Chapter III: Part 3

The illustration I have given saves me from dwelling at great length on the values of all the means within a woman's control for lessening the evil consequences of suffering, and if to few is given the largest moral and mental outfit for such a struggle, none are without the power to cultivate what they have, and, in the lesser ills of life, to make use of the lesson we may hope and know few will be called on to apply to an existence such as hers.

Pain of body, hurt of mind, all the sad gamut from discomfort to anguish, depend for their influence on her life upon how nature and training enable the woman to meet them.

To endure without excess of emotion saves her from consequent nervousness, and from that feebleness of mind and body which craves at all cost instant relief. It is the spoiled child, untaught to endure, who becomes the self-pampered woman. Endurance of pain has also its side-values, and is the handmaid of courage and of a large range of duties. Tranquil endurance enables the sufferer to seek and to use all the means of distraction which this woman I have described did use. It leaves the mind free, as it never can be otherwise in the storm of unrestraint, to reason on her troubles, and to decide whether or not her pain justifies the use of drugs, for on her the physician must measurably rely for this knowledge, and as she is morally strong or weak the decision will be.

There are those, indeed, who suffer and grow strong; there are those who suffer and grow weak.

This mystery of pain is still for me the saddest of earth's disabilities. After all is said that can be said on its values as a safeguard, an indicator of the locality of disease, after the moralist has considered it from the disciplinary view, and the theologian cracked his teeth on this bitter nut, and the evolutionist accounted for its existence, it comes at last to the doctor to say what shall be done with it. I wish it came to him alone. Civilized man has ceased to torture, but nature, relentless still, has in store possibilities of utmost anguish, which seem to fall alike on the guilty and the innocent, the poor and the rich, and in largest proportion on the gentler sex. But while pain is still here with its ever-ready presence, the direct means of lessening it have multiplied so that hardly a month goes by without some new method being added of destroying for a time the power to suffer. For, bear in mind that it is not usually the cause which can be at once destroyed by drugs, but only the bodily capacity to react to it in the fashion we call pain. Ether, chloroform, cocaine, and many other drugs enable us to-day to feel sure that the mass of real pain in the world is vastly less than it was. It is, indeed, possible to prevent all pain, and pain has no real value which we need respect and desire to preserve; at least this is so from the physician's stand-point.

The temptation which comes to us out of the accumulation of anaesthetic agents is one which every tender-hearted man can understand. The temptations which it presents to the suffering they only know who have suffered. To this all that I have said leads up. To most women, even to strong women, there comes a time when pain is a grim presence in their lives. If brief, the wise physician calls upon them for that endurance, of the value of which I have spoken. On some he calls in vain. Even if it recur at intervals, as in the shape of neuralgic headaches, in the name of reason let him be the sole judge of your need to be relieved by drugs. He well knows, as you cannot know, that the frequent use of morphia seems in the end to increase, not to lessen, the whole amount of probable future pain, and that what eases for a time is a devil in angelic disguise. If you are urgent, weak of will, unable through unrestraint to comprehend him, the fault will be only half his, if you plead too eagerly for help and too constantly claim the relief he holds.

But suppose that the woman I address is a long and true sufferer, and that the physician desires to use such help often, then comes her time of peril and his day of largest responsibility. If he be weak, or too tender, or too prone to escape trouble by the easy help of some pain-lulling agent, she is soon on the evil path of the opium, chloral, or chloroform habit. Nor is prevention easy. With constant or inconstant suffering comes weakness of mind as well as body, and none but the strongest natures pass through this ordeal of character unhurt. If the woman be unenduring and unthoughtful, if the doctor fail to command her faith, and be too sympathetic, at last she gets possession herself of the drug, or the drug and the hypodermatic needle. Then there is before her one of the saddest of the many downward paths which lead to destruction of body and soul.

More often, in my experience, the opium habit is learned during an illness of limited duration, and for the consequences of which there is always some one to be blamed.

As I remember these patients, and I have seen them by the score, far on in their evil ways, such women are most often those who lack the power, even in health, to endure pain. Some defect of training or of nature has made pain, or even distress or insomnia, ills to be relieved at once regardless of cost. Let them but feel that relief for the time is possible, and self-restraint is over. They will have the thing they crave. You cure them of the vile opium habit at awful cost of suffering, and they relapse on the first new trial of endurance, and men of their type more surely than women.

I see a good many cases of opium, morphia, or chloral habit, and I am sure that these forms of intoxication are becoming more prevalent than they were a generation ago. Is this due to an increase in the disorders which are eased by such drugs? Is it not rather due to the softening influence of luxury, and the fact that we are all being constantly trained to feel that it is both easy and our right to escape pain, however brief?

