satisfying my readers that we dwell in a +climate where work of all kinds demands greater precautions as to health +than is the case abroad. We cannot improve our climate, but it is quite +possible that we have not sufficiently learned to modify the conditions +of labor in accordance with those of the sky under which we live. + +No student of the nervous maladies of American men and women will think +I have overdrawn any part of the foregoing sketch. It would have been as +easy, had such a course been proper, to tell the individual stories of +youth, vigorous, eager, making haste to be rich, wrecked and made +unproductive and dependent for years or forever; and of middle age, +unable or unwilling to pause in the career of dollar-getting, crushed to +earth in the hour of fruition, or made powerless to labor longer at any +cost for those who were dearest. + +THE END. + + + + + + + +End of the Project Gutenberg EBook of Wear and Tear, by Silas Weir Mitchell + +*** END OF THE PROJECT GUTENBERG EBOOK 13197 *** diff --git a/13197-h/13197-h.htm b/13197-h/13197-h.htm new file mode 100644 index 0000000..c7b843b --- /dev/null +++ b/13197-h/13197-h.htm @@ -0,0 +1,1228 @@ +<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"> +<html> + +<head> +<meta http-equiv="Content-Type" content="text/html; charset=UTF-8"> +<meta name="GENERATOR" content="Microsoft FrontPage 4.0"> +<meta name="ProgId" content="FrontPage.Editor.Document"> +<title>The Project Gutenberg eBook of WEAR AND TEAR, OR HINTS FOR THE OVERWORKED +by S. WEIR MITCHELL.</title> +<style type="text/css"> + + p { text-align: justify; margin-top: .75em; margin-bottom: .75em } +table { border-collapse: collapse; border-style: none; border-width: medium } +*#col1 { border-style: none; border-width: medium } +h1, h2, h3, h4, h5, h6 { text-align: center } +hr { text-align: center; width: 50% } +html>body hr { width: 50%; margin-left: 25%; margin-right: 25% } +hr.full { width: 100% } +html>body hr.full { width: 100%; margin-left: 0%; margin-right: 0% } +hr.short { text-align: center; width: 20% } +html>body hr.short { width: 20%; margin-left: 40%; margin-right: 40% } +body { margin-left: 10%; margin-right: 10% } +img { border-style: none; border-width: medium } +.ctr { text-align: center } +.linenum { position: absolute; top: auto; left: 4% } +/* poetry number */ + .note { margin-left: 2em; margin-right: 2em; margin-bottom: 1em } +/* footnote */ + .blkquot { margin-left: 4em; margin-right: 4em } +/* block indent */ + .pagenum { position: absolute; left: 92%; font-size: smaller; text-align: right } +/* page numbers */ + .sidenote { width: 20%; font-size: smaller; float: right; clear: right; margin-top: 1em; + margin-bottom: 1em; padding-left: 1em } +.poem { text-align: left; margin-left: 10%; margin-right: 10% } +.poem br { display: none } +.poem .stanza { margin-left: 0em; margin-right: 0em; margin-top: 1em; margin-bottom: 1em } +.poem span { display: block; text-indent: -3em; margin: 0; padding-left: 3em } +.poem span.i2 { display: block; margin-left: 2em } +.poem span.i4 { display: block; margin-left: 4em } +.poem .caesura { vertical-align: -200% } + + </style> +</head> + +<body> +<div>*** START OF THE PROJECT GUTENBERG EBOOK 13197 ***</div> + +<br /> +<h1>WEAR AND TEAR,<br /> +<br /> +OR<br /> +<br /> +HINTS FOR THE OVERWORKED<br /> +<br /> +</h1> +<h4>BY</h4> +<h3>S. WEIR MITCHELL, M.D., LL.D. HARV.,</h3> +<h3>MEMBER OF THE NATIONAL ACADEMY OF SCIENCES, PRESIDENT OF THE COLLEGE OF +PHYSICIANS OF PHILADELPHIA, ETC.</h3> +<p> </p> +<p> </p> +<h5><i>FIFTH EDITION</i>,<br> +THOROUGHLY REVISED.</h5> +<h5>PHILADELPHIA:<br> +J.B. LIPPINCOTT COMPANY.<br> +LONDON: 10 HENRIETTA STREET, COVENT GARDEN</h5> +<h5>1891</h5> +<hr class="full" /> +<h5>Entered according to Act of Congress, in the year 1871, by<br> +J.B. LIPPINCOTT & CO.,<br> +In the Office of the Librarian of Congress at Washington.</h5> +<p> </p> +<h5>PRINTED BY J. B. LIPPINCOTT COMPANY, PHILADELPHIA.</h5> +<hr class="full" /> +<h2>PREFACE.</h2> +<p>The rate of change in this country in education, in dress, and in diet and +habits of daily life surprises even the most watchful American observer. It is +now but fifteen years since this little book was written as a warning to a +restless nation possessed of an energy tempted to its largest uses by +unsurpassed opportunities. There is still need to repeat and reinforce my former +remonstrance, but I am glad to add that since I first wrote on these subjects +they have not only grown into importance as questions of public hygiene, but +vast changes for the better have come about in many of our ways of living, and +everywhere common sense is beginning to rule in matters of dress, diet, and +education.</p> +<p>The American of the Eastern States and of the comfortable classes<a href="#fn1" name="fnref1"><sup>[1]</sup></a> +is becoming notably more ruddy and more stout. The alteration in women as to +these conditions is most striking, and, if I am not mistaken, in England there +is a lessening tendency towards that excess of adipose matter which is still a +surprise to the American visiting England for the first time.</p> +<p>I should scarcely venture to assert so positively that Americans had +obviously taken on flesh within a generation if what I see had not been observed +by many others. It would, I think, be interesting to enter at length upon a +study of these remarkable changes, but that were scarcely within the scope of +this little book.</p> +<blockquote> +<blockquote> +<p><a name="fn1"></a> <a href="#fnref1">[1]</a>Happily, a large class with us.</p> +</blockquote> +</blockquote> +<hr class="full" /> +<p> </p> +<h2>WEAR AND TEAR,<br> +<br> +OR<br> +<br> +HINTS FOR THE OVERWORKED.</h2> +<hr /> +<p>Many years ago<a href="#fn2" name="fnref2"><sup>[2]</sup></a> +I found occasion to set before the readers of <i>Lippincott's Magazine</i> +certain thoughts concerning work in America, and its results. Somewhat 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 accordance 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 doctor's stand-point, the evils which their own +experience had taught them to see in our present mode of tasking the brains of +the younger girls.</p> +<p>I hope, therefore, that I am justified in the belief 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 +statistics were taken from manuscript notes and have been printed in no +scientific journal.</p> +<p>I have called these Hints WEAR and TEAR, because this title clearly and +briefly points out my meaning. <i>Wear</i> 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. <i>Tear</i> 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.</p> +<p>The sermon of which these words are the text has been preached many times in +many ways to congregations 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 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.</p> +<p>The man who lives an out-door 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 colonist 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 prodigal 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 accumulations of power, but also wastefully spending +the capital? From a few we have grown to millions, and already in many ways 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 competitions which make it hard to live nowadays and embitter the daily +bread of life. Neither had they the 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.</p> +<p>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 competition +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 towards social advancement, +and the overeducation 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 re-examine this +question--to see if it be true that the nervous system 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 venturing 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 questions of +mental hygiene of which in general we hear but too little. If the strictures I +have to make applied 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 +mechanical labor, as opposed to that of the clerk, is being "levelled +upward" with fortunate celerity.</p> +<p>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.</p> +<p>The human body carries on several kinds of manufacture, 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 antagonize 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 centres 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 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 centres which originate or evolve muscular power do +sometimes suffer from undue taxation; but it is certainly true that when this +happens, the evil result is rarely as severe or as lasting as when it is the +organs of mental power that have suffered.</p> +<p>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-centres 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 excess of mental +labor? The simple answer is, that mental overwork is harder, because as a rule +it is closet or counting-room or at least in-door 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 quickening 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.</p> +<p>But there is more than this in the question. We do not know as yet what is +the cost in expended material of mental acts as compared with motor +manifestations, and here, therefore, are at fault; because, although 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.</p> +<p>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 motor 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 referable 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 <i>wide-awakefulness</i> 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 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.</p> +<p>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.</p> +<p>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 +writing 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.</p> +<p>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 Feuchtersleben's "Dietetics of the +Soul," both out of print, which deals in a readable fashion with this or +kindred topics.<a href="#fn3" name="fnref3"><sup>[3]</sup></a> +Many men are warned by some sense of want of clearness 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 attentive 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 system drive him to take exercise. Especially when working 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.</p> +<p>One of our ablest medical scholars reports himself to me as having never been +aware of any sensation 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 accustomed 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 clasping his hands over his head; and also there is desire to lie +down and rest.</p> +<p>"I am not aware," writes a physician of distinction, "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 thinking organs rather too hard. As a result, I began to have +headache after every period of intellectual exertion. 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 fulness 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 +conditions under which men of note are using their mental machinery would be +everyway worthy of attention.</p> +<p>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 +useless by the denial of full attention. Or else the imagination 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.</p> +<p>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 +overtasked brain belongs more or less to every man who overuses this organ, and +is the well-known initial symptom 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, 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 deserves, even from such thorough believers in unconscious +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 +biography 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.</p> +<p>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 before 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.</p> +<p>Looking broadly at the question of the influence of 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 thinking organs. But if into the life of a man whose powers are fully taxed +we bring the elements of great anxiety or worry, or excessive haste, the whole +machinery begins at once to work, as it were, with a dangerous 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.</p> +<p>I have been careful here to state that combined overwork of mind and body is +doubly mischievous, because 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 employed 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 horseback?" Perhaps, too, +there is concerned a physiological law, which, though somewhat mysterious, I may +again have to summon to my aid in the way of explanation. 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.</p> +<p>It has long been believed that maladies of the nervous system are increasing +rapidly in the more crowded portions of the United States; but I am not aware +that any one 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 +frequent 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 together 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 system. But the +most unquestionable proof of the increase of nervous disease is to be looked for +in the death statistics of cities.</p> +<p>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 +testing 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 +fulfils 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-awake business centre in America. I owe to the kindness of +Dr. J.H. Rauch, Sanitary Superintendent 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 conclusions 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.</p> +<p>The honest use of the mortuary statistics of a large town is no easy matter, +and I must therefore ask that I may be supposed to have taken every possible +precaution in order not to exaggerate the reality of a great evil. Certain +diseases, such as apoplexy, palsy, epilepsy, St. Vitus's dance, and lockjaw or +tetanus, we all agree to consider as nervous maladies; convulsions, 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-centres; 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 extremities 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 +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.</p> +<p>Taking the years 1852 to 1868, inclusive, it will be found that 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 labelled in the +reports as dropsy of the brain and convulsions, have risen to 20.4 times what +they were in 1852. Thus in 1852, '53, and '55, leaving out the cholera year '54, +the deaths from nerve disorders were respectively to the whole population as 1 +in 1149, 1 in 953, and 1 in 941; whilst in 1866, '67, and '68, 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 every 9.9 of all deaths.</p> +<p>I have alluded above to a class of deaths included in my tables, but +containing, no doubt, instances of mortality 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 proportion of this loss of life is really +owing to brain affections, I have thought best to include the whole class in my +statement.</p> +<p>A glance at the individual diseases which are indubitably nervous is more +instructive and less perplexing. For example, taking the extreme years, the +recent increase in apoplexy is remarkable, even when we remember that it is a +malady of middle and later life, and that Chicago, a new city, is therefore +entitled to a yearly increasing quantity of this form of death. In 1868 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 '53 there were but two deaths from this +disease; in the next four years there were none. From 1858 to '64, 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, increases in 1868,--8.6 times as compared with 1852; and 26 times as +compared with the four years following 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 one only, and the +last-mentioned year has but two. 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 general reader, he need only be told that tetanus is +nearly always caused by mechanical injuries, and that the natural increase of +these in a place like Chicago may account for a large part of the increase. Yet, +taking the record as a whole, and viewing it only with a calm desire to get at +the truth, it is not possible to avoid seeing that the growth of nerve maladies +has been inordinate.</p> +<p>The industry and energy which have built this great city on a morass, and +made it a vast centre of insatiate commerce, are now at work to undermine the +nervous systems of its restless and eager people,<a href="#fn4" name="fnref4"><sup>[4]</sup></a> +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 elsewhere +throughout the land.</p> +<p>The facts I have given establish the disproportionate increase in one great +city of those diseases which are largely produced by the strain on the nervous +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.</p> +<p>It were interesting to-day to question the later statistics of this great +business-centre; to see if the answers would weaken or reinforce the conclusions +drawn in 1871. 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 full, and +nowhere else are the faces so expressive of preoccupation, of anxiety, of +excitement. It is making money fast and accumulating a physiological debt of +which that bitter creditor, the future, will one day demand payment.</p> +<p>If I have made myself understood, we are now prepared to apply some of our +knowledge to the solution of certain awkward questions which force themselves +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 conditions under which all work must be done in +this country, some are out-growths of our modes of labor, and some go back to +social habitudes and defective methods of early educational training.</p> +<p>In studying this subject, it will not answer to look only at the causes of +sickness and weakness which affect the male sex. If the mothers of a people are +sickly and weak, the sad inheritance falls upon their offspring, 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 thoughtfully 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 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 deliberately place myself. Perhaps I ought to add that the replies I +have heard given by others were appalling.</p> +<p>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 ball-room. You will see many very charming faces, the like of +which the world cannot match--figures somewhat too spare of flesh, and, +especially south of Rhode Island, a marvellous 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 eighteen, 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 ungracious +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, neuralgia, +weak backs, and the varied forms of hysteria,--that domestic demon which has +produced untold discomfort 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 do to +make a household wretched. Mrs. Gradgrind is, 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.</p> +<p>If any reader doubts my statement as to the physical failure of our city-bred +women to fulfil 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 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 numerous artificial infant foods now for sale singularly prove the +truth of this latter statement. Many physicians, 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 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 blame; while really, with rare exceptions, the newer fashions have +been more healthy than those they superseded, people are better clad and better +warmed than ever, and, save in rare cases, late hours and overexertion in the +dance are utterly incapable of alone explaining 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 produce an effect which would +not in some other countries be so severe. I am quite persuaded, indeed, that the +development of a nervous temperament is one of the many race-changes which are +also giving us facial, vocal, and other peculiarities 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.</p> +<p>While a part of the mischief lies with climatic conditions which are utterly +mysterious, the obstacles to physical exercise, arising from extremes of +temperature, constitute at least one obvious cause of ill health among women in +our country. The great heat of summer, and the slush and ice of winter, +interfere with women who wish to take exercise, but whose arrangements to go +out-of-doors involve wonderful changes of dress and an amount of preparation +appalling to the masculine creature.</p> +<p>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 as well able to study, <i>with proper +precautions</i>, 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 usefulness.</p> +<p>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 reason, nearly +always exceeds the time stated by teachers to be necessary; and most girls of +our common schools and normal schools between the ages of thirteen and seventeen +thus expend two or three hours. Does any physician believe that it is good for a +growing 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, produce effects +on the growing brain which, in a vast number of cases, can be only disastrous.</p> +<p>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.</p> +<p>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 pushing,--of competitive +examinations,--of ranking, etc., is in a measure responsible for that worry +which adds a dangerous element to work.</p> +<p>The following remarks as to the influence of home life in Massachusetts are +not out of place here, and will be reinforced by what is to be said farther on +by a competent authority as to Philadelphia:</p> +<p>"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 non-promotion before the pupils; and when, added to those extra +inducements to work, there are given by committees and superintendents +examinations 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 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 they 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.</p> +<p>"In making up the verdict we must not forget that others besides the +teacher may be responsible for overwork and overworry. The parents and pupils +themselves 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 examinations 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.</p> +<p>"It will be observed that in this charge against parents I do not speak +of those causes of ill health which really have nothing to do with overwork, but +which are oftentimes forgotten when a school-boy 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 indulgence 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 circumstances of the pupil's life which can be +conveniently ascertained, even though those 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 understanding 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 particular pupil to lessen his work. Not unfrequently there are found +other causes of ill health than those which I have mentioned; such, for +instance, as poor ventilation, overheating of the school-room, 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 overwork, 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."<a href="#fn5" name="fnref5"><sup>[5]</sup></a></p> +<p>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 necessities as stimulate the pupils of what we are pleased to call a normal +(!) school.</p> +<p>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.</p> +<p>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 +problem by taking two sets of beings of different gifts, and of unlike +physiological needs and construction, and forcing them into the same educational +mould.</p> +<p>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 conscientiousness, 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 surpasses 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.</p> +<p>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.</p> +<p>The colleges for women, such as Vassar, are nowadays 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 feminine 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.</p> +<p>As concerns our colleges for young men I have little 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 proportion 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 professional +guardianship at Johns Hopkins is an admirable exception, and at some other +institutions the physical examination on matriculation becomes of the utmost +value, when followed up as it is in certain of these schools by compulsory +physical training and occasional re-examinations of the state of health.</p> +<p>I do not see why the whole matter could not in all colleges be systematically +made part of the examinations on entry upon studies. It would at least point out +to the thoughtful student his weak points, and enable 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 valvular troubles who had suffered +from having been allowed to play foot-ball. Cases of cerebral trouble in +students, due to the use of defective eyes, are common, and I have known many +valuable lives among male and female students crippled hopelessly owing to the +fact that no college pre-examination 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 compete on even +terms with their fellows.