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+*** 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 ***