I am sure, too, that a part of it lies in the readiness with which many physicians give sedatives, and their failure to feel the vast moral responsibilities of their position. But, whatever be the cause or causes, it is well in the hour of ease to learn beforehand the risks which come of too easy and too frequent appeals to agents which benumb the nerves.

When people are first given opium, it is apt to be the friend of the night and the foe of the morrow. Repeated often enough, it loses power to constipate and distress. It still soothes pain. It still gives sleep. At last it seems to be in a measure a tonic for those who take it. But after a while it does some other things less agreeable. The mind and memory suffer, but far more surely the moral nature is altered. The woman becomes indifferent, her affections dull, her sense of duty hopelessly weakened. Watchful, cunning, suspicious, deceitful,--a thief, if need be, to get the valued opiate,--she stops at nothing. It would seem as if it were a drug which directly affected the conscience. At last, before this one craving, all ties in life are slight and bind her not. Insensible to shame and dead to affection, she is happy if the alcohol habit be not added to her disorder, for if she cannot get the one drug she longs for, the other will serve her at need.

There is a popular idea that opium gives pleasant dreams, and that it takes us away into the land of poetry, to which it is supposed to have conducted Coleridge and De Quincey. As a matter of fact, there are but few persons who get more out of opium than relief of pain, sense of comfort, and next day's remorses. The opium dream is not for all. I have known only four or five cases of habitual and distinct opium dreamers. There was more of Coleridge than of opium in "Kubla Khan," and more of De Quincey than of the juice of poppies in the "Vision of Sudden Death." When it came to the telling of these immortal dreams, we may well suspect that the narrative gained in the literary appeal from the poet opium-drunk to the poet sober.

It is, I fancy, well known to physicians that opium may act on an individual differently at different times. In the case of one well known to me it usually causes sleep, and no longer gives rise to nausea the next day, as it once did. Although it leaves him sufficiently wretched, and he has taken it but rarely, the drug occasionally keeps him wide awake and delightfully indifferent to the passage of time. The striking hours are heard, and that is all. There is none of the ennui of insomnia. This effect of morphia is rare with him. He may have taken morphia a dozen times in his life to ease acute pain, but only twice has it made him thus wakeful. On these nights he saw an endless succession of visions, which he did not forget, as one does common dreams. Nearly all of the hallucinations were of the most amusing character, and were often long and connected series of ludicrous situations, over which he wondered, as he lay next day, a victim to the secondary miseries due to the soothing dose of the night before. This is one of the tricks which drugs play, and is not a thing to be anticipated. The drug is the same; the man varies, and with his variations arise peculiarities in the effects of remedies.

The excess sometimes attained in the use of opiates is almost past belief. I have seen a mere girl of seventeen years take at one dose thirty grains of morphia, and I know of a woman who took for years ninety grains a day, and ruined a weak husband, a man of small means, by the costliness of her habit.

The causes of the torment, which the cessation of the use of morphia brings about, are interesting. Agonizing pains show that the nerves, long muffled, have become more acutely sensitive than they were before the fatal drug was first employed. A host of lesser troubles--insomnia, pain, and indigestion--attend the cure. I know nothing more pitiful than such an ordeal, and, despite the most watchful care, I have seen it end more than once in suicide. When one has watched a woman from whom opium has been taken away, even with skilful tenderness, roll in agony on the floor, rend her garments, tear out her hair, or pass into a state of hysterical mania, the physician is made to feel that no suffering for which she took the drug can have been as bad as the results to which it leads. The capacity to suffer, which comes on as we remove the poison, is almost inconceivable. It lasts long, and is the true difficulty in the way of forming anew habits of wholesome endurance. The physician who imagines that his case is well, because he has enabled an opium-taker to eat, sleep, and be comfortable without use of the sedative, can have seen little of the future of such people. The oversensitiveness to pain persists for months, and is a constant temptation. The moral and mental habits formed under opium--the irresolution, the recklessness, the want of shame, in a word, the general failure of all that is womanly--need something more than time to cure. But I am not preaching to the woman just set free from this bondage to sin, and speak of her only to emphasize the horror with which I would wish to inspire the well, who yet may come some day to be the suffering.

If there be one set of women more liable than another to become victims of morphia or chloral, it is the wives of physicians. Every winter I see four or five, and always it is true that the habit has arisen out of the effort of the husband to attend medically on his wife. Physicians make good husbands, and this is in part due to the fact that their knowledge of the difficulties of feminine life causes them to be more thoughtfully tender, and more charitable as concerns the effects upon women of certain inevitable conditions as to which the layman is ignorant or indifferent. But the very fulness of the husband's appreciation of a woman's drawbacks and little moral ailments, the outcome of her womanhood, becomes dangerous when he ventures to be her medical caretaker. What he coolly decides in another's case, he cannot in hers. How can he see her suffer and not give her of the abundance of relief in his hands? She is quick to know and to profit by this, and so the worst comes of it.