</p> +<p>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 remonstrate 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 with +multiplied studies and unwholesome home life, plods on, doing poor work, until +somebody 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 +perfectly 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. Practically, 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 admission at Harvard or Yale. +Now, let any one compare the scale of studies for both sexes employed half a +century ago with that of to-day. He will find that its 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 or earlier.<a href="#fn6" name="fnref6"><sup>[6]</sup></a></p> +<p>I firmly believe--and I am not alone in this opinion--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. Anything, 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 school-girls are suffering in health from confinement, want of +exercise at the time of day when they most incline to it, bad ventilation,<a href="#fn7" name="fnref7"><sup>[7]</sup></a> +and too steady occupation of mind. At no other time of life is the nervous +system so sensitive,--so irritable, I might say,--and at no other are abundant +fresh air and exercise so important. To show more precisely how the growing girl +is injured by the causes just mentioned would lead me to speak of subjects unfit +for full discussion in these pages, but no thoughtful reader can be much at a +loss as to my meaning.</p> +<p>The following remarks I owe to the experience of a friend,<a href="#fn8" name="fnref8"><sup>[8]</sup></a> +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 every one concerned in our public schools.</p> +<p>"There can be no question that the health of growing 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 examinations; 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 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 in-door social amusements 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 school-room 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.</p> +<p>"A Latin graduating class of seven girls, aged seventeen and eighteen +years, stated that they do their work without nervousness, restlessness, or +apprehension.</p> +<p>"This, with other statistics, would seem to bear out your theory that +after seventeen girls may study with much less risk to health.</p> +<p>"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.</p> +<p>"Our own normal school,<a href="#fn9" name="fnref9"><sup>[9]</sup></a> which is doing +a great, an indispensable, work in preparing a trained body of faithful, +intelligent teachers, has succumbed to this injurious 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 hundreds of girls hurried annually forward +beyond their physical or mental capacity, in advance of their physical 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."</p> +<p>"Overpressure in school appears to me to be a disease of the body +politic from which this member suffers; but it also seems to me that this vast +school system is the most powerful agency for the correction of the evil. In the +case of girls, the first principle to be 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 education for boys.</p> +<p>"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.</p> +<p>"Edward Everett Hale, with his far spiritual sight, has discerned the +necessity for restoring home training, 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.</p> +<p>"When it was discovered that citizens must be prepared 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 afterward,' cannot be too +often quoted. Let branches in household economy 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 insufficient food, and of +acquiring skill in household duties in addition to the school curriculum, we not +only simplify and harmonize her work, but we send out in every case a woman +prepared to carry this new influence 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 pre-empted by men, it will be by the essential +quality of this new feminine element.</p> +<p>"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 advantage 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 capacity 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.</p> +<p>"The first step toward the relief of over-pressure 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 a teacher. +This unwholesome feature is the one distinctive strain which must be removed +from the 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.</p> +<p>"Every teacher knows that the average girl of seventeen has not reached +the physical, mental, or moral development necessary to enter upon this severe +and high professional course of studies, and that one year is insufficient for +such a course.</p> +<p>"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 instruction to a good high school covering a term of four years. In this +as in all other progressive formative periods the way out is ahead.</p> +<p>"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, when they +have sent out a large body of American women prepared, not for a single +profession, even the high feminine vocation of pedagogy, but equipped for her +highest, most general and congenial functions as the source and centre of the +home."</p> +<p>I am unwilling to leave this subject without a few words as to our remedy, +especially as concerns our public schools and normal schools for girls. What +seems to me to be needed most is what the woman 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 hygienic needs in +the way of sleep, hours of study, light, and meals.</p> +<p>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 perhaps of all civilized females the least qualified +to undertake 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?</p> +<p>While making these stringent criticisms, I am anxious not to be +misunderstood. The point which 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 dangers 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.</p> +<p>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 national career +alone will be willing to admit my proposition, but among the higher intellectual +workers, such as astronomers, physicists, and naturalists, I have frequently +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 answered 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 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 honored 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 savans 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 be. Why this is I cannot say, +but it is not more mysterious than the fact that agents which, as sedatives or +excitants, affect the great nerve-centres, do this very differently in different +climates. There is some evidence 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 external temperatures, as well as by the fact +which Dr. Brown-Séquard discovered, and which I have frequently corroborated, +that many poisons are retarded in their action by placing the animal affected in +a warm atmosphere.</p> +<p>It is possible to drink with safety in England quantities 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 influences.</p> +<p>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 corporal 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 in Europe, and is followed by greater sense of +fatigue.</p> +<p>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.</p> +<p>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.<a href="#fn10" name="fnref10"><sup>[10]</sup></a></p> +<p>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 anxiety or of grave +responsibility, are subject to the same form of disease; and this I presume is +why we meet with numerous instances of nervous exhaustion among merchants and +manufacturers. The lawyer and clergyman offer examples, but I do not remember to +have seen many bad cases among physicians. Dismissing the easy jest which the +latter statement will surely suggest, the reason for this we may presently +encounter.</p> +<p>My note-books 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.</p> +<p>The worst instances to be met with are among young men suddenly cast into +business positions involving 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 business, 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 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 counting-house 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 sea-shore. This incessant +monotony tells in the end. Men have confessed to me that for twenty years they +had worked every day, often travelling 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 representative of a frightfully +general social evil.</p> +<p>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, and just as they are +thinking, "Now we will stop and enjoy ourselves," the brain, which, +slave-like, 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 maturing; +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.</p> +<p>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 +responsibilities 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-increasing strain, and responsibilities of gradual growth +tend, with his out-door life, to save him from the form of disease I have been +alluding to. This element of open-air life, I suspect, has a share in protecting +men who in many respects lead a most unhealthy existence. 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. For these +reasons I do not doubt that the effects of our great civil war were far more +severely felt by the Secretary of War and President Lincoln than by Grant or +Sherman.</p> +<p>The wearing, incessant cares of overwork, of business 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-centres if the lighter warnings 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 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 centres with which he feels and thinks are more grave +and are less open to ready relief.</p> +<p>When affections of the outlying organs are neglected, 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 centres, 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 late war. Severe +marches, bad food, and other causes which make war exhausting, were constantly +in action, until certain 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 with palsy of the legs. A few months of absolute +rest, good diet, ale, fresh beef and vegetables restored them to perfect health.</p> +<p>In all probability incessant use of a part flushes with blood the +nerve-centres which furnish it with motor energy, so that excessive work may +bring about a state of congestion, owing to which the nerve-centre 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.</p> +<p>Now let us see what happens when the intellectual organs are put over-long on +the stretch, and when moral causes, such as heavy responsibilities and +over-anxiety, are at work.</p> +<p>When in active use, the thinking organs become full of blood, and, as has +been shown, rise in temperature, while the feet and hands become cold. Nature +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 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 than +mere thought; and lastly, she desired that, during digestion, all the surplus +blood of the body should go to the stomach, intestines, and liver, and that +neither blood nor nerve-power should be then misdirected upon the brain: in +other words, she did not mean that we should try to carry on, with equal energy, +two kinds of important functional business at once.</p> +<p>If, then, the brain-user wishes to be healthy, he must limit his hours of +work according to rules which will come of experience, and which no man can lay +down for him. Above all, let him eat regularly and not at too long intervals. I +well remember the amazement of a distinguished naturalist when told that his +sleeplessness and irregular pulse were due to his fasting from nine until six. A +biscuit and a glass of porter, at one o'clock, effected a ready and pleasant +cure. As to exercise in the fresh air, I need say little, except that if the +exercise can be made to have a distinct object, not in the way of business, so +much the better. Nor should I need to add that we may relieve the thinking and +worrying mechanisms by light reading and other amusements, or enforce the lesson +that no hard work should be attempted during digestion. The wise doctor may +haply smile at the commonplace of such directions, but woe be to the man who +neglects them!</p> +<p>When an overworked and worried victim has sufficiently sinned against these +simple laws, if he does not luckily suffer from disturbances of heart or +stomach, he begins to have certain signs of nervous exhaustion.</p> +<p>As a rule, one of two symptoms appears first, though sometimes both come +together. Work gets to be a little less facile; this astonishes the subject, +especially if he has been under high pressure and doing his tasks with that ease +which comes of excitement. With this, or a little later, he discovers that he +sleeps badly, and that the thoughts of the day infest his dreams, or so possess +him as to make slumber difficult. Unrefreshed, he rises and plunges anew into +the labor for which he is no longer competent. Let him stop here; he has had his +warning. Day after day the work grows more trying, but the varied stimulants to +exertion come into play, the mind, aroused, forgets in the cares of the day the +weariness of the night season, and so, with lessening power and growing burden, +he pursues his purpose. At last come certain new symptoms, such as giddiness, +dimness of sight, neuralgia of the face or scalp, with entire nights of insomnia +and growing difficulty in the use of the mental powers; so that to attempt a +calculation, or any form of intellectual labor, is to insure a sense of distress +in the head, or such absolute pain as proves how deeply the organs concerned +have suffered. Even to read is sometimes almost impossible; and there still +remains the perilous fact that under enough of moral stimulus the man may be +able, for a few hours, to plunge into business cares, without such pain as +completely to incapacitate him for immediate activity. Night, however, never +fails to bring the punishment; and at last the slightest prolonged exertion of +mind becomes impossible. In the worst cases the scalp itself grows sore, and a +sudden jar hurts the brain, or seems to do so, while the mere act of stepping +from a curb-stone produces positive pain.</p> +<p>Strange as it may seem, much of all this may happen to a man, and he may +still struggle onward, ignorant of the terrible demands he is making upon an +exhausted brain. Usually, by this time he has sought advice, and, if his doctor +be worthy of the title, has learned that while there are certain aids for his +symptoms in the shape of drugs, there is only one real remedy. Happy he if not +too late in discovering that complete and prolonged cessation from work is the +one thing needful. Not a week of holiday, or a month, but probably a year or +more of utter idleness may be absolutely essential. Only this will answer in +cases so extreme as that which I have tried to depict, and even this will not +always insure a return to a state of active working health.</p> +<p>I am very far from conceding that the vehement energy with which we do our +work is due altogether to greed. We probably idle less and play less than any +other race, and the absence of national habits of sport, especially in the West, +leaves the man of business with no inducement to abandon that unceasing labor in +which at last he finds his sole pleasure. He does not ride, or shoot, or fish, +or play any game but euchre. Business absorbs him utterly, and at last he finds +neither time nor desire for books. The newspaper is his sole literature; he has +never had time to acquire a taste for any reading save his ledger. Honest +friendship for books comes with youth or, as a rule, not at all. At last his +hour of peril arrives. Then you may separate him from business, but you will +find that to divorce his thoughts from it is impossible. The fiend of work he +raised no man can lay. As to foreign travel, it wearies him. He has not the +culture which makes it available or pleasant. Notwithstanding the plasticity of +the American, he is now without resources. What then to advise I have asked +myself countless times. Let him at least look to it that his boys go not the +same evil road. The best business men are apt to think that their own successful +careers represent the lives their children ought to follow, and that the four +years of college spoil a lad for business. In reality these years, be they idle +or well filled with work, give young men the custom of play, and surround them +with an atmosphere of culture which leaves them with bountiful resources for +hours of leisure, while they insure to them in these years of growth wholesome, +unworried freedom from such business pressure as the successful parent is so apt +to put on too youthful shoulders.</p> +<p>Somewhat distracted by the desire to be brief, and yet to tell the whole +story, I have sought, in what I fear is a very loose and disconnected way, to +put in a new light some of the evils which are hurting the mothers of our race, +and those which every day's experience teaches the doctor are gravely affecting +the working capacity of numberless men. I trust I have succeeded in satisfying +my readers that we dwell in a climate where work of all kinds demands greater +precautions as to health than is the case abroad. We cannot improve our climate, +but it is quite possible that we have not sufficiently learned to modify the +conditions of labor in accordance with those of the sky under which we live.</p> +<p>No student of the nervous maladies of American men and women will think I +have overdrawn any part of the foregoing sketch. It would have been as easy, had +such a course been proper, to tell the individual stories of youth, vigorous, +eager, making haste to be rich, wrecked and made unproductive and dependent for +years or forever; and of middle age, unable or unwilling to pause in the career +of dollar-getting, crushed to earth in the hour of fruition, or made powerless +to labor longer at any cost for those who were dearest.</p> +<blockquote> +<blockquote> +<p><a name="fn2"></a> <a href="#fnref2">[2]</a>In 1871.</p> +<p><a name="fn3"></a> <a href="#fnref3">[3]</a>See, now, "Brain-Work and +Overwork," by H.C. Wood, M.D.; also, "Mental Overwork and Premature +Disease among Public and Professional Men," by Ch. K. Mills, M.D.; also, +"Overwork and Sanitation in Public Schools, with Remarks on the Production +of Nervous Disease and Insanity," by Ch. K. Mills, M.D.,--<i>Annals of +Hygiene</i>, September, 1886.</p> +<p><a name="fn4"></a> <a href="#fnref4">[4]</a>I asked two citizens of this uneasy town--on +the same day--what was their business. Both replied tranquilly that they were +speculators!</p> +<p><a name="fn5"></a> <a href="#fnref5">[5]</a>Forty-ninth Annual Report of the +Massachusetts Board of Education, p. 204 (John T. Prince).</p> +<p><a name="fn6"></a> <a href="#fnref6">[6]</a>Witness Richardson's heroine, who was +"perfect mistress of the four rules of arithmetic"!</p> +<p><a name="fn7"></a> <a href="#fnref7">[7]</a>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 +school-house. As a consequence, we hear endless complaints from young ladies of +overheated or chilly rooms. If the teacher be old, the room is kept too warm; if +she be young, and much afoot about her school, the apartment is apt to be cold.</p> +<p><a name="fn8"></a> <a href="#fnref8">[8]</a>Miss Pendleton.</p> +<p><a name="fn9"></a> <a href="#fnref9">[9]</a>Philadelphia.</p> +<p><a name="fn10"></a> <a href="#fnref10">[10]</a>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.</p> +</blockquote> +</blockquote> +<h2>THE END.</h2> + +<div>*** END OF THE PROJECT GUTENBERG EBOOK 13197 ***</div> +</body> + +</html> diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..ddc0f6c --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #13197 (https://www.gutenberg.org/ebooks/13197) diff --git a/old/13197-0.txt b/old/13197-0.txt new file mode 100644 index 0000000..8f17006 --- /dev/null +++ b/old/13197-0.txt @@ -0,0 +1,1785 @@ +The Project Gutenberg EBook of Wear and Tear, by Silas Weir Mitchell + +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 + + +Title: Wear and Tear + or, Hints for the Overworked + +Author: Silas Weir Mitchell + +Release Date: August 17, 2004 [EBook #13197] + +Language: English + +Character set encoding: UTF-8 + +*** START OF THIS PROJECT GUTENBERG EBOOK WEAR AND TEAR *** + + + + +Produced by Bryan Ness and PG Distributed Proofreaders + + + + + +WEAR AND TEAR, + +OR + +HINTS FOR THE OVERWORKED. + +BY +S. WEIR MITCHELL, M.D., LL.D. HARV., + +MEMBER OF THE NATIONAL ACADEMY OF SCIENCES, PRESIDENT OF THE COLLEGE OF +PHYSICIANS OF PHILADELPHIA, ETC. + +_FIFTH EDITION_, +THOROUGHLY REVISED. + +PHILADELPHIA: +J.B. LIPPINCOTT COMPANY. +LONDON: 10 HENRIETTA STREET, COVENT GARDEN. + +Entered according to Act of Congress, in the year 1871, by +J.B. LIPPINCOTT & CO., +In the Office of the Librarian of Congress at Washington. + + +PRINTED BY J.B. LIPPINCOTT COMPANY, PHILADELPHIA. + + + +PREFACE. + +The rate of change in this country in education, in dress, and in diet +and habits of daily life surprises even the most watchful American +observer. It is now but fifteen years since this little book was written +as a warning to a restless nation possessed of an energy tempted to its +largest uses by unsurpassed opportunities. There is still need to repeat +and reinforce my former remonstrance, but I am glad to add that since I +first wrote on these subjects they have not only grown into importance +as questions of public hygiene, but vast changes for the better have +come about in many of our ways of living, and everywhere common sense is +beginning to rule in matters of dress, diet, and education. + +The American of the Eastern States and of the comfortable classes[1] is +becoming notably more ruddy and more stout. The alteration in women as +to these conditions is most striking, and, if I am not mistaken, in +England there is a lessening tendency towards that excess of adipose +matter which is still a surprise to the American visiting England for +the first time. + +I should scarcely venture to assert so positively that Americans had +obviously taken on flesh within a generation if what I see had not been +observed by many others. It would, I think, be interesting to enter at +length upon a study of these remarkable changes, but that were scarcely +within the scope of this little book. + +[Footnote 1: Happily, a large class with us.] + + + + + + +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. Somewhat 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 accordance 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 doctor's stand-point, +the evils which their own experience had taught them to see in our +present mode of tasking the brains of the younger girls. + +[Footnote 1: In 1871.] + +I hope, therefore, that I am justified in the belief 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 statistics 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. + +The sermon of which these words are the text has been preached many +times in many ways to congregations 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 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 out-door 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 colonist 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 prodigal 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 accumulations of power, but also wastefully +spending the capital? From a few we have grown to millions, and already +in many ways 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 competitions which make it +hard to live nowadays and embitter the daily bread of life. Neither had +they the 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 +competition 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 towards social advancement, and the overeducation 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 re-examine this +question--to see if it be true that the nervous system 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 venturing 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 questions of mental +hygiene of which in general we hear but too little. If the strictures I +have to make applied 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 mechanical +labor, as opposed to that of the clerk, is being "levelled 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 manufacture, 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 +antagonize 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 centres +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 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 centres which originate or +evolve muscular power do sometimes suffer from undue taxation; but it is +certainly true that when this happens, the evil result is rarely as +severe or as lasting as when 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-centres 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 excess of mental labor? The simple +answer is, that mental overwork is harder, because as a rule it is +closet or counting-room or at least in-door 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 quickening 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 material of mental acts as compared with motor +manifestations, and here, therefore, are at fault; because, although 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 motor 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 referable 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 +_wide-awakefulness_ 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 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 writing 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 Feuchtersleben's "Dietetics of the +Soul," both out of print, which deals in a readable fashion with this or +kindred topics.