Infomotions, Inc.Wear and Tear or, Hints for the Overworked / Mitchell, S. Weir (Silas Weir), 1829-1914



Author: Mitchell, S. Weir (Silas Weir), 1829-1914
Title: Wear and Tear or, Hints for the Overworked
Publisher: Project Gutenberg
Tag(s): brain; nervous; labor; mental; nervous system; school; health
Contributor(s): Garnett, Constance, 1861-1946 [Translator]
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Rights: GNU General Public License
Size: 17,646 words (really short) Grade range: 13-16 (college) Readability score: 46 (average)
Identifier: etext13197
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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

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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.







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