"It is easy for you to sit by in your strength and see me suffer," said a woman once to me. She was on the verge of the morphia habit, and I was trying to break it off abruptly. I felt, as any gentle-hearted man must feel, the sting and hurt of her words. Next day she said to me, "Of course you were right. I used to talk that way to B----, and he never could stand it." He was her husband and a physician. She got well easily.

I do not believe that most women who sin in this way slip into it either quite so ignorantly and so unwarned as they would have you to suppose. Nearly always there is a time when some one--the physician, a friend, or their own reason--bids them pause, reflect, and choose.

"Alas I for thee, if thou from thine own soul dost turn and flee.
Better the house and company of pain;
Better distress;
Better the stones of strife, the bread with tears;
Humiliation and despair and fears;
All, all the heart can suffer, the soul know,
Rather than with the bestial train to go,
With base rejoicings, ignorant of woe."[3]

[Footnote 3: "Sylvian, and Other Poems," by Philip Varley.]

THE MORAL MANAGEMENT OF SICK OR INVALID CHILDREN.

Not long ago a pretty little girl of ten was brought to me from a long distance to get my advice as to a slight paralysis of one leg. The trouble had existed for several years. I soon saw that the child was irritable, sensitive, and positive, and I was, therefore, careful to approach her gently. The moment it was proposed to show me the leg, she broke into a fury of rage, and no inducement I could offer enabled me to effect my purpose. An appeal to the parents, and from them to force, ended in a distressing battle. She bit, scratched, kicked, and at last won a victory, and was left sullen and sobbing on the floor. Next day the same scene was repeated. It is true that at length they were able to undress her, but neither threats nor persuasion would keep her quiet long enough to enable me to apply the simplest tests. The case was obscure, and demanded the most careful study. Their time was limited, so that at length they were obliged to take her home in despair, without any guiding opinion from me, and with no advice, except as to her moral education, concerning which I was sufficiently explicit. I have seen many such illustrations of a common evil, and have watched the growth to adult life of some of these cases of wrecked character, and observed the unpleasant results which came as they grew older. I have used an extreme case as a text, because I desire to fix attention on the error which parents and some doctors are apt to commit in cases of chronic ailments in children.

As to the miserable sufferers who pass through long illness to death I have little to say. We naturally yield to their whims, pet and indulge them, moved by pitiful desire to give them all they want of the little which life affords them. In acute illness, with long convalescence, I am pretty sure that the tender mother does no real good by over-indulgence; but the subject is difficult, and hard to handle with justice and charity without calling down upon me the indignation of the unthoughtful. It is so easy and pleasant to yield to the caprices of those we love, when they are in pain or helpless from illness,--so doubly hard at such times to say no. Yet, if in the case of a long convalescence, such as follows, perhaps, a typhoid or scarlet fever, we balance for the little one the too-easily yielded joy of to-day against the inevitable stringency of discipline, which, with recovered health, must teach the then doubly difficult lesson of self-restraint, we shall see, I think, that, on the whole, we do not add to the sum of happiness to which the child is entitled.

The mother at the sick-bed of her young child is, however, a being quite often as difficult to manage as her child. All her instinctive maternity is up in arms. Deep in the heart of many mothers there is an unconfessed and half-smothered sense of wrath at the attack which sickness has made on her dear one. Then nothing is too much to give; no sacrifice of herself or others too great to grant or demand. The irritability and feebleness of convalescence makes claims upon her love of self-sacrifice, and her prodigality of tenderness as positive and yet more baneful. That in most cases she may and does go too far, and loses for her child what it is hard to recover in health, is a thing likely enough, yet to talk to her at such times of the wrong she does the child is almost to insult her. Nevertheless the unwisdom of a course of reckless yielding to all a child's whims is plain enough, for if the little one be long ill or weak, it learns with sad swiftness to exact more and more, and to yield less and less, so that it becomes increasingly hard to do for it the many little unpleasant things which sickness demands. Character comes strongly out in the maladies of the child, as it does even less distinctly in the sickness of the adult. The spoiled, over-indulged child is a doubly unmanageable invalid, and when in illness the foolish petting of the mother continues, the doctor, at least, is to be pitied.

The ductility of childhood has its dangerous side. This is seen very well in cases which, fortunately, are rather rare, and, for some reason, are less frequent in girls than in boys. These little ones observe sharply the faces and obvious motives of those about their sick-beds, and more readily than adults are led to humor the doubts they hear expressed by the doctor or their elders as to their capacity to do this or that. Too frequent queries as to their feelings are perilously suggestive, and out of it all arises, in children of nervous or imaginative temperaments, an inexplicable tendency to fulfil the predictions they have heard, or actively to humor the ideas they acquire as to their own ailments and disabilities.