[1] Many men are warned by some sense of want of +clearness 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 attentive 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 system drive +him to take exercise. Especially when working 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. + +[Footnote 1: See, now, "Brain-Work and Overwork," by H.C. Wood, M.D.; +also, "Mental Overwork and Premature Disease among Public and +Professional Men," by Ch. K. Mills, M.D.; also, "Overwork and Sanitation +in Public Schools, with Remarks on the Production of Nervous Disease and +Insanity," by Ch. K. Mills, M.D.,--_Annals of Hygiene_, September, +1886.] + +One of our ablest medical scholars reports himself to me as having never +been aware of any sensation 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 accustomed 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 +clasping his hands over his head; and also there is desire to lie down +and rest. + +"I am not aware," writes a physician of distinction, "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 thinking organs rather too hard. As a +result, I began to have headache after every period of intellectual +exertion. 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 fulness 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 conditions under which men of note are using their mental +machinery would be everyway worthy of attention. + +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 useless +by the denial of full attention. Or else the imagination 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 overtasked brain belongs more or less to every man who overuses +this organ, and is the well-known initial symptom 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, 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 deserves, even from such thorough believers in unconscious +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 biography 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 before +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 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 thinking organs. But if into +the life of a man whose powers are fully taxed we bring the elements of +great anxiety or worry, or excessive haste, the whole machinery begins +at once to work, as it were, with a dangerous 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, because 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 +employed 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 horseback?" Perhaps, too, +there is concerned a physiological law, which, though somewhat +mysterious, I may again have to summon to my aid in the way of +explanation. 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 nervous system are +increasing rapidly in the more crowded portions of the United States; +but I am not aware that any one 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 frequent 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 together 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 system. But the most unquestionable proof of the increase 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 testing 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 fulfils 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-awake +business centre in America. I owe to the kindness of Dr. J.H. Rauch, +Sanitary Superintendent 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 conclusions 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 therefore ask that I may be supposed to have taken +every possible precaution in order not to exaggerate the reality of a +great evil. Certain diseases, such as apoplexy, palsy, epilepsy, St. +Vitus's dance, and lockjaw or tetanus, we all agree to consider as +nervous maladies; convulsions, 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-centres; 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 extremities 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 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 that 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 +labelled in the reports as dropsy of the brain and convulsions, have +risen to 20.4 times what they were in 1852. Thus in 1852, '53, and '55, +leaving out the cholera year '54, the deaths from nerve disorders were +respectively to the whole population as 1 in 1149, 1 in 953, and 1 in +941; whilst in 1866, '67, and '68, 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 every 9.9 of all deaths. + +I have alluded above to a class of deaths included in my tables, but +containing, no doubt, instances of mortality 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 proportion of this loss of life is really owing to brain +affections, I have thought best to include the whole class in my +statement. + +A glance at the individual diseases which are indubitably nervous is +more instructive and less perplexing. For example, taking the extreme +years, the recent increase in apoplexy is remarkable, even when we +remember that it is a malady of middle and later life, and that Chicago, +a new city, is therefore entitled to a yearly increasing quantity of +this form of death. In 1868 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 '53 there were but two deaths from +this disease; in the next four years there were none. From 1858 to '64, +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, increases in 1868,--8.6 times +as compared with 1852; and 26 times as compared with the four years +following 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 one only, and the +last-mentioned year has but two. 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 +general reader, he need only be told that tetanus is nearly always +caused by mechanical injuries, and that the natural increase of these in +a place like Chicago may account for a large part of the increase. Yet, +taking the record as a whole, and viewing it only with a calm 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 centre 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 +elsewhere throughout the land. + +[Footnote 1: I asked two citizens of this uneasy town--on the same +day--what was their business. Both replied tranquilly that they were +speculators!] + +The facts I have given establish the disproportionate increase in one +great city of those diseases which are largely produced by the strain on +the nervous 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 statistics of this +great business-centre; to see if the answers would weaken or reinforce +the conclusions drawn in 1871. 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 full, and nowhere else are the faces +so expressive of preoccupation, of anxiety, of excitement. It is making +money fast and accumulating a physiological debt of 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 solution of certain awkward questions which force +themselves 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 conditions +under which all work must be done in this country, some are out-growths +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 affect the male sex. If the mothers of a +people are sickly and weak, the sad inheritance falls upon their +offspring, 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 +thoughtfully 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 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 deliberately 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 ball-room. You will see many very +charming faces, the like of which the world cannot match--figures +somewhat too spare of flesh, and, especially south of Rhode Island, a +marvellous 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 eighteen, 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 ungracious 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, neuralgia, weak backs, and the varied +forms of hysteria,--that domestic demon which has produced untold +discomfort 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 do to make a household wretched. Mrs. Gradgrind is, 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 physical failure of our +city-bred women to fulfil 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 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 +numerous artificial infant foods now for sale singularly prove the truth +of this latter statement. Many physicians, 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 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 blame; while really, with rare +exceptions, the newer fashions have been more healthy than those they +superseded, people are better clad and better warmed than ever, and, +save in rare cases, late hours and overexertion in the dance are utterly +incapable of alone explaining 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 produce an effect which +would not in some other countries be so severe. I am quite persuaded, +indeed, that the development of a nervous temperament is one of the many +race-changes which are also giving us facial, vocal, and other +peculiarities 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 conditions which are +utterly mysterious, the obstacles to physical exercise, arising from +extremes of temperature, constitute at least one obvious cause of ill +health among women in our country. The great heat of summer, and the +slush and ice of winter, interfere with women who wish to take exercise, +but whose arrangements 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 as well able +to study, _with proper precautions_, 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 usefulness. + +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 reason, nearly always +exceeds the time stated by teachers to be necessary; and most girls of +our common schools and normal schools between the ages of thirteen and +seventeen thus expend two or three hours. Does any physician believe +that it is good for a growing 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, produce effects +on the growing brain which, in a vast number 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 +pushing,--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 be reinforced by what is to be said +farther on by a competent 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 non-promotion before the pupils; and when, added to +those extra inducements to work, there are given by committees and +superintendents examinations 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 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 they 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 overwork and overworry. The parents and +pupils themselves 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 examinations +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. + +"It will be observed that in this charge against parents I do not speak +of those causes of ill health which really have nothing to do with +overwork, but which are oftentimes forgotten when a school-boy 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 +indulgence 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 +circumstances of the pupil's life which can be conveniently ascertained, +even though those 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 understanding 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 particular pupil to lessen his work. Not +unfrequently there are found other causes of ill health than those which +I have mentioned; such, for instance, as poor ventilation, overheating +of the school-room, 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 overwork, 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."[1] + +[Footnote 1: Forty-ninth Annual Report of the Massachusetts Board of +Education, p. 204 (John T. Prince).] + +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 necessities 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 problem by taking two sets of beings of different gifts, and +of unlike physiological needs and construction, and forcing them into +the same educational mould. + +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 +conscientiousness, 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 surpasses 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 nowadays 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 feminine 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 little 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 proportion 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 professional guardianship at Johns Hopkins is +an admirable exception, and at some other institutions the physical +examination on matriculation becomes of the utmost value, when followed +up as it is in certain of these schools by compulsory physical training +and occasional re-examinations of the state of health. + +I do not see why the whole matter could not in all colleges be +systematically made part of the examinations on entry upon studies. It +would at least point out to the thoughtful student his weak points, and +enable 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 valvular troubles who had suffered from having been allowed +to play foot-ball. Cases of cerebral trouble in students, due to the use +of defective eyes, are common, and I have known many valuable lives +among male and female students crippled hopelessly owing to the fact +that no college pre-examination 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 +compete 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 remonstrate 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 with multiplied studies and unwholesome home life, +plods on, doing poor work, until somebody 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 perfectly 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. +Practically, 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 +admission at Harvard or Yale. Now, let any one compare the scale of +studies for both sexes employed half a century ago with that of to-day. +He will find that its 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 or earlier.[1] + +[Footnote 1: Witness Richardson's heroine, who was "perfect mistress of +the four rules of arithmetic"!] + +I firmly believe--and I am not alone in this opinion--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. Anything, 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 school-girls are suffering in health from +confinement, want of exercise at the time of day when they most incline +to it, bad ventilation,[1] and too steady occupation of mind. At no +other time of life is the nervous system so sensitive,--so irritable, I +might say,--and at no other are abundant fresh air and exercise so +important. To show more precisely how the growing girl is injured by the +causes just mentioned would lead me to speak of subjects unfit for full +discussion in these pages, but no thoughtful reader can be much at a +loss as to my meaning. + +[Footnote 1: 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 +school-house. As a consequence, we hear endless complaints from young +ladies of overheated or chilly rooms. If the teacher be old, the room is +kept too warm; if she be young, and much afoot about her school, the +apartment is apt to be cold.] + +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 every one concerned in our public +schools. + +[Footnote 1: Miss Pendleton.] + +"There can be no question that the health of growing 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 +examinations; 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 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 in-door +social amusements 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 school-room 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 apprehension. + +"This, with other statistics, would seem to bear 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 injurious 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 hundreds of girls hurried annually forward +beyond their physical or mental capacity, in advance of their physical +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." + +[Footnote 1: Philadelphia.] + +"Overpressure in school appears to me to be a disease of the body +politic from which this member suffers; but it also seems to me that +this vast school system is the most powerful agency for the correction +of the evil. In the case of girls, the first principle to be 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 education 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. + +"Edward Everett Hale, with his far spiritual sight, has discerned the +necessity for restoring home training, 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 prepared 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 +afterward,' cannot be too often quoted. Let branches in household +economy 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 insufficient food, and of acquiring skill in +household duties in addition to the school curriculum, we not only +simplify and harmonize her work, but we send out in every case a woman +prepared to carry this new influence 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 pre-empted 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 +advantage 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 capacity 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 over-pressure 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 a teacher. This unwholesome feature is the one distinctive +strain which must be removed from the 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. + +"Every teacher knows that the average girl of seventeen has not reached +the physical, mental, or moral development necessary to enter upon this +severe and high professional course of studies, and that one year is +insufficient for such a course. + +"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 instruction to a good high school covering a term of four +years. In this as in all other progressive formative periods the way out +is ahead. + +"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, +when they have sent out a large body of American women prepared, not for +a single profession, even the high feminine vocation of pedagogy, but +equipped for her highest, most general and congenial functions as the +source and centre of the home." + +I am unwilling to leave this subject without a few words as to our +remedy, especially as concerns our public schools and normal schools for +girls. What seems to me to be needed most is what the woman 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 hygienic +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 perhaps of all +civilized females the least qualified to undertake 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 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 dangers 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 national career alone will be +willing to admit my proposition, but among the higher intellectual +workers, such as astronomers, physicists, and naturalists, I have +frequently 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 answered 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 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 honored 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 +savans 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 be. Why this is I cannot say, but it is not more +mysterious than the fact that agents which, as sedatives or excitants, +affect the great nerve-centres, do this very differently in different +climates. There is some evidence 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 external temperatures, as well +as by the fact which Dr. Brown-Séquard discovered, and which I have +frequently 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 quantities 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 influences. + +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 +corporal 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 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] + +[Footnote 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.] + +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 anxiety or of +grave responsibility, are subject to the same form of disease; and this +I presume is why we meet with numerous instances of nervous exhaustion +among merchants and manufacturers. The lawyer and clergyman offer +examples, but I do not remember to have seen many bad cases among +physicians. Dismissing the easy jest which the latter statement will +surely suggest, the reason for this we may presently encounter. + +My note-books 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 involving 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 business, 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 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 counting-house 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 sea-shore. This +incessant monotony tells in the end. Men have confessed to me that for +twenty years they had worked every day, often travelling 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 representative 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, and +just as they are thinking, "Now we will stop and enjoy ourselves," the +brain, which, slave-like, 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 maturing; 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 responsibilities 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-increasing strain, and responsibilities +of gradual growth tend, with his out-door life, to save him from the +form of disease I have been alluding to. This element of open-air life, +I suspect, has a share in protecting men who in many respects lead a +most unhealthy existence. 