There is something profoundly human in this. With careless, unthoughtful people, who have trained a child to know that illness means absolute indulgence, and who pour out unguardedly their own fears and expectations at the bedside, the result for the child is in some cases past belief. The little one gets worse and worse. It accepts automatically the situation, with all the bribes to do so made larger by feebleness, and at last gains that extreme belief in its own inability to rise or move about which absolute convictions of this nature impose on child or man.

There is a further and worse stage possible. The child's claims increase. Its complaints gather force, and alarm those about it. Gratified in all its whims, it develops perverted tastes, or refuses all food but what it fancies. At last it becomes violent if opposed, and rules at will a scared circle of over-affectionate relatives. When all else fails, it exaggerates or invents symptoms, and so goes on, until some resolute physician sees the truth and opens the eyes of an amazed family.

Certain physicians explain these cases as due to hysteria, and in a small number of instances there are signs which justify such an explanation. But in the larger proportion the mode of origin is complex, and depends on the coincidence of a variety of evils, none of which are of hysterical character. I am not here concerned so much with the exact nature of these troubles as I am with the avoidable errors in the management of sick childhood. If I can make the mother more thoughtfully alert, less disposed to terror and exaggeration, less liable to be led by her emotions, I shall have fulfilled my purpose without such discussion as is out of place in essays like these.

To make clear, however, the possibility of the disasters I have briefly described, an illustration may answer better than any length of generalized statements. A little fellow of nine once came under my care, and was said to have inflammation of the coverings of the brain. There was a long story, which I may sum up in a few sentences. An only child; feeble in youth; indulgence to almost any degree; at the age of eight, a fall, not at all grave, but followed by some days of headache; long rest in bed, by order of a physician; much pity; many questions; half-whispered, anxious discussions at the bedside; yet more excessive indulgence, because every denial seemed to increase or cause headache. At last the slightest annoyance became cause for tears, and finally for blame, all of which a gentle, fearful mother bore as if it were part of the natural trials of disease. It took but a few months of complete non-restraint to make of a shrewd, bright, half-educated, spoiled boy a little brute, as to whose sanity there seemed to be some doubt. He was easily made well, and has lived to thank the sternness which won back the health of mind and body his parents had so foolishly helped to lose for him.

A single example may suffice, nor have I any fear that it may lead any one, least of all nature's gentlest creation, a mother, to be more severe than is reasonable. She it is who is really most responsible. She is ever beside the child when the little actor is off guard. She may have the cleverness to see through the deceit or she may not. The physician comes and goes, and must take for granted much that he has no chance to see, and for which he has to trust the more constant attendant. Moreover, the rarity of these cases is apt to help to deceive him quite as much as does the mother's affectionate trust. Nevertheless, it is his fault if soon or late he fail to see the truth; but he may well be careful how he states his doubt. The mother at the sick-bed but too often resents as a wrong any hint at the true state of the case.

Children are singularly imitative, and more or less prone to suffer from this tendency. Hence the curious cases in which a child simulates, I do not say dissimulates, the malady it sees constantly before it, as when one child has attacks of false epilepsy, owing to having seen the real attack in a sister or brother, or when St. Vitus's dance runs through a school or an asylum.

To sum up, we credit these little ones with a simplicity of moral organization which forbids us to believe that the causes which are active for mischief in their elders are not as potent for evil in them. The popular and reasonable creed of moral education, which teaches us to ask from a well child self-control, self-restraint, truth of statement, reasonable endurance of the unavoidable, good temper, is not too lightly or too entirely to be laid aside when sickness softens the rule of health and all our hearts go out in pity to the little sufferer.

Certain of the nervous and other maladies of children sometimes keep them a long while under treatments which are annoying, painful, or disabling. They often end by leaving them as strong as their fellows, but crippled, lame, disfigured, or with troubles that attract remark, or, at least, notice. Thus, a child may have hip-disease, and, after years of treatment, get well, and although vigorous enough to do all that is required in life, be more or less lame. In another case, there is disease of the bones of the spine. After a wearying treatment, it is well, but the little one has a distorted spine,--is humpbacked. Again, we have the common malady, palsy of childhood, and here, too, most probably, there is left a residue of disability, or, at all events, some loss of power.

In each case there are years of troublesome treatment, all sorts of unpleasant limitations, pain it may be, and certainly, at the best, a variety of discomforts. The joy and little pleasures of youth are gone. It makes one sorrowful to think of such cases, even when all that competent means can do to help them is at their disposal, and still more to reflect on those who have to battle for health with no more resource than is left to the needy. What shall we not do for them! The woman's whole tendency is to give them all of herself and all else that she can control. Indulgence becomes inevitable, or seems to become so, and the mother is rare who does not insist that they shall have what they desire, and that her other children shall yield to them in all things. Her answer to herself and others is, "They have so little; let them at least have what they can." As rare as the reasonable mother is the sick child who can stand this treatment and survive with those traits of character which it above all others requires to make its crippled life happy, not to say useful. The child thus unrestrained and foolishly indulged must needs become ill-tempered. It loses self-control, and yet no one will need it more. It learns to expect no disappointments, and life is to hold for it less than for others. Disease has crippled its body and the mother has crippled its character.

I have no belief that long illness is good for the mass of people, but the character of the adult sufferer is in his or her own hands to make, mar, or mend. In childhood the mother is in large measure responsible for the ductile being in her care. If she believes that unrestraint is her duty, she is laying up for the invalid a retribution which soon or late will bitterly visit on the child the sin or, if you like, the mistakes of the parent. It is her business and duty, no matter how hard may be to her the trial, to see that this child, above all others, shall be taught patience, gentleness, good temper, and self-control in all its varieties, nor should she fail to point out, as health returns and years go by, that it is not all of life to be straight and uncrippled. I need not dwell on this. Every wise woman will understand me, and be able to put in practice better than I can here state what I might more fully say.

I do not wish, however, to be understood as urging that all children long ill or crippled grow to be unamiable and spoiled. I do not quite know why it is, but, after all, children are less apt to suffer morally from long illness than adults, and very often, despite careless or thoughtless usage, these young sufferers come out as wholesome in mind and heart as if they had known no trial, or, perhaps, because of it. It is in a measure a matter of original temperament. In other words, what the sick child was as to character modified results, and this is especially true as concerns the peculiarities which attract unpleasant notice. One person who has twitching of the muscles of the face is made miserable by the attention it invites; another is indifferent.

The cases of Lord Byron and Walter Scott are to the point. The former was sensitive and morbid about his deformity. I cannot help thinking that had his mother been other than she was, he would have been brought up to more wholesome views as to what was after all no very great calamity. Walter Scott suffered from a like trouble, but healthy moral surroundings and a cheerful nature saved him from the consequences which fell so heavily upon his brother poet.

Epilepsy is a malady but too common in childhood, and as to which a few words apart are needed. Usually a child epileptic for some years will carry the disease with it for a time, the length of which no man can set. The disease may be such as to ruin mind and body, or the attacks may be rare, and not prevent courageous and resolute natures from leading useful lives. All intermediate degrees are possible. As a rule, no children need so inflexible a discipline as epileptics. Indulgence as regards them is only another name for ruin. Do as we may, they are apt to become morally perverted, and require the utmost firmness, and the most matured and educated intelligence, to train them wisely. Difficult epileptics and most idiots are best looked after, and certainly happiest, in some one of the competent training-schools for feeble-minded children.

Even the milder epileptic cases are hard to manage. I rarely see one which has been intelligently dealt with. Few mothers are able or willing to use a rule as stern, as enduring, as unyielding as they require.

As to education, I am satisfied that these children are the better for it, and yet almost invariably I find that in the cases referred to me some physician has, with too little thought, recommended entire abandonment or avoidance of mental training. I have neither space nor desire to go into my reasons for a different belief. I am, however, sure that education limited as to time, education of mind, and especially of the hands, has for these cases distinct utility, while to them also, as to the other children crippled in mind or body, all that I have already urged applies with equal force.

As to the management of sick or crippled childhood, I have said far more than I had at first meant to say, and chiefly because I have been made to feel, as I thought the matter over, how far more difficult it is in practice than in theory. But this applies to all moral lessons, and the moralist must be credited by the thoughtful mother with a full perception of the embarrassments which lie in her path.

NERVOUSNESS AND ITS INFLUENCE ON CHARACTER.

There are two questions often put to me which I desire to use as texts for the brief essay or advice of which nervousness[4] is the heading. As concerns this matter, I shall here deal with women alone, and with women as I see and know them. I have elsewhere written at some length as to nervousness in the male, for he, too, in a minor degree, and less frequently, may become the victim of this form of disability.

[Footnote 4: Neither _nerves_ nor _nervousness_ are words to be found in the Bible or Shakespeare. The latter uses the word nerve at least seven times in the sense of sinewy. _Nervy_, which is obsolete, he employs as full of nerves, sinewy, strong. It is still heard in America, but I am sure would be classed as slang. Writers, of course, still employ nerve and nervous in the old sense, as a nervous style. Bailey's dictionary, 1734, has nervous,--sinewy, strongly made. Robt. Whytte, Edin., in the preface to his work on certain maladies, 1765, says, "Of late these have also got the name of nervous," and this is the earliest use of the word in the modern meaning I have found. Richardson has it in both its modern meanings, "vigorous," or "sensitive in nerves, and consequently weak, diseased." Hysteria is not in the Bible, and is found once in Shakespeare; as, "Hysterica passio, down," Lear ii. 4. It was common in Sydenham's day,--_i.e._, Charles II. and Cromwell's time,--but he classified under hysteria many disorders no longer considered as of this nature.]