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. +For these reasons I do not doubt that the effects of our great civil +war were far more severely felt by the Secretary of War and President +Lincoln than by Grant or Sherman. + +The wearing, incessant cares of overwork, of business 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-centres if the lighter warnings 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 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 centres with which he feels and thinks are more grave +and are less open to ready relief. + +When affections of the outlying organs are neglected, 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 +centres, 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 late war. Severe marches, bad food, and other +causes which make war exhausting, were constantly in action, until +certain 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 with 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-centres which furnish it with motor energy, so that excessive work +may bring about a state of congestion, owing to which the nerve-centre +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 +over-long on the stretch, and when moral causes, such as heavy +responsibilities and over-anxiety, are at work. + +When in active use, the thinking organs become full of blood, and, as +has been shown, rise in temperature, while the feet and hands become +cold. Nature 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 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 +than mere thought; and lastly, she desired that, during digestion, all +the surplus blood of the body should go to the stomach, intestines, and +liver, and that neither blood nor nerve-power should be then misdirected +upon the brain: in other words, she did not mean that we should try to +carry on, with equal energy, two kinds of important functional business +at once. + +If, then, the brain-user wishes to be healthy, he must limit his hours +of work according to rules which will come of experience, and which no +man can lay down for him. Above all, let him eat regularly and not at +too long intervals. I well remember the amazement of a distinguished +naturalist when told that his sleeplessness and irregular pulse were due +to his fasting from nine until six. A biscuit and a glass of porter, at +one o'clock, effected a ready and pleasant cure. As to exercise in the +fresh air, I need say little, except that if the exercise can be made to +have a distinct object, not in the way of business, so much the better. +Nor should I need to add that we may relieve the thinking and worrying +mechanisms by light reading and other amusements, or enforce the lesson +that no hard work should be attempted during digestion. The wise doctor +may haply smile at the commonplace of such directions, but woe be to the +man who neglects them! + +When an overworked and worried victim has sufficiently sinned against +these simple laws, if he does not luckily suffer from disturbances of +heart or stomach, he begins to have certain signs of nervous +exhaustion. + +As a rule, one of two symptoms appears first, though sometimes both come +together. Work gets to be a little less facile; this astonishes the +subject, especially if he has been under high pressure and doing his +tasks with that ease which comes of excitement. With this, or a little +later, he discovers that he sleeps badly, and that the thoughts of the +day infest his dreams, or so possess him as to make slumber difficult. +Unrefreshed, he rises and plunges anew into the labor for which he is no +longer competent. Let him stop here; he has had his warning. Day after +day the work grows more trying, but the varied stimulants to exertion +come into play, the mind, aroused, forgets in the cares of the day the +weariness of the night season, and so, with lessening power and growing +burden, he pursues his purpose. At last come certain new symptoms, such +as giddiness, dimness of sight, neuralgia of the face or scalp, with +entire nights of insomnia and growing difficulty in the use of the +mental powers; so that to attempt a calculation, or any form of +intellectual labor, is to insure a sense of distress in the head, or +such absolute pain as proves how deeply the organs concerned have +suffered. Even to read is sometimes almost impossible; and there still +remains the perilous fact that under enough of moral stimulus the man +may be able, for a few hours, to plunge into business cares, without +such pain as completely to incapacitate him for immediate activity. +Night, however, never fails to bring the punishment; and at last the +slightest prolonged exertion of mind becomes impossible. In the worst +cases the scalp itself grows sore, and a sudden jar hurts the brain, or +seems to do so, while the mere act of stepping from a curb-stone +produces positive pain. + +Strange as it may seem, much of all this may happen to a man, and he may +still struggle onward, ignorant of the terrible demands he is making +upon an exhausted brain. Usually, by this time he has sought advice, +and, if his doctor be worthy of the title, has learned that while there +are certain aids for his symptoms in the shape of drugs, there is only +one real remedy. Happy he if not too late in discovering that complete +and prolonged cessation from work is the one thing needful. Not a week +of holiday, or a month, but probably a year or more of utter idleness +may be absolutely essential. Only this will answer in cases so extreme +as that which I have tried to depict, and even this will not always +insure a return to a state of active working health. + +I am very far from conceding that the vehement energy with which we do +our work is due altogether to greed. We probably idle less and play less +than any other race, and the absence of national habits of sport, +especially in the West, leaves the man of business with no inducement to +abandon that unceasing labor in which at last he finds his sole +pleasure. He does not ride, or shoot, or fish, or play any game but +euchre. Business absorbs him utterly, and at last he finds neither time +nor desire for books. The newspaper is his sole literature; he has never +had time to acquire a taste for any reading save his ledger. Honest +friendship for books comes with youth or, as a rule, not at all. At last +his hour of peril arrives. Then you may separate him from business, but +you will find that to divorce his thoughts from it is impossible. The +fiend of work he raised no man can lay. As to foreign travel, it +wearies him. He has not the culture which makes it available or +pleasant. Notwithstanding the plasticity of the American, he is now +without resources. What then to advise I have asked myself countless +times. Let him at least look to it that his boys go not the same evil +road. The best business men are apt to think that their own successful +careers represent the lives their children ought to follow, and that the +four years of college spoil a lad for business. In reality these years, +be they idle or well filled with work, give young men the custom of +play, and surround them with an atmosphere of culture which leaves them +with bountiful resources for hours of leisure, while they insure to them +in these years of growth wholesome, unworried freedom from such business +pressure as the successful parent is so apt to put on too youthful +shoulders. + +Somewhat distracted by the desire to be brief, and yet to tell the whole +story, I have sought, in what I fear is a very loose and disconnected +way, to put in a new light some of the evils which are hurting the +mothers of our race, and those which every day's experience teaches the +doctor are gravely affecting the working capacity of numberless men. I +trust I have succeeded in satisfying my readers that we dwell in a +climate where work of all kinds demands greater precautions as to health +than is the case abroad. We cannot improve our climate, but it is quite +possible that we have not sufficiently learned to modify the conditions +of labor in accordance with those of the sky under which we live. + +No student of the nervous maladies of American men and women will think +I have overdrawn any part of the foregoing sketch. It would have been as +easy, had such a course been proper, to tell the individual stories of +youth, vigorous, eager, making haste to be rich, wrecked and made +unproductive and dependent for years or forever; and of middle age, +unable or unwilling to pause in the career of dollar-getting, crushed to +earth in the hour of fruition, or made powerless to labor longer at any +cost for those who were dearest. + +THE END. + + + + + + + +End of the Project Gutenberg EBook of Wear and Tear, by Silas Weir Mitchell + +*** END OF THIS PROJECT GUTENBERG EBOOK WEAR AND TEAR *** + +***** This file should be named 13197-0.txt or 13197-0.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/1/3/1/9/13197/ + +Produced by Bryan Ness and PG Distributed Proofreaders + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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WEIR MITCHELL.</title> +<style type="text/css"> + + p { text-align: justify; margin-top: .75em; margin-bottom: .75em } +table { border-collapse: collapse; border-style: none; border-width: medium } +*#col1 { border-style: none; border-width: medium } +h1, h2, h3, h4, h5, h6 { text-align: center } +hr { text-align: center; width: 50% } +html>body hr { width: 50%; margin-left: 25%; margin-right: 25% } +hr.full { width: 100% } +html>body hr.full { width: 100%; margin-left: 0%; margin-right: 0% } +hr.short { text-align: center; width: 20% } +html>body hr.short { width: 20%; margin-left: 40%; margin-right: 40% } +body { margin-left: 10%; margin-right: 10% } +img { border-style: none; border-width: medium } +.ctr { text-align: center } +.linenum { position: absolute; top: auto; left: 4% } +/* poetry number */ + .note { margin-left: 2em; margin-right: 2em; margin-bottom: 1em } +/* footnote */ + .blkquot { margin-left: 4em; margin-right: 4em } +/* block indent */ + .pagenum { position: absolute; left: 92%; font-size: smaller; text-align: right } +/* page numbers */ + .sidenote { width: 20%; font-size: smaller; float: right; clear: right; margin-top: 1em; + margin-bottom: 1em; padding-left: 1em } +.poem { text-align: left; margin-left: 10%; margin-right: 10% } +.poem br { display: none } +.poem .stanza { margin-left: 0em; margin-right: 0em; margin-top: 1em; margin-bottom: 1em } +.poem span { display: block; text-indent: -3em; margin: 0; padding-left: 3em } +.poem span.i2 { display: block; margin-left: 2em } +.poem span.i4 { display: block; margin-left: 4em } +.poem .caesura { vertical-align: -200% } + + </style> +</head> + +<body> + + +<pre> + +The Project Gutenberg EBook of Wear and Tear, by Silas Weir Mitchell + +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 + + +Title: Wear and Tear + or, Hints for the Overworked + +Author: Silas Weir Mitchell + +Release Date: August 17, 2004 [EBook #13197] + +Language: English + +Character set encoding: UTF-8 + +*** START OF THIS PROJECT GUTENBERG EBOOK WEAR AND TEAR *** + + + + +Produced by Bryan Ness and PG Distributed Proofreaders + + + + + +</pre> + + +<br /> +<h1>WEAR AND TEAR,<br /> +<br /> +OR<br /> +<br /> +HINTS FOR THE OVERWORKED<br /> +<br /> +</h1> +<h4>BY</h4> +<h3>S. WEIR MITCHELL, M.D., LL.D. HARV.,</h3> +<h3>MEMBER OF THE NATIONAL ACADEMY OF SCIENCES, PRESIDENT OF THE COLLEGE OF +PHYSICIANS OF PHILADELPHIA, ETC.</h3> +<p> </p> +<p> </p> +<h5><i>FIFTH EDITION</i>,<br> +THOROUGHLY REVISED.</h5> +<h5>PHILADELPHIA:<br> +J.B. LIPPINCOTT COMPANY.<br> +LONDON: 10 HENRIETTA STREET, COVENT GARDEN</h5> +<h5>1891</h5> +<hr class="full" /> +<h5>Entered according to Act of Congress, in the year 1871, by<br> +J.B. LIPPINCOTT & CO.,<br> +In the Office of the Librarian of Congress at Washington.</h5> +<p> </p> +<h5>PRINTED BY J. B. LIPPINCOTT COMPANY, PHILADELPHIA.</h5> +<hr class="full" /> +<h2>PREFACE.</h2> +<p>The rate of change in this country in education, in dress, and in diet and +habits of daily life surprises even the most watchful American observer. It is +now but fifteen years since this little book was written as a warning to a +restless nation possessed of an energy tempted to its largest uses by +unsurpassed opportunities. There is still need to repeat and reinforce my former +remonstrance, but I am glad to add that since I first wrote on these subjects +they have not only grown into importance as questions of public hygiene, but +vast changes for the better have come about in many of our ways of living, and +everywhere common sense is beginning to rule in matters of dress, diet, and +education.</p> +<p>The American of the Eastern States and of the comfortable classes<a href="#fn1" name="fnref1"><sup>[1]</sup></a> +is becoming notably more ruddy and more stout. The alteration in women as to +these conditions is most striking, and, if I am not mistaken, in England there +is a lessening tendency towards that excess of adipose matter which is still a +surprise to the American visiting England for the first time.</p> +<p>I should scarcely venture to assert so positively that Americans had +obviously taken on flesh within a generation if what I see had not been observed +by many others. It would, I think, be interesting to enter at length upon a +study of these remarkable changes, but that were scarcely within the scope of +this little book.</p> +<blockquote> +<blockquote> +<p><a name="fn1"></a> <a href="#fnref1">[1]</a>Happily, a large class with us.</p> +</blockquote> +</blockquote> +<hr class="full" /> +<p> </p> +<h2>WEAR AND TEAR,<br> +<br> +OR<br> +<br> +HINTS FOR THE OVERWORKED.</h2> +<hr /> +<p>Many years ago<a href="#fn2" name="fnref2"><sup>[2]</sup></a> +I found occasion to set before the readers of <i>Lippincott's Magazine</i> +certain thoughts concerning work in America, and its results. Somewhat 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 accordance 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 doctor's stand-point, the evils which their own +experience had taught them to see in our present mode of tasking the brains of +the younger girls.</p> +<p>I hope, therefore, that I am justified in the belief 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 +statistics were taken from manuscript notes and have been printed in no +scientific journal.</p> +<p>I have called these Hints WEAR and TEAR, because this title clearly and +briefly points out my meaning. <i>Wear</i> 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. <i>Tear</i> 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.</p> +<p>The sermon of which these words are the text has been preached many times in +many ways to congregations 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 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.</p> +<p>The man who lives an out-door 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 colonist 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 prodigal 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 accumulations of power, but also wastefully spending +the capital? From a few we have grown to millions, and already in many ways 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 competitions which make it hard to live nowadays and embitter the daily +bread of life. Neither had they the 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.</p> +<p>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 competition +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 towards social advancement, +and the overeducation 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 re-examine this +question--to see if it be true that the nervous system 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 venturing 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 questions of +mental hygiene of which in general we hear but too little. If the strictures I +have to make applied 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 +mechanical labor, as opposed to that of the clerk, is being "levelled +upward" with fortunate celerity.</p> +<p>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.</p> +<p>The human body carries on several kinds of manufacture, 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 antagonize 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 centres 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 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 centres which originate or evolve muscular power do +sometimes suffer from undue taxation; but it is certainly true that when this +happens, the evil result is rarely as severe or as lasting as when it is the +organs of mental power that have suffered.</p> +<p>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-centres 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 excess of mental +labor? The simple answer is, that mental overwork is harder, because as a rule +it is closet or counting-room or at least in-door 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 quickening 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.</p> +<p>But there is more than this in the question. We do not know as yet what is +the cost in expended material of mental acts as compared with motor +manifestations, and here, therefore, are at fault; because, although 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.</p> +<p>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 motor 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 referable 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 <i>wide-awakefulness</i> 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 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.</p> +<p>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.</p> +<p>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 +writing 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.</p> +<p>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 Feuchtersleben's "Dietetics of the +Soul," both out of print, which deals in a readable fashion with this or +kindred topics.<a href="#fn3" name="fnref3"><sup>[3]</sup></a> +Many men are warned by some sense of want of clearness 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 attentive 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 system drive him to take exercise. Especially when working 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.</p> +<p>One of our ablest medical scholars reports himself to me as having never been +aware of any sensation 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 accustomed 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 clasping his hands over his head; and also there is desire to lie +down and rest.</p> +<p>"I am not aware," writes a physician of distinction, "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 thinking organs rather too hard. As a result, I began to have +headache after every period of intellectual exertion. 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 fulness 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 +conditions under which men of note are using their mental machinery would be +everyway worthy of attention.</p> +<p>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 +useless by the denial of full attention. Or else the imagination 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.</p> +<p>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 +overtasked brain belongs more or less to every man who overuses this organ, and +is the well-known initial symptom 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, 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 deserves, even from such thorough believers in unconscious +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 +biography 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.</p> +<p>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 before 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.</p> +<p>Looking broadly at the question of the influence of 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 thinking organs. But if into the life of a man whose powers are fully taxed +we bring the elements of great anxiety or worry, or excessive haste, the whole +machinery begins at once to work, as it were, with a dangerous 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.</p> +<p>I have been careful here to state that combined overwork of mind and body is +doubly mischievous, because 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 employed 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 horseback?" Perhaps, too, +there is concerned a physiological law, which, though somewhat mysterious, I may +again have to summon to my aid in the way of explanation. 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.</p> +<p>It has long been believed that maladies of the nervous system are increasing +rapidly in the more crowded portions of the United States; but I am not aware +that any one 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 +frequent 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 together 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 system. But the +most unquestionable proof of the increase of nervous disease is to be looked for +in the death statistics of cities.</p> +<p>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 +testing 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 +fulfils 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-awake business centre in America. I owe to the kindness of +Dr. J.H. Rauch, Sanitary Superintendent 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 conclusions 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.</p> +<p>The honest use of the mortuary statistics of a large town is no easy matter, +and I must therefore ask that I may be supposed to have taken every possible +precaution in order not to exaggerate the reality of a great evil. Certain +diseases, such as apoplexy, palsy, epilepsy, St. Vitus's dance, and lockjaw or +tetanus, we all agree to consider as nervous maladies; convulsions, 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-centres; 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 extremities 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 +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.</p> +<p>Taking the years 1852 to 1868, inclusive, it will be found that 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 labelled in the +reports as dropsy of the brain and convulsions, have risen to 20.4 times what +they were in 1852. Thus in 1852, '53, and '55, leaving out the cholera year '54, +the deaths from nerve disorders were respectively to the whole population as 1 +in 1149, 1 in 953, and 1 in 941; whilst in 1866, '67, and '68, 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 every 9.9 of all deaths.</p> +<p>I have alluded above to a class of deaths included in my tables, but +containing, no doubt, instances of mortality 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 proportion of this loss of life is really +owing to brain affections, I have thought best to include the whole class in my +statement.</p> +<p>A glance at the individual diseases which are indubitably nervous is more +instructive and less perplexing. For example, taking the extreme years, the +recent increase in apoplexy is remarkable, even when we remember that it is a +malady of middle and later life, and that Chicago, a new city, is therefore +entitled to a yearly increasing quantity of this form of death. In 1868 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 '53 there were but two deaths from this +disease; in the next four years there were none. From 1858 to '64, 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, increases in 1868,--8.6 times as compared with 1852; and 26 times as +compared with the four years following 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 one only, and the +last-mentioned year has but two. 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 general reader, he need only be told that tetanus is +nearly always caused by mechanical injuries, and that the natural increase of +these in a place like Chicago may account for a large part of the increase. Yet, +taking the record as a whole, and viewing it only with a calm desire to get at +the truth, it is not possible to avoid seeing that the growth of nerve maladies +has been inordinate.</p> +<p>The industry and energy which have built this great city on a morass, and +made it a vast centre of insatiate commerce, are now at work to undermine the +nervous systems of its restless and eager people,<a href="#fn4" name="fnref4"><sup>[4]</sup></a> +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 elsewhere +throughout the land.</p> +<p>The facts I have given establish the disproportionate increase in one great +city of those diseases which are largely produced by the strain on the nervous +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.</p> +<p>It were interesting to-day to question the later statistics of this great +business-centre; to see if the answers would weaken or reinforce the conclusions +drawn in 1871. 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 full, and +nowhere else are the faces so expressive of preoccupation, of anxiety, of +excitement. It is making money fast and accumulating a physiological debt of +which that bitter creditor, the future, will one day demand payment.</p> +<p>If I have made myself understood, we are now prepared to apply some of our +knowledge to the solution of certain awkward questions which force themselves +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 conditions under which all work must be done in +this country, some are out-growths of our modes of labor, and some go back to +social habitudes and defective methods of early educational training.</p> +<p>In studying this subject, it will not answer to look only at the causes of +sickness and weakness which affect the male sex. If the mothers of a people are +sickly and weak, the sad inheritance falls upon their offspring, 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 thoughtfully 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 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 deliberately place myself. Perhaps I ought to add that the replies I +have heard given by others were appalling.</p> +<p>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 ball-room. You will see many very charming faces, the like of +which the world cannot match--figures somewhat too spare of flesh, and, +especially south of Rhode Island, a marvellous 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 eighteen, 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 ungracious +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, neuralgia, +weak backs, and the varied forms of hysteria,--that domestic demon which has +produced untold discomfort 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 do to +make a household wretched. Mrs. Gradgrind is, 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.