So much has been written on this subject by myself and others, that I should hesitate to treat it anew from a mere didactic point of view. But, perhaps, if I can bring home to the sufferer some more individualized advice, if I can speak here in a friendly and familiar way, I may be of more service than if I were to repeat, even in the fullest manner, all that is to be said or has been said of nervousness from a scientific point of view.

The two questions referred to above are these: The woman who consults you says, "I am nervous. I did not use to be. What can I do to overcome it?" Once well again, she asks you,--and the query is common enough from the thoughtful,--"What can I do to keep my girls from being nervous?"

Observe, now, that this woman has other distresses, in the way of aches and feebleness. The prominent thing in her mind, nervousness, is but one of the symptomatic results of her condition. She feels that to be the greatest evil, and that it is which she puts forward. What does she mean by nervousness, and what does it do with her which makes it so unpleasant? Remark also that this is not one of the feebler sisters who accept this ill as a natural result, and who condone for themselves the moral and social consequences as things over which they have little or no reasonable control. The person who asks this fertile question has once been well, and resents as unnatural the weaknesses and incapacities which now she feels. She wants to be helped, and will help you to help her. You have an active ally, not a passive fool who, too, desires to be made well, but can give you no potent aid. There are many kinds of fool, from the mindless fool to the fiend-fool, but for the most entire capacity to make a household wretched there is no more complete human receipt than a silly woman who is to a high degree nervous and feeble, and who craves pity and likes power. But to go back to the more helpful case. If you are wise, you ask what she means by nervousness. You soon learn that she suffers in one of two, or probably in both of two, ways. The parentage is always mental in a large sense, the results either mental or physical or both. She has become doubtful and fearful, where formerly she was ready-minded and courageous. Once decisive, she is now indecisive. When well, unemotional, she is now too readily disturbed by a sad tale or a startling newspaper-paragraph. A telegram alarms her; even an unopened letter makes her hesitate and conjure up dreams of disaster. Very likely she is irritable and recognizes the unreasonableness of her temper. Her daily tasks distress her sorely. She can no longer sit still and sew or read. Conversation no longer interests, or it even troubles her. Noises, especially sudden noises, startle her, and the cries and laughter of children have become distresses of which she is ashamed, and of which she complains or not, as her nature is weak or enduring. Perhaps, too, she is so restless as to want to be in constant motion, but that seems to tire her as it once did not. Her sense of moral proportion becomes impaired. Trifles grow large to her; the grasshopper is a burden. With all this, and in a measure out of all this, come certain bodily disabilities. The telegram or any cause of emotion sets her to shaking. She cries for no cause; the least alarm makes her hand shake, and even her writing, if she should chance to become the subject of observation when at the desk, betrays her state of tremor. What caused all this trouble? What made her, as she says, good for nothing? I have, of course, put an extreme case. We may, as a rule, be pretty sure, as to this condition, that the woman has had some sudden shock, some severe domestic trial, some long strain, or that it is the outcome of acute illness or of one of the forms of chronic disturbance of nutrition which result in what we now call general neurasthenia or nervous weakness,--a condition which has a most varied parentage. With the ultimate medical causation of these disorderly states of body I do not mean to concern myself here, except to add also that the great physiological revolutions of a woman's life are often responsible for the physical failures which create nervousness.

If she is at the worst she becomes a ready victim of hysteria. The emotions so easily called into activity give rise to tears. Too weak for wholesome restraint, she yields. The little convulsive act we call crying brings uncontrollable, or what seems to her to be uncontrollable, twitching of the face. The jaw and hands get rigid, and she has a hysterical convulsion, and is on the way to worse perils. The intelligent despotism of self-control is at an end, and every new attack upon its normal prerogatives leaves her less and less able to resist.

Let us return to the causes of this sad condition. It is a common mistake to suppose that the well and strong are not liable to onsets which cause nervousness. As a rule, they rarely suffer; but we are neatly ballasted, and some well people are nearer to the chance of being so overturned than it is pleasant to believe. Thus it is that what for lack of a better name we call "shock" is at times and in some people capable of inflicting very lasting evil in the way of nervousness.