</p> +<p>If any reader doubts my statement as to the physical failure of our city-bred +women to fulfil 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 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 numerous artificial infant foods now for sale singularly prove the +truth of this latter statement. Many physicians, 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 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 blame; while really, with rare exceptions, the newer fashions have +been more healthy than those they superseded, people are better clad and better +warmed than ever, and, save in rare cases, late hours and overexertion in the +dance are utterly incapable of alone explaining 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 produce an effect which would +not in some other countries be so severe. I am quite persuaded, indeed, that the +development of a nervous temperament is one of the many race-changes which are +also giving us facial, vocal, and other peculiarities 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.</p> +<p>While a part of the mischief lies with climatic conditions which are utterly +mysterious, the obstacles to physical exercise, arising from extremes of +temperature, constitute at least one obvious cause of ill health among women in +our country. The great heat of summer, and the slush and ice of winter, +interfere with women who wish to take exercise, but whose arrangements to go +out-of-doors involve wonderful changes of dress and an amount of preparation +appalling to the masculine creature.</p> +<p>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 as well able to study, <i>with proper +precautions</i>, 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 usefulness.</p> +<p>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 reason, nearly +always exceeds the time stated by teachers to be necessary; and most girls of +our common schools and normal schools between the ages of thirteen and seventeen +thus expend two or three hours. Does any physician believe that it is good for a +growing 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, produce effects +on the growing brain which, in a vast number of cases, can be only disastrous.</p> +<p>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.</p> +<p>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 pushing,--of competitive +examinations,--of ranking, etc., is in a measure responsible for that worry +which adds a dangerous element to work.</p> +<p>The following remarks as to the influence of home life in Massachusetts are +not out of place here, and will be reinforced by what is to be said farther on +by a competent authority as to Philadelphia:</p> +<p>"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 non-promotion before the pupils; and when, added to those extra +inducements to work, there are given by committees and superintendents +examinations 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 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 they 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.</p> +<p>"In making up the verdict we must not forget that others besides the +teacher may be responsible for overwork and overworry. The parents and pupils +themselves 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 examinations 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.</p> +<p>"It will be observed that in this charge against parents I do not speak +of those causes of ill health which really have nothing to do with overwork, but +which are oftentimes forgotten when a school-boy 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 indulgence 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 circumstances of the pupil's life which can be +conveniently ascertained, even though those 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 understanding 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 particular pupil to lessen his work. Not unfrequently there are found +other causes of ill health than those which I have mentioned; such, for +instance, as poor ventilation, overheating of the school-room, 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 overwork, 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."<a href="#fn5" name="fnref5"><sup>[5]</sup></a></p> +<p>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 necessities as stimulate the pupils of what we are pleased to call a normal +(!) school.</p> +<p>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.</p> +<p>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 +problem by taking two sets of beings of different gifts, and of unlike +physiological needs and construction, and forcing them into the same educational +mould.</p> +<p>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 conscientiousness, 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 surpasses 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.</p> +<p>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.</p> +<p>The colleges for women, such as Vassar, are nowadays 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 feminine 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.</p> +<p>As concerns our colleges for young men I have little 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 proportion 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 professional +guardianship at Johns Hopkins is an admirable exception, and at some other +institutions the physical examination on matriculation becomes of the utmost +value, when followed up as it is in certain of these schools by compulsory +physical training and occasional re-examinations of the state of health.</p> +<p>I do not see why the whole matter could not in all colleges be systematically +made part of the examinations on entry upon studies. It would at least point out +to the thoughtful student his weak points, and enable 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 valvular troubles who had suffered +from having been allowed to play foot-ball. Cases of cerebral trouble in +students, due to the use of defective eyes, are common, and I have known many +valuable lives among male and female students crippled hopelessly owing to the +fact that no college pre-examination 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 compete on even +terms with their fellows.</p> +<p>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 remonstrate 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 with +multiplied studies and unwholesome home life, plods on, doing poor work, until +somebody 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 +perfectly 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. Practically, 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 admission at Harvard or Yale. +Now, let any one compare the scale of studies for both sexes employed half a +century ago with that of to-day. He will find that its 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 or earlier.<a href="#fn6" name="fnref6"><sup>[6]</sup></a></p> +<p>I firmly believe--and I am not alone in this opinion--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. Anything, 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 school-girls are suffering in health from confinement, want of +exercise at the time of day when they most incline to it, bad ventilation,<a href="#fn7" name="fnref7"><sup>[7]</sup></a> +and too steady occupation of mind. At no other time of life is the nervous +system so sensitive,--so irritable, I might say,--and at no other are abundant +fresh air and exercise so important. To show more precisely how the growing girl +is injured by the causes just mentioned would lead me to speak of subjects unfit +for full discussion in these pages, but no thoughtful reader can be much at a +loss as to my meaning.</p> +<p>The following remarks I owe to the experience of a friend,<a href="#fn8" name="fnref8"><sup>[8]</sup></a> +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 every one concerned in our public schools.</p> +<p>"There can be no question that the health of growing 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 examinations; 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 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 in-door social amusements 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 school-room 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.</p> +<p>"A Latin graduating class of seven girls, aged seventeen and eighteen +years, stated that they do their work without nervousness, restlessness, or +apprehension.</p> +<p>"This, with other statistics, would seem to bear out your theory that +after seventeen girls may study with much less risk to health.</p> +<p>"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.</p> +<p>"Our own normal school,<a href="#fn9" name="fnref9"><sup>[9]</sup></a> which is doing +a great, an indispensable, work in preparing a trained body of faithful, +intelligent teachers, has succumbed to this injurious 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 hundreds of girls hurried annually forward +beyond their physical or mental capacity, in advance of their physical 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."</p> +<p>"Overpressure in school appears to me to be a disease of the body +politic from which this member suffers; but it also seems to me that this vast +school system is the most powerful agency for the correction of the evil. In the +case of girls, the first principle to be 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 education for boys.</p> +<p>"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.</p> +<p>"Edward Everett Hale, with his far spiritual sight, has discerned the +necessity for restoring home training, 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.</p> +<p>"When it was discovered that citizens must be prepared 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 afterward,' cannot be too +often quoted. Let branches in household economy 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 insufficient food, and of +acquiring skill in household duties in addition to the school curriculum, we not +only simplify and harmonize her work, but we send out in every case a woman +prepared to carry this new influence 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 pre-empted by men, it will be by the essential +quality of this new feminine element.</p> +<p>"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 advantage 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 capacity 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.</p> +<p>"The first step toward the relief of over-pressure 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 a teacher. +This unwholesome feature is the one distinctive strain which must be removed +from the 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.</p> +<p>"Every teacher knows that the average girl of seventeen has not reached +the physical, mental, or moral development necessary to enter upon this severe +and high professional course of studies, and that one year is insufficient for +such a course.</p> +<p>"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 instruction to a good high school covering a term of four years. In this +as in all other progressive formative periods the way out is ahead.</p> +<p>"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, when they +have sent out a large body of American women prepared, not for a single +profession, even the high feminine vocation of pedagogy, but equipped for her +highest, most general and congenial functions as the source and centre of the +home."</p> +<p>I am unwilling to leave this subject without a few words as to our remedy, +especially as concerns our public schools and normal schools for girls. What +seems to me to be needed most is what the woman 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 hygienic needs in +the way of sleep, hours of study, light, and meals.</p> +<p>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 perhaps of all civilized females the least qualified +to undertake 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?</p> +<p>While making these stringent criticisms, I am anxious not to be +misunderstood. The point which 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 dangers 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.</p> +<p>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 national career +alone will be willing to admit my proposition, but among the higher intellectual +workers, such as astronomers, physicists, and naturalists, I have frequently +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 answered 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 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 honored 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 savans 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 be. Why this is I cannot say, +but it is not more mysterious than the fact that agents which, as sedatives or +excitants, affect the great nerve-centres, do this very differently in different +climates. There is some evidence 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 external temperatures, as well as by the fact +which Dr. Brown-Séquard discovered, and which I have frequently corroborated, +that many poisons are retarded in their action by placing the animal affected in +a warm atmosphere.</p> +<p>It is possible to drink with safety in England quantities 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 influences.</p> +<p>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 corporal 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 in Europe, and is followed by greater sense of +fatigue.</p> +<p>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.</p> +<p>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.<a href="#fn10" name="fnref10"><sup>[10]</sup></a></p> +<p>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 anxiety or of grave +responsibility, are subject to the same form of disease; and this I presume is +why we meet with numerous instances of nervous exhaustion among merchants and +manufacturers. The lawyer and clergyman offer examples, but I do not remember to +have seen many bad cases among physicians. Dismissing the easy jest which the +latter statement will surely suggest, the reason for this we may presently +encounter.</p> +<p>My note-books 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.</p> +<p>The worst instances to be met with are among young men suddenly cast into +business positions involving 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 business, 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 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 counting-house 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 sea-shore. This incessant +monotony tells in the end. Men have confessed to me that for twenty years they +had worked every day, often travelling 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 representative of a frightfully +general social evil.</p> +<p>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, and just as they are +thinking, "Now we will stop and enjoy ourselves," the brain, which, +slave-like, 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 maturing; +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.</p> +<p>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 +responsibilities 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-increasing strain, and responsibilities of gradual growth +tend, with his out-door life, to save him from the form of disease I have been +alluding to. This element of open-air life, I suspect, has a share in protecting +men who in many respects lead a most unhealthy existence. 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. For these +reasons I do not doubt that the effects of our great civil war were far more +severely felt by the Secretary of War and President Lincoln than by Grant or +Sherman.</p> +<p>The wearing, incessant cares of overwork, of business 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-centres if the lighter warnings 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 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 centres with which he feels and thinks are more grave +and are less open to ready relief.</p> +<p>When affections of the outlying organs are neglected, 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 centres, 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 late war. Severe +marches, bad food, and other causes which make war exhausting, were constantly +in action, until certain 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 with palsy of the legs. A few months of absolute +rest, good diet, ale, fresh beef and vegetables restored them to perfect health.</p> +<p>In all probability incessant use of a part flushes with blood the +nerve-centres which furnish it with motor energy, so that excessive work may +bring about a state of congestion, owing to which the nerve-centre 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.</p> +<p>Now let us see what happens when the intellectual organs are put over-long on +the stretch, and when moral causes, such as heavy responsibilities and +over-anxiety, are at work.</p> +<p>When in active use, the thinking organs become full of blood, and, as has +been shown, rise in temperature, while the feet and hands become cold. Nature +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 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 than +mere thought; and lastly, she desired that, during digestion, all the surplus +blood of the body should go to the stomach, intestines, and liver, and that +neither blood nor nerve-power should be then misdirected upon the brain: in +other words, she did not mean that we should try to carry on, with equal energy, +two kinds of important functional business at once.</p> +<p>If, then, the brain-user wishes to be healthy, he must limit his hours of +work according to rules which will come of experience, and which no man can lay +down for him. Above all, let him eat regularly and not at too long intervals. I +well remember the amazement of a distinguished naturalist when told that his +sleeplessness and irregular pulse were due to his fasting from nine until six. A +biscuit and a glass of porter, at one o'clock, effected a ready and pleasant +cure. As to exercise in the fresh air, I need say little, except that if the +exercise can be made to have a distinct object, not in the way of business, so +much the better. Nor should I need to add that we may relieve the thinking and +worrying mechanisms by light reading and other amusements, or enforce the lesson +that no hard work should be attempted during digestion. The wise doctor may +haply smile at the commonplace of such directions, but woe be to the man who +neglects them!</p> +<p>When an overworked and worried victim has sufficiently sinned against these +simple laws, if he does not luckily suffer from disturbances of heart or +stomach, he begins to have certain signs of nervous exhaustion.</p> +<p>As a rule, one of two symptoms appears first, though sometimes both come +together. Work gets to be a little less facile; this astonishes the subject, +especially if he has been under high pressure and doing his tasks with that ease +which comes of excitement. With this, or a little later, he discovers that he +sleeps badly, and that the thoughts of the day infest his dreams, or so possess +him as to make slumber difficult. Unrefreshed, he rises and plunges anew into +the labor for which he is no longer competent. Let him stop here; he has had his +warning. Day after day the work grows more trying, but the varied stimulants to +exertion come into play, the mind, aroused, forgets in the cares of the day the +weariness of the night season, and so, with lessening power and growing burden, +he pursues his purpose. At last come certain new symptoms, such as giddiness, +dimness of sight, neuralgia of the face or scalp, with entire nights of insomnia +and growing difficulty in the use of the mental powers; so that to attempt a +calculation, or any form of intellectual labor, is to insure a sense of distress +in the head, or such absolute pain as proves how deeply the organs concerned +have suffered. Even to read is sometimes almost impossible; and there still +remains the perilous fact that under enough of moral stimulus the man may be +able, for a few hours, to plunge into business cares, without such pain as +completely to incapacitate him for immediate activity. Night, however, never +fails to bring the punishment; and at last the slightest prolonged exertion of +mind becomes impossible. In the worst cases the scalp itself grows sore, and a +sudden jar hurts the brain, or seems to do so, while the mere act of stepping +from a curb-stone produces positive pain.</p> +<p>Strange as it may seem, much of all this may happen to a man, and he may +still struggle onward, ignorant of the terrible demands he is making upon an +exhausted brain. Usually, by this time he has sought advice, and, if his doctor +be worthy of the title, has learned that while there are certain aids for his +symptoms in the shape of drugs, there is only one real remedy. Happy he if not +too late in discovering that complete and prolonged cessation from work is the +one thing needful. Not a week of holiday, or a month, but probably a year or +more of utter idleness may be absolutely essential. Only this will answer in +cases so extreme as that which I have tried to depict, and even this will not +always insure a return to a state of active working health.</p> +<p>I am very far from conceding that the vehement energy with which we do our +work is due altogether to greed. We probably idle less and play less than any +other race, and the absence of national habits of sport, especially in the West, +leaves the man of business with no inducement to abandon that unceasing labor in +which at last he finds his sole pleasure. He does not ride, or shoot, or fish, +or play any game but euchre. Business absorbs him utterly, and at last he finds +neither time nor desire for books. The newspaper is his sole literature; he has +never had time to acquire a taste for any reading save his ledger. Honest +friendship for books comes with youth or, as a rule, not at all. At last his +hour of peril arrives. Then you may separate him from business, but you will +find that to divorce his thoughts from it is impossible. The fiend of work he +raised no man can lay. As to foreign travel, it wearies him. He has not the +culture which makes it available or pleasant. Notwithstanding the plasticity of +the American, he is now without resources. What then to advise I have asked +myself countless times. Let him at least look to it that his boys go not the +same evil road. The best business men are apt to think that their own successful +careers represent the lives their children ought to follow, and that the four +years of college spoil a lad for business. In reality these years, be they idle +or well filled with work, give young men the custom of play, and surround them +with an atmosphere of culture which leaves them with bountiful resources for +hours of leisure, while they insure to them in these years of growth wholesome, +unworried freedom from such business pressure as the successful parent is so apt +to put on too youthful shoulders.</p> +<p>Somewhat distracted by the desire to be brief, and yet to tell the whole +story, I have sought, in what I fear is a very loose and disconnected way, to +put in a new light some of the evils which are hurting the mothers of our race, +and those which every day's experience teaches the doctor are gravely affecting +the working capacity of numberless men. I trust I have succeeded in satisfying +my readers that we dwell in a climate where work of all kinds demands greater +precautions as to health than is the case abroad. We cannot improve our climate, +but it is quite possible that we have not sufficiently learned to modify the +conditions of labor in accordance with those of the sky under which we live.</p> +<p>No student of the nervous maladies of American men and women will think I +have overdrawn any part of the foregoing sketch. It would have been as easy, had +such a course been proper, to tell the individual stories of youth, vigorous, +eager, making haste to be rich, wrecked and made unproductive and dependent for +years or forever; and of middle age, unable or unwilling to pause in the career +of dollar-getting, crushed to earth in the hour of fruition, or made powerless +to labor longer at any cost for those who were dearest.</p> +<blockquote> +<blockquote> +<p><a name="fn2"></a> <a href="#fnref2">[2]</a>In 1871.</p> +<p><a name="fn3"></a> <a href="#fnref3">[3]</a>See, now, "Brain-Work and +Overwork," by H.C. Wood, M.D.; also, "Mental Overwork and Premature +Disease among Public and Professional Men," by Ch. K. Mills, M.D.; also, +"Overwork and Sanitation in Public Schools, with Remarks on the Production +of Nervous Disease and Insanity," by Ch. K. Mills, M.D.,--<i>Annals of +Hygiene</i>, September, 1886.</p> +<p><a name="fn4"></a> <a href="#fnref4">[4]</a>I asked two citizens of this uneasy town--on +the same day--what was their business. Both replied tranquilly that they were +speculators!