We see this illustrated in war in the effects of even slight injuries on certain people. I have known a trivial wound to make a brave man suddenly timid and tremulous for months, or to disorder remote organs and functions in a fashion hard to understand. In the same way, a moral wound for which we are not prepared may bring about abrupt and prolonged consequences, from which the most robust health does not always protect us; and which is in proportion disastrous if the person on whom it falls is by temperament excitable or nervous. I have over and over seen such shocks cause lasting nervousness. I knew a stout young clerk who was made tremulous, cowardly, sleepless, and, in the end, feeble, from having at a funeral fallen by mishap into an open grave. I have seen a strong woman made exquisitely nervous owing to the fall of a wall which did her no material damage. Earthquakes cause many such cases, and bad ones, as we have had of late sad occasion to know. The sudden news of calamity, as of a death or financial disaster, has in my experience made vigorous people nervous for months. A friend of mine once received a telegram which rather brutally announced the disgrace of one dear to him. He had a sense of explosion in his head, and for weeks was in a state of nervousness from which he but slowly recovered. There is something in cases like his to think about. The least preparation would have saved him, and we may be sure that there is wisdom in the popular idea that ill news should be gently and guardedly broken to such as must bear it. To be forewarned is to be forearmed we say with true wisdom.

Prolonged strain of mind and body, or of both, is another cause apt to result in health failures and in nervousness as one attendant evil. The worst one I know is to nurse some person through a long disease. Women are apt to think that no one can so well care for their sick as they. Intrusion on this duty is resented as a wrong done to their sense of right. The friend who would help is thrust aside. The trained nurse excites jealous indignation. The volunteer gives herself soul and body to the hardest of tasks, and is rather proud of the folly of self-sacrifice. How often do we hear a woman say with pride, "I have not slept nor had my clothes off for a week." She does not see that her very affection unfits her for the calm control of the sick-room, and that her inevitable anxiety is incompatible with tranquil judgment. If you tell her that nursing is a profession, and that the amateur can never truly fill the place of the regular, she smiles proudly, and thinks that affection is capable of all things, and that what may be lost in skill will be made up in thoroughness and compensated by watchfulness, such as she believes fondly only love can command. It is hard to convince such a woman.

It rarely chances that women are called upon to suffer in their common lives emotional strains through very long periods, and at the same time to sustain an excess of mental and physical labor. In days of financial trouble this combination is sometimes fatal to the health of the strongest men. When a loving relative undertakes to nurse one dear to her through a protracted illness, she subjects herself to just such conditions of peril as fall upon the man staggering under financial adversity.

The analogy to which I have referred is curiously complete. In both there is the combination of anxiety with physical and mental overwork, and in both alike the hurtfulness of the trial is masked by the excitement which furnishes for a while the means of waging unequal battle, and prevents the sufferer from knowing or feeling the extent of the too constant effort he or she is making. This is one of the evils of all work done under excessive moral stimulus, and when the excitation comes from the emotions the expenditure of nerve-force becomes doubly dangerous, because in this case not only is the governing power taken away from the group of faculties which make up what we call common sense, but also because in women overtaxing the emotional centres is apt to result in the development of some form of breakdown, and in the secondary production of nervousness or hysteria.

If she cannot afford a nurse, or will not, let her at least share her duties with some one. Above all, let her know that every competent doctor watches even the best of his trained nurses, and insists that they shall be in the open air daily. Your good wife or mother thinks in her heart that when she has sickness at home she should not be seen out of doors, and that to eat, sleep, or care for herself is then wicked or something like that.

If you can make a woman change her dress, eat often, bathe as usual, and take the air, even if it must be so at night, she can stand a great deal, especially if you insist that she shall sleep her usual length of time. If she will not listen or obey, she runs a large risk, and is very apt to collapse as the patient recovers, and to furnish her family with a new case of illness, and the doctor and herself with some variety of disorder of mind or body arising out of this terrible strain on both.

If physical tire, without chance for rest, with anxiety and incessant vigilance, is thus apt to cause wrecks in the nurse of ordinary illness, far more apt is it to involve breakdowns when a loving mother or sister endeavors to care for a protracted case of insanity. Unless the man of the house interferes, this effort is sure to bring disaster. And the more sensitive, imaginative, and loving is the self-appointed nurse, the more certain is she to suffer. There are no cases in which it is so hard to advise, none in which it is so difficult to get people to follow your advice. The morbid view of insanity, the vague sense of its being a stain, the horror of the hospital, all combine to perplex and trouble us. Yet here, if at any time, it is wise to cast the whole weight on the physician and to abide by his decision.

Families see this peril, and can be often made to understand the unwisdom of this sacrifice; but, in cases of prolonged disease, such as hysteria in a bedridden sister or mother, it is hard to make them hear reason, and still more hard to make the nursing relation understand that she is of necessity the worst of nurses, and may share the wreck she helps to make.