</p> +<p><a name="fn5"></a> <a href="#fnref5">[5]</a>Forty-ninth Annual Report of the +Massachusetts Board of Education, p. 204 (John T. Prince).</p> +<p><a name="fn6"></a> <a href="#fnref6">[6]</a>Witness Richardson's heroine, who was +"perfect mistress of the four rules of arithmetic"!</p> +<p><a name="fn7"></a> <a href="#fnref7">[7]</a>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 +school-house. As a consequence, we hear endless complaints from young ladies of +overheated or chilly rooms. If the teacher be old, the room is kept too warm; if +she be young, and much afoot about her school, the apartment is apt to be cold.</p> +<p><a name="fn8"></a> <a href="#fnref8">[8]</a>Miss Pendleton.</p> +<p><a name="fn9"></a> <a href="#fnref9">[9]</a>Philadelphia.</p> +<p><a name="fn10"></a> <a href="#fnref10">[10]</a>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.</p> +</blockquote> +</blockquote> +<h2>THE END.</h2> + + + + + + + + +<pre> + + + + + +End of the Project Gutenberg EBook of Wear and Tear, by Silas Weir Mitchell + +*** END OF THIS PROJECT GUTENBERG EBOOK WEAR AND TEAR *** + +***** This file should be named 13197-h.htm or 13197-h.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/1/3/1/9/13197/ + +Produced by Bryan Ness and PG Distributed Proofreaders + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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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 + + +Title: Wear and Tear + or, Hints for the Overworked + +Author: Silas Weir Mitchell + +Release Date: August 17, 2004 [EBook #13197] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK WEAR AND TEAR *** + + + + +Produced by Bryan Ness and PG Distributed Proofreaders + + + + + +WEAR AND TEAR, + +OR + +HINTS FOR THE OVERWORKED. + +BY +S. WEIR MITCHELL, M.D., LL.D. HARV., + +MEMBER OF THE NATIONAL ACADEMY OF SCIENCES, PRESIDENT OF THE COLLEGE OF +PHYSICIANS OF PHILADELPHIA, ETC. + +_FIFTH EDITION_, +THOROUGHLY REVISED. + +PHILADELPHIA: +J.B. LIPPINCOTT COMPANY. +LONDON: 10 HENRIETTA STREET, COVENT GARDEN. + +Entered according to Act of Congress, in the year 1871, by +J.B. LIPPINCOTT & CO., +In the Office of the Librarian of Congress at Washington. + + +PRINTED BY J.B. LIPPINCOTT COMPANY, PHILADELPHIA. + + + +PREFACE. + +The rate of change in this country in education, in dress, and in diet +and habits of daily life surprises even the most watchful American +observer. It is now but fifteen years since this little book was written +as a warning to a restless nation possessed of an energy tempted to its +largest uses by unsurpassed opportunities. There is still need to repeat +and reinforce my former remonstrance, but I am glad to add that since I +first wrote on these subjects they have not only grown into importance +as questions of public hygiene, but vast changes for the better have +come about in many of our ways of living, and everywhere common sense is +beginning to rule in matters of dress, diet, and education. + +The American of the Eastern States and of the comfortable classes[1] is +becoming notably more ruddy and more stout. The alteration in women as +to these conditions is most striking, and, if I am not mistaken, in +England there is a lessening tendency towards that excess of adipose +matter which is still a surprise to the American visiting England for +the first time. + +I should scarcely venture to assert so positively that Americans had +obviously taken on flesh within a generation if what I see had not been +observed by many others. It would, I think, be interesting to enter at +length upon a study of these remarkable changes, but that were scarcely +within the scope of this little book. + +[Footnote 1: Happily, a large class with us.] + + + + + + +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. Somewhat 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 accordance 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 doctor's stand-point, +the evils which their own experience had taught them to see in our +present mode of tasking the brains of the younger girls. + +[Footnote 1: In 1871.] + +I hope, therefore, that I am justified in the belief 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 statistics 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. + +The sermon of which these words are the text has been preached many +times in many ways to congregations 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 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 out-door 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 colonist 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 prodigal 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 accumulations of power, but also wastefully +spending the capital? From a few we have grown to millions, and already +in many ways 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 competitions which make it +hard to live nowadays and embitter the daily bread of life. Neither had +they the 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 +competition 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 towards social advancement, and the overeducation 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 re-examine this +question--to see if it be true that the nervous system 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 venturing 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 questions of mental +hygiene of which in general we hear but too little. If the strictures I +have to make applied 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 mechanical +labor, as opposed to that of the clerk, is being "levelled 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 manufacture, 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 +antagonize 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 centres +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 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 centres which originate or +evolve muscular power do sometimes suffer from undue taxation; but it is +certainly true that when this happens, the evil result is rarely as +severe or as lasting as when 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-centres 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 excess of mental labor? The simple +answer is, that mental overwork is harder, because as a rule it is +closet or counting-room or at least in-door 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 quickening 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 material of mental acts as compared with motor +manifestations, and here, therefore, are at fault; because, although 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 motor 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 referable 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 +_wide-awakefulness_ 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 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 writing 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 Feuchtersleben's "Dietetics of the +Soul," both out of print, which deals in a readable fashion with this or +kindred topics.[1] Many men are warned by some sense of want of +clearness 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 attentive 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 system drive +him to take exercise. Especially when working 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. + +[Footnote 1: See, now, "Brain-Work and Overwork," by H.C. Wood, M.D.; +also, "Mental Overwork and Premature Disease among Public and +Professional Men," by Ch. K. Mills, M.D.; also, "Overwork and Sanitation +in Public Schools, with Remarks on the Production of Nervous Disease and +Insanity," by Ch. K. Mills, M.D.,--_Annals of Hygiene_, September, +1886.] + +One of our ablest medical scholars reports himself to me as having never +been aware of any sensation 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 accustomed 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 +clasping his hands over his head; and also there is desire to lie down +and rest. + +"I am not aware," writes a physician of distinction, "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 thinking organs rather too hard. As a +result, I began to have headache after every period of intellectual +exertion. 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 fulness 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 conditions under which men of note are using their mental +machinery would be everyway worthy of attention. + +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 useless +by the denial of full attention. Or else the imagination 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 overtasked brain belongs more or less to every man who overuses +this organ, and is the well-known initial symptom 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, 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 deserves, even from such thorough believers in unconscious +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 biography 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 before +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 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 thinking organs. But if into +the life of a man whose powers are fully taxed we bring the elements of +great anxiety or worry, or excessive haste, the whole machinery begins +at once to work, as it were, with a dangerous 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, because 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 +employed 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 horseback?" Perhaps, too, +there is concerned a physiological law, which, though somewhat +mysterious, I may again have to summon to my aid in the way of +explanation. 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 nervous system are +increasing rapidly in the more crowded portions of the United States; +but I am not aware that any one 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 frequent 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 together 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 system. But the most unquestionable proof of the increase 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 testing 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 fulfils 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-awake +business centre in America. I owe to the kindness of Dr. J.H. Rauch, +Sanitary Superintendent 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 conclusions 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 therefore ask that I may be supposed to have taken +every possible precaution in order not to exaggerate the reality of a +great evil. Certain diseases, such as apoplexy, palsy, epilepsy, St. +Vitus's dance, and lockjaw or tetanus, we all agree to consider as +nervous maladies; convulsions, 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-centres; 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 extremities 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 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 that 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 +labelled in the reports as dropsy of the brain and convulsions, have +risen to 20.4 times what they were in 1852. Thus in 1852, '53, and '55, +leaving out the cholera year '54, the deaths from nerve disorders were +respectively to the whole population as 1 in 1149, 1 in 953, and 1 in +941; whilst in 1866, '67, and '68, 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 every 9.9 of all deaths. + +I have alluded above to a class of deaths included in my tables, but +containing, no doubt, instances of mortality 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 proportion of this loss of life is really owing to brain +affections, I have thought best to include the whole class in my +statement. + +A glance at the individual diseases which are indubitably nervous is +more instructive and less perplexing. For example, taking the extreme +years, the recent increase in apoplexy is remarkable, even when we +remember that it is a malady of middle and later life, and that Chicago, +a new city, is therefore entitled to a yearly increasing quantity of +this form of death. In 1868 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 '53 there were but two deaths from +this disease; in the next four years there were none. From 1858 to '64, +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, increases in 1868,--8.6 times +as compared with 1852; and 26 times as compared with the four years +following 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 one only, and the +last-mentioned year has but two. 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 +general reader, he need only be told that tetanus is nearly always +caused by mechanical injuries, and that the natural increase of these in +a place like Chicago may account for a large part of the increase. Yet, +taking the record as a whole, and viewing it only with a calm 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 centre 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 +elsewhere throughout the land. + +[Footnote 1: I asked two citizens of this uneasy town--on the same +day--what was their business. Both replied tranquilly that they were +speculators!] + +The facts I have given establish the disproportionate increase in one +great city of those diseases which are largely produced by the strain on +the nervous 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 statistics of this +great business-centre; to see if the answers would weaken or reinforce +the conclusions drawn in 1871. 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 full, and nowhere else are the faces +so expressive of preoccupation, of anxiety, of excitement. It is making +money fast and accumulating a physiological debt of 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 solution of certain awkward questions which force +themselves 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 conditions +under which all work must be done in this country, some are out-growths +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 affect the male sex. If the mothers of a +people are sickly and weak, the sad inheritance falls upon their +offspring, 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 +thoughtfully 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 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 deliberately 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 ball-room. You will see many very +charming faces, the like of which the world cannot match--figures +somewhat too spare of flesh, and, especially south of Rhode Island, a +marvellous 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 eighteen, 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 ungracious 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, neuralgia, weak backs, and the varied +forms of hysteria,--that domestic demon which has produced untold +discomfort 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 do to make a household wretched. Mrs. Gradgrind is, 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 physical failure of our +city-bred women to fulfil 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 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 +numerous artificial infant foods now for sale singularly prove the truth +of this latter statement. Many physicians, 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 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 blame; while really, with rare +exceptions, the newer fashions have been more healthy than those they +superseded, people are better clad and better warmed than ever, and, +save in rare cases, late hours and overexertion in the dance are utterly +incapable of alone explaining 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 produce an effect which +would not in some other countries be so severe. I am quite persuaded, +indeed, that the development of a nervous temperament is one of the many +race-changes which are also giving us facial, vocal, and other +peculiarities 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 conditions which are +utterly mysterious, the obstacles to physical exercise, arising from +extremes of temperature, constitute at least one obvious cause of ill +health among women in our country. The great heat of summer, and the +slush and ice of winter, interfere with women who wish to take exercise, +but whose arrangements 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 as well able +to study, _with proper precautions_, 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 usefulness. + +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 reason, nearly always +exceeds the time stated by teachers to be necessary; and most girls of +our common schools and normal schools between the ages of thirteen and +seventeen thus expend two or three hours. Does any physician believe +that it is good for a growing 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, produce effects +on the growing brain which, in a vast number 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 +pushing,--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 be reinforced by what is to be said +farther on by a competent 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 non-promotion before the pupils; and when, added to +those extra inducements to work, there are given by committees and +superintendents examinations 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 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 they 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 overwork and overworry. The parents and +pupils themselves 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 examinations +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. + +"It will be observed that in this charge against parents I do not speak +of those causes of ill health which really have nothing to do with +overwork, but which are oftentimes forgotten when a school-boy 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 +indulgence 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 +circumstances of the pupil's life which can be conveniently ascertained, +even though those 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 understanding 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 particular pupil to lessen his work. Not +unfrequently there are found other causes of ill health than those which +I have mentioned; such, for instance, as poor ventilation, overheating +of the school-room, 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 overwork, 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."[1] + +[Footnote 1: Forty-ninth Annual Report of the Massachusetts Board of +Education, p. 204 (John T. Prince).] + +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 necessities 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 problem by taking two sets of beings of different gifts, and +of unlike physiological needs and construction, and forcing them into +the same educational mould. + +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 +conscientiousness, 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 surpasses 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 nowadays 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 feminine 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 little 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 proportion 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 professional guardianship at Johns Hopkins is +an admirable exception, and at some other institutions the physical +examination on matriculation becomes of the utmost value, when followed +up as it is in certain of these schools by compulsory physical training +and occasional re-examinations of the state of health. + +I do not see why the whole matter could not in all colleges be +systematically made part of the examinations on entry upon studies. It +would at least point out to the thoughtful student his weak points, and +enable 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 valvular troubles who had suffered from having been allowed +to play foot-ball. Cases of cerebral trouble in students, due to the use +of defective eyes, are common, and I have known many valuable lives +among male and female students crippled hopelessly owing to the fact +that no college pre-examination 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 +compete 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 remonstrate 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 with multiplied studies and unwholesome home life, +plods on, doing poor work, until somebody 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 perfectly 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. +Practically, 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 +admission at Harvard or Yale. Now, let any one compare the scale of +studies for both sexes employed half a century ago with that of to-day. +He will find that its 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 or earlier.[1] + +[Footnote 1: Witness Richardson's heroine, who was "perfect mistress of +the four rules of arithmetic"!] + +I firmly believe--and I am not alone in this opinion--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. Anything, 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 school-girls are suffering in health from +confinement, want of exercise at the time of day when they most incline +to it, bad ventilation,[1] and too steady occupation of mind. At no +other time of life is the nervous system so sensitive,--so irritable, I +might say,--and at no other are abundant fresh air and exercise so +important. To show more precisely how the growing girl is injured by the +causes just mentioned would lead me to speak of subjects unfit for full +discussion in these pages, but no thoughtful reader can be much at a +loss as to my meaning. + +[Footnote 1: 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 +school-house. As a consequence, we hear endless complaints from young +ladies of overheated or chilly rooms. If the teacher be old, the room is +kept too warm; if she be young, and much afoot about her school, the +apartment is apt to be cold.] + +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 every one concerned in our public +schools. + +[Footnote 1: Miss Pendleton.] + +"There can be no question that the health of growing 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 +examinations; 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 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 in-door +social amusements 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 school-room 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 apprehension. + +"This, with other statistics, would seem to bear 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 injurious 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 hundreds of girls hurried annually forward +beyond their physical or mental capacity, in advance of their physical +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." + +[Footnote 1: Philadelphia.] + +"Overpressure in school appears to me to be a disease of the body +politic from which this member suffers; but it also seems to me that +this vast school system is the most powerful agency for the correction +of the evil. In the case of girls, the first principle to be 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 education 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. + +"Edward Everett Hale, with his far spiritual sight, has discerned the +necessity for restoring home training, 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 prepared 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 +afterward,' cannot be too often quoted. Let branches in household +economy 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 insufficient food, and of acquiring skill in +household duties in addition to the school curriculum, we not only +simplify and harmonize her work, but we send out in every case a woman +prepared to carry this new influence 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 pre-empted 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 +advantage 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 capacity 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 over-pressure 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 a teacher. This unwholesome feature is the one distinctive +strain which must be removed from the 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. + +"Every teacher knows that the average girl of seventeen has not reached +the physical, mental, or moral development necessary to enter upon this +severe and high professional course of studies, and that one year is +insufficient for such a course. + +"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 instruction to a good high school covering a term of four +years. In this as in all other progressive formative periods the way out +is ahead. + +"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, +when they have sent out a large body of American women prepared, not for +a single profession, even the high feminine vocation of pedagogy, but +equipped for her highest, most general and congenial functions as the +source and centre of the home." + +I am unwilling to leave this subject without a few words as to our +remedy, especially as concerns our public schools and normal schools for +girls. What seems to me to be needed most is what the woman 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 hygienic +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 perhaps of all +civilized females the least qualified to undertake 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 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 dangers 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 national career alone will be +willing to admit my proposition, but among the higher intellectual +workers, such as astronomers, physicists, and naturalists, I have +frequently 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 answered 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 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 honored 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 +savans 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 be. Why this is I cannot say, but it is not more +mysterious than the fact that agents which, as sedatives or excitants, +affect the great nerve-centres, do this very differently in different +climates. There is some evidence 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 external temperatures, as well +as by the fact which Dr. Brown-Séquard discovered, and which I have +frequently 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 quantities 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 influences. + +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 +corporal 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 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] + +[Footnote 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.] + +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 anxiety or of +grave responsibility, are subject to the same form of disease; and this +I presume is why we meet with numerous instances of nervous exhaustion +among merchants and manufacturers. The lawyer and clergyman offer +examples, but I do not remember to have seen many bad cases among +physicians. Dismissing the easy jest which the latter statement will +surely suggest, the reason for this we may presently encounter. + +My note-books 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 involving 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 business, 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 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 counting-house 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 sea-shore. This +incessant monotony tells in the end. Men have confessed to me that for +twenty years they had worked every day, often travelling 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 representative 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, and +just as they are thinking, "Now we will stop and enjoy ourselves," the +brain, which, slave-like, 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 maturing; 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 responsibilities 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-increasing strain, and responsibilities +of gradual growth tend, with his out-door life, to save him from the +form of disease I have been alluding to. This element of open-air life, +I suspect, has a share in protecting men who in many respects lead a +most unhealthy existence. 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. +For these reasons I do not doubt that the effects of our great civil +war were far more severely felt by the Secretary of War and President +Lincoln than by Grant or Sherman. + +The wearing, incessant cares of overwork, of business 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-centres if the lighter warnings 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 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 centres with which he feels and thinks are more grave +and are less open to ready relief. + +When affections of the outlying organs are neglected, 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 +centres, 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 late war. Severe marches, bad food, and other +causes which make war exhausting, were constantly in action, until +certain 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 with 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-centres which furnish it with motor energy, so that excessive work +may bring about a state of congestion, owing to which the nerve-centre +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 +over-long on the stretch, and when moral causes, such as heavy +responsibilities and over-anxiety, are at work. + +When in active use, the thinking organs become full of blood, and, as +has been shown, rise in temperature, while the feet and hands become +cold. Nature 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 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 +than mere thought; and lastly, she desired that, during digestion, all +the surplus blood of the body should go to the stomach, intestines, and +liver, and that neither blood nor nerve-power should be then misdirected +upon the brain: in other words, she did not mean that we should try to +carry on, with equal energy, two kinds of important functional business +at once. + +If, then, the brain-user wishes to be healthy, he must limit his hours +of work according to rules which will come of experience, and which no +man can lay down for him. Above all, let him eat regularly and not at +too long intervals. I well remember the amazement of a distinguished +naturalist when told that his sleeplessness and irregular pulse were due +to his fasting from nine until six. A biscuit and a glass of porter, at +one o'clock, effected a ready and pleasant cure. As to exercise in the +fresh air, I need say little, except that if the exercise can be made to +have a distinct object, not in the way of business, so much the better. +Nor should I need to add that we may relieve the thinking and worrying +mechanisms by light reading and other amusements, or enforce the lesson +that no hard work should be attempted during digestion. The wise doctor +may haply smile at the commonplace of such directions, but woe be to the +man who neglects them! + +When an overworked and worried victim has sufficiently sinned against +these simple laws, if he does not luckily suffer from disturbances of +heart or stomach, he begins to have certain signs of nervous +exhaustion. + +As a rule, one of two symptoms appears first, though sometimes both come +together. Work gets to be a little less facile; this astonishes the +subject, especially if he has been under high pressure and doing his +tasks with that ease which comes of excitement. With this, or a little +later, he discovers that he sleeps badly, and that the thoughts of the +day infest his dreams, or so possess him as to make slumber difficult. +Unrefreshed, he rises and plunges anew into the labor for which he is no +longer competent. Let him stop here; he has had his warning. Day after +day the work grows more trying, but the varied stimulants to exertion +come into play, the mind, aroused, forgets in the cares of the day the +weariness of the night season, and so, with lessening power and growing +burden, he pursues his purpose. At last come certain new symptoms, such +as giddiness, dimness of sight, neuralgia of the face or scalp, with +entire nights of insomnia and growing difficulty in the use of the +mental powers; so that to attempt a calculation, or any form of +intellectual labor, is to insure a sense of distress in the head, or +such absolute pain as proves how deeply the organs concerned have +suffered. Even to read is sometimes almost impossible; and there still +remains the perilous fact that under enough of moral stimulus the man +may be able, for a few hours, to plunge into business cares, without +such pain as completely to incapacitate him for immediate activity. +Night, however, never fails to bring the punishment; and at last the +slightest prolonged exertion of mind becomes impossible. In the worst +cases the scalp itself grows sore, and a sudden jar hurts the brain, or +seems to do so, while the mere act of stepping from a curb-stone +produces positive pain. + +Strange as it may seem, much of all this may happen to a man, and he may +still struggle onward, ignorant of the terrible demands he is making +upon an exhausted brain. Usually, by this time he has sought advice, +and, if his doctor be worthy of the title, has learned that while there +are certain aids for his symptoms in the shape of drugs, there is only +one real remedy. Happy he if not too late in discovering that complete +and prolonged cessation from work is the one thing needful. Not a week +of holiday, or a month, but probably a year or more of utter idleness +may be absolutely essential. Only this will answer in cases so extreme +as that which I have tried to depict, and even this will not always +insure a return to a state of active working health. + +I am very far from conceding that the vehement energy with which we do +our work is due altogether to greed. We probably idle less and play less +than any other race, and the absence of national habits of sport, +especially in the West, leaves the man of business with no inducement to +abandon that unceasing labor in which at last he finds his sole +pleasure. He does not ride, or shoot, or fish, or play any game but +euchre. Business absorbs him utterly, and at last he finds neither time +nor desire for books. The newspaper is his sole literature; he has never +had time to acquire a taste for any reading save his ledger. Honest +friendship for books comes with youth or, as a rule, not at all. At last +his hour of peril arrives. Then you may separate him from business, but +you will find that to divorce his thoughts from it is impossible. The +fiend of work he raised no man can lay. As to foreign travel, it +wearies him. He has not the culture which makes it available or +pleasant. Notwithstanding the plasticity of the American, he is now +without resources. What then to advise I have asked myself countless +times. Let him at least look to it that his boys go not the same evil +road. The best business men are apt to think that their own successful +careers represent the lives their children ought to follow, and that the +four years of college spoil a lad for business. In reality these years, +be they idle or well filled with work, give young men the custom of +play, and surround them with an atmosphere of culture which leaves them +with bountiful resources for hours of leisure, while they insure to them +in these years of growth wholesome, unworried freedom from such business +pressure as the successful parent is so apt to put on too youthful +shoulders. + +Somewhat distracted by the desire to be brief, and yet to tell the whole +story, I have sought, in what I fear is a very loose and disconnected +way, to put in a new light some of the evils which are hurting the +mothers of our race, and those which every day's experience teaches the +doctor are gravely affecting the working capacity of numberless men. I +trust I have succeeded in satisfying my readers that we dwell in a +climate where work of all kinds demands greater precautions as to health +than is the case abroad. We cannot improve our climate, but it is quite +possible that we have not sufficiently learned to modify the conditions +of labor in accordance with those of the sky under which we live. + +No student of the nervous maladies of American men and women will think +I have overdrawn any part of the foregoing sketch. It would have been as +easy, had such a course been proper, to tell the individual stories of +youth, vigorous, eager, making haste to be rich, wrecked and made +unproductive and dependent for years or forever; and of middle age, +unable or unwilling to pause in the career of dollar-getting, crushed to +earth in the hour of fruition, or made powerless to labor longer at any +cost for those who were dearest. + +THE END. + + + + + + + +End of the Project Gutenberg EBook of Wear and Tear, by Silas Weir Mitchell + +*** END OF THIS PROJECT GUTENBERG EBOOK WEAR AND TEAR *** + +***** This file should be named 13197-8.txt or 13197-8.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/1/3/1/9/13197/ + +Produced by Bryan Ness and PG Distributed Proofreaders + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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Thus, we do not necessarily +keep eBooks in compliance with any particular paper edition. + +Most people start at our Web site which has the main PG search facility: + + https://www.gutenberg.org + +This Web site includes information about Project Gutenberg-tm, +including how to make donations to the Project Gutenberg Literary +Archive Foundation, how to help produce our new eBooks, and how to +subscribe to our email newsletter to hear about new eBooks. + diff --git a/old/old/13197-8.zip b/old/old/13197-8.zip Binary files differnew file mode 100644 index 0000000..055e9a5 --- /dev/null +++ b/old/old/13197-8.zip diff --git a/old/old/13197.txt b/old/old/13197.txt new file mode 100644 index 0000000..528310c --- /dev/null +++ b/old/old/13197.txt @@ -0,0 +1,1786 @@ +The Project Gutenberg EBook of Wear and Tear, by Silas Weir Mitchell + +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 + + +Title: Wear and Tear + or, Hints for the Overworked + +Author: Silas Weir Mitchell + +Release Date: August 17, 2004 [EBook #13197] + +Language: English + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK WEAR AND TEAR *** + + + + +Produced by Bryan Ness and PG Distributed Proofreaders + + + + + +WEAR AND TEAR, + +OR + +HINTS FOR THE OVERWORKED. + +BY +S. WEIR MITCHELL, M.D., LL.D. HARV., + +MEMBER OF THE NATIONAL ACADEMY OF SCIENCES, PRESIDENT OF THE COLLEGE OF +PHYSICIANS OF PHILADELPHIA, ETC. + +_FIFTH EDITION_, +THOROUGHLY REVISED. + +PHILADELPHIA: +J.B. LIPPINCOTT COMPANY. +LONDON: 10 HENRIETTA STREET, COVENT GARDEN. + +Entered according to Act of Congress, in the year 1871, by +J.B. LIPPINCOTT & CO., +In the Office of the Librarian of Congress at Washington. + + +PRINTED BY J.B. LIPPINCOTT COMPANY, PHILADELPHIA. + + + +PREFACE. + +The rate of change in this country in education, in dress, and in diet +and habits of daily life surprises even the most watchful American +observer. It is now but fifteen years since this little book was written +as a warning to a restless nation possessed of an energy tempted to its +largest uses by unsurpassed opportunities. There is still need to repeat +and reinforce my former remonstrance, but I am glad to add that since I +first wrote on these subjects they have not only grown into importance +as questions of public hygiene, but vast changes for the better have +come about in many of our ways of living, and everywhere common sense is +beginning to rule in matters of dress, diet, and education. + +The American of the Eastern States and of the comfortable classes[1] is +becoming notably more ruddy and more stout. The alteration in women as +to these conditions is most striking, and, if I am not mistaken, in +England there is a lessening tendency towards that excess of adipose +matter which is still a surprise to the American visiting England for +the first time. + +I should scarcely venture to assert so positively that Americans had +obviously taken on flesh within a generation if what I see had not been +observed by many others. It would, I think, be interesting to enter at +length upon a study of these remarkable changes, but that were scarcely +within the scope of this little book. + +[Footnote 1: Happily, a large class with us.] + + + + + + +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. Somewhat 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 accordance 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 doctor's stand-point, +the evils which their own experience had taught them to see in our +present mode of tasking the brains of the younger girls. + +[Footnote 1: In 1871.] + +I hope, therefore, that I am justified in the belief 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 statistics 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. + +The sermon of which these words are the text has been preached many +times in many ways to congregations 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 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 out-door 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 colonist 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 prodigal 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 accumulations of power, but also wastefully +spending the capital? From a few we have grown to millions, and already +in many ways 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 competitions which make it +hard to live nowadays and embitter the daily bread of life. Neither had +they the 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 +competition 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 towards social advancement, and the overeducation 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 re-examine this +question--to see if it be true that the nervous system 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 venturing 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 questions of mental +hygiene of which in general we hear but too little. If the strictures I +have to make applied 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 mechanical +labor, as opposed to that of the clerk, is being "levelled 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 manufacture, 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 +antagonize 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 centres +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 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 centres which originate or +evolve muscular power do sometimes suffer from undue taxation; but it is +certainly true that when this happens, the evil result is rarely as +severe or as lasting as when 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-centres 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 excess of mental labor? The simple +answer is, that mental overwork is harder, because as a rule it is +closet or counting-room or at least in-door 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 quickening 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 material of mental acts as compared with motor +manifestations, and here, therefore, are at fault; because, although 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 motor 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 referable 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 +_wide-awakefulness_ 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 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 writing 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 Feuchtersleben's "Dietetics of the +Soul," both out of print, which deals in a readable fashion with this or +kindred topics.[1] Many men are warned by some sense of want of +clearness 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 attentive 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 system drive +him to take exercise. Especially when working 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. + +[Footnote 1: See, now, "Brain-Work and Overwork," by H.C. Wood, M.D.; +also, "Mental Overwork and Premature Disease among Public and +Professional Men," by Ch. K. Mills, M.D.; also, "Overwork and Sanitation +in Public Schools, with Remarks on the Production of Nervous Disease and +Insanity," by Ch. K. Mills, M.D.,--_Annals of Hygiene_, September, +1886.] + +One of our ablest medical scholars reports himself to me as having never +been aware of any sensation 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 accustomed 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 +clasping his hands over his head; and also there is desire to lie down +and rest. + +"I am not aware," writes a physician of distinction, "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 thinking organs rather too hard. As a +result, I began to have headache after every period of intellectual +exertion. 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 fulness 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 conditions under which men of note are using their mental +machinery would be everyway worthy of attention. + +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 useless +by the denial of full attention. Or else the imagination 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 overtasked brain belongs more or less to every man who overuses +this organ, and is the well-known initial symptom 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, 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 deserves, even from such thorough believers in unconscious +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 biography 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 before +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 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 thinking organs. But if into +the life of a man whose powers are fully taxed we bring the elements of +great anxiety or worry, or excessive haste, the whole machinery begins +at once to work, as it were, with a dangerous 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, because 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 +employed 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 horseback?" Perhaps, too, +there is concerned a physiological law, which, though somewhat +mysterious, I may again have to summon to my aid in the way of +explanation. 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 nervous system are +increasing rapidly in the more crowded portions of the United States; +but I am not aware that any one 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 frequent 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 together 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 system. But the most unquestionable proof of the increase 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 testing 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 fulfils 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-awake +business centre in America. I owe to the kindness of Dr. J.H. Rauch, +Sanitary Superintendent 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 conclusions 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 therefore ask that I may be supposed to have taken +every possible precaution in order not to exaggerate the reality of a +great evil. Certain diseases, such as apoplexy, palsy, epilepsy, St. +Vitus's dance, and lockjaw or tetanus, we all agree to consider as +nervous maladies; convulsions, 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-centres; 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 extremities 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 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 that 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 +labelled in the reports as dropsy of the brain and convulsions, have +risen to 20.4 times what they were in 1852. Thus in 1852, '53, and '55, +leaving out the cholera year '54, the deaths from nerve disorders were +respectively to the whole population as 1 in 1149, 1 in 953, and 1 in +941; whilst in 1866, '67, and '68, 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 every 9.9 of all deaths. + +I have alluded above to a class of deaths included in my tables, but +containing, no doubt, instances of mortality 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 proportion of this loss of life is really owing to brain +affections, I have thought best to include the whole class in my +statement. + +A glance at the individual diseases which are indubitably nervous is +more instructive and less perplexing. For example, taking the extreme +years, the recent increase in apoplexy is remarkable, even when we +remember that it is a malady of middle and later life, and that Chicago, +a new city, is therefore entitled to a yearly increasing quantity of +this form of death. In 1868 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 '53 there were but two deaths from +this disease; in the next four years there were none. From 1858 to '64, +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, increases in 1868,--8.6 times +as compared with 1852; and 26 times as compared with the four years +following 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 one only, and the +last-mentioned year has but two. 