These old and happily rare cases of chronic nervous invalids are simply fatal to loving nurses. I have said, perhaps too often, that invalidism is for most of us a moral poison. Given a nervous, hysterical, feeble woman, shut out from the world, and if she does not in time become irritable, exacting, hungry for sympathy and petty power, she is one of nature's noblest. A mother or sister gives herself up to caring for her. She is in the grip of an octopus. Every fine quality of her nature helps to hurt her, and at last she breaks down utterly and can do no more. She, too, is become nervous, unhappy, and feeble. Then every one wonders that nobody had the sense to see what was going on. I can count many examples of nervousness which have arisen in this fashion. Perhaps my warning may not be without good results. Over and over I have made like statements in one or another form, and the increasing experience of added years only contributes force to my belief that, in still urging the matter, I am doing a serious duty. I ought to say also that the care of these invalids is, even to the well-trained and thoughtful nurse, one of the most severe of moral and physical trials, and that, in the effort to satisfy the cravings of these sick people, I have seen the best nurses crumble as it were in health, and at last give up, worn out and disheartened. A part of the responsibility of such disasters falls on the physician who forgets that it should be a portion of his duty to look sharply after the health of too devoted nurses as well as that of selfish patients.

I have now said all that I need to say of the causes which, directly or indirectly, evoke the condition we call nervousness. Many of these are insidious in their growth. Too often the husband, if she be married, is immersed in his own cares, and fails to see what is going on. "I am not ill enough to see a doctor," she says, and waits until she has needlessly increased the difficulties of his task. Let us suppose, however, that, soon or late, she is doing, in a merely medical way, all that he insists upon, what more can she do for herself? She has before her very likely a long trial, severe in its exactions in proportion to her previous activity of mind and body. She most probably needs rest, and now that physicians have learned its value, and that not all ills are curable by exertion, she is told to lie down some hours each day. If she cannot get rid of her home duties, let her try at least to secure to herself despotically her times of real and true rest. To lie down is not enough. What she needs is undisturbed repose, and not to have to expect every few minutes to hear at her door the knocks and voices of servants or children. It is difficult to secure these most needful times of silent security even in health, as most women too well know. Very often the after-meal hours are the most available and the more desirable as times of repose, because in the weak digestion goes on better when they are at rest. She will find, too, that some light food between meals and at bedtime is useful, but this is within the doctor's province, and I am either desirous to avoid that or to merely help him. Air, too, she wants rather than any such great exertion as wearies; and, as regards this latter, let her understand that letter-writing, of which many women are fond, must be altogether set aside.

It is, however, the moral aspects of life which will trouble her most. The cares which once were easily shaken off stick to her like burrs, and she carries them to bed with her. I have heard women say that men little know the moral value to women of sewing. It becomes difficult when people are nervous, but this or some other light handiwork is then invaluable.

By this time she has learned that her minor, every-day duties trouble her, and when about to meet them, if wise, she will put herself, as we all can do, in an attitude of calmness. This applies still more forcibly to the larger decisions she must so often have to make as to children, house, and servants. Worry, as I have elsewhere said, is as sand in the mental and moral machinery, and easily becomes a mischievous habit. We can stand an immense deal of work, and can, even if weak, bear much, if only we learn to dismiss small questions without worry or unreasonable reconsiderations. As concerns temper, we constantly prepare ourselves to meet even just causes of anger, and thus by degrees learn more and more easily, and with less and less preparation, to encounter tranquilly even the most serious vexations. In health, when not nervous, a woman well knows that there are seasons when she must predetermine not to be nervous; and when ill-health has made her emotional, she must learn to be still, more constantly on guard. Above all, it is the small beginnings of nervousness which she has to fear.

Tears are, for the nervous woman, the seed of trouble. Let her resolutely shun this commencement of disaster. The presence of others is apt to insure failure of self-control. A word of pity, the touch of affection, the face of sympathy, double her danger. When at her worst, let her seek to be alone and in silence and solitude to fight her battle. Fresh air, a bath (if she can bear that), even the act of undressing, will often help her. I once quoted a valued friend as saying that "we never take out of a cold bath the thoughts we take into it," and the phrase is useful and true.

Above all, let such a woman avoid all forms of emotion. Her former standards of resistance apply no longer, and what once did not disturb will now shake her to the centre. A time comes, however, when she will do well to meet and relearn to bear calmly all the little emotional trials of life. I know a nervous woman--and no coward, either--who for months, and wisely, read no newspapers, and who asked another to open and read all her letters and telegrams. The day came when she was able to resume the habits of health, but for a long time the telegram at least was a sore distress, and she could only meet it by a resolute putting of herself in the attitude of tranquillity of which I have spoken. To say more should be needless. For the nervous strong emotions are bad or risky, and from violent mirth to anger all are to be sedulously set aside. Calm of mind and quiet of body are what she most needs to aid the more potent measures of the physician.