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 +general reader, he need only be told that tetanus is nearly always +caused by mechanical injuries, and that the natural increase of these in +a place like Chicago may account for a large part of the increase. Yet, +taking the record as a whole, and viewing it only with a calm 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 centre 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 +elsewhere throughout the land. + +[Footnote 1: I asked two citizens of this uneasy town--on the same +day--what was their business. Both replied tranquilly that they were +speculators!] + +The facts I have given establish the disproportionate increase in one +great city of those diseases which are largely produced by the strain on +the nervous 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 statistics of this +great business-centre; to see if the answers would weaken or reinforce +the conclusions drawn in 1871. 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 full, and nowhere else are the faces +so expressive of preoccupation, of anxiety, of excitement. It is making +money fast and accumulating a physiological debt of 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 solution of certain awkward questions which force +themselves 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 conditions +under which all work must be done in this country, some are out-growths +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 affect the male sex. If the mothers of a +people are sickly and weak, the sad inheritance falls upon their +offspring, 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 +thoughtfully 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 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 deliberately 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 ball-room. You will see many very +charming faces, the like of which the world cannot match--figures +somewhat too spare of flesh, and, especially south of Rhode Island, a +marvellous 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 eighteen, 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 ungracious 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, neuralgia, weak backs, and the varied +forms of hysteria,--that domestic demon which has produced untold +discomfort 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 do to make a household wretched. Mrs. Gradgrind is, 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 physical failure of our +city-bred women to fulfil 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 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 +numerous artificial infant foods now for sale singularly prove the truth +of this latter statement. Many physicians, 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 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 blame; while really, with rare +exceptions, the newer fashions have been more healthy than those they +superseded, people are better clad and better warmed than ever, and, +save in rare cases, late hours and overexertion in the dance are utterly +incapable of alone explaining 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 produce an effect which +would not in some other countries be so severe. I am quite persuaded, +indeed, that the development of a nervous temperament is one of the many +race-changes which are also giving us facial, vocal, and other +peculiarities 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 conditions which are +utterly mysterious, the obstacles to physical exercise, arising from +extremes of temperature, constitute at least one obvious cause of ill +health among women in our country. The great heat of summer, and the +slush and ice of winter, interfere with women who wish to take exercise, +but whose arrangements 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 as well able +to study, _with proper precautions_, 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 usefulness. + +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 reason, nearly always +exceeds the time stated by teachers to be necessary; and most girls of +our common schools and normal schools between the ages of thirteen and +seventeen thus expend two or three hours. Does any physician believe +that it is good for a growing 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, produce effects +on the growing brain which, in a vast number 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 +pushing,--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 be reinforced by what is to be said +farther on by a competent 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 non-promotion before the pupils; and when, added to +those extra inducements to work, there are given by committees and +superintendents examinations 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 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 they 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 overwork and overworry. The parents and +pupils themselves 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 examinations +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. + +"It will be observed that in this charge against parents I do not speak +of those causes of ill health which really have nothing to do with +overwork, but which are oftentimes forgotten when a school-boy 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 +indulgence 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 +circumstances of the pupil's life which can be conveniently ascertained, +even though those 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 understanding 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 particular pupil to lessen his work. Not +unfrequently there are found other causes of ill health than those which +I have mentioned; such, for instance, as poor ventilation, overheating +of the school-room, 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 overwork, 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."[1] + +[Footnote 1: Forty-ninth Annual Report of the Massachusetts Board of +Education, p. 204 (John T. Prince).] + +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 necessities 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 problem by taking two sets of beings of different gifts, and +of unlike physiological needs and construction, and forcing them into +the same educational mould. + +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 +conscientiousness, 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 surpasses 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 nowadays 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 feminine 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 little 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 proportion 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 professional guardianship at Johns Hopkins is +an admirable exception, and at some other institutions the physical +examination on matriculation becomes of the utmost value, when followed +up as it is in certain of these schools by compulsory physical training +and occasional re-examinations of the state of health. + +I do not see why the whole matter could not in all colleges be +systematically made part of the examinations on entry upon studies. It +would at least point out to the thoughtful student his weak points, and +enable 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 valvular troubles who had suffered from having been allowed +to play foot-ball. Cases of cerebral trouble in students, due to the use +of defective eyes, are common, and I have known many valuable lives +among male and female students crippled hopelessly owing to the fact +that no college pre-examination 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 +compete 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 remonstrate 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 with multiplied studies and unwholesome home life, +plods on, doing poor work, until somebody 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 perfectly 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. +Practically, 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 +admission at Harvard or Yale. Now, let any one compare the scale of +studies for both sexes employed half a century ago with that of to-day. +He will find that its 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 or earlier.[1] + +[Footnote 1: Witness Richardson's heroine, who was "perfect mistress of +the four rules of arithmetic"!] + +I firmly believe--and I am not alone in this opinion--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. Anything, 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 school-girls are suffering in health from +confinement, want of exercise at the time of day when they most incline +to it, bad ventilation,[1] and too steady occupation of mind. At no +other time of life is the nervous system so sensitive,--so irritable, I +might say,--and at no other are abundant fresh air and exercise so +important. To show more precisely how the growing girl is injured by the +causes just mentioned would lead me to speak of subjects unfit for full +discussion in these pages, but no thoughtful reader can be much at a +loss as to my meaning. + +[Footnote 1: 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 +school-house. As a consequence, we hear endless complaints from young +ladies of overheated or chilly rooms. If the teacher be old, the room is +kept too warm; if she be young, and much afoot about her school, the +apartment is apt to be cold.] + +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 every one concerned in our public +schools. + +[Footnote 1: Miss Pendleton.] + +"There can be no question that the health of growing 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 +examinations; 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 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 in-door +social amusements 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 school-room 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 apprehension. + +"This, with other statistics, would seem to bear 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 injurious 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 hundreds of girls hurried annually forward +beyond their physical or mental capacity, in advance of their physical +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." + +[Footnote 1: Philadelphia.] + +"Overpressure in school appears to me to be a disease of the body +politic from which this member suffers; but it also seems to me that +this vast school system is the most powerful agency for the correction +of the evil. In the case of girls, the first principle to be 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 education 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. + +"Edward Everett Hale, with his far spiritual sight, has discerned the +necessity for restoring home training, 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 prepared 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 +afterward,' cannot be too often quoted. Let branches in household +economy 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 insufficient food, and of acquiring skill in +household duties in addition to the school curriculum, we not only +simplify and harmonize her work, but we send out in every case a woman +prepared to carry this new influence 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 pre-empted 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 +advantage 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 capacity 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 over-pressure 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 a teacher. This unwholesome feature is the one distinctive +strain which must be removed from the 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. + +"Every teacher knows that the average girl of seventeen has not reached +the physical, mental, or moral development necessary to enter upon this +severe and high professional course of studies, and that one year is +insufficient for such a course. + +"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 instruction to a good high school covering a term of four +years. In this as in all other progressive formative periods the way out +is ahead. + +"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, +when they have sent out a large body of American women prepared, not for +a single profession, even the high feminine vocation of pedagogy, but +equipped for her highest, most general and congenial functions as the +source and centre of the home." + +I am unwilling to leave this subject without a few words as to our +remedy, especially as concerns our public schools and normal schools for +girls. What seems to me to be needed most is what the woman 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 hygienic +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 perhaps of all +civilized females the least qualified to undertake 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 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 dangers 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 national career alone will be +willing to admit my proposition, but among the higher intellectual +workers, such as astronomers, physicists, and naturalists, I have +frequently 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 answered 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 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 honored 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 +savans 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 be. Why this is I cannot say, but it is not more +mysterious than the fact that agents which, as sedatives or excitants, +affect the great nerve-centres, do this very differently in different +climates. There is some evidence 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 external temperatures, as well +as by the fact which Dr. Brown-Sequard discovered, and which I have +frequently 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 quantities 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 influences. + +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 +corporal 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 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] + +[Footnote 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.] + +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 anxiety or of +grave responsibility, are subject to the same form of disease; and this +I presume is why we meet with numerous instances of nervous exhaustion +among merchants and manufacturers. The lawyer and clergyman offer +examples, but I do not remember to have seen many bad cases among +physicians. Dismissing the easy jest which the latter statement will +surely suggest, the reason for this we may presently encounter. + +My note-books 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 involving 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 business, 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 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 counting-house 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 sea-shore. This +incessant monotony tells in the end. Men have confessed to me that for +twenty years they had worked every day, often travelling 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 representative 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, and +just as they are thinking, "Now we will stop and enjoy ourselves," the +brain, which, slave-like, 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 maturing; 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 responsibilities 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-increasing strain, and responsibilities +of gradual growth tend, with his out-door life, to save him from the +form of disease I have been alluding to. This element of open-air life, +I suspect, has a share in protecting men who in many respects lead a +most unhealthy existence. 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. +For these reasons I do not doubt that the effects of our great civil +war were far more severely felt by the Secretary of War and President +Lincoln than by Grant or Sherman. + +The wearing, incessant cares of overwork, of business 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-centres if the lighter warnings 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 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 centres with which he feels and thinks are more grave +and are less open to ready relief. + +When affections of the outlying organs are neglected, 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 +centres, 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 late war. Severe marches, bad food, and other +causes which make war exhausting, were constantly in action, until +certain 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 with 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-centres which furnish it with motor energy, so that excessive work +may bring about a state of congestion, owing to which the nerve-centre +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 +over-long on the stretch, and when moral causes, such as heavy +responsibilities and over-anxiety, are at work. + +When in active use, the thinking organs become full of blood, and, as +has been shown, rise in temperature, while the feet and hands become +cold. Nature 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 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 +than mere thought; and lastly, she desired that, during digestion, all +the surplus blood of the body should go to the stomach, intestines, and +liver, and that neither blood nor nerve-power should be then misdirected +upon the brain: in other words, she did not mean that we should try to +carry on, with equal energy, two kinds of important functional business +at once. + +If, then, the brain-user wishes to be healthy, he must limit his hours +of work according to rules which will come of experience, and which no +man can lay down for him. Above all, let him eat regularly and not at +too long intervals. I well remember the amazement of a distinguished +naturalist when told that his sleeplessness and irregular pulse were due +to his fasting from nine until six. A biscuit and a glass of porter, at +one o'clock, effected a ready and pleasant cure. As to exercise in the +fresh air, I need say little, except that if the exercise can be made to +have a distinct object, not in the way of business, so much the better. +Nor should I need to add that we may relieve the thinking and worrying +mechanisms by light reading and other amusements, or enforce the lesson +that no hard work should be attempted during digestion. The wise doctor +may haply smile at the commonplace of such directions, but woe be to the +man who neglects them! + +When an overworked and worried victim has sufficiently sinned against +these simple laws, if he does not luckily suffer from disturbances of +heart or stomach, he begins to have certain signs of nervous +exhaustion. + +As a rule, one of two symptoms appears first, though sometimes both come +together. Work gets to be a little less facile; this astonishes the +subject, especially if he has been under high pressure and doing his +tasks with that ease which comes of excitement. With this, or a little +later, he discovers that he sleeps badly, and that the thoughts of the +day infest his dreams, or so possess him as to make slumber difficult. +Unrefreshed, he rises and plunges anew into the labor for which he is no +longer competent. Let him stop here; he has had his warning. Day after +day the work grows more trying, but the varied stimulants to exertion +come into play, the mind, aroused, forgets in the cares of the day the +weariness of the night season, and so, with lessening power and growing +burden, he pursues his purpose. At last come certain new symptoms, such +as giddiness, dimness of sight, neuralgia of the face or scalp, with +entire nights of insomnia and growing difficulty in the use of the +mental powers; so that to attempt a calculation, or any form of +intellectual labor, is to insure a sense of distress in the head, or +such absolute pain as proves how deeply the organs concerned have +suffered. Even to read is sometimes almost impossible; and there still +remains the perilous fact that under enough of moral stimulus the man +may be able, for a few hours, to plunge into business cares, without +such pain as completely to incapacitate him for immediate activity. +Night, however, never fails to bring the punishment; and at last the +slightest prolonged exertion of mind becomes impossible. In the worst +cases the scalp itself grows sore, and a sudden jar hurts the brain, or +seems to do so, while the mere act of stepping from a curb-stone +produces positive pain. + +Strange as it may seem, much of all this may happen to a man, and he may +still struggle onward, ignorant of the terrible demands he is making +upon an exhausted brain. Usually, by this time he has sought advice, +and, if his doctor be worthy of the title, has learned that while there +are certain aids for his symptoms in the shape of drugs, there is only +one real remedy. Happy he if not too late in discovering that complete +and prolonged cessation from work is the one thing needful. Not a week +of holiday, or a month, but probably a year or more of utter idleness +may be absolutely essential. Only this will answer in cases so extreme +as that which I have tried to depict, and even this will not always +insure a return to a state of active working health. + +I am very far from conceding that the vehement energy with which we do +our work is due altogether to greed. We probably idle less and play less +than any other race, and the absence of national habits of sport, +especially in the West, leaves the man of business with no inducement to +abandon that unceasing labor in which at last he finds his sole +pleasure. He does not ride, or shoot, or fish, or play any game but +euchre. Business absorbs him utterly, and at last he finds neither time +nor desire for books. The newspaper is his sole literature; he has never +had time to acquire a taste for any reading save his ledger. Honest +friendship for books comes with youth or, as a rule, not at all. At last +his hour of peril arrives. Then you may separate him from business, but +you will find that to divorce his thoughts from it is impossible. The +fiend of work he raised no man can lay. As to foreign travel, it +wearies him. He has not the culture which makes it available or +pleasant. Notwithstanding the plasticity of the American, he is now +without resources. What then to advise I have asked myself countless +times. Let him at least look to it that his boys go not the same evil +road. The best business men are apt to think that their own successful +careers represent the lives their children ought to follow, and that the +four years of college spoil a lad for business. In reality these years, +be they idle or well filled with work, give young men the custom of +play, and surround them with an atmosphere of culture which leaves them +with bountiful resources for hours of leisure, while they insure to them +in these years of growth wholesome, unworried freedom from such business +pressure as the successful parent is so apt to put on too youthful +shoulders. + +Somewhat distracted by the desire to be brief, and yet to tell the whole +story, I have sought, in what I fear is a very loose and disconnected +way, to put in a new light some of the evils which are hurting the +mothers of our race, and those which every day's experience teaches the +doctor are gravely affecting the working capacity of numberless men. I +trust I have succeeded in satisfying my readers that we dwell in a +climate where work of all kinds demands greater precautions as to health +than is the case abroad. We cannot improve our climate, but it is quite +possible that we have not sufficiently learned to modify the conditions +of labor in accordance with those of the sky under which we live. + +No student of the nervous maladies of American men and women will think +I have overdrawn any part of the foregoing sketch. It would have been as +easy, had such a course been proper, to tell the individual stories of +youth, vigorous, eager, making haste to be rich, wrecked and made +unproductive and dependent for years or forever; and of middle age, +unable or unwilling to pause in the career of dollar-getting, crushed to +earth in the hour of fruition, or made powerless to labor longer at any +cost for those who were dearest. + +THE END. + + + + + + + +End of the Project Gutenberg EBook of Wear and Tear, by Silas Weir Mitchell + +*** END OF THIS PROJECT GUTENBERG EBOOK WEAR AND TEAR *** + +***** This file should be named 13197.txt or 13197.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/1/3/1/9/13197/ + +Produced by Bryan Ness and PG Distributed Proofreaders + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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